Hospice Services: Support

Caroline Nokes Excerpts

Wednesday 14th June 2023 Westminster Hall

[Several hon. Members rose—]

[Caroline Nokes (in the Chair)]

Order. Members will see that a lot of colleagues want to get in. I will do my best to call as many Members to speak as possible, and that will require a three-minute time limit from the start. I call Kate Hollern.

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[Several hon. Members rose—]

[Caroline Nokes (in the Chair)]

Order. I will reduce the time limit to two minutes after the next speaker.

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[Tim Farron (Westmorland and Lonsdale) (LD)]

It is a pleasure to serve under your chairmanship, Ms Nokes. I pay tribute to the hon. Member for Eastleigh (Paul Holmes) for securing this important debate.

St Mary’s Hospice at Ulverston, St John’s Hospice at Lancaster and the Eden Valley Hospice at Carlisle provide tender, professional and specialist care for people with life-limiting conditions and their loved ones—something we are so grateful for. They prove that life has dignity from beginning to end. Hospitals, however marvellous they are, do not have the resources to replicate the care that is provided by hospices.

The costs of running a hospice have gone through the roof in recent times. Val Stangoe, the chief executive of St Mary’s, one of our three local hospices, said to me:

“The recent settlement by the NHS Lancashire South Cumbria ICB of 0.0%”—

as pointed out by the hon. Member for Lancaster and Fleetwood (Cat Smith)—

“has left our hospices in a state of financial deficit, with potential loss of hospice beds and services.”

She went on:

“Your local hospices”—

our hospices—

“are now operating on a deficit budget, have received the lowest settlements in England. The proposed 0.0% uplift equates to almost 10% in cuts, significantly impacting delivery of services. This stands in contrast to other regions, where hospices have received an average uplift of 2.7%”—

which is not enough. She continued:

“The disproportionate treatment faced by hospices in Lancashire South Cumbria is unfair and must be addressed.”

My fundamental ask of the Minister is this: will she directly involve herself in that situation to stop our hospices in Cumbria suffering? I have been asking the Government for months to come up with a scheme to help hospices that are struggling with their energy costs, which have gone up three times in recent months. There are lots of promises and no action.

There is a cost to meeting the NHS pay settlement. There is a cost to ensuring that hospices are paid properly so that they can pay their staff, keep them, and recruit them in the first place, and so that they can pay their energy bills. But the cost of not doing that is far greater, not only in terms of the health damage and people’s pain and suffering, but for the hospitals that have to pick up the pieces when hospices are not able to meet people’s needs.

[Caroline Nokes (in the Chair)]

Because one speaker has dropped out, I am going to increase the time limit back to three minutes.

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[Jim Shannon (Strangford) (DUP)]

This is one of those occasions when being called last means I gain a minute, so I am pleased to have the opportunity to do just that—thank you, Ms Nokes. I thank the hon. Member for Eastleigh (Paul Holmes) for setting the scene so well, and for giving us the chance to participate in a debate that moves us all. Some Members have told very personal stories.

I put on the record my thanks to all the charities, groups and staff who give hospice care, and give families, and us in this House, so much across this great United Kingdom. Our NHS is under immense strain, and we completely understand that there is a finite budget, but questions have to be asked about the use of funds when we look at those at the end of their lives living in conditions that are not acceptable. Rising costs from energy, food prices and staff costs, which are required to meet expected NHS pay rises, mean that hospices across the United Kingdom of Great Britain and Northern Ireland are collectively budgeting for a massive deficit of £186 million this year. Unless we are going to understaff, under-feed, under-medicate or under-heat our dying patients, more money is needed—that is the bottom line.

It is always a pleasure to see the Minister in her place. She grasps the situation very well. She is a lady well known for her compassion and understanding, and I look forward to her response. I agree with Hospice UK, which says that hospices need financial support to continue to offer their essential services. Government funding of £30 million for UK hospices to offset the increased cost of energy bills in the year ahead needs to go beyond the energy bills discount scheme. Additional funding for hospices from the Department of Health in Northern Ireland is also needed; I do not know whether the Minister has had a chance to consider that. The fact is that funding for hospice care is unsustainable. By the end of the year, 86% of hospices will be impacted by increasing energy prices. They need to keep medical machines running and their in-patient units warm for those in their care. Some 71% of hospice expenditure is on staff, which is a massive issue. As I referred to in an intervention, charities and volunteers run 66% of adult hospices and 80% of children’s hospices.

Over the next few years, I and others, as we often do, will help those hospices. Marie Curie, based in Knock Road in Belfast, is a hospice that I have visited to see people who have now passed away. I understand what such hospices do. The facts are clear: savings can always be made with improvements, but on nowhere near the scale that is needed. I therefore believe, with respect, that the Government and the Minister must man the breach. We regularly prioritise human rights in other nations, and the most basic right to a good death must be prioritised in the United Kingdom. That is what we want. It is a very simple request, and I hope the Minister can answer in a positive fashion.

[Caroline Nokes (in the Chair)]

That brings us to our Front Benchers. I call Patrick Grady.

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[Abena Oppong-Asare (Erith and Thamesmead) (Lab)]

I thank the shadow Minister for giving way. I completely agree with the points she has raised. I thank the hon. Member for Eastleigh (Paul Holmes) for bringing the debate forward and for sharing his personal story, as have others in this room. It is not easy to share those stories, but it is important that we do.

I have seen first hand how hospices play a vital role in communities. They go over and beyond, and are truly heroic. I am patron of Greenwich and Bexley Community Hospice in my constituency; I have seen how they provide compassionate end of life care. Does my hon. Friend agree that it is vital that the Government recognise the issues hospices face, particularly during the pandemic and with the cost of living crisis?

[Caroline Nokes (in the Chair)]

Order. I remind the Member that interventions should be short.

[Liz Kendall]

I absolutely agree with my hon. Friend and will come on to many of the points she raises.

I want to touch on about five issues, as part of shifting us to a different position on how we ensure people have a good death in the 21st century. The first issue, which I hope the Minister will comment on, and which all right hon. and hon. Members have spoken about, is the real need to review how hospices in England are funded, so that this absolutely critical sector has certainty and security in the months and years ahead. That was a key recommendation of the all-party parliamentary group for hospice and end of life care.

Many Members have spoken about the huge financial pressures on hospices: food prices, energy costs, the costs of NHS pay settlements. As Sue Ryder says, most hospices have seen a 10% increase in their costs, but only a 1% increase and in some cases no increase at all in NHS funding from integrated care boards, creating a perfect storm. ICBs have a statutory requirement to meet palliative care and end of life needs of their populations, but where is the funding? I hope the Minister will say whether the Government will institute the review because, without that, we will not have security for the future.

My second point, which has not been discussed in this debate but which I care passionately about—I would like to hear the Minister say something about this—is inequalities in access to hospice, end of life and palliative care. We know from the Parliamentary Office of Science and Technology that the pandemic exacerbated inequalities in accessing good palliative and end of life care for minority ethnic groups, and there are also socio-economic inequalities in access to hospice care. We know from Sue Ryder that there are also inequalities in access to bereavement support. We want to see everybody have fair access. Will the Minister say something about that?

The third issue relates to help to die at home, something I have campaigned on for many years as a Member of Parliament. There are still at least 10,000 people a year dying in hospital when they want the choice of dying at home. They are not getting the fast track NHS continuing healthcare support that they are supposed to get within 48 hours so that they can die at home. Our brilliant hospices have all sorts of support that they want to give, so I ask the Minister: why is that still a problem and what are we doing about it?

My next issue, which has been raised by many Members, concerns children’s hospices. Rainbows, the sole children’s hospice in the east midlands, wrote to me to express its concern about the children’s hospice grant potentially being wound up. As recently as 22 May, the Government replied to a written question:

“Funding arrangements for children’s hospices beyond 2023/24 have not yet been agreed.”

We cannot have children’s hospices not knowing what is happening to their grants. We have to be able plan ahead better.

Fourthly is something that my hospice, LOROS, has raised with me, but also lots of care homes. Bear with me on this. Many care homes are now essentially providing a lot of end of life care because the level of need that people have when they go into a care home is so great that that is what they need. But the staff might not be properly trained, and LOROS has said that it could work with care homes to make sure the staff are trained. That is one specific ask, so perhaps the Minister could meet me and LOROS to look at what hospices could do to better support our care homes.

Last but by no means least is workforce shortages. Sue Ryder stated:

“The Government must plan for the workforce as a whole system across health and social care”

and charitable providers. That is really important. We have to stop seeing all those different bits of the system as separate. We Labour Members have set out our plans for the biggest expansion in the NHS workforce’s history and for fair pay agreements and for social care staff. We urgently need to see the Government’s workforce plan, and I would like to see that covering all the issues.

In conclusion, we have heard today about the manifold pressures on hospices. I do not think I have ever been in a debate where so many Members have spoken so powerfully and positively about a part of the health and care system and what it does. It shows the strength of feeling and support, but I ask everyone here to think about how we as a Parliament can put achieving a good death as a big thing that we can make progress on and continue this campaign in future. I look forward to hearing the Minister’s comments.

World AIDS Day

Caroline Nokes Excerpts

Thursday 1st December 2022 Commons Chamber

[Lloyd Russell-Moyle]

I agree exactly. I will come on to the Global Fund at the very end of my speech, but let me move on now to the picture globally, which I am afraid is totally different.

Back in 2018, I said that

“one young person every day is still diagnosed with HIV and young people continue to suffer some of the worst sexual health outcomes.”—[Official Report, 29 November 2018; Vol. 650, c. 496.]

The situation globally has become bleaker. Last year, an adolescent girl or young woman was newly infected with HIV every two minutes. In the past year alone, 650,000 people have died of AIDS-related illnesses and 1.5 million people became infected with HIV. Only half of children living with HIV have access to life-saving medication. Inequality between children and adults in HIV treatment coverage is increasing rather than narrowing.

Why are people still dying unnecessarily of AIDS? Why are there so many new HIV infections year after year, globally? It is too easy to put the blame on current crises such as covid and war; the reality is that we were already off target before many of those crises hit. The lack of a comprehensive healthcare system, a lack of education and the growing influence of evangelical Christian churches in Africa—often American-backed—have led to an environment that is hostile to an effective HIV response.

Uganda was the first country to host the world AIDS summit—it was a revolutionary leader. The same President is in power now, but has completely rolled things back. When Uganda hosted the world AIDS conference almost 30 years ago, condoms were given to every delegate and given out into community settings. When I went to Uganda only a few years ago to visit aid projects that we were paying for, I sat at the back of a classroom with Stephen Twigg, the then Chair of the Select Committee on International Development. We heard a teacher tell children that they could prevent AIDS if they washed the toilet seat and observed “sex only after marriage”. I am afraid that things have gone backwards because of the influence of some malign groups. It is concerning.

One of the inequalities standing in the way of ending AIDS is access to education, particularly for young girls. Six in seven new HIV infections among adolescents in sub-Saharan Africa occur among girls who are outside formal education. Enabling girls to stay in school until they complete secondary education reduces their vulnerability to HIV by more than 50%. All children, including those who have dropped out because of covid and those who were out of school anyway, should get a complete secondary education, including comprehensive sex education.

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

The hon. Gentleman makes such an important point. Does he agree that we cannot shy away from talking about sexual and reproductive health in the developing world, because that is the single most effective way to ensure that girls stay in school, stay not pregnant and stay free from diseases that will affect them in future? It is crucial that in our role as providers of international aid we do not step back from programmes that talk about contraception.

[Lloyd Russell-Moyle]

I totally agree. As dark forces around the world try, I am afraid, to withdraw money from programmes that talk in a rational and evidence-based way about sex and reproductive rights, we have a greater responsibility. We must step up, because if we do not, others will not. As the right hon. Lady points out, there are two sides to the coin: providing better sexual health education means that girls stay in school, and staying in school allows them to get better education about their health. Those are both positive things. Both issues need to be tackled together.

Another inequality standing in the way of ending AIDS is the inequality in the realisation of human rights. Some 68 countries still criminalise gay men. As well as contravening the human rights of LGBT+ people, laws that punish same-sex relations help to sustain stigma and discrimination. Such laws are barriers preventing people from seeking and receiving healthcare for fear of being punished or detained. Repealing them worldwide is vital to the task of working against AIDS.

Of the 68 countries that outlaw homosexuality, 36 are Commonwealth countries. The majority of Commonwealth countries are still upholding laws that we imposed and that never originated in the countries themselves. In fact, before British colonialism—British imperialism, I should say—many of those countries had better customs and practices around homosexuality than they do now. These customs and practices are not native to people’s home countries; they were imposed. They should be discarded with the shackles of imperialism, which we all now recognise was wrong. One in four men in Caribbean countries where homosexuality is criminalised have HIV. Globally, 60% of people with HIV live in Commonwealth countries. Collectively, we have a responsibility to tackle that in the Commonwealth. Barriers undermine the right to health: a right that all people should enjoy.

Beyond the human rights implications, the laws criminalising homosexuality also have an impact on public health. LGBT+ people end up not seeking health services for fear of being prosecuted. Those who do seek health services often have to lie about how they were infected. Astronomically high numbers of people with HIV in Russia say that they were infected because they were drug-injecting users; that is widely believed to be partly because of the attitude in Russia that it is better to be a drug-injecting user than an LGBTQ person. Without accurately knowing the source of infections, we cannot accurately run public health programmes to save people. Putting people undercover in the dark, hidden in corners, means that the virus lives on. That is a danger for us all.

In some countries, people living with HIV are at risk of being criminalised even when they take precautions with their sexual partners. That opens them up to blackmail and fraudulent claims from former partners. People with HIV in the UK are not immune to that either, as we have seen in some high-profile cases. We have known for at least 20 years that antiretroviral therapy reduces HIV transmission, and for the past few years we have known that it stops it completely, so there should be no doubt that a person with sustained undetectable levels of HIV in their blood cannot transmit HIV to their sexual partner, and laws should not punish them. However, under Canadian criminal law, for example, people living with HIV can be charged and prosecuted if they do not inform their partner about their HIV-positive status before having sex. The law does not follow the science, and it puts people at risk.

