GP Contract

Caroline Dinenage Excerpts

Monday 16th March 2026 Commons Chamber

[Stephen Kinnock]

My hon. Friend is absolutely right. The £292 million we have made available for advice and guidance is repurposed funding from the capacity and access improvement payments, so it is part of incentivising improved access and better patient outcomes. I can absolutely assure him that Jess’s rule remains fixed as a really important part of ensuring that it is three strikes and a referral. Whatever happens, that will be a top priority throughout the embedding of this contract.

[Dame Caroline Dinenage (Gosport) (Con)]

My constituents will welcome some of these headlines, such as clinically urgent cases being seen on the same day and more GPs, but what is being done to help accommodate them? Stubbington surgery in my constituency has excellent staff, delivering really great patient satisfaction, but they are hampered by really suboptimal buildings. They have expanded to fill every inch of available space, and the former cupboard under the stairs is now the phlebotomy room. They need a new site, but that is proving very difficult to find—not only the place, but the capital funding to deliver it. Can the Minister give them any hope from this announcement?

[Stephen Kinnock]

I am not familiar with the details of that specific case, but if the hon. Member writes to me, I will be more than happy to furnish her with a response. There is a real concern in some parts of the country, particularly where there have been new developments or populations moving into the area, that the GP practice does not have the required capacity. I am not sure whether that has happened in the case she refers to, but in such cases we also look to developers, including to section 106 and the community infrastructure levy as an opportunity. We have the primary care utilisation fund, and with neighbourhood health centre funding coming on stream, that may also be an opportunity. If she cares to write to me, I will furnish her with a response.

Funeral Directors: Regulation

Caroline Dinenage Excerpts

Monday 9th March 2026 Commons Chamber

[Dame Caroline Dinenage (Gosport) (Con)]

I am afraid that it will be a rather morbid debate this evening. We spend remarkably little time in our lives thinking about the practicalities of death, and it is probably part of human nature that we do not dwell too much on the inevitable future fate that awaits us. That means we put far too much implicit trust in those who take responsibility for our bodies, and in those of our loved ones when we die. We all assume that in death we will be treated with respect and care by professionals, but his evening I am afraid I will share some hard truths about the gruesome reality of death. I warn anyone watching that what I have to say will be graphic and distressing—there in no way around that.

Last year, Gosport residents and funeral directors Richard Elkin and Hayley Bell were found to have kept 46 bodies entrusted to their care in a completely inappropriate environment with an unregulated temperature. Describing entering the place to see his mother, one of my constituents said,

“the awful smell is something that will never leave me”.

Concerns about what was going on behind the doors of Elkin and Bell funeral directors were first raised by local residents, and then by the senior coroner at Queen Alexandra Hospital in Portsmouth. A body had been sent for a post-mortem that was

“laying in pools of bodily fluids”

and infested with maggots. The post-mortem also found that the deceased individual had suffered a spinal fracture after death.

After a Gosport borough council environmental health investigation raised concerns but took no further action, a few months later, simply because bills had not been paid, bailiffs attended the property, where two bodies were discovered, putrefying, in a room with bloodstained floors, water dripping from the ceiling, and broken windows. One of them was an elderly gentleman who had been left for 36 days. His body was found in a badly decomposed condition. It is too much of a cliché to compare this to a horror movie, because this is real life, or real death. When the family of one of the deceased was contacted, they were surprised, because they were under the impression that their loved one had already been cremated. The company had certainly taken payment for it.

As the Minister will know, it was completely legal for Elkin and Bell to keep dead bodies in a room like that. Elkin and Bell could only be brought to justice by some incredibly diligent work by Hampshire police, the Crown Prosecution Service, and John Price KC, using a variety of different offences including fraud, forgery and a piece of common law that dates back to Victorian times. The crime of preventing lawful and decent burial was dusted off from the days when it was used to convict grave robbers. That is instead of what should have been possible, which was sentencing the pair because they had wilfully neglected bodies in their care, and treated people’s loved ones as nothing more than money spinners.

