Electronic Cigarettes

Caroline Johnson Excerpts

Thursday 29th June 2023 Westminster Hall

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

I beg to move,

That this House has considered electronic cigarette use.

E-cigarettes were introduced as a stop-smoking device, but in my opinion they have moved from being a stop- smoking device to an alternative addiction. Indeed, they are attracting many non-smokers. In 2007, there were around 10.6 million smokers, according to official figures. The number fell to 6.6 million in 2022, so 4 million smokers had stopped. Sadly, it is estimated that around 1 million of those people died, which means that around 3 million quit smoking. That is undoubtedly a huge success, although it cannot be attributed entirely to vapes.

In the Health and Social Care Committee yesterday, we heard from the industry that it estimates that around 5 million people currently vape in the UK, which means that, even by the most generous estimates, 2 million of them were not smokers beforehand—a significant proportion of the vaping market. With the market estimated to be worth £4 billion a year, these products clearly have huge profit margins. Vapes have been available for a long time, but if they are genuinely safe, healthy devices that save lives by stopping people smoking, why does the NHS not provide any on prescription? I wonder whether it is because they are not safe and the NHS has been unable to develop the safety profile as well as it might wish.

The idea that e-cigarettes are 95% safer than smoking was quantified by Public Health England. Members will no doubt have heard the figure before, because the vaping lobby never tires of repeating it, but if we look into its origins, its veracity seems to suddenly disappear. The figure originated in a 2014 paper in a journal called European Addiction Research, but it comes with some important caveats. The study was partly funded by the Italian Anti-Smoking League, and one of its authors was a member of that organisation and served as a consultant to an e-cigarette distributor at the time. That blatant potential conflict of interest did not escape the journal’s editors, who added a warning note at the end of the paper, but it certainly escaped subsequent reporting of the figure.

The scientific journal The Lancet was even more excoriating of the original article, accusing it of having

“an almost total absence of evidence”

and of being based on

“the opinions of a small groups of individuals with no prespecified expertise in tobacco control”.

Furthermore, it is worth noting that the paper is seriously outdated. Since 2014, a plethora of evidence has emerged about the negative effects of these novel and fast-evolving devices, in studies that were never considered when the figure of 95% was reached. I am concerned that the statistic will age about as well as the claims made to past generations about the health benefits of smoking.

As we delve deeper into the topic, it becomes evident that a growing body of evidence links vaping to severe complications. Chronic bronchitis, emphysema, increased blood pressure and significantly worse physical performance are just some of the adverse effects associated with vaping that scientists have found. Furthermore, the high nicotine content, which some say is roughly equivalent to between 40 and 50 cigarettes in a disposable vape, poses a grave risk to the health and wellbeing of young people. We heard yesterday in the Health and Social Care Committee from Dr Helen Stewart of the Royal College of Paediatrics and Child Health—I should declare my interest as a member of that college and a consultant paediatrician—who told us about the difficulties that children are facing. Some of them are not going to the toilet during school time because the clouds of vapour they experience there trigger their asthma and make them unwell. We heard about children collapsing, too.

The number of children vaping is increasing. The evidence submitted to the Health and Social Care Committee by the vaping industry suggests that over 83% of children have never vaped or are unaware of vaping, but that flies in the face of the experience of most of the children, teachers and doctors I have spoken to. Indeed, a report on Blackpool published by Healthwatch in May found that a staggering 31% of children and young people claim to vape or sometimes vape. More disturbingly still, when I asked Healthwatch if it could break down its figures by age, it said that one in ten 10 and 11-year-olds vapes. These are children in year 6. That rises to nearly one in five 12 to 13-year-olds, while for 16 to 17-year-olds the figure was almost one in two. We have also noticed that the number of children vaping is rising extremely quickly.

I would like share a distressing incident from my constituency. In just one school, St George’s Academy in Sleaford, there have been eight reported cases of children collapsing after vaping. Those incidents occurred at different times with different children. I was deeply troubled to hear about this, so I went to visit them and met with one of the intelligence officers from Lincolnshire police, who had collected five vapes from another school.

In just those five vapes they found Velvana Fridex Eko, a modern non-toxic coolant intended for cooling cast iron and aluminium engines, as well as Avanti coolant antifreeze, Steol-M, which is designed for filling hydraulic devices, and Rauvolfia serpentina, or Indian snakeroot. Also found was Agip antifreeze, trichloro- ethylene, and poster and watercolour varnish—1-methoxy-2-propanol—along with diethylene glycol diacetate and 2-methoxyethyl acetate, a substance that may damage fertility and unborn children and is harmful to the skin if inhaled or swallowed. They also found aviptadil, a synthetic vasoactive intestinal peptide that is used to treat certain medical conditions.

These vapes do not contain what the children think they do, and they can be very dangerous. The police found that some children had significant health issues. The eight children who collapsed in Sleaford were taken to hospital. Thankfully, they have all recovered, but in one description given to me, a child taken to hospital in the back of a car had one side of his face drooped down as if he had had a stroke. His mother was clearly terrified by this. Another young boy said that he thought he was walking along through the marketplace in Sleaford when he realised that people were gathered around someone who had collapsed. Then he realised, as if looking from above, that that person was him. We have heard some really scary stories about what has been going on.

We hear that vaping is a good route to quitting, but we should balance the fact that it may help adults to quit with the need to keep these devices away from children. One of the things that makes vapes attractive to children is how inexpensive they are. We have seen them at £4 each, three for a tenner and those sorts of prices, which is clearly within pocket money range. When children can get disposables so cheaply, they are easy to discard. If a child finds that mum or dad is coming down the corridor or up to the bedroom, they can dispose of them quite quickly. When teachers come into the toilet, they can be disposed of, including in sanitary waste bins, which poses other hazards, too.

How much nicotine is in vapes? The average disposable contains 2 ml of e-liquid at 20 mg/ml nicotine strength, which I am told is the equivalent of 40 to 50 cigarettes. The reason for that is that people only take about 10% of the nicotine from cigarettes into their lungs—the rest of the time it just goes into the air—so vapes are stronger in many cases than cigarettes.

The other issue I want to raise with the Minister today is marketing tactics. We heard yesterday from the chief executive of Totally Wicked, who I challenged on his marketing techniques. Totally Wicked sponsors Blackburn Rovers and a rugby team as well, so the stadium is called Totally Wicked. The young men on the pitch—the heroes, as he called them, who those young men and women admire so much—are running around with T-shirts emblazoned with “Totally Wicked”. He said that the young people’s ones do not have that logo on. I checked this morning and found no evidence of them selling any junior shirts, which begs the question of what happened to them all. The suspicion might be that they have disappeared off sale—we do not know.

