Tobacco and Vapes Bill

Caroline Dinenage Excerpts

Report stage
Wednesday 26th March 2025 Commons Chamber

[Mary Kelly Foy (City of Durham) (Lab)]

I begin by declaring an interest as the co-chair of the all-party parliamentary group on smoking and health. I will speak to my amendments and one or two others.

The Tobacco and Vapes Bill is world-leading health legislation that will create the first smokefree generation, protecting children and young people from the harms of smoking. In the City of Durham alone, some 5,500 children start smoking each year. Most of them will go on to wish that they had never started. This Bill will end that. It will stop the start and ensure that every child has a smokefree future. Recent data from UCL has shown that the rates of smoking are falling fastest in the north-east. This can at least partly be attributed to hard work and amazing regional programmes such as Fresh, which works so hard to tackle inequalities in our region. The same data also shows that progress is not guaranteed; in some areas, smoking rates appear to be increasing. The case for action is clear.

New clause 13, in my name, would put a duty on the Secretary of State to publish a road map to a smokefree country every five years. It was a Labour Government who introduced the first-ever smoking strategy in 1998, “Smoking Kills”. It is 2025, and smoking still kills. This world-leading Bill is to be celebrated for many reasons, but the rising age of sale will not impact the 6 million people who are currently smoking in the UK. Smoking is not spread equally across our society; the most affluent 10% are set to become smokefree this year. However, at the current rate, the most deprived will not achieve that until 2050. It is vital that the Government ensure that no one is left behind as we create a smokefree future. Having a clear plan for achieving that, and targets for reducing smoking not only for the whole population, but for pregnant women, those struggling with their mental health and those in occupations with high rates of smoking, will save lives. Will the Minister meet the all-party parliamentary group following the publication of our report to discuss how we can turbocharge reductions in smoking and create the smokefree generation?

New clause 19, tabled by the Conservatives, would require the Secretary of State to publish reports on the illicit market. Let us be clear that His Majesty’s Revenue and Customs already publishes annual data with a detailed analysis of the illicit market, so it is difficult to see what the Department of Health and Social Care could do in addition. There are no additional data sources available that would yield any different results.

Finally, amendments 82 and 83 would remove the exemption for performers. Since 2007, it has been against the law to smoke inside. However, that does not apply to actors smoking in performances for artistic reasons. There is a play on in London’s west end that tells the story of the American oil lobbyist and master strategist Don Pearlman. Don Pearlman was a heavy smoker who died from complications arising from lung cancer. The actor playing the lead role smokes on stage. The exemption should be removed, because actors deserve to have their health protected at work as much as everyone else. Audiences and other actors also deserve to be protected from second-hand smoke. Performances at the National Theatre already require that smoking in performances be substituted for vaping or other alternatives. There is no reason why all performances should not follow suit.

Amendments 85 and 86 deal with smokefree extensions. I know that there will be further consultation and debate on the regulations creating extensions to smokefree places and vape-free areas, but can the Minister confirm that there will be exemptions if it is shown that the use of vapes in certain settings aids smoking cessation efforts? I am thinking of, for example, mental health settings. The Mental Health and Smoking Partnership has pointed out that vapes are a valuable tool in such settings to help patients quit. Will the Minister undertake to visit a mental health trust to hear directly about people’s experiences? It is vital that we all work with trusts to provide clear guidance on how to navigate these changes. Particular attention must be paid to how the policies in the Bill, and those that will come into effect after it, such as the disposable vapes ban in June, will interact with each other.

Today’s funding announcement is welcome, but we have gone down to the wire, given that the funding was due to end at the end of this month. Can we be reassured that, following the spending review, services can expect consistent, long-term funding that will allow them to plan their activities and hire staff on longer contracts?

The Bill presents us with a historic opportunity to transform public health in this country, and, after working tirelessly on it for more than a decade, I am proud to support it. However, we must remain vigilant to ensure that no one is left behind. All aspects of the Bill, from the smoking cessation measures to protections for workers in the arts, must be fully realised if we are to create a truly smokefree generation.

[Dame Caroline Dinenage (Gosport) (Con)]

I think you may agree, Madam Deputy Speaker, that the longer we spend in this job, the more we realise that almost nothing is ever straightforward. Even the best intentions nearly always have unintended consequences, and there is absolutely no doubt that smoking, and specifically smoking tobacco, has done untold damage in my constituency and continues to do so. The health of my constituents has suffered as a result of the well-documented effects of regular smoking, and, moreover, smoking is a driver of social and economic inequality. Smokers earn, on average, 7% less than non-smokers. I could not believe that statistic when I first read it, but when I thought about it, I realised that it made complete sense. Those who take more time off work because of the inevitable ill-health effects of smoking, those who spend more of their disposable income on tobacco, and those who develop a dependency on a drug such as nicotine will obviously experience, over time, an impact on their earnings. Smoking is like an extra tax on the most disadvantaged communities, and I can see why this Government have maintained the last Government’s ambition to phase it out.

[Sir Edward Leigh (Gainsborough) (Con)]

I agree with everything that my hon. Friend is saying about smoking, but the elephant in this room is the dramatic decline in legal tobacco sales. According to HMRC, they have declined by 44% since 2021, while the number of smokers has declined by only 0.5%. We are reaching a stage at which we are taxing cigarettes so heavily that we are fuelling the black market and criminality, and we have to be aware that, as my hon. Friend says, these are unintended consequences.

[Dame Caroline Dinenage]

It is almost as if my right hon. Friend had read what is written next on my piece of paper. I was about to say that unfortunately we do not live in a perfect world, even our noblest ambitions have unintended consequences, and the Bill is not a silver bullet. There is already a thriving black market for tobacco in Gosport, and I am extremely concerned about the possibility that prohibition will exacerbate the problem. I am keen to hear from the Minister what action she plans to take, alongside the phased prohibition, to provide proper resources for the police forces in Hampshire and the rest of the country to ensure that the law is upheld, and what plan she has to take on the criminals who are already profiting, and who will only profit more as the age at which a person can legally buy tobacco rises.

Even without the Bill, smoking rates are falling across the UK as a result of a number of policy interventions, including education, smoking support and awareness campaigns. I recently visited a company in Gosport that provides innovative smoking cessation support. It is a vaping company, but it has a partnership with Mid and South Essex NHS foundation trust, which signposts smokers to its stores, where they are given continuing support to further enhance their shift away from tobacco. Hampshire county council has a similar Smokefree Hampshire scheme, which it says contributes to 500 quits per year. Interventions such as these have proven to be successful, so has the Minister weighed up their merits against the possible implications of the Bill?

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[Ashley Dalton]

The entire Bill is about preventing addiction among our young people and preventing their move into crime. These things are already illegal and the Government believe that existing legislation will allow for them to be dealt with.

On cigarette filters, I understand hon. Members’ concerns about tobacco litter, but new clause 2, tabled by the hon. Member for Gosport (Dame Caroline Dinenage), could lead to greenwashing, improving the reputation of tobacco manufacturers while not necessarily improving environmental outcomes.

[Dame Caroline Dinenage]

That is an incredibly lazy argument. We do not care about greenwashing; greenwashing is just semantics. We care about cleaning up our beaches, cleaning up our streets and reducing the cost to local councils of cleaning up litter. It is ridiculous if the Government are going to be swayed by one lobby or another and not do the thing that is common sense and much better for our environment.

[Ashley Dalton]

I thank the hon. Member for her intervention. If I am allowed to finish, that is one of the issues and that proposal may not necessarily improve environmental outcomes. However, we consider that powers are already available to the Department for Environment, Food and Rural Affairs that enable the Government to limit the damage to the environment caused by filters, so the amendments are unnecessary.

