Tobacco and Vapes Bill

Caroline Johnson Excerpts

Report stage
Wednesday 26th March 2025 Commons Chamber

[Madam Deputy Speaker (Judith Cummins)]

I call the Opposition spokesperson.

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

It is now a truth universally acknowledged that smoking is bad for one’s health. It is the leading cause of preventable death in this country, responsible for over 80,000 deaths every year. When we say that number, it is easy to allow it to trip off the tongue as another statistic without really realising just how many people it represents. For each of them—such as my Nana Burton, who was a smoker and who died of lung cancer—there is a personal story of damaged health and often an early and preventable death.

The Conservative party introduced a Bill based on a similar premise to this one in the last Parliament, although the Government have made significant changes since to the legislation, including taking a power that could be used to ban smoking and vaping in pub gardens, as well as a licensing scheme for tobacco products.

On amendment 85, while we have received repeated assurances that the Secretary of State intends to use the measures in the Bill only to improve public health, we must still examine whether the legislation is proportionate and reasonable. As far as I can see, it gives the Secretary of State enormous powers to extend the smokefree legislation to any place with minimal oversight and without needing to provide a reason. There were whispers last summer that the Government were considering banning smoking in pub gardens, before they hastily withdrew this provision in the face of public backlash. If only they would withdraw more of their policies in the face of public backlash, because perhaps then we would not be in the situation we are in now.

The Bill empowers the Secretary of State to extend smokefree and vape-free regulations to more places—essentially, to any place—with the aim of reducing exposure to second-hand smoke and promoting public health. However, on Second Reading the Government did not accept our amendment that it should apply only to places that have a provable significant risk to public health to justify such a ban. For that reason, I commend amendment 85 once again, which would restrict the Secretary of State to being able to designate only open or unenclosed spaces outside a hospital, a children’s playground, a nursery school, a college or a higher education premises as a smokefree area. Those are the areas the Secretary of State has said he wants to target, and the amendment would prevent any targeting of other areas, such as pub gardens, by the back door. While he claims that that is not his intention now, that may not remain the case for the rest of this Government’s time in office, nor indeed for any future Government. That is the risk in allowing these measures to stand, and for those reasons I encourage the House to support amendment 85.

3.15 pm

On new clause 18 and amendment 89, the new Bill also gives powers to the Secretary of State to introduce a new licensing scheme for retailers selling tobacco, vaping or nicotine products. However, we know that licensing schemes will come at a cost, to businesses and local authorities that will administer them, and in enforcement. That does not make it the wrong thing to do, but we would need to make sure that any licensing scheme is not excessively burdensome or expensive. New clause 18 and amendment 89 would therefore require the Government to consult on the new licensing scheme for tobacco sales before it came into force. That would mean that the views and impact on businesses including small businesses are heard, and ensure that councils and trading standards have the capacity to deliver such a scheme. Ultimately, there is a balance to strike between the requirements on business and public health, and a public consultation would ensure that the Government are more likely to get that balance right.

On new clause 19, another concern we have heard from those who oppose the Bill is about the impact that the legislation would have on the black market. His Majesty’s Revenue and Customs estimates that the illicit market in tobacco duty and related VAT was £2.8 billion in 2021-22, with the tobacco duty tax gap remaining broadly unchanged since 2015, while in 2023 the Chartered Trading Standards Institute estimated that a staggering one in three vape products were non-compliant. Given warnings that increasing the age requirement for tobacco products and prohibiting more vaping could expand the black market economy further, it is sensible to take precautions to tackle the issue.

[Sir Ashley Fox (Bridgwater) (Con)]

Specifically on new clause 19, does my hon. Friend agree that it is inevitable that the generational smoking ban will lead to an increase in the illegal tobacco market and that that is a highly regrettable consequence of the Bill?

[Dr Johnson]

That is certainly a significant possibility, and that is the reason for moving the amendment, as my hon. Friend will understand.

