Car Parking: Care Workers

Andrew Gwynne Excerpts

Thursday 16th March 2023 Westminster Hall

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

It is a pleasure as always to serve under your chairmanship, Sir Robert, and to speak on behalf of the shadow Health and Social Care team. I thank the hon. Member for Southport (Damien Moore) for securing this important debate and for all the work he has done to raise awareness and champion the cause, which I do not think anybody can have any issue with. I very much support it—let us get it over the line.

We have had a small but perfectly formed debate today. As well as thanking the hon. Member for Southport for securing the debate from the Backbench Business Committee, I also thank the hon. Member for Strangford (Jim Shannon) for always giving the Northern Ireland perspective in these debates. It is really important that we learn from different parts of the United Kingdom, because no one home nation has the right answer to all these things. It is good to learn from one another and have the perspective from other parts of the United Kingdom as we deliberate on what we should be doing here in England to support our care workers.

I thank my hon. Friend the Member for Erith and Thamesmead (Abena Oppong-Asare) for her contribution. She is absolutely right about how we need to come together across party lines and support care workers. Parking is a big issue and a pressure on those who work in our health and care system. I also place on the record my thanks to care workers, because they do an extraordinary job, as has been highlighted throughout the debate. We should never take their efforts for granted, because they are the linchpin in ensuring that the most vulnerable people in society are cared for and looked after in their time of need.

I am not making a party political point, but we know that the care sector is in crisis. It is under enormous stress and strain; the demand far outstrips the ability for us to meet many expectations. Primarily, a recruitment and retention issue in the workforce is at the heart of that. As a consequence of those pressures, many staff feel undervalued, overworked and underpaid, and it is our duty as parliamentarians to try to resolve those issues. We will support the Government on the measures they introduce; we have our own ideas as well, which the next Labour Government can hopefully introduce, but while the current Government are in office we will work with them to try to resolve these issues.

Problems such as parking charges put additional financial pressure on carers already going above and beyond and compound the stress that many of those people are under. That is demonstrated by the difficulty in retaining domiciliary care staff. As Nuffield Health points out, more than one in three domiciliary care workers left their roles last year, and many opted to work in sectors that offer better working conditions and pay.

Two issues are at play here. There is, of course, the specific issue of car parking changes, but that speaks to the question of how we treat our social care staff in general. Some good points have been made, mainly by the hon. Member for Southport in opening the debate, about free parking for domiciliary care workers—what the charity Engage Britain refers to as a green badge scheme for care workers. As the charity points out, several local authorities already operate a similar scheme, but a bit of a postcode lottery in provision seems to be developing. At the heart of the issue are care workers who are just trying to do their job.

I want some clarity from the Minister on a few questions. First, have the Government considered the green badge proposal? There is a huge problem here. It cannot be right that care workers are effectively being priced out of doing an essential job. They are desperately trying to care for vulnerable individuals, rushing between houses and having to worry about whether they will be able to afford the parking. I am not comfortable with that being a calculation that care workers have to make in 21st century Britain, and I sincerely hope and expect that the Minister feels the same. Will the Minister set out whether the Government are in conversation with care leaders and staff on what support can be offered?

Secondly, in the absence of a national free parking scheme, what steps is the Minister taking to engage with care agencies to incentivise companies to pay their staff back for the money that they have to spend on parking? It is not right that staff can accrue personal costs in the day-to-day administration of their employment and not be fairly recompensed by their employer. There needs to be a clear message from the Government that that is not an acceptable business practice.

Engage Britain provided my office with a good quote from a care support worker on a zero-hour contract, who said that with free parking,

“social care workers will be able to make appointments on time, with less stress, less rushing around”

and would be able to

“provide more attention and better support to the vulnerable people we are visiting”.

That quote raises an important point. Has there been any assessment of the impact that parking charges are having on quality of care? If care workers are scrambling around trying to find a parking place, there is a risk that they are unable to do their work to the standard that they want. Indeed, it has been brought up in the debate that, in an emergency in which a care worker has to stay with a very ill person until a blue-light response can arrive, the worker may incur not just additional parking costs but, potentially, fixed penalty notices and fines. That is totally unsustainable. It is little wonder that the care sector is asking for the Government sincerely to look again at this measure and provide more support.