Similarly, new clause 14, tabled by my hon. Friend the Member for Dartford (Jim Dickson), would prohibit the supply of all cigarette filters or cigarettes containing filters, whether they contain plastic or not. Ultimately we believe that the best way to tackle filters is through the reduction of smoking rates. On bundles of tobacco products, the Bill gives the Government the powers to regulate retail packaging of tobacco products and devices, herbal smoking products and cigarette papers, as well as vaping and nicotine products. In addition, the Bill already gives the Government powers to regulate how products are packaged together in bundles, so amendments 86 and 87, also tabled by my hon. Friend, are not necessary.

Amendments 46, 90 and 91 and new clauses 8 to 10 and 15 would all undermine our promise to the electorate to stop vapes being advertised to children. We have a clear mandate, with 74% of adults in Great Britain supportive of a ban, and we will not create any exemptions that could undermine this. On amendment 90 and new clause 15, let me reassure the shadow Secretary of State and my hon. Friend the Member for Newcastle upon Tyne East and Wallsend (Mary Glindon) that the Government are not prohibiting the promotion of vapes in general as a smoking cessation tool.

Let me reassure my hon. Friends the Members for Newcastle upon Tyne East and Wallsend and for Suffolk Coastal (Jenny Riddell-Carpenter) that the Bill already provides the Government with powers to limit the amount of nicotine in a nicotine pouch, to regulate vaping products in such a way that would prohibit the sale of high puff count vaping devices, including setting tank capacity limits for devices where multiple refill tanks are attached, and to ban any other ingredient that may be harmful. The Government believe that these measures are more appropriate for secondary legislation due to the technical details that need to be captured, rather than in primary legislation as new clauses 4 and 21 would require.

On amendment 37, tabled by my hon. Friend the Member for Newcastle upon Tyne East and Wallsend, we recognise that vape flavours are a really important consideration for adult smokers seeking to quit smoking, but we also know that sweet or fruity flavours are the main flavours that appeal to children and that certain flavours and ingredients can be particularly harmful to health. We have been clear that we will carefully consider our future regulations so that we get the balance right, and this is subject to a statutory duty to consult. Similarly, I reassure my hon. Friend that amendment 88 is unnecessary. We will honour the long-established principles of good consultation when consulting on regulations under part 5 of the Bill, including in relation to who is consulted.

On new clauses 6 and 7, while the Government are committed to protecting children from the risk of harms through addiction, our approach across all products in the Bill is for age to be verified at the point of sale, not at the point of use. Mandating any age-gating technology for vapes would create harsher restrictions on vaping than smoking. That could make vapes less accessible and attractive to adult smokers wishing to quit and use vapes as a smoking cessation tool.

I recognise the concerns of the hon. Member for Harrow East (Bob Blackman) about online sales. However, it would not be proportionate to ban all online sales because that would impact on those retailers seeking to operate within the law.

As was discussed in Committee, going back to the issue of wider enforcement, new clause 18 and amendment 89 do not reflect the complex processes required to develop the licensing scheme in England and Wales. Although I am sympathetic to the shadow Secretary of State’s aims, rushing to publish draft regulations within two months of Royal Assent would risk creating flawed policy.

I pay tribute to colleagues in the Scottish Government, Welsh Government and the Northern Ireland Executive. This UK-wide Bill has been developed in partnership with them, and I thank them for their support. Our manifesto committed to resetting our relationship with the devolved Governments, and this Bill is a great success in demonstrating collaboration across Governments in improving the health of the nation.

National Cancer Plan

Caroline Dinenage Excerpts

Tuesday 4th February 2025 Commons Chamber

[Andrew Gwynne]

I am very grateful to my hon. Friend for all the work that she has done on ovarian cancer since becoming an MP. She knows—the rest of the House might not—that I lost my mum to ovarian cancer. I was 19 when my mum died and she was only 50—my age today. She had a late diagnosis. They basically opened her up to perform a hysterectomy and the cancer had spread all the way through her body. They sewed her back up and she died at the end of a hospital ward two days later in pain and agony. Having awareness of those symptoms is so important. My mum was fobbed off by her GP, because she worked in a shop and lifted boxes. She had a bad back and was bloated and so on. The GP said it was down to her work, rather than erring on the side of caution and getting her checked out. We must ensure that women today are heard by GPs and, more importantly, that we err on the side of caution and get people on to treatment.

[Dame Caroline Dinenage (Gosport) (Con)]

The Minister is absolutely right to focus on this. I warmly welcome the reinstatement of the children and young people’s cancer taskforce. I take this opportunity to pay tribute to my constituent Charlotte Fairall, who was pivotal in the work to bring the taskforce together in the first place. Charlotte’s daughter Sophie died of rhabdomyosarcoma when she was just 10 years old. I know the Minister met Charlotte to discuss this issue. Unfortunately, Sophie is not alone—around 500 children and young people die of cancer every year in the UK. It is the biggest cause of death by illness of children under the age of 14. Sophie had a wish list of things that she wanted to achieve before she died, including cooking with Gordon Ramsay and wearing high-heeled shoes, but she also wanted to meaningfully change the way we detect, treat and care for children with cancer. Does the Minister agree that the taskforce is a great step in that direction?

[Andrew Gwynne]

It absolutely is, and I thank the hon. Lady for agreeing to co-chair the re-formed taskforce. I know that she cares passionately about this issue, and it was lovely to meet Charlotte some time before Christmas.

Cancer is terrible, and cancer affecting children even more so. As the hon. Lady knows, we paused the taskforce because the general election got in the way. We wanted to carry out a real-time stocktake to establish whether we needed all these different taskforces, but, along with Charlotte, she convinced me, and convinced the Secretary of State, that the work of this taskforce will be crucial to informing our national cancer plan, and I wish her all the best in securing the outcomes that both she and I want to see.

NHS: Independent Investigation

Caroline Dinenage Excerpts

Thursday 12th September 2024 Commons Chamber

[Wes Streeting]

For all the innovations that modern technology will bring—the revolution in big data AI, machine learning and medical advances that we will see very soon but can scarcely imagine today—health and social care will always be fundamentally a people-based service. If you do not value your people, you lose them and end up in the appalling situation that we are in today. We have invested so much money and time in training people who imagined a long future for themselves in the NHS but who, because of the reality to which they were subjected by the previous Government, are now packing up and moving into different careers—or to other continents. We are determined not just to recruit the great staff we need, but to value and retain the brilliant staff we already have.

[Dame Caroline Dinenage (Gosport) (Con)]

The Secretary of State will know that cancer is the biggest cause of death by illness for children under 14 in the UK, and that this is Childhood Cancer Awareness Month. He will not know that it is also the third anniversary of the death of my constituent Sophie Fairall, who was 10 years old. With Sophie’s mum Charlotte, I have been campaigning for the past three years for the children and young people cancer taskforce to be set up. The taskforce was set up at the beginning of this year with the stated aim of meaningfully changing detection, treatment and care for children with cancer. I have listened carefully to the Secretary of State and have heard him passionately set out that he wants to focus on prevention and early intervention, yet this month we learned that he is pausing the taskforce. Parents of children with cancer are deeply disturbed by that announcement, as am I. Can the Secretary of State set out why it was made?

[Wes Streeting]

Absolutely. I thank the hon. Member for the way she put her question. I send my deepest condolences to Sophie’s family on what will inevitably be a difficult day—I suspect just the latest of many difficult days—on the imaginable pain, grief and loss that they have suffered. I thank the hon. Member for her work over many years campaigning on children’s cancer in this House on behalf of her constituents and so many other families affected by young cancer.

