Draft Human Fertilisation and Embryology (Amendment) Regulations 2024

Caroline Johnson Excerpts

Tuesday 22nd October 2024 General Committees

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

It is a pleasure to serve under your chairmanship, Mr Mundell. The Opposition will not object to the draft regulations, particularly because they were drafted by the Conservative Government and introduced by my former colleague, Maria Caulfield, who was then the Minister. They were announced last year and were laid earlier this year.

However, I have a couple of questions. The draft regulations mention donations from family members. Given that we know that infants conceived where both biological parents have close family relations are at higher risk of genetic and other medical conditions, will the Minister update us on any specific guidance on the use of the word “family” in relation to who can donate? Will he confirm that the NHS will still screen all donations for HIV?

The Minister said that there are no implications for the NHS. Does that mean that shared motherhood will not be provided for by the NHS or that the NHS will not provide services to those who are HIV positive, or does he expect the numbers to be so small that it will not make any difference? Finally, he said that the provisions are being brought forward in Northern Ireland under the Windsor framework and the EU withdrawal Act. Does that mean that he considers the ability to bring in these regulations to be a benefit of Brexit?

Access to Primary Healthcare

Caroline Johnson Excerpts

Wednesday 16th October 2024 Commons Chamber

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

As a doctor myself, I wish to start by recognising the substantial work ethic and expertise of my primary care colleagues and thank them for all that they do.

Saying what is wrong with the NHS is very easy; solving problems takes much longer and is far more difficult. Rather than the next few hours being filled with constructive ideas, I expect that we will simply hear complaints about the challenges faced by the NHS, perhaps some party political jibes and a wish list of promises and the things that people want to see, but no concrete plans on how to deliver them beyond more money. I hope that I am wrong about that, but I suspect that I am not.

Our NHS is facing significant challenges. We have an ageing population with more complex health needs, a rising demand for services and a rapidly growing population. We also have the legacy from the pandemic, which many are quick to forget. Although we were the first country to deliver a vaccine, there are many persistent problems stemming from the pandemic. Let me give the House an example. Before the pandemic, in 2019, there were 54 women who had been waiting more than a year to see a gynaecologist, but due to the reduction in elective activity during the lockdown, by the time the pandemic was over that number was more than 40,000. This is, of course, replicated across other medical specialties. Although my secondary care colleagues have been working extremely hard to reduce those numbers—and, indeed, they have fallen—the individuals concerned will, on average, visit their GPs more while they are waiting and that inevitably puts more pressure on primary care services.

The simple truth is that we gave the NHS more money than it has ever had and, as a result, it has delivered more clinical activity than ever before, but the ageing population, the rising demand for services and the legacy of the pandemic have meant that, in places, that has not been enough. Many people are not being seen as quickly as we would want them to be.

The previous Labour Administration did not do enough to train new doctors, and the reality is that we cannot train one overnight. The Conservative Government built five new medical schools, and the graduates of those medical schools have recently started work. The Secretary of State says that he will double the number of medical students. That is an item on his wish list with which I agree, but I do have a few questions. Will he build new medical schools, expand the old ones, or do both? If he is going to build new ones, where will he build them? [Interruption.] The Minister for Secondary Care is talking about primary care. I believe that doctors are a part of primary care.

The UCAS deadline to apply for most medical school places to start next autumn was yesterday, so when does the Secretary of State expect these new places to be available and those new students to start? On the broader primary care workforce, we expanded the number of primary care professionals in GP practices, such as dietitians and physiotherapists, and we delivered 50 million more GP appointments last year than in 2019. We also saw the launch of Pharmacy First, which delivered more care in the community while easing pressure on GP appointments. I was pleased to hear the Liberal Democrat spokesman acknowledge the success and the benefits of that programme.

I have a few questions for the Secretary of State. The Conservatives produced the first NHS workforce plan. Can the right hon. Gentleman say whether he will proceed with those plans or write a new one? What are the timescales for his plan? In the spring Budget, we had the NHS productivity plan, with £3.4 billion to improve NHS productivity. Does the right hon. Gentleman still intend to follow that? The Minister for Secondary Care said that she was recruiting 1,000 GPs. Can the Secretary of State tell us how many have been recruited so far?

The Secretary of State and I also agree on the ability of technology to improve NHS services.

[Ben Coleman (Chelsea and Fulham) (Lab)]

As a new Member, I am learning how this place works, so I am interested to see how much you expect the Labour Government to have achieved in 100 days. Why is it, after 14 years, that you left the country with the longest waiting lists ever and small children having to get their rotten teeth seen at A&E? What can you say that is helpful to us in understanding why the failure of 14 years of Conservatism took place, and do you feel any remorse about that?

--- Later in debate ---

[Madam Deputy Speaker]

Yes, several times. It is not me; I have never been a Health Minister. I reiterate that interventions will have to be short. I will be imposing a time limit, as we have to hear from an enormous number of Members this afternoon.

[Dr Johnson]

I thank the hon. Gentleman for his intervention. I have talked about the challenges the NHS faces. I will come shortly to the achievements of the Labour Government so far in the Department of Health and Social Care.

Turning back to technology, I was saying that I agree with the Secretary of State on how technology can improve NHS services. Over the last few years, in my professional capacity, I have seen improvements in making communication between primary and secondary care and within secondary care much more efficient. As a patient, I have used the askmyGP service, which is an excellent way to communicate with a GP, particularly for working people. I have also used the NHS app, which millions of people have downloaded and which has huge potential. I hope he intends to build on that potential and harness the benefit of AI for diagnostics in particular.

The Secretary of State and I also agree on the importance of prevention. It is vital to make the NHS accessible to those who need it, but it is even better if people stay healthy in the first place. Before the election, he was supportive of measures to protect children from the dangers of vaping—measures I campaigned for actively. In fact, he was quite critical that it had not been done sooner, as in some respects was I. Given that the legislation has already been written and that it passed both Second Reading and Committee stage with the support of his friends on the Labour Benches, why is it taking him so long to produce a tobacco and vapes Bill? Can he guarantee that he will deliver it, like a present, in time for Christmas—for clarity, I am hoping for this Christmas?

[The Secretary of State for Health and Social Care (Wes Streeting)]

Have you been naughty or nice?

[Dr Johnson]

I have been a good girl, thank you, Secretary of State.

Furthermore, can the Secretary of State explain how cancelling dozens of new hospitals will reduce pressure on general practice? Can he explain how cutting the winter fuel payment for millions of pensioners will help the NHS? The End Fuel Poverty Coalition predicts that Labour’s winter fuel payment cut will result in an additional 262,000 pensioners needing NHS treatment because they are cold, resulting in a great deal of suffering and millions of pounds of additional cost to the NHS. Does he agree with that assessment? I have asked repeatedly, in both oral and written questions, if the Government will conduct a proper impact assessment of the policy on the NHS and on the wellbeing of vulnerable older people. Will he commit to producing and publishing such as report?