That all speaks to a point that I made at the beginning of my contribution: social care staff feel that they have been neglected for many years and that they have been a bit of a Cinderella in the health and care system. We desperately need staff to feel more love from Government and to be better paid and supported in their careers. Vacancy rates are at a record level—up by 50% in the last year alone—and we now have a record 165,000 vacancies in the sector. That is totally unsustainable and we cannot just sit on our hands and wait for the system to collapse.

Labour has committed to a new deal for care workers, which would focus on recruiting and retaining the staff we need by ensuring fair pay and terms and conditions, and by improving training and career progression. We would change the remit of the Low Pay Commission, so that, alongside median wages and economic conditions, the minimum wage would reflect the cost of living. That would have a transformative effect across all sectors, but particularly on social care, where problems are especially acute. We would also ensure that new contracts for care are given to ethical providers—to providers who will provide fair pay, fair conditions and training for staff. Parking may well be part of that equation, in the terms and conditions, or through the reimbursement of costs incurred by agency staff.

The Chancellor could have used his Budget yesterday to announce a long-term workforce plan for the NHS and to reform pay for social care. He did not, even though we offered him Labour’s plan—we would have been very happy for him to pinch it. Instead, he handed a tax cut to the very wealthiest. That says all we need to know about the priorities of this Government. The next Labour Government will improve and invest in social care. At the very heart of that ambition will be ensuring that our incredible social care staff receive the pay and terms and conditions that they so deserve.

On the issue before us today, I implore the Minister to do the right thing. As the hon. Member for Southport so eloquently set out in his opening speech, this would be a small improvement, but a game changer for so many hard-pressed, social care staff. I urge the Minister to do the right thing.

[The Minister for Social Care (Helen Whately)]

It is a pleasure to serve under your chairmanship, Sir Robert. I congratulate my hon. Friend the Member for Southport (Damien Moore) on securing this debate on free parking passes for care workers. I know it is an issue close to his heart and I commend him on his speech.

Improving adult social care and supporting care workers is one of my highest priorities, and I am delighted that my hon. Friend shares my enthusiasm, particularly for supporting domiciliary care workers. In his compelling speech, he spoke about the difficult job they do and the skills necessary for their work, as well as some of the practicalities of the job, such as the many short journeys that some care workers will be making and the challenges that result, including parking. He also spoke about the vacancy rate in social care, particularly in domiciliary care.

Recruiting and retaining staff is a particular challenge for many care providers, especially following the reopening of the economy after the pandemic. Many people had come from the hospitality or travel sectors to work in social care during the pandemic, which was hugely helpful in those difficult times, but many then often returned to those sectors. Not all did; some had found their vocation in social care, and that has been wonderful, but others, understandably, returned to their previous sector, making it harder for the social care sector to retain and recruit staff as the economy opened up. I am hearing some positive news about recruitment at the moment, but that does not mean that it is easy. It remains a real challenge, particularly with domiciliary care and in rural areas.

As my hon. Friend also said, we are seeing a growing demand for social care, as people live longer—that is a positive for us all to remember, but it does mean more people living with health conditions, and more frail and elderly people, who need people to come in and care for them. The hon. Member for Strangford (Jim Shannon) talked about the importance of living independently. We want people to be able to live longer in their own homes. There is a time when it is better for people to live in residential care—that can be the right thing for some people—but most of us want to stay living in our own home behind our own front door for as long as possible. Domiciliary care workers, who go to someone’s home, are absolutely crucial.

My hon. Friend for Southport referred to our 10-year vision for social care, which I am truly passionate about. The shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), talked about the challenges that social care faces. Those challenges have been around for many decades, so we are not going to fix this overnight. I share the impatience of my hon. Friend the Member for Southport. That is one reason why I try to do things in the here and now. However, I am also realistic, and some social care reforms that we want to do will take time, hence that long-term vision.

My hon. Friend spoke very specifically about the cost of parking and rightly about the stress of looking for a parking space when the clock is ticking. He also spoke about unexpected situations, such as when care workers need to stay longer and call an ambulance. The hon. Member for Erith and Thamesmead (Abena Oppong-Asare) also spoke about that in her intervention.