The Online Safety Bill offers an opportunity to ensure that vapes are not advertised on platforms such as TikTok. Vapes have bright, attractive packaging, with colours and flavours such as bubble gum. Why does an adult smoker need a unicorn milkshake-flavoured vape to quit? My 12-year-old daughter is too old for unicorns, she would tell me now, so why an adult would need a unicorn, I do not know. These vapes have become fashion accessories, and are being matched to outfits. Walk into any corner shop and we can see a whole rainbow from which to choose. There are understandable concerns that some manufacturers are deliberately doing that. They would all deny it, of course, and I hope that it is not the case, but with flavours such as unicorn milkshake, bubble gum, candy floss and green Gummy Bear, it is clear that these things are far too attractive to children. I ask the Minister to consider whether, if these are truly stop-smoking devices and not lifestyle products that are attractive to children, they really need to be coloured and flavoured. I do not think they do.

The environmental impact of disposable vapes has been highlighted by a number of my colleagues in the House on a number of occasions. Some 1.3 million disposable vapes are discarded in the UK every week. The vast majority are not recycled. Their complex construction and high nicotine concentration make proper disposal challenging. They also contain lithium batteries, a precious and vital resource in our transition away from fossil fuels that is being discarded willy-nilly, sometimes into rivers and water courses. That further exacerbates the environmental consequences.

Vapes have also been known to cause fires in bins, bin lorries and recycling centres. They pose a danger. I am also advised that the plastic, because the nicotine salts leak into it, becomes hazardous waste and is non-recyclable in any case. I urge the Government to back my ten-minute rule Bill and to ban these devices. A ban has been backed by the Royal College of Paediatrics and Child Health, and by the Royal Society for the Prevention of Cruelty to Animals. It is a widely supported measure.

As well as the issue with colours and flavours, we need tougher regulations on the advertising and marketing of vaping products. Health warnings should cover 65% of the front and back of the pack, in the same way as for tobacco. Sports club sponsorships should be banned. I cannot see why these products need to be advertised on sporting shirts; there is also the worry that that will make them more attractive to children.

When the former Government brought in bans on where people could smoke and where cigarettes could be displayed, the number of smokers dropped dramatically. I appreciate that that is a nanny state measure and, as Conservatives, we are reluctant to bring in nanny state measures. Nevertheless, it did work. If we were to ask people now whether we should reverse that measure, I do not think that many, if any, would agree. I suggest that as a sensible step forward.

At the moment, we are banning sweeties at the till because we think that will help to stop people becoming obese, but I have been into shops where those sweeties have been replaced with vapes. I am sure most people would much prefer that their child had a packet of Rolos than a vape.

My third point is about regulation. The industry is actually quite positive on this issue, and is keen for regulation—at least, that is what they say. At the moment, anyone can sell a vape. When I take my son for a haircut, we could get three lemon-flavoured vapes for £1 while we are there. He is only eight, so he will not be getting any, but we could. If we go to the sweetie shops on Oxford Street, we can buy them along with the candy.

Having the same sort of regulations as for tobacco or alcohol would mean that people would have to be licensed and would be challenged to make sure that vapes did not get into the hands of children, and there would be bigger fines. I saw an example of someone being fined £200 for selling these things to children. That is clearly no disincentive. A proper regulatory framework, where people lose their ability to sell these fairly lucrative products in the event that they break the regulations, will reduce the supply to children.

I also wanted to raise taxation. I appreciate that it is not the Minister’s responsibility, but he can raise it with the Chancellor and other colleagues. This measure was supported by Action on Smoking and Health in the Health Committee yesterday. If vapes are around £4 and a packet of cigarettes is £12, we could add considerable amounts—ASH is asking for a £5 tax on every disposable vape—as a way of taking them out of the range of children’s pocket money, while making sure that they are still cheaper than a packet of cigarettes for those adults who genuinely are smokers who wish to quit. Children are very price-sensitive and we need to deter them from this harmful habit.

My final point is about education. We heard from the headteacher of St George’s Academy yesterday in the Health Committee. Children need to know about vapes, and understand that they are not lifestyle products for them to use but aids for adults to stop smoking. The relationships, sex and health education curriculum review that is being done at the moment offers Ministers an opportunity to ensure that that happens. I am interested to hear what the Minister has to say.

--- Later in debate ---

[Dr Caroline Johnson]

I thank everyone who has contributed to this debate. It was interesting to hear that my right hon. Friend the Member for Calder Valley (Craig Whittaker) has given up smoking, on which I congratulate him. I hope he will soon be able to give up heated tobacco as well; I am sure his health will benefit.

I also thank the SNP spokesperson, the hon. Member for Paisley and Renfrewshire North (Gavin Newlands), and the Opposition spokesperson, the hon. Member for Ilford North (Wes Streeting), for their support. I think I am correct in saying that there was support from all corners of the House for doing everything possible to ensure that children cannot get their hands on vapes.

I welcome the measures in the Minister’s speech, particularly those on education, preventing the distribution of free vapes, the introduction of the enforcement team and nicotine-free vapes. I also welcome the consultation, but we need to be quick about this because more children are vaping every day. That means that every day more children are becoming addicted and developing a nicotine habit that they will find difficult to break.

One of the challenges of quitting smoking is giving up nicotine, and giving up the nicotine in vapes is no different; in fact, it may be more difficult. I urge the Minister to look very closely at banning disposables and at marketing. He did not mention this in his speech, but I do not think that vapes should be advertised on the kits of any sports team. In shops, vapes are often positioned in the front of display cabinets where children can see them. I have seen advertisements for vapes on taxis and things like that—they should not be there.

The Minister’s review should look closely at flavours and colours, because I do not think they are necessary for stop-smoking devices. He should regulate where they can be sold and increase the penalties for those that break the rules. The Minister did not mention tax. I appreciate that that is a matter for the Treasury, but vaping companies should be taxed heavily to lift their pocket money. That is the right way to go.

As well as education, children need support. A huge number of children are already addicted to vaping products, and they need support. When they realise and are educated about the harms and wish to quit, they will need support and help to do so.

Perhaps my most important ask of the Minister is for him to look at the latest evidence. The 95% safer approach was predicated on evidence that is not terribly robust and on a study that is nearly 10 years old. It was based on an apparent absence of evidence of harm, but we are now seeing evidence of harm. I urge him to review the evidence. We are in a situation in which our headteachers are telling us that children must be able to vape so that they can discuss the flavours to fit in with their peer group, and we must get away from that. This issue is urgent and I urge the Minister to act quickly.

Question put and agreed to.

Resolved,

That this House has considered electronic cigarette use.

Oral Answers to Questions

Caroline Johnson Excerpts

Tuesday 6th June 2023 Commons Chamber

[Maria Caulfield]

I thank the hon. Gentleman for his question. We take this issue very seriously, and we have already made interim payments to those infected. The Minister for the Cabinet Office came to the Dispatch Box in April when Brian Langstaff’s review was published, and we are working night and day to respond to those recommendations and get that plan out as soon as possible. We recognise the impact on families, and on those infected and affected.

