NHS England Update

Caroline Johnson Excerpts

Thursday 13th March 2025 Commons Chamber

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I thank the Secretary of State for advance sight of his statement. It is disappointing, once again, that it was not made to the House first; in recent days, there have been numerous media briefings about this potential restructure.

Under new leadership on the Conservative Benches, we believe in a leaner and more efficient state. That means using resources effectively, reducing waste and preventing duplication, spending money where it is most beneficial. After all, the public understandably want to see the focus on patient care and not on backroom managers. Therefore, we are supportive of measures to streamline management, and we do not oppose the principle of taking direct control, but we need to know what steps will be taken to meet targets while all the upheaval happens. We need to know the specifics of what is being planned.

What are the timeframes for the abolition of NHS England? By what date will it be completed? How many people will be moved into different roles? How many people will lose their jobs altogether? How much money is that expected to save? Labour runs the NHS in Wales, which has the highest waiting lists and the longest waiting times in Great Britain. What lessons has Labour learnt from its failure in Wales?

NHS England, as the Secretary of State said, has just lost much of its leadership. Is that because they no longer had confidence in the Secretary of State, or because he did not have confidence in them? Perhaps he can tell the House whether Alan Milburn will keep his job in the upheaval. We also need to be clear that moving people into different roles will not fix the challenges that face the NHS.

The Secretary of State has spoken about taking direct control. That may help him ensure that the NHS stops wasting money on expensive diversity, equity and inclusion staff, and ensures that it provides dignity and privacy for female staff and patients, but what does it mean for clinical prioritisation? Will conditions that are less common and have less glitzy campaigns and fewer celebrity backers suffer because the Secretary of State now has political considerations? Does the Secretary of State have the bandwidth for this, given he has such a busy role already? How does the centralisation of power measure up with the commitment to give more powers to regional bodies and local integrated care boards?

In the first six months after entering office, the Government announced 14 reviews, consultations and calls for evidence, all of which require more staff. Are those jobs at risk, or are other pre-existing roles set to be cut? This announcement comes the same week as Labour’s Employment Rights Bill passes through the Commons. Is the Secretary of State getting a move on because he knows that red tape and bureaucracy will dramatically increase afterwards and make the decisions he has to take more difficult to deliver?

A drive to improve efficiency in the civil service and the management of the health service is welcome, but what about the NHS itself? The Government slimmed down our productivity plan and delivered a 22% pay rise in return for no modernisation or reform. How will those decisions improve efficiency? I asked the Department what proportion of people with a nursing qualification working in the NHS are in patient-facing roles, but the Minister said that they did not know. How can he use the skills and resources effectively if he does not know where those skills and resources are?

The Prime Minister is making a lot of noise about productivity and cutting waste, but he still refuses to set a target for cutting the civil service headcount. Thanks to the decisions he and the Chancellor took at the Budget, the size of the state is growing rapidly, not shrinking, while changes to national insurance contributions have diverted funding away from the frontline into compensating the Treasury. Ultimately, any restructure will be challenged by the Government’s continued failure to tackle immigration. While steps to improve efficiency in the healthcare service are welcome, these words ring hollow across Government.

[Wes Streeting]

I will take the more serious questions from the shadow Minister first. On timeframes, we will work immediately to start bringing teams together, as we have done with the one-team culture we have been building over the past eight months. I want the integration of NHS England into the Department to be complete in two years.

The shadow Minister asks about the reduction in the number of officials. NHS England has 15,300 staff; the Department of Health and Social Care has 3,300. We are looking to reduce the overall headcount across both by 50%, which will deliver hundreds of millions of pounds of savings. The exact figures will be determined by the precise configuration of staff, and we will obviously keep the House updated on that.

The shadow Minister asks about clinical leadership. One change we will be making with the transformation team is to have two medical directors succeeding Professor Sir Stephen Powis, whose departure from NHS England was planned long before these changes. There will be one medical director for primary care and one for secondary care, underpinning our commitment to the shifts we have described. I must say, there are enormous improvements to be made in clinical leadership for patient outcomes, patient safety and productivity, and I am demanding stronger clinical leadership to drive those improvements to productivity. Frankly, many consultants and clinical teams on the frontline will welcome that liberation—they are hungry for change.

The shadow Minister asks about the workforce data and complains that we have not been able to give her the precise answers. I agree: it is frustrating not having that precise information at my fingertips. I would gently remind her, though, on this as on so many things, that her party was in power for 14 years. She cannot very well complain eight months in given that they left us a woeful, embarrassing data architecture and infrastructure.

The shadow Minister asks about efficiency. Once again, she refers to the resident doctors deal as if it was a failure. The actual failure was leaving doctors on the picket line, not on the frontline, and wasting huge amounts of taxpayers’ money, with cancellations and delays to patients’ appointments, operations and procedures. We stopped that within weeks of coming into office. The deal does include reforms to improve productivity—if she is any doubt about the results, she should look at the fact that despite winter pressures, NHS waiting lists have fallen five months in a row.

Once again, we get the facile points about my right hon. Friend Alan Milburn, who is the lead non-executive board member for my Department. I honestly do not know why he bothers to pay for a mortgage; he lives rent-free in the Conservatives’ heads. They need to move on. By the way, just for the record: Alan Milburn has a record on the NHS that the Conservatives cannot even begin to touch.

The shadow Minister asks about confidence. I am delighted to be introducing a new transformation team. Different leadership challenges require different leadership skills. As I say, I have been really pleased to work with Amanda Pritchard for the past eight months, including on this transition; people should have no doubt about the confidence I have in her skills, talents and abilities, and I think she has a lot still to contribute to our NHS. We do not need to ask about confidence in the Conservative party; it is reflected in the scarce numbers on the Opposition Benches.

What is the lesson from Wales? The lesson is that when there is a Conservative Government in Westminster, the national health service suffers in England, Wales, Scotland and Northern Ireland. That is why we are creating a rising tide to lift all ships. I am sure we will see improvements across the United Kingdom. SNP Members, who are not in their place, do not have any excuses now. As I said before the election, all roads lead to Westminster, and the biggest funding settlement since devolution began is going down the road to Holyrood. There are no hiding places there for the SNP. If people want real reform of the NHS in Scotland, they should vote for Scottish Labour under Anas Sarwar and Jackie Baillie.

People can see here in Westminster the difference that new leadership provides. The shadow Minister laughably referred to new leadership in the Conservative party. Well, it is certainly leaner and meaner, but it is the same old Conservative party. The only thing that the Conservatives have shrunk is their own party. The only jobs that they have laid off are those of their poor party staff. The only thing that they are capable of changing—[Interruption.] Well, come to think of it, I do not think that there is anything they are capable of changing. Instead they look over their shoulder at a party leader who cannot even manage a five-aside team, let alone a country. The Conservatives are just so diminished as a party. I appreciate that it must be so painful for them to watch a Labour Government doing the things that they only ever talked about: reducing bloated state bureaucracy; investing in defence; reforming our public services; and bringing down the welfare bill. The public are asking: “What is the point of the Conservative party?” I bet they are glad that they chose change with Labour.

Ambulance Response Times

Caroline Johnson Excerpts

Thursday 6th March 2025 Westminster Hall

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

It is a pleasure to serve under your chairmanship, Ms Jardine. I thank the hon. Member for Glastonbury and Somerton (Sarah Dyke) for securing a debate on this important subject. I pay tribute to the ambulance services and to paramedics and their colleagues, who are on the frontline of our healthcare service, today and every day. Regardless of the weather, or whether it is a bank holiday, they are always there for all of us.

In my medical career, I have been required to deliver full intensive care to children, and particularly babies, who were being transferred across the county in East Midlands ambulances throughout the night and day. I have hurtled along in the back of an ambulance as it travelled down country roads, around corners and down the hard shoulder of motorways, so I understand some of what ambulance crews do. That has given me a deep appreciation of their work, and highlighted to me some of the unique challenges and pressures they face, particularly in our rural areas.

Before I was elected, I had two experiences of delayed ambulance services. On one occasion, I was driving up the A1 when the gentleman in the car in front of me skidded on some water and went into a tree. I am sorry to say that the ambulance took a very long time to arrive, and he died shortly afterwards. There was a fire truck, police officers and an incident manager, but there was no ambulance service. I do not think it would have made a difference to the outcome, but in other cases it might have.

On another occasion, I was sat in traffic when a police officer knocked on the window, which is always slightly worrying. They were looking for a doctor because they had been waiting so long for an ambulance for the people in the accident that was causing the traffic. It took a further 40 minutes from me arriving at the scene for the ambulance to arrive�I am not clear how long the people at the scene had been waiting before. So this issue was a great priority for me before I became a Member of Parliament.

In my first question at Prime Minister�s Question Time, in January 2017, I thanked the East Midlands Ambulance Service for its brave and stellar work serving the people of Sleaford and North Hykeham, and asked for ambulance service response times to be a priority. I also raised the issue in my first meetings with the then Prime Minister and Health Secretary. I understand that response times have improved somewhat, at different periods with different initiatives but overall, as we have heard, they are not where we need them to be.

In January, a constituent wrote to my office detailing the difficult experience of waiting too long for an ambulance to arrive. This 85-year-old gentleman came downstairs at 10 am to find his 82-year-old wife, who suffers from advanced dementia, lying on the hardwood floor, covered in blood, crying and confused. He managed to get her into a chair, calm her down and call 999. The operator could not hear him properly because the phone service was bad, his wife was crying and trying to get out of the chair, and he was struggling. Eventually, he was told the ambulance would be there in 12 hours. The ambulance did eventually arrive, and his wife is now in a stable condition, but that was a traumatising experience for her and the 85-year-old man. I was sorry to read that harrowing tale, and tales like it are too common across the country. I am interested in what the Minister will do to improve the situation; it is easy to say that things are not where they need to be, but it is important to consider how one can improve them, and that is what I hope to hear from her.

Of course, the pandemic threw everything off kilter, and demand for ambulance services rose significantly, with almost 3 million calls in March 2020. In 2022-23, an extra �150 million was allocated to improve ambulance response times through extra call handler recruitment and retention. In January 2023, to improve performance further, the last Government published an urgent and emergency care plan, which set out ambitions to improve average ambulance response times for category 2 incidents to 30 minutes over 2023-24, with further improvement in 2024-25 to get back towards pre-pandemic levels. The plan aimed to increase ambulance capacity by making over 800 new ambulances available during 2023-24, including 100 new specialist mental health vehicles for those who require different types of service. However, in December 2024, under this Government, ambulance response times rose to an average of three hours and two minutes for category 3 calls�category 3 covers elderly people who suffer falls but not a head injury. What steps will the Government take with NHS England to reduce those response times so that people are not waiting hours in pain and discomfort?

I have said to the Minister that it is important that we talk about how we can improve things, as well as about what the problems are. It is crucial that we all do that, and one suggestion from my hon. Friend the Member for West Suffolk (Nick Timothy) was co-located blue-light services�I am sure he is aware that the first such services were opened not long ago in Lincolnshire. The blue light hub tri-service centre, in the Lincoln constituency, is a co-located site, and co-location is leading to improvements in services. Although that is not my constituency, I am sure the hon. Member for Lincoln (Mr Falconer) would be open to an approach if my hon. Friend wished to see the site.

It is important to look at risk all along the pathway. We have talked about handover delays, but there is a whole pathway from the moment someone calls 999 to the transfer journey, the wait to get into A&E and then the wait in A&E. The risk is clearly highest at the point where someone has called 999 but does not yet have access to on-site or in-person medical care. To improve that, we need more ambulances on the road and fewer sat outside A&E.

I have some questions for the Minister. Ambulances are double-crewed�there are two people in the ambulance �but do two staff need to stay with the patient? If two ambulances have arrived, each with two staff and one patient, could two of the four crew go off in one of the ambulances to see more patients? That would avoid a situation where there are two staff per patient in the ambulance, when many patients are not that unwell medically. Nursing in intensive care is only one to one, but we are providing higher levels of care than that with these staffing ratios. Is that necessary?

We also have a delay in handover�in getting people out of the ambulances�because the A&E is said to be full. The front door is open, but the back door, for people coming in an ambulance, is in effect closed. If patients got out of the ambulance and walked round the building to the front door, they could go in and be triaged as normal. It does not make sense. Some of my medical colleagues have gone to see people in the ambulance and discharged them from there, without their needing to come into the hospital at all. So there are clearly people with a level of medical acuity that would potentially allow the crew, with guidance and training, to discharge them into the front door of the hospital instead.