Further on the issue of prevention, the right hon. Gentleman will know that folic acid supplementation can prevent neural tube disorders, such as spina bifida and anencephaly. The previous Government brought forward regulations on the matter. What conversations has the Secretary of State had with the Department for Environment, Food and Rural Affairs about ensuring that that work is continued?

Our approach to dentistry was also underlined by prevention. We introduced the Health and Care Act 2022, which gave the Secretary of State the power to introduce water fluoridation schemes. Those powers have since been used to extend existing schemes, particularly in the north-east of England. Does the Secretary of State intend to continue that work and exercise the powers the previous Government gave him? He knows that I am passionate about dentistry. I have raised the issue many times in the House, including by securing an Adjournment debate on dentistry in Lincolnshire. It troubles me greatly that children are coming to hospital for multiple dental extractions due to rotten teeth. It is worth noting that the issue is not a shortage of dentists overall or, as the hon. Member for North Shropshire (Helen Morgan) says, a shortage of money, but a shortage of dentists doing NHS work rather than private work specifically.

The previous Government were encouraging dentists to take up NHS work with a range of measures, including golden hellos for dentists in underserved areas, dental vans going out to rural communities, and tie-ins for new dental graduates. We were also in the process of broader contract reform after a small change in the units of dental activity rate when we went into the election. Let us look at Labour-run Wales in comparison. Wales is delivering only 58% of pre-pandemic dental activity. It is burdened with the highest proportion of NHS dental practices not accepting adult patients and the longest waiting lists in the UK. One in four Welsh residents is currently on a waiting list. The new Secretary of State for Wales has said that the Government “will take inspiration from” Labour-run Wales on dentistry. Given their woeful record in office, I sincerely hope that that is not the case.

Before the election, when I listened to the Secretary of State for Health and Social Care say that Labour had a plan to reform and modernise the NHS, I believed him, but in Monday’s debate on the Lord Darzi report, we uncovered that his plan was not really a plan at all, but a list of desired outcomes and a proposal to make a plan if he got into office. It is unclear how long this plan will take to develop. The Minister for Secondary Care said that it is a listening exercise like we have never seen before, but how much will that cost, and had Labour not been listening already?

[Mike Martin (Tunbridge Wells) (LD)]

Why did the previous Government shift funding from secondary care to primary care, despite saying that they would do the exact opposite?

[Dr Johnson]

Essentially, because there is more clinical acute need in primary care hospitals. Given the choice, with one amount of money, between saving a life and preventing a problem for later, it is inevitable that money gets shifted towards acute care. That is where the pressure is, but I agree with the hon. Gentleman that we need to work harder to prevent people from becoming ill in the first place.

[Ellie Chowns (North Herefordshire) (Green)]

On that point, will the shadow Minister give way?

[Dr Johnson]

No, I will not give way again, because I know that you will give me eyes if I do, Madam Deputy Speaker.

Labour has spent 14 years in opposition. The Secretary of State has had plenty of time to consider what he would do if he gained office, so, further to the intervention of the hon. Member for Chelsea and Fulham (Ben Coleman), what have the Government achieved in 14 weeks to help the health of the nation? I will tell you, Madam Deputy Speaker. They have opened the Department’s doors to their Labour mates. They have awarded an inflation-busting pay rise to junior doctors without negotiating any modernisation or productivity reform in return. They have overseen GPs entering industrial action and nurses rejecting their pay offer. They have scrapped the social care costs cap. They have produced a report of selected statistics with no policy recommendations. They have broken their manifesto pledge to deliver the new hospital programme. They have taken the winter fuel payment from millions of vulnerable pensioners. They have even stopped the children’s cancer taskforce.

That dire record, underlined by the Labour legacy in Wales, fills me with huge trepidation for the future of the NHS. I hope that when the Government’s plan eventually comes, it is a good one, for all our sakes.

Oral Answers to Questions

Caroline Johnson Excerpts

Tuesday 15th October 2024 Commons Chamber

[Andrew Gwynne]

I have every sympathy with the case that the hon. Gentleman has put forward. This Government want to see a shift of health services from hospital to community, from analogue to digital, and from sickness to prevention, but these decisions are not taken through inertia; they are taken because of the Government’s inheritance from the Conservative party. We have had 14 years of running down our health services, with needless reorganisations that have destroyed and set back the progress that the last Labour Government made on the NHS. This Government will fix the NHS, including in the hon. Gentleman’s local area, but he has to recognise that the root cause of many of the problems faced by Members across the Chamber lies at the feet of the former Secretary of State and the last Government.

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

We have heard about the challenges facing Whipps Cross hospital. The Secretary of State’s decisions to pause capital projects across the country and put them under review has caused worry and uncertainty for staff in hospitals nationwide. Can he say when the review will be completed, so that we have certainty about when things will go ahead?

[Andrew Gwynne]

The review will be completed when all the information has been analysed. The hon. Lady should not just be a little more patient; she should be a little more apologetic for the fact that the Government found a hospital rebuilding programme that was not worth the paper it was written on, because the ultimate paper we needed—the cash—was not there.

Maternity Services: Gloucestershire

Caroline Johnson Excerpts

Wednesday 9th October 2024 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Sir Christopher, and I congratulate the hon. Member for Cheltenham (Max Wilkinson) on securing this important debate. Childbirth is a really special event. It has been described today as the best moment of someone’s life, and that description is often used. It is a special moment in the lives of not just the parents and of course the child, but the wider family and friendship group—the birth of a baby is enjoyed by everybody.

I have been privileged to attend many births over my career as a doctor, although aside from the births of my own three children, they have generally been skewed towards where things have not been going to plan—it is not, I hasten to add, that that is a result of my presence, but more that my presence is a result of things not going to plan. The work of the NHS—its midwives, its obstetricians and the wider team that look after women and their babies—is by and large exceptional. However, we hear stories of where things go wrong and we need to minimise those as much as possible.

Essentially, the talk of whether Cheltenham needs a midwifery centre comes back to the pull and tug that I have seen throughout my career between the centralisation and the localisation of services in general. When services are centralised, it can be argued that there is an increase in expertise and an increased volume of cases, which makes people more familiar with emergencies because they happen more frequently. More specialist services can also be offered for those with high-complexity and low-volume problems. There can also be more support from staff, because there are more staff present in the unit. However, centralised services can feel more remote, they can be too far away for people living in rural areas and they can feel too impersonal, particularly for a procedure such as giving birth. In a local unit, people may feel more comfortable and know the staff, and there may be a close-knit team. However, as our veterinary colleague, the hon. Member for Winchester (Dr Chambers), so amply described, if things go wrong, people can be a long way from the help they need. So there is that balance and that push and tug.