The case highlighted that the funeral sector is nothing better than a wild west. When this was first brought to my attention, I was incredulous and horrified to learn that there is no regulation of any kind governing the sector. In fact, the only law that governs the funeral industry is around the financial transparency of funeral plans, and that was put in place after a Competitions and Markets Authority investigation in 2021. There are simply no mandatory qualifications, no accreditation, no licensing, no designated working practices or formal inspection and, crucially, no law to fall back on when things go wrong.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Member for Gosport (Dame Caroline Dinenage) for securing the debate. She is right to raise this issue. In Northern Ireland, we are fortunate to have a number of funeral directors of long standing who have impeccable reputations and integrity. However, funeral directors in Northern Ireland as a whole are not regulated either. Trade bodies such as the National Association of Funeral Directors and the National Society of Allied and Independent Funeral Directors require members to follow codes of practice, but many operate without that oversight, although those who provide prepaid funeral plans are regulated by the Financial Conduct Authority. Does the hon. Lady agree that more must be done to protect the general public and instil confidence in a regulated system? That is the way forward.

[Dame Caroline Dinenage]

The hon. Gentleman is absolutely right; better regulation is exactly what we are pushing for. In fact, everything needs to be better when it comes to the services governed by those organisations. As he says, the vast majority of funeral directors up and down this country work with incredible professionalism, great pride and integrity. They care deeply about what they do, and about the families and the individuals who they look after. One funeral technician told me that she does not see her work as a job—she sees it as a privilege. Such businesses and individuals have been silent pillars of our communities for centuries.

[Mark Sewards (Leeds South West and Morley) (Lab)]

The hon. Lady is making a powerful speech on an incredibly difficult topic. On behalf of my constituents, Cody and Liam Townend and Zoe Ward, who had horrific things happen to their babies’ bodies as a result of the lack of regulation, I spoke to both main professional bodies, which cover 80% of the sector, and lots of businesses, including the biggest player in the sector. They are united in thinking that regulation is the answer to restoring public trust in the funeral sector. Does she agree?

[Dame Caroline Dinenage]

The hon. Gentleman is absolutely right and I am about to make exactly that point. I am grateful to him for teeing it up so beautifully for me, because it takes only one business to do the wrong thing to erode trust, but unfortunately the case of Elkin and Bell is not the only case. There have been similar cases at Legacies Independent in Hull and Florrie’s Army in Leeds, which I think is the case he refers to, where deceased babies were staged in lifelike positions in a living room. These are unspeakable and unimaginable horrors. There have been other cases where bodies have been found in the most unimaginable condition, but no further action could be taken by the police or others because, simply and incredulously, those businesses have not actually broken any laws.

[Simon Hoare (North Dorset) (Con)]

The Minister will know that this is the second Adjournment debate on this issue that he has had to respond to in these last several months. Given the fact that most practitioners want to see regulation and the public want to see regulation, does my hon. Friend share my concern that the Government seem to be very slow on this issue—unless the Minister is going to give us some earth-shattering news this evening? This is too vital and important a set of circumstances just to leave to an unregulated marketplace in continuation; it needs regulation and it needs it quickly.

[Dame Caroline Dinenage]

I thank my hon. Friend for listening to me on this issue when he was the Justice Minister, when I first brought his attention to the situation. The points he makes are absolutely right. Over the past couple of years I have met the two voluntary trade bodies for the funeral sector, the National Society of Allied and Independent Funeral Directors and the National Association of Funeral Directors, as well as countless reputable funeral businesses and, crucially, many of the families impacted by these cases. I am so grateful to all of them for the time that they gave me, but as my hon. Friend said, every single one of them has stressed the need for the sector to be better regulated. I echo his calls for the Minister to give us some good news on that in a minute. That is important for everybody; otherwise, all those who carry out their work with such enormous care and diligence will have to operate under the shadow of suspicion. We owe it to them as much as anyone else to get this right.

The Minister knows that malpractice is not uncommon. Quite simply, taboos and sensitivities around death have effectively created a smokescreen for bad care. I am especially concerned about one area: the rise in direct cremations. For those who do not know what that is, it is where the loved ones do not see their deceased at any point in the journey. In their cases, there are absolutely no safeguards, checks or balances. The key thing here is that direct cremations have expanded hugely in the last few years, partly as a result of covid, from just 3% of funerals in 2019 to 20% in 2023.

We all see the charming adverts on the television in which an elderly gentleman explains with a smile that he has arranged for himself a direct cremation. He says, “I just didn’t want any fuss. It is much easier for my children.” We know that some very reputable and caring businesses do this process, but if the children knew what direct cremation might be, they would know that it might be little better than a conveyor belt. Mum and dad may be bundled into a van, maybe still in their soiled nightclothes, with a catheter attached and without any form of temperature controls. They could be taken to an unknown location and left for days before a slot becomes available at a crematorium. Who knows? In the hands of an unscrupulous company—who knows which ones they are?—it is all too possible for any human dignity and respect to become a completely unnecessary complication and expense in this process.