On another question, if some people are well enough to be discharged from ambulances, are the public sufficiently aware of what constitutes a necessity when it comes to calling an ambulance? How many ambulances that are called are necessary? One would not wish to deter anyone who is frightened and concerned for their wellbeing from calling an ambulance if they feel they need one, but education on when one is needed might be useful.

As has been alluded to, staff retention is also important. One o constituent�a single mum with children�left her role as a paramedic because she was struggling with working hours that overlapped with getting her children ready for school in the morning. She was able to cover most other aspects of childcare�such as picking them up from school�with after-school clubs and the like, but she struggled in a morning, and her flexible working request was refused. I recognise that there must be balance, and that all hours of the day must be covered by ambulances, but has the Minister thought about how working practices and hours could be changed?

The Liberal Democrat spokesperson, the hon. Member for North Shropshire (Helen Morgan), mentioned resources in rural areas. That is important because response times will necessarily be increased by the geography, so greater levels of resource perhaps need to be provided to rural areas, in recognition of the fact that if we want response times in them to fall, we need a higher level of ambulance availability.

Another significant factor causing delayed ambulance response times is staff sickness, which is not necessarily an issue of NHS funding. Ambulance services in England report the highest level of sickness absence rates of any other profession across the NHS. Against a national average absence rate of 4.3% over an eight-year period, ambulance staff showed an average absence rate of 6.2%, with year-on-year increases. There are stark regional differences in sickness rates, with the West Midlands Ambulance Service consistently maintaining a lower absence rate�around 50% lower than its counterparts in London or the east midlands. The NHS would benefit from sharing best practices between trusts, which would make a real difference, ensuring a healthier workforce and, ultimately, better patient care. The issue is also costly financially, and an independent review published by Lord Carter in 2016 estimated even then that a mere 1% reduction in staff absences could save ambulance trusts up to �15 million a year. That figure would clearly be even higher now.

I also want to raise the issue of air ambulance services. Air ambulance charities deliver lifesaving treatment every single day and complete more than 25,000 lifesaving missions across the country every year�an average of more than one every 10 minutes. I commend the work of all those involved, and particularly Lincs & Notts Air Ambulance, which operates in and around my constituency, the crew who airlifted my husband from Silverstone to Coventry last year and looked after him so well.

In the last Parliament, the previous Government gave significant support to air ambulances. The Department of Health and Social Care�s three-year capital grant programme in 2019 allocated �10 million to nine charities across England. That funding supported air ambulance charities to move towards 24/7 operations and improved seven airbase facilities across England. However, services are now under threat from the Chancellor�s rise in national insurance and taxes. Lincs & Notts Air Ambulance will need to find another �70,000 just to pay the national insurance rise�this is an entirely charitably funded organisation. Can the Minister justify that policy, given the vital work that air ambulance charities do across the country?

On 19 November, my right hon. Friends the Members for Newark (Robert Jenrick), for Gainsborough (Sir Edward Leigh), for South Holland and The Deepings (Sir John Hayes) and for Louth and Horncastle (Victoria Atkins), my hon. Friends the Members for Rutland and Stamford (Alicia Kearns) and for Grantham and Bourne (Gareth Davies), the hon. Member for Boston and Skegness (Richard Tice) and I wrote to the Chancellor to ask about exemptions from the national insurance hike for air ambulances. Despite raising the issue at Treasury questions and in a point of order, and despite repeated chasing from my office, we have not had the courtesy of a proper response to our letter from the Government, although they have suggested that they are now asking the Department of Health and Social Care to respond to the letter. That is a huge discourtesy to the House, and I would be grateful for the Minister�s assurance, because the letter is apparently with the Department of Health, that we will receive a response by the end of the week. That is quite a reasonable request.

Finally, it is fair to say that ambulance crews are doing a sterling job, but that response times are not where we need them to be. I look forward to hearing the Minister tell us how she will improve those services for our constituents.

--- Later in debate ---

[Ashley Dalton]

The hon. Member will be delighted to know that I am coming to that point next.

We are working on reducing delays and getting hospital handovers back to within 15 minutes, ensuring that no handover between hospital and ambulance services takes longer than 45 minutes. We want to improve the range and co-ordination of services to avoid unnecessary ambulance conveyances, including through improving access to urgent community response and hospital at home services, and continuing to build on ambulance services and the great work that they do to increase the hear and treat rates so that people can be advised on what they can do and what services they can access that might mean they do not need that ambulance. We will also be driving consistency and commissioning practices across England for ambulance services. I will say a little more about the rurality element in a moment.

We are taking the first steps in the reform and improvements that we want to see in services, and we will shortly set out further plans in the urgent and emergency care services plan. We know that there is no solution for ambulances that does not include tackling the challenges facing adult social care. Health and care services need to be more joined up.

Today, there are approximately 12,000 patients in hospital beds who have no criteria to reside. They do not need to be there but cannot be discharged for reasons of capacity. Over the last month, on average, 276 of the patients with no criteria to reside were in the Somerset integrated board area. That is why the Government are making available up to �3.7 billion of additional funding for local authorities that provide social care. We are funding more home adaptations through the disabled facilities grant this year and next, so that people�s homes can be safer, reducing the risk of their needing an ambulance. We are reforming the better care fund to ensure that the pooled NHS and local authority funding spent on social care contributes to wider efforts to reduce emergency admissions and delayed discharges.

[Dr Caroline Johnson]

Social care is clearly very important, but what assessment has the Department made of the effect of national insurance contributions on social care provision as a whole?

[Ashley Dalton]

The hon. Member will be aware, because we have discussed the matter many times in Westminster Hall and the main Chamber, that the funding has been made available to the statutory sector bodies for employer national insurance contributions for public sector pay, and the negotiations for the delivery of commissioned services locally and within the NHS will take place locally. I am sure that we will be able to point her to some more detail on that issue, which has been discussed at length by colleagues.

We have announced the largest ever increase in the carer�s allowance earnings limit since the benefit was introduced in 1976. It is worth approximately �2,000 a year for unpaid carers. We are also introducing fair pay agreements to empower worker representatives, employers and others to negotiate pay and terms and conditions in a responsible manner. That will help to address the recruitment and retention crisis in the sector. It is not all about ENICs; it is about making sure that our social care service is resourced in order to make sure that social carers are recognised for the powerful and important work that they do. We have appointed Louise Casey to help to build a national consensus on the long-term solution for social care.

The social care cross-party talks, to which the Liberal Democrat spokesperson referred, have not been called off; they have been merely delayed. As I told her in the Chamber just yesterday, it is very much about making sure that we have the right people in the room and that they can attend. It is our intention for the talks to go ahead very soon. They have not been called off; they have been merely postponed.

Of course, we need further reform. We are bringing it forward through the 10-year plan this spring to accompany the additional investment in the NHS. The Government will publish that plan for radical reform in the NHS, with those three big reform shifts: from hospital to community, from analogue to digital and from sickness to prevention. The reforms will support putting the NHS on a sustainable footing so that it can tackle the problems of today and of the future.

The shadow Minister asked about the configuration of ambulance services. As I am sure she is aware, decisions on service configuration must be made by those who are experts in delivering it.

We have also talked about the key issues of rurality. A range of adjustments are made in the core ICB allocations formula to account for the fact that the costs of providing healthcare may vary between rural and urban areas. Some of the differences, such as the tendency for rural populations to be older, are naturally captured within the formula. We continue to review the formula for the impact of the characteristics of local areas, such as rural, urban and coastal, in the development programme.

I encourage all hon. Members to raise these matters with their local ICBs, which are responsible for commissioning the right configuration of local services. The NHS has increased the availability of local data on ambulance response times performance, with category 2 ambulance performance now published at ICB level, which has increased the transparency of the important data. I encourage hon. Members to use that data to direct conversations with their ICBs.

We have also talked about air ambulances. I am sure that all hon. Members recognise the contribution that they make, as the Government do. The Government support the long-standing independent air ambulance charities model for the successful operation of helicopter emergency medical services in England, which gives the sector the independence to raise funds through commercial activity and sponsorship from corporate partners. The NHS continues to support air ambulance services, including through thorough training and the provision of NHS clinicians.

Communities right across the country, including the constituents of the hon. Member for Glastonbury and Somerton, are struggling with poor services and crumbling NHS estates. We are putting record capital into the NHS. We will bring down ambulance response times. We will get waiting lists back down to what they were in 2010. It will take time, but we will deliver an NHS and a national care service that provide people with the care they need, when and where they need it.

Department of Health and Social Care

Caroline Johnson Excerpts

Wednesday 5th March 2025 Commons Chamber

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I draw right hon. and hon. Members’ attention to my entry in the Register of Members’ Financial Interests, as I am a consultant paediatrician. I congratulate my hon. Friend the Member for North Cotswolds (Sir Geoffrey Clifton-Brown) on securing this important debate on the finances of the NHS.

Labour said that it had a plan to reform and improve our NHS. Unfortunately, it has become clear from the series of consultations—on the NHS plan, the 10-year plan, the patient safety review, leading the NHS and the independent commission to transform social care, to name just a few that are in progress—that Labour did not have a plan, other than to get into power and then consider what its plan should be. As my hon. Friend the Member for North Cotswolds has said, we need improvements in productivity, technology and long-term investment. I completely agree, and as a medic I could give many examples of wasteful spending, especially in relation to paperwork and increasingly inflexible guidance and procedures that are well-meaning but often unhelpful.

There is general talk of productivity improvements from Government Members, but few specifics. I would be grateful if the Minister could provide any specifics in her closing remarks, but let us see what the Government have said and done so far. In the autumn Budget, the Chancellor announced that overall NHS funding would be increased by £22.6 billion over two years—for this year, that is £10.6 billion. The Government are asking us to welcome that extra money. It sounds great, but is it extra or not?

Julian Kelly, NHS England’s chief financial officer, told the Health and Social Care Committee that the proposed 2.8% pay rise for 2025-26 would cost £3.8 billion. The NICs pressure is worth around £1.7 billion, alongside £1.9 billion in non-pay inflation, £0.8 billion for the GP settlement and £3.5 billion for basic demand growth in the NHS. Right hon. and hon. Members will note that those figures add up to more than £10.6 billion, and with the unions having threatened to strike again for even greater pay awards and with Labour’s propensity to capitulate to the unions, it is likely that that figure will increase. Can the Minister confirm whether the £10.6 billion that Labour talks about will really lead to an improvement in services, or will it merely cover inflation, tax rises and the pay rises given by the Labour Government to their union paymasters?

[Several hon. Members rose—]

[Dr Johnson]

I will give way in a moment; let us first look further at those tax rises. It is clear that the Chancellor had not properly considered the effects of the NICs rise on the wider healthcare system. For example, the Government have exempted the NHS from that tax rise, but that exemption does not cover general practice, hospices, charities, many social care providers—including many care homes—air ambulance charities, dental clinics, opticians, private healthcare providers, agency staff, local pharmacies and other suppliers and contractors, to name but a few.

[Alex McIntyre]

I am sure that the shadow Minister is about to come on to this in her speech, but given that she has just criticised this Government for lacking a plan —a plan that is about to come forward to the House later this year—surely she will now put forward her plan for how much extra the Conservatives propose to put forward for the NHS and how they would pay for it, and explain why they did not do that for the past 14 years.

[Dr Johnson]

If the hon. Gentleman looks back at the figures, he will see that there has been a substantial real-terms increase in NHS funding over the past 14 years. That cannot be said for this year, potentially, which is why I am asking the question.

[Mr Betts]

Perhaps I will ask the shadow Minister an easier question, then. She has just rejected the pay deals that this Government have agreed to give a proper reward to our nurses and doctors. By how much does she think that pay deal should be reduced to bring it in line with her policy? If she is opposed to the deal that has been agreed, she must have an alternative in mind.

[Dr Johnson]

One of the key things about the Government’s deal is that they have given in on money without asking for anything in return in terms of productivity. The Government needed to agree a pay deal that was sensible and affordable, not talk about the money that they are giving to the NHS while taking away with the other hand in taxes.