As has been mentioned, choice is important to women who are making informed consent choices on where to give birth, based on the information they receive. The hon. Member for Cheltenham has made a good case for why the balance may not be as it ought to be in Gloucestershire; the Government should look carefully at that.

I was sorry to hear of the experience of the hon. Member for Gloucester (Alex McIntyre) with his new-born baby. As a paediatrician, I am familiar with the need to weigh all the factors in the balance: the fact that a baby has gone home and may have picked up a viral illness that has brought them back in again; the risk to the baby from going on a children’s ward where the impact of disease is more predominantly based in infection and infectious conditions than in older age groups and adult wards; and the risk of putting a baby on a neonatal unit and introducing the virus to that unit, which could make the babies already there so very unwell. We need to think carefully about a solution to that, so that people do not go round and round in circles, as the hon. Member for Gloucester described, being passed from pillar to post. I am sure that was a frightening experience for him and I am sorry that happened.

I now turn to other issues raised today. The hon. Member for Stroud (Dr Opher) talked about the importance of community midwives. Even though my eldest is now 17 and my youngest nine, I still remember my post-natal midwife Marie and the care she gave. Sometimes, maternity care focuses a little too much on what is going on in a hospital when what happens in the community is also very important.

The hon. Member for Thornbury and Yate (Claire Young) suggested that we could have a midwifery in-patient unit with mothers and babies and only one member of staff. I am afraid I do not agree with her on that. The hon. Member for Winchester raised the concept of two simultaneous emergencies. If there is only one member of staff, how do they go on a break, or what if they are in the bathroom when they are needed? If we have a unit, unless it is attached to a major centre with more staff, we need that second person.

As of December 2023, there were 2,361 full-time equivalent midwives working in the NHS’s trusts and other core organisations in England. That is an increase of 3,707—18.9%—since 2010. On the one hand, the birth rate is falling and the number of midwives is rising, but I recognise that the births that are taking place are more complex in some ways than they used to be. At the spring Budget, there was a further investment of £35 million to improve maternity safety over the next three years, including £9 million for brain injury.

I asked the Minister, at the previous debate on maternity safety on 4 September, whether she would commit to that money being spent and I have not received an answer. I asked her several questions during that debate, including whether she could confirm that the Government would proceed with the fortification of bread products with folic acid to protect babies from spina bifida. I asked her about the non-essential communications budget, which the Chancellor had said on 29 July would essentially be cut, and whether that was affecting public health budgets. Those budgets are very important, particularly around optimising public health messaging regarding chronic illness and conditions such as diabetes and obesity before conception. I have not received an answer to either of those questions.

I also raised the NHS saving babies’ lives care bundle, which was due to be updated on maternity early warning scores and tracking tools, to ask the Minister whether that was on track. Again, she has not written to me as promised with the answer to that question. I asked her whether she would be supporting the healthcare safety investigations branch and about the £35 million budget I have just described. I have not received answers to any of those questions more than a month later; none of my staff can find any correspondence from the Minister. Can she answer those questions today, or at least commit to doing so by the end of the week? We have waited quite a long time.

My final question last time was about the group overseeing maternity services nationwide, because following the East Kent report—I was the Minister when that was published—Dr Kirkup’s recommendations were accepted. Maria Caulfield, then Minister for Women’s Health, set up and chaired a working group to review the work being carried out by a whole range of programmes to improve maternity and neonatal care and implement those recommendations. I asked her who would go on to chair the group and whether she could guarantee that the work would continue, but I still have not received an answer. It would be helpful for the Minister to answer the questions raised in the last debate as well as in today’s.

Sepsis Awareness

Caroline Johnson Excerpts

Wednesday 9th October 2024 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Sir Christopher. I congratulate the hon. Member for Ashfield (Lee Anderson) on securing a debate on this very important topic. I should also declare an interest as an NHS consultant paediatrician. I have cared for and continue in my work to care for people with this condition.

I would like to thank Abbi for coming today. It was an honour to meet earlier today and to hear her story from her MP, which highlighted both the difficulties she faced in getting good immediate care for sepsis and the consequences of that. I commend her for the bravery she has shown in coming today and for raising this issue for the benefit of other people. This debate will increase awareness, which is a very positive thing.

I remember sitting in the Chamber earlier this year when the former hon. Member for South Thanet re-entered Parliament to a standing ovation—an exceptionally rare occurrence in the House of Commons. It is truly humbling to reflect on the journey that he has been through in such a short space of time. Little over a year ago, he had no outward signs of sepsis at all. He has now become one of the most well-known advocates for people with it. His case brought renewed attention to this disease, which kills nearly 50,000 people in the UK every year. As the hon. Member for Ashfield said, that is around the same number of people who die from bowel, breast and prostate cancer combined.

The case of our former colleague speaks to not only a remarkable recovery but the suddenness with which sepsis can utterly change someone’s life. As many people have said today, early identification is vital. Under the previous Government, awareness of sepsis improved significantly, as did the clinical recognition of symptoms, screening rates and the administration of antibiotic treatment, but there is much more to do.

I want to commend the UK Sepsis Trust and other public campaigners who played a significant role in improving awareness among the general public. A recent YouGov survey showed that the UK has high levels of public awareness compared with other countries. Will the Minister say what steps the Government will take to work with NHS England and patient groups such as the UK Sepsis Trust to raise public awareness, so that people can more easily identify the signs of sepsis? I have also asked this of another Minister, but have not yet received an answer. The Chancellor said that she was cutting the communications budget—can the Minister confirm that those cuts will not affect the important public health messaging for campaigns like this? It is important that we do not cut budgets that will save people’s lives and, indeed, save the NHS money. It is also important to raise awareness not just across the general public, but among health professionals, including medical staff in both hospitals and communities.

The national early warning score has been introduced and is being rolled out, along with the sepsis six, which was developed with the UK Sepsis Trust. The six—oxygen, cultures, antibiotics, fluids, lactate management and urinary output monitoring—must all be carried out within the first hour. Has the Minister established how well those measures are being rolled out across the UK, and what is he doing to ensure that is being done effectively? The National Institute for Health and Care Excellence updated its guidance earlier this year. Will the Minister update the House on how effectively that guidance has been implemented across the UK? Martha’s rule was introduced before the election; the rule relates to the ability for people to get a second opinion from another health professional if they remain concerned about their loved one or themselves. Will the Minister update the House on the work the NHS is doing to roll that out, too?