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

I refer Members to my entry in the Register of Members’ Financial Interests. Today Dr Mike McKean, a respiratory consultant and vice-president of the Royal College of Paediatrics and Child Health, said that vaping is “fast becoming an epidemic” among children. The Royal College of Paediatrics and Child Health said that we should ban disposable cigarettes—e-cigarettes—“without a doubt”. Will the Minister do all he can to prevent children from starting vaping, and will he back my ten-minute rule Bill, which was first introduced in this place in February, to ban disposable e-cigarettes?

[Neil O’Brien]

I pay tribute to my hon. Friend and her leadership on this issue. Many of the ideas that she has been putting forward are already in the plan that we set out to tackle youth vaping, including the creation of the “flying squad”, the ongoing call for evidence on youth vaping, and all the different things we could do to continue to drive it down.

Recovering Access to Primary Care

Caroline Johnson Excerpts

Tuesday 9th May 2023 Commons Chamber

[Steve Barclay]

I have touched on the numbers a few times, but let me give the hon. Gentleman the precise figures. There are 335 more pharmacists than there were in 2010, so it is simply not the case that there are fewer. There are 2,000 more doctors in general practice, and there are also the extra 25,000 in additional roles. As I have said, someone who wants a prescription review should see a pharmacist, and someone with back pain should see a physiotherapist; not everything has to go through a GP, and it is better for GPs’ time to be used more effectively. There are also more doctors in training: 4,000 are receiving training in primary care, as opposed to 2,600 in 2014. So we are seeing more staff, more effort on recruitment, more effort on retention through the pension changes, and better use of the additional roles.

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

I am pleased that the Government are looking at how they can best support GPs and improve access to primary care, but how will these plans protect and enhance the role of GPs who dispense in their own practices? How will my right hon. Friend deal with concerns about antibiotic resistance, and how will he solve the root cause of the problem, which is the fact that there are not enough GPs?

[Steve Barclay]

In respect of my hon. Friend’s first point, these plans will not make any changes. As for the second, about prescribing, that will be part of the consultation, and we will be learning lessons from what is being done elsewhere: for instance, Pharmacy First is already up and running in Scotland. We are looking into what tests can be performed alongside those prescribing rights so that antimicrobial resistance is targeted effectively.

Vaping: Under-18s

Caroline Johnson Excerpts

Tuesday 2nd May 2023 Westminster Hall

[Dr Hudson]

I completely agree, and I want to stress that key point: it is illegal to sell vapes to under-18s. I will be asking the Minister about that. I know that the Government are moving on it, and we need to address it going forward.

Similarly, an NHS survey in 2021 said that 9% of 11 to 15-year-olds, and 18% of 15-year-olds, had used vapes. Those are alarming statistics. ASH England also noted that the most frequently used e-cigarettes among young people are disposable vapes, with an astonishing increase from 7.7% in 2021 to 52% in 2022. Although this is not the main focus of my speech, I will point out that, quite aside from the health concerns associated with such a marked rise in the sale and consumption of disposable vapes, they are a major environmental concern, with over 1 million of them thrown away every week. It is estimated that the lithium used in those batteries equates to about 10 tonnes of lithium per year, which is equivalent to the lithium used in approximately 1,200 electric vehicle batteries.

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

My hon. Friend will be aware of my ten-minute rule Bill to ban disposable vapes for exactly the reasons he has described: the effects on children’s health particularly, and on the environment. Does he agree that the Government should support the Bill?

[Dr Hudson]

I very much agree with my hon. Friend. I thank her for intervening and I welcome her medical expertise in this debate.

I have touched on some of the environmental concerns, and there are also concerns about fires related to disposable vapes. However, at the heart of my speech is the impact that such a frightening level of vape use is having on our young people, even as young as primary age. I urge our policymakers not to underestimate it. There are increasing reports suggesting that the use of vapes has negative effects on heart and lung health, and may be associated with tooth and gum disease. Other issues reported include coughs, shortness of breath and headaches. Nicotine, which these products often contain, is highly addictive with potentially harmful effects on the adolescent brain, which is still developing.

--- Later in debate ---

[Dr Hudson]

I agree with the hon. Member. The industry needs to take a close look at itself, but it is also the case that a lot of the vapes that are ending up with children are coming through illicit means. We need to have a targeted approach to look at how best we can prevent our young people from accessing those products.

[Dr Caroline Johnson]

My hon. Friend made a very good point about advertising. We need to get across the nuanced message that vaping may be beneficial to people who want to quit smoking—although I would argue that it could become an alternative addiction rather than a stop-smoking aid—but we must also prevent children from using vapes. In the past, nuanced advertising for formula milk stated that breast milk was better at the beginning but that formula milk was a reasonable alternative for six month olds. Could a form of words be used in vaping adverts to make it clear that the products should be for people who smoke, not for those who do not?

--- Later in debate ---

[Neil O'Brien]

Absolutely, and I will touch on that in just one moment. Vapes—

[Dr Caroline Johnson]

Will the Minister give way?

[Neil O’Brien]

I think I should try to answer the last intervention before taking another one; I will come back to my hon. Friend in a second. Vapes are not yet being used widely enough to reach their full potential as a quit smoking aid, so on 11 April, I announced new funding for a new national “swap to stop” programme—the first of its kind anywhere in the world. We will work with councils and others to offer 1 million smokers across England a free vaping starter kit. Smokers who join the scheme, which will run initially over the next two years, will join on one condition: they must commit to quitting smoking, with support. We will provide additional support to help them quit vaping after they have quit smoking. We will target the most at-risk communities first, focusing on settings such as jobcentres, homelessness centres and social housing providers. I do not know whether my hon. Friend still has a burning question.

[Dr Johnson]

Yes, and I thank the Minister for giving way; he has been extremely generous with his time. He has talked about the importance of educating children about the risks. Does he agree that a key problem is that many young people and children who use vapes do not believe that they are harmful at all?

[Neil O’Brien]

My hon. Friend is quite probably right. There is a lack of understanding of some of the risks, and of the effects on mental health and wellbeing. I am very, very worried when I hear about young people at school smoking, and about the disruption that various hon. Members have raised in this debate.

I conclude by thanking all Members here for highlighting concerns about these issues, and for their contributions, not only in the debate but over a longer period. That has had an effect on Government policy, and will continue to. The Government are committed to doing all we can to prevent children and young people from vaping, while also ensuring that we use the full potential of vaping as a tool to help smokers quit.

Question put and agreed to.

NHS Strikes

Caroline Johnson Excerpts

Monday 17th April 2023 Commons Chamber

[Steve Barclay]

I share my hon. Friend’s concern. We have worked constructively with the Royal College of Nursing and, as I say, I was happy to put on the record my acknowledgment of the exemptions it had previously granted. I hope that between now and the end of the month, it will further reflect on the fact that the 48 hours of continuous strike action will happen without consultation with other staff council members and without waiting for the decision of other trade unions that are currently balloting. He will know that “Agenda for Change” is a deal that covers all the trade unions, not just the RCN in isolation, and I think it is right to wait for all the trade unions to vote and for the staff council to meet.

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

I draw the attention of Members of the House to my entry in the Register of Members’ Financial Interests.