Laws requiring disclosure perpetuate the stigma against HIV-positive people. With the advent of PrEP and with “Undetectable = untransmittable”, the law should now reflect the fact that everyone has a role in protecting themselves against HIV and everyone must step up. The criminalisation of drug-injecting users and sex workers has an equally negative effect on HIV prevention and treatment, as I have outlined, in LGBT communities. In all these areas, a health and human rights-based approach must be taken if we truly want to see the end of HIV.

Beating pandemics is a political challenge. We can end HIV and AIDS by 2030 in this country, but only if we are bold in our actions and our investments. We need courageous leadership. We need people worldwide to insist that their leaders be courageous. That is why last month it was so disappointing not to see courageous leadership from this Government. The UK Government were the only donor to the Global Fund to Fight AIDS, Tuberculosis and Malaria to cut their financial settlement—by £400 million. The fund asked donors to raise their pledges by 30% this year, and almost all the G7 nations—which are suffering economic problems that are, in many respects, similar to ours; as the Government often remind us, this is a global crisis, not a crisis of their own making, although in our view it is a bit of both—increased their amounts. For decades the UK was the leader in the global response to these infections and diseases, but that is no longer the case. When our allies met the fund’s request for a 30% increase, the UK went for a 30% cut from their 2019 pledge.

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

It is a pleasure to follow the hon. Member for Brighton, Kemptown (Lloyd Russell-Moyle), who speaks with such passion, knowledge and indeed experience. I vividly remember being in the Chamber four years ago when he spoke of his own diagnosis, and of how he had coped with the emotional stress and trauma and the physical challenges. Of course it is always a privilege to follow any Member who speaks with such a depth of knowledge.

I apologise for the fact that my speech will focus almost exclusively on women. As Chair of the Women and Equalities Committee, I am very conscious that some of the people who are diagnosed at the latest stage, and some of those who are afraid of going for a test, are women. It has always been a humbling experience for me, in my role as Chair of the Committee, to meet those women living with HIV who have spoken of the barriers that they felt prevented them from taking a test. That is why I commend the work done by organisations such as the Terrence Higgins Trust and, indeed, the all-party parliamentary group, which has always led the way in trying to break down the stigma associated with testing.

There should be no such stigma. After all, there has been no stigma attached to covid tests over the past two years; and making oneself aware of one’s own HIV status is actually one of the most empowering actions that an individual can take. That is why, as Chair of the Select Committee and indeed before that—I was about to say, “I have never been afraid”, but that is the wrong term to use. I have always been keen to ensure that I use my role to emphasise to others that it is perfectly okay to go and get a test, and it is also much easier to do so nowadays than it used to be.

I was going to say that I had never been afraid, but I vividly recall that Simon Kirby, the hon. Gentleman’s predecessor as Member of Parliament for Brighton, Kemptown, used to arrange in this place, every year, a testing session for Members. I remember Simon telling me, years ago, “Nokesy, you have to go along and get a test”, and I remember rolling my eyes and saying, “I don’t really fancy that.” I was rather terrified of the prospect of going. However, I also remember coming away after the test and thinking, “That was the right thing to do. I now know that I don’t have HIV, so I can relax about that, but I also know how important it is to talk about it.”

I remember, too, the grief that I was given on social media from the ill-educated, ignorant and—to be frank—bigoted people who used that as a stick with which to beat me: “Ooh—why did she need an HIV test?” Why did I need one? First, to know, and secondly, to be a voice for everyone else who felt anxious about getting an HIV test. I wanted to tell them, “There is nothing wrong with it; there is no stigma attached to it; you are doing it for your own wellbeing.” That is why I now act as a champion for all women, telling them how important it is to go and get a test.

The hon. Member for Brighton, Kemptown made a very important point—I dwelt on it a little when I was thinking about what I wanted to say—about the prevalence of online and postal tests. I think that they are great innovations. Earlier this year, however, I received a little package through the post with the message “Give HIV the finger”—which was a wonderful message, but it was hard to get the required amount of blood out of my finger, and I felt slightly concerned about whether it was enough. I thought, “Will this be effective? Who knows?” For me, much of that process was about being photographed proudly holding up the box, having taken an HIV test. However, another part of it was to do with the fact that we need these testing programmes to be effective, we need people to be confident enough to use them, and we need them to be available in all sorts of locations.

That brings me to my next point. We need people to be culturally competent and aware. We know from statistics that a third of the people living with HIV are women, and we know that 25% of the new diagnoses are in women, but we also know of the prevalence of HIV in black African communities. Covid taught us—and I am an absolute advocate of this—that we must learn the lessons of really difficult experiences. We learnt through covid about the importance of speaking to people in languages that they understand, in a way that they can relate to, on the media channels that they instinctively use. It is no good broadcasting our public health messages exclusively on the BBC; we have to find different channels in order to communicate with the audiences who are most at risk, where the prevalence is highest, and where people might not be engaging with the traditional forms of media that you and I, Madam Deputy Speaker, might use. That is a really important message that I would like to give to NHS England and the Department of Health and Social Care. We must keep up the pressure, and talk to communities in which there is high prevalence and where there might be barriers, cultural or otherwise, to getting a test.

I have an important wider point on research. It was crucial that a great deal of the research on HIV and AIDS be done on those who were most likely to be affected by them, so of course, a massive wealth of research has been done on men. I absolutely acknowledge that that was right, but there are knowledge gaps when it comes to women with HIV and which drugs might be most effective for them. There is certainly still a barrier to women accessing PrEP; that is borne out by the numbers. They are simply not using it. We have to understand why that is, and how effective that drug and indeed other HIV drugs may be on women. We have to make sure that the DHSC and NHS England not only have sufficient data, but disaggregate it, so that it can be broken down by gender and ethnicity. Often when I talk about health, I find myself complaining and browbeating others about the lack of data that is relevant exclusively to women, the lack of women coming forward in drug trials, and the lack of research done on women. Those things are true when it comes to HIV.

I turn to what we have been good at. The action plan for HIV talks about the successes on vertical transmission; a tiny number of children are now born with HIV in this country. A big part of that is down to opt-out testing of pregnant women; the take-up has been absolutely enormous. The figures show the result: of the 60 people diagnosed in 2019 who acquired HIV through vertical transmission, only five were born in the UK. That is a huge step forward, and we have done brilliantly on vertical transmission, but it is crucial that we never let up on that, and that we get the message out that effective drugs taken during pregnancy can prevent HIV transmission to a baby. The mother has to be mindful of risks to do with the method of birth, be that natural delivery or via caesarean, and there is a risk factor involved in breastfeeding. All those pieces of information can effectively and easily be communicated to expectant mothers, and they absolutely should and must be.

I am conscious that my knowledge is not as great as that of other Members in the Chamber, so I have deliberately kept my comments relatively brief. We need to keep up the pressure. The hon. Member for Brighton, Kemptown referred to approaching the finish line. When I do anything that involves running, there is definitely a slowdown, usually due to exhaustion, as I approach the finish line, but we cannot afford a slowdown here. We must accelerate to the finish. We can now see a UK without HIV. He made important points about the developing world and the efforts that still need to be made there, but the end is in sight, and it is absolutely crucial that we reach it and see a world that is free of HIV.

World Menopause Day

Caroline Nokes Excerpts

Thursday 27th October 2022 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Hollobone. I pay tribute to the hon. Member for Swansea East (Carolyn Harris), and to my hon. Friend the Member for Lewes (Maria Caulfield), who did so much to ensure that people can get prescriptions for HRT over the counter. I also pay tribute to my hon. Friend the Member for Mid Sussex (Mims Davies), who is here but cannot speak in the debate. In her role as employment Minister, she recognises that the menopause is not simply a health issue; it also affects the economy, employment and women’s wellbeing in later life. I hesitate to use that phrase; I must declare my interest.

I will give the Minister a hard time. Back in July, the Women and Equalities Committee published our “Menopause and the workplace” report. I recognise that he is a Health Minister, but I hope he understands my disappointment that we are still waiting for a Health response to our report. This afternoon, I was sent an email apologising again for the fact that tomorrow the response to that report will be one month late, and telling me to expect the full response in the coming months. It is a very bad plan to tell a menopausal woman to wait for anything. They should not be waiting for their single prescription over 12 months, and we should not be waiting for months for the Government to come up with a response to a very sensible—I would say that—report.

What do I actually want from that response? I want to see flexible working, so I want an employment Bill. That is not the Minister’s responsibility. I want to see a consultation on whether the menopause should be a protected characteristic. That is not the Minister’s responsibility either. I am disappointed, because we should have a cross-Government response to the report.

We should see mandatory workplace policies, with the Department for Business, Energy and Industrial Strategy leading the way to provide that resource to employers, free of charge on its website, as easy as anything. Great organisations such as Henpicked already do that. I was at the Menopause Friendly employers awards last month, and it was absolutely brilliant. Lots of employers have signed up, but why is BEIS not leading the way on that? We want to see the enactment of section 14 of the Equality Act 2010. That will be lost on the Minister; he will not know what I am talking about. I urge him to talk to the Government Equalities Office and at least consider that.

I want to see menopause ambassadors Government. It was great that Maddy McTernan was appointed HRT tsar, but she has returned to vaccines now. I want confidence from the Health Minister, as I have him here today, that Dame Lesley Regan will stay in place as the women’s health ambassador and that there will be a real commitment to the women’s health strategy. I shuddered when we had an “ABCD” of priorities, because I thought, “How long does it take to get to W for women’s health?” That was from the former Health Secretary; I hope the new Health Secretary will reinvigorate the women’s health agenda, and I urge the Minister to encourage him to do so.

I would like to see the Government working with a large-scale public sector employer to trial menopause workplace leave. I hesitate to point this out to the Minister, but it seems to me that the NHS is a large-scale public sector employer with lots of women working in it, so it might be ideal. I also want to see better training for GPs, and I want to know who is supporting our GPs. It is great that the workforce in general practice have been hugely feminised over the last few decades, but those women working in the health service also need support.

I want to champion the local women doing such fantastic work, whether that is Claire Hattrick and Jo Ibbott in Hampshire, or the brilliant GP I met at the Sutton Women’s Centre, where I went to do a menopause event, who was absolutely taking the message out there: “Your menopause can be celebrated and enjoyed, but it also needs to be managed.” For my final shot to the Minister, let us have a national formulary, let us deal with HRT shortages once and for all, and let us ensure that the info is out there for women.

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[Will Quince]

I certainly agree with that. I also want to say thank you in passing to PHS Group; it is important that employers play their part, and it is good to hear about what that organisation is doing. I did some work with it on the period product scheme in a previous role as Minister for Children and Families. We should celebrate companies that are doing the right thing by their employees.

Somebody said that the hon. Member for Swansea East—I will call her my hon. Friend—has a lot to answer for. There is no more effective campaigner in the House of Commons. I recognise the incredible work that she has done in raising awareness of the menopause, which affects millions of women across our United Kingdom. I also thank her for chairing the all-party parliamentary group, which recently published its first report, on menopause support.

It will not have escaped your notice, Mr Hollobone, that I am not my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson). I have stepped in at the last minute, and I wish her well.

The hon. Member for Swansea East said that women are more sceptical and less jubilant. Although I am not the Minister responsible for this policy area or brief, the hon. Lady knows me and knows the issues on which we have campaigned together. She knows that, in me, she has an ally at the Department of Health and Social Care. She referred to men at the football coming to get a selfie with her. I think I speak for all men in the Chamber when I say that I would be honoured to have a selfie with her. In seriousness, I was moved by the stories that she and others told of the impact of the menopause on women in the workplace. In bringing about the change that we all want to see, she has an ally in me. That change is an issue not just for the Department of Health and Social Care but for BEIS. I have heard that loud and clear.

I thank my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) for all her work as Chair of the Women and Equalities Committee. Its recent report, “Menopause and the workplace”, to which she referred, demonstrates the significance of the topic to the House. I know that my hon. Friend the Member for Sleaford and North Hykeham has written, albeit today, to my right hon. Friend to explain that we are carefully considering the Committee’s recommendations. We will respond in due course, and I will ensure that that happens—I will chase it up today. I will also speak with BEIS and the Government Equalities Office about the issues my right hon. Friend raised.

I thank all Members who have spoken, whether on behalf of themselves or their constituents, to mark World Menopause Day. It is important to say that 51% of our population will experience the menopause. There is no question but that the stigmatisation of this important part of life must end. That begins with us talking more openly about the symptoms and the treatment and support available. Vitally, when women talk, we have to listen.

I would like to update the House on the Government’s important work in this area and to reflect on how far we have come and the distance we still have to go, and I will respond to as many of the points raised by hon. Members as I can. For too long, women’s experiences of menopause support have not been good enough. That was the clear message from our call for evidence on the women’s health strategy last year. The menopause was the third most selected topic for inclusion in the strategy. It was chosen by 48% of nearly 100,000 individual respondents.

During last year’s debate on World Menopause Day, the Government committed to listening and to making menopause a priority for our women’s health strategy. I am delighted that the first ever women’s health strategy for England has been published. It contains our 10-year ambitions and the immediate actions we are taking to improve the health and wellbeing of women and girls across our country, from adolescents through to older age. It details an ambitious programme of work to improve menopause care.

It is important to stress that we are not implementing the strategy alone. As I think was said already, we appointed Professor Dame Lesley Regan as the first women’s health ambassador. The hon. Member for Swansea East and I have worked with her on both baby loss and maternal health. She is an expert, and she will do an amazing job as the first women’s health ambassador for England. She will help us to raise the profile of women’s health and break down harmful taboos. I have no doubt that she will bring a range of voices to help us implement the strategy and deliver on our commitments.

