Tobacco and Vapes Bill

Caroline Nokes Excerpts

2nd reading
Tuesday 26th November 2024 Commons Chamber

[Wes Streeting]

That is a very helpful intervention because it gives me the opportunity to say thank you to my counterparts in Wales, Scotland and Northern Ireland. This is a genuinely four-nations Bill, and through it, we have an opportunity to create a smokefree generation in every corner of our country.

I say to people who have an ideological objection to the Bill that if they believe in lower taxes, as they say they do, and in maintaining a national health service, as they say they do, they cannot duck this simple equation: an ageing population plus a sicker society equals more spending on the NHS, paid through higher taxes. The Bill is just one measure, but it will make a significant difference to the health of our society, and to the balance of that equation.

The question that opponents of the Bill must answer is this: if they want our health and care services to continue having to spend £3 billion every year on the symptoms of smoking, are they willing to accept that that means higher taxes or higher healthcare charges for their constituents? Are they happy for their constituents to shoulder the welfare bill for smokers falling out of the workforce? Those are the consequences of what we are voting on today. Higher taxes and higher welfare are not the Labour way.

There are arguments about liberty from those who oppose based on libertarian belief. They say that the state should not deny individuals the choice to smoke if they want to, but three quarters of smokers want to stop and wish they had never started. It takes a smoker an average of 30 attempts to quit before they manage it. By definition, an addict is not free; there is no choice, no liberty and no freedom in addiction. Nor is choice afforded to anyone inhaling second-hand smoke. Tobacco is not only highly addictive but uniquely harmful. Yes, some smokers can quit, but most who want to cannot. Those who have help to quit are three times more likely to succeed. That is why the Government are, as I said, investing £70 million in smoking cessation services—an investment that will pay for itself several times over—but prevention is better than cure, and that is why we are taking action, through the Bill, to stop the start.

In conclusion, this Bill marks the start of a decade in which we will shift the focus of healthcare from treatment to prevention; take serious action on not just smoking, but obesity; reform the NHS, so that it catches problems earlier and gives patients the tools that they need to stay out of hospital; harness the revolution taking place in life sciences; and fundamentally transform the NHS, so that it predicts illness and prevents it from ever taking hold. That is the future available to us, and it is the future we must realise if we are going to put our welfare system, health service and public finances on a sustainable footing. It starts with this Bill. Smokers are more likely to need NHS services, be admitted to hospital, drop out of the workforce and on to welfare, and need social care years earlier than if they did not smoke. By taking the measures set out in the Bill, we are putting the UK on the road to becoming smokefree, building a healthier, wealthier nation with a health service fit for the future and leading the world as we do so. I commend this Bill to the House.

[Madam Deputy Speaker (Caroline Nokes)]

I call the shadow Secretary of State.

Infected Blood Inquiry

Caroline Nokes Excerpts

Tuesday 19th November 2024 Commons Chamber

[Nick Thomas-Symonds]

I can indeed confirm that. The authority is working in a way that will allow it to scale up as quickly as it possibly can. The need for speed in delivering compensation payments is paramount.

Memorialisation will be really important in how we remember the victims of this scandal. Sir Brian Langstaff makes a compelling case about the need to recognise what happened to people, and for it to be recognised by future generations. Officials have begun the necessary work to respond to Sir Brian’s recommendations on memorialisation, and we recognise that this is an incredibly sensitive issue that we need to get right.

Sir Brian Langstaff’s recommendations call for fundamental changes to the way that politics and Government operate, and for one of the largest compensation schemes in UK history. That is entirely in line with the scale of the injustice that he has uncovered. Given the scale of the recommendations, I am committed to updating formally on them within the 12-month timeframe set out by Sir Brian Langstaff, but I assure Members of this House, and, indeed, the infected blood community, that we will drive forward this vital work. We will deliver the changes that are needed, which will stand as a testament to the bravery and determination of people who have been so badly failed.

I pay tribute to all those who fought so hard to bring us to this moment. Their efforts are monumental, and we commit again today to ensuring that they have not been in vain. I commend the motion to the House.

[Madam Deputy Speaker (Caroline Nokes)]

Before I call the shadow Minister, I wish to make a short statement about the House’s sub judice resolution. I understand that several legal cases relating to contaminated blood products have not yet concluded. However, given the public interest in this issue, Mr Speaker has exercised his discretion to allow reference to specific proceedings where necessary, as they concern issues of national importance.

I call the shadow Minister.

--- Later in debate ---

[Ian Lavery (Blyth and Ashington) (Lab)]

In the past three years alone, I have spoken in this House at least 10 times about the delays that the victims of contaminated blood have faced in obtaining the justice and compensation they deserve. Progress has been painfully slow and, as my right hon. Friend the Paymaster General said, there is much anger, frustration and mistrust for us to deal with, as it has not gone away. It has not been diluted by the general election, and those seeking compensation are rightly angry and mistrustful.

In May 2024, the inquiry found that more than 3,000 people had sadly died as a result of this scandal. Roughly one victim dies every two days, many without receiving compensation. I would not like to calculate how many people have died since I first spoke about contaminated blood in the House. My right hon. Friend mentioned further legislation and, between now and then, more people will sadly pass on as a result of this scandal.

I appreciate that my right hon. Friend has had only a few months to try to rectify the consequences of the previous Government’s slow response to Sir Brian Langstaff’s demands. Again, I urge my right hon. Friend to do everything in his power to ensure that the Infected Blood Compensation Authority hires the staff needed to address the challenges and to design the procedures required with the utmost urgency. I am sure that my right hon. Friend has got the message.

I have spoken in the House many times of my constituent Sean Cavens, who was one of the youngest people in the country to be infected with hepatitis C as a result of being given contaminated blood. He has campaigned tirelessly on behalf of fellow victims of the scandal. Many people have died waiting for justice.

At the current rate of settling claims, which is another huge issue, victims and others are concerned that many more people will die without seeing a ha’penny of compensation for themselves or their families. They question whether the Government are acting quickly enough, with only 270 claims expected to be dealt with by the end of the financial year and more than 4,500 claims in limbo. I share their concerns; I am not sure if that is good enough.

Sean is now 43 years of age. He was infected with hepatitis C and other viruses in 1983. He wonders where he fits in the selection process. He will not be alone in wondering whether he must simply hang on and hope to survive long enough to see justice done for him and his family.

While the scheme currently has no effect on payments made through the infected blood support schemes, that will cease to be the case in the new financial year. I hope my right hon. Friend the Minister will review that approach and extend the deadline, so that people who receive payments after 31 March 2025 do not see that deducted from compensation through the new scheme. Will my right hon. Friend the Minister consider that point?

Fundamentally, Sean and others are concerned that those currently on the infected blood support schemes are not automatically being offered the core route payment. They wonder why they cannot be offered a lump sum payment equivalent to payments up to the average life expectancy of 86. They are also concerned that the rates of compensation to be offered are rumoured—I emphasise the word “rumoured”—to be only 20% of current annual payments. I am sure that will be outlined by my right hon. Friend in his winding-up speech.

The uncertainty about the compensation scheme’s date of infection criteria is causing concern for victims. The burden of proof for those who were infected after screening for relevant viruses began is deemed by the Infected Blood Compensation Authority to be “higher”, but without any clarification on what that actually means in practice. Will the Minister provide such clarification? Screening began for HIV in November 1985 and for hepatitis C in September 1991, but for hepatitis B it was as early as December 1972. As I mentioned, Sean was infected with hepatitis B in 1983. He needs to know how that will affect his final compensation. For instance, will the IBCA take into account that the screening test for hepatitis B in 1983 is estimated to have been only 43% effective? Will the IBCA recognise that victims were treated for hepatitis C with the retroviral drug Interferon, which has well known serious side effects on patients’ mental health? Will that be reflected in their compensation?

Will the Minister confirm that Sir Brian Langstaff’s recent guidance, contained in his letter dated 13 November 2024, regarding the siblings of victims who deserve compensation, will be accepted by the IBCA and reflected in any compensation scheme that it designs? Will, as Sir Brian has recommended, any family member whose relationship was “so close” to the victim that damage to their own mental or physical health caused by witnessing their sibling’s suffering was “reasonably” foreseeable receive full compensation, if they were so damaged? It has been reported that the IBCA will only compensate siblings of victims if they lived with the victim in the family unit for a full two years. Will the Minister ensure that that arbitrary restriction is not contained in any IBCA compensation scheme?

Will the Minister confirm that the family of any victim who dies before his or her application to the IBCA has been completed will receive full compensation? There are indications that the IBCA interpreted the inquiry’s final report as saying the contrary—that it intends to pay only those who live long enough to receive a final reward. That cannot, in any way, shape or form, be correct. It is not fair and it is not just.