The pause is because we are looking at the breadth of the work of the Department to make sure that we have the right vehicles to deliver the outcomes that we want. That is why we have paused rather than cancelled, slammed or criticised the work that she was doing. I would be delighted to meet her to talk about the genesis of the taskforce and how we can take forward the outcomes that she wants to see. What we are trying to avoid is a plethora of taskforces, and the risk that there has sometimes been—this is not a party political point, because this spans successive Governments—of taskforces being an alternative for action. I know that she wants action, so let us meet and see what we can do together.

Glaucoma and Community Optometry

Caroline Dinenage Excerpts

Tuesday 30th April 2024 Westminster Hall

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

I want to place on the record the fact that a month ago I made my first visit to Belfast. I had an incredible time meeting Members of the Assembly at Stormont, and going to Harland & Wolff, around Belfast and to an inclusive school. It is a remarkable place, and I just wanted to add, as the hon. Gentleman is putting on the record that everyone else has been to Northern Ireland, that so have I—although I know that is not the subject of our discussion, Dame Caroline.

[Dame Caroline Dinenage (in the Chair)]

Order. I gently remind Members that, charming as it is to hear about Northern Ireland—we are all wildly in favour of going there at every available opportunity—this is a debate on glaucoma.

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[Andrew Stephenson]

NHS England is looking at a range of different interventions across the country. One of the benefits we have across England, and of course across the United Kingdom, is that we can try different things, such as models of delivery, in different parts of the United Kingdom and learn lessons from one another.

The current strategy pursued by the NHS is to look at different programmes across England and evaluate them to see what delivers the best outcomes for patients. That will help us to improve access for patients and deliver quality treatment. We hope that that evaluation will enable us to suggest best practice. It will still be up to ICBs to commission services—we believe they should be commissioned locally—but we hope that by providing an evidence base for them they can take decisions in the best interests of their local communities. To address the point made by the shadow Minister, that will address the growing demand for services. We recognise the fact that there will be more demand in the years to come. It will also help to address some of the backlogs with which we have struggled since the pandemic.

I hope I have said a few things to convince the hon. Member for Strangford that, while we still have much to learn from Northern Ireland, the Government take glaucoma extremely seriously. Community optometry is helping us manage the flow of glaucoma patients and it is already deployed effectively in many areas across the country to support patients.

We should be under no illusion about how many people watch Parliamentlive.tv. I think it was Stanley Baldwin who once said that the best way to keep a state secret was to announce it on the Floor of the House of Commons. Nevertheless, I wish to end with an appeal to anyone watching this debate at home: remember to take an eye test and please check the NHS website to see whether you are eligible for help. In preparing for today’s debate, I decided to do just that and I will be having my eyes tested tomorrow morning.

[Dame Caroline Dinenage (in the Chair)]

That is good to know; thank you very much. I call Jim Shannon to wind up the debate.

[Jim Shannon]

I thank the Minister. That appeal was a wonderful way to end this debate. I began the debate today by asking that we move towards measures to getting more people tested. The Minister has just done that. He has thrown out a challenge to everyone across this great United Kingdom of Great Britain and Northern Ireland, to do just that.

My hon. Friend the Member for East Londonderry (Mr Campbell) is well aware, as I am, of the merits of what we do in Northern Ireland, of the investment that optometrists are making personally and the need to work together. I am encouraged by the helpful contributions of the Minister, the shadow Minister and my hon. Friend.

The hon. Member for Denton and Reddish (Andrew Gwynne) referred to the fact that routine glaucoma testing can save eyesight. We all know that, and that is the purpose of the debate. We need more people to take the test—that is the purpose of the debate. The response from the Minister outlined a plan. I loved the term the hon. Member for Denton and Reddish used when he referred to turbocharging access to ophthalmology services. Wow! That is exactly what we need: a turbocharger. The Minister, in his response, turbocharged the challenge of eye tests and optometry.

The hon. Member for Denton and Reddish also referred to Labour’s commitment to making eye care a priority, which I welcome. I think that is where we are, and that that will follow hard on what the Minister and the Government are doing. The hon. Gentleman also referred to the 6,000 opticians on the high street with whom we can have a better partnership, and he stated that inaction was not an option—how true that is. He said that it was important to ensure there was not a postcode lottery, and he said that Labour would act.

The Minister always tries to be helpful, positive and proactive in his responses. That is what I like in any Minister, and it is what I particularly like about this Minister. It is helpful to have something to be encouraged by. The Minister has grasped the modus operandi of the debate, and why it is important, even though the subject is not in his portfolio. He referred to the need for people to have an eye test every two years, and said that the Government were working with high street opticians to ensure ICB involvement. He also said that the Government were pushing to increase the number of ICBs engaged with that. He said that the pandemic had created some problems, but also referred to an increase in cataract surgery. I think that is positive. Another positive that is sometimes forgotten, to which the Minister referred, is research. Well done, Minister and well done to the Government.

The Minister referred to £5 million of pioneering technology from the United Kingdom. We lead, across the world, in relation to that. He also referred to a new model within the NHS: proactive, progressive ICB best practices.

Today, we have been encouraged by the Minister. We are very pleased with his response. I can tell people who watch this debate on Parliamentlive.tv or who read Hansard—people will get copies from me in my constituency —and want to know what we are doing that we do not need to do anything really expensive. We just need to be proactive.

I look forward to the implementation of the plan to which the Minister referred, and I very much welcome the turbocharged priority that the shadow Minister and his party are prepared to give to the issue. I thank you, Dame Caroline, as always, for your chairship. You make so much of these debates and we appreciate that.

[Dame Caroline Dinenage (in the Chair)]

Thank you very much.

Question put and agreed to.

Resolved,

That this House has considered glaucoma and community optometry.

Health Services: Cross-border Co-operation

Caroline Dinenage Excerpts

Tuesday 16th April 2024 Westminster Hall

[Dame Caroline Dinenage (in the Chair)]

I will call Virginia Crosbie to move the motion and then I will call the Minister to respond. As is the convention for 30-minute debates, there will not be an opportunity for the Member in charge to wind up, or indeed for anyone else to make a speech, but there will potentially be opportunities to intervene.

[Virginia Crosbie (Ynys Môn) (Con)]

I beg to move,

That this House has considered cross-border cooperation on health services.

It is an honour to have you chairing this important debate on cross-border co-operation on the health service, Dame Caroline, and I thank you for the opportunity to hold it.

My constituents in Ynys Môn, like those of my colleagues here today, are served by the devolved Welsh NHS, which is managed and funded by the Welsh Government in Cardiff. Despite health having been devolved for 25 years, around a third of my most serious casework is for my constituents who are suffering, or perhaps even dying, because of failures in our local health board. I hear from patients, families and even members of staff who are deeply concerned about Betsi Cadwaladr University Health Board—BCUHB for short—and the effect that its failings are having on the people of north Wales. That is why my colleagues and I want the UK Government to help find a solution and why we desperately need the following: much better co-operation across borders on our health services; data that allows the direct comparison of performance across all health boards in the UK, regardless of whether they are devolved; a recognition that the UK Government have a moral, and arguably a legal, duty to take action where the wellbeing of their citizens is compromised; and a willingness to act on that duty where necessary.

I can best explain why we are so concerned by sharing the issues we face in north Wales. BCUHB is by far the largest health board in Wales; with a budget of £1.9 billion, it is responsible for a quarter of the Welsh population—more than 700,000 people spread across a huge area roughly four times the size of Greater London. BCUHB is currently in Welsh Government special measures for not the first but the second time; it has spent all of the last six years in special measures. Despite that, its performance seems to be getting worse, not better. It has been called “dysfunctional”, “chaotic” and a “basket case”. In February 2023, the Welsh Health Minister sacked its entire board. An audit of its 2021-22 accounts found £122 million unaccounted for, with senior executives accused of deliberately falsifying entries. It is now on its eighth chief executive in 11 years. All that is despite a devolution settlement that funds the Welsh Government with £1.20 per person for every £1 we spend here in England.