Numerous Members raised healthcare support. I bring to the House’s attention the NHS England national menopause care improvement programme, which is improving clinical menopause care in England and reducing disparities in access to treatment. That important work sits alongside a menopause education and training package that the NHS is developing for healthcare professionals.

I turn to the important point of raising awareness. My right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom) said that we know more about Viagra than about the menopause, and she may well be right. Awareness is vital to tackling the stigma around the menopause. We want everyone in this country to be educated about the menopause from an early age. All women going through the menopause and perimenopause should be able to recognise the symptoms and know their options. We are transforming the NHS website into a world-class first port of call for women’s health and have recently updated the menopause page.

As my hon. Friend the Member for North Devon (Selaine Saxby) rightly pointed out, we should educate the next generation of boys and girls to help break taboos and ensure that children growing up today can speak about the menopause openly. Menopause is included—I know this as a former schools Minister—in the statutory relationships, sex and health education curriculum, and we are working across Government to understand women’s health topics that teachers feel less confident about to provide further support.

The hon. Member for Enfield North (Feryal Clark) raised the issue of HRT supply. Although most HRT products remain in good supply, various factors, including increased demand, have led to supply issues with a limited number of products. That has improved significantly recently, and we have been working hard to ensure that women can access the treatment they need. We are implementing the recommendations of the HRT supply taskforce and continuing to use serious shortage protocols where appropriate. We keep that under close review.

The hon. Members for Swansea East and for Enfield North and my right hon. Friend the Member for South Northamptonshire mentioned the cost of HRT—an incredibly important issue. We are committed to reducing the cost of HRT prescriptions through a bespoke prepayment certificate for HRT, which we will introduce from April 2023, subject—here is the caveat—to the necessary consultation with professional bodies. The hon. Member for Swansea East asked me for a cast-iron guarantee, but she knows that I do not make promises that I cannot keep. I am not the Minister responsible, but I do know and firmly believe that politics is the art of the possible, and as long as I am a Minister of State at the Department of Health and Social Care I will ensure that the Department’s feet are held to the fire to deliver on that April 2023 ambition. It is taking longer than any of us would like because we have developed an entirely new system, and we have to create an implementation programme as well.

[Caroline Nokes]

I am not sure that what we have heard is entirely consistent. The Minister, who I know will work hard on this, indicated that there still needed to be a consultation with professional bodies, but he then indicated that the delay was in bringing forward a whole new technical system. Can he clarify that point?

[Will Quince]

My right hon. Friend is right to push me on that point. The reason for any potential delay would only be around the consultation that we would need to have. The delay—as in why we could not have done it before April 2023—is because we needed to design a whole new system. We are confident that that will be okay for April 2023. I am caveating it only because I am not the Minister responsible, and I try wherever possible not to make promises that I definitely cannot deliver on. I will not be the Minister delivering on this, but I have no doubt that the Minister who will be responsible will be able to update my right hon. Friend in due course.

Importantly, numerous Members mentioned menopause in the workplace, and, as I mentioned earlier, there were some very difficult stories. As a former Department for Work and Pensions Minister, I know the impact that that has on individuals who want to go to work and on employers, so we have to tackle that. This summer the Government responded to the independent, Government-commissioned report into menopause in the workplace, and we committed to working with a range of stakeholders to consider what more we can do. That will include an employer-led, Government-backed communications campaign on menopause in the workplace.

My right hon. Friend the Member for Romsey and Southampton North mentioned the civil service and the NHS. They are two of the biggest employers and they have signed Wellbeing of Women’s menopause workplace pledge, which is a public commitment to making our organisations a supportive and understanding place for employees going through the menopause. I encourage all other employers to do the same.

Hon. Members also referenced an employment Bill. Again, that is a promise that I cannot make because it does not fall under the remit of the Department of Health and Social Care. Nevertheless, I will have that conversation with my counterpart at BEIS.

I want to ensure that the hon. Member for Swansea East has plenty of time to sum up, so I will conclude by thanking all right hon. and hon. Members for their contributions to this important debate and for their dedicated work across Parliament to improve the experiences of women in this country going through the menopause. As I said, they have an ally in me at the Department of Health and Social Care. I am glad that we have had the opportunity to discuss this hugely important topic and that I have had the opportunity to update the House on the work under way. It is vital that this conversation continues.

Super Health Hub in Plymouth City Centre

Caroline Nokes Excerpts

Tuesday 25th October 2022 Westminster Hall

[Caroline Nokes (in the Chair)]

I will call Luke Pollard to move the motion and then call the Minister to respond. There will not be an opportunity for the Member in charge to wind up; that is the convention for 30-minute debates.

[Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)]

I beg to move,

That this House has considered Government support for a potential super health hub in Plymouth city centre.

It is good to see you in the Chair today, Ms Nokes. Plymouth’s NHS is in crisis. Our brilliant NHS and social care staff are working their socks off. The health crisis is not their fault. Things in Plymouth are getting worse, with severe ambulance waiting times, a critical shortage of hospital beds at Derriford Hospital, a social care system in crisis, a shortage of GPs and gaps across our NHS that we simply cannot fill, and we have dentistry waiting lists that last for years. I am here today to deliver a very simple cross-party appeal from Plymouth for the funding we need to build a super health hub, or Cavell centre, in Plymouth city centre.

I know the Minister is familiar with what a super health hub is, but the genesis of the project is important to understand as it shows Plymouth’s health services and our political parties all working together to deliver something truly transformational for our city. The super health hub project is one that I have been associated with for many years. In October 2018, I proposed that Plymouth should build on the success of the network of health hubs across the city with a super health hub in the city centre, repurposing one part of our city centre and bringing health to the high street. That was in response to GP practices, including the one that I was registered at, handing back their contracts and closing.

The proposal was swiftly adopted and advanced by Plymouth City Council and then ultimately rolled into the nationwide Cavell centre programme. Both Conservative and Labour-run councils in Plymouth recognised the importance of the scheme, which enjoys considerable and locked-in cross-party support. The project goes by many names—the super health hub, the West End health hub, the Cavell centre. They are all different names for the same pioneering development.

The Minister will know that the Cavell centre’s programme, developed by the NHS, has six sites under consideration nationwide, of which Plymouth is by far the furthest advanced. Although it was not funded in the comprehensive spending review, the Plymouth Cavell centre project advanced thanks to financial reassurances from the NHS about using capital underspends elsewhere in the national budget. I am sorry to report that the promised funding is no longer available and the project is now at risk. The Minister confirmed to me about the funding last week. So my job today is simple: to ask the Minister to restore or find from elsewhere the £41 million NHS funding that we need for Plymouth to build the super health hub.

Plymouth’s primary care crisis is acute. In 2019, the BBC’s “Panorama” programme showed the severe problems that staff face at the North Road West medical centre: GP vacancies unable to be filled, severe illness and far too few staff. The practice was due to move into the new super health hub—the West End health hub—into modern facilities, and that is now at risk.

Hiring a GP in Plymouth is almost impossible, especially for the practices in the most deprived areas. We are moving at pace to move to paramedic and senior nurse-led practices, because there are simply no doctors available to provide the healthcare that they might provide elsewhere. As a city, we are innovative and creative because we have to be. One third of Plymouth’s population is currently covered by GP practices with emergency standing contracts, but as more GP surgeries close in our communities and practices hand back their contracts, we need an alternative long-term and large-scale intervention. That is what the super health hub, the Cavell centre project, delivers in buckets.

The new super health hub would provide a number of considerable health benefits. At least three GP surgeries in substandard accommodation, currently with large lists of patients—North Road West medical centre, Adelaide surgery and Armada surgery—would relocate to larger premises where they could see more patients. There would be space for 24/7 out-of-hours GP surgeries and pharmacy and X-ray facilities, enabling earlier diagnosis and better management of conditions, such as weight management, smoking cessation, district and practice nursing facilities, physiotherapy and occupational therapy space, mental health services, drug and alcohol treatment, and nutrition. Importantly, alongside that would be advice and information services, debt assistance and housing support, and access to training and employment, volunteer support, social care and prevention services, all under one roof with a single entrance. People would not have to travel miles and miles and fork out for buses or taxis to see someone who can help. In short, the super health hub in Plymouth is about giving people better chances to live longer, healthier and happier.

The benefit that the super health hub would bring to the area cannot be underestimated. The super health hub is to be built on Colin Campbell Court car park, in Stonehouse. Stonehouse is a community with extreme levels of poverty and deprivation. It is an area full of life and full of good people, but the economic and social picture is challenging and the cost of living crisis is making it worse. Stonehouse is in the bottom 0.2% of communities for super output in the entire country, and in the bottom 1% for nearly every other major economic indicator.

Life expectancy in that community is a full 7.5 years lower than the national average; health outcomes are poorer; cardiovascular and heart disease are found in younger people than elsewhere. A third of our private rented homes are classed as non-decent in that community, school grades are a third lower than the city average, and crime is a considerable scourge. Health problems are exacerbated by poverty. This community is responsible for approximately 20% of Derriford Hospital’s emergency admissions. I say this not to talk Stonehouse down but to make the case that this is a community worthy of investment, priority and attention.

The Cavell centre’s focus on early prevention and good healthcare is key not only to dealing with the health inequalities that we have face as a city but to cutting the ambulance queues at Derriford hospital. At this very moment, nearly 20 ambulances are queuing outside our hospital. Derriford has the fourth worst record in the country for ambulance queues. The pressure on our emergency department is critical. Staff there do an extraordinary job, but we need to find ways of reducing the number of people going to the hospital—not just building better facilities at the hospital but reducing the flow.

As more surgeries and dentists close in our community, the case for a super health hub—a centrally located facility—is more profound and powerful than ever. Bringing health to the high street really helps: it repurposes the city centre with the creation of a new health village, with the super health hub at its heart. Plymouth city centre is a very large, post-war city centre serving a population that has found new ways to shop, so we need to repurpose many of the empty buildings. The Colin Campbell Court part of town is an area that could do with a bit more love. It would not only regenerate a part of our city centre but would create more local jobs and, importantly, healthcare accessible to local people. Every bus in Plymouth goes to the city centre—it is not just about supporting people in Stonehouse; it would support people right across our city to access first-class healthcare services.

We have had some mixed messaging from the NHS about this project. It is well regarded and supported. One part of the national health service believes that the £41 million of capital funding would be available for the project. However, it now seems apparent that the intention to make that funding available is no longer present. I thank the Minister for investigating the funding options and speaking to me and my neighbour, the hon. Member for South West Devon (Sir Gary Streeter), so frequently. This issue matters right across Plymouth. A predecessor of the Minister, the right hon. Member for Charnwood (Edward Argar), has also been very helpful. I encourage the Minister to continue being helpful as we look at the options to ensure that we can build a super health hub in Plymouth.

There is considerable support for this project from our local NHS infrastructure, the NHS system and the city as a whole: from the primary care sector to the acute hospital at Derriford; Livewell, our health social enterprise; NHS England; the University of Plymouth; Nudge Community Builders; our local councillors of every party; and our integrated care commission. The project is well supported. But the Minister knows that the capital funding does not exist in the Devon healthcare system to deliver the project without Government support. Without the spending commitment being honoured, the plans for the super health hub in Plymouth will not be able to proceed. The intention was that spades would be in the ground in the new year, once demolition of the site was complete. At this very moment in Plymouth, JCBs are knocking down buildings surrounding the Colin Campbell Court car park in preparation for construction to begin in the early new year.

The business case for the super health hub has been praised locally and regionally, and is supported nationally, but it cannot proceed unless the funding can be allocated within an NHS budget. Because the hub does not neatly fit into an NHS line item, there was always going to be a challenge of sweeping up underspent capital funding from other projects, but being able to do so was the route whereby we could construct this project, as a trail- blazer for the country.

I would like to propose the three ways to proceed that could rescue this project. First, I ask the Minister to look again at the capital underspends across the NHS to see whether a combined effort with our local NHS groups’ funding could deliver this project as a national pilot for a Cavell centre roll-out in every town and city in the country. I would like a research and evaluation project to be attached to this project, so that when it is rolled out the expected massive benefits can be calculated, valued and understood.

Secondly, the Minister knows that so many of the so-called new hospitals are exceeding the spending envelope that has been allocated for them, so that without huge extra sums being allocated to many of the 40 new hospitals, they simply will not be able to proceed. Extra funding is very unlikely given the state of the national finances, but there is a way through. Will the Minister consider whether as part of the Government’s new hospitals programme, funding could be allocated to the Cavell centre programme, delivering a new fleet of pocket hospitals or health hubs before the next general election? It would use only a fraction of the allocated capital budget for the so-called new hospitals.

Work at Derriford’s new emergency department extension starts in the new year. That is because as a city we were further ahead in wanting to invest in our NHS facilities, before the Cavell centre and new hospital programmes were even invented. I encourage the Government to not punish us for being innovative early. I do not mean to do the Government’s PR for them, but I suggest that the super health hub could be the Tesco Express of new hospitals, with everything people need on a regular basis, while still allowing for a big shop at a larger store on an irregular basis. There would be GPs, nurses, physios, diagnostics, X-rays and prevention services on the high street, with the emergency cases, complex treatment and scans at larger hospitals, thus taking pressure off the acute hospitals and ensuring that healthcare is more accessible.

The super health hub is precisely what Dr Claire Fuller’s stocktake of primary care recommends in many ways. The Minister will know that report’s vision for integrating primary care and improving access, with more personalised care available locally to the individuals. The integrated offer is powerful. More importantly, it is more cost-effective than the distributed model we have today, which is failing. It also gives patients more of what they want—more same-day services, less travelling and greater continuity of care—not to mention the expected boost for recruitment and retention of GPs and medical staff in more integrated and better facilities.