On Friday, I was working at the hospital and my usual clinic had cancelled all but one patient. I spoke to the secretaries about the various cancellations they had had to make as result of the strikes, and I was really sad to hear not only that they had often been verbally abused by people who were upset, but that they have had to cancel some patients on two occasions because of the earlier strikes and the more recent ones. I was also sad to hear that we are looking at further strikes in the next few weeks.

Will the Secretary of State join me in thanking the members of staff who came into work, who did not strike and who continue to deliver a very important and valuable service? What is he doing to expedite the legislation on minimum service guarantees, so that we do not have any implications from strikes on emergency and intensive care in particular?

[Steve Barclay]

First, I thank my hon. Friend for her service and for the work she was doing on Friday. I join her in putting on the record my thanks to all those staff who did provide cover, as I said in my opening remarks. She is right to highlight the minimum service legislation, and we will obviously need to reflect on recent events in that context. She also points to the fact that the decision by the BMA junior doctors committee to advise members not to notify hospital management about whether they were striking obviously made it more likely that clinics would be cancelled, even when it then transpired that doctors could have provided cover. That is clearly regrettable and indicates the need for resolution, and we want to work constructively with the junior doctors on this.

NHS: Long-term Strategy

Caroline Johnson Excerpts

Wednesday 11th January 2023 Commons Chamber

[Dame Angela Eagle (Wallasey) (Lab)]

Through neglect, ideological hostility and incompetence, the Tory Government are presiding over the worst crisis the NHS has ever seen. Some 7.3 million people are on the waiting list; there has been a virtual collapse of emergency response; and people cannot see a GP or get follow-up treatment without unacceptably long waits. Today, there have been reports of more than 1,000 excess deaths a week—the highest total, excluding the pandemic, since 1951. There have been many, many preventable deaths on the Government’s watch, and each and every one is a tragedy.

Our NHS is in crisis from top to bottom. There are patients in hospital beds who cannot be discharged because there is no domiciliary care and nowhere for them to safely go. Ambulances are queuing for hours, unable to admit critically ill patients. There are inhumane waits in A&E before anyone can be admitted to beds they desperately need. Staff, who are already burnt out from the stresses of the pandemic, are unable to care properly for patients and are barely able to get through a shift because of the emotional exhaustion of having to deal with those failures.

A nurse at Arrowe Park in the Wirral, which serves my constituency, wrote to me recently. After 21 years of service to our NHS, she says she has

“never worked in such an unsafe environment”.

She says:

“Staff are literally on their knees, leaving shifts late in tears, and leaving in their droves”.

My constituent went on to detail a case in another local hospital in which a patient had a cardiac arrest in a hospital corridor. Frankly, a hospital should be the best place to have a cardiac arrest if somebody is going to have one, but it is now not so in Tory Britain. The individual collapsed and died.

With 132,000 NHS vacancies in England—over 17,800 in the north-west alone—our NHS is dangerously understaffed, under-resourced and under-respected. That is why NHS staff at the end of their tether have taken the desperate decision to go on strike. That is why any Government worth their salt would have decided to negotiate properly with them, to listen to them and to try to deal with and recognise that, in the last 13 years, a real-terms cut of 20% in nurses’ remuneration is simply not acceptable, but what did they do? They chose to have a divide-and-rule strategy, and they chose to try to scapegoat and blame NHS staff for the terrible conditions I have been talking about.

Perhaps the Government should consider legislating for a minimum service outside of strike days, because we are going to be in the absurd position of having, by law, guarantees on strike days—they could be negotiated anyway and always have been—that do not apply on non-strike days. It is an insult when the Secretary of State meets the health unions and says they have to increase their productivity. They are working beyond any amount of time that any human being should be asked to work.

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

I confess to being a bit confused by the Labour party’s position on minimum service levels. We all want to ensure that our constituents are as safe as possible. The ambulance workers want to ensure that people are as safe as possible. The hon. Lady has said herself that these things would be negotiated anyway. But the challenge people face on the ground is not knowing who is going to come in, the fact that people do not have a say on whether they are going to come in and the fact that a negotiated settlement might be different in different areas of the country, which makes messaging and public health messaging very difficult and puts people at risk. So why is Labour so against minimum service guarantees?

[Dame Angela Eagle]

I think the hon. Lady, and I know that she is a doctor, needs to recognise that these agreements have always been made when there have been strike days in the NHS—always. I think she also needs to recognise that any Government who were being responsible would have negotiated to put an end to these strikes, recognised the fantastic service that nurses have given and dealt with the issue, instead of going for confrontation.

[Dr Johnson]

Will the hon. Lady give way?

[Dame Angela Eagle]

I am not giving way again.

I am going to leave the last parts of my speech to another constituent of mine, an 83-year-old who fell alone in his home and was left. The ambulance was called at 4.15 in the afternoon—it was thought he had a fractured hip—and he was warned of a potential 14-hour wait. My constituent said he

“naively thought this must be the worst case scenario and thought it was very unlikely to be that long”.

He could not move, he could not sleep and he could not go to the toilet. Eighteen hours later, the ambulance arrived—18 hours later—at 10.15 the following morning. At the hospital, things got no better. There were patients on trolleys lining the corridors. For nearly another 24 hours, this 83-year-old man immobilised with pain was to lie on a trolley in a hospital corridor after 18 hours of waiting for an ambulance.

This is in no way acceptable. This should not be accepted by any Government worth their salt. They should hang their head in shame at what they have done to our NHS. We need to have a Government finally, which we will after the next election, who will solve these problems, instead of seeking to blame everybody else—the weather, the pandemic, the staff and any number of other things. It is about time we had a Government who have the guts to take responsibility for the decisions they have made and put it right. We are going to have such a Government soon. Shamefully, we have not now.

--- Later in debate ---

[John Redwood (Wokingham) (Con)]

No one can deny that the health service is under extreme pressure. No one can look at it and not realise that there has been a big surge in extra demand, that there are problems from the hangover of covid when a large waiting list for less urgent treatments built up, and that we are short of doctors and nurses, not because Ministers will not authorise their appointment but because there are vacancies to be filled. As one of those who has been urging for some time to see a published workforce plan, I welcome the decision of Ministers to insist on that, and the sooner we get it the better. However, I am quite sure that there are a whole series of workforce plans already in the many dozens and hundreds of working trusts and quangos that constitute the NHS. It is about aggregating and making sense of those plans.

[Dr Caroline Johnson]

We often talk about the shortage of doctors. We know we cannot create a doctor overnight. It takes a substantial amount of time to train them. The Chancellor, a former Health Secretary, invested in five new medical schools to increase the number of doctors in training. Does my right hon. Friend agree that the Chancellor, with the Health Secretary, needs to invest more money in more medical schools and medical school places, but also look at how we increase the number of doctors by reducing the amount of bureaucracy and paperwork they have to fill in, so that they can spend more time doctoring and less time filling in forms?