It is difficult to relate just how bad some of the stories I hear are: people discharged from hospital sicker than when they went in; hours spent waiting for ambulances, and hours spent waiting in ambulances outside A&E; errors in patient records; appointments lost; significant failures in the provision of medication; palliative patients dying in hospital because fast-tracking them home would take weeks; and medical appointments cancelled and rearranged for hospitals 60 miles away.

Building an NHS Fit for the Future

Caroline Dinenage Excerpts

Monday 13th November 2023 Commons Chamber

[Dame Caroline Dinenage (Gosport) (Con)]

I am grateful for the opportunity to talk about the NHS and our nation’s health and wellbeing. I welcome the Minister’s commitment to prevention and early detection of disease. For the long-term stability and affordability of our NHS, it is vital that there continues to be a laser-like focus on diagnostic centres and more medical staff. The stronger role for pharmacists is very welcome, but there is still so much more that we need to do to provide adequate GP provision and dentistry. That is acutely felt in my Gosport constituency.

I have spoken many times in this House about childhood cancer, which is the biggest killer by disease of children under the age of 14 in the UK. Early detection is more crucial here than almost anywhere, yet over 50% of children’s cancers are missed in primary care and picked up at A&E, meaning longer, harsher and more invasive treatment, along with a long-term impact on the children themselves, their families and loved ones, and the NHS as well. There are no long-term impact studies in the UK, but studies by St. Jude Children’s Research Hospital in the United States reveal that everyone who has undergone treatment for cancer as a child will experience some long-term health implications in adulthood, from infertility to blindness.

The title of today’s debate is “Building an NHS Fit for the Future”. A future-focused NHS means smarter, more efficient and more appropriate treatment, as well as earlier detection and, ultimately, prevention. We already lead the world in genome sequencing and we should be harnessing its power; that means a childhood cancer mission. I must say that found it disappointing that such a vital piece of the puzzle was missing from the King’s Speech. I look forward to hearing the new Health Secretary talking more about this in the future.

Prevention, as much as cure, is the key to managing the health of the nation, and I am glad to see the tobacco and vapes Bill in the Government’s legislative programme. Smoking is the biggest entirely preventable cause of death and disease. Although vaping is an important tool for quitting smoking, it is absolutely right that more is done to reduce the appeal and availability of vapes to our young people.

As Chair of the Culture, Media and Sport Committee, I have seen and heard about the huge value that grassroots sports have to the health and wellbeing of people—young and old—across the country, so I was pleased to see the guidance from the Government earlier this year on preventing and dealing with concussion in grassroots sport. The Committee’s work in this area, alongside the work of the all-party parliamentary group on acquired brain injury, has shown that signs and risks of concussion, including possible links to dementia, are not yet well enough understood. It is right that the focus is on encouraging everyone in sport—players, parents, coaches, teachers and administrators—to make sure they can recognise and act on concussion, so I look forward to hearing more about what the Government are going to do on that vital issue.

I cannot move on without paying tribute to Sir Bobby Charlton, whose memorial service was today. He was a giant among British sportsmen and will be sorely missed by our football fraternity.

At the grassroots and professionally, women’s sport is thriving in the UK. The Culture, Media and Sport Committee and the Women and Equalities Committee are both considering what more can be done to support women in sport. It is such an important component to women and girls’ physical and mental health and wellbeing. It is crucial to make sure that women have access to the facilities that they need—whether that is schools providing the opportunities to play a range of sports, local clubs providing women’s changing rooms, or training schedules that are not based principally on the convenience of male players. It is also about national institutions finally waking up to the value of women’s sports and ending the disgraceful situation where the England women’s cricket team have never played a test match at Lord’s, the so-called home of cricket.

I look forward to the Committee completing our inquiry in the new year, bringing recommendations from the Government and sporting bodies to improve the provision of sport for women, and I look forward in the new year to revisiting the Committee’s work on discrimination in cricket as the England and Wales Cricket Board begins to implement the recommendations of the Independent Commission on Equity in Cricket.

Looking more widely at sport, it is fair to say that English football has been in the grip of an existential crisis. The failed European Super League, the collapse of Bury FC and the impact of the pandemic called into question the sustainability of our national game. The fan-led review, chaired by my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch), and the Government’s White Paper were both important steps to reform. The promise of a football governance Bill in the King’s Speech is the biggest step in the right direction.

Earlier this year, my Committee published our report on football governance. We want to see the Government getting on with setting up the independent regulator, and for it to be ready to step in to prevent the collapse of more clubs and to ensure fair funding and revenue sharing throughout the football pyramid. We will wait to see the detail of the Bill, and I hope that the Department will be able to introduce it at the earliest possible opportunity.

I also strongly welcome the inclusion of the Media Bill in the King’s Speech and the decision to introduce it so early in this Session. The Culture, Media and Sport Committee conducted pre-legislative scrutiny of the Bill earlier this year, and our key recommendation in both our report on the radio measures and our report on the Bill overall was that this legislation needs to be enacted, because it is vital to protecting the long-term health of the media in this country.

I especially welcome the fact that the Government have listened to the Committee and strengthened the legislation to ensure that specific genres of content are still relevant to the public service remit. I welcome, too, that the Government and Channel 4 have worked together to ensure that the channel is sustainable, while also protecting independent content producers. The Bill balances the ability to adapt to future changes in TV and radio, while ensuring that viewers and listeners have necessary safeguards in place, and I look forward to seeing that Bill progress.

Much of our country’s culture, media and sport does not need legislation to flourish. They are remarkably resilient, imaginative and innovative sectors, but I am glad that the Government continue to act where it is necessary. I am pleased that the Pedicabs (London) Bill will tackle one of the antisocial rip-off behaviours that is targeted at visitors to London, but there is much more that the Government could be doing to support our tourist industry. Tomorrow, the Culture, Media and Sport Committee will be taking evidence on what more can be done, whether that is through restoring tax-free shopping, improving our visa system or growing investment. I look forward to continuing to press for more action wherever it is needed.

HIV Action Plan Annual Update 2022-23

Caroline Dinenage Excerpts

Tuesday 18th July 2023 Westminster Hall

[Several hon. Members rose—]

[Dame Caroline Dinenage (in the Chair)]

I plan to call the Front Benchers at 5.13 pm, to be precise. I do not think there is any need to impose a time limit at the moment, but we are looking at roughly six and a half minutes per Member, if everybody could self-edit.

--- Later in debate ---

[Nickie Aiken (Cities of London and Westminster) (Con)]

It is a pleasure to serve under your chairmanship, Dame Caroline. I am glad to have the opportunity to contribute to this debate on the Government’s annual update on their HIV action plan. I thank my hon. Friend the Member for West Bromwich East (Nicola Richards) for securing it.

The annual update makes it clear that progress has been made. The plan has set the stage for a transformative approach to prevention, testing, treatment and support but, as ever, there is still room for improvement, and the annual report highlights several key opportunities. First, there is scope for improving access to the HIV prevention drug PrEP, HIV testing and care for people living with HIV. As the Member of Parliament for Cities of London and Westminster, I know how important that is. Reports show that Westminster has among the highest HIV prevalence in the country: eight 15 to 59-year-olds per 1,000 are living with HIV. The action plan will change those statistics, and the Government’s investment in opt-out HIV testing and emergency departments in areas classed by the UK Health Security Agency as having a very high HIV prevalence should be highly commended.

As a result of additional funding, in St Mary’s Hospital in my constituency, three people were newly diagnosed with HIV, seven with hepatitis B and 14 with hepatitis C in the first 10 months of the Government’s programme. Those figures from the first year of the programme have been broken down by the Terrence Higgins Trust. There have been more than 2,000 positive diagnoses across London, Blackpool, Brighton and Manchester.

