Prescription Charges: People Aged 60 or Over

Andrew Gwynne Excerpts

Monday 6th March 2023 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Edward. I want to start by thanking the Petitions Committee for facilitating this debate, and my hon. Friend the Member for Gower (Tonia Antoniazzi) for the passionate way in which she put forward the arguments of Peter, Denise and many others who find themselves in the predicament of having to pay for prescriptions or who worry that they might have to pay for them as pensioners.

It is a pleasure to respond to the debate on behalf of the shadow Health and Social Care team, but also as the Member of Parliament for Denton and Reddish, and I know that many of my constituents are concerned about this potential policy change. As we have heard, we are in the middle of a cost of living crisis, when many people face unsustainable rises in their energy and household bills. It is little surprise that the Government’s decision to consult on scrapping free NHS prescriptions for the over-60s will be of profound concern to many people already struggling to make ends meet. That anxiety has been compounded by characteristic delay from the Department of Health and Social Care.

The Government first announced the consultation to scrap free NHS prescriptions for the over-60s in July 2021, meaning that there was little or no time for Members of this House to sufficiently scrutinise the proposals before that year’s summer recess. The consultation closed in September 2021 and, two and a half years on, we are still none the wiser about where the Government are on the issue.

A quick glance at written parliamentary questions shows that many Members from across the House have asked the Government for clarity, only to receive a boilerplate response that an announcement would be made “in due course”. In his response, will the Minister set out precisely when that announcement will be made and why there has been such a delay in the Government addressing their own consultation?

That is important, because the Government’s own impact assessment raises several potential problems with the proposals. Notably,

“some people towards the lower end of the income distribution may struggle to afford all their prescriptions”,

which can result in

“future health problems for the individual and a subsequent cost to the NHS.”

That is precisely the point made in their interventions by my hon. Friends the Members for Gower and for Coventry North West (Taiwo Owatemi) and, indeed, the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier), who is not in her place. Therefore, if the Government do decide to opt for this policy, we need to know what steps they will take to support people—especially those over 60 and with long-term conditions—with their prescription fees.

Prescription charges have already increased by 30% since 2010 and, given the financial context we are in, there are really valid concerns about people being priced out of accessing vital medicines. The Royal Pharmaceutical Society recently conducted a survey of 269 pharmacies, with half of respondents saying that patients were asking them which medicines they could do without. Half of pharmacies surveyed also said that they have seen a rise in people not collecting their prescriptions at all. That is incredibly concerning.

Last year, Asthma & Lung UK found that 15% of surveyed people with respiratory conditions were rationing the use of their inhalers to make them last longer. Some 5% of people said they were being forced to borrow medicine from others, which really frightens me, because someone’s prescription is pertinent to them and them alone. I had hoped that we had moved away from a world where we lend medicines to others. Frankly, these statistics should be ringing alarm bells in the Department of Health and Social Care and, for that matter, in the Department for Work and Pensions, but unfortunately we have had radio silence.

I would like to impress on the Minister the simple fact that if people are not taking vital medication, they could be living in extreme pain, and in some cases they will be at risk of serious medical complications as well. Have the Minister and his officials made any assessment of the number of people in England who are currently unable to afford medicine, and of the knock-on impact on NHS services, which are already at breaking point thanks to this Government’s mismanagement of the NHS?

Last year, the Government froze prescription charges in a move that was welcome to many in England. The next review is due to take effect in April, and I am sure I do not need to remind the Minister that that will come at the same time as the implementation of Ofgem’s new energy price cap. Will the Minister provide an update on that review? Does he anticipate another rise in the cost of prescription charges, or will the Government do the right thing and freeze them again, for another year?

While he is at it, perhaps the Minister will also nudge his colleagues in the Treasury to do the decent thing and implement a proper windfall tax on energy and gas giants to extend energy support, so that those on the lowest incomes are protected against astronomical price rises. In the 21st century, here in the United Kingdom, no one should be forced to choose between accessing vital medication, heating their home or feeding their family.

The final point I wish to make is connected to this issue. The Government seem to have no vision or appetite to prioritise preventive public health. In the context of an ageing population, it is important that we build healthier communities. That is important not only morally, but practically, especially if we want to reduce reliance on prescriptions and primary care. What steps is the Minister taking to prioritise preventive health? On that note, will he set out why the public health grant allocation has still not been announced for local authorities in England? Many local authorities that have already set their budgets still do not know what their public health grant allocations will be in three and a half weeks’ time.

The next Labour Government will give the NHS the tools, staff and technology it needs to treat patients on time and to put prevention right at the heart of everything it does. Coming back to the issue before the Chamber, I really hope that the Government understand the concern, worry and anxiety of those over 60 in England, who are concerned that their free prescriptions may come to an end.

I want to mention my right hon. Friend the Member for Wentworth and Dearne (John Healey), who was here at the start of proceedings. As a member of the shadow Cabinet, he cannot take part in these deliberations, but he wanted me to highlight some of the work he has done in his constituency. He and his local team collected signatures against the proposed scrapping of free prescriptions for the over-60s. His story can be told 650 times over to the Minister, because there are elderly people across England who are concerned about this issue and who want answers from Ministers. They want their concerns to be heeded, they want assurances that the Government get the reason why prescriptions are free for the over-60s and they want the Government to understand why it is important that that remains the case. They also want to know that the Government are on their side on this issue, that their free prescriptions are not at risk and that we will not face people who cannot afford their medication with the dilemma of whether to heat their homes, feed their families or get the medication they so desperately need. Britain is better than that, and I hope the Minister has some positive news for us.