Research is the cornerstone of transforming sepsis care, and the last Government invested more than £1 billion through the National Institute for Health and Care Research. It is important that we research the causes of and treatment for sepsis, but we must also research new antibiotics, because we are starting to see antibiotic resistance to infections. If we do not invest in antibiotic research, new antibiotics will not be developed—we are essentially asking people to develop a drug to be kept on the shelf for when we need it, and there is no money in that, so it will not get commercial take-up. It is therefore important that the Government invest in that.

The UK Sepsis Trust is calling on the Government to publish data on the sepsis care pathway so that we can see where it is performing well and where it is performing less well. I urge the Government to do that. It would be helpful if the Minister could confirm today that they will do so.

As we close the debate, let us remember what we are fighting for. Sepsis takes the lives of 50,000 people every year. It strikes suddenly and often without warning, as Lord Mackinlay’s case reminds us so powerfully. Early identification and rapid treatment are the keys to saving lives; we have made strides, and awareness is growing, but we must do more. We must continue to improve recognition, strengthen control and push forward with life-saving initiatives. I urge the Government today not just to maintain their commitment but to strengthen it by partnering with NHS England, publishing more data, researching the causes of sepsis and ensuring we can fight this disease together.

[Sir Christopher Chope (in the Chair)]

I thank the Front Benchers for sticking to their five minutes, which means the Minister now has 10 minutes; there will hopefully also be a couple of minutes for the proposer to reply.

NHS Performance: Darzi Investigation

Caroline Johnson Excerpts

Monday 7th October 2024 Commons Chamber

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

I am mindful of the need to be brief, but I wish to congratulate the hon. Members for South Norfolk (Ben Goldsborough), for South West Norfolk (Terry Jermy), for Esher and Walton (Monica Harding), for Gloucester (Alex McIntyre), for St Neots and Mid Cambridgeshire (Ian Sollom), for Mid Dunbartonshire (Susan Murray), and for Basingstoke (Luke Murphy) on excellent maiden speeches.

When I first heard that the Government had commissioned Lord Darzi to conduct a report on the NHS I wondered two things: why has this report been commissioned, and why has a former Labour Minister been asked to do it? The answer to the first question is still somewhat unclear after this debate. Much of the information is publicly available, and Labour had access to the civil service for six months before the general election, as is routine to help with planning. Before the election, in its manifesto Labour claimed to have a plan, and the Secretary of State said that he and the Government have a 10-year plan to reform and modernise the NHS. In the draft speech that I brought to this debate I was going to say that I assume that is the case, so where is that plan and when will it be published, but during the debate the Secretary of State said that he will soon meet to engage with patients and staff who will write the plan. Does it exist, or is it yet to be written? Given that Lord Darzi specifies that policy suggestions are outside the remit of his report, and notwithstanding the amount of time and dedication he has put into it, what primary purpose does it serve? Is it simply a political statement to cover the right hon. Gentleman’s plan and an increase in taxes in the Budget when it comes?

[Ben Coleman (Chelsea and Fulham) (Lab)]

Will the hon. Lady give way?

[Dr Johnson]

I will not because there is not much time. A potential answer to the second question of why a former Labour Minister has been asked to conduct the report is its silence on a number of issues, for example on increasing the number of medical students. I could not find any reference in the report to the five additional medical schools that were commissioned and opened by the former Conservative Government, and whose first new doctors have recently graduated. Indeed, I found no mention of the NHS workforce plan at all.

My constituency mailbag, no doubt much like that of Members across the House, is full of letters from elderly people who are frightened that their homes will be cold this winter, and that they will become ill, or perhaps even die, as a result. It is notable—again, perhaps this answers my second question—that despite being published two months after the Government’s announcement about the winter fuel allowance, the Darzi report appears to be silent on the subject. The chief medical officer said that,

“cold homes and fuel poverty are directly linked to excess winter deaths”

in his annual report from 2023. Is it remarkable that this report by a former Labour Minister does not mention cold homes? Perhaps it does not recognise the impact of such a decision because no impact assessment has been made.

On 29 July, I asked the Chancellor of the Exchequer what estimate she had made of the impact that her winter fuel payment changes would have on the NHS. Her answer implied to me that that was something that had not been given enough consideration. On 5 September I submitted a written question to the Secretary of State, asking whether he would make an assessment of the winter fuel payment changes on a range of factors relating to the NHS and the health of elderly people, including hospital admissions, deaths, GP appointments and so on. The answer to whether he will do something or not is clearly “yes”, “no”, or “I have already done it”, but it seems the Government struggled to answer that question and I would be grateful if the Minister could do so today: will the Secretary of State make an assessment of the various effects of the changes to the winter fuel allowance and the consequent cold homes on the NHS and the health of elderly people?

Earlier, the Secretary of State said that investment without reform would reduce productivity. He even said that it was “killing with kindness.” Actions, however, speak louder than words, so what substantial productivity gains come with the junior doctors’ 22% pay rise? None. What productivity benefits arise from a significant increase in the wages for train drivers? None. The NHS and the Government are now facing potential future industrial action from groups seeking similar pay deals. The Government’s willingness to take money from pensioners and give it to already well-paid train drivers suggests that such union demands will be successful, further creating a vicious cycle of industrial action that will ultimately be damaging to patients.

I fear that the Labour party sees the Darzi report as a political bludgeon rather than as a blueprint for any meaningful reform. There are undeniable challenges within the NHS—something that I as a doctor see—and we must be honest about them, but instead of a constructive conversation on policy, Labour brings partisan attacks to the table. We now need real leadership, specific reforms, and the courage to make the tough decisions that will keep the NHS suitable for generations to come.

Preventable Baby Loss

Caroline Johnson Excerpts

Wednesday 4th September 2024 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Dowd. I congratulate the hon. Member for Ashfield (Lee Anderson) on securing the debate; the stories he read were very emotive.

Many people witnessing birth for the first time describe the experience as the miracle of birth. It is indeed the most wonderous occasion. I have been honoured to be present at the birth of many hundreds of babies in my work as an NHS doctor. Unfortunately, birth is an unpredictable process, and the hon. Member for North Shropshire (Helen Morgan) is right that we should focus not on natural birth but on the outcome of a healthy mother and child.

Birth does not always go smoothly. Generally, and increasingly as I became a more senior doctor, I attended only the very high-risk deliveries—those when things go wrong. In a job focused on saving lives, the opportunity to do so at birth is perhaps the most rewarding, but sadly, despite the best efforts of the whole team—midwives, obstetricians, paediatricians and allied professionals—some babies die, and that leaves a hole in the families that, as others have said, does not go away.