Let us hear what some healthcare providers have had to say about the implications of Labour’s NICs rises for their constituents’ healthcare. The Royal College of General Practitioners has warned that the NICs increase will force GP practices to choose between redundancies and closure. The hospice sector believes that the cost of national insurance rises could be £30 million a year. The Government have given that sector a capital grant worth £100 million, which is welcome and will improve facilities; however, if those facilities are empty and cannot be staffed, they will not deliver much in the way of improvement. Air ambulances are also under threat from the Chancellor’s rise in national insurance and taxes in last year’s autumn Budget, with the local service in my constituency, Lincolnshire and Nottinghamshire air ambulance—which is entirely charitably funded—needing to find another £70,000 just to pay for those national insurance rises.

The Independent Pharmacies Association estimates that the rises in employer national insurance contributions and the minimum wage will cost the average pharmacy over £12,000 a year, totalling more than £125 million for the sector as a whole. Nick Kaye, chairman of the National Pharmacy Association, has warned that

“Pharmacies face a financial cliff edge at the beginning of April, with a triple whammy of rising National Insurance, National Living Wage, and business rates all arriving at once.”

What impact will this have on our constituents’ health? The Government talk a good talk about bringing healthcare closer to the community, but actions speak louder than words, and putting extra pressure on community-delivered services is not a good way of delivering their aims.

The Nuffield Trust suggests that the national insurance rise alone will add a £900 million burden to the adult social care sector. With other new costs factored in, the care sector is believed to be facing a bill of an additional £2.8 billion, dwarfing the £600 million extra allocated to the local authorities responsible for providing social care. This will have a devastating knock-on effect: the amount of care that can be bought by local authorities will fall, the cost of private care will rise—so more people will be reliant on the state, rather than the private sector—and the waiting lists that the Government claim to prioritise will also rise. The Nuffield Trust warns that many small care providers will either have to increase prices, stop accepting council-funded patients, or go bust.

That will have a knock-on effect on the hospital sector, as people are unable to be discharged because there is not adequate social care for them. The Government talk about creating a new national care service, but they have managed to damage the existing one by hiking the costs borne by care homes through national insurance rises and other tax and wage increases.

In January, the Government announced a deal with private hospitals in an attempt to cut waiting lists. The deal, which sounded good to start with, would see private hospitals being paid for each patient that they treated, incentivising them to treat as many people as possible. However, The Times reported that NHS England has recently capped the amount that each hospital can be paid. The chief executive of the Independent Healthcare Providers Network has warned that the policy will actually lengthen waiting times. Will the Minister comment on that?

The Minister is focused on prevention, but when the Government announced that they would be cutting the overseas development aid budget by 40%, the Prime Minister said that the UK would continue to play a key humanitarian role on a range of issues, including global health and challenges such as vaccination. I would appreciate clarification from the Minister on whether the global health budget will be cut, or whether the cuts will be made from other aspects of the ODA budget.

Workforce is the key asset of the NHS, yet sickness levels are running at around 5.5%, which is a considerable cost to Government and drag on productivity. They vary considerably across trusts and professions, with consistently less than 2% of consultants off sick, but almost 8% of ambulance support staff. If those rates could be reduced, it would lead to improved productivity and patients being treated much faster. What is the Minister doing to look at that? Perhaps she will have another one of her reviews.

[Josh Fenton-Glynn]

The hon. Member has frequently been quick to criticise NHS pay rises. Will there be more or fewer sickness absences in the ambulance service if its staff are better paid?

[Dr Johnson]

Is the hon. Gentleman suggesting that whether someone becomes ill is entirely dependent on whether they get another 2% in their pay packet? I am not sure that it is.

The Government promised a great deal when they came into power last July. Since then, they have handed out inflation-busting pay rises, raised costs and abandoned election pledges. At the centre of the Government’s approach is a classic socialist trick—a sleight of hand, taking money away from NHS providers in taxes with one hand, and expecting praise when they give some of it back with the other. The public will see straight through it.

Draft Food and Feed (Regulated Products) (Amendment, Revocation, Consequential and Transitional Provision) Regulations 2025

Caroline Johnson Excerpts

Tuesday 4th March 2025 General Committees

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

It is a pleasure to serve under your chairmanship, Sir John. As the Minister said, the regulations use a Brexit freedom to deregulate, and I welcome the fact that the Government are choosing to use that opportunity to reduce the amount of regulation that may be unnecessary.

I was also pleased to hear the shadow Minister talking about the economic benefits—[Laughter.] I am sorry; it is early in the morning. The Minister talked about the benefits, including financial benefits, that our great food industry provides to this country. As a farmer’s wife, I am very familiar with those, and I would encourage hon. Members—particularly Government Members—to go to the farmers’ protest and rally in Downing Street and Whitehall after the Committee this morning. They will be able to get a pancake and some of our other great British food, and also to learn about what the Government are doing to the farming industry and why that is important.

The first of the two changes in the regulations removes the requirement for 10-yearly renewals of authorisations for feed additives, genetically modified organisms and smoke flavourings, aligning the regimes with those for regulated food and feed products that do not require renewal. The second change eliminates the need for secondary legislation to bring the initial authorisations into effect, allowing them to be enacted following a ministerial decision and to be published in an official register.

That will certainly make the process more efficient and more effective, but I am interested to understand the Minister’s views on the level of oversight that can be provided. If I heard her correctly, she talked about approving 500 renewals over the next three years. Given the many other significant demands on her time, can she guarantee that those renewals will be given the scrutiny and oversight required?

The FSA and FSS will continue to assess products at the initial application stage and will maintain their powers to review authorised products if new evidence of risks emerges. The Minister talked about reviews, but what mechanism will trigger them? How will those organisations know that the risks are there if they are not doing regular reviews?

The Minister talked about how applications will work in Great Britain, but can she tell us more about what regulatory framework will be available in Northern Ireland. How does she see trade between GB and NI working, given the difference on either side of the Irish sea?

In summary, we do not plan to divide the Committee on the regulations, because we recognise their benefits, but we are keen to understand how the Minister feels that Parliament—and she herself—will be able to keep track of the various changes she will be making.

--- Later in debate ---

[Ashley Dalton]

I thank hon. Members for their valuable contributions to the debate. Removing renewals and statutory instrument requirements will not lower food and feed safety or standards.

On scrutiny, removing SI requirements for authorisations will not change the FSA’s or the FSS’s robust risk analysis and public consultation process. Public consultations will remain open to all for scrutiny, and recommendations to Ministers for all authorisations of products will take those responses into account.

The shadow Minister asked how Ministers will be able to keep track of decisions. Of course, whether decisions come under this new proposal or the existing process, they will need to be assessed. Under this new process, Ministers can take advice from the FSA and the FSS, and we will then lay those decisions in the public register. If we did not bring this proposal forward, everybody would be involved in multiple SIs, which I am sure the shadow Minister will agree is a far more onerous process.

In response to concerns about divergence with Northern Ireland, our priority is to ensure that Northern Irish consumers benefit from the same robust public health protections as the rest of the UK, while also facilitating the smooth movement of goods to consumers. The robust system of controls that applies across the UK enables all consumers to trust that the food they buy and eat is safe and is what it says it is. Any differences in approach are managed through the relevant common frameworks.

As has been stated, the current requirement for renewals applies only to three regulated product regimes: feed additives, food or feed containing, consisting of or produced from genetically modified organisms, and smoke flavourings. No other regulated products, including novel foods and food additives, have this requirement at the moment. These reforms introduce a consistent, proportionate and evidence-based approach.

The FSA and FSS will focus on horizon scanning and risk assessment so that they can respond to new safety evidence as it emerges. We are not going to ask businesses to bring their products routinely for review. However, if there are any changes in a product’s make-up, or it comes to light that the product has any new impacts, that will trigger the FSA and the FSS to look into those.

[Dr Johnson]

I did not quite understand the Minister’s point regarding Northern Ireland. At the moment, under the new regulations, it is clear what will be done in Great Britain to approve new products. However, if a new product has been produced in another part of the United Kingdom—that is, Northern Ireland—how will it be assessed? How will products that have been assessed under the system in GB be able to be sold in Northern Ireland? Will they require further investigation?

[Ashley Dalton]

Businesses in Northern Ireland that develop new regulated products and wish to place them on the market in the EU must apply to the EU for authorisation—that is all within the Windsor framework, and the reforms in this SI do not affect the operation of the Windsor framework in any way. Regulated products that are approved in Great Britain can be placed on the Northern Ireland market if moved via the Northern Ireland retail movement scheme. I think that that answers the question.

To return to the safety concerns, by carrying out horizon scanning and risk assessment, the FSA and the FSS will consistently provide insights into whether already authorised products are safe to remain on the market, instead of working arbitrarily to renew authorisations on fixed timetables. The burden on industry and the public sector of having a comprehensive review for all products, even if there is no evidence to suggest that a review is needed, will be removed. We are looking for an evidence-based review system to help focus resources on new and innovative products and on where there may be problems.

The reforms build on existing powers under which the FSA and the FSS can request information for review, and it is in the interests of businesses to proactively provide it. The reforms ensure that the regulatory framework remains comprehensive and adaptive, and enables regulators to respond swiftly and effectively to the emerging risks we have discussed. Where necessary, approvals can be modified, suspended or revoked if a safety concern is identified.

The FSA and FSS, along with the independent scientific advisory committees, have the expertise to assess all applications for authorisation. Ministers must provide reasoning if they disagree with the advice from the FSA and FSS when making authorisation decisions. So there are appropriate tools and resources to allow hon. Members and the public to scrutinise regulated product applications and authorisations. The reforms will speed up the process, use resources more productively, efficiently and effectively, and align with other UK regulatory systems.

In summary, the reforms will remove requirements for the periodic renewal of authorisations for the three regulated product regimes I mentioned, and will allow authorisations to come into effect following ministerial decisions. The changes will streamline the process, allow regulators to keep pace with innovation, and support economic growth without compromising consumer safety. I am grateful for all the contributions today.

Question put and agreed to.

HIV Testing Week

Caroline Johnson Excerpts

Thursday 13th February 2025 Westminster Hall

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

It is a pleasure to serve under your chairmanship, Dr Allin-Khan. I congratulate my right hon. Friend the Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell) on securing this important debate, and I thank the hon. Member for Sittingbourne and Sheppey (Kevin McKenna) for sharing his lived experience of this condition.

As we mark National HIV Testing Week 2025, we should be proud of the progress we have made since the ’70s and ’80s in raising awareness of the disease and reducing stigma, but we must reflect on the great challenges that remain in the battle against HIV and AIDS. I pay tribute to charities such as the National AIDS Trust, the George House Trust and the Terrence Higgins Trust, whose work has been at the forefront of the fight against HIV and to improve the nation’s sexual health.

The campaign strapline for National HIV Testing Week is “I test”—a message that cannot be repeated enough. Public campaigns such as this have helped to normalise HIV testing as routine and beneficial to both the individual concerned and society at large. Testing is quick, easy, confidential and free. It is the gateway to prevention and treatment and, ultimately, to ending new HIV transmissions. During National HIV Testing Week, anyone in England can order a free postal HIV test, funded by the Department of Health and Social Care and delivered by the Terrence Higgins Trust, as part of the national HIV prevention programme for England. I encourage anyone who is concerned to get such a test and take it.

There has been encouraging progress in reducing the prevalence of HIV across England in recent years. In introducing a national HIV action plan, the last Government sought to achieve an 80% reduction in new infections by 2025. Remarkably, the UK achieved the UNAIDS 95-95-95 targets back in 2020: 95% of individuals living with HIV were thought to be diagnosed, 99% of them were on treatment and 98% were achieving good viral suppression.

A growing proportion of HIV testing has been taking place by post or at home—44% in 2023 compared with 19% in 2019—which shows that the tests are acceptable to the public and welcomed by them. There has been a substantial increase in the number of tests taking place in emergency departments, with 857,000 in 2023 compared with 114,000 in 2019, mostly because of the opt-out testing introduced by the last Government.

We cannot be complacent. Although there have been areas of progress, in recent years we have seen a reversal of hard-won gains in reducing HIV transmission. Data published by the UK Health Security Agency in 2024 shows that the number of heterosexual men and women in England newly diagnosed with HIV has increased by more than 30% since 2022. Around 5,000 undiagnosed people are currently living with HIV in England.

HIV and AIDS cannot be solved in the UK without acknowledging the global context. Last year, AIDS-related illness claimed as many lives as the total of all wars, homicides and natural disasters that have ravaged our planet. In parts of southern Africa, in countries such as Botswana and Zimbabwe, more than a fifth of the adult population is living with HIV. Such figures remind us that the global fight with HIV is far from over.