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)]

I am grateful to the hon. Member for Gower (Tonia Antoniazzi) for opening the debate so effectively on behalf of the Petitions Committee, and I thank all Members for their constructive contributions. I also thank the 46,000 members of the public who signed the petition.

The Government provided their initial response to the petition in January 2022, and I am pleased to be able to respond again today, having listened to hon. Members’ important and interesting contributions. The context, of course, is the Russian invasion of Ukraine and the high energy prices, inflation and cost of living pressures that it has unleashed. It is worth situating the debate in the context of some of the things we are doing to take action on that, some of which hon. Members have already referred to.

This winter, we are spending a total of £55 billion to help households and businesses with their energy bills—one of the largest support packages in Europe. A typical household will save about £900 this winter through the energy price guarantee, in addition to £400 through the energy bills support scheme. We are also spending £9.3 billion over the next five years on energy efficiency and clean heat, making homes cheaper to heat. Some of that is being paid for by the windfall tax; at 75%, it is one of the highest in any of the countries around the North sea, and it is enabling us to do more on the cost of living, such as the £900 cost of living payment for 8 million poorer households, and the largest ever increase to the national living wage, which will help 2 million workers. In total, we are spending £26 billion on cost of living support next year.

Turning specifically to prescription exemptions, I should start by trying to manage expectations about what I can say today, for reasons on which I will elaborate. It is clear that the outcome of the consultation on aligning the upper age exemption for prescription charges with the state pension age is very important to many Members’ constituents. However, I can only say at this point that no decision has been made yet to bring proposals forward.

We received over 170,000 responses to the consultation —a testament to the strength of feeling on the issue. We want to ensure that everyone across the country, especially those affected by the cost of living pressures caused by the Russian invasion, can afford their prescriptions. That is why we have thought long and hard about how best to balance the needs of those in the affected age group, many of whom will find that they have additional health needs compared with when they were younger, with the pressures facing the public finances. I can, however, assure Members that we will respond to the consultation in due course.

Hon. Members will be aware that the petition calls on the Government to protect free NHS prescriptions for all over-60s. We value our older members of society, and we recognise their social care and health needs. On the one hand, we recognise that families up and down the country are facing unprecedented pressures with the cost of living; on the other, we have to recognise that in the light of the covid pandemic, which has tested the NHS like never before, and the challenging economic landscape, we must ensure that public sector spending represents the best value for money for the taxpayer. As we look to the future in a post-pandemic world, there is no shortage of challenges ahead of us: an ageing population, an increasing number of people with multiple health conditions, and deep-rooted inequalities in health outcomes, which we are tackling. That is all in addition to the challenges of the pandemic and the elective backlog.

Charges have been around in the NHS for over 70 years, and prescription charges provide a valuable source of income for the NHS, contributing £652 million in 2021-22. That significant funding helps to maintain vital services for patients, and it is particularly important given the increasing demands on the NHS.

It is for those reasons that we consulted on aligning the upper age exemption for prescription charges with the state pension age. Historically, the initial exemption for prescriptions was for people aged 65 and over. The exemption was then extended to women aged 60 and over in 1974, and to men aged 60 or over in 1995, based on the state pension age for women at that time. The state pension age has subsequently increased to 66 for both men and women, with legislation already in place to increase it to 67, and then 68, in future years.

The Government have abolished the default retirement age, meaning that most people can continue to work for as long as they want and are able to. That means that many people in the 60 to 65 age range can remain in employment and be economically active, and therefore more able to meet the cost of their prescriptions. Indeed, more than half of people aged between 60 and 65 are economically active, with a further 20% receiving a private pension or some other income.

As increasing numbers of people live longer, work longer and so on, there are more people claiming free prescriptions on the basis of their age. It is projected that by 2066 there will be a further 8.6 million UK residents aged 65 and over, and that they will make up about a quarter of the total population.

It is important to know that over 1.1 billion prescription items are dispensed in the community each year, with nine out of 10 currently dispensed free of charge. The exemptions that allow that may be based on the patient’s age, certain medical conditions, or income. We estimate that if we were to make the proposed change, around 85% of 60 to 65-year-olds would be minimally affected by it. As I have just noted, more than half of them are in employment, with about another 20% retired with a private pension, so they have a higher income, while others would continue to qualify for free prescriptions on the basis of their particular conditions.

It is also worth noting that there are extensive arrangements in place to help those who are most in need of support with prescription charges. People who are on a low income but do not qualify on the basis of an automatic exemption, such as being on universal credit, can get help through the NHS low income scheme, which provides either full or partial help with health costs on an income-related basis. Anyone can apply for the scheme if they or their partner, or they jointly as a couple, do not have savings, investments or property totalling more than £16,000, not including the place where they live. A person will qualify for full help with their health costs, including free NHS prescriptions, if their income is less than or equal to their requirements.

To support those who do not qualify for an exemption due to one of the many other reasons, such as their age or their condition, or for the NHS low income scheme, prepayment prescription certificates, which were mentioned earlier in the debate, are available to help those who need frequent prescriptions to reduce the cost. The prescription charge is currently £9.35; a three-month PPC is £30.25; and a 12-month certificate is £180.10, which amounts to just over £2 a week. PPCs can offer significant savings, and an annual PPC can be paid for in 10 direct debit payments, to allow people to spread the cost over the year.

[Andrew Gwynne]

I am a little concerned about the tone of what the Minister is communicating. He seems to be accepting that there will be a change on prescriptions for pensioners, but does he acknowledge the challenge with pension credit, whereby a large number of pensioners who are eligible for it do not apply for it, because they are fearful of the means test? What will he do to ensure that that does not happen when it comes to prescriptions?