Will the Minister ensure that those who, as children, were purposefully infected with contaminated blood in the name of medical research are awarded enhanced punitive levels of compensation, to reflect the country’s abhorrence at such horrific criminal behaviour, carried out by medical professionals who had sworn to dedicate themselves to healing the sick? That is one thing I just cannot understand. The whole tragic scandal is an absolute disgrace, but it is really abhorrent that this great country of ours experimented on little children. Those children, many of whom have not survived, deserve the compensation. How much they should be awarded is obviously to be determined, as has been stated, but bearing in mind the abhorrent nature of what we have done as a nation, I ask the Minister to ensure it is enough.

The infected and contaminated blood scandal is just one of far too many injustices in the UK in recent decades, in which powerful people have treated institutional reputations, career prospects and, in a number of cases, profits as being more important than working-class lives. Hillsborough, Orgreave, the postal service Horizon scandal and Grenfell all share this shameful characteristic: each one sent out a message that ordinary working-class lives do not matter. The Minister can take this opportunity to show that this Labour Government think that the lives of ordinary people matter by ensuring that the victims of contaminated blood products receive just and meaningful compensation without any further unconscionable delay.

[Madam Deputy Speaker]

I call the Liberal Democrat spokesperson.

[Liz Jarvis (Eastleigh) (LD)]

I am grateful for the opportunity to speak in this incredibly important debate. I begin by paying tribute to all those who had their life destroyed by the infected blood scandal, and everyone who has campaigned for justice. They include my constituent Gary Webster. For those who are not familiar with his story, Gary was born with haemophilia, and at the age of nine he was sent to Treloar’s college, a specialist boarding school in Hampshire. His parents hoped that the school’s on-site medical facilities would enable Gary to lead as normal and happy a childhood as possible. All the boys at the school and their parents trusted the doctors who saw them implicitly, but in fact, the boys were being given contaminated factor VIII blood products imported from the US. Gary was in his final year at school when he was told that he had been infected with HIV/AIDS and hepatitis, and that there was no guarantee that he would be alive in six to 12 months. Of the 122 haemophiliac boys who attended Treloar’s between 1973 and 1986, 80 have since died.

The infected blood inquiry report by Sir Brian Langstaff found that

“deaths, illness and suffering were caused needlessly to people with bleeding disorders by…Treating children at Treloar’s with multiple, riskier, commercial concentrates, prophylactically and as objects for research”

and

“Treating children unnecessarily with concentrates (especially commercial ones) rather than choosing safer treatments.”

One can only imagine the pain of the survivors and all the families, and it beggars belief that it has taken so long for them to get justice.

The thousands of victims of the infected blood scandal and their families from across the UK have been waiting far too long for justice, accountability and compensation. The Liberal Democrats welcome the introduction of the infected blood compensation scheme. We are glad that it will bring the victims of this gross miscarriage of justice, including those who were infected and those who have been affected, closer to the justice that they deserve. It is crucial that this compensation scheme is implemented as quickly and effectively as possible. We are also backing calls by the survivors for a duty of candour on all public officials.

The infected blood scandal campaign organisation Factor 8 has highlighted that the guidance on the Infected Blood Compensation Authority website states:

“Should an eligible affected person die during the application process to the Scheme, their compensation award will not be paid. This is in line with the Inquiry’s recommendation.”

However, Factor 8 has examined the inquiry’s second interim report, and in the summary of conclusions, on page 14, at conclusion t), Sir Brian Langstaff says:

“Where an affected person who has not made a claim dies, the sums that they might have received if they had claimed should not become part of their estate.”

The key wording is

“who has not made a claim”.

Will the Government update their policy and ensure that all affected persons who make an eligible claim have their claim honoured? That is important for those affected who are elderly or ill, and are concerned that they may not live to see the end result of the claim process. I hope the Minister will look at that as a matter of urgency.

The infected blood scandal has highlighted the importance of robust blood safety measures and tools. Will the Government look into the merits of pathogen inactivation technology to ensure that no one else unnecessarily suffers from infected blood, and that we have a safe, reliable supply of blood products?

I spoke with Gary Webster on Friday, and as he put it,

“the whole process needs speeding up”.

After so many years of secrecy, deceit and delay, the Government must ensure full transparency about the progress of the scheme, and open, ongoing communication with all those affected. As for the families who have been impacted by this appalling scandal, please give them a national memorial, and reassurance that measures will be put in place to ensure that nothing like this can ever happen again.

[Madam Deputy Speaker (Caroline Nokes)]

I call Michael Payne to make his maiden speech.

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[Amanda Martin (Portsmouth North) (Lab)]

We must always remember that at the heart of any public scandal, there are people. So many of my hon. Friends this afternoon have told tragic stories, but also stories of courage and humility. Alongside other brave, courageous victims and their families, Becca, Jess and their siblings have campaigned for justice for people infected and affected, in loving memory of their father, Joe. Like me, they welcome the decisiveness and commitment from this Government. With families like them in mind, I would like to ask the Minister to outline when he expects the second set of regulations to be laid before Parliament, how victims and their families can continue to be involved and informed of progress, and how claims can be made.

[Madam Deputy Speaker (Caroline Nokes)]

I call the shadow Minister.

Income Tax (Charge)

Caroline Nokes Excerpts

Tuesday 5th November 2024 Commons Chamber

[Edward Argar]

I gave way to the hon. Gentleman earlier. I am afraid I want to conclude my remarks, because I am keen for others to have a chance to speak.

That offer to the Secretary of State stands. I am always happy to work constructively with him when he is willing to work constructively with me. He knows that we have done that before, not least as we emerged from the pandemic, when I was still a Minister in the Department.

Unfortunately, despite the rhetoric, I fear that the Budget was a missed opportunity that will not achieve the ambitions the Government have set out. As I have said, we cannot tax our way to growth, and without growth we cannot sustainably fund public services. I urge the right hon. Gentleman to be brave, to stand up to those in his party who would have him back down or water down reform, and to deliver a genuinely radical plan for the future of our NHS and for social care that works for those who work in it, but also, crucially, for all the people who rely on it. Our constituents deserve nothing less from him.

[Madam Deputy Speaker (Caroline Nokes)]

I call Kate Osamor.

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[Kate Osamor]

I thank the hon. Member for her intervention. I would add that it is important that patients, doctors and everyone else are listened to. I am assured that the Secretary of State will be listening to all voices.

NHS data is a public asset. Its management should be rooted firmly within the NHS, not placed in the hands of private interests, especially those controlled by an individual who is so hostile to the principles of public healthcare. Our NHS thrives due to the work of everyone in the system, from nurses to administrative staff and healthcare assistants, who each play a critical role in patient care. We must listen to all NHS staff, not just those in the highest-ranking medical roles, as everyone brings valuable frontline perspectives on improving efficiency, patient experience and accessibility.

I especially draw attention to the hard-working staff who provide out-of-hours services for our communities, often doing so on top of their normal hours. The Government must ensure that those professionals receive not only recognition, but the resources and support they need to continue serving our communities in this vital way. Staff in out-of-hours services often only work in such settings part time. However, they are often the last resort for people who are unable to get appointments with their GP or access the care they need.

We must also address the postcode lottery in healthcare. For various conditions, disparities persist in access to specialists, waiting times and outcomes in relation to area, ethnicity and gender.

The stark reality is that mental health services remain woefully inadequate. We face a mental health crisis, especially among young people, and this impacts on personal wellbeing and ruins life chances. We urgently need targeted investment in mental health services, and I look forward to supporting the Government in ensuring that the crisis in mental health support is treated with the seriousness it demands.

This Budget is a strong step in the right direction, but we must go further to ensure that the NHS remains public, that mental health is prioritised and that all NHS staff have a voice in shaping the future of our health system. I ask the Secretary of State to focus on all those areas, because I believe that if we have consistent investment throughout this Parliament, we can ensure that we make progress towards an NHS that works and in which everyone is able to access the quality and timely care that they justly deserve.

[Madam Deputy Speaker]

I call the Liberal Democrat spokesperson.

--- Later in debate ---

[Several hon. Members rose—]

[Madam Deputy Speaker (Caroline Nokes)]

Members will be aware that this is a very heavily subscribed debate, so a time limit will be coming, but not until after we have heard some maiden speeches. I call Juliet Campbell.

--- Later in debate ---

[Esther McVey]

I will carry on for a little longer.

To put that into context, it dwarfs the UK’s annual defence spend, which stands at £55 billion. This is money being wasted instead of being spent on public services.

And if all that was not bad enough, the Office for Budget Responsibility has downgraded its growth forecast to a measly 1.5% for the years running up to the next general election. So much for Labour saying this would be a Budget for growth. This Labour Budget has taken our country back to the 1970s, with crippling taxation, unsustainable levels of borrowing and the trade unions in control. The Budget has also broken virtually every economic promise Labour made during the election. In fact, even worse than the economic misery this Budget will bring might be the further mistrust in politicians it will cause.

