Oral Answers to Questions

Charles Walker Excerpts

Tuesday 5th March 2024 Commons Chamber

[Maria Caulfield]

I thank the hon. Lady for raising her concerns, but as I said, this is a public consultation. It runs for 14 weeks and will close on 17 March. I urge her to raise her concerns as part of that consultation. It is absolutely crucial that we keep expertise in our maternity services, but I understand that the local proposals by the trust and the integrated care board outline plans for £40 million of significant additional investment into maternity services. Those decisions are for the local ICB and the local trust. The deadline is 17 March, and I urge the hon. Lady to ensure she takes part in that process.

[Sir Charles Walker (Broxbourne) (Con)]

Remaining in north London, can I bring to those on the Treasury Bench my concern over the quality of nursing care at Barnet Hospital? An elderly constituent of mine, who is in her 80s, was admitted there recently. She asked to use the lavatory but was told no one could take her, and was handed a nappy; she waited three hours until someone could actually take her to the loo. She is a coeliac, but was not offered any food for coeliacs during her 10-day stay because nobody had read her notes. She was also moved around her bed by her arms despite having a broken shoulder, which nobody knew as nobody had read her notes.

[Maria Caulfield]

I am very sorry to hear about the experience of my hon. Friend’s constituent. That level of care is absolutely unacceptable. I know he has raised this particular issue with the Patient Safety Commissioner, Henrietta Hughes, but I am very happy to meet with my hon. Friend and his constituent to discuss those complaints, because that care is not acceptable.

North Tees and Hartlepool NHS Foundation Trust

Charles Walker Excerpts

Tuesday 27th February 2024 Westminster Hall

[Alex Cunningham]

Can I wind up, Sir Charles?

[Sir Charles Walker (in the Chair)]

No, not in a half-hour debate.

Question put and agreed to.

Oral Answers to Questions

Charles Walker Excerpts

Tuesday 11th July 2023 Commons Chamber

[Maria Caulfield]

I absolutely pay tribute to the school in the hon. Gentleman’s constituency. I also point out that Red Kite View is a new unit specifically for young people in his constituency. That 22-bed mental health unit opened last year and aims to eliminate out-of-area placements for young children with mental ill health. I am sure that he would welcome that investment in his constituency.

[Sir Charles Walker (Broxbourne) (Con)]

The Joint Committee on the Draft Mental Health Bill reported back in January this year. One of the most important recommendations we made was about how people, during a period of wellness, could set out how they wish to be treated during a period of illness. The Government have yet to respond to the Joint Committee, but can we have a mental health Bill in the forthcoming King’s Speech, please?

[Maria Caulfield]

I thank my hon. Friend for raising that issue. There were many recommendations during pre-legislative scrutiny. We are working through those and we hope to be able to respond fully shortly after the summer recess.

Defibrillators: Public Access

Charles Walker Excerpts

Tuesday 4th July 2023 Westminster Hall

[Sir Charles Walker (in the Chair)]

I reassure the hon. Member, as Chair of the Administration Committee as well as Chair of this proceeding, that we will certainly look at her request around defibrillators on the estate. An email is being sent to the Clerk now. I remind Members who want to speak to bob up and down.

--- Later in debate ---

[Dr Rosena Allin-Khan (Tooting) (Lab)]

It is a pleasure to close for the Opposition with you in the Chair, Sir Charles. I thank my hon. Friend the Member for Erith and Thamesmead (Abena Oppong-Asare) for bringing forward this debate. She never ceases to bring the voice of her constituents right to the heart of this place, and today is yet another shining example her doing her community incredibly proud.

It is welcome that there is such unity and consensus on this issue. As we have heard, tremendous progress has been made towards making defibrillators accessible to the public, thanks to the many incredible charities and people who have been working hard to do so. The Community Heartbeat Trust, the Oliver King Foundation and SADS UK are just some of the organisations that are doing brilliant work to provide education and information about automatic external defibrillators, AEDs, and to ensure that more defibrillators are easily accessible in public spaces.

The British Heart Foundation’s Circuit project has ensured that thousands of defibrillators and their locations are registered online, but, as we have heard, that work needs to go further. People who experience the very worst in the heart of their communities need to know that they are able to find and access an AED when they so desperately need it. The Premier League defibrillator fund will provide AEDs to grassroots clubs, which is very welcome and will ensure that lifesaving treatment can be rolled out to even more stadiums.

As we have heard, in the UK one person dies every three minutes from heart or circulatory disease, and 60,000 out-of-hospital cardiac arrests occur every year. Take a minute to think about that. My hon. Friend the Member for Erith and Thamesmead quoted research published by the National Institute for Health and Care Research, which found that just over 8% of people suffering a cardiac arrest outside hospital survive—just 8% of the 60,000 out-of-hospital cardiac arrests. The same research found that the odds of survival increase to 32% if a bystander has access to a public AED, and some studies place that figure even higher. It is simple: AEDs save lives.