[Neil O’Brien]

Perhaps I can set the hon. Member’s mind at ease. I said earlier that no decision had been made, and I reiterate that now. I have talked about the different measures that cause people either to be exempt from charges or to have the cost of their prescriptions cut, and I talked about PPCs as a final step, which can reduce the cost of prescriptions for those who do pay them.

It has been mentioned several times that prescription charges have been abolished entirely in the devolved Administrations. Health is of course a devolved matter, but it is worth noting that spending is £1.25 in Scotland and £1.20 in Wales for every £1 in England, so there is that additional budget. Those devolved Administrations, with the record increases in their spending settlements, have full discretion about how they choose to spend those budgets.

Several hon. Members asked me quite specific questions about the outcome of the consultation. I can only reiterate that we continue to consider, long and hard, the many responses that we received, trying to balance the cost of living pressures with the need for increasing funding for the NHS, and we will respond to the petition in due course. I thank hon. Members for their contributions today.

Cystic Fibrosis: Living Costs

Andrew Gwynne Excerpts

Thursday 2nd February 2023 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is always a pleasure to respond on behalf of the shadow Health and Social Care team, and to see you in the Chair, Ms Harris, guiding our proceedings. I sincerely thank my hon. Friend for securing this important debate—I know the convention is to call him the hon. Member for Strangford (Jim Shannon), but he is my friend. He always manages to find a way of getting pressing issues such as this one, which are all too often overlooked by this place, discussed on the Floor of the House. I am grateful for that, and for the comprehensive and detailed way in which he set out the case before us. This has been a good debate.

I thank the hon. Members who made short contributions, such as the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) and my hon. Friends the Members for Blaydon (Liz Twist) and for Bristol East (Kerry McCarthy). Coming to the substantial contributions, I sincerely thank the hon. Member for Ashfield (Lee Anderson) for sharing his personal experiences. It is often difficult to do that in this place, and he added a great amount of knowledge, detail and worth to our considerations. I am sure that the Minister will feel the same. On behalf of the whole House, I send our best wishes for the future to him and his wife, and to Amelia and her family. Sharing our constituents’ personal experiences is also important, because we are sent here to advocate for them.

I also thank my hon. Friend the Member for Stretford and Urmston (Andrew Western). He has certainly hit the ground running as a newly elected MP. He is already making eloquent contributions following the by-election, including today on behalf of his constituents, Penny and Eva. In a similar vein to what I said about the hon. Member for Ashfield, it is important that real-life experiences are articulated in these debates.

The cost of living crisis is impacting people right across the country, as we are all too aware with our constituency caseloads. We all hear regularly that many constituents are having to make the difficult choice between putting food on the table or heating their home. It is all too commonplace for constituents to open their energy bills with a feeling of dread in the pit of their stomachs. Many have no idea how they will get through the next week, let alone month.

For those with cystic fibrosis, however, the problems are even more challenging. As many Members highlighted, they are much more likely to be struggling with their finances than the general UK population. They are at a significant social and economic disadvantage. As we have heard, CF is a genetic condition that affects almost 11,000 people in the United Kingdom. People with CF experience, as we heard graphically from the hon. Member for Ashfield, a build-up of sticky mucus in the lungs, digestive system and other organs. It can affect multiple parts of the body, with symptoms including, but not limited to, reduced lung function, increased susceptibility to infection, weakened bones, liver disease, diabetes and more.

Households affected by CF face a median loss of about £564 a month. That financial hit would be extremely difficult in favourable economic circumstances, but in the current financial context it is nothing short of devastating for too many people who live with CF. As the Cystic Fibrosis Trust points out, many people with CF incur a “double-hit” to their finances by having to spend more to keep themselves healthy and being forced to make different decisions about education or employment opportunities.

Jess, an adult living with CF, said:

“Living with CF has always caused my life to be unpredictable, which has cost me financially as well as in many other aspects of my life”.

Jess sums up what many people living with CF know all too well: in almost every aspect of day-to-day living, it is more expensive to be a person with CF.

Energy bills are a prime example. Many people with CF have to use nebulisers, feeding pumps, electric sterilisers and other energy-intensive appliances for their health. That means that the median energy cost for an adult with CF is £26 more than a typical bill. For a child with CF, that climbs to £36 more. I would be interested, then, if the Minister could set out what assessment the Government have made of the current support available to those living with CF.

Furthermore, like Members from across the House—this is not a party political point—I am really concerned that, although energy bills are predicted to rise to an average of £3,000 from April, the Government have still not yet set out their plans to support households beyond that date. Will they explain what is likely to happen, particularly for people with additional costs that they cannot do anything about because of the need for medical assistance? Extra support would benefit people across the country and households affected by CF, which are particularly vulnerable to energy price rises.

I also want to raise the issue of access to benefits with the Minister. I know this is not her direct responsibility, but I am sure she is in dialogue with colleagues in the Department for Work and Pensions. As has been said, disability living allowance and PIP were the most commonly claimed benefits from people living with CF. However, as the Cystic Fibrosis Trust makes clear, a surprising number of those with CF have either been turned down or have not applied for support because they expect to be refused.

CF is a changeable condition. Many people living with it have good days as well as bad days, and that can lead those applying for benefits being unfairly declined or facing stigma in accessing support. What assessment has the Minister made of access to welfare support for people with CF, and are the Government taking any steps to improve access for those with the condition?