Illegal products can include smuggled and counterfeit cigarettes, vapes with nicotine levels way above the legal limits, and products containing illegal and potentially dangerous ingredients. They can be more harmful and may not include the appropriate labelling requirements and health warnings that genuine products have to carry. Regardless of whether colleagues support or oppose this Bill as a whole, I am sure we all agree that a black market is unacceptable. We have therefore put forward an amendment that would require the Government to produce annual reports on the rate of sale and availability of illegal tobacco and vaping products and their impact on public health and safety.

[Sir John Hayes (South Holland and The Deepings) (Con)]

My hon. Friend has rightly taken a fierce line on illegal tobacco sales in Lincolnshire. Does she acknowledge that those illegal tobacco sales are often linked to serious and organised crime? The shops that sell them are often linked to money laundering—and are usually foreign owned, by the way—and the damage they do is extreme. Will she join me in urging further action by Government to support trading standards and the local police, who are doing such a fine job in trying to clamp down on this industrial-scale crime?

[Dr Johnson]

As is usually the case, I find myself agreeing with my right hon. Friend, and that is of course why we have tabled the amendment: it will give us the evidence that we and the enforcement authorities require to make sure that the black market is reduced.

[Jack Rankin (Windsor) (Con)]

Does my hon. Friend accept that there is not a risk that a black market will open, because a significant black market in tobacco already exists? In 2021, some 23.6 billion cigarettes were sold under duty, whereas in 2024 the figure was 13.2 billion, a 44% reduction. Yet an Action on Smoking and Health survey has found that smoking has reduced by only 0.5%. The black market is already here—it is not a new thing that will be created—so the Bill presents an even greater risk.

[Dr Johnson]

My hon. Friend makes a fair point. We know the black market exists, but the amendment would enable the Government to understand the scale of that black market and the changes in it, so that regulation could be enforced more robustly.

On amendment 90, as currently drafted the legislation will ban all forms of advertising of nicotine and non-nicotine vapes, nicotine products and sponsorship that promotes those products. Adverts will no longer be permitted on posters, billboards or the sides of buses, and sports teams will be prevented from being sponsored by a vaping company. As a Member of Parliament and a children’s doctor, I have been very concerned by the sharp increase in children addicted to vaping and, more recently, the other nicotine products such as pouches that have begun to flood the market. Schoolteachers have reported that children are unable to concentrate or even to complete a whole lesson without visiting the bathroom to vape.

Action to tackle the rise in vaping is welcome, and I support steps that restrict the appeal of vapes to young people, including through flavours and packaging. However, as the Minister mentioned in her opening speech, vaping can be a useful smoking cessation tool for adult smokers trying to quit; in my view, that should be their only purpose. Within the context of proposed advertising restrictions, amendment 90 would ensure that vapes that are targeted solely as a quit aid, to help adults stop smoking, can continue, in recognition of their role in bringing down smoking rates.

Finally, new clause 20 would introduce a requirement on online vaping products to operate an age verification policy, as is currently the case in Scotland. Whether someone is buying vaping products online or in store, robust provisions must be in place to ensure that the purchaser is of legal age, and businesses must have a robust policy in place. As we have seen through recent tragedies, the age verification process for online sales on age-restricted products has not always been effective. The new clause would be an important step towards protecting children from accessing products online that they should not be able to buy.

In closing, the Conservative party has a strong record of action on tobacco control. It was under a Conservative Government that plain packaging was introduced for all tobacco products and that minimum pack sizes for cigarettes and rolling tobacco were introduced—policies that have been demonstrably effective at reducing smoking rates. I have personally campaigned passionately on the issue of tobacco and vapes for over two years, and I am pleased that some of my original amendments to the Bill have made it beyond Committee stage and are with us today. I was also glad to see some of the new Government amendments introduced on Report that were born of debates we had in Committee, which have strengthened the Bill.

Our amendments are designed to highlight some of the difficulties in the Bill. We oppose the Government’s power-grab—creating powers to ban smoking and vaping wherever they choose by regulation, but without consultation or enough notice. We have concerns about how the Bill will operate in practice, especially the burden on small businesses, and the potential for unintended consequences, such as a growth in the black market for tobacco products, so we ask that the Government seriously consider our amendments today.