I was troubled to hear in a House of Lords debate earlier this week that the head of UNAIDS has warned that global HIV infections could increase by more than 600% by 2029 if the US continues to suspend the UN HIV/AIDS programme. That will mean higher infection rates here in the UK, as communicable diseases do not recognise national borders.

[Florence Eshalomi]

I thank the shadow Minister for highlighting that. Does she share my concern that data and research from the Elton John AIDS Foundation shows that almost 228,000 people a day will miss out on HIV testing due to the pause in US aid? What should we do collectively, on a cross-party basis, to call that out?

[Dr Johnson]

The key is to ask the Government what support they will give to the UN and what conversations they are having with their US counterparts about the benefits to people both overseas and at home of ensuring that the battle against HIV and AIDS is won.

[Florence Eshalomi]

The hon. Lady was formerly the public health Minister, so I know she cares passionately about this issue. Does she agree that HIV has to be a cross-party issue, and that both the Government and the Opposition should be calling out the US pause?

[Dr Johnson]

It is clear that the battle against HIV is a cross-party issue. We have seen strides and improvements over the years under Governments of different colours. Yes, I was the public health Minister, and we met at an event where I announced the results of the first year of the opt-out testing and its success in reducing infections.

HIV testing is really important. I was pleased to see the Prime Minister test earlier this week; that is helpful in reducing the stigma associated with testing. It showed that anybody in any circumstances can have a test. Opt-out testing has identified cases where people who were thought to be very low risk unexpectedly turned out to be HIV-positive. When we brought in the opt-out testing, we targeted first the A&Es in areas of the highest risk, and we need to continue to target those highest-risk areas.

In October 2024, the Department of Health and Social Care revealed that over half of those with HIV had been previously diagnosed abroad. Will the Department consider the implications of these trends when it puts together its new HIV action plan in order to achieve the goal of no new HIV transmissions in the UK by 2030? Countries such as Australia and New Zealand require applicants to take an HIV test before they obtain a visa. Have there been any discussions between the Department of Health and Social Care and the Home Office about introducing such a requirement in the UK, as we have for tuberculosis?

Guidance from the Office for Health Improvement and Disparities—the Government’s own guidance, effectively —suggests that all men and women, and recently arrived children, known to be from a country of high prevalence should be recommended a test. It might be helpful if the Government followed their own guidance, because if we test the high-risk population, we stand more chance of picking up more cases, which would be beneficial.

Under the opt-out testing scheme brought in by the Conservative Government, a patient can explicitly decline instead of explicitly accept an HIV test. It has been rolled out in many A&Es across the country, and I am pleased that it will be coming to more. It has identified hundreds of people who were undiagnosed or lost to follow-up for treatment for HIV, and includes hepatitis B and C. Identification of those cases helps the individuals concerned and helps to reduce transmission across the wider population.

Between 2019 and 2020, the estimated number of diagnosed cases in England declined. However, somewhat counterintuitively, opt-out testing suggests there are more cases than we realise. Does the Minister have plans to re-estimate the number of undiagnosed HIV cases that may be out in the community waiting to be treated, in the light of the evidence from opt-out testing? The Opposition welcome the Government’s commitment to fund opt-out testing until March 2026, but NHS services need clarity on funding beyond that point. Will the Minister clarify whether long-term funding for opt-out HIV testing will be considered as part of this year’s spending review?

HIV prevention goes beyond testing. A perennial issue is access to PrEP treatment, to maintain the reduction in HIV cases in England. PrEP has been described as a miracle drug, which prevents HIV-negative people from acquiring the virus, and is a key tool to stop new HIV transmissions by 2030. However, waiting times for PrEP are too long—at one point, they were measured in months rather than weeks. What steps is the Minister taking to improve that? The last Government improved access to PrEP across the country by setting up the PrEP access and equity task and finish group. What steps have been taken to implement the group’s recommendations since the Government took office?

We have only one Parliament left to finally eradicate new cases of HIV by 2030. We owe it to everyone who has lost their life to this virus, everyone who has faced the stigma—thankfully, that is reduced but it still exists—of being HIV-positive and everyone who is living with HIV today to end new transmissions once and for all. I hope the Government continue the progress of the last Government with their new HIV action plan, and I hope that it will be developed soon. The former Minister, the hon. Member for Gorton and Denton (Andrew Gwynne), said in November that the plan was in production. I hope that it is getting closer to completion and that the Minister can give us an idea of when it will be complete. I hope that today’s debate will inspire thousands of people to get themselves tested.

Oral Answers to Questions

Caroline Johnson Excerpts

Tuesday 11th February 2025 Commons Chamber

[Mr Speaker]

I call the shadow Minister.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

There were almost 67,000 cases of serious antimicrobial-resistant infections in the United Kingdom in 2023. War is increasing such infections globally; 80% of patients in one Kyiv hospital in Ukraine are said to have such infections. The Conservative Government had a plan to tackle that. Do the Labour Government plan to follow that plan, are they on track to meet those targets, and if not, what will the Secretary of State do about it?

[Wes Streeting]

I am delighted that Dame Sally Davies continues her work on antimicrobial resistance. That is an absolutely critical issue, and I pay tribute to the previous Government, particularly Minister Quince, for their work on it. It is in the national interest that we maintain not just the national focus but the international focus on antimicrobial resistance, which is why UK leadership in those global fora is so important.

[Dr Johnson]

Another time when it is important to work together is during a pandemic, such as by sharing research. Unfortunately, recent history tells us that when Labour negotiates, Britain loses out. Can the Secretary of State confirm that, whatever emerges from discussions with the World Health Organisation, he will not reduce the UK’s capacity to take decisions in the interests of the British people.

[Wes Streeting]

May I just say how regrettable it is that a sensible shadow Minister is sent along to parrot the absurd lines of her leader?

National Cancer Plan

Caroline Johnson Excerpts

Tuesday 4th February 2025 Commons Chamber

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I thank the Minister for advance sight of his statement, and I thank all the NHS workers, charities, scientists and others working to help those with cancer.

We can all agree that tackling cancer should be a top priority for the NHS. From diagnosing people quickly to starting treatment quickly and using the latest technology and drugs, we all want to see improvements. The recent trends in cancer survival rates are positive. The one-year survival rate for cancer increased by 5.9% between 2010 and 2020, and the five-year survival rate increased by 4.3% in the same period. Despite those improvements, we are not yet where we want to be, and we will be up front about that.

In government, we took action to catch cancer sooner and boost survival rates, with initiatives such as lung cancer screening and prostate cancer trials, and we welcome that Labour is continuing with that mission. We will work constructively with the Government on that, as we all want to achieve the same positive outcomes. However, the statement as a whole is rather disappointing. The Minister has told us that this is a cancer plan, but it is not; it is a statement that there is to be one. The Government saying that they want cancer survival rates to increase and that they are going to have a plan does not make it so—we need the plan itself.

The announcement of the AI trial in breast cancer is a welcome approach. Artificial intelligence has the capacity to revolutionise the way we diagnose disease, and I am delighted that the Government wish to explore those opportunities. We also very much welcome the relaunch of the children and young people’s cancer taskforce, and are pleased it will be able to continue its valuable work under the co-chairmanship of my hon. Friend the Member for Gosport (Dame Caroline Dinenage) and Professor Darren Hargrave. It is just a shame that the Labour Government wasted seven months by suspending the Conservative taskforce, only to reinstate it now.

I note the Minister’s comments about waiting times to start treatment, and we agree that these must improve. I am sure it will not have escaped his notice that NHS Wales, which has been under a Labour Administration for 25 years, has a poorer performance, and I am certain he would not want party politics to affect such an issue. Can he tell the House what conversations he is having with his Welsh counterparts to improve cancer care there?

I am also concerned that last month, the Government appeared to quietly abandon the target of ensuring that patients receive treatment a maximum of 62 days from an urgent referral of suspected cancer, despite the Health Secretary having said before the election that a Labour Government would meet that target within the first term. Will the Minister clarify his commitment to the 62-day target?

More scanners are, of course, welcome, but what are the Government doing to ensure that there are enough trained professionals to interpret the results of the scans effectively?

With charities such as Macmillan and Marie Curie being hit with devastating increases in national insurance contributions, what help will be provided so that they do not have to cut back the vital support and guidance services they provide to cancer patients?

Anyone who has faced cancer will know that time is of the essence. The second half of the year—if it is not until December—could be quite a long time from now. Will the Minister therefore be more clear about when he intends to publish the plan? May I recommend using the evidence collected in our 2022 call for evidence, as well as the policies of the interim major conditions strategy, published in 2023, to speed up the plan? The quicker the Government act, the more lives they will be able to save.

[Andrew Gwynne]

I start by genuinely thanking the shadow Minister for the co-operation she has pledged as we seek to improve the outcomes for people with cancer. This is not a party political issue. We all want people to be diagnosed more quickly and to be put on the effective treatment pathways as quickly as possible, and we all want people to have better outcomes. I would just remind her, however, that while progress was made over the past decade, as I referred to in the statement, Lord Darzi clearly set out that the rate of progress was much slower than in comparator countries, and that we could and should have been on a much better trajectory.

That is why we are committed to a new national cancer plan—something for which the sector has been calling for some time. We are going to consult on that plan. I hope the shadow Minister is not suggesting that we should just pull a plan out of thin air without any consultation with the sector, patients or anybody with any interest in cancer.

Of course, things have changed over recent years. New technology has advanced and scientific progress is advancing, although there are still some areas where, stubbornly, there is not enough research. We need to build up the case for research and get the funding in; I think especially of brain tumours, where, quite frankly, things have not progressed at all. We need to ensure that in the 10-year cancer plan, we really drive forward in some of those areas, using the latest technology and scientific advances.

The shadow Minister asked about targets. I just say to her that we have actually strengthened targets, rather than setting new ones for cancer. Currently, the NHS is on track to deliver against its cancer targets for this year. Yes, we should be ambitious where we can, and that is exactly what this Labour Government are going to do.

Accessibility of Radiotherapy

Caroline Johnson Excerpts

Tuesday 4th February 2025 Westminster Hall

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

It is a great pleasure to serve under your chairmanship this afternoon, Sir John.

As we discuss the future of radiotherapy services, it is essential that we acknowledge the vital role our radiographers, medical physicists and oncologists play, along with all the nursing staff and others, in the delivery of care.

The professionals are the backbone of any successful radiotherapy service, and without them progress is impossible. However, it is clear that Governments have faced significant challenges in both staffing and infrastructure. I will take this opportunity to scrutinise the current state of radiotherapy services and the plans to address those concerns. The demand for radiotherapy has increased substantially in recent years, driven primarily by one factor: our ageing population, and the fact that as we grow older our chances of being diagnosed with cancer increase significantly. However, radiotherapy is and remains one of the most cost-effective treatments available within the NHS. Previous Governments recognised that fact, and between 2016 and 2021 they invested £162 million to enable the replacement or upgrade of approximately 100 radiotherapy machines.

Since April 2022, the responsibility for investing in new machines has sat with local integrated care boards in England, supported by the 2021spending review, which set aside money for the purpose. As hon. Members have said, to keep up with increasing demand and the need for cutting-edge care, there must be significant sustained investment in radiotherapy services. Radiotherapy is one of the most technologically advanced areas of healthcare, so it is incumbent on us to keep up with the latest scientific developments.

It is welcome that the Government have announced £70 million for new radiotherapy machines, but Radiotherapy UK has said that that is not enough and has suggested that the Government invest five times that amount to upgrade out-of-date machines. I would appreciate clarification on that point. The Government have consistently stated in written answers that funding for new radiotherapy machines will be allocated by ICBs using criteria set by NHS England, but how will they monitor the upgrading of the machines across ICB areas to ensure that that takes place and to prevent the postcode lottery that Members have described? Furthermore, NHS England has confirmed that it will give high-performing local systems greater freedom around capital spending. Will such freedoms include capital retention, which can be used to invest in new radiotherapy equipment?

One of the most pressing issues is the need for a comprehensive long-term strategic plan for radiotherapy from the Government. The absence of such a plan hinders the ability to think strategically about the future of cancer care and to make the necessary investment to meet growing demand. I am glad that today, World Cancer Day, the Government have committed to produce a new cancer plan. We are told that it will include details about how outcomes for cancer patients, including waiting times, will be improved. Will the Minister indicate whether it will provide specifics on the roll-out of radiotherapy machines in the short, medium and long term?

In response to a written question last month, the Minister clarified:

“NHS England does not hold any data on the effectiveness of radiotherapy machines relative to the number of doses that they deliver.”