[John Redwood]

Yes, indeed. From my hon. Friend’s own expertise, I am sure she is right. When people talk about productivity, they do not believe that hard-pressed staff have to work harder; they are saying there must be smarter working, making jobs more manageable or enabling them to concentrate on the things they are most skilled at, with more relief for the other necessary record keeping, which may indeed need slimming.

My hon. Friend is right that we could expand our training places further, but as we have heard there has been a big increase in educational provision and it takes seven years for it to flow through. I am glad we are getting to the point where we will see some benefits from that. We need more homegrown talent. Many people are attracted to the privileged career of being a doctor and the more we can allow to do that, the better. However, given the immediate urgency of needing more capacity, and therefore more doctors and nurses, the most obvious place is to look at all those who have already had the training and have left the profession or the NHS for one reason or another. Some may be in early retirement. That is probably not something my hon. Friend wants to change because she enjoys her new job, but there are many others who are not in a very important job like her who might be attracted back. I hope the Treasury will be engaged in the review, because I hear from doctors, as many do, that the quirk in the tax system at just over £100,000 where some of the better paid doctors are resting, producing a more penal 60% rate, is an impediment to extra working. I also hear about the pension problems that have been cited on both sides of the House. The Government need to take those issues more seriously if they wish to accelerate returns.

Ministers have very clearly set out that they want more NHS staff and have obtained much larger budgets in the last three years to help bring that about. They have also said very clearly that the public’s priority—and indeed the Opposition’s priority—is to get more treatments and get those waiting lists and waiting times down for those needing more urgent or emergency care. Those Ministers must translate that through the senior health service managers into ways of spending that extra money. If it needs a bit more extra money, there is always some extra available—every time we meet another additional sum is announced—but it has to be well spent. It has to be spent on motivating and recruiting the medical workforce.

Oral Answers to Questions

Caroline Johnson Excerpts

Tuesday 6th December 2022 Commons Chamber

[Steve Barclay]

I refer the hon. Lady to the autumn statement, in which my right hon. Friend the Chancellor set out a wide range of support packages to help with the cost of living across the United Kingdom, including the cost of energy. That is part of wider discussions that we have on a regular basis with the Treasury.

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

The pandemic has had a devastating effect on the number of people waiting for treatment. In 2019, there were 54 women waiting more than a year to see a gynaecologist. That number is now more than 40,000. What is my right hon. Friend doing to reduce this wait?

[Steve Barclay]

This is a good illustration of the challenge the country faces with backlogs that are very much driven by the pandemic. We are working with senior figures such as Jim Mackey and Professor Tim Briggs and the Getting It Right First Time programme to look at patient pathways, how we use our diagnostics and our surgical hubs and streamlining the way we get services to patients where backlogs have built up.

Diagnostic Hospital: Stockton

Caroline Johnson Excerpts

Wednesday 26th October 2022 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Dr Caroline Johnson)]

I congratulate my hon. Friend the Member for Stockton South (Matt Vickers) on securing this debate. He will appreciate that I am standing in for my right hon. Friend the Member for Newark (Robert Jenrick), who has been promoted to the Cabinet and the Home Office, so I ask him to forgive me if I do not have the answers to all of his questions, but I will ask the Department to write to him with those.

I know that this is an important subject for my hon. Friend and that he works tirelessly for the people of Stockton South on healthcare and on other matters. The waiting time for a diagnosis or an all-clear can be a very anxious one. It is something with which all of us who have been on a waiting list, or who have had a family member, a friend or a loved one on a waiting list, will be familiar. It is right that we do all we can to support services to recover from the pressures of the pandemic and to innovate and improve so that patients can have tests and receive diagnoses in a quicker and more convenient way.

Today, I will outline the work being done through the elective recovery programme to improve access to diagnostics and how that will impact patients across the UK, including in Stockton South. The waiting list for diagnostic tests in England currently stands at more than 1.5 million patients. Some 30% of those patients are waiting more than six weeks. That is up from a little under 1 million in 2019, before the pandemic. In the north-east and Yorkshire region, the waiting list for diagnostic tests is more than 213,000 patients, 26% of whom have been waiting more than six weeks. Community diagnostic centres are part of the answer and are a fantastic example of how we are providing more efficient, easier and more convenient access to vital services in the community.

The Government have committed £2.3 billion in capital spend as part of the 2021 spending review to support diagnostic services to recover and improve and to ensure that patients have access to often life-saving diagnostic tests that they need. This includes money to allow the NHS to continue to roll out a community diagnostic centre programme across England. This is a new way of delivering care, and it will ensure that elective diagnostic services are resilient in the face of winter pressures, because they have ring-fenced elective diagnostic activity.

Local healthcare systems, including NHS trusts, integrated commissioning boards, and local authorities, which know their patients and communities best, are being empowered to plan and bid for funding for new CDC sites, ensuring that they are placed where there is the greatest community need and the most clinical value, with successful bids ultimately signed off by the Secretary for Health and Social Care. I am pleased to say that 89 CDCs are currently operational across the country in a variety of sites, including hospitals, football stadiums and shopping centres, ensuring that patients have access to the care they need where they live. Those centres and hard-working NHS staff have so far delivered more than 2 million tests and are well on their way to providing capacity for 9 million tests a year by 2025.

With regard to the provision of a community diagnostic centre in Stockton, I am pleased to be able to inform my hon. Friend that the business case for the centre is currently in development. He will be pleased to learn that a large-model CDC, including capacity for imaging, physiological measurements, pathology and endoscopy, is planned for construction on the Castlegate shopping centre site, with plans for the centre to be fully operational by March 2025.

Castlegate is an ideal site for a CDC because of its accessibility for different population groups experiencing health inequalities, with excellent transport links. It is exactly the sort of area where the new centres can have the biggest impact. The Castlegate CDC will add to the 12 existing CDCs in the north-east and Yorkshire region and the four hub and spoke sites in the Tees Valley area, which have delivered more than 200,000 tests for patients in the north-east and Yorkshire region. Ten further sites across the north-east and Yorkshire are due to be approved in the near future and will all be operational by March 2025 to support our target of up to 160 CDCs.

I heard the comments of my hon. Friend the Member for Old Bexley and Sidcup (Mr French), but I am afraid I do not have the answers for him today. I will ask the Department to write to him with information on his specific bid.

[Alex Cunningham]

This is music to my ears. We have all worked very hard for this—local authority, health authority and politicians—and I am grateful for the positive message the Minister is giving us. Now I am going to be even cheekier and say that we desperately need a new general hospital to serve Stockton and the wider Hartlepool area. We need new facilities there. I hope, 12 or 13 years after the original hospital was cancelled, that this Minister will be the one to deliver it.

[Dr Johnson]

I thank the hon. Gentleman for his comments. The building new hospitals programme is in process and bids are in play, so I am afraid I cannot comment any further, as he will appreciate.

In conclusion, I encourage my hon. Friend the Member for Stockton South to continue his productive conversations with both his local ICB and NHS England to ensure that new developments in Stockton continue to support the local community health needs. I will ensure he is made aware when the proposal for the new centre has progressed further and when he can expect to see it open in his constituency.