I spoke in the baby loss debate in 2022 as the responsible Minister, and I am reminded today of the words of Hayley Storrs, which were read by the hon. Member for Leeds East (Richard Burgon):

“What people fail to understand when someone loses a child, it is that you have lost a lifetime. First days at school, first steps, graduations, what their favourite story would have been, birthdays, Christmases.”—[Official Report, 25 October 2022; Vol. 721, c. 65WH.]

That very moving account has stuck with me. It reminds us that this pain endures, so we must do all we can to prevent it.

I pay tribute to my NHS colleagues who strive every single day to ensure that pregnancy and birth lead to the happy, healthy outcome that we all want. Politicians and the Government must do all we can to support that. We must hold the NHS to account when it fails to uphold the very highest standards.

I also pay tribute to the many great charities, such as Sands, Tommy’s and Bliss, which have been mentioned by others, that do such great work in this area. I was proud to run the London marathon with a constituent earlier this year to raise money for Bliss, and I am grateful for the support it provided to him.

We must focus relentlessly and systematically—starting at pre-conception, as the hon. Member for Sheffield Hallam (Olivia Blake) said—on every single factor that can cause or increase the risk of baby death. That includes reducing teenage pregnancy, smoking and obesity; ensuring that there is chronic illness optimisation, so that if someone has diabetes, it is optimally managed before they conceive; making medication changes if needed, so that someone is not taking teratogenic drugs at the onset of pregnancy; and ensuring that women are aware that folic acid should be taken before and during the early parts of pregnancy. Before the general election, the Government consulted on the fortification of flour with folic acid to reduce the number of babies who suffer from a shortage of folic acid during pregnancy. Can the Minister confirm whether this Government will go ahead with the proposed legislation to fortify bread products?

Additionally, the Chancellor has said that she will stop all non-essential communications. Many of the messages we are talking about are public health messages that need public communication strategies. Can the Minister confirm that this essential form of communication is not affected by the Chancellor’s restrictions on communication costs?

NHS England introduced the saving babies’ lives care bundle, which currently focuses on six areas: smoking; the assessment of foetal growth during pregnancy; awareness among parents and families that a reduction in foetal movements can be a significant warning sign; expertise training for cardiotocography monitoring during labour and pregnancy; the reduction of premature birth; and the management of diabetes to ensure that people have optimal control. The NHS had a plan to update the bundle to introduce maternal early-warning schools and tracking tools. Can the Minister confirm whether it is on track to deliver that? Can she also confirm that the saving babies’ lives care bundle will be updated this year and at regular intervals, as evidence improves on how we can best reduce the number of baby deaths?

Two years ago, as Minister, I delivered a statement to the House on behalf of the Government regarding the outcome of Bill Kirkup’s independent review of maternity services in East Kent. His report was very sobering. Those tragic events revealed failings—failings seen previously elsewhere, which should and must not be repeated. In response to the review, the Government set up a group chaired by Maria Caulfield, then the Minister for Women’s Health, to oversee the work being done to improve maternity services nationwide, including by implementing the recommendations in Dr Kirkup’s report. Can the Minister confirm that the group’s work will continue under the new Government? If so, can she confirm who will lead it?

Can the Minister confirm that she will support the work of the healthcare safety investigations branch, which investigates all cases of stillbirth and life-changing injury, to see what lessons can be learned and how care can be improved?

Other have talked about the Sands and Tommy’s “Saving Babies’ Lives” report, and particularly about workforce issues. The previous Government invested heavily in increasing workforce numbers, building five new medical schools. That takes time, but it will ultimately increase the number of obstetricians and paediatricians. The number of midwives also increased. There were 23,361 full-time equivalent midwives in NHS trusts and other core organisations in 2023, which is an increase of 19% since 2010. Births fell in England and Wales during a similar period. In the spring Budget, the Government committed £35 million to improving babies’ care, £9 million of which was related to preventing brain injury. The remainder related mostly to funding 160 additional posts in midwifery and neonatal care. Can the Minister confirm that that investment will proceed in order to support the care of pregnant women and babies?

In summary, it is almost 10 years since the Government launched the maternity safety ambition. While that goal has not yet been achieved, from 2010 to 2022, the stillbirth rate fell by a fifth, the rate of maternal mortality fell by a fifth, and the rates of neonatal mortality for those babies born after 24 weeks fell by 36%. Those statistics are a good achievement, representing many hundreds of families who will now enjoy watching with love as their children grow, thrive and develop. We must build on that now to ensure that many more families—all families—have the same opportunity.

Oral Answers to Questions

Caroline Johnson Excerpts

Tuesday 23rd July 2024 Commons Chamber

[Mr Speaker]

I call the shadow Minister.

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

I congratulate the right hon. Gentleman on his position. I should declare that I have been working in the NHS for 23 years, currently as an NHS consultant paediatrician. I look forward to using that experience in my new role as shadow Minister of State to scrutinise the Government constructively.

Under the new hospital programme, the previous Government had already opened six hospitals to patients, with two more due to open this financial year and 18 under construction. The Government are now putting that at risk by launching a review of that work, delaying those projects, which are vital to patients across the country. Could the right hon. Member please confirm when the review will be completed?

[Wes Streeting]

First, I welcome the hon. Lady to her new post. I must say I preferred her much more as a Back-Bench rebel than a Front-Bench spokesperson, but I have enormous respect for her years of contribution to the NHS and the experience that she brings to this House. I always take her seriously.

However, on this one, once again I say to the Opposition that they handed over an entirely fictional timetable and an unfunded programme. The hon. Lady might not know because she was not there immediately prior to the election, but the shadow Secretary of State, who is sitting right next to her, knows exactly where the bodies are buried in the Department, where the unexploded bombs are, and exactly the degree to which this timetable and the funding were not as set out by the previous Government.

NHS

Caroline Johnson Excerpts

Thursday 23rd May 2024 Commons Chamber

[Victoria Atkins]

I most certainly do, and it is a pleasure to hear that my hon. Friend, who is such a great campaigner in his constituency, has that as a clear target for his area to represent his constituents. On the recruitment of general practitioners, we have set out, through our long-term workforce plan, our ambitions—and, importantly, the plans underlying those ambitions—to ensure that we recruit even more doctors, nurses, midwives, dentists, and so on, to build the NHS of the future. My hon. Friend might want to share this fact with his constituents: since 2010, there are more than 41,000 more doctors in our NHS in England and more than 73,000 more nurses. Those are figures to be proud of.

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

I associate myself with the good wishes that have been sent to you this morning, Madam Deputy Speaker.

Prevention is, of course, better than cure, so will my right hon. Friend confirm that she is doing all that she can to ensure that the Government’s world-leading Tobacco and Vapes Bill is passed during the wash-up? She knows of my concern about children’s exposure to vaping. If the Bill will not be passed through wash-up, will she confirm that a Conservative Government would act quickly, once re-elected, to protect our children from deadly nicotine addictions?