The Cavell centre in Plymouth would deliver these objectives, the Government’s own objectives and so much more. That is why I am here to ask for a rethink on the funding—not just to help Plymouth, but to provide a national pilot that the Government could champion nationwide. The building’s design is already set, and it is common across all six Cavell centres across the country. Why not replicate that model elsewhere as well? These pocket hospitals could revolutionise primary and social care.

To raise an issue that is closer to home, we need to be bolder about reimagining our high streets. I have heard the Minister in a previous role talk about the need to put health on the high street and have more innovative city centre and high street models. That is precisely what the Cavell centre model could deliver. I would like to see the Cavell centre in Plymouth be part of a new Plymouth health village, attaching to Plymouth not just a super health hub, but a dental development centre and community diagnostics hubs. It would be a new destination for healthcare. That would not just be for Plymouth; it would be a model for elsewhere. Importantly, that would take pressure off Derriford Hospital, allowing it to breathe and ensuring a better flow through the hospital, which is what we need. While the super health hub project is on pause until we find the funding, can the Minister give reassurances that the other ambitions for the health village—the dental development centre and the community diagnostics hub—will not be sidelined as part of that integrated plan?

If the Minister is looking for shovel-ready projects that demonstrate the Government’s commitment to addressing ambulance times, backlogs, care, doctors and dentistry, this project would be an excellent way of delivering it and, importantly, delivering it quickly. The Minister needs to know that, although I am making the case for this project as a Labour MP, it enjoys cross-party support. Richard Bingley, the Conservative leader of Plymouth City Council, said:

“The Super Health Hub will critically reduce demand on Derriford Hospital and is a key development in addressing some of the vast health inequalities in the area.”

Labour’s Councillor Mary Aspinall said:

“I am absolutely shocked that the rug is being pulled from under this huge investment in our city which would provide about 3,000 appointments a day and employ 250 staff and we will fight for it tooth and nail. People in Plymouth do not deserve to be treated this way.”

I thank all the NHS staff who have been working so hard on the project, not just in Plymouth but in the regional NHS and the national Cavell centre programme. I know the work that they are doing. I will be grateful if the Minister looks again at where £41 million could be found to support our work. For many people, today is the day they learned that that £41 million has been lost. Work was expected to start in just a few weeks’ time, and the news will be a gut punch for many of our GP services, which were hoping to move out of dilapidated premises and into the super health hub. It will be a real dent to our confidence. We know that the problems in primary care will worsen over the winter, and for many people, this was our hope that better days would be ahead.

Such is the strength of feeling that I alone cannot hope to do justice to the case for the super health hub. Will the Minister therefore commit to visit Plymouth and hold a cross-party multi-stakeholder roundtable, so he can hear about the real benefits that the hub would bring to our community? It would be not only a nation-leading project for Plymouth but a trailblazer for healthcare in the rest of Britain.

Menopause

Caroline Nokes Excerpts

Thursday 9th June 2022 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Robertson, and, dare I say—I do not wish to be rude—an even greater pleasure to follow the hon. Member for Swansea East (Carolyn Harris), who has been such a champion on this issue.

As I said at an event earlier this week, having got to the grand old age of nearly 50, I am now a woman in a hurry. I do not feel as if I have an awful lot of time left to effect real change and I have got to the point with the menopause where I am determined that we see change, and we see change quickly. I think it is an age thing, but I have turned into a woman in a hurry. I want there to be change, support and help for women.

Over the last 12 years in this place, one thing I have learned—apologies, Mr Robertson—is that women do things differently in Parliament. We have become very pragmatic. We look at the solutions and the answers, not at the problems and the ideologies. There is no political ideology around the menopause; we just want it sorted, and as quickly as possible. That is why it has always been a huge privilege to work in tandem with the hon. Member for Swansea East. She and I come from different parts of the country and different political persuasions, but we have both recognised a problem that just needs solving.

Women across the country do things pragmatically. We heard from the hon. Member for Swansea East about different support groups, and it really struck me that women, usually of a certain age, come together to provide each other with support, advice, hints and tips about how to get through the menopause. We have all done it in this place, and turned to someone who may be a little bit older or wiser than us to ask them for advice. Last October, I gave up a weekend away. Fridays tend to be precious to Members of Parliament, and none of us likes being in here for private Members’ Bills on a Friday, but occasionally a private Member’s Bill comes along and one thinks, “That is worth it. That is where I will be this Friday. Instead of going away for a nice weekend, I will be in Parliament to make sure that we effect real change.”

On that day, I sat and I listened to a speaker from the other side of the House who cannot be here today because, absolutely fabulously, she is on maternity leave; that speaker was the hon. Member for Leicester West (Liz Kendall), who spoke about her own menopause symptoms. It took real bravery and courage for her to stand up in a packed Chamber of the House of Commons and start listing off all the weird and wonderful symptoms she was suffering. She identified anxiety, sleeplessness and night sweats, and I sat there thinking, “I get that. Yes, I get that. Yes, I get that too.”

I then trotted downstairs and found Dr Louise Newson sitting in Portcullis House and said, “The speech by the hon. Member for Leicester West was absolutely fascinating and it made me think that I am suffering from some of those things.” Dr Louise Newson turned to me and said, “Will you please go and get yourself a prescription for HRT?” For me, it was a lightbulb moment that showed that in this place, and indeed outside, people can learn so much from their peers.

I take my hat off to my constituent Jo Ibbott, who runs the naughtily entitled What the Fog? group, which is specifically designed for menopausal women in the Romsey area. Jo is a menopause guru and a fount of advice. She wanted to come and talk to me about the debate initiated by the hon. Member for Leicester West and about the menopause, and instead she found herself sat in Costa Coffee in Romsey giving me advice about what I needed, the importance of body identical HRT and not allowing myself to be fobbed off with anything that was a lesser product. She managed to persuade the Chamber of Commerce in Romsey to bring together a group of employers, and she has held a number of seminars, in the evening, talking to employers in the town about what they can do to support menopausal women.

That brings me to the whole raison d’être of the Women and Equalities Committee over the course of the last year. It feels as if we have been talking about the menopause forever, and I am not going to stand here and trail the recommendations of our report, because it is not yet public but is coming very soon indeed. We have taken evidence from some brilliant and interesting men and women about what we can do to help menopausal women in the workplace. It is not good enough to have policies that sit in filing cabinets gathering dust. They have to be real, living documents that both employers and employees can talk about, so that people can highlight the challenges of their symptoms and be open about them and the flexibilities and changes that might help.

I have spent the last two years trying to find some positives from the pandemic. One of the positives we have learned is that, while flexible working can be a benefit to everyone, it can particularly work for women. I get terribly cross when male employers say that it has been great for women in the workforce. It has been great for everyone—men as well—and particularly for people suffering from hot flushes, anxiety or sleeplessness. We all know how debilitating insomnia can be. Flexible working could be something that helps menopausal women stay in the workplace.

Standard Chartered and the Fawcett Society have done research on this. They learned that 50% of women do not take on additional responsibilities at work if they are going through menopausal symptoms. I scratched my head and thought, “What does that mean?” It means that they do not take promotions, which means they have less income, which means that they make smaller pension contributions. The menopause does not just affect women physically; it affects them financially, because those promotions are gone.

We know that 25% of women consider leaving work altogether. That is not just an additional income forgone. It is their whole income and whole pension contribution forgone. Is it any wonder that we suffer from a gender pensions gap when over a million women have left the workplace because of the menopause and many more have been forced to take career breaks? That brings me on to some of the wider governmental issues.

I am not going to copy the speech of the hon. Member for Swansea East. Members will have noticed me tearing up pages of my speech, because she covered the issues I wanted to speak about. There is a whole Government challenge around the menopause. I desperately want to see the Department for Work and Pensions and the Department for Business, Energy and Industrial Strategy working hand in hand. It is crucial that if somebody is lost from the workplace, there are routes back into it. It is important that work coaches are given support and training so that they understand what the challenges may be for women in their late 40s and early 50s returning to work.

The menopause can give people anxiety, so it is about restoring confidence and giving people the belief in themselves to be able to take on new challenges. Perhaps we need to be looking at retraining programmes that are gendered. I get terribly cross from time to time with the employment Minister, my hon. Friend the Member for Mid Sussex (Mims Davies), who tells me that she must look at employment policies in the round. We have lost a million women going through the menopause from the jobs market. How can we get them back? What additional training and programmes might be put in place in order to achieve that?

We heard yesterday from the Minister for Children and Families, my hon. Friend the Member for Colchester (Will Quince), about the work being done in schools and the statutory nature of what I refer to as PSHE and what he refers to as RSHE. It is crucial that we focus not just on building resilient young people and teaching them how not to get pregnant, how to respect each other and about their own bodies; we do have to have to those conversations, but there will come a time in every girl’s life when they will not be able to get pregnant any more. How will it impact them?

I got to the age of 49 without knowing the slightest thing about the menopause. I have managed to turn myself over the course of the last year into something of an expert. We do not educate children and young women enough about the changes that the menopause will bring to their body and how important it is that they have knowledge and the ability and confidence to talk about it, whether it be with their employer, family or friends.

We heard moving evidence during the course of the Select Committee’s inquiry. It would be unfair to stand here and reel off a great long list; Members would get bored by me, but I do want to highlight some particular challenges. No two women will experience the menopause in the same way. Yes, of course, there will be many similarities, but it is different for each woman. I would particularly like to highlight these challenges for the sake of younger women, for those who might be going through a surgical menopause and for those who go through very early menopause. It can suddenly be very debilitating and feel completely out of kilter with their age and the experience of their peer group. We have to realise that those women need particular assistance.

There are other groups. We heard evidence from a fantastic woman called Karen Arthur, who set up the organisation Menopause Whilst Black. I was being very bad that day and did not take part in a Division that was happening in the House. Instead, I snuck out into the corridor to talk to her about her personal experience. My goodness—she was the most incredibly inspirational and motivating woman. It is true not only that different ethnicities experience the menopause differently but that there are different cultural expectations. It may well be harder for those people to talk to their friends and family about it, and we have to keep breaking down those stigmas.

We heard from representatives from the police service and the ambulance service. I personally picked up the phone to one of the Justice Ministers and begged them to allow the Davina documentary into a prison to talk about the work that was being done not only with inmates but with staff going through the menopause. Every organisation, large or small, has menopausal women in its workforce.

I have been bowled over by the constituents who email or phone me to thank me for doing this, including Simon Parkes, who runs a tiny company in Romsey. Sometimes people say to me, “Will you please stop banging on about the menopause?”, but he rang me up to say, “Will you please keep talking about the menopause?” He has very few female employees, but he said that suddenly the penny dropped about what was going on with his wife and what the challenge was with staff members. We have to be able to talk about this and give women in the workforce the support they need.

There were some shocking, sad, awful stories too. I was stunned by how many people wanted their evidence kept confidential. I was struck by an email from the female human resources director of a major blue chip company, who emailed me with her personal story of the menopause and finished by saying, “Please keep this confidential, because I would never want my employers to know what I am going through.” That is the HR director of an organisation who did not want her employers to know what she was going through, so we have a long way to go in beating down the taboo.

I am conscious that I have probably spoken for far too long, but I want to make a final plea to the Minister. These are my asks for the Government. The hon. Member for Swansea East rightly focused on prescriptions and the shortages of some HRT products. The DHSC is working hard to resolve that matter, and I very much welcome the establishment of the taskforce and the appointment of Maddy McTernan. I think we are beginning to see progress on that front, and that gives me hope. It would be wrong of me not to reiterate that we were promised last October that there would be the £18.70 charge for 12 months-worth of prescriptions. I know there are IT challenges and that it is difficult, but please can that be expedited?

I implore BEIS and the DWP to work hand in hand. Why do we still not have an employment Bill that promises flexible working from day one? Why do we not have programmes targeted at retraining women over 45? Why are work coaches not easily able to identify the additional challenges of menopausal women who want to get back into the workforce? I have pointed out the challenges with personal, social, health and economic education and the importance of the Department for Education in ensuring girls are educated about the challenges they will face later in life.

It is really important that we have a women’s health ambassador to champion these issues. I raised that with the Minister just yesterday, and it would be remiss of me not to remind her of it. We need to see that appointment. I want to see somebody in place who is experienced, dedicated and committed, and will be a real champion for women up and down the country on a wide range of issues, but please can menopause be front and centre in that?

--- Later in debate ---

[Nickie Aiken (Cities of London and Westminster) (Con)]

It is a pleasure to serve under your chairmanship, Mr Robertson. I want to start by congratulating my dear friend, the hon. Member for Swansea East (Carolyn Harris), on securing this debate and on all her brilliant work highlighting the importance of speaking about the menopause. I am very proud to be a vice chair of the APPG on menopause, which she chairs. We have done some brilliant work together and will continue to do so. We have finally lifted the lid off the menopause jar—the genie is out of the bottle. I could refer to other sayings, but it is important that finally we are ensuring this is no longer a taboo subject where we whisper, “the change”.

The issue crosses over every demographic—from royalty, including the Countess of Wessex, all the way through. I was fascinated to hear the hon. Member for Swansea East refer to it as a “posh” issue. That is so depressing, but she is absolutely right that some women feel that HRT products and help and support are available only if they are posh and can demand them. She is right that in the cost of living challenge we are now living through, too many women will be putting food on the table for their children rather than spending £18 on the vital HRT products that they need.

I welcomed the Minister and the Secretary of State for Health’s support for the private Member’s Bill promoted by the hon. Member for Swansea East. They agreed to her proposals, but it is disappointing that we have to wait until April 2023, given that there are women in England who are desperately waiting for an annual prescription.