I look forward to continuing to work with NHS England, local NHS systems such as the North East and North Cumbria ICS and fellow Members of the House to ensure that as a Government we meet the challenge posed by diagnostic waiting lists and ensure that patients are able to receive the often life-saving diagnostic tests that they need, as quickly and conveniently as possible.

Question put and agreed to.

Baby Loss and Safe Staffing in Maternity Care

Caroline Johnson Excerpts

Tuesday 25th October 2022 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Dr Caroline Johnson)]

First, I thank all the Members who have taken the time to attend the debate and those who have spoken so openly about their own, and their constituents’, experiences and concerns. I particularly thank my hon. Friend the Member for Hartlepool (Jill Mortimer) for securing the debate and enabling us to have this important conversation.

Let me take this opportunity to recognise the work of everyone who has been involved in Baby Loss Awareness Week. It is important that we make it easier to speak about pregnancy loss and enable people to have open conversations about their experiences, which in turn can help those who have experienced the tragic loss of a baby. I also take this opportunity to commend the work of the charities that provide excellent support to families experiencing baby loss, including all the members of the Baby Loss Awareness Alliance and the Lily Mae Foundation, which was mentioned by my hon. Friend the Member for Meriden (Saqib Bhatti).

As we take time to reflect, I want to acknowledge how difficult the loss of a baby is. Everyone’s grief will be different. It is a personal, individual process, which people will try to navigate in many different ways. Although it can be challenging to reflect on such tragic losses, this week provides an opportunity for people to remember, reflect, share and seek support and comfort from other people.

This is the seventh year in a row that a debate has been held to mark Baby Loss Awareness Week. I am honoured to take part as the new Parliamentary Under-Secretary of State at the Department of Health and Social Care and to work with everyone to continue making a difference in an area as vital as maternity and neonatal safety.

The independent review into maternity and neonatal services at East Kent Hospitals University NHS Foundation Trust, as mentioned by my right hon. Friend the Member for North Thanet (Sir Roger Gale), was published last Wednesday. I take this opportunity to extend my condolences to the families who suffered due to the care they received and express my gratitude to the individuals who were instrumental in establishing the review and to the inquiry team for carrying out the review to such a high standard. The Government and I take the findings and recommendations of that report extremely seriously, and I am committed to preventing families from experiencing the same pain in the future.

Our maternity safety ambition, as mentioned by my hon. Friend the Member for Hartlepool, is to achieve half the 2010 rates of stillbirths, neonatal and maternal deaths, and brain injuries in babies occurring soon after birth. Since 2010, the rate of stillbirths has reduced by 19.3%, the rate of neonatal mortality for babies born over 24 weeks gestational age has reduced by 36% and maternal mortality has reduced by 17%. However, it is important to note that there was an increase in the rate of stillbirths between 2020 and 2021. This increase occurred at the same time as the covid pandemic, and detailed work is going on to establish why that was the case. I reassure hon. Members that we remain committed to our maternity safety ambition.

Every woman giving birth has the right to a safe birth, and the Government and NHS England are committed to providing women with personalised and individual maternity care. The role of NHS staff in maternity services is critical to safe care for families, and I recognise all the great, hard work by teams across the country and thank them for it.

Members on both sides of the Chamber have talked about funding and workforce. NHS England has invested £127 million in bolstering the maternity workforce even further and in programmes to strengthen leadership and retention and provide capital for neonatal maternity care. We will keep that funding under review. That investment is on top of the £95 million investment made last year in the establishment of 1,200 more midwifery posts and 100 more consultant obstetrician posts. There are increasing numbers of midwifery and obs and gynae trainees.

I am grateful to the APPGs on maternity and on baby loss for producing their report into the maternity workforce, and I acknowledge the important themes in it. The hon. Member for Enfield North (Feryal Clark) raised the issue of retention. NHS England has established a nursing and midwifery retention programme, supporting organisations to assess themselves against a bundle of interventions aligned to the NHS people promise and it will use the outcomes to develop high-quality local retention improvement plans. In addition, in 2022-23 we made £50,000 available for each maternity unit in England to enhance retention and pastoral support activities.

[Bell Ribeiro-Addy]

Will the Minister give way?

[Dr Johnson]

I will not, because I have a lot of questions to get through in a really short time.

Many hon. Members talked about bereavement. In the difficult scenario of baby loss, we understand that bereavement care for women and families is critical. We continue to engage closely with the bereavement sector to assess what is needed to ensure that bereaved families and individuals receive the support that they need. This year we have provided £2.26 million of national funding to support trusts, expand the number of staff trained in bereavement care and directly support trusts to increase the number of days of specialist bereavement provision that families can access.

In the women’s health strategy, which hon. Members mentioned, published earlier this year, we discussed the introduction of pregnancy loss certificates for England. This will allow a non-statutory, voluntary scheme to enable parents who have experienced a pre-24 weeks pregnancy loss to record and receive a certificate to provide recognition of their baby’s potential life. The certificate will not be a legal document, but it will be an important acknowledgement of a life lost, and we hope that it will provide comfort and support by validating a loss.

We understand the impact of pregnancy and childbirth on mental health, especially for those affected by the loss of a baby, and we are committed to expanding and transforming our mental health services so that people can receive the support that they need when they need it.

As part of the NHS long-term plan, we are looking to improve the access to and quality of perinatal mental health care for mothers and their partners. Mental health services around England are being expanded to include new mental health hubs for new, expectant, or bereaved mothers. These will offer physical health checks and psychological therapy in one building.

[Guy Opperman]

I accept that my hon. Friend has many things to cover today. As a former Minister, may I advise her that she might want to be encouraged to write to everyone with detailed answers from civil servants to the points raised?

Does my hon. Friend agree on one key point—that the collation of data and the consistency of approach must be nationwide? While we have many wonderful trusts, that has to be driven by the NHS, for which she is a Minister.

[Dr Johnson]

I absolutely agree with my hon. Friend.

Going back to the issue of perinatal mental health, we have previously funded Sands, the stillbirth and neonatal death charity, to work with other baby loss charities and the royal colleges to produce and support the roll-out of a national bereavement care pathway to reduce the variation in the quality of bereavement care provided by the NHS and ensure that, wherever a woman and family are being cared for, they get a high standard of care. The pathway covers a range of circumstances of baby loss, including miscarriage. As of April this year, 78% of trusts in England had committed to adopting the nine national bereavement care pathway standards.

The hon. Member for North Ayrshire and Arran (Patricia Gibson) talked about pre-eclampsia. NHS England is establishing maternal medicine clinics. These are specialist networks across the UK, which will manage pre-conception, antenatal, post-natal and medical issues in women, and reduce long-term morbidity, thereby improving outcomes for those women who have co-existing medical conditions.

My hon. Friend the Member for Macclesfield (David Rutley) spoke about the maternity unit in his constituency. I know that he is a doughty campaigner for that unit. I will write to him with further information on progress in that area.

The hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone) talked about the Scottish health service and how it is performing in relation to maternity care. It is, of course, a devolved issue in Scotland, but I was moved to hear about what is happening in areas of the north of Scotland near Elgin. I would encourage the devolved Scottish Administration to consider carefully what is going on there and to see what they can do to improve care. It seems unacceptable for women to travel 102 miles to give birth.

The NHS in England has a medical education reform programme, co-sponsored by NHS England and Health Education England, to direct investment for specialty training for population needs back towards smaller and rural hospitals. That programme entered its implementation phase in August 2022.

Hon. Friends mentioned The Lancet recommendations. While the pregnancy loss review will be published shortly, I am not in a position today to commit to what it is going to say, but we will consider it carefully.

[Feryal Clark]

I understand that the Minister is not in a position to comment on that review, but now that she has had the opportunity to review the recommendations from the East Kent investigation by Dr Kirkup, is she in a position to say whether the Government will accept those recommendations, or when the Government will announce whether they are going to accept them? They will have a nationwide impact.

[Dr Johnson]

I thank the hon. Lady for her question. We were both horrified by the East Kent report, which made for extremely difficult reading. We are carefully considering the review. The hon. Lady will appreciate that we are having a change of Prime Minister today and possibly a change of Minister too, so it is difficult for me to make any commitments at this stage, beyond that the Government will consider the matter carefully and further information will be provided in due course.

Let me conclude by making three broad points. First, we appreciate how difficult and distressing baby loss can be at any point in pregnancy and childbirth. I highlight again the importance of sharing experiences and coping mechanisms that may guide other families through their own bereavement. It is important to continue this conversation past this year’s campaign and, again, I thank my hon. Friends who shared deeply personal experiences.

Secondly, I touched on the important range of targeted programmes we are developing to better support families with their bereavement and ensure all families have access to the care they need and deserve, such as pregnancy loss certificates and the national bereavement care pathway. We understand how difficult baby loss can be, and families deserve compassionate and personalised care from their local health professionals.

Thirdly, we are committed to our maternity safety ambition to halve the 2010 rates of stillbirth, neonatal and maternal death, and brain injuries in babies occurring during or soon after birth. NHS England will consider the actions from both the Ockenden report and the East Kent report and map a coherent delivery plan for maternity that will be delivered through the maternity taskforce programme. We have also established a joint working group led by the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists to help deliver the plan as effectively as possible. I thank hon. Members for taking time to be here today and I thank everyone who took part in Baby Loss Awareness Week.

Covid-19 Vaccines: Safety

Caroline Johnson Excerpts

Monday 24th October 2022 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Dr Caroline Johnson)]

It is a pleasure to serve under your chairmanship, Sir Roger. I thank my hon. Friend the Member for Carshalton and Wallington (Elliot Colburn) for his kind words regarding the covid vaccine programme, and for bringing this important and timely debate to the House. It is timely because we started the covid-19 boosters autumn scheme just a few weeks ago.

Before I respond to the points that have been made in the debate and try to answer all the questions posed by right hon. and hon. Members, I thank Members—particularly those on the Opposition Benches, including the hon. Members for Denton and Reddish (Andrew Gwynne) and for Coatbridge, Chryston and Bellshill (Steven Bonnar)—for their support for the vaccine scheme. I also thank each and every person in the country who has come forward for their jabs, as well as the tens of thousands of NHS staff and volunteers who made that happen.

My hon. Friend the Member for Carshalton and Wallington asked why the vaccine programme had worked so well. It worked so well because of the dedication and hard work of all who were involved in it—from the Government to the NHS, and from the volunteers to pharma. I was honoured to volunteer alongside people from my local area as young as 15 and as old as in their 80s. It was truly a community effort.

The take-up of the covid-19 vaccine has been huge, and over 151 million vaccines have been delivered in the UK, meaning that more than 90% of people aged 12 and over have received at least one dose and more than 40 million have received a booster or third dose. We have also made a great start to the autumn booster campaign. Since the start of the campaign on 5 September, more than 10 million people in England have stepped forward for their jabs.

Our safe and effective vaccines have underpinned the Government’s strategy for living with covid-19. They have allowed the economy and society to reopen, and the country’s ability to live with the virus in the future will continue to depend on deeper and broader population immunity. Critically, they have also reduced the pressure on the national health service and allowed us to start to tackle the elective care backlog.

Vaccines remain our biggest line of defence as we head into a challenging winter period. Vaccinated people are less likely to get seriously ill with covid-19 or seasonal flu, or to be admitted to hospital, and there is also evidence that they are less likely to pass the virus on to others. We know the covid vaccine has saved tens of thousands of lives—that is tens of thousands of mothers, fathers, husbands, wives, sisters, brothers, sons and daughters who are thankfully still with us.

[Andrew Bridgen]

Is the Minister aware that excess deaths run somewhere—there are two different sets of figures—between 18,000 and 25,000 this year alone?

[Dr Johnson]

I am referring to the covid vaccine, which has saved hundreds of thousands of lives. I take my hon. Friend’s point, but there is no evidence that those deaths were caused by the covid vaccine. Let me acknowledge and pass on my sympathies to the very small number of people for whom vaccines may not have worked as intended, and who may have suffered an adverse reaction from vaccines.

I turn to vaccine safety. All vaccines used in the UK covid-19 vaccine programme are safe. In the UK we have some of the highest safety standards in the world. The MHRA is globally recognised for high standards of quality, safety and medicines regulation. Each covid-19 vaccine candidate is assessed by teams of scientists and clinicians on a case-by-case basis. There are extensive checks and balances at every stage of vaccine development. It is only once each potential vaccine has met robust standards of effectiveness, safety and quality set by the MHRA that it will be approved for use.

It is also important to stress that the surveillance of vaccine safety and adverse reactions does not stop once a vaccine has been approved. The MHRA and the UK Health Security Agency constantly review a wide range of available data on the safety of vaccines, including UK and international reports of adverse reactions.

[Sir John Hayes]

People outside the House will not know that although the Minister has been in her job a relatively short time, she is a remarkably dedicated and diligent person. No Minister is more likely or determined than she is to get to the facts when looking at the international data. Will the Minister give the assurance that she will consider all the information available, including that international data, when she draws conclusions about the content of this debate and the cases that have been made by many of my constituents and others?

--- Later in debate ---

[Dr Johnson]

I thank my right hon. Friend for his kind words. I will, of course, look at all the evidence. He is aware of my experience as a clinician and he knows that I will look at the evidence-based medical process.

As part of the surveillance into currently used medicines and vaccines, the MHRA continues to review all the suspected adverse drug reaction reports—known as the yellow card reports—relating to covid vaccines, which right hon. and hon. Members have mentioned. Through the MHRA yellow card scheme, members of the public and healthcare professionals can report any suspected side effects. A comprehensive surveillance strategy alerts us to any unforeseen adverse reactions to the vaccine, to enable us to act swiftly when required.