Labour ruled out tax hikes on working people more than 50 times, and it ruled out changing the fiscal rules to fiddle the figures. Mark my words, on top of the betrayal of pensioners with the scrapping of the winter fuel allowance, this Budget will be a nail in this Government’s coffin, only four months after they secured a huge majority.

At the weekend, the Chancellor eventually came round to admitting that Labour will be taxing workers, but I am afraid that saying it now, having denied it at the general election, does not wash. It is way too late to be admitting it. All it has done is expose the fact that this Labour Government were elected on a false premise and therefore do not have a mandate for this Budget. [Laughter.] Laughing after not telling the public what they were going to do is why I certainly will not be supporting this Budget.

[Madam Deputy Speaker (Caroline Nokes)]

I call Lewis Atkinson to make his maiden speech.

[Lewis Atkinson (Sunderland Central) (Lab)]

It is pleasure to follow my hon. Friend the Member for Broxtowe (Juliet Campbell), who spoke movingly about her experience in the NHS, as well as the barriers she has ignored and, indeed, knocked down.

I start by paying tribute to my predecessor, Julie Elliott, who not only worked with commitment for Sunderland Central, but provided political leadership and mentorship across the north-east. Julie understood that organising and advocating on a regional basis is often the best way to deliver for our communities. I hope to follow her example. It is the honour of my life to be in the House of Commons representing the city by the sea that I love.

I am pleased that my first debate contribution is about the budget and the NHS, for what is our purpose here if not to improve the economic conditions of our constituents and the care available to those we serve? Health and wealth have always been linked—twin assets—as families like mine, forged in the Durham coalfield, know well. My grandparents were only able to toil at the pit, in the munition factory or in the home for as long as they were healthy. Working-class communities have always feared illness and injury, not just in its own right but because the resulting inability to work was disastrous for family finances. The introduction of the NHS and national insurance by the Attlee Government was intended to protect against such calamities. We have important work to do to repair and renew those civilising protections today.

The link between inequalities of health, wealth and power has been impressed upon me by the privilege of working for two decades in NHS North East. Whether managing dentistry, mental health or cancer services, I saw at first hand how the poorest generally experience the poorest health outcomes. I intend to spend some of my time in this place working to right that situation.

The qualities of innovation and hard work have always been the building blocks of Sunderland’s economy. From the introduction of glassmaking in Britain at Bede’s monastery of St Peter’s, through the education of lightbulb inventor Joseph Swan, to becoming the UK’s leading digital smart city, Sunderland has always been a home of innovation. We have always made things. For 600 years, that meant ships. At our peak, the people of Sunderland were hard at work “macking” a quarter of all ships produced globally each year, and we were likely dubbed “Mackems” as a result. Wealth from shipyards and pits built Sunderland, but such work often caused a thirst, so it was handy that the most popular stout in the country was produced in the centre of town, at the Vaux brewery, until the second world war interrupted production.

In that war, as in others before and since, the patriotic people of Sunderland answered their country’s call. This weekend, I will be honoured to play a small part in what is thought to be one of the largest Remembrance services outside London, reflecting the high number of veterans in our city and the sacrifices made by so many, including my constituents who served in Iraq and Afghanistan.

While the bravery and fortitude of Sunderland’s people has never been lacking, too often they have faced the headwinds of economic change without a Government on their side. By the end of my childhood, the pits, the shipyards and even Vaux had all gone. But the people’s spirit and an understated determination remained, and it is thanks to them that our city is now on the up.

I am not just referring to top-of-the-Championship Sunderland AFC, a football club that has provided me with more agony and ecstasy than even the Labour party has managed. Our Stadium of Light stands on the site of the Monkwearmouth colliery, but now instead of coal we produce a rich seam of talented players, such as Jill Scott, Jordan Pickford, Lucy Bronze and Chris Rigg.

I also celebrate the workers at the most productive car plant in Europe, Nissan, which although not in my constituency is the modern cornerstone of our city’s economy, continuing our advanced manufacturing heritage and skills.

Elsewhere around the city, where there was previously decline we now see new beginnings. On the banks of the Wear, we no longer have shipyards, but we do have the Crown Works studio site, ready to be transformed into a landmark film studio. Where the brewery once stood, we have cranes in the sky for Riverside Sunderland, the most ambitious city centre regeneration project in the UK. We have our excellent university, with particular strengths in media and healthcare, and we have a city that loves a good time, where growing hospitality and cultural businesses provide plenty of decent days and nights. It might be a show at the Sunderland Empire, a meal at one of our many excellent British-Bangladeshi restaurants, or a gig at one of our independent venues.

Where passion and identity are strong, there is music—and Sunderland is a music city. Having produced talent from Dave Stewart to the gone-too-soon Faye Fantarrow, our city’s artists reflect who we are, honour our proud heritage and point towards our bright future as an inclusive city.

Nowadays, we celebrate that Mackems are found in mosques and churches, our community centres, our gurdwara and our social clubs, and now there are even two Mackems in the Cabinet. All my constituents, no matter what their background, deserve a strong economy and quality public services. Because Sunderland was built on hard work, its people rightly expect nothing less from their politicians. It is in that spirit that I recognise the privilege of being in the House on behalf of our entire community. I will do what I can to serve them and repay the trust they have placed in me.

[Madam Deputy Speaker (Caroline Nokes)]

I call Adam Dance to make his maiden speech.

--- Later in debate ---

[Luke Myer (Middlesbrough South and East Cleveland) (Lab)]

On a point of order, Madam Deputy Speaker.

[Madam Deputy Speaker (Caroline Nokes)]

It is not the time to make a point of order.

I call Cat Eccles to make her maiden speech.

--- Later in debate ---

[Several hon. Members rose—]

[Madam Deputy Speaker (Caroline Nokes)]

Order. I propose to put a four-minute time limit on contributions after the next speaker.

--- Later in debate ---

[Bradley Thomas (Bromsgrove) (Con)]

It is not just public services that we need to focus on: the third sector provides vital services that many of our constituents rely on, particularly children’s hospices. I would like to highlight to the House the Acorns children’s hospice in my constituency, which provides vital support to many local families in a really acute moment of need. In 2019, NHS England decided to increase the children’s hospice grant—

[Madam Deputy Speaker (Caroline Nokes)]

Order. That intervention was far too long.

[Jess Brown-Fuller]

I thank the hon. Member for his intervention. He will be pleased to know that I am going to mention hospices later in my speech.

To fix the NHS, we must fix both the front and the back door. Taking the pressure off secondary care can only be achieved by properly funding primary care. That is why the decision to increase employer’s national insurance contributions is a significant mistake, as it risks worsening the crisis in the NHS and care sector. Increasing that rate will drive up GP surgery costs, significantly raising the annual expense of GP practices. Those practices are not eligible for the employment allowance that protects our small employers, so surgeries in Chichester and across the country will bear the full weight of that rise—a burden that they and my constituents simply cannot afford. Surgeries such as Southbourne surgery, Langley House surgery and Selsey medical practice have already reached out to me with concerns about their ability to continue providing services amid those financial challenges. They all agree that this increase will directly undermine patient access and care.

Charities have long suffered the burden of failing statutory services. Chichester boasts some of the most amazing charitable organisations, and one of the great pleasures of my role is to spend time with the people at the heart of those organisations. Charities such as Stonepillow, which works to prevent homelessness in our area, face an increase in costs of £125,000. I also visited St Wilfrid’s hospice after the Budget announcement—an incredible hospice that provides palliative care for hundreds of people every year, both in the hospice and in the community. It now faces an increased bill of £175,000—money that it needs to find annually, with only 17% of its annual budget covered by the NHS. I urge the Government to consider exempting the health and social care sector from the national insurance rise, so that the Treasury is not giving with one hand and taking with the other.

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[Mr Will Forster (Woking) (LD)]

I am surprised to be called so quickly, so thank you, Madam Chair. I was really pleased by the statement that the Secretary of State is looking at how to compensate those in the health and social care sector for national insurance rises. I have in my constituency Central Surrey Health, a not-for-profit, employee-owned group. It serves much of Surrey, and it stands to lose £500,000 as a result of the proposed changes. It delivers community services across Woking and Surrey, including most of the services in my constituency. It would be awful if we lost services as a result of measures introduced by the Government in a Budget that is supposed to invest in the NHS. I welcome the Government’s investment in the NHS, but they must not make the mistake of increasing national insurance on social care firms, health partners and GPs.

I am concerned about the elephant in the room: social care. Local authorities and our health system are really struggling, but social care helps to fix things. It is a more efficient use of our money to invest in social care and prevention than spend on primary care in hospitals. The Government are rightly investing in the NHS, but they have failed to invest in our social care system. Surrey county council is under huge pressure, and Woking borough council has effectively gone bankrupt. It is reported that without further support, almost 50% of local authorities could go under. If the Government do not invest in social care, I fear that they will make the mistakes that the Conservatives made, which we do not want. We need to invest in social care, so I hope that the Government will agree to a cross-party social care agreement that tackles those issues.

