Oral Answers to Questions
Caroline Voaden Excerpts(4 days, 8 hours ago)
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Stephen Kinnock
On the NPA, it has taken us a while to clean up the utter mess that we inherited in community pharmacy. That involved agreeing financial envelopes and getting into negotiations with CPE. Those negotiations have been constructive, and I am delighted to confirm again that we will soon announce the outcome of those negotiations. What we see here is the shadow Minister apparently taking the side of people taking collective action in a premature way that is detrimental to patients. They would be better off waiting for the outcome. The Government are taking industrial relations into the 21st century, as opposed to the performative nonsense that we saw for 14 years.
Caroline Voaden (South Devon) (LD)
The Minister for Care (Stephen Kinnock)
When someone is detained, family involvement is extremely valuable, and families should be supported to maintain contact with their loved ones. Our Mental Health Bill will strengthen requirements to involve families in people’s care. We will require clinicians to involve patients and their families where possible when developing new statutory care and treatment plans.
Caroline Voaden
I have two ongoing constituency cases with adult men who have serious and long-term mental health issues. One of my constituents believes that her life is in danger because of her son’s threatening behaviour towards her—her own mental health has been seriously affected by the fear and stress. The other case involves a young man causing serious distress to his neighbours with his behaviour, which recently led to an incident where he reportedly threatened a police officer with a knife. Both men are living alone in unsupported accommodation, both are at risk of coercion and abuse because of their mental health problems, and both are causing serious distress to their families and neighbours. Will the Minister tell the House whether he is working with other Departments to ensure the availability of more provision to support people such as my constituents to live safely in the community and not cause harm or distress to those around them?
Stephen Kinnock
I know that the hon. Member has met my right hon. Friend the Secretary of State about at least one of those constituency cases. NHS England has asked mental health trusts to review the care of high-risk patients and has published national guidance on the standards of care that are expected. Ultimately, the Mental Health Act is there to protect people and provide the necessary powers to enable clinicians to manage and support such patients—and to do so, where possible, in the community.
Ambulance Response Times
Caroline Voaden Excerpts(3 weeks, 2 days ago)
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Caroline Voaden (South Devon) (LD)
It is a pleasure to serve under your chairmanship, Ms Jardine. I congratulate my hon. Friend the Member for Glastonbury and Somerton (Sarah Dyke) on securing this important debate.
From the January 2024 figures, we can see that the South Western Ambulance Service consistently ranked near the bottom across all categories of ambulance response times. The mean response times were nearly all below NHS targets, and the longest category 4 response was over nine hours against a target of three. The geography of rural Devon, and particularly of my constituency of South Devon, is not conducive to speedy ambulance response times�I would challenge anyone to drive along our hedge-lined rural lanes at speed, even with a blue light flashing�so it is no wonder that figures might be lower than national NHS targets dictate, but while ambulances spend hours waiting at clogged A&E departments, they are not out on the road responding to patients.
I will focus particularly on two areas. The first is the very worrying issue of the proposed relocation of out-of-hours emergency cardiac services from Torbay Hospital to Exeter, which is being proposed by Getting It Right First Time�a programme that claims to present
�a data-driven evidence base to support change.�
Patients in Torbay and South Devon currently face significant delays with ambulances already struggling to meet response time targets, but with the relocation of cardiology services, ambulances will have to travel an extra 20 miles to Exeter after collecting and stabilising a patient, and for those who live in the furthest southern part of my constituency�Dartmouth, for example�this is a significant extra travel time to add to what is already quite a long and slow journey. That extra travel time will delay critical interventions for heart attack patients. For every 30-minute delay to treatment, there is a 7.5% increase in mortality. In other words, that is 15 people out of every 200 who could lose their life because of an extra half-hour delay.
Last week, a dozen cardiologists at Torbay hospital met me and other local MPs. They told us that they have been calling on the local ICB for a year not to go through with the change and that, crucially, no evidence has been presented in a case that would justify the move. They said that even 10 to 15 minutes can literally save a life. We know that quicker response times also mean a better chance of full recovery for patients who get to hospital in time to survive. Most worryingly, South Western Ambulance Service did not know anything about the proposed move. It feels appropriate, while we are discussing ambulance services, to say that that strikes me as wholly unacceptable for a body that wants to �get it right�.