Labour has committed to overhauling routes into work for sick or long-term unemployed people and doing away with some of the gruelling reassessments. We have pledged to guarantee extra support for flexible working for those with chronic conditions, and I would like to see that pledge matched by the Government today. It is something that the shadow Front Bench would be willing to support the Minister in pursuing, as she has responsibility for this matter. I appreciate that the Minister works in the Department of Health and Social Care, but she must realise that many of the levers to improve the lives of people with cystic fibrosis sit in other Departments, including the DWP. Will she commit to working cross-departmentally on the issues we have discussed to improve the lives of those living with serious conditions such as CF?

CF is a difficult enough condition to manage without having to face systemic, financial, employment and social barriers, too. The Government need to take the experiences of those living with cystic fibrosis seriously and try to fix the issues we have been discussing. The tools are there for the Government to act. That means ensuring that support is in place to guarantee that those living with acute conditions like cystic fibrosis cannot just make it through the cost of living crisis, but in future can lead lives that are meaningful, joyful and supported by us in this place through the welfare system and employment support. The Government will have our support in making that happen.

Oral Answers to Questions

Andrew Gwynne Excerpts

Tuesday 24th January 2023 Commons Chamber

[Mr Speaker]

I call the shadow Minister.

[Andrew Gwynne (Denton and Reddish) (Lab)]

There were 50,000 more deaths than we would otherwise have expected in 2022. Excluding the pandemic, that is the worst figure since 1951. The Health Secretary—part man, part ostrich—says he does not accept those figures, but as many as 500 people are dying every week waiting for essential care, and we are still getting the same old Tory denial and buck-passing. In her answer, will the Minister finally take some responsibility, accept the ONS excess deaths figure, and recognise the damage that she and her Government are doing to our NHS?

[Maria Caulfield]

I prefer to deal with facts rather than—[Interruption.] The BMJ has ranked the UK mid-table in Europe for mortality figures, which makes it comparable with Italy. In fact, Germany has higher excess deaths, at 15.6%, as do Finland, at 20.5%, and Poland, at 13.3%. However, if the hon. Gentleman wants to hear about what is happening in Labour-run Wales, the statistics available on the gov.wales website show that Wales, in December, had the highest number of red calls ever and that only 39.5% received a response within eight minutes—the lowest figure on record. Those are clinical reasons for excess deaths, not political ones. Perhaps the hon. Gentleman needs to recognise that fact.

Draft Health and Social Care Information Centre (Transfer of Functions, Abolition and Transitional Provisions) Regulations 2023

Andrew Gwynne Excerpts

Tuesday 17th January 2023 General Committees

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Mrs Latham and good to be speaking on behalf on the shadow health and social care team.

As the Minister has outlined, the regulations effectively abolish the Health and Social Care Information Centre, which we all refer to as NHS Digital, and transfer those functions to NHS England. The SI essentially creates a single statutory body that is responsible for data and digital technology. The clear intention of the merger between NHS Digital and NHS England is to streamline data-sharing processes. It is noteworthy that in their own explanatory note, the Government recognise that

“leadership of digital transformation has been disjointed…the fragmentation of national bodies had made it hard to achieve”

an integrated and accessible digital health system. That view has been informed, of course, by the Laura Wade-Gery review, which was published in 2021. Ensuring that patients can access transparent data easily and effectively is crucial not only to informing patient choice but to monitoring whether relevant standards are adhered to.

The Department of Health and Social Care has said that NHS Digital staff and assets will transfer to NHS England before going through the wider “Creating a new NHS England” change programme. That will ensure that

“the necessary talent and expertise of NHS Digital”

is maintained.

The maintenance of high-level expertise is essential, especially when we consider the concerns that have been raised about the shrinking workforce in NHS England. Can the Minister tell us how long he anticipates the change programme will take? Can he also expand on his assurances that talent and expertise will be retained? As the transfer begins, the Opposition will hold the Government to their assurance that all expected standards governing the protection of patient data are maintained. That is an essential aspect of good data management and I have no doubt that the Minister recognises that.

New duties on NHS England include a requirement for the body to report on how effectively it discharges its relevant data functions, as well as a new duty on the Secretary of State to issue guidance to NHS England about the exercise of its “relevant data functions”. When does the Minister expect that guidance to be published? What expertise has he drawn on to generate that guidance? Can he also take this opportunity to assure Members that the acceleration of the merger, originally planned for April 2023 but now brought forward to January, will not have an adverse effect on IT continuity or staff preparedness? Will he also outline what level of communication current NHS Digital staff have received about the merger, and has that process been impacted by the acceleration?

The Opposition will not oppose the regulations, because we are committed to streamlined data processes, as long as that does not come at the expense of expertise or patient access.

--- Later in debate ---

[Neil O'Brien]

Some excellent questions have been asked. My hon. Friend the Member for Amber Valley asked about the vision that the proposal is part of. It is certainly the case that there is a process of simplification of organisations, of which the transfer is another major step. The Health and Social Care Act 2022 also gave Ministers powers of direction over NHS England that did not exist before. None the less, that basic operational independence and structure still stands, so there is change but not a wholesale one compared with the 2012 arrangements.

My hon. Friend the Member for South Thanet asked a really important question about interoperability across the UK. As well as trying to promote that in the NHS, a piece of work is being done by the Department for Levelling Up, Housing and Communities and the Cabinet Office about comparability of data not just in health, but across the work of Government. I am sure that my hon. Friend would find that interesting.