I want to touch on the cost of living. The Government have to turn around an awful record from the previous Government. They have introduced some good measures and have suggested that they would increase the tax threshold—something for which we have long campaigned —but I am concerned about the national insurance rises, which will hit small businesses hard. I met many small businesses this morning in Woking, and they are really concerned about the impact of those rises. I like the rhetoric from the Prime Minister and the Government about this being a Government of service, and a Government who want to promote growth. They are using the correct wording, but good rhetoric needs to be followed up with good announcements. The Government say that they are going for growth, but their actions do not support that. They are ignoring Brexit, they are ignoring social care, which undermines our local authorities, and they are undermining small businesses.

The Budget is better than the Budgets of the previous Government, but that is nothing to shout about. It should be a lot better for my constituents in Woking, and for constituents of Members across the House.

[Madam Deputy Speaker (Caroline Nokes)]

There will be a reduction in the time limit to three minutes after the next speaker. A note: when I am in the Chair in the Chamber, I am Madam Deputy Speaker, not Madam Chair; that is for Westminster Hall, or when the Chamber is in Committee. I call Richard Burgon.

Access to Primary Healthcare

Caroline Nokes Excerpts

Wednesday 16th October 2024 Commons Chamber

[Several hon. Members rose—]

[Madam Deputy Speaker (Caroline Nokes)]

Order. Before I call the Minister, I must respectfully point out that a huge number of Members wish to speak, and that interventions from Members will only eat up the time available to colleagues and, in some instances, themselves. I call the Minister, Karin Smyth, to move the amendment.

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[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?

[Madam Deputy Speaker (Caroline Nokes)]

Order. Before I call on the shadow Minister to return to the Dispatch Box—

[Ben Coleman]

I apologise, Madam Deputy Speaker. I used the word “you” instead of “the hon. Member”.

[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?

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[Several hon. Members rose—]

[Madam Deputy Speaker (Caroline Nokes)]

Before I call the chair of the Health and Social Care Committee, I inform the House that there will be time limits of three minutes on Back-Bench speeches and six minutes on maiden speeches.

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[Several hon. Members rose—]

[Madam Deputy Speaker (Caroline Nokes)]

Order. Before I call the next speaker, I am going to give some helpful guidance to Members still wishing to speak: interventions are only going to eat up your own time and that of others, and may well see you put to the bottom of the list.

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[Deirdre Costigan (Ealing Southall) (Lab)]

There is an old Irish saying, “Your health is your wealth”, and all the money in the world and all the nice things mean nothing if we do not have our health. Too many people in my constituency do not have good health—10% have diabetes, which is higher than the London and UK average, and the rate of preventable deaths is almost 14% higher than the England average. Time and again when I knock on doors across Ealing Southall, people tell me three things: they cannot get a GP appointment when they need it; they cannot see a doctor face to face; and if they are lucky enough to see a doctor, they never see the same one twice. With long-term conditions such as diabetes, not seeing the same doctor is damaging the health of my constituents. They are getting sicker, and they end up relying more on expensive hospital services. In Southall, emergency hospital admissions are 47% higher than the England average. Why can’t my constituents get to see a doctor? For starters, there simply aren’t enough. North-west London has a ratio of one GP for every 2,268 patients—a lot worse than the UK average.

We have had 14 years of the Conservative party running our NHS, and it is clear that it has run it into the ground. It started with a big-bang approach and the disastrous top-down reorganisation of the NHS. That caused so much damage that even they recognised it in the end, and they had to dismantle many of the changes a few years later, but not before the rot had set in. Since then, their approach has been like moving the deckchairs on the Titanic. All they can come up with is piecemeal tweaks and small pilots that never seem to amount to anything. In the meantime the NHS ship is slowly sinking.

Lord Darzi’s independent and honest report found that patients have never been more dissatisfied with the services they receive. I can only take the empty Conservative Benches as proof that they are finally embarrassed about it. We must also ask why Conservative Members have been happy to preside over 14 years of decline in our NHS. Is it because they want it to fail, or to replace our NHS with a privatised American-style insurance system? The mask slipped during covid when they fast-tracked their private healthcare mates and handed them multimillion pound contracts for often dodgy personal protective equipment. Was that the future they have in mind for the NHS? That is not what the public wanted, and it is why the public voted them out. My constituents in Ealing Southall are already impressed by the new Government’s approach. They know that the damage to the NHS is so deep that it cannot be fixed overnight.

Your health is indeed your wealth, Madam Deputy Speaker. The last Government frittered away that wealth, gave it to their private healthcare mates, and squandered it on damaging and costly reorganisations. This new Labour Government will turn the page on over a decade of Tory decay and help us all to live longer, healthier lives.

[Madam Deputy Speaker]

I call Ian Roome to make his maiden speech.

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[Andrew Lewin (Welwyn Hatfield) (Lab)]

It is a privilege to follow that powerful maiden speech. I am certain that the hon. Gentleman will do his constituents proud, as he did in his time serving in our armed forces.

I welcome this debate. After 14 years of Conservative government, our health service is in a critical condition. In my constituency, the drive from the centre of Hatfield to Welwyn East takes about 10 minutes, but the difference in life expectancy between the two areas is now 10 years. The responsibility for the crisis sits not with our wonderful healthcare professionals, but squarely with the previous Conservative Government. I have spent as much time as I can with our NHS heroes, and I recently saw the professionalism of our paramedics at first hand after joining a shift with Daisy and Jake in the East of England ambulance service. They were a credit to their badge, and I am pleased to say that I got through blue lights okay. But GPs are battling a backlog—in my constituency more than 2,000 people have been waiting more than a month for a local appointment—dentists are withdrawing from the NHS, including in Peartree ward in Welwyn Garden City, and, invariably, the most vulnerable are the most seriously impacted. As the Darzi report made clear, people experiencing homelessness attend A&E four times as often as the general population and are eight times more likely to need in-patient care, all at immense cost to them and the overall NHS budget. We will only rescue our health service if we reform primary care, and that is why this debate is so important.

Despite rising demand, 5% fewer nurses were working in the community in September 2023 than in September 2009. The NHS Confederation is clear that spending in primary and community settings has a superior return on investment compared with spending on acute hospital services, and Darzi was clear that it “therefore makes sense that” there should be a “fundamental strategic shift” to the community.

Innovative work is out there. In my constituency, the Hospital at Home service run by East and North Herts NHS trust is particularly powerful for those over 80 who need rehabilitation and care, but for whom the best place for that is their home and not the hospital. The shadow Minister, the hon. Member for Sleaford and North Hykeham (Dr Johnson), said that she was not expecting to hear new ideas, but they are out there, and it is the job of our Government to embrace them and take them forward. I have every confidence that this Labour Government will do that. The party that founded the national health service has a clear vision for the future —from analogue to digital, from hospital to communities, and from sickness to prevention.

[Madam Deputy Speaker (Caroline Nokes)]

I call Llinos Medi.

--- Later in debate ---

[Madam Deputy Speaker (Caroline Nokes)]

I call Martin Wrigley to make his maiden speech.

--- Later in debate ---

[Dave Robertson (Lichfield) (Lab)]

I congratulate the hon. Member for Newton Abbot (Martin Wrigley) on his excellent maiden speech. I am sure he will be a fierce advocate for the people of Newton Abbot and the surrounding area over the coming years. I look forward to working with him.

I am very glad to be able to speak in this debate, because primary care is an important issue that affects all our constituents. During the election campaign, it was absolutely the No. 1 issue that came up on the doorstep across Lichfield, Burntwood and the villages in my constituency.

We are effectively here to discuss the centralism and poor decision making that typified the last decade and a half of incompetence by the Conservative party on primary care. There can be fewer more obvious examples of that than the fate of Burntwood health and wellbeing centre in my constituency. The building was home to a GP surgery serving almost 5,000 residents in the town. The contract for the surgery expired in March last year, but no replacement facility was ready for that date. The surgery could not move, which meant it had to close. The building itself is still in use by the integrated care board and the practice was happy to seek an extension, but that was not allowed by NHS England.

As a result, more than one in eight people in the town have had to be redistributed to other surgeries because a process in London did not allow organisations in Staffordshire to deliver the best solution for my constituents. It is centralist and wrong. It was wrong then and it is wrong now, and it needs to change. Even worse still is that the proposed replacement facility, originally scheduled for completion in October 2023—last year—is nowhere near ready. We are expecting planning permission sometime in early 2025 and who knows when it will actually be completed.