There is growing support for treating strokes as category 1 emergencies, on a par with conditions such as cardiac arrest, due to their time-sensitive nature, which my hon. Friend the Member for Glastonbury and Somerton described. Quicker responses could significantly improve long-term outcomes, reducing the risk of permanent disability or death. The first three hours are critical for intervention as brain tissue continues to deteriorate after that. Faster treatment helps to prevent that damage. Although strokes are in category 2, evidence shows that response times often exceed the ideal timeframe. The average time it takes for an ambulance to arrive and provide care for category 2 calls is often well beyond the optimal window for effective stroke treatment.
In the south-west, the mean time for an ambulance to respond to a cat 2 call was nearly 52 minutes, against an NHS target of just 18 minutes. The longest time was one hour and 53 minutes. Changing the categorisation of stroke could ensure that ambulances prioritise stroke victims as they would a cardiac arrest or a trauma case, which could improve response times and overall care. That would put yet more pressure on ambulance services but, after all the public education campaigns about recognising stroke symptoms�which are very welcome�ambulances are simply not arriving in time to provide the necessary treatment.
Our paramedics and ambulance services have so much to offer, from providing lifesaving urgent medical care to delivering care in the community and driving welcome innovation for the NHS. Yet according to official NHS figures, in the winter of 2023-24 ambulances across England collectively spent a staggering total of 112 years waiting outside hospitals to hand patients over. It is an astonishing and dangerous waste of resources for ambulances to be stuck for hours waiting outside crammed A&Es. As my hon. Friend the Member for Glastonbury and Somerton said, the crisis in our social care system goes a long way to exacerbating bed blocking in hospitals, which is having a direct impact on ambulance services.
The Liberal Democrats are calling on the Government to publish accessible, localised reports of ambulance response times and create an emergency fund to reverse closures of community ambulance stations�which are particularly vital in rural areas�and cancel planned closures where needed. We need a proper plan to fund this crucial part of our NHS, rather than last-minute emergency funding each year during repeated winter crises, which does not enable local trusts and ICBs to plan effectively and efficiently.
Hospice Funding
Caroline Voaden Excerpts(3 months, 1 week ago)
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Karin Smyth
I am delighted to support my hon. Friend in the work that she has been doing with St Michael’s and Demelza hospices. She is absolutely right to highlight that, and I hope that she will be able to meet the staff in the new year and discuss how they can best use some of this funding.
Caroline Voaden (South Devon) (LD)
I wish you, Mr Speaker, and all the House staff, a very merry Christmas.
Following on from the hon. Member for Calder Valley (Josh Fenton-Glynn), next year I will be taking part in a strictly dancing competition for my local Rowcroft Hospice. However, I am pretty sure that, even if all the Members in this House sponsored me, I would not be able to raise the £225,000 needed by Rowcroft to cover the additional national insurance contribution payments that it will have to make. Will this extra funding, which is very welcome, be additional funding, or will it be just enough to cover the extra costs that have been imposed on the hospice sector through the increase in national insurance contributions in the recent Budget?
Karin Smyth
I have to say that dancing is more my style than marathon running, so I wish the hon. Lady luck with that. At least she did not ask me for any money. I refer her to my earlier answer: this is additional money to support the hospice sector. It is a £100 million boost for adult and children’s hospices to ensure that they have the best physical environment for care, and £26 million in revenue to support children and young people’s hospices. We look forward to working with the sector in order to best deploy that in the New Year.
Community Pharmacies: Devon and the South-west
Caroline Voaden Excerpts(3 months, 1 week ago)
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Dr Danny Chambers (Winchester) (LD)
I pay tribute to my hon. Friend the Member for Tiverton and Minehead (Rachel Gilmour) for securing this debate, which is very timely because just yesterday the hospital in Winchester declared a critical incident. It has had so many infectious patients come in with various flus, the norovirus and other infectious diseases that it is short of beds. It has asked people to seek other healthcare arrangements, and has specifically mentioned pharmacies as a place to go for advice.
Alongside providing more social care packages to free up beds, one part of the solution to prevent the yearly NHS winter crisis is to increase the delivery of flu and covid vaccinations well before winter. We have seen that, with the right Government support, our community pharmacies are well placed to deliver vaccinations; they are not just accessible but convenient, and they deliver care right in the heart of a community.
I have been to many pharmacies in and around Winchester, including the Springvale pharmacy in Kings Worthy, the Wellbeing pharmacy on Winchester High Street and the Colden chemist in Colden common. I have spoken to the staff who work there and have heard at first hand that the NHS funding model really isn’t working for them. I was saddened to hear that, although those pharmacists are passionate about their work, they struggle to see how they will remain open for the next 12 to 24 months.