It was interesting to listen to the hon. Member for Belfast South (Claire Hanna). The issue applies to all four nations, and it is a shame that England is still the poor relation of the four. She reminded me of a close friend of mine who lives in Northern Ireland and is a constituent of the hon. Member for Strangford (Jim Shannon). She was telling me a few weeks ago of all the symptoms she had. She had been to her GP in Northern Ireland and he was suggesting antidepressants. I begged her and said, “Please, you are 51. You are going through the menopause. Go back to that GP and demand.” She did, and now she is on HRT. She is an educated woman who has been to university and has a high-profile job, but she still has to beg her GP to take her seriously. That is unacceptable. There is more to do to ensure that GPs across the four nations have the right advice and training.

I want to highlight Pausitivity, an organisation I know very well and whose posters I have previously mentioned in the Chamber. I wrote to the Minister recently and I hope she will respond positively. We need to support Pausitivity’s Know Your Menopause campaign. Its leaflets are a signpost for women and highlight symptoms, so that they can go back to their GPs and demand support and help.

[Caroline Nokes]

My hon. Friend makes an important point about Pausitivity. Claire Hattrick from Hampshire has published a whole book about self-help. There is a brilliant case for the Department of Health and Social Care to consider making small funding streams available to ensure that the work of all those smaller, regional self-help and campaign groups can be disseminated much more widely. All of us have friends, like my hon. Friend’s friend in Northern Ireland, who have not had the confidence, knowledge or expertise to go to their GP and say, “This is what I have got. Please can I have?” We need to spread the information. Perhaps DHSC should look at how it can fund that.

[Nickie Aiken]

My right hon. Friend is absolutely right. I wrote in my letter to the Minister that we need to support organisations such as Pausitivity so that women can use them as a signpost. Its posters are brilliant. They are in Urdu, Punjabi, French, Dutch, German, English and also, as the hon. Member for Swansea East will be delighted to know, Cymraeg. Let us support women from all walks of life, and let us also support families.

This morning I went to talk to a group of year 10 pupils at Pimlico Academy. They asked me what I was doing this afternoon and I said that I would be speaking in the menopause debate. I said, “It is really important that you guys, aged 15—boys and girls—are aware.” I said to the girls, “PMT and periods are tough enough, but you wait: the menopause is something to really know about. You have to know for your mums who are going through it, or are about to go through it, and for your grandmothers and your aunties. It is really important that you know about the menopause so that you can support them and so that you know that when they are screaming at you, there is probably a reason for it. It is not because of you, but because they are probably having a really tough time because they haven’t slept for five days, they feel like they are having an out-of-body experience, they do not feel themselves and then they take that out on their families.” It is really important that husbands, partners, brothers and fathers also understand what women are going through.

We have come a long way. The Government have been listening. I know that the Minister takes a lead on this issue and I absolutely welcome the Government’s real emphasis on it, but we still have issues with a shortage of HRT products. When I went to get my prescription a few months ago, I was told that I could not have my Oestrogel because it is not in supply at the moment. I was really worried. I have one bottle left and am squeezing every single ounce of it. I hope to God that it will be back in when I go back to the GP next week. I urge the Minister to do all she can to make sure that the products get back on the shelves. I fear for my Chief Whip and my Whip if I do not get my HRT product. I am just putting that out there to the Minister—you have been warned.

More seriously, there is so much more that we have to do on education and for businesses. I am extremely proud that this week the Cabinet Office—the Minister was also at this event—became the largest organisation to sign the menopause workplace pledge. More than 1,000 organisations have now done so. That is a start, and it is amazing. The Government are actually taking the lead, but as many have said here today, including my right hon. Friend the Member for Romsey and Southampton North, there is much more that each Government Department can do—like not working in silos. We know that when Governments work in silos, nothing gets done. There has to be a holistic approach. Let us get this done.

It is very important to ensure that women are aware of the symptoms of menopause, but also that they can be symptoms of other conditions. I have recently been diagnosed with hypothyroidism and Hashimoto’s, and the symptoms are very much related to the menopause. Although I may have been going through the menopause, I wonder whether the vast majority of my issues over the past two or three years were because of my thyroid problem. I am now on thyroxine, and it is changing my life, but women need to understand that their symptoms might not just be from the menopause. GPs have to understand that, too. Again, I would like there to be more information and for GPs to have a better understanding of those issues.

To conclude, being in politics can be very difficult. We have so many arguments, and there is so much that can divide us, but women’s health—particularly issues such as the menopause—unites us. We can see Northern Irish, Scottish, Welsh and English MPs here today in support of getting more help for the menopause. That is what makes it great to be a Member of Parliament—we can come together and join forces to ensure that we support women and men in all walks of life. The menopause revolution has only just begun. It is only the start, but I am sure that, working together, we will ensure that women have the products and support they need to carry on with their lives. The menopause is a change. It is the midpoint in our lives. It should never be the end of women’s lives. I feel that I am just beginning my life.

[Jim Shannon (Strangford) (DUP)]

As always, I am thankful to be able to speak on behalf of my constituents. I want to start by congratulating the hon. Member for Swansea East (Carolyn Harris). I have been fortunate in my life to have always been surrounded by powerful women. It was my mother to start with, then my wife, and in the political sphere the hon. Member for Swansea East, who is a really powerful lady. Whenever she asks me to be involved with debates, she is pushing on an open door. She knows I will be more than happy to support her—I always have been.

When the hon. Member for Swansea East started this campaign some time ago, she and I talked about it, and she was very keen to have a man on board. I am very happy to give my support, for a number of reasons. I do it because the request is right: it is about raising awareness. As a man, I do not find these subject matters particularly easy to discuss—it is probably my old-fashioned, traditional nature—but I know that these things happen. It happened to my wife, Sandra. We have been married 35 years. She is an extremely powerful lady. She is very understanding and has stuck with me for 35 years, so I think that tells you all about that lady.

I remember that when we married she had period problems. The doctor she went to see was very good and he said, “Sandra, when you have children, everything will change.” Well, it did not. We had three children fairly quickly in a period of five to six years. We both wanted children. I was very fortunate to get three boys. I think Sandra would have liked a wee girl, but it did not work out that way. Throughout her life, she always had problems with her periods—they were always very heavy—but then she came to the menopause.

I am pleased to speak in this debate and give a man’s point of view. I am giving a husband’s point of view, too, because I understood from the very beginning what the problems were for my wife. It was all the things that the hon. Members for Belfast South (Claire Hanna) and for Guildford (Angela Richardson) referred to: the night sweats, the brain fog, the pain, the agony. She just could not get settled and was always restless. I understood why that change was coming in Sandra’s life. I was not there all the time—perhaps that was better for her, actually—but whenever I was, on those three and a half days a week, I understood that she was having terrible difficulties. We are lucky that the boys have left the house, but the two cats and the dog absolutely dote on her. They do not understand what is happening, but they trot alongside her.

I tell that story because I want the ladies here—the right hon. and hon. Members—to know that I do understand, although I have not experienced it personally. The hon. Member for Belfast South asked what would happen if men could live through this. I tell you what—we would have a different attitude. I have lived through it with my wife, and I think I understand it—I hopefully understand it well.

I have been very pleased to see more businesses and people seeing the benefit of bringing menopause into the light. The civil service has launched a menopause strategy, citing that females account for 50% of the 24,000 Northern Ireland civil service workforce, and that more than 55% of the female employees are over the age of 45, so a significant number of employees are likely to be affected by the menopause. The aim of the policy is to raise awareness and understanding of menopause and outline the support available.

The hon. Member for Belfast South and I, as Northern Ireland MPs, understand this debate from a Northern Ireland perspective, but also because we are active constituency MPs. We understand the importance of having a good workforce who are able to do the work and understand when things are not right.

The hon. Member for Cities of London and Westminster (Nickie Aiken) referred to GPs. I have seen a change—I just whispered this to the hon. Member for Belfast South—in GPs and doctors in my constituency. The hon. Member for Cities of London and Westminster inadvertently, or maybe purposely, referred to her friend from Killinchy. Men have retired and ladies have taken their place, so I hope that means that there will be better understanding. Giving depression and anxiety mediation is the wrong thing to do; HRT should be given. I hope to see those changes. I see them in my doctor’s surgery and in the surgeries and clinics in Newtownards. That seems to be replicated across the whole of the constituency, and I suspect it is happening in other parts of Northern Ireland. The hon. Member for Belfast South, in conversations we have had, has said that women GPs and doctors have to take time out to look after their families. That happens at times, but I see a change coming, with a better understanding, so that in the future we will hopefully not have the problems that we once had in the past.

I referred to the strategy for the 24,000 members of the Northern Ireland civil service workforce, and that comes on the back of the first meeting of the UK-wide menopause taskforce, which has been established to strengthen co-ordination across Government and raise awareness of the impact of menopause, improving care and support for women and ending the taboos and stigmas what still surround a natural part of ageing.

I echo the request that every other Member has made. I am very pleased to see the Minister in her place. I have seen more of her this week than I have seen of my wife—she has been in this Chamber on three or four occasions to respond to debates. She said to me, “You’re back again,” to which I said, “Well, I never leave here.” I am so pleased to see her in her place. I know that she has understanding of the issue and compassion. When the hon. Member for Swansea East was introducing the debate, the Minister was cheering as much the hon. Lady was—that’s the Minister. I look forward to her response.

I am pleased that the taskforce is attempting to lead the way. While I am thankful to all the big businesses that are stepping in to acknowledge this medical issue, my mind turns to those smaller businesses that do not have a human resources department to guide them. I ask the Minister—I do not know whether this is under her control; responsibility might lie with another Minister —what support are the Government offering smaller businesses to help them understand the issues that their workforce are facing, and to support their workforce throughout their journey?

I am very fortunate to have always had powerful women in my life. I have six ladies in my office—apart from me, it is a purely female staff. That sometimes gives me an understanding of what happens in the office among ladies. One of the lovely ladies in my office had a hysterectomy and went through her menopause in her mid-50s. The hon. Member for Cities of London and Westminster referred to the age of 51 in relation to the menopause. I do not miss too much in the office; I usually have a fairly good idea of what is cooking. One of the other girls in the office did a small thing that I think made a big difference. She bought her a wee pink fan—I use the word “wee” all the time; it is a Northern Ireland thing—that sat on her desk and made a psychological difference for her. The girls were telling her, “We know what you are going through.”

[Caroline Nokes]

The hon. Gentleman makes a brilliant point about the small pink fan. Some of the interventions, changes and support measures that employers can put in place are small, cheap, unobtrusive and not difficult.

[Jim Shannon]

The right hon. Lady is absolutely right. As with constituents, the small things that we do are big things in their lives.

At the same time that my staff member had her hysterectomy, one of the younger girls in the office—I have two girls in their early 20s in my office—was going through endometriosis treatment, and her medication pushed her into menopause. It was drastic for a such a young girl, and one who is keen to have children someday— I very often feel for her.

The issue of menopause and perimenopause affects a large amount of the working population. It is great that work has begun to recognise that, but that support should be in every avenue of work, not simply the big companies. Can the Minister therefore give us some indication of what is happening for smaller companies in that regard?

The hon. Members for Cities of London and Westminster and for Belfast South asked about HRT. We would really appreciate an update on the supply of HRT medication. When ladies present themselves to GPs, there needs to be a better understanding of how to respond. In this House we need to ask ourselves how we can come alongside the small business owner to ensure that they are aware of how the small things—as the right hon. Member for Romsey and Southampton North (Caroline Nokes) said—can make a huge difference to the quality of life of their employees, as well as to the environment and productivity in the workplace. It has been said for many years that a contented workforce is a productive workforce, and which of us does not want to understand how to get the best work out of our employees and allow them a decent quality of life?

The hon. Member for Cities of London and Westminster and I must have been speaking to the same script writer. I remember the days when people muttered under their breath, in hushed tones, that someone “must be going through the change.” People almost whispered it—“don’t say it too loudly.” Today’s debate is about saying it loudly, because it is important. That is what the hon. Member for Swansea East has done, right down the line. I admire her courage and determination to make things happen, which is infectious—I come to all her debates and support her in everything she does. I do it because I want to, but also because it is right. This is a debate that is right.

It is time for us not to be ashamed of the menopause or to try to hide it; we should accept that it is a part of life with medical implications. We need appropriate responses in the workplace and appropriate responses from the general public—from men and all those out there who do not understand it. That may be because they do not want to, or because they have a wee bit of trepidation about it. We should give those businesses the opportunity to learn more, and put in place effective policies. That is up to the Departments for Work and Pensions and for Health and Social Care, working in partnership and, respectfully, what I believe we must see.

Again, I am thankful for the opportunity to represent my constituents, and to represent my wife, obviously, since I have first-hand knowledge of how this has affected her. I have always tried very hard to be supportive and understanding. I hope that this will not be another lost opportunity, where words are spoken but no action is taken. To be fair, today’s debate is about actions, and there are people here who drive actions.

I said this in the last debate, and I will say it again:

“Eighty per cent. of women suffer from menopausal symptoms; 100% of women deserve support.”—[Official Report, 21 October 2021; Vol. 701, c. 1023.]

For me, this debate is about every one of those 80% of the ladies, and giving them my 100% support, as everyone else here today does. I look forward to hearing the Minister’s response shortly, and to the participation of my male colleague, the hon. Member for Coatbridge, Chryston and Bellshill (Steven Bonnar).

Smokefree 2030

Caroline Nokes Excerpts

Tuesday 26th April 2022 Westminster Hall

[Bob Blackman]

I thank the hon. Lady for that intervention. Vaping has its purpose, which is to encourage people to quit smoking and take up vaping. I am concerned that people may take up vaping and then escalate to smoking. We do not yet have medical evidence on the long-term effects of vaping on health, so I am cautious. Clearly, it is better to vape than smoke, but let us not encourage people to take up vaping as an alternative to stopping smoking completely.

The all-party group has encouraged the “polluter pays” approach. The situation is very frustrating. The Government recognised in the Green Paper three years ago that budgets are tight and new sources of funding are needed. As recommended by the all-party parliamentary group, which I chair, the Government agreed to consider the “polluter pays” approach to funding. They also acknowledged that there were precedents, and that the approach had been taken by other countries, such as France and the USA.