Now that we are in the second year of the programme, it is only right that we consider expanding opt-out testing. I understand that NHS England has costed and prepared a plan for expanding HIV testing to 41 additional A&E units in areas with a high prevalence of HIV, and I hope that will go ahead. Modelling by the Terrence Higgins Trust shows that such an expansion has serious merit in supporting the Government’s aims and ambitions.

Also important in supporting the aims of the action plan is increasing equal access to PrEP. That revolutionary drug has changed so many lives—including for many of my friends. I am proud that my constituency is home to the outstanding 56 Dean Street—the sexual health clinic that pioneered PrEP in England—which is recognised internationally for its innovation, particularly in regard to its engagement with London’s higher-risk communities. More than that, it has been a haven for so many of the LGBT+ community over the decades. I pay tribute to the outstanding staff who work there today and have worked there in the past. They have always operated without prejudice, even in the face of systemic discrimination.

Nearly 60% of people wait more than 12 weeks for their PrEP. I am glad that the annual report acknowledges the publication of the first national PrEP monitoring and evaluation framework, but there is more to do. The framework is clear in showing that there are inequalities in who is able to access PrEP; we really need to push against that. The HIV action plan includes a commitment to develop a plan to expand access to PrEP through sexual health services, but there is a case to be made to have access through GP surgeries in particular, as well as pharmacies. We need to ensure equal access to PrEP if we are to meet our 2030 commitments.

In the remaining time I have left, I would like to pay tribute to the work of the Terrence Higgins Trust. From its policy to its fundraising efforts, it is second to none in its field. In fact, I have been to visit its brilliant team in Boutique, the only Terrence Higgins Trust charity shop in the UK, which happens to be based in Pimlico in my constituency. The shop recently reached £1 million raised for charity, which is utterly amazing. I pay tribute to all the volunteers who work there. For nearly 15 years, the shop has helped the Terrence Higgins Trust to fund its hardship grant, services for people living with HIV and its campaign to end new cases by 2030. I pay huge tribute to both the shop and the Terrence Higgins Trust.

The Government’s HIV action plan is the first step in reinforcing the progress the UK has already achieved. Now Government, civil society organisations, healthcare providers, researchers and communities must continue to work together to address the global challenge. By combining our knowledge, resources and expertise, we can develop innovative solutions, advocate for policy change and create a sustainable impact that will shape the future of HIV prevention and treatment.

[Dame Caroline Dinenage (in the Chair)]

I thank all Members for keeping to time so beautifully. I call Andrew Gwynne.

National Carers Week

Caroline Dinenage Excerpts

Thursday 8th June 2023 Commons Chamber

[Dame Caroline Dinenage (Gosport) (Con)]

I beg to move,

That this House has considered National Carers Week and respite for carers.

I thank the Backbench Business Committee for allowing us time to debate in the House today the important issue of unpaid carers. I thank, in particular, those Members who supported my application for the debate, including the right hon. Members for Kingston and Surbiton (Ed Davey) and for Dwyfor Meirionnydd (Liz Saville Roberts), and the hon. Members for Bolton South East (Yasmin Qureshi), for Strangford (Jim Shannon), for Brighton, Pavilion (Caroline Lucas), for Motherwell and Wishaw (Marion Fellows) and for St Albans (Daisy Cooper).

As all hon. Members and those watching the debate will know, it is taking place during Carers Week, which is held each year to raise awareness of those caring unpaid for family and friends who are living with a disability or who are frail or unwell. It is led by Carers UK but supported by Age UK, Carers Trust, the Motor Neurone Disease Association, Oxfam GB, Rethink Mental Illness and the Lewy Body Society. I encourage everyone who does not already know to go and find out more about the brilliant work of all those organisations.

The latest census data from 2021 shows that millions of people—in fact, 5.7 million people across the UK—are currently providing some form of unpaid care for a friend or family member who, due to illness, disability, mental health or an addiction, cannot cope without their support. The majority of people providing that care are women. Indeed, many of us may be personally caring for someone, or will have someone in their family, or will know of friends or neighbours, who go to great lengths to support people they love. There are virtually no families untouched by this responsibility across the country.

I speak today as co-chair of the all-party parliamentary group on carers. I am a former Minister for care and had responsibility for unpaid carers when in Government. However, my first experience of this came when my mum was a carer for my grandmother, who was living with dementia. At the same time, I had just had my first baby—he is now 20. My mum was attempting to support me in bringing up a small baby and my grandmother who was living with dementia. She was part of the generation of sandwich carers we see across the UK, who are sacrificing their own health and wellbeing, their own relationships and their own profession to show such love and dedication for someone else.

We know that caring can be an incredibly profound experience. For many carers it is a very positive experience that enables them to build a very special bond with those they care for. In the vast majority of cases, it is driven simply by love. But we also know that it can take its toll on their own health and wellbeing. Caring can take such a different variety of forms. It can be anything from really intimate personal care to quite complex healthcare, right the way through to the emotional support of being a stable companion and providing encouragement to the person they care for. The care can be utterly lifechanging for those who receive it. One person said to me:

“The difference she makes to my life is unbelievable. She has given me back the freedom to actually go out and enjoy my life.”

However, we also know that caring can be extremely complex, and there is no denying that it can be exceptionally challenging as well. Indeed, too often the efforts that carers go to, to keep those they love safe and well, leaves people exhausted, burnt out and struggling to live a life beyond their caring responsibilities. As a result, many carers are extremely concerned and worried about the future. Beverly told me about her caring responsibilities and the impact they have on her life. She said:

“I am a full-time carer to my son who has Down’s syndrome and my husband who has Parkinson’s. By full time, I mean every hour of every day, day and night. I do it because I love them and I want them to have as good a life as possible. It is a never-ending round of jobs like cutting meals, making sure meds are taken, washing, appointments, making sure they are appropriately washed and dressed—and that is without having elderly parents to support. The sad thing is that you also forget to look after yourself.”

That is one of the biggest messages I want to get across today. Many carers like Beverly find that their relationships are impacted by their caring responsibilities because of a lack of support and recognition. That can lead to social isolation and mean that carers who are struggling to balance paid work and unpaid care have to leave the labour market or reduce their hours of work.

There are also significant financial costs associated with caring. Carers often use their own incomes and savings to pay for support services and care equipment for the people they care for. We also know that carers can face poorer health outcomes than non-carers, with a high proportion struggling with their own physical and mental health problems, and experiencing very low levels of wellbeing.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady for securing the debate. She is right that there are so many unpaid carers across the whole of the United Kingdom of Great Britain and Northern Ireland. My brother was involved in a motorbike accident some 19 years ago, and my mother, my wife and my son all look after him. Conservative estimates say that £162 billion per year is saved through unpaid care. That is just one example of the vital nature of carers. The hon. Lady refers to the impact on those who care: the pressures psychologically, financially, emotionally and physically. Does she agree that some consideration must be given by Government for respite care? I know how important that is to some of my constituents. I suspect she will confirm that when she replies to me, but I think something needs to be done there.

[Dame Caroline Dinenage]

The hon. Gentleman is absolutely right. Respite care comes up time and again as one of the big asks for unpaid carers. They want to carry on doing the role they are doing. They deeply love the people they are caring for. They take a huge amount of personal responsibility and pride with the care they are giving, but they need that little bit of support. Around the time of covid, in particular, we saw many, many unpaid carers going on for months, years even, without the ability for any kind of respite. The figure he quotes is crucial: £162 billion a year is the value that unpaid carers are saving our health and care system. That is an incredible amount of money. It is like a whole separate, second NHS, saving that amount of money. The huge pressures placed on the other NHS we have result in delays for unpaid carers in obtaining the primary and secondary healthcare appointments that they need. The record demand for our social care services means that carers are not getting the support that they need.