The only requirement before cremation takes place is that the body needs to be rid of objects such as pacemakers and other medical equipment. That was another part of my journey through understanding this process. This surgical procedure is carried out by embalmers, who also drain the body of blood in order to replace it with embalming fluid and remove the contents of the stomach. I was really shocked to learn that that can be performed without any accreditation or qualification whatsoever, and with no minimum standards of care for the body. That is not to say that there is not a form of qualification—the British Institute Of Embalmers provides professional training, and reputable companies such as Co-op funeral directors require a level 5 apprenticeship qualification for their embalmers—but it is not mandated to be able to practise.

In a nutshell, if the political career of any one of us in this room did not work out, we could walk out of here and set up our own funeral home—in our house, if we wanted to—with no special skills or accreditation and nobody inspecting our work. With that as the starting point, who can ever say for sure that their family member was treated with the appropriate professionalism? I have a question for the Minister; I know he has been hoping that I would get to this for some time. What can the Government do to restore trust in this sector? It is unfair on those who practise with enormous integrity that their professionalism is being called into question.

The Minister will know that the Fuller inquiry was set up in the wake of the crimes of the necrophiliac David Fuller, who abused 100 dead women and girls in a hospital mortuary in Kent. Those women were between the ages of nine and 90. In the wake of cases such as those in Hull and Gosport, Sir Jonathan Michael, who led the work into the Fuller report, was asked by the Government to prepare stage 2 of the report, which considers the wider funeral sector and those working in it. The report was published last July and includes some very sensible recommendations, including a statutory regulatory regime for funeral directors that invokes a licensing scheme, mandatory standards and regular inspection.

[Perran Moon (Camborne and Redruth) (Lab)]

This is a really important debate. While regulation of the funeral sector is fundamental, does the hon. Member agree that it must be proportionate? A small, independent home carer for 20 or 30 people a year cannot be expected to have to mirror the administrative burdens placed on a large, multi-site corporate provider. Does she agree that core standards must be universal, but related to the structure and scale of a business?

[Dame Caroline Dinenage]

I do not think that the size of a business is necessarily any reflection of its professionalism. We know that a large number of small, independent funeral services up and down the country work with incredible professionalism.

The hon. Gentleman is also right that nothing should be introduced that is unnecessarily bureaucratic or costly for those businesses.

The Fuller report says:

“It is important that real change is implemented to ensure the security and dignity of the deceased, and that a specific government department is given responsibility for overseeing this.”

Everybody who is involved in this sector recognises that there is a need for it to be properly regulated, inspected and overseen, so can the Minister set out clearly what his initial thoughts are on the recommendations of the Fuller report and when the Government will respond to them in full? When they do so, will they set out clearly what firm action will be taken, and when? We have waited so long, so when the Government respond, it must be with clarity, with purpose and—above all—with urgency.

[Tessa Munt (Wells and Mendip Hills) (LD)]

When the Minister replies, can he be clear about whether it is the Department of Health and Social Care or the Ministry of Justice that has control over this area? There seems to be a bit of a wrestling match going on between the two. I am sure the hon. Lady agrees that responsibility needs to sit in one place, so that there is definite control over this sector.

[Dame Caroline Dinenage]

The hon. Lady is absolutely right. It is crucial to know which Department will take the lead on this work and ensure that it happens, because while I think the Minister will be responding to the Fuller report, we are also awaiting the outcome of a Law Commission report that was kicked off in 2022 by the last but one Justice Minister, the former Member for Finchley and Golders Green. That report is looking at different laws on what happens to our bodies after death; it does not include the regulation of funeral directors. My fear is that, as the hon. Lady just said, efforts to regulate the sector will fall between the silos of Government Departments, and nobody will grip this issue.

As we have discussed, what is required is a minimum standard of qualification, accreditation or licensing, and robust inspection. A regulator with the power to withdraw licences and sanction wrongdoers might seem like a tempting first step, and Scotland is ahead of England, having passed legislation 10 years ago to introduce a licensing and inspection regime. However, 10 years on, not a single Scottish funeral director I have spoken to has actually been inspected. I am concerned that this could be the worst of both worlds, with the illusion of regulation masking the possibility that nothing has changed in practice.