Only months after the consultation closed in October 2019, the pandemic struck and put the prevention strategy on the back burner. It soon became clear that an effective prevention strategy was essential to build back better from the pandemic. It is also essential to deliver on the Conservative manifesto commitments to level up, reduce inequality and increase healthy life expectancy by five years. Those commitments are baked into the levelling-up White Paper and, the Government have said, will be enshrined in statute.

On the anniversary of the Green Paper’s publication, on 22 July 2020, the all-party group held a roundtable to examine the actions needed to deliver the smokefree ambition. The then Public Health Minister, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), and her opposite number, the hon. Member for Nottingham North (Alex Norris), were the keynote speakers. The Minister gave her commitment that the Department would continue to explore further funding mechanisms with the Treasury, as had been promised in the Green Paper.

On 30 March, the former Public Health Minister, my hon. Friend the Member for Winchester (Steve Brine), challenged why the commitment to consider a “polluter pays” approach had not been fulfilled. The response at the Dispatch Box from the Health Minister, my hon. Friend the Member for Charnwood (Edward Argar), was:

“My understanding—although my recollection may fail me, so I caveat my comment with that—is that this was initially looked at that stage, but was not proceeded with.”—[Official Report, 30 March 2022; Vol. 711, c. 867.]

My hon. Friend the Member for Charnwood might like to check his recollection. The all-party group on smoking and health, following its initial recommendations, put forward detailed proposals to Government in its June 2021 report about how a “polluter pays” levy could operate. I shared a copy of the report with Health Ministers at that time and wrote to the Secretary of State in July 2021, and again in December, asking for a meeting to discuss the levy. In September, I wrote to the Chancellor about the proposals. However, to date I have not had the courtesy of a reply to any of those letters.

If the “polluter pays” levy has been seriously looked at and a decision has been taken not to proceed, that was certainly not communicated to MPs or the all-party parliamentary group. That is precisely why officers of the APPG tabled amendments to the Health and Care Bill calling for a consultation on the levy. The amendments would not have committed the Government to going ahead, but would have ensured that they fulfilled their commitment to consider a “polluter pays” approach and that our proposals get the consideration they deserve. Our amendments were carefully considered by the other place and passed by a majority of 59—the greatest defeat the Government suffered on the Health and Care Bill. However, to the great disappointment of the APPG, the Government opted to oppose our amendments when they returned to the Commons for consideration. That leaves us without a mechanism for funding the smokefree 2030 ambition, with only eight years to go.

It appears that when the noble Lords met Ministers and Treasury officials to discuss the amendments, it was the Treasury, not the Department of Health and Social Care, that objected to the proposal to consult on a levy—not to introduce one, but to consult on the principle. The Treasury has a philosophical aversion to anything that smacks of hypothecation—raising funds to be put to specific purposes. Its preference is for funds raised to go into one big pot—the Consolidated Fund, from which all Government spending flows—that it controls and allocates, thereby giving it ultimate control. However, there are already numerous exceptions where hypothecation has been justified. One is the health and social care levy, which has just come into force. Another is the pharmaceutical pricing scheme, which the Department of Health and Social Care uses to raise funds for the NHS and provides a model for how our proposals could be implemented.

The noble Lord Stevens, formerly chief executive of the NHS, pointed out that the pharmaceutical pricing scheme was put in place by a Conservative Government in 1957 and has been sustained ever since with the support of Conservative, Labour and coalition Governments. He also said—and who could disagree?—that if it is deemed appropriate to have a form of price and profit regulation for the medicines industry, which delivers products that are essential for life saving, it is not much of a stretch to think that an equivalent mechanism might be used for an industry whose products are discretionary and life-destroying. I completely agree with him on that approach.

The Government already accept the principle that the polluter should pay to fix the damage they do. The extended producer responsibility scheme, which comes into force in 2024, is another good example. It requires producers of packaging waste to pay for its collection and recycling. Lord Greenhalgh, the Housing Minister, said:

“The reality is that we cannot keep looking to the Treasury to keep bailing everybody out—we have to get the polluter to pay.”—[Official Report, House of Lords, 5 January 2022; Vol. 817, c. 566.]

I could not agree more, and that principle applies even more strongly to smoking, which, as the chief medical officer pointed out, is a deadly addiction created and marketed by companies for profit.

There were objections because we were part of the European Union, but when speaking for the Government on Report in the House of Lords, the noble Lord Howe stated:

“the tobacco industry is already required to make a significant contribution to public finances through tobacco duty, VAT and corporation tax.”—[Official Report, House of Lords, 16 March 2022; Vol. 820, c. 297.]

However—this is the key point—tobacco companies pass on the cost of tax increases to smokers, which means that it is not the tobacco industry that contributes to the public finances but ordinary smokers, who have little choice but to buy cigarettes to maintain their deadly addiction. Indeed, when HM Treasury consulted on and rejected a levy in 2015, it was on the grounds that it would add an extra tax burden to smokers. That may have been true in 2015, but it is not the case today.

In 2015, we could not prevent tobacco manufacturers from passing the costs on to consumers because we were in the European Union. We are no longer part of the European Union, and therefore by capping tobacco prices and controlling profits, the Government can ensure that tobacco manufacturers bear the full cost of the levy, helping incentivise the industry to move out of combustible products and make smoking obsolete by 2030. I can think of few better Brexit dividends than making tobacco companies pay for the damage they do.

To quote my noble Friend and fellow APPG officer Lord Young of Cookham, speaking in the other place, our proposed levy will allow the Government to

“put the financial burden firmly where it belongs, on the polluter—the tobacco manufacturer—and not the polluted—the smoker.”—[Official Report, House of Lords, 16 March 2022; Vol. 820, c. 290.]

The reality is that this levy could raise £700 million a year from the profits of the tobacco companies—money that could be applied to smoking cessation services.

There is public support for this measure. It has been endorsed by more than 70 health organisations, including Cancer Research UK, Asthma + Lung UK, the British Heart Foundation, the Royal College of Physicians and the Health Foundation. It is also supported by three quarters of the public, including those who voted Conservative in the 2019 election, with fewer than one in 10 being opposed to the levy. What could be better than introducing a tax that the public support?

If we want to achieve a smokefree 2030, it is vital that we tackle high rates of smoking among our most deprived communities, pregnant women and people with mental health conditions. As the Government have said, this will be “extremely challenging” and cannot be achieved on the cheap. Health Ministers in both Houses have said that they do not want to prejudge the review, and therefore could not accept amendments calling for a consultation on a levy. However, as I have said, that review will report very shortly—in the middle of next month—and the discussions I have had with the chairman of the review make it very clear that the measures he will be recommending will need investment, and will be radical.

Once Javed Khan has reported back to the Government, there will need to be serious consideration of how the funding to deliver the smokefree 2030 ambition can be found. That will need to be done in parallel with decisions about what interventions are needed, as interventions cost money and can be delivered only if the funding is found. Pressure on budgets has only worsened since 2019, with the covid-19 pandemic wreaking havoc on our nation’s health and on Government finances. The Government made it very clear in the spending review that there is no new money for public health, so an alternative source of funding is urgently needed. With only eight years to go before we reach 2030, the Government need to decide where that money is coming from.

The existing funds are not sufficient, and our proposals provide a new source of funding in addition to tobacco taxes. If the Government are unwilling to accept our proposals, they must come up with an alternative solution that will match the scale of their ambition. As such, my question to my hon. Friend the Minister is this: if the Javed Khan review recommends a levy, will she commit to meet with us as APPG officers and with independent experts to discuss our proposals for a “polluter pays” levy to provide the investment that is needed to deliver the Government’s smokefree ambition?

My final point is that this review also needs to look at shisha tobacco, chewing tobacco and snus. Unfortunately, those areas are completely unregulated at the moment, but are extremely damaging to people’s health. I look forward to hearing the contributions of other Members and of the Front Benchers.

[Caroline Nokes (in the Chair)]

I will call the Front Benchers at 10.40, so perhaps Back Benchers could try to limit their contributions to about six minutes.

[Mary Kelly Foy (City of Durham) (Lab)]

It is a pleasure to serve under your chairmanship, Ms Nokes, and I wish my hon. Friend the Member for Harrow East (Bob Blackman) many happy returns. I declare an interest as a vice-chair of the APPG on smoking and health; I hope, therefore, that I can speak for a little more than six minutes, if that is okay.

The north-east is the most disadvantaged region in England, with high rates of smoking and all the harms that it brings. However, I am proud to say that in the last five years, the fastest declines in smoking rates have been in the north-east. Credit goes to our local authorities, which prioritised tackling smoking and banded together to fund Fresh—the longest-running and most effective regional tobacco control programme in the country. However, the north-east started with much higher smoking rates than the rest of England, so we have further to go to achieve a smokefree 2030.

More than 4,000 people died prematurely from smoking in our region last year, with 20 times as many suffering disease and disability caused by smoking, yet there is also an economic cost to our already disadvantaged communities. Smoking costs the north-east £685 million in lost productivity, £125 million to the NHS and £67 million in social care costs to local authorities. We simply cannot afford this strain on our economy.

When the smokefree 2030 goal was launched nearly three years ago, the Government acknowledged the scale of the challenge, admitting that it would be extremely challenging and promised bold action to finish the job. Since then, however, the Government have sat on their hands. Rather than stepping up their efforts to achieve the smokefree 2030 ambition, the Government have failed to announce a single new policy to that effect, while the £1 billion cut to public health funding since 2015 appears to be baked in.

The Minister knows that half the difference in life expectancy between the rich and the poor is due to differences in smoking rates. The Government’s lack of action threatens our ability to achieve not just the 2030 smokefree goal, but their levelling-up mission to narrow the gap in life expectancy between areas where it is highest and lowest by 2030 and to increase healthy life expectancy by five years by 2035.

Today’s debate was originally secured to discuss the recommendations of the independent review. The fact that the review was delayed made the debate even more necessary. The Secretary of State committed, when he announced the review in February, that it would report back in April. Javed Khan said he would report back on 22 April, so we were very disappointed that the Secretary of State told Parliament last week that he hoped it would be published in May, with no commitment that that would be the case. That is just the latest of many delays and missed opportunities, which we want to put on the record.

We want a commitment from the Government that they will accept no further delays in bringing forward a plan to achieve a smokefree 2030. Let us start with the Green Paper that announced the Government’s goal of a smokefree 2030, which was launched with much fanfare in July 2019. Further proposals included considering the “polluter pays” levy, which my hon. Friend the Member for Harrow East mentioned, and giving the ultimatum of making smoked tobacco obsolete by 2030. Cabinet Office guidelines say that Departments should:

“Publish responses within 12 weeks of the consultation or provide an explanation why this is not possible.”

The Green Paper consultation ended in 2019. In July 2020, on the anniversary of the Green Paper, the then public health Minister, the hon. Member for Bury St Edmunds (Jo Churchill), told the APPG that work was under way to publish the further proposals envisaged in the Green Paper, and that she was keen to work with us to explore whether the current regulatory framework was sufficient. Since then, we have heard nothing.

The lack of an outcome on the Green Paper was disappointing, so in November 2020, we held a debate urging the Government to commit to publishing a new and ambitious tobacco control plan. We were therefore delighted when the then Minister committed in December to publishing a new tobacco control plan in 2021. The APPG commissioned Action on Smoking and Health, working in collaboration with SPECTRUM, the academic public health research consortium, to provide us with a report setting out our recommendations and the measures that the Government needed to take to achieve their 2030 ambition. The then Minister attended the launch of our report, welcomed our recommendations and committed to publishing the plan by the end of 2021. We are understandably disappointed by the delay in its publication.

There were other opportunities that could have been seized but were not. The Government were legally required to review the impact of existing tobacco product regulations, including those on standardised packaging, health warnings, product standards and e-cigarette regulations. The regulations set out in law a deadline for the review to report by May 2021. To that end, the Government launched a consultation last January to assess whether the objectives were still appropriate and whether the regulations were fit for purpose. Those regulations predated the Government’s commitment to a smokefree 2030, and it was blindingly obvious that they needed to be strengthened to match the scale of the Government’s new goal.

Since the regulations came into force, it has been clear that there are serious loopholes. The menthol ban relies on subjective rather than objective measurements to determine whether the regulations are being adhered to. An investigation by the Express newspaper revealed that the industry has exploited that loophole in the law and that Britain’s biggest tobacco giant sold £1 billion-worth of cigarettes flavoured with menthol in the year after the ban came into force.

That was not the only loophole; although e-cigarettes can be sold to those aged 18 and above, it is completely legal to hand them out free to children. While the advertising, promotion and sponsorship of e-cigarettes are heavily regulated, packaging and labelling are not. That has allowed the use of sweet names for vaping products, with cartoon characters and garish colouring, all of which appeal to children. Those are clear gaps in the law that need to be fixed without further delay.

The consultation was well timed to feed into the Health and Care Bill. ASH and SPECTRUM provided the Government with detailed and well-evidenced proposals for a number of improvements that would strengthen regulations and fix those loopholes. When the outcome of the review was not published in May 2021, as was required, we hoped that the Health and Care Bill would contain the further proposals the Government had promised to bring forward. Imagine our disappointment when the Bill was introduced to Parliament last July. Although it included measures on prevention and public health, there was nothing on tobacco or smoking, despite the Government’s much-trumpeted smokefree 2030 ambition.