Hon. Members have said that newer machines will be able to deliver more doses more quickly. I would be interested to know whether the Department has any plans to collect such data.

Of course, any strategic plan should focus not just on the machines, but on the people who operate them—the radiotherapy workforce. What steps are the Government taking to improve the recruitment and retention of the radiotherapy workforce?

In a written question, the hon. Member for Westmorland and Lonsdale asked the Government whether they had consulted or planned to consult with clinical experts, the radiotherapy industry, patients or charities about how best to allocate the funds announced in the Budget for the new radiotherapy machines. The Minister responded by saying:

“The Department has no plans to consult on this matter”,

and reiterated that the funding would be allocated using NHS England criteria. The Minister today announced the plan to produce a cancer strategy. Will that include radiotherapy? Will he commit to working with Radiotherapy UK and providers to improve access to radiotherapy treatment where it is currently lacking?

The hon. Member for Westmorland and Lonsdale (Tim Farron) made a very compelling case about long journeys. He spoke about a service in his constituency, and there are others that are similarly affected. We know that earlier treatment affects survival rates. I asked the Minister a question in the main Chamber earlier about the 62-day target, and I did not hear him answer. Will he confirm that he intends to stick to the Health Secretary’s previous commitment to reaching the 62-day target by the end of this Parliament?

In addition to Government investment, the private sector plays a role in ensuring the future success of radiotherapy services. The NHS has signed a significant partnership agreement with the independent sector to increase capacity for diagnostic and elective procedures, which will help to reduce waiting times, but it is not clear whether that agreement includes treatment equipment such as radiotherapy machines. Will the Minister confirm whether the Government will work with the independent sector to upgrade equipment such as radiotherapy machines? A partnership that includes capital investment in radiotherapy equipment could ease the burden on the NHS and speed up access to treatment for patients.

I know the Minister is hugely motivated to do all he can to improve cancer care, as we all are. This debate should have helped to give him a steer on how that can be achieved.

[Sir John Hayes (in the Chair)]

I ask the Minister to leave a few moments for Mr Farron to say a final word of wind-up, and Mr Farron, in turn, to leave me a few moments to put the question.

Draft Medicines for Human Use (Clinical Trials) (Amendment) Regulations 2024

Caroline Johnson Excerpts

Monday 3rd February 2025 General Committees

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

It is a pleasure to serve under your chairmanship, Sir Desmond. The Minister said that 17.5 million people in the United Kingdom are living with a long-term health condition. Every time the news comes on of an evening, they will hope that it brings some hope of a new treatment that promises the cure or effective treatment of their condition, or the condition of one whom they love. Unfortunately, the news today tells them that AstraZeneca has cancelled its investment in the UK, which is a big loss for life sciences and cures for people in this country.

Never the less, these regulations are a positive change. This instrument will reform the UK’s clinical trial regulatory regime with the aim of delivering a more

“proportionate, streamlined and effective clinical research environment”

by amending the Medicines for Human Use (Clinical Trials) Regulations 2004. These draft regulations are a response to a public consultation launched under the Conservatives in 2022, which asked for feedback on how the regulation of clinical trials could be improved and strengthened in the UK.

I agree with the Minister that we have an opportunity, now we have left the European Union, to design a world-class, sovereign regulatory environment for clinical trials that supports the development of innovative medicines and ensures that the UK retains and grows its reputation as a world-leading base for life sciences, generating opportunities for skilled jobs in the UK. As Conservatives, we welcome innovation and want to support UK patients getting early access to new and innovative treatments. For those reasons, we welcome the changes.

Among the many changes this instrument would make, it would legislate for a notification scheme to enable lower-risk clinical trials to be automatically approved by the licensing authority, where the risk is similar to that of standard medical care. A favourable opinion from an ethics committee would still be required to safeguard people taking part in the trial. The impact assessment estimates that around 20% of initial clinical trial applications would qualify for the notification scheme.

When asked about eligibility criteria for the scheme, the Medicines and Healthcare products Regulatory Agency explained that an application would be eligible if the medicine being investigated is used in line with its authorised use or established practice, supported by evidence; a previous similar clinical trial of a product has been approved in the last two years; or the same trial has been approved in the United States or a European economic area country.

While the clinical trial sponsor is responsible for determining whether the application meets the criteria for notification, the MHRA stated that a verification process would ensure their determination is correct. The notification scheme currently exists on an opt-in basis. The MHRA says that that has reduced the time required to initiate lower-risk clinical trials by more than 50% without compromising patient safety. That will clearly help people to get the new treatments quicker, and is to be welcomed.

We consider that the draft regulations will simultaneously remove obstacles to sponsors’ carrying out clinical trials, while ensuring the focus remains on protection of those participating in the trials. It will remove the aspects of legislation that are more prescriptive, in favour of introducing greater flexibility and more risk proportionality, to reflect that trial design and operation is evolving with innovations in the products that trials investigate. Ultimately, these proposed new requirements will ensure that trial participants and their safety are at the heart of legislation.

One thing I would like the Minister to clarify is that on the one hand he was saying that this change in regulation will be revolutionary for people getting trials and drugs more quickly, whereas on the other hand he gave a de minimis amount in terms of the financial benefit. Could he explain that contradiction?

[Andrew Gwynne]

I thank the shadow Minister for her support for this piece of secondary legislation, which marks the most substantial update to UK clinical trial regulations in more than two decades. This is an important step forward to deliver a more efficient and adaptable regulatory framework, all while ensuring the safety of the trial participants. The reforms will deliver a proportionate, flexible and efficient clinical research environment, with patients at the very heart of the process.

The shadow Minister raised the issue of AstraZeneca and the support for life sciences in the UK. Without straying too much from the measures before us, Sir Desmond, I want to reassure the Committee that this Government are fully committed to supporting the UK’s life sciences sector. Today we have heard about how vital clinical trials are in driving the health and wealth of the UK. The sector has experienced strong growth in recent years; between 2022 and 2023, the number of UK industry-led clinical trials increased by 3.7%. The UK has also gone up in the global rankings for phase 2 trials, moving from sixth to fourth place.

That progress is a testament to our thriving research ecosystem, something that was developed under the previous Government and that we want to build on, which is what this set of regulations is all about. They are about making sure that our country is at the cutting edge of the latest developments in medical science and that British patients are able to access those treatments as early as possible, through clinical trials and then through the early adoption of those medicines once they are brought to market.

The shadow Minister asked about the de minimis assessment. An assessment of the updated legislation has been produced, which estimates that there will be a total transition cost of approximately £720,000 to business for organisations to familiarise themselves with and operationalise the changes. It is expected that the annual total benefit to businesses will be £1 million, primarily due to the changes in the approval processes. I sought to correct the record in my opening remarks because it had originally been anticipated that we would need to have the full assessment, but on closer scrutiny that is not necessary because of the reasons that I have just set out.

[Dr Johnson]

When the Minister talks about £1 million, is that the benefit to businesses in the current level of trials? Or is that his estimate of the rise in the number of trials as a result of the changes?

Tobacco and Vapes Bill (Thirteenth sitting)

Caroline Johnson Excerpts

Committee stage
Tuesday 28th January 2025 Public Bill Committees

[Gregory Stafford (Farnham and Bordon) (Con)]

It is a pleasure to serve under your chairmanship this morning, Mr Pritchard.

Clauses 126 and 127 and schedule 16 pertain to audiovisual and radio broadcasting restrictions on tobacco, vapes and the related products that we have been discussing endlessly in this Committee. Although there is a strong argument for the measures from a public health perspective, there may be legitimate concerns regarding freedom of expression and the impact on broadcasters and advertisers —I may be pre-empting points my hon. Friend the Member for Windsor will raise.

One of the most compelling arguments for the clauses is their role in protecting young people from exposure to tobacco and vaping products. Studies have consistently shown that advertising plays a significant role in influencing smoking and vaping initiation. Research from Cancer Research UK indicates that young people who are exposed to tobacco advertising are more likely to start smoking, and similar findings have been observed with vaping products, where targeted marketing strategies have contributed to a rise in e-cigarette use among teenagers.

By restricting tobacco and vape-related advertisements on television, radio and on-demand services, the clauses aim to reduce the normalisation of smoking and vaping. The UK has already seen the benefits of such measures in relation to tobacco: since the implementation of the Tobacco Advertising and Promotion Act 2002, smoking rates have declined significantly. Extending similar restrictions to vaping is the logical next step to ensure that history does not repeat itself, with a new generation becoming dependent on nicotine.

Critics might argue that the clauses may have unintended consequences for broadcasters, advertisers and the creative industries. The sector relies heavily on advertising revenue, and restrictions on tobacco and vaping-related content may limit potential funding sources, particularly for smaller, independent broadcasters, in an already challenging economic environment. However, as we have seen with the existing bans in relation to tobacco, the public health benefits clearly outweigh the potential issues with the funding that broadcasters could get from vape advertisements.

There is a practical consideration about how the clauses are enforced. We must ensure that broadcasters and on-demand services comply with the new restrictions, and that will require regulatory and oversight resources. Perhaps the Minister could give us some idea of how the provision will be enforced, whether that is through Ofcom or some other means. There is also a concern about what I describe as cross-border broadcasting. Many streaming services operate internationally, so content produced abroad but accessible in the UK may not be subject to the same restrictions, and if it is, ensuring compliance with UK regulations on the global platforms will present a significant challenge. How does the Minister intend to enforce the provisions in those cases?

This is a complex issue and a balanced approach is necessary, but as I have said, investing in public health campaigns alongside the regulatory measures could help to ensure that the public receive accurate information about smoking and vaping. I therefore support the clauses.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I support the clauses too, although I have a couple of questions. I hope the Minister will be so kind as to answer them.

Clause 126 outlines that part 6 does not apply to independent television or radio services, services provided by the BBC or Sianel Pedwar Cymru, on-demand programme services, or non-UK on-demand programme services that are tier 1 services as defined in the Communications Act 2003. Essentially, they will be covered by Ofcom. Paragraphs (a) and (b) specify exclusions for independent television and radio services regulated by Ofcom, provided they are not classified as additional services. Will the Minister clarify how additional television services and digital additional sound services are defined in practice, and what criteria will be used to classify services at the margins of those categories?

The clause exempts services that are defined as on- demand services under section 368A of the Communications Act from provisions of the Bill. In the rapidly evolving digital media landscape, does the Minister believe that the definition of an on-demand programme service is sufficiently clear to encompass emerging service models? Given the rapid growth of online platform streaming services and the desire he previously expressed to future-proof the bill, does he foresee current exclusions in clause 126 remaining relevant in the future? Should how these platforms, whether UK or non-UK based, are regulated be reconsidered, to ensure they adhere to the same standards as traditional broadcast media in relation to tobacco and vapes while being viewed in the UK? We keep coming to this point—how online services can be used to circumvent measures of the Bill.

[Gregory Stafford]

My hon. Friend makes a good point, raised in a number of our debates, about future-proofing the Bill. There is a big discussion going on about artificial intelligence and how that plays in. I do not know whether my hon. Friend has thought about that, or whether the Minister can clarify how artificial intelligence may be used by the tobacco and vaping industry to get round some of the provisions, and whether the future-proofing is strong enough to deal with that.

[Dr Johnson]

I know my hon. Friend is very interested in AI. I am sure that if it is possible to do so, these industries will use any means available to them to maintain their market.

The clause extends the regulations from tobacco to cover all vaping products, herbal smoking products, cigarette papers and nicotine products. Given my concerns about children and vaping and the use of nicotine, I think this is a sensible measure, which I support.

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

It is a pleasure to serve under your chairmanship, Mr Pritchard. Clauses 126 and 127 and schedule 16 contain provisions relating to audiovisual services and radio broadcasting. Clause 126 provides that part 6, which deals with advertising and sponsorship, does not apply to certain categories of television and radio service. That is because these services are already prohibited under the Communications Act 2003.

Clause 127 introduces schedule 16, which amends the Communications Act 2003. The amendments extend provisions in that Act that ban advertising and sponsorship of tobacco products in certain TV and radio services to include herbal smoking products, cigarette papers, vaping products or nicotine products. That ensures that the advertising ban on tobacco in television, radio and on-demand programme services is extended to all of those products. In practice, the measure means we will no longer see banned products or promotional material for those products on any of those mediums.