I want to spend a little time exploring some of those challenges in more detail. Other Members across the House will add their own voices. As I noted earlier, many carers are struggling with poor mental and physical health. According to Carers UK research, one in five carers says that their physical health is bad or very bad, 30% suffer from poor mental health and over a quarter say that they often or always feel lonely. Carers provide many hours of support for the people they care for, but very few are able to take a break from their caring. That results in tiredness and, in some cases, exhaustion and burnout. As the hon. Member for Strangford said, worryingly, 41% of carers have not taken a break from their caring role in the last year. A carer called Anton told me about the strain that caring is placing on him:

“It is hard, often draining and mentally and emotionally painful work, bordering on damaging. Due to my responsibilities and the amount I am depended on, I am often anxious, feel hopeless and depressed.”

Carers are not getting the support that they need from our health and social care systems, as both systems are under intense and increasing pressure. Many carers have experienced delays in accessing healthcare appointments and services. One fifth of carers who request a GP appointment have to wait more than a month to see a doctor, and over a third have had to wait more than a year for specialist treatments or assessment. That causes additional stress and anxiety, and results in many feeling isolated or forgotten about.

This year, only a quarter of carers said that they had undertaken a carer’s assessment in England—a statutory right under the Care Act 2014. Of those who received an assessment, many were concerned that it did not lead to any improvements in the support provided to them. Could the Minister outline what she is doing to ensure that those carer assessments are not only conducted but conducted properly and that the outcomes are delivered? In fact, 39% of carers said that they did not even know what a care assessment was—that is the severity of the problem. A carer called Trevor told me:

“I get no support whatsoever. It has taken nearly 4 years to get a carer’s assessment from the Local Authorities which is now imminent. I have no expectations whatsoever.”

What is the Minister doing to communicate with local authorities to make sure that those important carer’s assessments take place? Debbie contacted me to tell me:

“I’ve had no support whatsoever. Support seems to consist of ticking a box to say I’m a carer but nothing more.”

It is just not good enough.

I want briefly to touch on the financial impact that caring can have. The cost of living means that carers currently face unprecedented demands on their finances. Concerningly, more than half of carers say that they are extremely worried about managing their monthly costs. A quarter told Carers UK that they are cutting back on essentials such as food or heating, and over three quarters said that the rising cost of living is the main challenge that they will face in the coming year. Many have been desperately trying to find ways of saving money, but that can be difficult because, quite often, the people they are caring for need life-saving care equipment that requires energy, or they need to ensure that the person they are caring for is kept warm. David told me about the financial impact that caring was having on him:

“I have been a full-time carer for my wife for over 10 years, and I’ve found that the money I get doesn’t even cover energy bills. It’s a constant struggle: all unpaid carers want is enough money to pay our bills and still have something left over to buy things when we need to. We are saving the country a lot of money by doing what we do and some recognition would be appreciated.”

[Stephen Doughty (Cardiff South and Penarth) (Lab/Co-op)]

I thank the hon. Lady for bringing forward this crucial debate. The other day, I had the pleasure of visiting Tŷ Hafan, the children’s hospice of Wales, in my constituency. I heard many similar stories to those she is reporting, about how people are struggling with the cost of living, particularly if they are having to run expensive medical equipment, given the associated energy bills. It is brilliant that Tŷ Hafan provides not only crucial respite for families and those they support directly, but support and advice on the cost of living.

[Dame Caroline Dinenage]

That is absolutely right. The Government have spoken about a social tariff for energy, but identifying who the carers are and how they can access that support is vital.

Gary told me about the financial struggles he has because of caring:

“After giving up a reasonable salaried job to care for my wife, we fell into severe financial hardship and were resorting to food banks. When the cost of living crisis happened, it was so bad I had to take up part-time taxi driving, which takes me away from my care role, in order to survive, but I can only earn so much due to the limits imposed or lose the carer’s allowance.”

That is adding additional stress and complexity to his life.

Supporting carers to stay in or return to paid work is essential. We want to ensure that carers can live a life free from poverty in older age, but 75% of carers who are working alongside their caring responsibilities are worried about juggling work and care. Increasing numbers of employers are recognising the importance of supporting carers in the workplace, and it is vital that they maintain flexibility so that people can continue to do their incredible juggling acts.

Nicola told me that she had to give up her career as an embryologist to care for her daughter, who has Angelman syndrome. She said:

“We have no family support, no help from the council and my daughter is awake for hours in the middle of the night, which means that we are unable to sleep and are completely exhausted. The only income I now receive is carer’s allowance. We solely rely on my partner’s income, which covers our bills. We have already moved to a cheaper house, but it is still extortionate as we live in Surrey and my partner has to commute into London daily.”

Lucy, who cares for her disabled son, who has cerebral palsy, told me:

“I have had to give up my job as a company director as his needs and required medical operations means I cannot keep a job any longer. I have gone from having a £40k+ job and am now claiming carer’s allowance.”

Finally, more needs to be done to support and help carers to recognise themselves as carers. Many are not doing so, which means they are missing out on the support they need. Research that the charities involved with Carers Week released on Monday found that 73% of people in the UK who are providing or have provided unpaid care in their lifetime—roughly 19 million people—have not identified themselves as carers. Research also shows that half of all carers take over a year to recognise that they are in a caring role, with over a third taking over three years to recognise themselves as carers.

That is particularly pertinent to young carers, who may not know that they are carers. In many cases, their situation can be misinterpreted. Schools can perceive young carers to be bad students because they are not paying attention, when in many cases they are just extremely tired and stressed by their caring responsibilities. Schools need to go much further to identify young carers in their midst and to support them.

In cases where a young person is supporting a parent with mental ill health, there is a stigma attached and they do not want to tell their friends. I remember meeting one young gentleman at a carers’ festival that is run every year, which is a wonderful way of supporting young carers to live life like normal young people and enjoy themselves. He told me that his mother had made many attempts to take her own life and that, as a very young child, he had to get used to phoning 999 for the ambulance to take his mum away and save her. He never told his school about this because of the stigma attached to it; he felt deeply isolated and ashamed. We need to double down on our efforts to ensure we identify young carers in schools.

[Jim Shannon]

I thank the hon. Lady for giving way; she is very generous. Figures mentioned in the press last week indicated that some 25% of those who care have mental stress, depression and concerns themselves. She has outlined that from a young person’s point of view—what she says clearly illustrates the need for Government to grasp the role of carers and the impact that role has on them.

[Dame Caroline Dinenage]

The hon. Gentleman is absolutely right about the mental pressure put on carers because of the responsibilities they take on, but also because of the perceived lack of support or respite. It is important that we recognise that that can mount up and overwhelm people, and that they can experience burn-out and ill health.

I want to recognise the work of Governments across the UK and the range of actions they have taken to provide carers with more help and support. In England, the Government aim to support carers primarily through adult social care reform, but also provide support through the Better Care Fund. In the context of reform, I was pleased to note that there is a specific chapter on support for unpaid carers in the White Paper “People at the Heart of Care”, which states that the Government will

“build on the foundations of the carers action plan”

—which I published when I was Minister for Care—

“to set out a new strategic approach”.

I look forward to hearing more about that. Perhaps the Minister will give us further details about the timescales. I should also like to hear more about the £25 million investment that the Department of Health and Social Care has pledged to make in support of unpaid carers. I understand that the details will be announced shortly, but given that it is Carers Week, I should be grateful if the Minister could indulge us and give us a sneak preview of what might be coming up.