That is why, in Committee, I tabled a set of amendments for increased regulation on tobacco, based on the APPG’s recommendations. The amendments included requirements to consult on a “polluter pays” levy; introduce pack inserts containing quit information; put warnings on cigarettes; close loopholes in the existing regulations on menthol and e-cigarettes; and consult on raising the age of sale to 21—a measure that has been proven to reduce smoking rates in the population at large by 30%. That measure has also been shown to reduce inequalities, because it has the greatest impact on the poorest and most disadvantaged communities. Throughout the passage of the Bill, Ministers in both Houses have repeatedly said that the Government were sympathetic to our aims and amendments, and that they would be considered for the next tobacco control plan. However, the tobacco control plan has already been delayed by a year and still does not have a publication date.

If the Government had supported those amendments, we would now have the foundation in place for a comprehensive strategy to end smoking by 2030. Instead, the Government have chosen to reject the amendments and, yet again, to kick tobacco control into the long grass. Now we are waiting for the tobacco control plan. Before the plan can be published, we have to wait for Javed Khan’s independent review, which will be followed by a public health disparities White Paper in the spring, which will in turn be followed by the tobacco control plan. That will leave only seven years to deliver the smokefree 2030 goal.

Since evidence first emerged of the harms caused by tobacco in the 1950s, smoking has killed more than 10 million people in the UK, and it continues to kill hundreds more every day. Up to two thirds of those smokers die prematurely from their addiction. There is a crucial message around children: every day, 280 children start smoking—that is more than 280,000 since the smokefree 2030 ambition was launched. Smoking is highly addictive; two thirds will go on to become daily smokers. With that in mind, can the Minister assure us that the tobacco control plan to deliver the smokefree 2030 ambition will be published no later than three months after the independent review? Will she also assure us that the Queen’s Speech will include a commitment to bring forward legislation in the next Session to deliver regulatory measures essential to delivering the Government’s ultimatum to the industry to make smoked tobacco obsolete by 2030?

I end with a comment from the chief medical officer. He pointed out that one in five people who die from cancer will die from lung cancer, and went on,

“the reason that people like me get very concerned and upset about it is that this cancer is almost entirely caused for profit…a small number of companies make profits from the people who they have addicted in young ages and then keep addicted to something which they know will kill them.”

[Caroline Nokes (in the Chair)]

I shall now put Members, starting with Hywel Williams, on a formal time limit of six minutes.

Childhood Cancer Outcomes

Caroline Nokes Excerpts

Tuesday 26th April 2022 Commons Chamber

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

With a all the moving stories, this is a difficult debate to listen to, but I congratulate my near neighbour, my hon. Friend the Member for Gosport (Dame Caroline Dinenage), on securing it. Hampshire is a small community, so it can be no surprise that nurses who treated Sophie live in Romsey and Southampton North and that her family have friends who live in my constituency. I have heard from them about Sophie’s bucket list and what her mother Charlotte wants to secure for children suffering from cancer, and that very much echoes comments made to me by my constituent Jane O’Brien, who lost her son George to teenage cancer some years ago. The O’Brien family have dedicated their time to setting up George’s trust, to raising funds to bring the first ever teenage cancer unit to Southampton General Hospital and to raising funds for the world-leading immunology centre in Southampton. Of course, we have heard today that too little of that research and money goes to childhood cancers, which are not as rare as we would like to hope.

George’s family have made a really important point to me about when he was diagnosed. When he went to the doctor’s surgery on the Tuesday, nobody recognised how serious his symptoms were. He died on the Friday, a matter of days later, but they felt strongly that the support was not there for them as a family. They did know what George had died of. They were not given the same level of support and assistance that other bereaved families might have received in similar circumstances.

[Justin Tomlinson (North Swindon) (Con)]

My right hon. Friend is making a typically powerful speech and she makes a key point. We must be better at linking up parents so that they have crucial peer-to-peer support as they go through the unimaginable horrors they face in such situations.

[Caroline Nokes]

That is a really important point, not just for parents but for the wider family and siblings who also need such help.

When I was a very new MP, I remember being contacted by my constituent Pip Armitage, who came to see me with Sacha Langton-Gilkes—the most amazing woman—to talk about the charity HeadSmart. They made a point that we have heard several times in the Chamber: we need a joined-up strategy and public awareness. We have heard about the meningitis campaign that has seen hugely improved awareness among families, parents and the medical profession and enables the condition to be identified early. In George’s case and that of too many childhood cancer victims, the condition is diagnosed too late because GPs do not have the awareness and the family do not know what signs to look for.

Sacha ran the most phenomenal campaign to put awareness cards, particularly on brain tumours, into schools and local authorities, and that was really effective. As part of the children’s cancer mission that my hon. Friend the Member for Gosport is rightly calling for, we need to have that same level of public awareness campaigning on childhood cancers. We need better referral guidelines for doctors, so that doctors such as George’s GP, who I levy no criticism at, spot the signs and refer children quickly and efficiently to the brilliant hospitals that are there to treat them.

This is such a crucial subject. As we can see this afternoon, there is enormous cross-party support for something to be done. I know that the Minister is listening hard and I look forward to what she will propose.

--- Later in debate ---

[Tom Tugendhat (Tonbridge and Malling) (Con)]

I was going to make quite a different speech, but I am going to start by saying that, from Kirkcaldy to Kent and from Gosport to Glasgow, we have heard such a strong message of support for so many families in this great country, and I have to say that I am incredibly moved. My hon. Friend the Member for Sevenoaks (Laura Trott) and many others have recounted stories of great sadness and great tragedy, but what I am going to take away from this is not the tragedy or the sadness but the extraordinary love, courage and strength that so many families across the United Kingdom have shown, wherever they are from, whatever their background and however cancer has affected their young lives. They have shown extraordinary resolve and determination to be together as a family, to strengthen each other, to hold together and to really make a difference, even if lives are brief and even if the cancer is brutal. They have shown amazing determination to be so united in the face of such a horrific disease.

I am going to talk about a wonderful family I am privileged enough to represent. Claire Scott is just the most extraordinary woman—forgive me, I know that there are others in the Gallery, but Claire is a remarkable individual. When she was just about to give birth to her second child, Kylie, she found out that her first, Liam, had neuroblastoma. She had that extraordinary, horrific moment that so many families have had, of having to take in news that nobody would wish on anyone—not even their worst enemy in this place. We would all rather that these incidents never happened, but the truth is that they do. What Claire did when she heard the news was motivate herself and mobilise her friends around her to raise money to support the care that her son was receiving and also to take him to the United States to try an experimental vaccine. I am very glad to say that Liam is still with us. He is currently in remission and I very much hope he stays that way.

There is clearly an extraordinary amount of innovation coming through pharmaceutical routes and various other routes, and we really need to encourage that. We need to invest in it, we need to welcome the scientists and we need to celebrate the achievements of so many who are working on this right now. I am delighted to say that my right hon. Friend the Secretary of State for Health and Social Care met Claire recently and was able to talk to her about the possibility of looking at the various forms of treatment that are available and that may come in.

[Caroline Nokes]

There is clearly a challenge, in that therapies that are available abroad are not yet available here. Would my hon. Friend agree that more work needs to be done on that?

[Tom Tugendhat]

My hon. Friend is absolutely right, and that is exactly the commitment we got from my right hon. Friend the Secretary of State. We need to look hard at the various forms of treatment, and to encourage the NHS and NICE to look further into the many areas that offer hope for some. It is sadly not the hope for all that we sometimes read about in the papers, but these areas could possibly be the future for so many.

The House is united and strong today, and I hope we will be able to urge, encourage and persuade the Government to push forward with greater research, greater investment and greater support. Most of all, the House has spoken as one in celebrating the families, the love, the courage, the determination and the strength that have supported so many through this extraordinarily difficult time.

Health and Care Bill

Caroline Nokes Excerpts

Consideration of Lords amendments
Wednesday 30th March 2022 Commons Chamber

[Dame Diana Johnson]

I am talking about women’s experience, so I will continue, if the hon. Gentleman does not mind.

The woman may have to make arrangements if she has childcare or caring responsibilities, or she may have to take time off work. In the case of a coercive and controlling relationship, she would have to explain where she is going to a perpetrator, such as the Mumsnet user who said she had to visit a hospital to access abortion care and was “terrified” of her abusive ex-partner finding out where she was. She spoke of having to construct “various lies” about where she was that day and why she had to have someone look after her children.

I referred to NICE and the World Health Organisation in an intervention, but we should be aware that since telemedicine was introduced the risk of complications related to abortion has reduced, as women are able to access care much earlier in their pregnancy. I will rehearse the long list of supporters of the measure continuing: The Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives, the Royal College of General Practitioners, the British Medical Association, the Royal Pharmaceutical Society, the Faculty of Sexual and Reproductive Health, the TUC, Women’s Aid, Rape Crisis, Karma Nirvana, the Terrence Higgins Trust, End Violence Against Women, Mumsnet, and many others. What I find most disappointing is that the Government are going against a wealth of robust and widely accepted peer-reviewed evidence from medical professionals and women’s charities, and appear to give greater weight to anecdote, erroneous opinion and misinformation focused on campaign groups with extreme views who bombarded a consultation. Sadly, that further emphasises that this is not an evidence-based policy decision.

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

Will the hon. Lady give way?

[Dame Diana Johnson]

I want to address the issue of safeguarding. Let me be clear: creating more barriers to access does not help women; it helps abusers. The End Violence Against Women coalition and other major VAWG organisations reject the claim that telemedical abortions put women at greater risk of coercive abortions. The fact is that coercive pregnancies are far more common than coercive abortions, and since the introduction of telemedical abortions providers have seen a rise—a rise—in safeguarding disclosures, highlighting that the system provides a safe space for women to come forward if they are being coerced. Nurses are highly trained to assess safeguarding issues, and if concerned they will ask the women to come to the clinic for face-to-face assessment.

Finally and crucially, women themselves strongly favour keeping telemedicine for early medical abortion. A clear majority want it to continue.

As a country, we have an opportunity to be seen to be a shining light for women’s reproductive rights around the globe at a time when those rights are being rolled back elsewhere. The weight of the evidence in favour of maintaining this essential women’s healthcare pathway is overwhelming. I ask Members to support the amendment in lieu.

Oral Answers to Questions

Caroline Nokes Excerpts

Tuesday 1st March 2022 Commons Chamber

[Gillian Keegan]

I thank the hon. Lady for her question. She raises an incredibly important point. As a Government, we are determined to tackle long autism diagnosis waiting times. We are investing £2.5 million as part of the NHS long-term plan to test and implement the most effective ways to reduce autism diagnosis waiting times for children and young people across England. That is vital, because we know that the earlier children get the support, the better the outcomes are for them. We are absolutely determined to work on this, but the diagnosis pathways are sometimes quite complex.

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

16. What plans his Department has to take steps to permanently implement the telemedicine service for early medical abortion.

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

The Government will end the temporary approval put in place at the beginning of the pandemic. We have extended the temporary approval for six months until midnight on 29 August 2022. From that point, abortion services for early medical abortion will return in line with pre-covid regulatory requirements. As with any healthcare service, this measure will be kept under review.

[Caroline Nokes]

Can my hon. Friend explain how the decision to end telemedicine for early medical abortion supports women who responded to the Department’s own consultation, how it works in line with the Royal College of General Practice, the Royal College of Obstetricians and Gynaecologists, and the Royal College of Midwives, and what the dangers are in ignoring their advice when pulling together a women’s health strategy?

[Maggie Throup]

The temporary approval was put in place during the pandemic to address a specific and acute medical need to reduce the risk of transmission of covid-19. It was recognised that without it, significant numbers of women would not have been able to safely access abortion services. Thanks to the success and impact of the national vaccination programme, the situation is now very different. In making this decision, the Secretary of State has considered all the risks and benefits regarding the temporary approval.

Cumberlege Report

Caroline Nokes Excerpts

Thursday 3rd February 2022 Westminster Hall

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

My right hon. Friend has made that point a number of a times during his speech, and it is worth highlighting. I know that my hon. Friend the Minister will do some great work on the women’s health strategy, but time and again my right hon. Friend has said that women’s voices are being ignored and dismissed. They are told that they are imagining things and that it is in their heads. It is not good enough.

[Alec Shelbrooke]

I completely agree with my right hon. Friend. In fact, I will later make a couple of points on what I have discovered about women’s health. The way women are treated is quite appalling.

Another person says:

“I had my TVT in Exeter 12 years ago. Exeter consultant in 2020 told me I couldn’t be referred to Bristol. He said he would refer me to UCLH but I never heard from them, I rang in 2021 to be told UCLH hadn’t received any referral but they then put me on their wait list from when I’d been told the referral was made. I then heard nothing from them for ages so I paid for a private consultant at Bristol to be told I could have been referred to Bristol on the NHS in the first place. Bristol requested NHS tests in Exeter which were done in August 2021 and they referred me back to Bristol in October, so I am now on Bristol NHS list for removal”.

Somebody else says:

“Took 4 years to be referred to specialist mesh centre, after a lot of pushing and pushing for it, referred to Royal Victoria Hospital in Newcastle upon Tyne. The mesh centre was no better, more lies, gaslighting and a really appalling treatment and total indifference, lots and lots of mistakes, cancelled appointments and no regard for any pain or suffering.”

Another person says:

“Told too dangerous to remove…left in agony...self-catheterising, lost job, pain management referral but they are behind 12 months …invisible and invalid is how I feel…is this my life at 54?”

Somebody else says:

“I went for a consultation for removal in 2020 had a scan then asked to contact his secretary when I’d had an MRI which I did in December 2020. Now still waiting for them to contact me. I leave messages and nothing happens.”

I could go on and on and on, and I am sure that many other right hon. and hon. Members will be raising similar cases. What I want the Minister to comment on in today’s debate is this. There is now, from the relevant royal colleges, the “Purpose Statement for the Mesh Complications Management Training Pathway”. That statement outlines several areas, but I will highlight just the “Mesh Complication Management credential”. Its subheading is “Professional Identity: Clinical Expert” and it states:

“The doctor has the knowledge, skills and attitudes required for clinical assessment of patients presenting with suspected mesh-implant complications…The doctor is able to investigate mesh complications, and interpret the results of tests, appropriately…The doctor is competent in non-surgical management of mesh complications…The doctor is competent to undertake mesh removal surgery as part of a multidisciplinary team”.