The Opposition spokesman, the hon. Member for Denton and Reddish, asked who we have discussed the transfer with, and the answer is that we have discussed it with the devolved Administrations, the Information Commissioner’s Office, the National Data Guardian, medConfidential and, of course, NHS England and NHS Digital. The staff of those latter two organisations have been fully consulted and know all about the plans. In terms of the speed of the merger, the powers in the SI come into effect immediately, so that the merger can take place towards the end of the month.

I am trying to remember the hon. Gentleman’s other question—

[Andrew Gwynne]

Staff involvement.

[Neil O'Brien]

Absolutely. All the staff know about what is happening and have been consulted fully about the streamlining.

The SI will bring together NHS Digital and NHS England. It will not only preserve existing safeguards around people’s data but will establish slightly stronger ones. Effectively, it will deliver the preservation of the existing regime governing data protection as we bring the two organisations together and it will create all the efficiencies that that process will enable. I commend the regulations to the Committee.

Question put and agreed to.

Sudden Unexplained Death in Childhood

Andrew Gwynne Excerpts

Tuesday 17th January 2023 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Twigg, and to speak on behalf of the shadow Health and Social Care team about this tragic and vital issue. I pay tribute to the work of the right hon. Member for Spelthorne (Kwasi Kwarteng), who has been such a strong advocate in addressing sudden unexplained death in childhood. I extend my sincere condolences to his constituents, Julia and Christian, who lost their son Louis to SUDC. Their work, alongside representatives of the charity SUDC UK, to raise awareness of this tragic cause of death has been extraordinary. I would like to place on record my recognition of the work that they and others have done.

As has been outlined, SUDC is the unexpected and unexplained death of a child. Data from the Office for National Statistics estimates that around 40 children are affected by SUDC in the United Kingdom each year. As we have heard in other Members’ contributions, it is the fourth leading category of death in children aged between one and four. SUDC is similar to SIDS—sudden infant death syndrome—but whereas SIDS applies to a child who dies before they are 12 months old, SUDC can occur between the ages of one and 18. Another important difference is that SIDS research has resulted in vital safer sleep guidance, whereas there is currently no guidance and there are no recommendations to mitigate the risks of SUDC in children aged one to 18.

I cannot even begin to imagine losing a child—there can be nothing worse and no pain more unimaginable. The additional cruelty of SUDC lies in its inexplicability, because we do not know what causes it. As it stands, these deaths are unpredictable and largely unpreventable. I know I speak for those on both sides of the Chamber when I say that it is incredibly important that the Government do everything they can to support research, awareness and understanding of this tragic disease. We also need to ensure that families burdened with grief after such an enormous loss have access to the mental health and emotional support that is undoubtedly necessary after losing a child.

The National Child Mortality Database has done amazing work to improve understanding of the scale and risk markers associated with SUDC. A recent study conducted by the NCMD highlighted the role that poverty plays in a higher risk of SUDC. Some 42% of unexplained deaths of infants happened in deprived neighbourhoods, as opposed to 8% in the wealthiest.

I would appreciate it if the Minister could outline what work is ongoing to understand SUDC and what action his Department is taking to support parents and families who have lost a child to it. I would also like to impress on him the importance of tackling socioeconomic inequalities, which we know drive poorer health outcomes for those living in the most deprived communities. If we are to build a happier and healthier future for every family, irrespective of where they are born, we must get a grip on these endemic inequalities across England. I would be grateful if the Minister could update the House on the Government’s work to tackle health disparities, with SUDC particularly in mind.

We must ensure that every child gets a healthy start in life—something that has informed Labour’s commitment to train 5,000 additional health visitors. Health visitors are skilled in spotting where there may be a problem with a child’s health and are therefore key to prevention and providing that support to families.

We also need to raise awareness. In preparing for the debate, I was incredibly surprised to discover that there is currently no information about SUDC on the NHS website, as we have heard from other Members. There is no co-ordinated national research and very little public awareness. I want to use the debate to support the calls for improved public awareness, information and research, and I hope the Minister will join me in that respect and set out what discussions he will have with the NHS to improve the availability of SUDC information and support.

In closing, we owe it to the families who have lost children, the campaigners who have raised awareness and the researchers who work around the clock to better understand and ultimately defeat SUDC.

Oral Answers to Questions

Andrew Gwynne Excerpts

Tuesday 6th December 2022 Commons Chamber

[Mr Speaker]

I call the shadow Minister.

[Andrew Gwynne (Denton and Reddish) (Lab)]

In 2019, the Tories promised to extend healthy life expectancy by five years, but on this they are failing. In the last year, the health disparities White Paper has disappeared, the tobacco control plan has been delayed and they have chickened out on implementing the obesity strategy because the Prime Minister is too cowardly to stand up to his Back Benchers. Health inequalities are widening as a consequence. Does the Minister plan to revive any of these strategies, or have the Conservatives completely given up on prevention?

[Neil O’Brien]

I have already talked about some of the things we are doing to crack on with improving public health and narrowing inequalities, but I will add some more. We are driving up blood donations from shortage groups and vaccine uptake in areas with the lowest uptake. I mentioned the extra £900 million for drug treatment, taking the total to £3 billion over three years. I will not repeat all the things I mentioned but, across the board, we are working at pace to improve public health and narrow health inequalities.

World AIDS Day

Andrew Gwynne Excerpts

Thursday 1st December 2022 Commons Chamber

[Andrew Gwynne (Denton and Reddish) (Lab)]

I, too, congratulate both my hon. Friend the Member for Brighton, Kemptown (Lloyd Russell-Moyle) on securing this debate, and the Backbench Business Committee on granting it. In thanking my hon. Friend, I want to say that we listened intently to his opening contribution. It was full of wisdom, insight and personal advocacy and showed the commitment that he brings to the issue in this place. The House of Commons is a better place when we speak openly and challenge those in power about the issues that still prevail, not just in this country but across the world when it comes to HIV/AIDS.