I should like now to think back, briefly, to the support that the Government provided to help carers through the pandemic. A number of measures were introduced, including a highly effective identification programme. The Government worked with local authorities, GPs and local carers’ organisations to identify new carers and ask them to come forward for the covid vaccine, for which they were prioritised thanks to fantastic lobbying work by Carers UK and the Minister—who was also the Minister at that time, although there have been a few bumps in the road since then. It is great to see her back in her place. The programme demonstrated an ability to identify carers that does not seem to be moving on into everyday life, and I should like to see that continue. The Government also relaxed some of the rules applying to claims for carer’s allowance, and I should like to see that continue as well.

Further significant steps have been taken in the last year. The Carer’s Leave Act 2023, which gained Royal Assent only last month, will provide dedicated employment rights for carers for the first time. I congratulate the hon. Member for North East Fife (Wendy Chamberlain), my hon. Friend, on her work in securing the passage of her private Member’s Bill, because the Act is a game-changer.

Despite those successes, however, I believe that much more needs to be done. Carers have contacted me to let me know about key areas in which they wanted more support. If the House will indulge me for a little longer, I will run through some quotations. Bryony told me that she wanted carers to be given more financial support:

“Carer’s Allowance should be higher to reflect the impact and reasons it is claimed. I didn’t choose not to work; I didn’t choose to lose a well-paid career. I will always choose my son, but the financial burden is destroying families.”

Tracy talked about the need to be able to take a break from caring:

“Respite is essential. If carers reach burnout, the person they care for could end up in care sooner. If you support the carer and they feel valued without having to worry about finances, they would be less stressed and able to cope day to day.”

Rebecca called for greater recognition for carers:

“I feel we are overlooked by all the groups in society. It makes you feel bottom of the pile in everyone's priorities.”

Sarah said that she needed better signposting to the support available to help carers with their responsibilities:

“It would be fantastic if there was a directory of support and benefits that are appropriate as soon as a diagnosis is recognised. For years we didn’t claim Personal Independence Payment and Disability Living Allowance for our daughter because we didn't know about it. For over ten years I didn’t know I was entitled to Carer’s Allowance. I also didn’t know for the last three years my daughter was entitled to elements of Universal Credit. This would have helped us as a family and taken the stress and pressure off for myself to be able to ‘fight’ in other areas of my daughter’s life.”

The testimonies that I have shared are my reason for being here today, and the reason I support the call from the charities that are backing Carers Week for the Government to establish a cross-departmental ministerial group to focus on the help that carers need. I was delighted to learn earlier this week of the Minister’s commitment to establishing just such a group. Carers’ issues do not fall solely within the remit of the Department of Health and Social Care; they are everywhere, involving everything from energy prices to the circumstances of the young carers we have spoken about, carers in employment and carers’ benefits. The establishment of the ministerial group will ensure that carers’ needs are understood and responded to at the highest level of Government, and will improve ministerial oversight of policies and measures that support unpaid carers.

It is my hope, and that of the all-party parliamentary group on carers, that this work will lead to the development of a full and financially supported national carers strategy. Such a strategy would help to ensure that we went further in respect of a range of measures to help unpaid carers, including improved data sharing to ensure that carers are identified and support and entitlements are not missed; better support for and identification of carers at key transition points—for example, when people move from children’s to adult’s services; more funding for social care to ensure that unpaid carers are given the support that they need once they have been identified; and a review of carers’ financial support and benefits, including carer’s allowance, to ensure that they are fit for purpose and prevent financial hardship.

I want to encourage all those in the House today, and those watching the debate, to involve themselves in the activities taking place during Carers Week, and to reach out to the thousands of people in each of our communities who do so much to support the people whom they love. I also want to encourage all Members who have not already done so to join the all-party parliamentary group—I hope you do not mind the quick advertisement, Madam Deputy Speaker—which I co-chair with Baroness Pitkeathley. We have some exciting plans for the coming year.

Let me end by saying what I say every year. While Carers Week is an important opportunity to recognise, for one week in the year, the extraordinary lengths to which carers go, we must also recognise that they go to those lengths every single day. Every week should be Carers Week. Day in day out, year in year out, carers work to ensure that their loved ones are cared for, are safe, and lead the best lives that they can. That is something that happens 52 weeks of the year.

--- Later in debate ---

[Dame Caroline Dinenage]

I reiterate my thanks to the Backbench Business Committee for allowing us to have this debate today. I thank both the Minister and the Front-Bench spokesman, the hon. Member for Leicester West (Liz Kendall), for showing that they both understand and care about this issue. I also thank all the Members who have taken part: the hon. Members for Worsley and Eccles South (Barbara Keeley), for North East Fife (Wendy Chamberlain), for Ceredigion (Ben Lake) and for Motherwell and Wishaw (Marion Fellows), the right hon. Member for Hayes and Harlington (John McDonnell), and my hon. Friend the Member for Cities of London and Westminster (Nickie Aiken).

Many Members shared their own personal experiences; I kicked off by talking about mine, when my mum cared for my grandmother who lived with dementia. I think it is only now that I am probably at a similar age to my mum in that caring role that I fully understand what she was going through and the toll that it would have taken on her own wellbeing. I put on record today—because I have never had the opportunity to do so—my thanks to her, and to the 7,000 carers in my constituency of Gosport and the millions across the UK. They deserve our thanks.

In many cases, what those carers do is so invisible. I know that they do not do it for thanks—they do it because they love the people who they care for—but that does not mean that we should take it for granted. It means that we need to recognise them and value them, and to put our money where our mouth is when we do that. It means that we need to provide them with support, funding and respite, and with everything they need to continue doing their role, because it is thankless and hard. I know that they probably would not have it any other way, but that does not mean that it should be done for free. The final thing I will say to the Minister today is that we need a national carers strategy to bring together all that good work, and to demonstrate to carers that we do care.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I know that the young people from Balby Central Primary Academy will have enjoyed the contributions made about carers, particularly young carers.

Question put and agreed to.

Resolved,

That this House has considered National Carers Week and respite for carers.

Healthcare Services: Carshalton and Wallington

Caroline Dinenage Excerpts

Tuesday 23rd May 2023 Westminster Hall

[Dame Caroline Dinenage (in the Chair)]

I will call Elliot Colburn to move the motion and then I will call the Minister to respond. There will not be an opportunity for the Member in charge to wind up, as is the convention for 30-minute debates.

[Elliot Colburn (Carshalton and Wallington) (Con)]

I beg to move,

That this House has considered healthcare services in Carshalton and Wallington constituency.

It is a pleasure to serve under your chairmanship, Dame Caroline. I am grateful to the Speaker’s Office for granting the debate to talk about the important issues facing the NHS and patients living in my constituency. This is an opportunity not only to raise the good work being done by our local NHS staff but to focus on three or four particular issues. I thank the Minister and the Department of Health and Social Care for their continued engagement with me over the course of the past few years. They must be getting sick of my name coming up on their phones, but they have been gracious with their time and I am grateful to them for that.

One of the most pressing issues facing our local healthcare in Carshalton and Wallington concerns our local hospital St Helier. I will not dwell too long on what it means to me, as I have said this before in other contributions, but it was the hospital that I and most of my family were born in. It saved a number of my family members’ lives and not too long ago it saved my life as well, so I have a great sense of personal loyalty to this hospital. The staff do an absolutely incredible job, and they are doing it under very difficult circumstances because the hospital is incredibly old. It is older than the NHS itself, and that is starting to show.

The hospital suffers from more than just outdated aesthetics; the state of disrepair is showing, and that is evident to anyone who has to visit St Helier. It has been the subject of numerous news articles and television exposés in recent months. The BBC, ITV and The Observer have all covered the state of disrepair at St Helier. There is a litany of problems including the sinking foundations, the faulty lifts—they are so old that the parts to repair them are no longer readily available—and the leaking roofs causing wards to be closed. My inbox regularly features emails from patients who have had to deal with the fallout and repercussions of these issues when visiting the hospital or waiting for treatment, alongside stories and reports from staff working at the hospital.