I heard that my hon. Friend the Member for Southport called on his local council to fix that in his area during the pandemic. He welcomed our free parking scheme during the pandemic, so I am glad that he saw it taking good effect. That was one of many things that we tried to do to help key workers through that difficult time. That ended, and I absolutely hear his argument for a new national scheme, particularly to help care workers with parking while they are on duty.

I thank the hon. Member for Strangford. It is a pleasure to be in Westminster Hall with him at any time in the week, but particularly on a Thursday; we do this not infrequently. He spoke powerfully, if I understood him correctly; sometimes I do not pick up every word he says. He spoke about his brother, Keith. He said that, following a brain injury, Keith might well have lived in a care home, but has in fact been able to live independently with the support of family, including his mother and the hon. Member, but of course with care workers visiting. He brings a very personal perspective on the important role of care workers in our communities.

The hon. Gentleman also spoke about us working across the parts of the United Kingdom. I am always happy to talk to colleagues in other parts of the Union, because I think we can all learn from each other to try to get the best for our constituents.

Taking a step back, I want to say that I am incredibly grateful to all health and care staff. I recognise the extraordinary commitment and hard work, particularly of our care workers and domiciliary care workers, who are less frequently spoken about in Parliament. I want to ensure that care workers gain the recognition they deserve from society. I truly thank them for all the vital work they do every single day, whether in care homes, people’s homes or beyond.

Many people want to work in care because they want to make a difference to the lives of others. In my conversations with care workers, many have told me that they find their work truly rewarding. Just a few weeks ago, I had a wonderful conversation with a home care worker, who told me that she loves her job. That is great to hear, but there is no denying that it can be a very demanding job, both physically and emotionally. Domiciliary care workers play a crucial role in providing care and support to people who need it within their own home, enabling them to continue living independently even when they have substantial care needs. From going on the rounds with care workers and speaking to them, I know how committed and passionate they are about what they do.

Turning specifically to parking, I heard the points made by my hon. Friend the Member for Southport on free parking for care workers, and I am sympathetic to them. I have had many conversations with those who provide care in people’s homes about some of the challenges they face, including travel and parking costs. For instance, I share the concerns about underpayment for travel times, which is a live issue within the sector.

All social care workers are entitled to be paid at least the minimum wage—I should say, the national living wage—for the work they do. The Government are clear that time spent caring for clients, travelling between appointments and waiting to start the appointment must be included in pay calculations. I labour that point because I hear accounts, usually anecdotal, of whether travel and waiting time is being paid for. It may not be within the care worker’s control if they turn up for an appointment when, for instance, another health worker is visiting somebody and they have to wait. If they are having to wait as part of their job, of course they should be paid for that working time.

Responsibility for setting the terms and conditions for parking permit schemes and delivering social care is devolved to local authorities. Some local authorities, such as Cornwall and Devon, already run health and care parking permit schemes. I am glad to be talking about this important issue today and it is right that, at the very least, the national Government support the sector by raising awareness of and driving forward innovation and best practice. I therefore encourage local authorities who are not already undertaking similar projects to look and learn from those areas that have implemented their own parking schemes, especially as we know about the recruitment and retention challenges in adult social care. I also commit to working with my colleagues across Government, in particular in the Department for Transport and the Department for Levelling Up, Housing and Communities, to consider what more can be done to help care workers with the cost of parking.

More broadly on the adult social care workforce, the Government recognise the current workforce challenges in social care.

[Andrew Gwynne]

I want to take the Minister back to where she rightly said that terms and conditions are matter between the employer and the employee. She was, rightly, very robust on the expectations of the national living wage being paid for waiting to do work. Does she also take a strong view that employers should reimburse their staff for any incurred parking costs?

[Helen Whately]

The hon. Gentleman will allow me to pause, because I do not want to find that I have unintentionally misled anybody. I am very happy to write to him on that specific question. What I am completely happy to do here and now is reiterate the importance of social care workers being appropriately paid for the work they do. At the very least they should be paid at the legal level to which they are entitled and reimbursed for the expenses of the job they do. I hope the hon. Gentleman is happy with that response.