On this day, we remember the 40 million people who have lost their lives to the worldwide AIDS pandemic and related illnesses since the disease was first found in the 1980s. In this debate, Members from across the House, in a small, but perfectly formed manner, have raised some important issues. I particularly thank the right hon. Member for Romsey and Southampton North (Caroline Nokes) for the way in which she always challenges inequalities around the world, especially inequalities facing women and girls, and, of course, this is an issue that affects women and girls around the globe. It is an equalities issue, and I thank her for her contribution. I also thank the hon. Members for West Bromwich East (Nicola Richards), for Heywood and Middleton (Chris Clarkson), and for Strangford (Jim Shannon) and even the SNP spokesman, the hon. Member for Coatbridge, Chryston and Bellshill (Steven Bonnar), for their contributions. The great thing about this issue is that it brings us together in unity on World AIDS Day. This is not a party political issue. As with covid, if we are to defeat the first pandemic, we must work together across party lines, and this has been a good debate because of that.

We all recognise the extraordinary work of those who have fought to eradicate the virus. As has already been said, we have come a long way since the first World AIDS Day in 1988. Here in the UK, we have seen unprecedented scientific advancement. We understand more about HIV, and we have legislated against discrimination to better protect those living with HIV. We have seen some long-overdue justice delivered to victims of the contaminated blood scandal, with interim payments being granted for some—but not all—of those impacted. This victory is a testament to the unstinting work of campaigners and, indeed, colleagues from both sides of the House. However, as has been made clear in the Chamber today, there is still much more work to do with regards to this injustice. I hope that, in his response, the Minister will provide an update to the House on when the Government will respond in full to the 19 recommendations laid out in Sir Robert Francis’s framework for compensation.

This World AIDS Day is not just about recognising and celebrating how far we have come, but about issuing a call to action. There can be no room for complacency in the late stages of this campaign. Today, we stand on the brink of achieving something extraordinary: ending all new HIV transmissions in England by 2030. That goal is ambitious, but achievable, and it is one that Labour is proud to support and to push the Government on to achieving. None the less, too many opportunities are still being missed, and sexual health services are struggling to keep up with demand. A total of 46% of people diagnosed with HIV are still diagnosed too late, and 38% of people attending sexual health services were not offered an HIV test last year. That is not good enough. Some 20% fewer people were tested for HIV in 2021 than in 2019, and research shows that 57% of people have waited more than 12 weeks for PrEP.

Shockingly, in 2021, no local authority in England—not one—reported more than five women accessing PrEP, and there are still stark racial disparities in treatment and in support that must be addressed. I wish to use this debate to press the Minister on what steps the Government are taking to tackle unequal access to sexual health services and, in particular, to PrEP.

In a recent study, 40% of people surveyed reported difficulty in booking a sexual health appointment online; 23% of people were turned away due to a lack of available appointments. With that in mind, what assessment have the Government made of sexual health accessibility levels, and what consideration has the Minister made of making PrEP available beyond sexual health services—for example in GPs, gender clinics, pharmacies and abortion clinics? I assume that that work would be included in the promised PrEP action plan, but that has yet to materialise. Will the Minister commit to an implementation date for this plan today, and if not, why not? Furthermore, what recent assessment has the Minister made of the eligibility criteria for PrEP, and are there any plans to expand it?

PrEP is one side of the coin, but we do not often talk about the other side anymore—partly because of the success of PrEP—and that is access to post-exposure prophylaxis. The publicity has fallen for that, but it is still an important tool in the box for people who are fearing that they may have been inadvertently exposed to the HIV virus. There is a small window for those people who fear that they may have been exposed, or who have been exposed to HIV, to get access to PrEP for it to be successful. What are the Government doing to ensure that there is adequate advice and information on the availability of post-exposure prophylaxis?

Sexual health services are under unprecedented pressure due to mpox. Service displacement means that appointments for PrEP, STI testing and long-active, reversible contraceptives have been cut. That has also led to reported hesitancy by clinics to deliver mpox vaccines. What action will the Minister take to ensure that all those who need the mpox vaccine can access one, and not to the detriment of other vital sexual health services?

Moving to testing, the Minister will no doubt be aware that yesterday, NHS England released its report on HIV and hepatitis opt-out testing in areas of very high prevalence. Labour has been proud to support that for several years. The report shows that because of the tests, more than 800 people living with undiagnosed HIV and hepatitis have been identified in these areas. We have saved an estimated £6 million to £8 million on treatment costs. Put simply, opt-out testing has been a huge success. With that in mind, can the Minister set out whether there are any plans to change the current scope of HIV opt-out testing to include all areas of high prevalence?

Finally, I want to touch on stigma. A study recently published by the Terrence Higgins Trust found that just 38% of people knew that those living with HIV and on effective treatment cannot pass the virus on to partners. Only 30% of people said that they would be comfortable dating somebody with HIV. The HIV epidemic is exacerbated by stigma, ignorance and misinformation. If we want equitable access to HIV treatment, we must proactively tackle the myths and bigotry that still permeate discussions around HIV. I am sure that the Minister will agree wholeheartedly with me about that.