A sensible approach would be to extend the scope of the Human Tissue Authority beyond public mortuaries to the whole death pathway. The Fuller report recommends that the HTA

“should require the organisations it licenses to ensure that any individual who provides care to deceased people is suitably qualified, experienced and supervised.”

If inspections are going to be carried out by local authorities, they need to be significantly better trained and resourced to do so, and we would have to take into consideration the fact that some of them run funeral services of their own. They cannot mark their own homework. Inspections must have public trust. The regulator can make sure of this by aligning its minimum codes of practice with those provided by the two voluntary trade bodies we have already heard about, the SAIF and the NAFD.

I am also concerned about the existing marketplace in training. For sums of money reaching into the thousands of pounds, professional qualifications are delivered by the British Institute of Funeral Directors. At face value, that seems quite promising; after all, those courses are accredited by the University of Greenwich. So far, though, I have seen absolutely nothing that gives me confidence in the legitimacy of the BIFD’s work, particularly in light of the fact that Hayley Bell of Elkin and Bell fame, who has now been sentenced to four years in prison, was one of its examiners. If its own examiners cannot uphold even the most basic standards of care for the dead, what is the value of the qualifications it is selling people? Just as important as qualifications is a person’s suitability for a job. Surely, a lesson from the Fuller case is that funeral technicians and embalmers, as well as anyone else involved in the death pathway, should undergo a Disclosure and Barring Service check.

As we have heard, the death pathway is open to so much abuse, and I warn the Minister that the cases I have mentioned will only be the tip of the iceberg while there is no regulation to tackle them. Doing so will require a whole system of changes, not just licensing and inspection. In some cases, this could be achieved by expanding existing legislation, such as the Human Tissue Act 2004, and it must be done in a way that is not punitive for small, independent businesses.

I would also like the Government to explore the possibility of a new crime, that of the mistreatment of a body after death, because we cannot keep relying on Victorian common law. We must ensure that the death pathway is much clearer and runs more smoothly, to provide a minimum of opportunity for things to go wrong. For example, I have heard that in some cases, bodies are already decomposing by the time they make it to a funeral director because of a lack of medical examiners to sign off the death. What reassurance can the Minister give me that his Department is going to improve standards in this area as well?

I believe that for there to be full accountability and trust in the system, a clear method of tracking the bodies is necessary. One of the most heartbreaking parts of the Elkin and Bell trial was the story of baby Albie, who died after just 11 minutes of life. His parents still have no clear picture of what happened to his body after it was taken into the care of Elkin and Bell. At every step of the journey, identification numbers and proof of licence should be shown when a body is passed from one responsible authority to another. Without that, families simply do not have the certainty that their family members have been well treated, or even that they have been reunited with the correct ashes.

Madam Deputy Speaker, you will be pleased to know that I am coming to a conclusion. Why is this issue important? We all know people who say, “I don’t care what happens to me after I’m dead; I won’t know anything about it.” It is a truism that funerals are for the living. I have been heartbroken by the stories I have heard from families who regret the arrangements made for loved ones—stories of feeling racked with guilt and unable to say goodbye in the way that they wanted. Grieving is such an important part of human ritual, regardless of someone’s religion or beliefs. We are elected to Parliament to make things better and to improve people’s lives, but today I am asking the Minister to commit to improving people’s deaths, to restoring dignity in death, and to ensuring that our loved ones are treated with the care and professionalism that they deserve.

Oral Answers to Questions

Caroline Dinenage Excerpts

Tuesday 13th January 2026 Commons Chamber

[The Minister for Secondary Care (Karin Smyth)]

I know that this is of great concern to my hon. Friend and his constituents. It is a matter for the commissioning officer at his local ICB. I recommend that he keeps talking with them about the best provision for his constituents.

[Dame Caroline Dinenage (Gosport) (Con)]

I was fascinated by the Minister’s earlier answer about the closure of pharmacies, because there has been fantastic news in Lee-on-the-Solent in my constituency: a new pharmacy wants to open there. Local people are desperate for a second pharmacy in Lee-on-the-Solent and the local GP practice supports it. The problem is that the Hampshire ICB has rejected it. Does the Minister share my disappointment that local people are not going to be served in the correct way by pharmacy provision, and will he meet me to discuss this?

[Stephen Kinnock]

That does sound somewhat baffling, given that there is demand for the service. Pharmacies play an absolutely vital role in our communities. I would be happy to meet the hon. Lady to discuss the details further.