This is such an important issue for my constituents in Burntwood, as we all know the potential knock-on effects that delays in accessing primary care can cause. The staff at the remaining surgeries are doing all they can to support the community, but at some point increased patient rolls like this cannot be mitigated. It is one example of the challenges people face in seeing a GP. It is not the only one in my constituency and very far from being the only one across the whole country. It cannot be fixed overnight; 14 years of it going wrong will take longer than 14 weeks to fix. However, I applaud the Health Secretary for going as far as he has so quickly: cutting red tape to allow 1,000 new GPs to be taken on and commissioning the Darzi review of the NHS so that this party, the one that created the NHS, can ensure that we build a health service that is fit for the 21st century.

[Madam Deputy Speaker (Caroline Nokes)]

I thank the hon. Gentleman for not using all his time. I call Tom Gordon to make his maiden speech.

World ME Day

Caroline Nokes Excerpts

Wednesday 1st May 2024 Westminster Hall

[Caroline Nokes (Romsey and Southampton North) (Con)]

It is a pleasure to see you in the Chair, Dame Siobhain. I congratulate my right hon. Friend the Member for Bromsgrove (Sir Sajid Javid) on his leadership on this issue. We know that he started the train of getting work done on ME when he was Health Secretary. Too often in this place, we move on from Departments and never speak of them again, but he has not. He has championed the cause of the sufferers of ME, and indeed their families, with real vigour.

It seems bizarre in this place to refer to long covid with a welcome message, but long covid has shone a spotlight back on ME. We know that it is a post-viral condition, but we do not know why. The number of sufferers of long covid has given us an opportunity to look again at ME. Hopefully, in this place some of us will begin to understand more and broaden our knowledge of the condition. My right hon. Friend taken a new approach, and my constituents certainly wish to extend their thanks to him for that.

I always say that I am blessed with constituents in Romsey and Southampton North who are not only articulate and willing to share their views with me, but in many instances are often experts as well. Professor Sir Stephen Holgate contacted me ahead of the debate to make the pertinent point that, for sufferers of ME, many of whom have been bedbound for years, surely I could spend an hour of my time raising their plight in this Chamber. I am certainly very pleased to do so. He highlighted, as did the hon. Member for Putney (Fleur Anderson), the well-established sex bias among sufferers of ME. Of the 17,000 sufferers recently surveyed, women made up 83.5% of the respondents. We know that they are five times more likely to suffer than their male counterparts.

I say to the Minister, very gently—an unusual stance for me—that we have to do more about the bias that exists in medical research and clinical trials. We have to stop the situation, which prevails to this day, where too often conditions suffered by women are portrayed as them being simply hysterical. ME is a serious condition. It is not all in the mind, as my constituents have been told on too many occasions. We need to ensure not only more investment into research to find the causes of ME and hopefully more effective treatments—and of course, the holy grail, a cure—but research focused on the women who need it.

I welcome the cross-Government delivery plan that was set in train by my right hon. Friend the Member for Bromsgrove, but we need to see it. We need to see not just the interim version but the final plan, and we need it to be delivered. We need it to be rolled out into every trust and integrated care board. We need it to be effective for our constituents, which brings me on to my next point: my constituent. I was contacted by a mother, Elaine. The point she made in her email was that she wants her voice and the voice of her daughter to be heard. Her daughter was a high achiever, training to be a dancer. She had already secured 5 A-levels when she was struck down with ME. The words that she used are heartbreaking. She has been stigmatised, gaslighted and ridiculed. As a result, she now avoids doctors. She avoids going to get the very help that she needs because she fears that her condition will lead to ridicule.

That is simply not acceptable in a 21st-century health system. We have to do more to ensure greater awareness not just in the Chamber today, but out in our ICBs and GP surgeries, so that the sufferers who are presenting for the first time do not get ridiculed or labelled as hysterical women, but actually get the help that they need. We cannot have a situation where our constituents are avoiding the people they need to turn to for help.

As I have said, there is bias that we have to overcome. There is a gap in research funding. Only £8 million has been spent on ME research over the last 10 years, which is simply disproportionate to the number of sufferers—it should be several times that figure—and we still know less about every aspect of female biology than we do about male biology. I would like to hear a commitment from the Minister that, while he is in this role, he will do his utmost to eliminate the gender bias that we still see in medical research.

Cass Review

Caroline Nokes Excerpts

Monday 15th April 2024 Commons Chamber

[Madam Deputy Speaker (Dame Rosie Winterton)]

I call the Chair of the Women and Equalities Committee.

[Caroline Nokes (Romsey and Southampton North) (Con)]

Dr Cass’s observations about violent and degrading pornography are chilling, and we know of the impact that is having not just on young girls but on all our young people. Her recommendations also include significant and specific references to expanded services and follow-through services for 17 to 25-year-olds. What concerns has my right hon. Friend about the capacity for that, and about the possible impact on other areas of healthcare?

We know that the transition from children’s services to adult services can be problematic in the case of a wide range of services, not least for those suffering from body dysmorphia or eating disorders. Might there be any crossover, with young people having access to some sort of interim service before the age of 25, and will more funds be committed so that we do not continue to see what all of us will face in our constituencies: the horror of young people being unable to access child and adolescent mental health services before they turn 18 and become reliant on adult mental health care?

[Victoria Atkins]

My right hon. Friend is right to identify the cohort of young people between the ages of 17 and 25 as being of particular concern. Now that we have a clear pathway in relation to the treatment of children and young people under the age of 17, I have asked NHSE to focus primarily on that next cohort. Speaking to parents gives one a very real sense of their concerns about what they describe as the cliff edge between children and young people’s services and adult services for this very vulnerable group of young people. I do not want that to continue, and over the coming months we will see NHSE develop work to help that cohort.

My right hon. Friend has an understanding not just of how transformational the report and its evidence are, but of the challenges that this means for our health service in England and how we choose to respond. As for funding, NHSE has committed more than £17 million to the two new hubs in the current financial year, and I hope and expect that our devolved Administrations will commit similar sums to looking after children and young people in their areas.

Access to Migraine Treatment

Caroline Nokes Excerpts

Wednesday 20th March 2024 Westminster Hall

[Caroline Nokes (Romsey and Southampton North) (Con)]

I congratulate my hon. Friend the Member for Bishop Auckland (Dehenna Davison) on having secured this important debate. I am going to be a little bit cheeky: it is always a privilege and a delight to follow my right hon. Friend the Member for South Staffordshire (Sir Gavin Williamson, but I have absolutely no memory of him advocating radical and bold behaviour from the Dispatch Box when he was Chief Whip—in fact, quite the opposite.

Migraine treatment is a serious subject. In November last year, I was privileged to host an event for the Migraine Trust. My hon. Friend the Member for Bishop Auckland did an incredible job of setting out the history of migraine and explaining in detail the challenges that sufferers face. When I agreed to host an event for the Migraine Trust, I thought I understood migraine and recognised the symptoms and impacts and how sufferers endure the most horrible events in their lives. That was right up until I spoke to some of the sufferers who were there that evening.

We have focused on the one in seven people—the 10,000—in each of our constituencies who suffer from migraines, but I was particularly struck by the chronic migraine sufferers who were there that evening. They are triggered endlessly by such a radical thing as light, and they were having to stand in that room with dark glasses on and with ear plugs in to avoid noise. They were telling me about the food and drink they avoided rigorously, because they could identify each individual trigger that would perhaps set off a period when they would have a migraine literally every single day for days on end. It was eye-opening for me, because I thought I understood migraine after the first attack I had when I was about 10 years old.

We should not focus exclusively on our own experiences, but I remember my first attack to this day. I blame my father—I blame him for many things—because he took me to McDonald’s when I was 10 years old. The blue light in those McDonald’s in the early 1980s—I can remember where this McDonald’s was; it was in Southend—triggered a migraine in me that day, and I did not understand what was happening to me. That is the challenge for children: they do not understand and they cannot process that this is something that, if they lie down quietly and take their medications, they may get through. It impacts their education and their entire childhood because they become anxious, as my hon. Friend detailed. They become anxious and worry endlessly about when the next one will come. Of course, as we know, stress can trigger migraines, so the sheer act of worrying about the next migraine can in fact trigger one.

My evening with the Migraine Trust talking to those chronic migraine sufferers was incredibly eye-opening and made me absolutely determined to redouble my efforts to tackle the lack of knowledge and the stigma that surrounds migraine. I was quite surprised to hear from only one constituent ahead of the debate, but I want to focus on her story, because many of the issues have been highlighted today. She has suffered from migraines for 30 years—30 years in which it has impacted every single job she has had. Not a single employer has understood that this is not just a headache, but something utterly debilitating, and that she will not be able to attend work or function normally. As a result, she has had extreme difficulties with her employers. Her ask of me is that I advocate to the Minister—and I do so now—that we should perhaps look at considering migraine as a disability, because, to be frank, it absolutely is.