The shadow Minister rightly points out that the services listed in the clause include ITV, independent television and radio, the BBC and Sianel Pedwar Cymru, and on-demand programme services—that covers the points that Members have made—and non-UK on-demand programme services, which are tier 1 services as defined in the Communications Act 2003. I hope that reassures the hon. Member for Farnham and Bordon that it also includes programmes produced and aired outside the United Kingdom that are brought into the United Kingdom.

As a helpful aide-mémoire for the Committee, the Communications Act 2003 regulates telecommunications broadcasting. It confers functions on the Office of Communications, a regulator, to oversee the services. The Act puts in place effective rules for the advertising of tobacco on television, radio and on-demand services. By amending the Act, we ensure that this existing framework also applies to vaping products, nicotine products, and cigarette and herbal smoking papers. There is no need to reinvent the wheel and add more to the Bill, as we can use the existing provisions in the 2003 Act. I therefore commend the clauses to the Committee.

Question put and agreed to.

Clause 126 accordingly ordered to stand part of the Bill.

Clause 127 ordered to stand part of the Bill.

Schedule 16 agreed to.

Clause 128 ordered to stand part of the Bill.

Clause 129

Enforcement authorities

Question proposed, That the clause stand part of the Bill.

[The Chair]

With this it will be convenient to consider clauses 130 and 131 stand part.

[Dr Johnson]

The clause outlines the responsibilities and jurisdictions of enforcement authorities tasked with ensuring compliance with part 6, which covers advertising and sponsorship. Subsection (1) establishes that the enforcement authorities are legally bound to enforce the provisions of the Bill, and subsection (2) contains the definition of an “enforcement authority”. All that sounds very straightforward and sensible, but my question is about funding. If the weights and measures authorities are given an obligation to enforce something but not given the resources to enforce it, they are being given a legal obligation with which they have not got the resources to comply.

Paragraphs 613 and 614 of the impact assessment state that the average trading standards service, of which there are 197, has 9.4 full-time equivalent professionally qualified staff. It is assumed that all those staff would need to be familiarised with the policies and all the various regulations once they are passed through Parliament. We have talked about the amount of regulations that will be created under the Bill; staff will need to be trained in all that. In 2024, the cost of such training was estimated at £23,137, but given that the Bill will not come into force until later—we are in 2025 now—that is a moot point. How much does the Minister think training will cost once all the regulations are up and running? Clause after clause of the Bill provides for regulations to be made, which may be done in one go or several, repeating the need for training.

The impact assessment also talks about the cost of training for the Advertising Standards Authority, estimating it to be £1,945. If it costs that to train all the staff from the ASA on a given topic, it suggests the rest of the public sector’s training could definitely be made more efficient. I suggest that the Minister has a chat with the Chancellor about it—I believe she is looking for ways to make the country more efficient, which she has done so far by making businesses not exist—as it seems a little out of kilter, although I was not sure whether it was a dot or a comma. The impact assessment also measures what it believes Ofcom would need to enforce the training under the new measures. It estimates £3,500 for the staff there, but again, does the Minister think that is realistic?

Clause 130 is about the power of Ministers to take over enforcement functions in a specific case. We have talked at some length in previous debates about the potential for abuse of power in such measures. Clause 131, similarly, is about the power of Ministers to take over proceedings as part of the enforcement functions in respect of a specific case. Again, while I can understand the Minister’s desire to be able to take over from a weights and measures authority as a whole if there were to be a problem with the way it was functioning in a specific case, can he give assurances that there would not be any abuse of power in that respect?

[Andrew Gwynne]

I thank the shadow Minister for her questions. The Government are investing over £100 million over five years to boost His Majesty’s Revenue and Customs and Border Force’s enforcement capability to tackle illicit tobacco. In 2025-26 we will invest £30 million of new funding for enforcement agencies, including trading standards, Border Force and HMRC, to tackle illicit and under-age sales of tobacco and vapes, supporting them to implement the Bill.

Decisions on funding for trading standards in future years will be made as part of the spending review process, but given our clear commitment to enforcement in the Bill and the fact that we have put down the payment of £30 million for enforcement in the next financial year, I hope hon. Members are assured that we take these matters seriously. We are investing £3 million over two years specifically to enhance the work led by National Trading Standards to tackle under-age and illicit vape sales. That work is carried out through enhancing market surveillance and enforcement action on ports, online sales enforcement, and boosting the storage and disposal of illicit vapes. The new funding for 2025-26 will build on this work to tackle under-age and illicit vape sales.

The shadow Minister asked how trading standards will use their additional enforcement funding. The crucial point is that we want to boost trading standards’ capacity, to enable the services to conduct more under-age sales test purchases, remove illicit products from the market and identify non-compliant products and bring them into compliance where possible.

[Dr Johnson]

My question was not simply how trading standards will use the money allocated, but whether the Minister feels that the money he has allocated is adequately purposed?

[Andrew Gwynne]

I do, which I have just said. The £30 million in the next financial year to boost the enforcement agencies will meet the needs that the Bill sets out. It is also about boots on the ground and having greater capacity. We will be working with trading standards on this additional enforcement funding to ensure that they increase their capacity and are able to take on the roles and responsibilities that the Bill places on them. We will continue to discuss with trading standards how we can best support them in respect of the measures of the Bill. I commend the measures to the Committee.

Question put and agreed to.

Clause 129 accordingly ordered to stand part of the Bill.

Clauses 130 to 132 ordered to stand part of the Bill.

Clause 133

Power to extend Part 6 and Communications Act 2003 to other products

Question proposed, That the clause stand part of the Bill.

[Dr Johnson]

Clause 133 gives the Secretary of State the power to extend part 6, which deals with advertising and sponsorship, and the Communications Act 2003 to other products, specifically products that are devices of a specified description enabling a tobacco product to be consumed, such as a heated tobacco device or pipe, or an item that is intended to form part of such a device. It allows the Secretary of State to consult with the required persons and gain consent where required with the devolved legislatures. However, how will the Secretary of State further define that, and can the Minister give us some examples of the types of products that might be included under the power? Could it allow for the expansion of regulation to a wide range of products not originally envisaged in the Bill?

The inclusion of devices and items potentially covers a wide array of consumer products without any clear boundary. What are the specific criteria or considerations that the Secretary of State must use when deciding whether to extend the provisions? Could that lead to arbitrary or inconsistent decision making, depending on the political or public health priorities of the Government of the day? The wording seems to give considerable latitude, but not much clarity on when or how the Secretary of State should exercise the power.

[Andrew Gwynne]

I am very happy to answer the question posed by the shadow Minister. It is a simple answer: we need clause 133 to avoid loopholes. Otherwise, newer products such as heated tobacco—and those products that have not even been developed yet—are in scope of the restrictions, but devices used alongside them could still be used to promote tobacco consumption.

Question put and agreed to.

Clause 133 accordingly ordered to stand part of the Bill.

Clauses 134 and 135 ordered to stand part of the Bill.

Clause 136

Addition of smoke-free places in England

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[The Chair]

I remind Members that we are at this point talking about amendments, so any comments should be restricted to those amendments. We can talk about the generalities of the clause later in the debate. It is always helpful to have a reminder of that—for myself as well.

[Dr Johnson]

I thank the hon. Member for Dartford for clearly laying out what he seeks to do. I understand that his desire to see a healthy population is driving his good intentions behind this amendment, but I have some concerns. We are creating an offence of smoking in specific places: that requires buy-in from the public, because we police with consent, and the public need that knowledge. I visit Newcastle a reasonable amount, and I did not know that there was a rule banning smoking on park benches. I do not smoke, so it did not apply to me in any case, but it is conceivable that others are not aware that Newcastle has local rules.

I am concerned about the consistency of such measures and about people’s awareness of where it is possible to do something; otherwise, we will create criminal offences and fine people large amounts of money for doing something they had no reason to prevent themselves from doing because they had no way of knowing. The Government are also in the midst of reorganising —or trying to reorganise—all the local authorities; if local authorities are going to make such decisions and then be reorganised, that could further add to complexity and confusion for the public.

For people who smoke, we want to limit the harms to their health and ensure they have the opportunity to quit or to minimise those harms. Not everybody has a garden or outside space of their own. If they live in a flat and are a smoker, only being able to smoke in that flat because all the outside spaces are gone will increase the dangers to them, for health and for other reasons. My personal opinion is that these laws, or at least the principle of which spaces may and may not count, should be made nationally—even if there is some local guidance to be followed.

That is why we will come to the principle of which sort of spaces, because at the moment it is any space. It is conceivable therefore that, under the hon. Gentleman’s amendment, a group of local councils could decide to make all outdoor spaces of all kinds smoke-free. While I would find that desirable as a non-smoker, it would not be good for the overall health of the 11% of people who do smoke.

[Gregory Stafford]

Looking at the amendments, I can see why the hon. Member for Dartford wants to do this. There clearly could be public health benefits and, as a localist myself, I am naturally sympathetic to having local decisions made as close to people as possible. I think the point I made during the intervention stands, however: the potential for confusion among people who are potentially not from the area, or who are from the area but do not understand the local byelaws, probably makes the amendments unworkable.

My hon. Friend the shadow Minister and the hon. Member for Dartford mentioned that smoking prevalence is higher in places of social deprivation. The hon. Member seemed to be suggesting it would therefore be better to enforce regulations, or byelaws for regulations, in those areas. I can see the public health impact, but we must not ghettoise people who are from lower socio-economic backgrounds and who are more likely to smoke, as seen in the evidence. The shadow Minister makes a good point that people who do not have outside space, and who may have children and not want to smoke and vape in their properties because they are rightly worrying about their children’s health, will find that difficult if there are local byelaws in place that prevent it. I think that is especially true with women who smoke.

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[Sarah Bool (South Northamptonshire) (Con)]

Taking on board what you said, Mr Pritchard, I just want to build on the point that my hon. Friend made about enforcement—I always talk about enforcement in practice. I want to know how rules will be advertised between different jurisdictions. I think we will end up spending an inordinate amount of money on trying to run a campaign that could have been better spent on helping with smoking cessation or on more practical measures.

[Dr Johnson]

My hon. Friend is talking about the enforcement and practicalities of such a move. If we have a national campaign and national uniformity about the areas in which one can and cannot smoke, that will be quite straightforward for people to understand and there will be no real excuses for breaking the rules. If the advertising has to be done locally, it will have to be continuous to reach all the visitors and tourists who come to that town or city.

[Sarah Bool]

I absolutely agree, and my hon. Friend makes a powerful point. I would like us to consider this issue when we look at whether to take these proposals any further. I cannot see how we can ensure in practice that everyone knows what is happening without there being a national campaign.

[Sarah Bool]

I thank the hon. Member for clarifying that point. Many Members would prefer that local councils were dealing with potholes rather than advertising those different spaces, but I thank him for his amendment and his proposal.

[Dr Johnson]

Amendment 14 defines a local authority as

“a county council…a district council, a London borough council, the Common Council of the City of London in its capacity as a local authority, the Council of the Isles of Scilly, a combined authority or a combined country authority.”

By the time we get to next summer, Lincolnshire will probably have district councils, a county council and a mayoral authority—I do not agree with having a mayoral authority, because I think that is too many tiers of government, but that is an aside. What if those authorities do not agree? If we give them all the power to make regulations, they could all make different regulations based on different opinions—as is currently the case in Lincolnshire, the various authorities are not always under the control of the same political party.

[Andrew Gwynne]

I am grateful to my hon. Friend the Member for Dartford for bringing this issue before the Committee. As we have heard, amendment 11 would introduce a power for local authorities to make byelaws relating to the designation of additional smoke-free places in England, which would sit alongside the Secretary of State’s power to make regulations in the same regard.

As we know, the Bill expands the Secretary of State’s powers to create additional smoke-free places at the national level. In England, the Government have already indicated that we intend to extend the smoke-free designation to outdoor places including children’s playgrounds and outside schools and hospitals, but not to outdoor hospitality settings or wider open spaces such as beaches. The reforms we are setting out in the Bill will be subject to full consultation, and we want to hear the views of people from across the country to ensure that we get them right.

As drafted, the Bill gives no additional powers to local authorities. However, they have existing mechanisms for designating certain spaces as smoke-free. As we have heard, areas such as Manchester, my home city, have already used pavement licensing provisions to ensure that people have smoke-free options when they consume food and drink in certain locations, and that works well. Some local authorities have implemented public space protection orders to prohibit smoking in certain areas. For example, the London borough of Enfield has used a public spaces protection order to restrict smoking within the boundaries of children’s playgrounds. Of course, that will be obsolete should the consultation for the national scheme extend to children’s playgrounds, as we intend it to.