[Preet Kaur Gill (Birmingham Edgbaston) (Lab/Co-op)]

I welcome the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for West Lancashire (Ashley Dalton), to her role. It is a great pleasure to speak in the debate and to support this genuinely world-leading piece of public health legislation, which will help to consign smoking to the history books.

Unless we act to help people to stay healthy, the rising tide of ill health in our society threatens to overwhelm our NHS. Paring back public health, as the last Government did, was the definition of penny wise, pound foolish. It is vital that we tackle the causes of ill health, not just the symptoms, so that we can save the taxpayer billions of pounds and, most importantly, save lives.

We know that prevention is better than cure. As we have heard today, smoking remains the single biggest preventable cause of ill health in our country, causing 80,000 deaths a year. It is responsible for one in four cancer deaths, and it is a factor in over 70% of lung cancer cases. In my own constituency alone, nearly 12,000 people smoke. They are more likely to leave the workforce due to ill health. Many will suffer strokes, heart attacks and conditions such as chronic obstructive pulmonary disease. On average, they will lose 10 years of life expectancy.

However, the real tragedy is how many thousands of those smokers will have started when they were children, when they did not know any better, and have simply never been able to quit. Most smokers report wishing that they had never started, which is why it is incumbent on us all to support this legislation to help stop the start. According to ASH, in my constituency alone the cost of smoking exceeds £90 million every year, including £56 million in lost productivity, £4 million drained from the NHS and £30.7 million in social care. The costs of smoking to our society are enormous, and that is why it is time to stub it out.

Even today, in 2025, hundreds of young people a day take the first drag of a habit they will never manage to kick, and will regret for the rest of their lives. I was proud to lead the Opposition’s response to the last Government’s Bill through Committee in the last Parliament and, as I said then, there is no freedom in addiction. It is a shame that the leader of the Conservative party allowed her ideology to blind her from that fact when she voted against the legislation in the last Parliament, and against this Bill in this one. Where the last Government failed to get their Tobacco and Vapes Bill over the line, this Government will get the job done.

I am proud that the Government have vastly improved on the legislation that the previous Government drew up. First, the introduction of a new licensing regime to cover tobacco and nicotine products, including vapes, is hugely welcome. That was a key recommendation of the Khan review in 2022, which the last Government largely ignored and which retailers and the public overwhelmingly support, according to surveys conducted by ASH. The status quo, where there was no requirement to obtain a licence to sell those products, is a major gap in enforcement, particularly when we consider that the sale of alcohol is licensed, while nicotine and tobacco are not.

Secondly, I am pleased that the Government are taking forward an amendment I tabled in Committee during the last Parliament, for the introduction of £200 on-the-spot fines for retailers selling products to under-age people. In 2019 to 2020, 50% of the councils that undertook test purchasing reported that cigarettes or tobacco products were sold to children who were under 18 in at least one of their premises. That proves that the current regime is not enough of a deterrent. The introduction of new on-the-spot fines, which are double the amount proposed by the previous Government, will be much easier to issue and much harder to ignore. Does the Minister agree with me that double the fine is double the deterrent?

Thirdly, I commend Ministers on the action they are taking on vapes. Under the last Government, youth vaping trebled in two years. An estimated one in three vapes on the market were illicit, and products often contained harmful chemicals, heavy metals or even drugs. Gaping loopholes were left to sit on the statute book for years, putting children at risk. The promulgation of dangerous illicit vapes in shops, schools and on our streets is a real concern. Recently, in Birmingham, trading standards officers and the police led raids on retailers under Operation Cloud, when they seized nearly £6 million-worth of illicit vapes, tobacco and drugs. One raid alone, the biggest ever in Birmingham, clawed £1 million-worth of goods out of criminals’ hands. That shows the extent of the problem of the illicit market and the incredible job that council trading standards teams do to keep the public safe.