My constituent also talked at length about exactly the point my hon. Friend highlighted about medications. As we have heard, there is no one silver bullet; some medications will work for some people, and some will work for others. It is almost a process of trial and error, with someone going three months with a medication that they know is not working—going through the different steps and jumping through the hoops—so that they can demonstrate that it has not worked and then move on to the next stage of medication.

I want to talk briefly about the stigma and how some of us are too embarrassed and ashamed to talk about this issue. I remember taking beta blockers for migraines when I was a Minister, so let me talk about the side effects of beta blockers and how impactful they are. When I stood at the Dispatch Box, beta blockers made me feel stupid, slow and dull. The one thing that everyone expects a Minister to do at the Dispatch Box is to answer a question immediately, wittily and with facts tripping off the tongue instantly. When I was taking beta blockers, I found that I simply could not do that. I would stand there and feel dull, detached and as if I was not really in the room.

I stopped taking beta blockers and resorted to a type of medication that is hugely stigmatised. Botox is approved by NICE for migraine and is, for me, incredibly effective, but it is incredibly expensive because I cannot get it on the NHS. I was frantically tapping on my phone—I was not sending messages; I was using the calculator—to work out how much I might have spent on Botox over the past 15 or so years. It appears to add up to a phenomenal £20,000—just to ensure that I can stand in this place, talk relatively coherently and, at times, make sense.

I remember vividly being sat in the Tea Room and not being able to think of the right word. I thought, “Well, that’s fine. We all get a little bit of brain fog when you get to my age,” but it was not that, and it got worse and worse. The longer I sat there, it was not just that I could not think of the right word; I could not think of any word, and then I found that I had been sat in the Tea Room silent for about half an hour because I could not actually speak. As I mentioned, my right hon. Friend the Member for South Staffordshire, who is sitting next to me, is a former Chief Whip, and he would no doubt have been absolutely delighted if I had gone through entire spells of not being able to speak. I am sure the current Chief Whip would also be very happy if I lost the power of speech. But it is absolutely terrifying, and has a profound impact.

I resort to expensive treatments that are socially stigmatised. Everybody assumes that it is vanity—I prefer to use the phrase, “Two birds, one stone.” The impact those have means that I can live my life, but it is not a choice available to very many people. That is the stark reality. As Monica would tell us, she wants the new CGRP medications to be more easily available. She wants them to be available in every NHS trust so that there is no postcode lottery. Most of all, she wants the stigma to be beaten down so that she never again has to explain to an employer what a migraine is, and that it is not just a headache.

It was fascinating to hear the tales of the hon. Member for Caerphilly (Wayne David) and my hon. Friend the Member for Banff and Buchan (David Duguid), who cannot be here, about not only their migraine experiences, but watching a child suffer from them. As I said, I blame my father for my migraines, and my daughter blames me for hers. There is clearly quite a significant genetic link to suffering. We need to have much more research and investigation into not only the condition more widely, but some of the specifics we have heard in this debate.

We need to reflect that stress can be a phenomenal trigger of migraine, and we therefore need to be much more holistic in the way we approach it and think about how we manage our lives. If my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) was here, she would undoubtedly be making a pitch for a new Government Department for wellbeing, and that approach could sit very firmly in that. If we address the mental health challenges around stress, we can also address the challenges of migraine. I do not pretend that we can address all of them—there is clearly a crucial and important role for medication, which needs to be much more widely available.

I finish with the thought that this is a complex, difficult subject. There is no silver bullet, but what we require in this place is a real drive from the Department to make sure it is thinking about including migraine in all of its health strategies. I stand here as the Chair of the Women and Equalities Committee, and I was really struck by the fact that women are more than twice as likely as men to suffer from migraine. If we look around this Chamber today, it appears, as ever, that it is a male problem. We cannot allow things like the women’s health strategy, which is crucial, and which I welcome, to be about stereotypical women’s conditions. We also have to have a thread that weaves through the fact that in almost every health condition, women are under-represented in research and in how it is treated. As my hon. Friend the Member for Bishop Auckland mentioned, too often we are deemed hysterical as opposed to actually ill. My final comment to the DHSC is: please, can we make sure that the impetus on the women’s health strategy is maintained and kept up, and that we do not allow it to become about just reproductive health? It has to include the whole of women’s health to make sure that we are being treated fairly.

Sexual Harassment of Surgeons and Other Medical Professionals

Caroline Nokes Excerpts

Wednesday 13th December 2023 Westminster Hall

[Rosie Duffield]

Absolutely, and I thank the hon. Member so much for raising that important point, which is supported by all the work that the BMA has done, including the report that he mentioned.

The rape of a female child under 13 was included in those shocking statistics, alongside the rape of a female over 16 by multiple offenders in west midlands hospitals, three rapes of a female under 16 in Cambridgeshire, and six rapes of girls under 13 in Lancashire. It is important to note that although the FOI responses do not record the sex of the victims, national data shows that less than 5% of rape victims are men, so it is reasonable to assume that most victims are female. The investigation uncovered 13 rapes of males over the age of 16, however, including one incident involving multiple offenders, and the sexual assault of a male child under the age of 13 in a Cambridgeshire hospital.

We know that hospitals are, of course, monitored by many CCTV cameras, and individual wards usually have safe-door entry systems, which prompts the question of why only a tiny percentage of cases—4.1%—resulted in a charge or a summons. Indeed, five police forces did not issue a single summons or charge a single suspect for any of the 334 reported sexual assaults in their areas. Why not? The WRN report says:

“The damning figures are probably ‘the tip of an iceberg of indifference’ around the safety of NHS patients and staff”,

as some forces gave inadequate information. For example, Police Scotland did not provide any figures, citing cost constraints, and of those forces in England and Wales that did respond, seven forces provided incomplete responses, five did not give information on the number of assaults that occurred on hospital wards, and three did not provide information about the number of people charged or summonsed.

As Heather Binning, founder of the Women’s Rights Network, says:

“These statistics are jaw-dropping. We began this investigation because a number of members raised concerns about the safety of women and children on NHS wards, but we are horrified at what we have uncovered.”

I am grateful to the WRN for highlighting this problem and shining a light on something that has gone almost completely unnoticed in this place before.

The BMA represents doctors and medical students across the UK. It also produced a briefing for today’s debate, as we heard earlier from the hon. Member for Strangford (Jim Shannon). It states:

“The BMA is deeply concerned by the overwhelming number of doctors who have experienced sexual harassment at work.”

Its “Sexism in medicine” report of September 2021 found that 91% of women doctors in the UK have experienced sexism at work, with 42% feeling that they could not report it.

[Caroline Nokes (Romsey and Southampton North) (Con)]

The hon. Lady is highlighting a very important issue. She made a point about reporting, which is certainly an enormous challenge. The Women and Equalities Committee heard from Chelcie Jewitt of Surviving in Scrubs, who made the point that when doctors tried to report harassment, they were often told by the General Medical Council that it was a trust issue, yet the trust would say that it was a GMC issue. Does the hon. Lady think that goes some way to explaining why there is a lack of reporting and that, when there is reporting, it seems nothing gets done?

--- Later in debate ---

[Caroline Nokes]

I thank the Minister for giving way, and welcome him to his new role, appreciating that he has only been in it a few weeks. I gently say to him that there is a real challenge in our NHS when 10% of women in one study reported unwanted sexual conduct in return for career opportunities. That is absolutely about power, and it is going to take a step change to break down those structures that enable such harassment to continue, behind a veil of silence, so that women are still afraid to speak out.

[Andrew Stephenson]

I pay tribute to my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes), who is the Chair of the Women and Equalities Committee, for her work in this area. I completely agree with her point; there needs to be a serious culture change. We would all recognise that over many years the NHS has been fantastic in treating patients. However, quite often the same clinicians, in many regards, have not been as compassionate when looking after each other.

The workplace culture that has developed in parts of the NHS need addressing. Even though I am new to my role, with only three weeks in post, as part of the NHS long-term workforce plan, I am looking at that culture and the staff leaver rates across a whole range of different parts of the profession. That is important because we must ensure that people have a safe and enjoyable working environment. At the moment, reports such as those detailed by the hon. Member for Canterbury show that in far too many trusts, employers are falling well short of providing that supportive environment, which is the least people should expect.

Turning to what has been happening, most NHS organisations now have trained staff to help colleagues raise concerns in this area. That includes a network of more than 1,000 local freedom to speak up guardians across all trusts, supported by an independent national guardian to help drive positive cultural change. We have also established a confidential helpline for staff who want to speak up but need guidance about what to do and where to turn. That, again, goes to the point made earlier by my right hon. Friend the Member for Romsey and Southampton North about the experience of people complaining but being passed from pillar to post between the GMC and trust. I hope that the confidential helpline will help make a difference.