[Victoria Atkins]

I am very grateful to my hon. Friend, who, of course, brings her professional expertise into the Chamber. On the Bill, she will appreciate that we are at a very delicate stage, which I am not allowed to say anything about at the Dispatch Box, but she should be confident of my commitment, and that of the Prime Minister, to this important legislation and to a smoke-free generation.

Tobacco and Vapes Bill (Fifth sitting)

Caroline Johnson Excerpts

Committee stage
Thursday 9th May 2024 Public Bill Committees

[Preet Kaur Gill]

Right. However, that brings me to my second point. The Bill provides a number of powers for the Secretary of State to make secondary legislation, particularly on vapes. It is therefore important that we think carefully about how to achieve the objective of stopping young people from getting addicted to nicotine in the first place. Whoever the Government are after the next election, they will likely inherit those regulations, and some of them can be deceptively tricky to get right.

I want to ensure that whoever the next Government are, they have the powers they need to get a grip on this issue given that so recently this Government have not done so—when one in three vapes on the market is illicit, when youth vaping has trebled in two years, and when gaping loopholes in the law have undermined enforcement and put children at risk.

Vaping is a valuable stop-smoking tool, but those trends are a serious concern. There are areas where the Bill can be strengthened, and I hope the Minister will listen closely to our arguments. The Bill is an opportunity to think about not just the public health challenge as it manifests today, but the challenge we will face in 10 years’ time. That is what a real agenda on prevention must do.

When the last Labour Government took office, one in four people in the country was a smoker. Every pub we walked into was clouded with the fumes, and one in 10 of our 11 to 15-year-olds smoked. When we banned smoking in public spaces and raised the age of sale to 18, we were met with a lot of opposition. Some of the charges put to us were like the ones we heard on Second Reading: that the law would be unenforceable, that it was an attack on working people and their culture, that it would fuel the illicit market, and so on. None of them held up.

Today the idea that children should be allowed to smoke or that non-smokers should have to tolerate deadly second-hand smoke is unthinkable. No one would think of making those arguments now. Just as the opponents of that legislation were wrong then, they are wrong now. Since 2007, the number of people who smoke has been cut by almost a third. The percentage of 15-year-olds who smoke regularly has dropped from 20% to 3%, and our understanding of second-hand smoke has grown. There has been a culture shift around where it is acceptable to smoke. Even at home, people go outside to smoke instead of smoking in front of their children. The year after the smoking ban came into effect, there were 1,200 fewer hospital admissions for heart attacks according to The BMJ.

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

Could the hon. Lady tell me about the consumption of nicotine among people once the Government had brought in the smoking ban in public places? Was there a reduction in nicotine consumption among the people who continued to smoke because of the restrictions on where they could do so?

[Preet Kaur Gill]

I have just said that after the smoking ban came into effect, there were 1,200 fewer hospital admissions for heart attacks. We saw a drop in people smoking—the data from The BMJ is already out there. By working towards a smoke-free future by progressively raising the age of sale, I hope that this Parliament can leave a similar legacy.

I turn to clause 1 and its equivalents for the devolved nations—probably the most important clauses in the Bill. Clause 1 of course changes the age of sale for tobacco products from 18 to a set date of 1 January 2009, meaning that anyone born on or after that date will never be able to legally buy cigarettes. It will progressively raise the age of sale by one year every year, so that the generation who are 15 now will—we hope—never smoke.

When the shadow Secretary of State, my hon. Friend the Member for Ilford North (Wes Streeting), proposed the measure in January 2023, it was because we know that it will take fresh, radical thinking on public health to take the pressure off the NHS and get our ambition for a smoke-free future back on track. The rationale for the progressive approach, compared with what some MPs have argued for in raising the age of sale to 21, is that it is a radical but realistic way of phasing out tobacco over time. It means that no one loses a right they already have, but it does not limit its ambition to young people —there is no safe age to smoke.

I hope that a lead-in time of three years will be enough for us to get support to those under-18s who already smoke, so they are not affected by the time the legislation comes in. Will the Minister say whether she is planning a targeted campaign to ensure that we reach those young people, perhaps by working through schools? Almost two thirds of long-term smokers began smoking before they were 18. University College London has calculated that every day around 350 young adults aged 18 to 25 start smoking regularly, risking being trapped in a lifetime of addiction and premature death. The vast majority of smokers and ex-smokers—85%—regret ever starting in the first place, but it is infamously difficult to quit. Stopping people from starting is the single best way of saving them from a lifetime of potentially deadly addiction.

I reject the suggestion that the legislation will be uniquely difficult to implement or enforce. Labour raised the age of sale in 2007, and that is well understood and widely enforced.

Shopkeepers are already used to enforcing age of sale legislation, and we have initiatives like Challenge 25, so it would not be until 2034 that we enter the uncharted territory of routinely checking the age of customers who look 26 years old. I would expect by then that we would already be beginning to see a considerable reduction in the number of people still smoking under that age, but even then, arguably this legislation makes implementation easier: instead of having to ask for someone’s ID to compare their birth date against the current date, which involves doing maths in one’s head, it will be as simple as checking against one static date every time. I do not want to insult the intelligence of anyone working in retail, but that has formed part of the arguments of some of the Bill’s opponents, so I really want to call that out.

As for the right to feel protected and confident in their jobs, there is no doubt that violence against shop workers has risen in recent years, but that is why we in the Opposition have long campaigned for violence against shop workers to be a separate criminal offence. As with much recent legislation, I am glad that the Government have seen sense and followed Labour’s lead on that, too.

I know that some libertarian Conservative MPs have a philosophical objection to this legislation—the Business and Trade Secretary is one—but let us be honest: if we had known the social, public health and economic harms of smoking that we now know, would we not have legislated in similar terms long ago? Let us be clear: addiction is not freedom. The impact of second-hand smoke on the children of smokers is not freedom. It is certainly no freedom if, as is the case for two thirds of long-term smokers, one’s life is cut short as a result of smoking. It should be a source of pride if, from having the highest smoking rates in the world, we can successfully introduce genuinely world-leading legislation to phase out tobacco for good.

I want to make some brief remarks on other clauses. I have no substantial concerns about clause 2. For the Bill to work, it cannot be possible for adults over the legal age to buy tobacco on behalf of others who cannot buy it. It is obviously right that the clause avoids criminalising children by specifying that it applies to over-18s in its alignment with the commencement date in 2027. I see no issue with that.

I do, however, have questions about implementation. We have spoken a lot about physical retailers but less about online retailers. This is undoubtedly an enforcement challenge and I wonder what the Minister can say on that. In response to the consultation, the Government said that they were exploring how to enhance online age verification so that young people under the legal age cannot buy age-restricted products online. What progress have the Government made since the consultation response was published in February?