[Dr Caroline Johnson]

I thank the Minister for making those interesting points. Can he clarify whether powers such as those enacted in Enfield create a criminal offence?

[Andrew Gwynne]

We want to ensure that people who are smokers are not criminalised. Public space protection orders do potentially go down the criminal route. We want to ensure that that is not the case, which is why the Enfield scheme would of course be obsolete under the later provisions—which we are going to discuss today, hopefully—in relation to extending national outdoor smoke-free places.

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[Andrew Gwynne]

I suspect we are straying off the measures before us, Mr Pritchard, but I assure the hon. Gentleman that consultation is a statutory duty in this Bill. Were the Secretary of State, or indeed Welsh, Northern Irish or Scottish Ministers, to seek to change the scope in the future, they would have a duty at every stage to consult further. I hope that reassures the hon. Gentleman.

I was talking about Enfield and its public spaces protection orders. It is of course for the local authority to determine whether a PSPO is appropriate and that the legal test for implementing a PSPO is met, along with completion of the relevant consultation requirements. Nottingham has created a voluntary smoke-free zone at events, especially those where children are present, and it introduced a smoke-free play park policy in 2015. Other local authorities, such as Oxfordshire county council, have introduced voluntary smoke-free school gates policies. Given the options already available to local authorities and the national reforms introduced through this Bill, which we will debate further, neither the Government nor I think it is necessary to grant these byelaw-making powers via the Bill.

In answer to a point that the shadow Minister raised, which I hope to answer for my hon. Friend the Member for Dartford, legislation sets out all the different types of local authority. Enforcement in terms of the requirement to police any changes would appertain to the particular local authority, because it would be on that local authority’s land that the measures would apply. For example, in a two-tier area, if the county council as the highways authority deemed that pavement licensing were to be introduced, it would be for the county council to enforce its own measures; if a district council brought in measures in a park for which it was responsible, it would be for the district council. I think that is quite a simple explanation.

I understand that we have a complex jigsaw of local government, but it is for the particular type of council or authority that introduces a measure to enforce it. For example, the pavement licence in the City of Manchester is for the City of Manchester to enforce—not Andy Burnham as the Mayor of Greater Manchester, or indeed the Greater Manchester combined authority. That is pretty simple.

[Dr Johnson]

My question was not so much about the enforcement, which is defined in the Bill as the local weights and measures authority. Amendment 11 says that a local authority may make byelaws. The local authority that may make these byelaws includes the whole range of county councils, district councils and combined authorities, implying that, whoever is enforcing it, those that could make a byelaw could overlap and have contrary views.

[Andrew Gwynne]

Obviously, if a local authority introduces byelaws, as the City of Manchester has done in respect of pavement licensing, it is for that local authority to ensure that those byelaws are adhered to. Of course, in that case, the weights and measures authority is the City of Manchester, so I suppose that makes it easier.

These powers are already being used. Local authorities are already designating areas, whether it is for pavement licences, public space protection orders or just deeming that land within their own responsibility is smoke-free. We do not believe that the amendments are necessary. I kindly ask my hon. Friend the Member for Dartford to withdraw them.

--- Later in debate ---

[Dr Johnson]

I shall speak to amendments 95 and 94, which stand in my name. Amendment 95 is similar to the amendment moved by the hon. Member for Dartford a few minutes ago. Members will remember that earlier in the summer the Labour Government suggested that they would include hospitality venues within the scope of outside spaces, which led to pushback from a number of sources, mostly the hospitality industry. Speaking to Sky News on 5 November, the Secretary of State said that it was

“a leak of a Government discussion”,

but that it had promoted

“a really good debate about whether or not it would be proportionate”.

He then said:

“I think people know that the UK hospitality industry has taken a battering in recent years—”.

I agree with the Secretary of State on that. Covid-19 certainly challenged the hospitality industry. The previous Government supported it through business loans, reduced taxation and furlough schemes. Now, just as the industry is getting back on its feet, this Government have battered hospitality providers by raising national insurance contributions, increasing the minimum wage for young people, increasing business rates, introducing the deposit return scheme, and nearly doubling business rates for small businesses. They are indeed taking a battering; we can agree on that. In that Sky News interview, the Secretary of State also said:

“we do not want to add to their pressures, so we are not proposing to go ahead with an outdoor hospitality ban at this time”.

That was in November, but does he still mean it now? How will we know?

The challenge of this clause is trust. The Prime Minister has talked about trust. Before the general election, the current Secretary of State for Environment, Food and Rural Affairs said, at the Country Land and Business Association conference, that Labour had no intention of changing the rules on agricultural property relief—but they have. The Government’s manifesto said that they would not increase national insurance on working people —but they have. On 11 June, Rachel Reeves told the Financial Times that she had no plans to increase capital gains tax—but she did. Labour said that it would not make changes to pensioner benefits, but then removed the winter fuel allowance. So there is no trusting that this Government will do what they say they are going to do and not do what they explicitly say they will not. I hope the Minister understands my reasoning.

It is interesting that the Liberal Democrats have a similar amendment to the Conservative amendment on this topic. As I said before, people need some form of open space and not everyone has a garden. There is some confusion about hospitality venues. For example, some pubs have a kids’ play area; will that be treated as a play area within the scope of the regulations, or will it be a hospitality area? Under the current statement, the Secretary of State will not include play areas, but the powers under the clause, which we will come to as a whole, give wide scope for the Minister and the Secretary of State to designate virtually anywhere as smoke-free, with criminal sanction for those smoking or vaping. The Minister and the Secretary of State have said that their only intention is to use these policies for NHS properties, hospital buildings, children’s play areas and education facilities. This being the case, I cannot see why the Minister would not be happy to have that on the face of the Bill. It is the stated intent. I am sure the Government will understand my point about trust.

There are a few minor differences between the Liberal Democrat amendment 4 and the Conservative amendment, mainly in that the Conservative amendment includes nurseries and the Liberal Democrat amendment defines play areas and playgrounds, as opposed to simply playgrounds. These are relatively small differences other than the addition of nurseries, which is beneficial that is where the smallest children are. Clearly smoking in a nursery school is an antisocial behaviour, so it would make sense for them to be included.

Amendment 94 states that:

“The Secretary of State may designate a place or description of place under this section only if in the Secretary of State's opinion there is a significant risk that, without a designation, persons present there would be exposed to significant quantities of smoke.”

The Health Act 2006 states that the Secretary of State has to be clear, in his own mind, that there is a risk of high levels of smoke if he is going to ban smoking, so it is a measure of proportionality. Smoking in an outdoor space, miles from anywhere with nobody about, exposes no one but the smoker, making it slightly safer to smoke outside than inside for both the smoker and the people around them.

Why did the Minister choose to remove the “significant smoke” measure from the legislation? Does he feel that there is no significant amount of smoke to be inhaled by somebody who is in an outdoor space with somebody else? What is the chief medical officer’s advice on the amount of smoke that is likely to be inhaled by someone in an outdoor space alongside or nearby someone who is smoking? I understand that there will be a duration issue—how long the person is sat there, how long the smoker is smoking for and how many cigarettes they have, how close the person is and how windy it is—but will the Minister explain why he chose to remove that measure?

[Gregory Stafford]

I agree with my hon. Friend the shadow Minister. It seems strange that the Government want to have such wide-ranging powers in this area. Unlike other parts of the Bill, where technologies and such may move on and where I appreciate the need to future-proof, here it is very clear. I do not think that at some point in the future we will believe that smoking in playgrounds, or smoking in a field with nobody else around, are better or worse than they are now.

I have a lot of sympathy for the Liberal Democrats’ amendment 4 and our amendment 95. As my hon. Friend pointed out, the amendments are relatively similar, if not word for word the same. It almost takes us back to coalition days in 2010—let us hope that does not happen too often—and shows that His Majesty’s Official Opposition and the Liberal Democrats have significant concerns. While the Minister and his colleagues have said that they will not extend a smoking and vapes ban to hospitality venues, there is a lack of trust on our part, because even if it is not in the current Minister or Secretary of State’s mind, a future Secretary of State may be minded to put such a ban in place. That is why the amendments tightly define exactly where the smoke-free areas could be.

It is obvious that we do not want people smoking in children’s playgrounds, nurseries, schools or higher education premises. We have had some debate about this on other clauses, but I personally believe that we should not be smoking in NHS properties either. None the less, to return to a point I made previously, if we are going to permit people to do something within the law—people born before 1 January 2009 if we are talking about smoking and everybody over the age of 18 if we are talking about vaping—they must have somewhere safe to be able to do it.

The point of the clause is to address the impact of smoking and vaping on others. I take the shadow Minister’s point that clearly, if someone is smoking in a playground, it will have a greater impact on other people than if they are standing in the middle of a park or field with nobody else around. There needs to be an element of proportionality. As the shadow Minister and the hon. Member for Winchester said, we do not want to do anything that could harm our already stretched hospitality industry, which is under extreme pressure. If the Minister or Secretary of State were minded to start imposing bans in hospitality, that would have a significant impact on the hospitality business. I support the two amendments.

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[Gregory Stafford]

I thank the hon. Lady for her clarification. I have great respect for her public health abilities and knowledge. I accept the points that she made, but Opposition Members feel that including in the Bill areas that will potentially be consulted on being smoke-free is proportionate to ensure that there is not overreach. I know that if the amendments are accepted and, at a future point, attitudes and science change, she will be a doughty campaigner to have the law changed, and I am sure that she will achieve it, if that is the way she wants to go.

[Dr Johnson]

In response to what my hon. Friend and the hon. Lady the Member for Worthing West are saying, as a doctor, I have a lot of sympathy with her position. Certainly, if I take my children out for a meal in a restaurant and we sit outside in the summer, having a lovely day in the beer garden, and along comes a family or another group of people who sit and smoke, I dislike that. Whether it should be made illegal is a different matter, but it is something that I do not like.

As my hon. Friend said, there is a balance between enabling someone to do something that we have decided will be legal—that is, someone who is born in the right timeframe to be able to smoke—and giving them somewhere safe to do so. Over time, I suspect the measures that the Bill as a whole grants will lead to a reduction in smoking, which, of course, is its intention. As smoking becomes less prevalent, it is likely that smoking in front of children, particularly in outside hospitality spaces or in other places, will become less socially acceptable. We saw hospitality bring in non-smoking areas in the past.

The hon. Member for Winchester talked about having two different beer gardens in the same pub, one for smoking and one without. It is within the capacity of any given hospitality business to choose, as smoking becomes a minority and antisocial pastime, not to allow it within their facility, and to police that by throwing people out. It is also possible for individuals to choose not to attend a beer garden of a pub where smoking is allowed. To some extent, therefore, the ability of people to choose and vote with their feet, and the desire of the market and hospitality industries to maintain their custom, will surely have some effect on this over time.

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[Mr Alex Barros-Curtis (Cardiff West) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Pritchard. I rise to speak to amendments 4, 95 and 94; as they are very similar, my comments will apply in the generality. It is disappointing to hear the shadow Minister’s cynicism about the commitments made by the Minister at the Dispatch Box.

[Dr Johnson]

I was merely giving examples.

[Mr Barros-Curtis]

She may well have given a few examples—I can think of a litany of examples from the previous 14 years of Tory Government. However, that would stray from the amendments, and as we do not have the time, I will not indulge the Committee with that. But I would suggest that that cynicism is not merited because, as the Minister and his colleagues in the Department of Health and Social Care have shown in these sittings—

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[Andrew Gwynne]

I can speak only for England, but I am legislating for the United Kingdom with the permission of Health Ministers. It may well be that Health Ministers in other parts of the United Kingdom decide not to consult at all. In Wales, for example, they already have the coverage of all the areas that we are going to consult on in England.

The hon. Member for Farnham and Bordon says he is now even more worried. Well, I tell him this: worry not, because his amendment relates to England only. If he is so mithered about the rights of the Welsh to consult Welsh business on Welsh matters, he should have put Wales in his amendment. If he so bothered about the rights of the Scots to consult on Scottish matters with Scottish business, he should have put Scotland in his amendment. If he is so bothered about the rights of the Northern Irish to consult Northern Irish business about Northern Irish matters, he should have put Northern Ireland on the face of his amendment. He doth protest too much, Mr Pritchard!