Oral Answers to Questions

Caroline Dinenage Excerpts

Tuesday 25th November 2025 Commons Chamber

[Dame Caroline Dinenage (Gosport) (Con)]

A constituent of mine recently had successful high-intensity focused ultrasound treatment for prostate cancer, which was at Charing Cross hospital because it is not even offered to men at Portsmouth hospitals, despite being a less invasive treatment with fewer long-term health implications. As if to underline that inequality, imagine his surprise when he turned up at the hospital and found that the same doctor who had diagnosed him in Portsmouth was actually carrying out the procedure in London. What more are the Government doing to ensure that there is no postcode lottery when it comes to HIFU, and what will the Minister do to ensure that more men can access it?

[The Minister for Secondary Care (Karin Smyth)]

I thank the hon. Lady for that question and for her work on this issue. She makes a really important point about consistency of care. We understand that services are different in different parts of the country—sometimes the needs are different—but we want to ensure that, where there is good practice and proven evidence, care is rolled out. As we say, bring the best of the NHS to the rest of the NHS. I am sure that the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for West Lancashire (Ashley Dalton), will take note of that point.

Terminally Ill Adults (End of Life) Bill

Caroline Dinenage Excerpts

Report stage
Friday 13th June 2025 Commons Chamber

[Paul Waugh]

I will not; I am short of time.

Just how strong are the Bill’s safeguards? We are not commentators; we are legislators. Our job is to scrutinise, to test and to test again the Bills that come to this place. I spent 26 years up there in the Press Gallery writing about politics, but the big difference between them and us is that we have a vote in this place. With that vote, particularly a free vote, comes responsibility, and there is no greater responsibility than protecting the vulnerable from feeling they have to end their life. That is why I tabled the amendment.

I am not driven by religion, though I do not believe that those with religious faiths should be denigrated or patronised, as they have been during the passage of the Bill. It is worth saying that some of those who passionately support assisted dying have a faith—a devout faith—that their world view is the right one. I am driven instead by my duty as a legislator to get this Bill right, and by what I see as my moral duty to protect the most vulnerable in society.

I believe that my duty is to protect those who do not have celebrity names or campaign groups behind them—the people who do not get heard, who do not want to be a bother, who do not want to make a fuss, and who feel at the end of their lives that they are a burden on their family but may never say so. I worry about the unheard, the unseen, the ignored and the marginalised. Most of all, I worry about the heartbreaking modesty of that phrase we often hear from older people: “I don’t want to be any trouble, love.” We need, for their sakes, to make sure that the safeguards in the Bill are the strongest they can possibly be.

[Dame Caroline Dinenage (Gosport) (Con)]

I intend to speak only briefly. We have to be really honest about where we are, and the current situation under the legal status quo is not working. It is failing terminally ill people who want choice, compassion and control at the end of their lives.

Right now, those with the means are travelling abroad to die, often alone, away from their loved ones, without medical support, and when they can physically make it rather than at a time of their choosing. Those without the means face suffering they do not want, or try to take matters into their own hands here in the UK unsafely and illegally. It is not humane, it is not fair and it is not sustainable.

I spent two years as a Minister in the Department of Health, with palliative care and end-of-life care as part of my portfolio, so this matter came across my desk on a regular basis. I have had a lot of time to think about it. It is not easy to find an answer and a solution, but we owe it to people to try to do that. That is why I support the Bill: it brings the issue out of the shadows and into a framework of regulation with safety and dignity.

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

I do not know whether the hon. Member has yet had time to read the report from the independent commission on palliative and end-of-life care, which goes into how pain and symptoms can be palliated. Ultimately, the problem at the moment is poor care and poor provision of specialist commissioned palliative care services. Will she read that report to understand the difference that palliative medicine can make for all the examples of poor care we have heard about in these debates?

[Dame Caroline Dinenage]

I certainly will read that report. The hon. Member makes an excellent point. Palliative care is really important and needs to be improved. In many cases it makes such a difference, but it is not the solution for everybody. There are the most heartbreaking cases—I have met people in these situations in my constituency—where that form of palliative care would not have made the difference. That is why I support the Bill, and that begins with new clause 13.

[Sir Desmond Swayne (New Forest West) (Con)]

On a point of order, Madam Deputy Speaker. I wonder if you can assist me as I am at a loss as to what amendment we are discussing.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I have no doubt that if the right hon. Member gives the hon. Member for Gosport (Dame Caroline Dinenage) a moment, she will address it quickly, because even Members who are contributing do not have long.