On clause 37, I want to pick up on the specifics of the Scottish age verification policy. Will the Minister explain the Government’s view on introducing additional requirements for retailers to establish an age-of-sale policy in the rest of the United Kingdom, in addition to the requirements in clause 1? I understand that the Bill would require the existing Challenge 25 policy to stay in effect in Scotland with legal force until the end of 2033, at which point over-25s will be within the legislation’s scope and then 1 January 2009 would take precedence again.

Finally, on clause 41, we support the amendment to Scottish regulations to include herbal cigarettes. Herbal cigarettes may not include tobacco or nicotine, but they are still harmful to health. Their smoke still contains cancer-causing chemicals, tar and carbon monoxide, similar to a tobacco cigarette. I am glad to see an alignment of approach across the UK nations on the point that no smoking product should be left out of the Bill’s scope. We also have no problem with the inclusion of clauses 48 and 49 to change tobacco control laws in Northern Ireland to align with the approach that we have discussed.

I reiterate that the Opposition support these clauses and we will reject attempts to amend them that would water them down. I would be grateful if the Minister responded to my questions.

--- Later in debate ---

[Dame Andrea Leadsom]

I appreciate the clear cross-party support for the measures in the Bill. I understand that hon. Members will have views on ways to amend or strengthen it, but I urge the Committee to appreciate how little time we have. As we heard clearly from last week’s evidence sessions—from the chief medical officers from all parts of the United Kingdom and from so many medical professionals—this is a very good Bill, so let us not make the perfect the enemy of the good. Let us get this through.

I very much appreciate the welcome of all colleagues, and I assure them all that I will take away any suggestions and requests and come back with clear answers. Where something is relatively simple to do, we will seek to do that, but equally, as Members will appreciate, it is not always possible to accept every suggestion, no matter how well-meaning—and I absolutely accept that, in this Bill, it is always well-meaning.

I will answer the points that hon. Members specifically raised. The hon. Member for Birmingham, Edgbaston asked about how we will encourage young people to quit smoking at an early stage. She will be aware that there are lots of measures to try to help people to stop, including the financial incentives that we are providing, particularly for those expecting a baby and their partners. There are also the quit aids to help people to swap to stop—to move to vapes, which I think we all recognise can be a useful quit aid. They are not harmless, but are less harmful than smoking cigarettes.

We are working at pace with online retailers on how to support them to ensure age verification, and I hope that we will be able to say more about that. The issue of duty-free sales is a tricky one, as my hon. Friend the Member for Harrow East will appreciate, because we do not want to put the burden of legality on the purchaser. The idea is that it should be illegal to sell, and, of course, we have jurisdiction only in the United Kingdom, but I take his points on board and will come back to him on that.

The hon. Member for York Central is right that we need to do everything we can to stop advertising. There are already very strict rules around advertising, and smoking and vaping are severely restricted when it comes to advertising to children. But I think—I hope that the hon. Lady will agree—that the vaping measures, including the powers to limit packaging, flavours and in locations in stores, will do a lot to reduce the appeal to children, which I know we are all incredibly concerned about.

[Dr Johnson]

I say, first, that I fully support this Bill and what it intends to do. Having worked in respiratory medicine in my very first job as a doctor, I saw far too many people suffering from and dying of respiratory illness, and suffering through the final years of their life due to respiratory illness caused by smoking. I think this is excellent legislation.

My right hon. Friend talked about advertising being quite restricted, but, with vaping, we see sports teams—rugby teams and football teams—using vaping brands as adverts for children. These are not recreational substances, or should not be recreational substances. They are supposed to be quit aids and do not need advertising where children can see them.

[Dame Andrea Leadsom]

My hon. Friend makes an extremely good point. She will be interested to know that I have recently written to the Advertising Standards Authority to ask about how well it considers enforcement to be working, and what more it can do to enforce the already strict regulations. I am happy to share its response, when it comes, with all members of the Committee.

--- Later in debate ---

[Dr Johnson]

I welcome clause 3. It is sensible that we protect children from having easy access to products that we have decided should be age-restricted, and it is clearly sensible that tobacco products be age-restricted —that is part of the purpose of the whole Bill. However, clause 3 does not extend to vaping products or other nicotine products. We know that the use of such products is becoming increasingly prevalent among children.

As the Minister knows, I have tabled new clause 16, which would create the same offence for nicotine-containing products or vaping products to be sold in vending machines because they are age-restricted. It is not usual to have age-restricted products in vending machines and it is my view that children would quickly find a way round machines that are supposed to check their age. Will the Minister look at that sympathetically?

[Dame Andrea Leadsom]

The purpose of clause 3, as with a lot of the clauses that we will debate in line-by-line consideration of the Bill, is to tidy up the statute book for the whole tobacco regime, both to align all four nations and to make sure there is a clear understanding of the law where it relates to tobacco, tobacco products and vaping. The fundamental purpose is to tidy up the statute book by restating it with clarity at this critical time.

My hon. Friend the Member for Sleaford and North Hykeham made a point about vaping and vending machines. As she will be aware, the Government are taking powers in the Bill to look at issues such as location of sale, packaging and flavours. It was felt that it was important to have further consultation under those powers to look at issues such as whether vaping products should be sold in vending machines. It will be debated at a future time under those regulations. The key point is that we have clarity in the Bill.

[Dr Johnson]

I thank the Minister for that information. She talks about location of sale. I understood location of sale to refer to a geographical location, rather than a method of sale, such as through vending machines. Could she be clearer on that point?

[Dame Andrea Leadsom]

I will get back to my hon. Friend on that point, which is a good one. This clause and many others are intended to tidy up the statute book, rather than to introduce new subjects that would be more appropriately considered somewhere else.

--- Later in debate ---

[Preet Kaur Gill]

First, I want to make some general points about these first vaping-related clauses of the Bill. We agree fundamentally with the Government in their efforts to find a balance by phasing out tobacco use and cracking down on youth vaping while being careful not to undermine the proven success of vaping as a stop-smoking aid. There is no doubt, however, that the rise in youth vaping is a serious concern.

My main question about the Government’s response is “What took them so long?” Labour proposed measures more than two years ago to stop vapes being branded and marketed to appeal to children, but that was blocked by the Government. I am glad that the Government have listened to us. I hope that they will continue to do so as we debate the Bill; I firmly believe that some of its provisions can still be strengthened.