Caroline Voaden (South Devon) (LD)
Pharmacies in two of the major GP surgeries in my constituency, Leatside in Totnes and Compass House in Brixham, have closed in the past year because the private operators could not make a profit. Does my hon. Friend agree that it is urgent that we revise the funding model for prescriptions so that pharmacies, particularly in GP surgeries, can survive?
Dr Chambers
I completely agree. As other Members said, in some cases it costs pharmacies money to dispense NHS prescriptions. That is clearly not viable, especially given that the core NHS funding for pharmacies has been reduced by about 30% since 2015.
Some healthcare providers are really struggling and are on the brink of financial viability. They include pharmacies, hospices and some social care providers. The increase in national insurance contributions will cost the pharmacy industry approximately £50 million extra this year. Once again, we urge the Government to exempt some healthcare providers from the increase in national insurance or potentially repay that money through another mechanism, because it could be a death blow to social care providers, pharmacies and hospices that are on the brink of financial viability.
I thank hard-working pharmacists, such as the hon. Member for North Somerset (Sadik Al-Hassan), who really are part of the community. People come in; they trust them. Pharmacists have a really good personal relationship with their communities. Through the work they do and the hours they work, pharmacies are a lifeline for millions. They provide nearly a third of consultations outside normal working hours. They are often the only point of care for people living in rural areas. As our population grows older and faces increasingly complex health challenges, pharmacies must be empowered to step up and deliver the reliable, flexible care solutions that our communities desperately need.
As we talk about the strain on the public finances and the NHS budget, we cannot be tempted to see primary care—GPs, mental health provision, pharmacies or dentists—as a cost to be cut. We must invest in them and ensure we keep them viable, because it is always more cost-effective to treat people in their communities and prevent them from getting ill than it is to treat them when they end up in hospital.
Infant Formula Regulations
Caroline Voaden Excerpts(4 months, 2 weeks ago)
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The Minister for Care (Stephen Kinnock)
I thank and congratulate my hon. Friend the Member for Blackpool South (Chris Webb) for securing this debate on such a vital matter. He is a true champion for his constituents, and he is rightly concerned about people and families in his constituency who are struggling with the cost of living. I am aware that his constituency experiences high levels of deprivation, which creates challenges for the people who live there.
After 14 years of Tory neglect and incompetence, this Government are committed to improving the lives and health of everyone. However, as my hon. Friend will be all too aware, we have a significant challenge on our hands in transforming our health services so that they work better for the people who need them. When we came to office on 4 July, we made it clear that we would fix our broken NHS. We commissioned Lord Darzi, who published a report that laid bare the true extent of the challenges facing our health service, giving us the frank assessment we needed in order to face those problems honestly and to do the hard work required to fix them. That is why, in the Budget, we announced an additional £25.7 billion of health spending over this year and next.
However, investment works only if it is coupled with reform. That is why we have launched our 10-year health plan, which will address the root causes and fix the foundations by investing in preventive care, expanding mental health services and modernising NHS infrastructure to radically reform the NHS based on three seismic shifts: from hospital to community, from sickness to prevention and from analogue to digital. Our health mission also aims to reduce the time people spend in ill health by tackling health inequalities and driving economic growth.
My hon. Friend will be aware that children are at the centre of our health mission and that we are committed to raising the healthiest ever generation of children. Infant feeding is critical to a baby’s healthy growth and development. We are committed to giving every child the best start in life, and that includes helping families to access support to feed their baby. The family hubs and start for life programme is central to that. Through that programme, 75 local authorities across England are improving their infant feeding support for families, including breastfeeding support. Those services are helping parents to access face-to-face and virtual support whenever they need it, and in a location that suits them, be that in their home, their family hub or a hospital setting. We want to build on the actions that local areas are already taking through the programme, so that families can access the support they need when they need it to meet their infant feeding goals.
Breastfeeding has significant benefits for mothers and babies, but breastfeeding rates in England remain low compared with those in other countries. Data shows that around 53% of babies were breastfed at six to eight weeks, but that that dropped significantly by six months. My hon. Friend will know that in response to concerns about breastfeeding internationally, the World Health Organisation instigated an international code to promote breastfeeding and restrict the inappropriate marketing of breast milk substitutes that can discourage breastfeeding. The UK Government are absolutely committed to implementing that code.