[Dame Caroline Dinenage]

Thank you, Madam Deputy Speaker. I am addressing new clause 13, which provides the strict regulation of life-ending substances and self-administering devices. That means there will be transparency about what substances are used and how they are stored, prescribed and delivered. We owe it to patients, clinicians and the public to ensure that every part of the process is governed by clinical standards and ethical safeguards. For those physically unable to swallow or self-ingest, the new clause ensures that devices to support self-administration can be safely used. Without that, we risk creating a system that excludes some of the very people it is meant to support.

While we must regulate the system properly, we must also reject amendments that would undermine or stall the Bill’s delivery. Amendment 19 proposes adding suicide prevention, the Mental Health Act and deprivation of liberty safeguards to the code of practice. As the Minister who put much of that legislation through, those are really important topics for me, but this is not the legislation to address them. Let us keep the code focused on the Bill’s core function of ensuring a safe, consistent and compassionate assisted dying process.

Amendment 20 would allow non-adherence to the code to be used in civil or criminal proceedings. That is not appropriate. Guidance is meant to help professionals navigate difficult decisions, not become a legal trap. If clinicians act negligently, existing law already applies. We should not be creating new liabilities for those acting in good faith in very difficult conditions.

I also oppose amendments 97 and 27, which would require the MHRA to license drugs specifically for assisted dying and the National Institute for Health and Care Excellence to recommend them. That would make the Bill unworkable.

[Jonathan Davies (Mid Derbyshire) (Lab)]

Does the hon. Member share my concern that the impact assessment associated with the Bill says:

“The safety and efficacy of those substances used for assisted dying is currently difficult to assess”?

[Dame Caroline Dinenage]

I am not entirely sure that I agree with that.

However, I want to talk about the MHRA, which is just not set up to license drugs for ending life. Clinical trials to support such a licence and MHRA requirement would be impossible. However, the substances likely to be used are already tried and tested in other jurisdictions and are MHRA approved for other purposes. New clause 13 already provides us with the strict regulation that we need, without putting prohibitive hurdles along the path to a compassionate and painless death.

Amendment 42 would remove the backstop date for implementation, giving the Government indefinite discretion over when or whether to put this law into effect. That cannot be right. If Parliament passes the Bill, there must be a clear and reasonable timeframe for implementation. The four-year backstop already gives Government more than enough time to get this right. Removing it simply invites delay.

This is a moment to show that we can be both compassionate and competent, and that we can bring an end to the quiet suffering caused by an unjust status quo and replace it with a system that is safe, fair and accountable. Let us support new clause 13, let us reject amendments that would add red tape or stall the Bill’s progress, and let us show dying people that we are ready to treat them with the dignity and trust that they deserve.

NHS and Care Volunteer Responders Service

Caroline Dinenage Excerpts

Monday 19th May 2025 Commons Chamber

[Karin Smyth]

This is a good opportunity, which I very much welcome, to highlight again how important volunteering is to the NHS and the care system. It will remain an important part of our plans going forward that. People may have had an email and thought that something is stopping and that there is not more to do, but they should ensure that they press that button and register for upcoming opportunities and are in contact with their local NHS systems. As I said, volunteering is done locally, and it is important that we support those local systems and encourage more and more people to come forward to undertake this important work.

[Dame Caroline Dinenage (Gosport) (Con)]

I pay tribute to some of the volunteers across my constituency, who make such a difference to people’s lives. The Minister will have noticed that polling by More in Common today found that more and more people feel disconnected from society. That is compounded by the fact that so many of our community spaces are struggling to make ends meet as a result of a combination of business rate changes, national insurance rises and energy price rises. Those health and care volunteers make such a difference by chatting with those who are lonely and vulnerable in my constituency. Has the Minister considered the impact of this decision, particularly in the interim period, on communities such as mine? What cost will not having this voluntary service to support people in their times of need drive into our health services?

[Karin Smyth]

I agree with the hon. Lady about the roles that people play, particularly by having conversations and connecting with people who feel disconnected. To be very clear, this decision is about particular arrangements: it does not mean that things are stopping across our country or with local health systems ensuring that volunteers are still available. We want to ensure that we use that knowledge in building systems for the future. I was very pleased to host a roundtable with organisations as part of our 10-year plan process. There are some fantastic ideas and opportunities out there to use the knowledge we have learned, particularly during covid, to use technology to link with people and to recognise where people are not linked by technology and ensure that they remain connected. All of that will form part of our future plans.

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?

--- Later in debate ---

[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.

--- Later in debate ---

[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.