As I said, we recognise the recruitment and retention challenges in the social care workforce. The Government are supporting local authorities and providers with the recruitment, from both home and abroad, and retention of workers. For instance, we have been running a national recruitment campaign with continuous activity across job boards, video on demand, digital audio, radio and social media to encourage people to come and work in social care. That campaign will run until the end of this month.

In addition, in February last year we made care workers eligible for the health and care visa, and added them to shortage occupation list. The latest data published by the Home Office shows that a total of 56,900 visas were granted for care workers and senior care workers in 2022. I do not suggest for a moment that international recruitment is the whole answer to our recruitment challenges in social care, but given that we have such a substantial need for care workers, it is really important to help boost our care workforce. I have heard from many care providers who really welcome it, as it helps them to recruit and fill vacancies, and bring valuable staff into our workforce.

More broadly, the Government are making available up to £7.5 billion over the next two years to support adult social care and discharge, with up to £2.8 billion available this coming financial year and £4.7 billion the following year. That is an historic funding boost to put the adult social care system on a stronger financial footing and help local authorities to address waiting lists, low fee rates and workforce pressures in the sector.

Another way councils are able to support their adult social care workforce is through the market sustainability and improvement fund. At the autumn statement, the Chancellor announced that £400 million of new ringfenced funding would be made available for adult social care in the next financial year. We have combined that with £162 million of fair cost of care funding to create the fund. We are allowing councils to use the new funding flexibly on three target areas: support for the workforce measures; increasing fee rates paid to providers; and improving social care waiting times, which will improve adult social care market capacity and sustainability. My hon. Friend the Member for Southport might be pleased to know that Sefton Council will receive £3.6 million through that fund. Many local areas have chosen to use a significant proportion of the adult social care discharge fund on measures that support the adult social care workforce, including those who work in home care.

The hon. Member for Denton and Reddish talked about the importance of commissioning—I think he referred to ethical commissioning. I assure him that I think how local authorities commission care is really important, because it influences the terms and conditions on which care providers employ their workforce. That is one reason why, in April—just a couple of weeks away—we are starting the Care Quality Commission assurance of local authority social care provision. That will increase oversight of how local authorities are implementing the Care Act 2014, and part of that is very much about how they commission care. It will enable us to identify local authorities that are doing a really good job and will give us more information about those whose commissioning does not support their market or leads to some of the practices that we have been talking about.

As I said at the beginning, we want quick answers. My hon. Friend the Member for Southport wants change here and now, and so do I, but we also have to look to the longer term for our social care reforms. People at the heart of care must set out a longer-term vision for social care. I will shortly be publishing a plan setting out our next steps for the reforms. It will include substantial reforms to the adult social care workforce to strengthen careers and opportunities, and make adult social care a better sector to work in. That will help attract more people to work in social care and retain those valuable staff members.

I thank my hon. Friend for making the case and other Members for showing support for domiciliary care workers. I share my hon. Friend’s aspiration to support his care workers. In fact, I believe I have shown that in practice—for instance, through the support I put in place during the pandemic for the social care workforce; things I am doing right now with the funds such as the market sustainability and fair cost of care fund; and things that I will do in the future, including with our adult social care reform. I am happy to consider his proposals further as part of the work I am doing to boost our support for the care workers our constituents depend on.

National No Smoking Day

Andrew Gwynne Excerpts

Thursday 9th March 2023 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Efford, and to speak on behalf of the shadow Health and Social Care team. I congratulate the hon. Member for Harrow East (Bob Blackman), not just on securing the debate and on his opening speech, but for all the work that he has done over a long period of time on the issue. We know from his contribution today what drove him to champion the cause of smoke-free England 2030, and we thank him for the work that he has done. This is not a party political issue; it is something on which we all want action.

We also had good contributions from my hon. Friends the Members for North Tyneside (Mary Glindon), for York Central (Rachael Maskell), for Blaydon (Liz Twist) and for City of Durham (Mary Kelly Foy), and from the hon. Member for Cumbernauld, Kilsyth and Kirkintilloch East (Stuart C. McDonald), who leads on the issue for the SNP, and helpful interventions from my hon. Friend the Member for Ealing, Southall (Mr Sharma).