NHS organisations must do everything they can to stamp out the unacceptable behaviours at all levels across the health and care system. In April, the former Secretary of State, my right hon. Friend the Member for North East Cambridgeshire (Steve Barclay), convened an urgent meeting with NHS England to ensure that NHS organisations are doing more to tackle such behaviours. We have made some progress, although I acknowledge that there is much more to do.

This year, NHS England broadened and strengthened the remit of its domestic abuse and sexual violence programme, which was established in 2022, to address sexual harassment and misconduct on NHS premises. All trusts and integrated care boards were asked by NHS England to appoint an executive and operational lead for domestic abuse and sexual violence. Those leads are reviewing their policies, training and support systems to enhance support for staff and patients.

In September, NHS England launched the first ever NHS sexual safety charter across the healthcare system. There are now 200 signatories, including NHS employers and the Royal College of Surgeons. Signatories commit to taking a zero-tolerance approach to any inappropriate or harmful sexual behaviours in the workplace by implementing all 10 charter commitments by July 2024. The commitments include establishing clear reporting mechanisms, implementing training programmes and providing essential support for those involved in investigations. NHS England will use the new network of domestic abuse and sexual violence leads to share and promote good practice and develop practical solutions in implementing the new charter.

Data capture is also a key commitment in the charter and to gauge the charter’s impact, the NHS staff survey now includes a question related specifically to sexual safety. That systematic approach reflects a commitment to transparency and accountability in creating a safer working environment. The Equality Act 2010 has also been amended this year to include a new duty on employers to take steps to prevent the sexual harassment of their employees. Implementation of the charter will assist NHS employers with meeting the duty when it comes into force next October.

The GMC is unable to consider complaints about registrants that relate to matters more than five years old unless it considers it to be in the public interest to do so, which has been raised during the debate. We are modernising the legislation that governs professional regulators, which includes removing the five-year rule as part of the reforms to regulatory legislation for doctors. It will allow the GMC greater discretion to consider whether a concern should be investigated. Introducing those changes remains a top priority for the Government.

I hope that these measures show that we are committed to addressing the problem with targeted action. However, I acknowledge that there is more to do, and I would be happy to work with the hon. Member for Canterbury and Members across the House to ensure that we get it right. We will not be satisfied until the number of staff facing sexual harassment is down to zero. There must be a collective effort across our health service to enact change. Strong and effective leadership is crucial, and it starts from the top. The Government, with NHS England driving this work, are calling upon all NHS boards to sign the sexual safety charter and ensure that their healthcare settings are safe places for our current and future workforce.

I will close by acknowledging the bravery of all those women and men who have come forward with their experiences of sexual harassment and misconduct in the healthcare workforce. That includes the testimonies in the report from Surviving in Scrubs, some of which the hon. Member for Canterbury read out. It takes incredible bravery and selflessness to come forward. Thanks to those brave women, and some men, we are getting ever closer to ending the scourge of sexual assault in our health service. I thank the hon. Member for putting a spotlight on the issue today. We must not tolerate it.

Question put and agreed to.

HIV Action Plan Annual Update 2022-23

Caroline Nokes Excerpts

Tuesday 18th July 2023 Westminster Hall

[Caroline Nokes (Romsey and Southampton North) (Con)]

It is a pleasure to serve under your chairmanship, Dame Caroline. I, too, would like to congratulate my hon. Friend the Member for West Bromwich East (Nicola Richards) on securing the debate and on her comments. She has already said much of what I wanted to say, so that will spare us some time.

I apologise if anyone thinks I am about to drift out of order—I am not—but I want to focus on the women’s health strategy. We know that the HIV action plan has been incredibly effective in increasing the number of men diagnosed with HIV. We have seen a fantastic and sustained fall in HIV incidence for gay, bisexual and other men who have sex with men, but not for women. That is because there seems to be a lack of joined-up thinking when it comes to breaking down some of the stigmas and taboos that still exist for women, and we need to do more to ensure that they are tested.

This is where I drift off into the women’s health strategy, which is a comprehensive and excellent document, and I pay tribute to you, Dame Caroline, for ensuring we saw it get over the line. It clearly states:

“independent reports have shown, too often it is women whom the healthcare system fails to keep safe and fails to listen to.”

The document contains some important and crucial points around tackling taboos and stigma and addressing disparities in outcome that might be affected by age, ethnicity or where the woman is from. It says clearly that those factors should not impact a woman’s ability to access services, but they do.

We know that women are less likely to have access to PrEP and that they are the least likely group to have their need for it identified—only 33% in 2021 had had their need identified. They are also the least likely to continue taking PrEP. The HIV action plan told us about making PrEP available from GPs, and the hon. Member for Brighton, Kemptown (Lloyd Russell-Moyle) commented on making medication more readily available from pharmacies. We have already done that for a range of conditions. Some contraception is readily available from pharmacies. For women, some forms of hormone replacement therapy are available from pharmacies. The morning-after pill is available from pharmacies. What we need to do, to break down the stigma and taboo, is to ensure that PrEP is more accessible from pharmacies. It seems to be a complete no-brainer.

[Lloyd Russell-Moyle]

The right hon. Lady makes some very good points about PrEP. But is this not also about a problem with sexual health and reproductive testing in clinics? In Britain, only one in 10 clinics offers online testing. That means that many people who cannot take time off work, or who cannot get away at the right time, are never able to get tested.

[Caroline Nokes]

The hon. Gentleman makes an important point, and one that I had completely forgotten about but that I wanted to highlight. Online testing and receiving test packets through the post is incredibly discreet, quick, easy and efficient. I know that because even I have availed myself of those services—that will send the Twittersphere into an absolute frenzy. It is a really important point: to be in control of their own health, a person needs to know. Annually, I have an HIV test provided to me—I believe it is Terrence Higgins Trust that does that, because it is a brilliant charity that does fantastic work, not least in providing us with up-to-date information. It also promotes relentlessly the need to make sure that testing kits are readily and easily available through the post and online. It is absolutely critical that we have that. We learned during the pandemic, did we not, the importance of test, test, test?

That moves me on to tests, tests, tests of the opt-out variety. My constituency in Southampton does not benefit from opt-out testing at present. It is classified as having a high prevalence of HIV, with 2.4 adults per every 1,000 living with HIV in the area. We know that opt-out testing finds people living with HIV and brings about an earlier diagnosis in many cases. We all know that earlier treatment is the most effective and that once somebody on treatment has got to the point where their viral load is undetectable, it is untransmissible. Of course, we have to do the maths backwards; we know that if people are not diagnosed and not receiving treatment, they are more likely to be transmitting HIV.

We know that opt-out testing works. We know that it works in Blackpool and London, but we know that in Southampton, more than a third of HIV diagnoses are late, which puts people at much greater risk of ill health and death and increases the problem of onward transmission. We also know that women, black Africans and older people are more likely to be diagnosed late. My plea to the Minister is to ensure that we have an expansion of opt-out testing so that we can identify those people from groups who are less likely to be identified. We know that opt-out testing means that a higher proportion of women and older women are also likely to be identified.

That takes me very neatly back to the women’s health strategy, which puts people into three stages of life. There is the early stage, from puberty up to about 24; the mid-stage of life; and older people, such as me, who have passed their 51st birthday. The important thing about the women’s health strategy is that it is absolutely explicit in saying that sexual health and wellbeing is relevant across all three of those age groups. I make a big plea that we do not forget older people; the hon. Member for Vauxhall (Florence Eshalomi) mentioned a woman of 85 going through opt-out testing. It is absolutely, crucially important. Representing Romsey and Southampton North, it would be remiss of me not to make a quick plea for those living in rural areas, who wait an average of 19 days to get an appointment with a sexual health service. That is far too long to wait.

Much of this comes down to education and information. We know from the women’s health strategy that there is a big emphasis on relationships, sex and health education and that the Department for Education is conducting a review into that at the moment. We must teach boys as well as girls about sexual and reproductive health. The best place to do that is via RSHE, yet a written answer from the Department of Health and Social Care tells me that there has not yet been any contribution to the RSHE review from the Department. That is remiss of the DHSC; it should feed into the review in the same way that every other Government Department that has even a passing interest in the wellbeing of our young people and their ability to respect themselves and each other should. Notwithstanding the fact that I had a very negative answer from the Department, dated earlier this week—it might have been the latter end of last week—will the Minister take back to the Department how crucial that is if we are to hit the target of living HIV-free? Government Departments must work together to ensure that that happens.

Under-age Vaping

Caroline Nokes Excerpts

Wednesday 12th July 2023 Commons Chamber

[Andrew Gwynne]

Absolutely. There has to be a strategy that is not just about restricting packaging and advertising. There has to be more enforcement at the local level. I have some sympathy with local government, which has had to endure massive cuts over the past 13 years, so that things such as trading standards have been cut right back to the bone, but there can be no excuse whatsoever for shops selling these products to children. Every action should be taken to prevent that and to enforce the law.