The hon. Gentleman has actually made my case for why these measures are proportionate: they cover the whole of the United Kingdom and it will be down to Ministers in the respective parts of the United Kingdom to decide who they will consult, why they will consult and what areas they will consult on. But as far as England is concerned, I cannot be any clearer: hospitality is out of the scope of our consultation. We will consult on three things: hospitals, schools and play areas.

[Dr Caroline Johnson]

I thank the Minister for giving way, although I would point out that it was not my hon. Friend the Member for Farnham and Bordon’s amendment at all.

[Andrew Gwynne]

But he supported it.

[Dr Johnson]

He is supporting it, but the Minister asked why my hon. Friend did not include things in it. The answer is that he did not write it. The amendments were written by others, one by the Liberal Democrats, and supported by him, which is not the same thing.

The Minister will no doubt have caused concern for the people in hospitality industries in Wales, Northern Ireland and Scotland who are following proceedings today. Could he tell the Committee a bit about the discussions he has had with his counterparts? Have any of them indicated to him their intent regarding hospitality areas in their designated parts of the United Kingdom?

[Andrew Gwynne]

I certainly can. I have had umpteen conversations with Health Ministers from across the United Kingdom, and none of them has indicated to me that they intend to extend this to hospitality. But the point is that, as Ministers in their own legal jurisdictions, it for them to decide who they are going to consult and on what basis they are going to consult. In terms of the powers in this Bill, which areas they want to extend—if any—is a matter for them. It is not a matter for me or for this Parliament.

We are merely legislating to give those Health Ministers the tools; if they wish to go beyond the scope that the English Ministers are setting out, it is their right to do so. That is the devolution settlement. But they will, of course, have the statutory duty to consult, and they will, of course—I would imagine—want to work with businesses, in Northern Ireland, in Wales, or in Scotland, to make sure that whatever measures they bring forward are right and workable, just as we would in the Department of Health and Social Care, should we decide, at some stage in the future, to go further again.

[Dr Johnson]

I doubt whether the Minister has provided a huge amount of reassurance to the hospitality sectors in those jurisdictions.

I want to pick up on a point made by the hon. Member for Cardiff West in his intervention about prisons. As far as I can tell, closed prisons are smoke-free environments—that is already the case both inside and outside—but I understand that prisoners in closed prisons are allowed to vape, including in their cells, where they may be vaping near other prisoners who may not wish them to have that choice. We are depriving people of their liberty for good reason when sending them to prison, but we should not be exposing them to chemical vapour as part of that if they are not vapers themselves.

Could the Minister talk to us about the discussions he has had with Justice Ministers about how provision is made for the public health of those currently in prison?

[Andrew Gwynne]

I am grateful to the shadow Minister, who is now making my case perfectly for why we need to have the regulations as we do. It may well be that, at some stage in the future, a Public Health Minister, or indeed the Secretary of State, having had conversations with and guidance from the Ministry of Justice, seeks to quickly and simply extend provisions within the prison estate. Were the hon. Lady’s amendments to pass, the ability to do that would not be in the Bill.

We have had conversations with Ministers across Government. This Bill has been subject to the usual write-around, so it has the collective support of the Ministry of Justice. The details of which areas would be in or out of the scope of different measures within the Bill will be a matter for the regulations and for consultation. With that, the shadow Minister has precisely made the case for why having things prescriptively in the Bill ties the hands of Ministers.

[Dr Johnson]

The Minister is suggesting that to be able to restrict access to these products in prisons, he needs to have a wide scope within clause 136. Given that prisons are already smoke-free areas, that surely cannot be the case.

[Andrew Gwynne]

No, but the point the hon. Lady is making is about what conversations Ministers have had with other Ministers to extend the scope, to protect the rights of others and so on. It is precisely for that reason that the Bill is drafted as it is. At some stage in the future, a Government Minister in another Department may well decide that they want to extend the scope, using the powers we are talking about. Under her amendment, we would then have to find a slot in primary legislation to amend a piece of primary legislation. That is precisely why her amendments are unworkable.

The mechanism in place would allow a consultation on an extension; following consultation, secondary legislation would be debated as part of the affirmative process—there would be a debate, a discussion, and a vote in Parliament. That is precisely why the amendments are unworkable, and I call on the Committee to resist them.

I move on to the removal of the test in the Health Act 2006. That is to enable the Secretary of State to more easily make regulations designating outdoor spaces as smoke-free, but only where such a space is a workplace or open to the public. Reinserting the test would conflict with our intention to extend smoke-free status to places I have mentioned—for example, children’s playgrounds probably do not meet the requirement of there being significant risk of significant quantities of smoke. However, making them smoke-free would almost certainly protect some of the most vulnerable.

Since 2006, the evidence base for harms of second-hand smoking has evolved. It is therefore necessary to update the current legislation, as clause 136 does, to provide more flexibility should the Government wish to designate additional smoke-free places in future.

[Dr Johnson]

The Minister is making a reasonable point. However, the evidence can change on what constitutes a significant amount of smoke—in the past, people may have believed that someone had to be smoking in order to come to harm and then that someone could also come to harm in an enclosed indoor environment with someone smoking. It may be that the evidence now shows that even being in proximity to someone smoking outdoors—the fact that you can smell it means you are breathing it in—means you are coming to harm on some level. But does the amendment not account for that with the word “significant”? Amendment 94 says:

“if in the Secretary of State’s opinion there is a significant risk that, without a designation, persons present there would be exposed to significant quantities of smoke.”

A significant quantity of smoke may in the past have been considered to be quite a high volume, but now might be a much lower volume. The flexibility the Minister is seeking is already provided for in the amendment.

[Andrew Gwynne]

The shadow Minister would probably have a large degree of sympathy—at least one of her Back Benchers less so—with our updating the Health Act 2006 to allow us to take action to make more places smoke-free. We think that is right. We now have the ambition to make the whole United Kingdom smoke-free, and this is part of that effort.

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It is really important to recognise that, if we are serious about our ambition to make the United Kingdom smoke-free, we must have that flexibility. Tying the hands of Ministers—whether in England only, as is the shadow Minister’s intention, or across the United Kingdom—would run counter to our desire to be able to act with some degree of speed, should the evidence or public demand be there in future, or to extend the scope. Those are discussions for the future. We are clear that we will consult on three areas, and hospitality is not one of them.

[Dr Johnson]

The Minister is being generous with his time. He knows my thoughts on smoking and vaping, particularly in relation to children, and how important I think creating a smoke-free and nicotine-free generation is—although he does not share the second part. He is talking about how the Secretary of State needs to be able to move with the evidence. I completely and utterly agree with that, but the clause says that there is a significant risk that without designation, persons present will be exposed to significant quantities of smoke.

I support the addition of the smoke-free legislation for spaces like playgrounds. If a playground were to be included, the Secretary of State could quite easily justify that by saying that even seeing someone smoking would encourage children to smoke, particularly if it is their parents, and that therefore it is a sensible action to take.

The words—drafted, I believe by the Minister’s predecessors—are “exposure to significant quantities”. “Exposure” does not necessarily mean breathing it in; children could be seeing it across the playground. “Significant quantities” does not necessarily mean a quantity enough to do them harm. If they cannot see it, they are not being exposed to it and it is not doing them harm, why would we want to stop it happening?

[Andrew Gwynne]

The point is that that is open to interpretation; that now runs counter to our ambition to have a smoke-free United Kingdom. We have put in place a much more flexible and workable measure. The measure from 2006 was right for 2006, but it is not right for 2027, when we hope to introduce the Bill. That is why we are looking to the measures in the Bill rather than the measures as they stood in 2006.

Lastly, I remind the shadow Minister that her amendments apply only to the clause in the Bill that relates to England. If we agreed to them, the powers in England would not be consistent with the powers in the rest of the devolved jurisdictions across the United Kingdom. This is a UK-wide Bill that provides a consistent legislative framework for the whole of the United Kingdom—all four nations—while allowing devolved nations to go further on subsequent regulations if they so wish. For these reasons, I ask hon. Members to withdraw their amendments.

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[Jim Dickson]

I thank the hon. Member for those comments; I will do my best to answer them. Compliance with the measure is still not where we would like it to be: the last survey undertaken by an independent company on behalf of Action on Smoking and Health indicates that 9% of 11 to 15-year-olds say that

“they travel in a car with someone smoking some days, most days or every day in 2024.”

The current law also does not protect those with clinical vulnerabilities. The smoke-free powers in this Bill are driven by a desire to protect people with clinical vulnerabilities from second-hand smoke. That includes pregnant women and those with asthma and lung conditions, among others. No smoker wants to harm their family, friends, pets or co-workers, so no smoker should smoke in an enclosed vehicle.

The evidence is clear: concentrations of smoke in vehicles where someone is smoking are greater than in any other small, enclosed space. If we are to be led by the evidence when extending smoke-free places, we have to consider vehicles. That would provide consistency in policy and raise awareness of the harms of second-hand smoke even further than they currently extend. It would be easier to enforce than the current law, where we have to check who else is in the vehicle, and would make the regulations on vehicles simpler and easier to understand—“It’s a straightforward ban; you can’t do it.” Finally, it is worth pointing out that it is supported by the public, with 67% of British adults saying they are in favour of an outright ban on smoking in vehicles.

[Dr Johnson]

I thank the hon. Gentleman for his clear explanation of what he wishes to achieve. I have great sympathy with it, because nobody wants to see people making their health worse by smoking in a car. However, his statistics are quite interesting. He said that 9% of children find themselves on a regular basis in a car where someone is smoking, yet the Minister has said already this morning that 11% of people smoke. Given that not all of the 11% of people who smoke have children with whom they travel in a car, that implies that the measure is pretty badly enforced and badly adhered to at the moment. He might argue that a complete ban in all vehicles would make it more uniform and easier to enforce, but I am not sure that that is the case.

I will be interested to hear from the Minister when he responds to the amendment whether he has any information or statistics on the number of prosecutions that have occurred under the current legislation. I support the legislation that prevents someone from smoking in a car with children, and I would support an extension of that to include vaping and other nicotine products. I would also support a ban on people smoking while driving; if someone is holding a lit cigarette in their hand, that will have an impact on their ability to manoeuvre the car, particularly in an emergency situation.

Essentially the hon. Member is proposing to say to someone in a parked-up vehicle, perhaps in someone’s drive, “Although you are in a private space, you are not able to smoke.” I understand what he said about no smoker wanting to hurt someone—I am sure that is true—but I cannot imagine that there is any adult smoker that does not realise that smoking in a car with children is bad for the children. I find it very difficult to believe that that would be the case. I invite him to consider whether he is trying to prevent what is a legal activity—even under this Bill, if someone is the right age—in a private space that is theirs and theirs alone?

[Gregory Stafford]

My comments follow on the shadow Minister’s. My understanding of amendment 10 is that, even if the occupant of the vehicle is entirely alone in their private vehicle, the hon. Member for Dartford is seeking to ban them from smoking in that vehicle. We are in danger here of overreaching on what we need to do to achieve a smoke-free generation.

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[Gregory Stafford]

I accept that point, but I do not think my hon. Friend the Member for Windsor’s point was that the police do not currently have powers to stop people who are driving dangerously. I completely accept that they should stop people using their mobile phones or doing things that constitute dangerous driving. The shadow Minister gave the view that smoking a cigarette could be counted as driving without due care and attention or dangerous driving, so that may be a way of enforcing it. However, I think that having the police stop someone simply smoking in their own vehicle—something that is legal in every other private location—when they are over the legal age required in the Bill and they are not harming anybody else, is an overreach.

[Dr Johnson]

The key difference between a mobile phone and a cigarette is that with mobile phones, it is the driver using a mobile phone while driving that is the problem. If one is pulled over in a parking space in one’s private car, one can use one’s mobile phone to one’s heart’s content, and likewise when one is parked in one’s drive. If one wants to sit in one’s car on one’s drive and use a mobile phone, provided the car is stationary, that is also a legal thing to do. What the hon. Member for Dartford is suggesting is not that someone is unable to smoke while driving, which would be quite a sensible measure, but that if one’s car is stationary and private and one is essentially alone in an enclosed space like one’s home, one still would not be allowed to smoke, which seems a little odd.

[Gregory Stafford]

I completely agree with the shadow Minister. I have two final points. Proposed new subsection (1B) makes reference to the meaning of an enclosed vehicle. I just want to clarify what that means. The amendment says:

“which may include vehicles which are partially enclosed or enclosed (or capable of being enclosed) for some but not all of the time.”

Is the amendment trying to capture convertible cars—someone driving with the top down on a sunny day?