This is progress, but I think we can all understand that there is going to be a long time around that, so I say this to the Minister. Can the House please have regular updates on how this training process is going, within the royal colleges, for surgeons, because we need to understand what the process is and how long it is taking to try to deal with the main issue?

That brings me to the other parts of recommendation 5 in the report of the independent medicines and medical devices safety review. The written ministerial statement in response said:

“Recognising the need for enhanced data collection on pelvic mesh, the Government in 2018 announced the provision of £1.1 million for the development of a comprehensive database of urogynaecological procedures, including vaginal mesh, to treat pelvic organ prolapse and stress urinary incontinence. I can update the House that the pelvic floor information system has started to receive live data, including historical data from July 2017 onwards, with an initial focus on supporting specialist services to report every pelvic floor and comparative procedure to this national database.

The report of the IMMDS review also recommends that the information system is accompanied by a retrospective audit of mesh procedures, and by the development of a patient reported outcome measure (PROM) or patient reported experience measure (PREM). I am pleased to announce to the House today that the Government accept both these recommendations. NHS Digital has been commissioned to scope and deliver the retrospective audit. Subject to receiving high quality research bids, a new validated PROM for pelvic mesh procedures will be commissioned through the National Institute of Health Research in 2022.”—[Official Report, 21 July 2021; Vol. 699, c. 73WS.]

Again, I ask the Minister whether she can update us on progress in these areas and, after today’s debate, could she speak to her Department about ensuring, even if it is just through a written ministerial statement, that there is a regular update on the progress being made?

I will give a summary of the points that I have made. GPs are unaware of mesh complication centres and the referral process. Many patients are denied access and offered physio and pain management instead. They pay thousands of pounds for private care. They experience extremely long delays for appointments. Many women end up seeing their implanting surgeons, who then dismiss them. That leads to further deterioration in their physical and mental health. There is a lack of experience, particularly in mesh removal. There are only around four to five surgeons in the UK who can do mesh removal. There is no post-op aftercare.

More positively, on recommendations 6 and 7, the Government announced that the MHRA

“has initiated a substantial programme of work to improve how it listens and responds to patients and the public, to develop a more responsive system for reporting adverse incidents, and to strengthen the evidence to support timely and robust decisions that protect patient safety.”

Recommendation 7 was:

“A central patient-identifiable database should be created by collecting key details of the implantation of all devices at the time of the operation. This can be linked to specifically created registers to research and audit the outcomes both in terms of the device safety and patient reported outcomes measures.”

The Government accepted both recommendations. Again, I ask the Minister for an update.

Recommendation 8 states:

“'Transparency of payments made to clinicians needs to improve. The register of the General Medical Council (GMC) should be expanded to include a list of financial and non-pecuniary interests for all doctors, as well as doctors' particular clinical interests and their recognised and accredited specialisms. In addition, there should be mandatory reporting for the pharmaceutical and medical device industries of payments made to teaching hospitals, research institutions and individual clinicians.”

The Government said that they accepted the recommendation in principle:

“We agree that lists of doctors’ interests should be publicly available, but we do not think that the GMC register is the best place to hold this information”,

so “publications of interest” should be held by healthcare providers. Having approved the recommendation, how is that progressing and how easy is patient access?

Finally, we get to recommendation 9:

“The government should immediately set up a task force to implement this Review's recommendations. Its first task should be to set out a timeline for their implementation.”

The Government accepted the recommendation in part.

Having probed the recommendations to open the debate, I ask the Minister whether she and her Department are able to say positively that they are meeting recommendation 9. Are the recommendations being implemented properly and is she revisiting the recommendations rejected by the Department initially? We can all recognise from the examples that I have given that the mesh centres are not working, that people’s lives have been destroyed and that they will need to support throughout their lives. We cannot just draw a line, have a year zero and say that we hope such things do not happen again. We have to move forward.

Drawing on what my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) said and on my research, it is clear to me that the NHS is constantly failing women. During the pandemic, I read a report—unfortunately, I have not been able to reference this since, so it is open to challenge—stating that gynaecological surgeons were taken off their operating theatres for longer than any other surgeons, being kept on the frontline of the covid wards.

That says exactly where the problem in the NHS lies. That comes up not just in this debate, but next week, in another debate, on problems with endometriosis. It seems that the NHS is—I do not say this in a positive way—gender-blind to the needs of women and the complications that occur. It is an attitude, a built-in psychology, that we will have to address, and we can only start to do so if we take all the aspects of this report seriously.

Although men have mesh issues too, this debate is dominated fundamentally by women’s health. It speaks to that wider assessment of NHS priorities on women. We have to start doing something about that. We must stand up and say that we are not afraid to criticise areas of the NHS, because I am sure that as we go through the debate we will have example after example from which we can draw only one conclusion: women are being failed.

My hon. Friend the Minister, as a practising nurse, will know the importance and vocation of patient care. With her professional eyes, will she allow the NHS to ignore the plight of people who are suffering every day? To be blunt, her predecessor appeared to. I ask her to apply her considerable and dedicated professional expertise to get the Government to direct the NHS to adopt the recommendations, or at least to mirror them. That is the least we can do for the terrible and horrific damage that the NHS has caused to so many people. To finish: the NHS did this, so the NHS must fix this.

--- Later in debate ---

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

It is a huge pleasure to speak in this debate. I extend my congratulations to my right hon. Friend the Member for Elmet and Rothwell (Alec Shelbrooke) on opening the debate in an incredibly sensitive and thoughtful way. I hope that I can follow his lead and not get angry at the Minister. I do not blame her for this, and I know that she has a very real and personal commitment to the women’s health strategy, which we will see come forward in the spring—I was grilling special advisers on that only this morning. However, I urge her to listen carefully to the voices she has heard today, and to recognise that Members of Parliament speak up on behalf of their own constituents. We hear in our surgeries, week in and week out, about the issues that are affecting women and impacting their wellbeing and health. I urge her to ensure that those voices are listened to ahead of the final strategy being published.

We have heard it all today: sodium valproate; Primodos; mesh. I always hear “the victims of mesh”, and I absolutely regard them as that; they are victims of a surgical process that has left them in absolute agony. Each of us here this afternoon has a different perspective and interest. It is absolutely right that we all have highlighted the particular areas of concern to us.

Of course, I have victims of mesh living in my constituency. I also have a wonderful family whose daughter has been the victim of Primodos. Her story is one that always resonated with me, because she is exactly the same age as I am, and has been living with her disabilities since 1972. However, I really want to talk about sodium valproate. I do not know why that issue stuck with me so clearly, other than the fact that it was through the contribution of two amazing women—Emma Murphy and Janet Williams—who came to see me when I was a very newly-elected MP, and spoke to me about valproate. I am not an evangelist for banning the use of valproate—it is such an important drug, and has a valuable impact on those patients with epilepsy who need it to support them and manage their conditions well—but it is imperative to recognise that the dangers of valproate were known for many decades but not articulated to those women who were taking it and were of child-bearing age.

We have, for decades, had really effective pregnancy prevention programmes for various drugs. I always highlight—as my right hon. Friend the Member for Hemel Hempstead (Sir Mike Penning) pointed out, we have been here before—the use of Roaccutane, which I remember taking probably 30 years ago. I had to sign all sorts of bits of paper promising not to get pregnant. Then, when my daughter was prescribed it as an 11-year-old, she had to have a pregnancy test every single month— at 11—to demonstrate that she was not pregnant and that it was therefore safe to give her the drug. The same measures were not put in place for valproate.

Emma and Janet went digging around in archives; they have made endless freedom of information requests, and they have had their work recognised by the World Health Organisation. The pressure that they put on Members to convey the importance of a proper investigation to people like my right hon. Friend the Member for Maidenhead (Mrs May) brought forward the Cumberlege report, which was so valuable.

I will give a bit of a timeline: on 8 July 2020 that report was published; on 9 July, I was in the House for the oral statement on the Cumberlege report. I can remember my hon. Friend the Minister’s predecessor, the then Minister of State at the Department for Health and Social Care, my right hon. Friend the Member for Mid Bedfordshire (Ms Dorries), actually giving us hope and confidence.

I listened to her, that day in the House, and thought that she had the tone of her response absolutely right. She promised to take away the issues that we were all raising. She promised to look at all of the recommendations that the Baroness had brought forward so competently and effectively. I had hope, as did the campaigning women from In-FACT, and the hon. Member for Bolton South East (Yasmin Qureshi), who is on the APPG. We all had hope that the recommendations would be accepted and acted on with speed.

Then, on 21 July 2021, a whole year later, rather than having an oral statement in the House, when we could ask the Minister what was going to happen, and what action was going to be taken on the recommendations, the Government snuck out a written ministerial statement on the last day before recess so we had no opportunity to bring forward the concerns that we had on so many of the recommendations either being rejected or only accepted in part. Those campaigners felt despair—not the hope that they had a year before, but despair.

The third date that I want to highlight—this is where I will provide some air cover to the Minister—is 15 September 2021. Rarely in a Member’s career does the opportunity come along to ask question No. 1 at Prime Minister’s questions, and on 15 September is was my turn. It will probably never happen to me again, so I carefully considered what issue to raise. We all have brilliant constituency issues that we want to raise or things that we have been campaigning on, and suddenly, in a Zoom call with Emma Murphy and Janet Williams, I went, “Do you know what? I have question No. 1 on Wednesday.”

I used my question to ask the Prime Minister about the specific issue facing the parents of children impacted by foetal valproate syndrome: their children have learning difficulties and additional needs. Some are born with spina bifida, a cleft palate, heart defects or limb malformations. They have all sorts of additional challenges, which are expensive. They need redress and specialist centres where their children can get the support they need, to lead as full a life as possible. Guess what? Their parents also need respite. They need be confident that their children are being properly looked after, cared for, supported and helped to counteract all the challenges they face, and they need a break, but they have been offered none of those things.

So, in September 2021 I asked my right hon. Friend the Prime Minister if he would recognise that there was an additional cost—a fiscal impact—on these families and if would he commit to making redress available. He responded by indicating that the Government was

“committed to making rapid progress”—

I emphasise the word rapid—

“in addressing all the areas that”

the Cumberlege report

“mentions, including the one that my right hon. Friend covered today.”—[Official Report, 15 September 2021; Vol. 700, c. 964.]

Yet we are still waiting for redress and for the specialist centres, and the families are waiting for an acknowledgment that they face additional costs, day in, day out, and they want help with them.

I want to ask a specific question of the Minister, which was provoked in my mind by my right hon. Friend the Member for New Forest East (Dr Lewis), who sadly cannot be with us for the conclusion of this debate. He made the point about disability and the women who have had mesh implants whose ability to work is impacted forever. I remember being a Minister at the Department for Work and Pensions. We did a lot of work around people who had long-term conditions and whether they should have to go through the reassessment process.

This would be an excellent opportunity for my hon. Friend the Minister to outline to us what work she is doing with the DWP to ensure that these women can be included in that group, so that they do not have to go through endless reassessments time and again to establish whether they are still suffering pain from mesh. That is an important point, because that would give them a sense that we are making some sort of progress. That is my specific question for the Minister, which I hope she will be able to answer.

I will not take credit for my final, really important point, which should be given to my right hon. Friend the Member for Elmet and Rothwell, who passed me a note midway through the debate. We have to make sure that this stops. We must not continue to ignore the voices of women who say they had a procedure that has damaged them, but who are told it is a mental problem and it is all in their head. We cannot have a situation where people continue to be ignored, or where drugs come on to the market and are left in use and circulation for decades, before somebody recognises that there is a problem. If we go back to thalidomide and valproate, it was decades before people recognised that there was an issue.

The point was made earlier that the aircraft and airlines industry has a no-blame, no-consequence reporting system for errors, so that if someone finds something that is wrong, it will not come back on them in their career. As my right hon. Friend said, the career of the doctor who discovered the problem with Primodos was impacted by that discovery, for the rest of her career. We cannot have that situation. Just as the airline industry has a no-blame reporting system, can we also have that in our NHS, so that people have the confidence to report, knowing it will not come back upon them? Then we will not have medicines and devices that do harm, in the same way that we no longer have planes that simply drop out of the air.

--- Later in debate ---

[Maria Caulfield]

I will come to that point. The Government have apologised on behalf of the health and care sector for the time it took to listen and respond. We are doing more than apologising: we are changing the healthcare system so that it responds to women in a much better way.

As the hon. Gentleman has just raised the issue of redress, I will touch on it now. It is not just these cases where it is often difficult for patients to get redress and compensation. I gave evidence to the Health and Social Care Committee this week on the issue of clinical negligence. This week, we announced a fixed recoverable costs scheme, meaning that, for low-value claims, we can speed up the claims process, reduce legal costs and ensure that, whatever clinical negligence they have experienced, patients are able to get compensation as quickly as possible. The findings of the Cumberlege report highlight mesh, Primodos and sodium valproate. However, across the board, it is very difficult for patients to get redress, regardless of the clinical negligence they have suffered.

[Caroline Nokes]

I do not want to be too difficult, but I do not think it is any excuse to say that because it is difficult for everyone to get compensation, we should not try here.

--- Later in debate ---

[Maria Caulfield]

Specifically on Primodos, there is pending litigation so it is difficult for me to comment while that is in progress, but, depending on the outcome, the Government will respond to that.

[Caroline Nokes]

I will go for valproate, because there is not pending legislation about that. Have I understood the Minister correctly? Is she saying that if the Primodos case is successful, the Government will review it, and the women who have had mesh implants or who are the victims of sodium valproate will not be expected to have to go down that legal route?

[Maria Caulfield]

If I touch on the points in my response, hopefully I will be able to reassure colleagues on the progress being made.