[Caroline Nokes (Romsey and Southampton North) (Con)]

The hon. Gentleman is making an interesting and important speech, but he is focusing on advertising, marketing, the bright colours and the sweet flavours, and he has not mentioned price. Price promotions are banned for tobacco, yet vapes can sometimes be bought for three for £12, which is pocket money territory.

[Andrew Gwynne]

The right hon. Lady is absolutely right. We tabled the motion because we believe that the action it calls for is something we can do quickly, but the price of vapes is also a driver, and she is right that we should look into deals whereby vapes can be bought really cheaply—as she says, with pocket money—because that would be another step to take vaping out of the reach of children and young people.

As I said, ASH estimates that most children who vape make the purchases themselves. Put simply, children are then increasingly being hooked on to addictive substances that are deliberately packaged—and, indeed, sometimes priced—to catch their eye. This affects not only their health but their education.

Who could have seen it coming? Well, not the Government, it turns out. In November 2021, my hon. Friend the Member for City of Durham (Mary Kelly Foy) tabled an amendment to the Health and Care Bill that would have given the Secretary of State the power to prohibit branding that appeals to children on e-cigarette packaging. It received cross-party support but was voted down by the Government. When the Minister stands up in a few minutes and claims that the Government are on top of the epidemic of youth vaping, I hope he will explain to the House—to Members from all parties who supported that measure—why the Government voted down that sensible amendment in 2021, and why they are still failing to do something about this acute problem now.

Sadly, this approach to public health has become all too familiar when it comes to the Conservatives. We were promised a tobacco control plan; that was binned. We were promised a health disparities White Paper; that was binned. We were promised a ban on junk food advertising to children; that was binned. Why? Because the Prime Minister is too weak to take on those on the fringes of his own party who view public health with suspicion. That is why, on the Conservatives’ watch, health inequalities have widened, and why vaping companies have been given free rein to profit off children and young people.

The next Labour Government will not allow the trend to continue, which is why in Labour’s health mission we have been clear that we will ban the packaging and marketing of vapes to children, and we will come down like a ton of bricks on those who sell vapes illegally to children.

--- Later in debate ---

[Caroline Nokes (Romsey and Southampton North) (Con)]

It is an honour to follow the hon. Member for Ealing, Southall (Mr Sharma) and to be able to speak in this debate. May I first pay tribute to my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson), who has done so much work on this issue? She is a paediatrician and, frankly, we should always turn to her when looking for advice on vaping. I also pay tribute to a previous Member of this House, Jim Fitzpatrick, who was the Member for Poplar and Limehouse. He has now retired to my constituency—a blessing, although perhaps not an additional vote at the next election. His wife is a cardiologist, and she was talking to me about vaping and the fact that we simply do not know what the health implications might be 20 or 30 years hence. However, it would be an act of gross hypocrisy for me not to confess to liking the odd puff on a vape, and I regard it as an important tool for the cessation of smoking.

We need to be careful when we start discussing things such as flavours. The average vape stick has the most horrific, synthetic, disgusting flavour. They do not taste like strawberry ice, blue raspberry or anything else. They taste weird, but they do not taste as weird as the tobacco-flavoured ones. When I first came to this House—a long time ago now—it was when the tobacco companies were first marketing vaping. The products were almost invariably tobacco-flavoured and tasted disgusting, if we are being brutally honest. I do not know how best to describe them, but they were clunky in design. They were big and chunky and did not fit easily in the pocket. That is where the big difference has come—with cheap, slimline vape sticks, which are much more pocketable and much cheaper.

I really think that price is a two-edged sword. For those looking to stop smoking, there is the sheer fact that vaping disposable bars in particular, which are so cheap and easily obtainable, is really cost-effective. We therefore need to be a little careful and nuanced in looking at how we go about pricing them effectively. It is important that they still be a cost-effective route into smoking cessation, but equally—I made this point to the Minister—we must do something about what I referred to as promotional selling. It is simply not allowed to do two-for-one deals on packets of cigarettes or any other tobacco products—I hasten to add that two-for-one deals are not allowed on things such as baby formula, either—but they are allowed on vape sticks. I know from experience that the village shop sells three Elfbars for £12, making them £4 each, so three kids can easily club together and get a product that is incredibly cheap.

I think the hon. Member for East Renfrewshire (Kirsten Oswald) referred to the Elfbar as the most popular and one of the most widely accessible vape sticks. I take real offence to the Elfbar name, because I think it sounds somewhat like “health bar”, if not pronounced in quite the same way that I would.

It strikes me that the motion does not address myriad issues. It does not address the naming or pricing of these products. There needs to be some good and effective research on flavours. I am happy to say that these things should be in plain packaging, and they should not be brightly coloured. I do not see what is wrong with a slimline black vape stick—or olive green, which we know has been so effective in the plain packaging of cigarettes.

Tomorrow, I will meet the two headteachers of Romsey School and Mountbatten School. A problem in my constituency is the ease with which children can obtain vape sticks, including—we have heard reference to this—doctored vape sticks. We do not know what is in them. I think my neighbour, my hon. Friend the Member for Winchester (Steve Brine), commented on the letters home from school. At the start of the Whitsun half-term week, the two headteachers wrote a letter to parents explaining that children from both schools had been hospitalised because of vape sticks and, to be frank, nobody knew what was in them. One child was suffering from seizures, and they were having an impact on heart rates. Those are really serious health implications that are affecting children.

My hon. Friend mentioned toileting, and I will go there, too—nobody will want to listen to this conversation, but it is important. Way back in 1983, the most terrifying place I ever had to go was the girls’ loos in the main block of Romsey School, where the air was thick with cigarette smoke and hairspray—a unique combination that many male Members of the House will have had no experience of. It is disgusting. We now have a situation where Romsey School has had to introduce alarms because—guess what?—through vaping, it is back, but we cannot smell it.

My mother had the nose of a bloodhound, and if I had had a single cigarette some hours previously, she would sniff it the second I was in the house. If my daughter walks in today, having consumed God knows how many vape sticks, I have no idea that she has done so. The same, of course, is true for teachers, who simply will not know from sniffing children—there are probably all sorts of safeguarding rules why they do not go around sniffing children—whether they have been vaping in the girls’ loos. I suspect that the boys’ loos are also a hotbed of it.

This has massive health implications for children. I remember how, at 11 years old, I would not go to the loo all day because the main block loos were so scary. We do not want to go back to that. We need our children to be able to go to the loo safely and with confidence, and part of that is about making sure that the loos are a safe environment and free of vapes. I pay tribute to my constituent Pete Sandhu, who has developed and indeed marketed a vape alarm, but they are still in the region of £300 to £400 per alarm. I gather that they compare well with an American brand, which is about £1,200 per alarm, but our schools simply cannot afford to be installing such equipment to ensure that pupils are safe while going to the loo.

In addition, I want to mention the levels of nicotine in vape sticks and the nicotine hit. I can talk from experience. The stark reality is that someone will get a far more intense nicotine hit from a disposable vape stick than from a cigarette. That is getting children addicted very quickly.

I speak in defence and support of the Minister; he is right to do a great deal more work on this issue, which we need to be evidence-based. As the Chair of the Health and Social Care Committee said, children are very price-sensitive, but I was disappointed to see the issue of price not included in this motion. Clearly, the DHSC needs to have that conversation with the Treasury. We need the pricing to be right so that vaping remains affordable for those of us wanting to quit smoking, but is too expensive for those price-sensitive children to afford.

The places where vapes can be bought, such as hairdressers, beauticians and tanning salons, are inappropriate. We need a robust licensing regime that does not put those products on the ends of supermarket shelves, as I see in my local Morrisons. God bless Waitrose—Leckford, the home of the Waitrose estate, is in my constituency. It is a market leader in taking the right and principled stand. In the nearest Morrisons to my constituency—it is not actually in it—vape sticks are on the promotional end of supermarket shelves. Vape companies will have paid more to be in that prime location.

As Chair of the Women and Equalities Committee, hon. Members will expect me to make some comment at the end of my contribution—I will not drone on for too much longer—about gender. There has long been a real problem with girls still taking up smoking more than their male counterparts. Some of the packaging and design of Elfbars is gendered—there is an awful lot of pink out there. It is important that any sort of consultation bears in mind that there may be a more targeted marketing strategy towards young women than young men. Please could the Minister bear that in mind?

This is such an important debate and I commend the Opposition for having selected it. I am inclined to agree with my hon. Friend the Member for Winchester, but I hope the shadow Minister will take my comments in the spirit in which they are intended. I want the idea to be done better, not just trashed. It is an important step, but there is an awful lot more work to do than just ban advertising. That is too simplistic.