I would be interested to hear the Minister’s assessment of current legislative barriers affecting those living with HIV. A clear example is the fact that LGBT+ people with HIV are still not allowed to access fertility treatment, despite the fact that heterosexual people with HIV are able to do so. That is an out-of-date barrier and it needs scrapping. I am proud that the next Labour Government will equalise access to fertility treatment for LGBT+ people living with HIV. Will the Minister join us in committing to that, and pledge to introduce legislation now—before the general election—to end the restrictions that prevent people with HIV from starting a family?

Labour is committed to the HIV 2030 pledge. It is more than prepared to work on a cross-party basis to make this ambition a reality. But we must address some incredibly concerning trends in HIV treatment and access, and not become complacent because of the progress that has come before us. No new transmissions of HIV by 2030 is still possible. We want to succeed, but there is no time to waste. As my hon. Friend the Member for Brighton, Kemptown said, let us all, together, sprint to that finish line.

Smokefree 2030

Andrew Gwynne Excerpts

Thursday 3rd November 2022 Commons Chamber

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to speak in this important debate. It has been a small but, I think, perfectly formed debate, in which there has been a large degree of consensus throughout the House on our ambition for England to be smokefree by 2030.

I commend the hon. Member for Harrow East (Bob Blackman) not just for the work he has done on this subject over a long period, particularly in the all-party parliamentary group, but for the way in which he introduced the motion, which, as my hon. Friend the Member for Stockton North (Alex Cunningham) observed, enabled us to say, “We agree with Bob.” I congratulate my hon. Friend for his own work on the subject. I thank the hon. Member for Erewash (Maggie Throup) for her contribution, and also thank her for her time as the public health Minister: I used to enjoy our debates across the Dispatch Box, and I wish her well in whatever comes next.

The Health and Social Care Front Bench is a bit like a whirling dervish at the moment. We had the hon. Member for Erewash a few months ago, then the hon. Member for Sleaford and North Hykeham (Dr Johnson)—she was in post for just six weeks, and I want to thank her as well for the work she did in that short time—and now we have the new Under-Secretary of State for Health and Social Care, the hon. Member for Harborough (Neil O’Brien), whom I welcome. Let me also echo the words of the hon. Member for Harrow East in wishing my hon. Friend—indeed, my friend—the Member for City of Durham (Mary Kelly Foy) a speedy recovery after her hospital treatment.

It is now nearly five months since the release of the Khan review. Both the hon. Member for Erewash and I spoke at the launch, and I think the review was universally welcomed. It was generally agreed that we must move apace in ensuring that we meet the ambition of a smokefree 2030. In those five months we have had three different Health Secretaries, and we are now on our third Prime Minister. I do not blame the current Minister for all this chopping and changing, but it is little wonder that the Government have failed to find time to respond to the Khan review amid the endless changes. I hope that when the Minister responds to the debate, we will finally be given some clarity. I hope he will set out a timetable for when the Government will respond to the Khan review, and will outline which measures in the review itself the Government are currently considering. I also hope he will be able to reassure Members on both sides of the House that the Government stand by their commitment to create a smokefree England by 2030.

The importance of that smokefree 2030 cannot be overstated. Tobacco is the primary driver of health inequalities throughout the United Kingdom. In 2019-20, there were more than half a million hospital admissions and more than 74,000 deaths attributed to smoking. My constituency of Denton and Reddish straddles two local authorities, Tameside and Stockport in Greater Manchester. The public health charity Action on Smoking and Health—ASH—estimates that smoking costs those two local authorities about £172 million in lost productivity and health and social care costs. That is unsustainable.

Behind those stark economic figures, however, are individual lives that are being harmed or lost as a direct result of smoking. We know that more than 50% of people over the age of 16 who smoke say they want to quit—in fact, many say that they wish they had never started in the first place—and it is therefore imperative that the Government support them in their efforts to do so. Unfortunately, stop smoking services have suffered a 33% real-terms cut in their budgets since 2015-16. There is a drastic need for that to be reversed.

The Government have made a commitment to a smoke- free 2030, which is commendable. We support them, and we want them to succeed. However, a commitment alone is not enough: we want to see action to get there, and we need to see that action fast. The former Secretary of State had an interesting relationship with the tobacco industry, to put it mildly. She had previously accepted hospitality from the industry, and had voted against several sensible public health tobacco measures. During her brief but eventful tenure, it was reported that she had scrapped the Government’s proposals to publish a tobacco control plan, as well as the health disparities White Paper. I asked the Minister about the White Paper earlier this week during Health questions, and received something of a non-answer. I will therefore ask my questions again today, in the hope of getting some clarity. Are the Government planning to scrap the health disparities White Paper—yes or no? Are they planning to scrap the tobacco control plan—yes or no? We need transparency, as there seems to be an information vacuum in the Department of Health and Social Care. If the Government are indeed rowing back on their public health responsibilities, they should have the guts to say so, and face scrutiny for that decision.

By doing everything from inviting tobacco lobbyists into the heart of No. 10 to accepting gifts from the big four tobacco firms, the Government have shown themselves too willing to ally themselves to an industry that is damaging the health of the nation. However, the damage done by the tobacco industry is not confined to public health. Recent analysis conducted by The Daily Telegraph has revealed that the Russian Government have received almost £7 billion from tobacco companies in taxes since Putin’s invasion of Ukraine. That is despite several tobacco companies pledging to cut ties with Russia. I would be interested to know what the Minister makes of this revelation. Will the Government make it crystal clear to tobacco companies that they are expected to follow the lead of those companies that have ceased trading with Putin’s tyrannical regime?