I am pleased by the inclusion of clause 7. Coupled with clause 34, which defines a vaping product in a way that includes non-nicotine vapes, it will tackle a substantial loophole that we have been calling on the Government to close for a long time. Youth vaping is a serious and growing issue. In 2021, Labour voted for an amendment to the Health and Care Bill to crack down on the marketing of vapes to children. Since then, according to the most recent survey by Action on Smoking and Health, the number of children aged 11 to 17 who are vaping regularly has more than trebled. That is more than 140,000 British children. Meanwhile, one in five children have now tried vaping. In clause 7, a couple of issues therefore intertwine.

I think most people would be surprised to learn that it is legal to sell non-nicotine vapes to children, which could so obviously be designed as a gateway to addiction to the real thing, as the Minister mentioned. It is doubly concerning when we think about the illicit vapes that end up on British shelves. Testing by Inter Scientific, from which we heard last week, has found that a considerable percentage of seized vaping products that it tested contained nicotine, even when they were marketed as 0%.

That is highly concerning. It means that for the past several years, we may have seen a spate of accidental addictions among children. According to survey data from ASH, 9.5% of vapers aged 11 to 17 exclusively puff on so-called 0% nicotine vapes. Analysis of that and of data from the Office for National Statistics suggests that at least 40,000 child vapers could have been exposed to nicotine-containing vapes without their consent, becoming accidentally addicted by illegal products masquerading as nicotine-free that, under existing regulations, they are allowed to buy. That is an important testament to why not just regulation, but effective enforcement— especially over the illicit market—is vital to the success of the Bill.

The two-tier system of regulation for nicotine and non-nicotine vapes is not robust. The exclusion of non-nicotine vapes from the Tobacco and Related Products Regulations 2016 is important for a few reasons. Primarily, it is confusing and more difficult to enforce the rules on the ground if it is not clear which products contain nicotine and which do not. As 0% nicotine vapes are out of the scope of the current regulations, they do not need to be notified through the Medicines and Healthcare products Regulatory Agency process, on which trading standards officers often rely to identify illicit products. I raised that point with the Minister in a debate in January and am keen to seek clarity. Does the Minister think that all producers should have to notify vape products, regardless of nicotine content, to the MHRA?

I note that clause 71 provides the power to extend the notification process to non-nicotine vapes, but the Government have not, to my knowledge, explicitly expressed a view on the matter. Will the Minister do so now? In theory, including non-nicotine vapes in the notification process should allow for a complete database of products. Currently, it is difficult to identify which products are legal or illegal, which really undermines enforcement action.

As we heard in evidence, the impact of vaping products on the developing bodies of children has the potential to be very harmful. It is vital that we take every step to make sure that our systems of regulation and enforcement are as robust as possible to stop a new generation of products hooking our children on nicotine and harming their long-term health. We absolutely support the clause, and I am keen to hear the Government’s view on the issues that I have raised.

I have no substantial comments to make about clause 8. It is a common-sense reapplication of the principles of clause 2, which we have debated and which I support.

Clause 9 will finally address a loophole that I regret to say the Opposition raised in an amendment to the Health and Care Bill in 2021; I am glad that it is now receiving the Government’s attention. Our 2021 amendment would have prohibited the free distribution or sale of any consumer nicotine product to anyone under 18, while allowing the sale or distribution of nicotine replacement therapy licensed for use by under-18s. The then Minister rejected the amendment. To quote my hon. Friend the Member for City of Durham:

“There was no evidence of a serious problem, but the Minister sympathised with the argument for preventive action.”—[Official Report, 22 November 2021; Vol. 704, c. 56.]

Two and a half years later, it is clear what a widespread issue this has become. It goes without saying that Opposition support clause 9, which will close the loophole, as well as clause 44, which will introduce powers for the Scottish Government to extend the existing powers to regulate the free distribution of vapes and other nicotine products such as pouches, as mentioned by the Minister. Likewise, clause 51 will mean that age of sale restrictions can be extended to non-nicotine vaping products.

Finally, clause 53 relates to the free distribution of vapes and nicotine products in Northern Ireland, whether or not they contain nicotine. As I have discussed, I am very concerned that that has presented a loophole that has undermined enforcement, so I support a consistent approach across the United Kingdom. May I ask the Minister to set out what the words “in the course of business” will mean in practice when it comes to the free distribution of harmful products, given that we would expect any person caught out by the provision to argue that there is no “business” in giving away something for free? Of course, we know that that is not true in the case of addictive products, but I will be grateful if the Minister can reassure me that the clause will do in practice what it needs to do. Can she also please reassure me that it will not prohibit under-18s from accessing nicotine replacement therapies?

I reiterate that the Opposition support these clauses, but I am very interested in the Minister’s views on how the Bill should affect the notification process for vapes.

[Dr Johnson]

I welcome the clauses. I have been very concerned about the number of children who are taking up vaping and about its effects. We have heard in evidence, both in the Health and Social Care Committee and last week in this Committee, about the dangers of vaping for children who have never smoked. The chief medical officer has made it extremely clear that for someone who smokes, vaping may be better for them, but that someone who does not smoke should not vape. These measures will help to reduce the number of children who have access to such products, which is good. They will also close the loopholes for free samples and non-nicotine vapes, which can provide a gateway to such awful addiction.

We have also heard how nicotine in general is not just very addictive but harmful to children’s developing brains, and how getting them hooked early makes it more difficult for them to quit in the long term. We have heard about how children in schools are struggling to concentrate when leaving lessons to consume nicotine, which is having an impact on their education and wellbeing. We have heard from health experts about small particles going into children’s lungs, without our knowing what the long-term effects of that might be. I welcome any clause that will help to reduce the number of children vaping.

I do have one question. The cross-heading before clause 7 is “Vaping and nicotine products”, but clause 7 only makes it an offence to sell a vaping product to a person under the age of 18, rather than also making it an offence to sell all other nicotine products, although the capacity to do so is set out later in clause 9. I am just wondering why the Minister is taking a power to restrict nicotine product sales but is not actually doing so. We are starting to see that children at school are using nicotine pouches that are available in all sorts of different flavours. I can see nicotine pouches becoming the next way for the industry to try to hook children on nicotine. Has the Minister considered getting ahead of the game by saying that nicotine products cannot be sold to children at all?

[Kirsten Oswald]

Is the hon. Lady reflecting, as I am, on the comments that we heard in evidence about the link between professional footballers and some of these products? There is an obvious interest and attraction in these kinds of products for the very young people we are concerned might take up vaping.

[Dr Johnson]

Yes. Sportspeople, as we know, are very influential on young people. To promote products that are potentially harmful to children is morally wrong, in my view. They need to be careful to think about the effects that they may be having on children.

My question to the Minister is whether she will consider extending clause 7 outright to include nicotine products for children. We need to support children who are smokers or vapers and wish to quit, but those children can get nicotine replacement products from their GP on prescription. There is no need for those products to be sold to children.