Although breastfeeding has significant health benefits, we recognise that it is vital that families who cannot or choose not to breastfeed have access to infant formula that is both affordable and high quality. The price of infant formula has been brought back into the spotlight with the publication of the Competition and Markets Authority’s interim report last week on competition in the infant formula market. It highlighted the fact that the price of some infant formula has increased by more than 25% in recent years, and as my hon. Friend pointed out, parents and carers have had to bear the brunt of those price increases.
The Government’s infant formula regulations do not set the price of infant formula, which is agreed by infant formula manufacturers and retailers. Instead, they ensure that parents and carers have access to the highest quality and safe infant formula. The regulations cover infant formula and follow-on formula, which covers the first 12 months of a baby’s life. They require all infant formulas to comply with robust nutritional and compositional standards, meaning that they meet all the nutritional needs of babies, regardless of price or brand. However, the regulations rightly restrict the inappropriate marketing and promotion of infant formula. That is because there is considerable evidence that advertising directly to the consumer influences people’s decision on how to feed their babies.
My hon. Friend has raised questions about loyalty card points and vouchers from food banks or local authorities being used for purchasing infant formula. The regulations seek to restrict inappropriate marketing techniques that induce the sale of infant formula, including special sales or discounts, so as not to discourage breastfeeding. Loyalty card points on their own are not contentious within the infant formula regulations, and the regulations do not specifically mention them. I agree that consumers should be able to use their loyalty card points to achieve a saving on their shopping. However, my hon. Friend will be aware that numerous loyalty and reward card schemes are available, and they vary significantly between retailers. Some may offer special discounts beyond awarding loyalty points. Loyalty card points should not be used as an incentive or as a reward to purchase infant formula. There is unlikely to be a one-size-fits-all approach, and it is for businesses to ensure that their activities are in compliance with the regulations.
My hon. Friend asked about food banks, and I wish to be clear that the regulations do not prohibit infant formula from being distributed via food banks, including where they may issue vouchers to families. Food banks set their own policies on whether to distribute infant formula. I recognise the important role that they play in supporting some of our most vulnerable families. We have published guidance to businesses on the regulations, and can provide further clarity on those issues where needed.
My hon. Friend rightly mentioned the CMA’s report, and I wish to address that in more detail. The CMA looked at competition across the infant formula sector, including the regulatory framework, consumer behaviour and manufacturer behaviour, and it assessed the impact on market outcomes. It concluded that multiple factors are resulting in poor market outcomes for consumers, including the behaviour of infant formula manufacturers and retailers, and that those require a response beyond the regulations alone. The CMA has been clear that it recognises the public health importance of the regulations, and that they ensure that all infant formula is suitable for meeting the health and development needs of babies, regardless of price. However, it suggests that restrictions in the regulations on price promotions may be softening competition on prices, and it is also concerned about enforcement of the regulations.
Furthermore, the CMA is concerned that parents and carers are not being provided with sufficient information to make well-informed choices, and that their choices are often made in vulnerable situations after giving birth in healthcare settings. In these circumstances, they are unable to make choices that best meet their needs and budgets. The CMA has other market-based concerns about infant formula being indirectly promoted by infant formula manufacturers via the marketing of follow-on formula and growing-up milks, and about how statements on products may influence parent and carer choices.
To understand how the visibility of products online, in-store and in hospitals drives choices, the CMA commissioned qualitative research, which it published alongside its interim report. We will be carefully considering all the issues and options put forward by the CMA as it develops its final recommendations for Government early next year.
I understand that many families are struggling to meet the cost of feeding their baby, and the Government are committed to helping families most in need to access support. The Budget announcement on extending the household support fund will help those facing financial hardship with the cost of essentials. The Government’s Healthy Start scheme promotes a healthy diet for pregnant women, babies and young children by providing funds that can be used to buy or be put towards the cost of infant formula, as well as fruit and vegetables, pulses and milk. My hon. Friend has suggested that the value of the Healthy Start scheme should be increased. He may be aware that in April 2021, the value of the scheme increased by 37%.
Caroline Voaden (South Devon) (LD)
The Government have repeatedly said that they will not consider lifting the two-child benefit cap, but as we have been hearing from Members, the cost of infant formula can be prohibitive for parents who are not particularly well off. Will the Minister again consider lifting the two-child benefit cap, which we know is the biggest driver of child poverty in the UK? That would mean that fewer parents face difficult choices when it comes to paying for good-quality food.