The first No Smoking Day took place in 1984. Back then, 35% of people smoked. In the almost 40 years since then, we have made great strides in tackling smoking prevalence. We now have a smoking rate of around 13%. We have seen a clampdown on tobacco advertisements, an increase in public awareness of the dangers of cigarettes, and, most notably, Labour’s ban on indoor smoking, which led to a truly transformative impact on public health.

Do not get me wrong—smoking prevalence is still too high, and incredibly so in some of the poorest communities in England—but it is undeniably heartening to see the progress that has been made in the last four decades. The progress is primarily thanks to the tireless work of public health researchers and campaigners, who sounded the alarm about the dangers of smoking, and who continue to put much-needed pressure on policy makers for further action.

I do not say that to give us all a pat on the back, but to highlight how political will can make a real difference. We need that political will now more than ever. This Government have committed to a smoke-free England by 2030—an ambition that is supported across the House. However, we are on track to miss the target by around nine years, which is frankly unacceptable. The Government should not commit to a target because it is politically expedient, but then never deliver it. We need to see smoke-free 2030. Why? Because every year, the evidence of the damage of smoking continues to pile up. Smoking causes around 75,000 deaths every year in the UK alone. It harms pretty much every organ in the body. As the research to mark this year’s debate demonstrates, it is strongly linked to dementia, too. In addition to the tragic human cost, smoking also costs the economy around £20 billion in lost productivity, ill health and NHS resources. The facts are overwhelming, and we must act.

I am sure the Minister will agree on all those points, and I would like to raise a few matters on which I hope we can get some clarity. The first has already been mentioned to my hon. Friends—the tobacco control plan, which seems to have disappeared into the ether. Can the Minister confirm that he still intends to publish the tobacco control plan, and when it will be released? The hon. Member for Harrow East was very forceful on this point. If, as I fear, it is being held back because the Prime Minister is scared of upsetting some on his Back Benches, the Minister should front up and admit it.

The last tobacco control plan was published almost six years ago, and it has now expired. We are left in the bizarre situation where the Government continue to insist they are committed to smoke-free 2030, but they have no plan for how they intend to get there. The Minister is driving us to a destination, but he forgot to bring the map.

In addition to providing a date for the next tobacco control plan, will the Minister provide a date for when he expects to respond in full to Javed Khan’s smoke-free review, which his Department commissioned and seems to have forgotten? Secondly, given the extremely concerning figures from ASH that show just 18% of smokers know that smoking can cause dementia, will the Minister advise Members on what action the Government will take to increase awareness of that risk? Concerns have rightly been raised by public health charities about the fact that media spending on stop smoking campaigns has declined by 95% since 2008-09. Will the Minister confirm how much his Department has earmarked for spending on TV ads for Stoptober this coming October, and if he has assessed how current media campaigns are performing in raising public awareness?

Finally, it would be remiss of me not to mention the public health grant, which has still not been released to local authorities in England. I asked the Minister about this at Health questions on Tuesday and was told the grant was coming in days, not weeks. I am not sure what that means, because we are two days on and there is still no sign of it. Any additional information the Minister can give would be greatly appreciated, not least because this grant is essential to smoking cessation services in communities across the country, including communities I represent in Greater Manchester.

It is time to get serious about tackling smoking prevalence. The last Labour Government took decisive steps to improve public health, and we would do so again. That is why the next Labour Government will consult on all Javed Khan’s smoke-free 2030 recommendations and put prevention at the heart of everything they do. Our NHS is at breaking point. Seven million people are on waiting lists. Solving that challenge obviously requires an expansion of the NHS workforce, which Labour is proud to have committed to, but unless we simultaneously tackle the root causes of why people get ill, we do not stand a chance of rebuilding our NHS and making it fit for the future.

Labour stands ready and waiting to build a healthier, happier and more prosperous England. Until then, the Minister has my assurances that whatever support the Government need to get back on track for their smoke-free 2030 target in England, Labour will provide. He need not rely on the votes of those in his party who do not necessarily understand the importance of public health. Tackling smoking is not partisan. It is in all of our interests to work towards a smoke-free 2030, so my message to the Minister is clear: we will support him, and let’s get on with it.

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.

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.

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.

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.