In April 2021, we quickly responded to reports of extremely rare cases of concurrent thrombosis and thrombocytopenia following vaccination with the first dose of AstraZeneca. At that point, the Joint Committee on Vaccination and Immunisation advised that adults under 30 without underlying health issues should be offered an alternative vaccine to the AstraZeneca if one was available. That was later extended in May 2021 to adults under 40 without underlying health issues. The MHRA, as my hon. Friend the Member for North West Leicestershire (Andrew Bridgen) said, has undertaken a thorough review of UK reports of thrombosis and thrombocytopenia. While the estimated incident rate has increased over time as awareness of the condition increases across the healthcare system, the number of cases remains extremely low, given that more than 49 million doses of AstraZeneca covid-19 vaccine have been administered.

A number of colleagues asked about myocarditis. There is no evidence that people are at an increased risk of cardiac arrest in the days and weeks following the vaccine. The risk of getting myocarditis or pericarditis after the vaccine remains very low. A large study of 4 million vaccinated people in Denmark, published in the British Medical Journal, found that there were no deaths or diagnoses of heart failure in people who were diagnosed with myocarditis or pericarditis after being vaccinated.

In the highest-risk group, those aged 18 to 29, until the end of September this year there were 29 cases for every million second Pfizer doses and 68 cases for every million second Moderna doses given in the UK. The risk is much lower after a booster dose, and in other age groups the risk is lower still. However, it is worth remembering that catching covid-19 can significantly increase the risk of cardiac arrest and death, and the risk of developing myocarditis. There are an estimated 1,500 cases of myocarditis per million patients with covid—far greater than the risk of myocarditis following vaccination.

Let me turn now to some of the questions that have been asked. My hon. Friend the Member for Carshalton and Wallington asked about the inquiry and how people would be able to contribute to it. It will listen to and consider carefully the experiences of bereaved families and others who have suffered loss as a result of the pandemic. It will not consider individual cases; instead, listening to such accounts will inform its understanding of the impact of the pandemic and the response, and any lessons to be learned. Individuals will be able to engage through the inquiry’s listening exercise and the details of that will be brought forward in due course.

My hon. Friend the Member for Christchurch (Sir Christopher Chope) asked about informed consent. Indeed, I think that he produced the leaflet that provides the information that allows people to understand that the JCVI has recommended the vaccine because on balance it is beneficial to people; it is more likely to be of benefit to them than harm. Equally, however, each individual will be provided with information about the vaccine, as they are with all medical treatments, so that they know the benefits they can expect and the risk of side effects, however small, as well as what they are. As I say, he produced an example in the debate of a leaflet containing such information. What is important is that people are aware of the benefits and risks and can make informed decisions. Vaccination is not compulsory, but we are aware that it is of great benefit to the population and to individuals at risk of covid.

[Sir Christopher Chope]

What happens if somebody suffers a 50% disability as a result of having the vaccine, through an adverse reaction, or an unusual event? What do the Government do to help that person? They do not provide any compensation, or any special help through the health service, or a clinic, so what do they do?

[Dr Johnson]

My hon. Friend is talking about the vaccine damage payment scheme, which has been running since 1979 and provides a payment of up to £120,000—a tax-free lump sum, a one-off payment—for people who have been severely damaged by vaccines, on the balance of probabilities, which is determined when people apply. That does not prejudice any claim that they may have in a legal sense and they can still pursue a civil claim should they wish to do so. It has been asked whether there should be a separate scheme for covid, but of course it is right that all vaccines are treated in a similar fashion.

My hon. Friend the Member for Devizes (Danny Kruger) asked a few questions. He asked about the terms of reference of the inquiry being a matter for the chair, which indeed they are. He also asked whether I would commit the chair of the MHRA to meet specific people, but that is not for me to decide; it is up to the chair. My hon. Friend’s other question was about children’s vaccines. He is aware of my thoughts on that: it is important when we vaccinate children that the vaccines are of benefit to the child themselves. I am aware that when the vaccine was approved that was the decision made by all four chief medical officers and it is very important that the Government listen to and take medical advice. Since then, some things have changed. Natural immunity is more widespread and school disruption is no longer an issue. I understand that very shortly, at its next meeting, the JCVI will consider whether children’s vaccines should continue to be recommended, on the basis of the current situation. I think it is right that medical research is reviewed regularly as it becomes available and is taken into account.

The position of the MHRA remains that for most people the benefits of the covid-19 vaccine continue to outweigh the risks. The surveillance strategy is working, as we have discussed. We are able to respond quickly to ensure safe administration of all covid vaccines. I reiterate that the public should be very confident that all tests are completed to the very highest standards and that vaccines are safe.

Despite the progress we have made, we must not become complacent.

[Sir Christopher Chope]

Would the Minister be willing to address the all-party parliamentary group on covid-19 vaccine damage in a private meeting, so that she can hear at first hand some of the concerns that members have?

[Dr Johnson]

I thank my hon. Friend for that question. He will be aware of events today and I will at least have to see whether I remain in post before I potentially commit somebody else to such an event.

As I was saying, despite the progress we have made, we must not become complacent. We cannot risk an increase in serious illness, hospitalisations and deaths from covid. The UKHSA estimates that vaccinations had averted up to 128,000 deaths and 262,000 hospitalisations by the end of September 2021, and many more since then.

We must do everything in our power to protect those who are most vulnerable to the virus and keep pressure off the NHS in a tough winter period. Viruses such as covid-19 spread much more easily in winter when we socialise indoors. To protect those most at risk and help to reduce pressure on the NHS, we are delivering an autumn booster dose to those who are most in need of an extra layer of protection. Even if someone has had all of their jabs so far, and perhaps had covid too, they might still need an autumn booster to strengthen their protection. I encourage everyone who is eligible to come forward for their covid booster and seasonal flu jab today. To encourage vaccination against covid and flu and boost uptake, the NHS is making every effort to make it as convenient as possible for individuals to take up the offer, including offering both covid and flu vaccines at the same time, where possible, to reduce the number of appointments needed. Our NHS staff and volunteers are pulling out all the stops to deliver the next phase of the covid vaccine programme at speed once again, with more than 3,000 sites up and down the country involved.

The NHS was the first healthcare system in the world to deliver a covid-19 vaccine outside clinical trials, and it is now the first to deliver the new, variant-busting vaccine. Bivalent vaccines target two different strains of covid-19. They will give us a broader immunity and therefore potentially improve protection against variants of the virus. Whatever vaccine people receive in the autumn booster programme, they can be assured that it remains effective in preventing severe disease against all current variants and any potential future variants.

As I draw to a close, I thank my hon. Friend the Member for Carshalton and Wallington for bringing this important debate to the House at such an important time. The Government have already commissioned a public inquiry into the pandemic, and covid vaccines will be reviewed as part of that inquiry. There are no plans for an inquiry solely on vaccine safety. We face a tough winter ahead, and collectively we must do everything we can to protect those who are most vulnerable and to reduce pressure on the NHS. I encourage everyone who is eligible to step forward for their covid and flu vaccines as soon as they are able.