Stephen Kinnock
When this Government came into office on 4 July, we inherited the worst public finances since the second world war. We were elected on the basis of a manifesto that stated we would return fiscal responsibility and discipline to the management of the British economy. All of that means that we have had to take some hard choices. I do not think that a single member of the parliamentary Labour party wants to have the two-child cap in place, but the reality is that the profound irresponsibility and recklessness of previous Conservative Governments has left us with no choice but to take some difficult decisions. I hope that as we start to instil fiscal responsibility and bring growth back into our economy, we will be in a position to look again at the public finances, but we have to take it one step at a time because of the catastrophic situation left to us by preceding Administrations.
On the Healthy Start scheme, I add that pregnant women and children under four and over one each receive £4.25 a week, and children aged under one each receive £8.50 a week.
I once again thank my hon. Friend the Member for Blackpool South for raising this really important matter. I fully appreciate that there is no quick fix to reduce the prices of infant formula, which are set by manufacturers and retailers, but I have outlined the help available through Healthy Start for eligible families. I want to assure him that we are committed to addressing the concerns raised by the CMA so that the infant formula market delivers the better outcomes that parents deserve.
Question put and agreed to.
NHS Dentistry: South-west
Caroline Voaden Excerpts(4 months, 2 weeks ago)
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Richard Foord
The hon. Member for Tiverton and Minehead has clearly done her homework. It is quite staggering that recommendations from that long ago are still not implemented.
Caroline Voaden (South Devon) (LD)
Lord Darzi said in his review of the NHS that
“urgent action is needed to develop a contract that balances activity and prevention, is attractive to dentists and rewards those dentists who practise in less served areas”
such as mine in South Devon, where not a single dentist is taking on NHS patients any more. Would my hon. Friend agree that we urgently need a timeline for this work to be done?
Richard Foord
Yes, I think so. My hon. Friend is right to point to some of the recommendations in the Darzi report. I was encouraged to see reference to neighbourhood hubs, where perhaps we can have delivery of primary care, such as NHS dentistry, nearer to the constituents we represent.
Access to Primary Healthcare
Caroline Voaden Excerpts(5 months, 1 week ago)
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Caroline Voaden (South Devon) (LD)
I feel as if we are playing a game of Top Trumps with who has the worst dental services, but services in South Devon have been so badly neglected by the Conservative Government that we live in one of the worst dental deserts in the UK. NHS dentists in Totnes, Dartmouth, Brixham, Paignton and South Brent have closed, leaving thousands of my constituents, many suffering severe dental pain, with no choice but to pay extortionate private dentists for help.
One of my constituents said:
“My daughter is 18, a student at college, and I am on ESA. We lost our NHS dentist 2 years ago in Totnes. We took the decision to go on a basic payment plan that gives us one check-up and hygienist visit as I have gum disease. We can’t really afford it. On a visit to the dentist today we were hit with a £160 bill for a small filling that my daughter will need. I had to pay £80 upfront. This is our food money for the next 2 weeks gone, and will be the same again when she returns for her appointment in October. We will have to use the food banks to eat this month.”
Another told me she has a regular infection in her wisdom teeth that requires constant antibiotic treatment, and she has been told that it will cost £5,000 to remove them, or she will have to wait two more years for NHS treatment.
The state of dentistry in South Devon is absolutely shocking. There are currently no dentists taking on new NHS patients—not one—in a constituency of more than 300 square miles. It is shameful that there are not more Conservative Members on the Benches beside me to hear this. People in Devon and Cornwall are waiting 1,441 days on average just to register with a dentist. That is four years. The new Government have talked about the benefits and importance of preventive healthcare, and nowhere is that more clear than in dentistry. It is not just about filling cavities and giving someone a nice smile. We know there are links between gum disease and cancer. A poor oral microbiome can increase the risk of stomach and colorectal cancer.
We also know that visits to the dentist as a child increase the chance of a lifetime of good oral hygiene. Liberal Democrat research has shown that in the past five years, more than 100,000 children have been admitted to hospital with tooth decay. That is absolutely not what our hospitals need after 14 years of neglect from the Conservatives and with a system that is completely overwhelmed. The Government must immediately renegotiate the NHS dental contract. Has the Minister considered increasing the units of dental activity to stabilise dental practices immediately, before more of them go under? The Government must guarantee appointments for all those who need a dental check before commencing cancer treatment or chemotherapy, and they must support preventive dental healthcare. Preventive care will always be less costly than the extensive treatment required later in life if people do not get into good habits at a young age.