As I say, the staff are doing an incredibly good job in difficult circumstances, which is why I am pleased that the Government have recognised the good work that the Epsom and St Helier University Hospitals NHS Trust do, agreeing to a several hundred million pound investment to upgrade St Helier and build a new second hospital in the London Borough of Sutton. However, it is no secret that we have been waiting on the next stage for some time, so I would be grateful to hear from the Minister when we can expect an update on the next stages of the new hospital programme. I invite him and members of the Department of Health and Social Care team to come down to St Helier to see some of these issues for themselves.

To go into some more detail about what the new funding will provide, as well as improving St Helier and bringing it into the 21st century to provide modern medical care, it will provide a second hospital working in partnership with the Royal Marsden in Sutton to provide specialist emergency care for the sickest patients living in the borough. It will develop a partnership with the cancer hospital next door so that more cancer treatments can be provided in the London Borough of Sutton and patients do not have to be transferred to the Chelsea site, which can be difficult considering that the connectivity between my part of London and Chelsea is not fantastic.

So, this news is really exciting and the trust is raring to go; it really wants to get on with this work. I think that is why it has been so keen to highlight these issues in the press in the past couple of weeks. As I say, it is very keen to get going.

The pandemic has caused a delay to the timetable for this work; I completely understand that. However, we are still waiting for that all-important decision. I know I have secured assurances before that the plan is in development, but I hope today to relay the sense of anxiety felt by the staff and my constituents, who want to see progress made on the new hospital. It is the single biggest issue relating to local healthcare provision and it comes up time and time again locally. Having worked in the NHS locally myself, I know full well how much this development is needed, not just to ease demand on St Helier but to improve patient outcomes and to allow more specialist services and treatments to be carried out locally. That includes protecting services that were threatened under previous iterations of healthcare planning in our local area, which ranged from reducing services to closing St Helier all together.

This is the first time that the NHS has been able to come forward to the Government of the day and secure agreement to fully fund a plan that will not only protect services in the borough but improve them. And that includes making sure that accident and emergency services, critical care, acute medicine, emergency surgery, in-patient paediatrics and maternity services are all protected within the London Borough of Sutton and not transferred elsewhere. That is incredibly welcome news, but again we need to see progress.

What I like in particular about this plan is that it is not a Government reorganisation. This is not about bureaucrats sitting in the Department of Health and Social Care; this is about the Department agreeing to listen to what the NHS has said it needs to provide good-quality healthcare in the London Borough of Sutton. That is fantastic, but—again—we need to see the next steps.

In the time that I have left today, I will touch on a couple of other issues facing healthcare provision in Carshalton and Wallington, particularly access to local GPs and dentistry provision. We have some fantastic GP surgeries, made up of incredibly hard-working teams from the GPs themselves all the way through to the advisers, triage nurses, reception staff and administration staff. However, I am hearing from constituents that they are often struggling to get an in-person appointment. In particular, I hear from older constituents who struggle to navigate some of the new technology. I completely appreciate the need for that technology, but I would welcome anything that the Minister can say about encouraging GP surgeries to make it easier for those who find the digital world difficult to make an in-person appointment when they need one. I say that because many people have come to me and said that they had to take themselves off to the emergency department because they simply could not navigate the new online booking system that many GP surgeries now have.

I am sure that the Minister will agree that that is not what we want to see, because it puts an incredible strain on the healthcare system and especially emergency medicine, which is already under immense strain. Of course, primary care was one of the hardest hit sectors during the pandemic, and it is clear that there remains a backlog, both in terms of people with existing conditions and because people put off seeking help during the pandemic.

However, it was heartening, and the Government should be congratulated for this, to hear the recent announcement of £240 million specifically aimed at GP practices and getting patients appointments, so as to avoid the so-called “8 am scramble”. Nevertheless, the “8 am scramble” is still very much a thing for many of my constituents; it is still something that I hear about far too often. So, while I welcome the recent announcement, I would also welcome any update that the Minister can give me today about where he believes we are on recruiting new GPs and retaining those already in the sector and how we will deliver on the promises to our constituents that they can access a GP whenever they need to.

May I make a suggestion to help with that process? I was really pleased to hear the Prime Minister talking up the importance of community pharmacists and the role that they can play in the field by providing a range of services. It is incredibly welcome to see that recognition of pharmacies, as many think they went unthanked during the pandemic when their doors were left open while GPs were largely not seeing patients face to face. Pharmacists are doing an incredible job. I do not have time to go into all the issues now, but the Minister will know from our previous conversations about their immense struggles with how the reimbursement scheme for drugs is set up, and the fact that they cannot balance their treatment and advice for minor ailments with the time they have to dispense drugs, which is where the money is. I would welcome any update from the Minister, or a commitment to look in more depth at what role community pharmacies can play in supporting our local healthcare system.

Finally, I want to touch on dentistry. I spoke about it in a Westminster Hall debate not that long ago, but I want to reiterate a few key points. I am still getting horror stories from people who are turning to DIY solutions because they are struggling to access an NHS dentist. I have met local dentists in my consistency; they are clear that the way in which units of dental activity are set up in the dental contract, and the way in which they get reimbursed for their work, disincentivises them from doing more. Many say that it will be simply impossible to meet the targets this year to avoid money being clawed back, and they are worried about what effect that will have at the end of the financial year. I welcome the fact that £15 million has been put into dentistry to deal with the backlog, but there are long-standing, system-led issues. They span multiple decades and multiple Governments, but the pandemic has brought it all to a head. I would welcome any update from the Minister about what the Department is doing to reform the way in which the dental sector is set up, so that people can assess NHS dentists a lot more simply.

There is no magic wand that we can wave to solve everything overnight, but we can certainly do some things to get us there in the meantime. I hope that the Department will be able to let us know the next steps for the new hospital programme very soon, as that would be incredibly welcome. In addition, what assurances can the Minister give that existing maintenance problems will not be impacted by the new hospital programme, and that funding can be accessed to deal with some of those problems? Finally, what work is the Department doing to ensure access to GPs and NHS dentists? That will help us to improve on the most important thing that we all want to see—including the Government and the NHS—which is a better experience and outcomes for patients.

Oral Answers

Caroline Dinenage Excerpts

Tuesday 25th April 2023 Commons Chamber

[Steve Barclay]

There are two separate issues there: what we are doing for mental health in-patients and the point we just touched on about A&E. On mental health, it is good of the hon. Lady to give me the opportunity to remind the House of the significant increase in funding we are making to mental health. In the long-term plan, the former Prime Minister, my right hon. Friend the Member for Maidenhead (Mrs May), made a major strategic choice to invest more in mental health—an extra £2.3 billion per year. The hon. Lady is right to highlight the need for more capacity for mental health in-patients—[Interruption.] She asked a question on what we are doing on mental health. I am able to tell her that we are spending far more and investing far more in it, but it seems that she does not want to hear that answer.

[Dame Caroline Dinenage (Gosport) (Con)]

8. What steps his Department is taking to tackle health inequalities experienced by people with learning disabilities and autistic people.

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

Annual health checks for people with a learning disability are important in addressing the causes of avoidable deaths and avoidable morbidity and in improving health.

[Dame Caroline Dinenage]

It is eight years since the Transforming Care programme started, with a target of halving the number of people with a learning disability and autistic people in in-patient mental health settings by 2024, yet according to the Challenging Behaviour Foundation, the number of children in those settings has nearly doubled since then, the average length of stay is 5.4 years and, 12 years on from the Winterbourne View scandal, reports of appalling standards of care are still too frequent. Does the Minister agree that people with learning disabilities and autistic people deserve so much better?