Labour Members believe that if we want to ease pressure on our NHS and improve public health, we need to get serious about prevention. That means ensuring equitable access to smoking cessation services, and taking on tobacco companies that profit at the expense of public health. Smoking prevalence is not a problem that the Government can ignore and hope will magically go away. As a Greater Manchester MP, I have been really encouraged by Greater Manchester’s “Make Smoking History” strategy. If the Minister has not looked at that, I encourage him to do so, because it really is best practice. Indeed, it is cited as best practice in a case study in the Khan review.

Greater Manchester’s comprehensive approach to tobacco control means that smokers in Greater Manchester have more offers of support in quitting than ever before. Thanks to the scheme, smoking rates among people in routine and manual jobs have reduced faster in Greater Manchester than in any other region of England. If these strategies can work regionally, they can, with the political willpower, be scaled up to national level.

I urge the Minister to take the brave decisions. They are sometimes tough and often very unpopular with a significant vocal minority of people, but taking those decisions is the right thing to do, as history often shows. Smoking has gone up among young adults aged 18 to 24 in the past three years. To put that in context, in 2007, around 41% of young people said that they had smoked. By 2019, that had fallen to just a quarter, but in the short space from 2019 to 2022, that increased to a third. That is going in the wrong direction. Between 2007 and 2020, smoking fell, as successive Governments really ratcheted up the regulation of smoking and introduced smoke-free laws. They increased the age of sale from 16 to 18; banned the display of tobacco products; introduced standardised packaging and large, graphic health warnings; banned smoking in cars with children; and, lastly, banned menthol in 2020. Those measures worked, but they have to continue, as does the pace of change, if we are to meet the goals of Smokefree 2030.

The last Labour Government implemented one of the biggest and most significant public health interventions in modern political history. I am most proud of it, but it was not popular in all quarters; I was almost banned from holding surgeries at Denton Labour club. It was the ban on indoor smoking. When we go abroad to countries that still have smoking indoors in public places—in bars, restaurants and cafes—we wonder how on earth we put up with that in our country until fairly recently. Absolutely nobody with a modicum of common sense would want to reverse that legislation.

When we were in government, we supported taking the bold steps necessary to protect public health, and many thousands of lives were saved as a result. That is why we want the Government to commit to Smokefree 2030. They will miss that target unless they up the pace of change, accept the recommendations of the Khan review, and legislate to put measures in place. For far too long, public health has been an afterthought, or a battleground on which to have ideological arguments. We have had obesity strategies scrapped, tobacco strategies binned, and health inequalities widened. This neglect cannot continue. We will support the Government in being brave on public health. We will give the Minister the majority he needs, if he does not have one, to pass the right measures in this House. Labour Members will do right by Britain, and encourage the Government to do the same. Be brave, and build a healthier, happier and fairer Britain; we will support you.

Oral Answers to Questions

Andrew Gwynne Excerpts

Tuesday 1st November 2022 Commons Chamber

[Mr Speaker]

I call shadow Minister Andrew Gwynne.

[Andrew Gwynne (Denton and Reddish) (Lab)]

We know that, if poorer communities cannot afford to heat their homes, health inequalities will worsen significantly over the winter months and beyond. Despite the seriousness of this issue, the previous Health Secretary—that is the right hon. Member for Suffolk Coastal (Dr Coffey), in case Members are struggling to keep track—planned to ditch the Government’s long-promised health disparities White Paper. Does the current Minister intend to do the same? If he does, how will he seriously address the dreadful health inequalities that have widened after 12 Tory years?

[Neil O’Brien]

The hon. Gentleman implies that I disagree with him about this. In fact, the Government are working hard to clamp down on squalid housing. That is exactly what we were doing in my previous Department, DLUHC, and I have just mentioned some of the things that we are doing: the £37 billion we are spending to help people to meet the cost of living, the £15 billion of that that is targeted on the very poorest households, and the £12 billion that we are investing in making people’s houses easier to heat. We will continue to tackle health disparities across the board.

Draft Adult Social Care Information (Enforcement) Regulations 2022

Andrew Gwynne Excerpts

Monday 31st October 2022 General Committees

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Edward. I welcome the Minister back to her place in the Department of Health and Social Care. Hopefully, there will not be too many issues still on her desk from her previous time as a Minister; let us hope that those who served in between managed to clear the in-tray.

I am pleased to speak to this statutory instrument on behalf of the shadow Health and Social Care team. We see no reason to oppose the measures before us; it is sensible that adult social care providers will be required to supply the Department of Health and Social Care with important data. It is striking that prior to the pandemic there was no comprehensive national data from providers on workforce status, bed availability or the number of people in receipt of care. As the Minister said, having access to that crucial data will no doubt improve policymakers’ ability to judge risk in the care system, which we know to be under significant stress. Without the requisite data, they are unable to make those detailed assessments right now.

I am reassured by what the Minister said about the data being subject to GDPR restrictions, and the fact that data will be shared appropriately with local authorities and integrated care systems. It is right that when a provider is persistently in breach of its data obligations and has not made appropriate attempts to rectify them, financial penalties will be scaled to the provider’s type and size. That is common sense.

The Department of Health and Social Care has indicated that it will consider improving the accessibility of data available to providers and any opportunity to link the capacity tracker to other data sources. In her closing remarks, could the Minister provide a short update on that work and whether the capacity tracker data will be publicly available, so that the state of the social care sector can be robustly assessed in the public domain?

You will be pleased to hear, Sir Edward, that those are the remarks of the official Opposition. We do not oppose this instrument—indeed, we actively support measures to improve transparency in our social care sector.