I thank the Government for getting behind trading standards with a £10 million boost to support their work next year. In particular, I welcome the new Government’s introduction of clauses to this Bill to set up a testing regime for vapes, a proposal that I championed in the last Parliament. It is shocking that under the current rules, unlike with tobacco, there is no testing regime for vaping products. That means that dodgy products can be rubber-stamped by the British regulator and wind up on our shelves, undermining the valuable enforcement work that trading standards do to identify and seize un-notified products.

As testing of vapes marketed at young people has shown, a significant proportion of vaping products are not what they say they are. Some market themselves as 0% nicotine when they are not, leading to accidental addictions; others contain harmful substances, such as heavy metals and even anti-freeze, as evidenced by research undertaken by Inter Scientific. That is why during the last Parliament I tabled amendments that would have established a new testing regime for vapes. Unfortunately, the Conservatives voted them down. I commend Ministers for introducing powers that the previous Government snubbed. Nearly 3 million people have quit smoking using vapes. Clearly vapes have a role to play in the transition to a smokefree future, but if they are to be used as stop-smoking aids, we need confidence that the products people buy are safe, which is what routine testing would do.

Finally, I commend the Government on the amendments that have strengthened this Bill; they close the loopholes on vape vending machines and ban vape advertising, promotions and sponsorships. The new clauses will ensure that these products are kept away from the impressionable eyes of young people, so that the next generation are not simply substituting one nicotine addiction for another. There were significant holes in the last Government’s plan, and I am glad that the new Government are slamming them shut.

The health crisis facing our country has never been confined to the running of its hospital wards, doctors’ surgeries and dental practices. We are a sicker nation, and that public health challenge needs confronting. Life expectancy was extended by three and a half years over the course of the last Labour Government, but in the 14 years under the Tories, it grew by just four months. In this Bill, we see the epitome of the future-facing approach that only a Labour Government can deliver. By stopping the start and ensuring that the next generation never develop an addiction to nicotine, we can protect their health and wellbeing and protect our NHS for many years to come.

Oral Answers to Questions

Caroline Johnson Excerpts

Tuesday 25th March 2025 Commons Chamber

[Mr Speaker]

This question is about sex and gender. Do not worry; I am sure that the Secretary of State has the message.

I now call the shadow Minister.

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

Given the findings of the Sullivan review on patient and health safety, which came about as a result of inaccurate and poor data collection, can the right hon. Gentleman confirm what meetings he has had with Secretary of State for Science, Innovation and Technology to discuss the reliability of the data on sex that is intended to be used by the digital verification platform in the Data (Use and Access) Bill?

[Wes Streeting]

I am grateful to the shadow Minister for her question. I speak to the Science Secretary on too frequent a basis—on a daily basis. He and I are both looking very carefully at the findings of the Sullivan review and working through its implications for both the health and care services, for which I am responsible, and for the Government digital and data services, for which he is responsible.

[Dr Johnson]

The UK Health Security Agency, for which the Secretary of State is responsible, publishes health statistics. This includes data on sexually transmitted infections, which is published by sexual orientation and sex. However, a footnote states that women are defined in the dataset as “women and trans women”, which does somewhat undermine the value of the data. What will the Secretary of State do to ensure that data is not just collected properly, but published and presented in a way that is most clinically useful?

[Wes Streeting]

The shadow Minister raises a good example of how conflation of sex and gender identity is not helpful both in terms of data analysis and of recognising health inequalities. It is also not helpful in making sure that we understand variances between people based on their different backgrounds and characteristics and that we provide targeted, personalised and effective healthcare that deals with healthcare inequalities. That is why we are carefully studying the recommendations made by Professor Sullivan, with a view to making sure that we are meeting the needs of everyone, including the trans community, who I understand, not least because of the way that the debate has been conducted in recent years, are anxious about the implications of the report. However, I genuinely think that the report will lead to better, more inclusive and fairer outcomes for everyone, including the trans community.

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?

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.

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.