According to the British Heart Foundation, the low cardiac arrest survival rate in Britain can be attributed to a lack of access to defibrillators. This critical technology must be accessible to work. With my medical hat on, I will take a moment to explain how it works. CPR works to send the blood around the body to take oxygen to the tissues as a holding measure, but the AED is required to shock the heart and try to restart it again so that it can pump the oxygen around the body. Imagine somebody providing non-stop CPR for hours on end. Not only would that be far too long and the person would be brain dead at the end, but without an AED—without that shock delivered to the heart—CPR is actually pointless.

We must be clear: AEDs are simple, safe and effective. They are portable, have plain instructions and the user cannot give a shock accidentally or hurt somebody. From my professional experience in the emergency department, I know how important quick access to treatment is for patients in cardiac arrest. There can be no doubt that patients who are admitted to hospital after having received prompt treatment with chest compressions or, even more effective, a defibrillator have far improved chances of making a recovery. There is also an economic benefit, because the people whose chances of recovery are worse may spend a long time in an expensive intensive care bed, often not surviving at the end of it. That makes the argument for giving people a better outcome in the first place, which prevents those protracted stays in intensive care and saves money in the long run.

When the heart stops beating, every second counts, and a person’s chance of survival decreases by approximately 10% with every minute that defibrillation is delayed. That speaks to the importance of everyone knowing where the AEDs are. With our NHS in crisis and emergency care at breaking point, lives are being endangered. In December last year, the average ambulance wait for category 1 patients had increased to 10 minutes—the worst performance on record. Those stats make a very clear argument: the painful fact is that people are dying as a result of not being able to get the shock they need from a trained person, whether they arrived in an ambulance or came from an AED in the vicinity.

Category 1 patients are the most serious and life-threatening cases, including cardiac arrest. In a category 1 scenario, every second is the difference between life and death, and longer ambulance waits are costing lives. Sadly, after 13 years of Conservative governance, patients can no longer rely on an ambulance arriving in time. At the end of last year, one in 10 urgent cases waited over 11 hours for an ambulance. How can we in all conscience say to people who lost loved ones in such cases that their loss could not have been avoided, when we know full well that it could have been?

Last year, the Government committed to funding a defibrillator in every state-funded school in England by the end of the academic year. As the academic year is nearing its end, will the Minister outline what progress has been made on that commitment? The Government also committed last year to £1 million of funding to provide an estimated 1,000 public access defibrillators across communities in England. I note that the Department re-announced that policy just last week, so has there not been any progress on that commitment? Will he update us on how the application process is progressing and whether any PADs have been installed, and if they have, in which communities? It is crucial that they are placed in communities where the need is greatest to tackle growing health inequalities, which we have heard about extensively today.

It is really important that health inequalities are not allowed to widen any further through a lack of access to equipment that could save lives. That has to go hand in hand with training people in how to use them. I would be interested to know what work the Department is doing to encourage uptake in the communities that are most in need. While many of us will agree that public access to defibrillators will be a fantastic step towards saving lives, we must not forget that our country also deserves a well-funded, well-resourced and well-supported NHS. It is heartening that there is widespread, cross-party support for publicly accessible AEDs. I hope that the Government will build on the support from across the House and do what is needed to ensure that access is available.

[Sir Charles Walker (in the Chair)]

I remind the Minister that if he takes up the full time he must leave two minutes for the mover of the motion to wind up.

--- Later in debate ---

[Will Quince]

I totally agree. I will check whether registering will be among the conditions for grant funding; I would like to think that it will, and I will work with the Minister for Social Care to ensure that it is. We know that there are many defibrillators that are not on The Circuit, and—short of legislating, which would not be a quick or easy solution—we have to get them on it as quickly as possible. We have to urge as many organisations and individuals as possible to register.

The hon. Lady asked what steps we are taking to promote that. I recently wrote to all local authorities to ask them to check and, if they have not done so already, to consider adding their defibrillators to The Circuit. I also asked them to reach out and share that message with parish councils, town councils, community groups, village halls, businesses and others that may have a defibrillator that is not registered on The Circuit. I am keen to work with local authorities, which have a reach into their communities that neither central Government nor the national charities could possibly have. I also urge all right hon. and hon. Members to encourage those organisations that have a defibrillator to ensure that it is registered. I join hon. Members in paying tribute to and congratulating the Daily Express on its important campaign, which I am happy to support.

I hear what the hon. Lady says about raising more public awareness about AEDs and where they are located, not on just the parliamentary estate but across communities and the country. I will continue to look at what more we can do centrally, but also by working with national and local charities, to raise that awareness.

The hon. Member for Plymouth, Sutton and Devonport asked about businesses. Some organisations—such as the Premier League, which the hon. Member for Erith and Thamesmead referred to—are leading the way, but we want to encourage more to do so. I will give further thought to how we can encourage other businesses to do the same.

The hon. Member for Tiverton and Honiton asked about first aid, and particularly about CPR. Better awareness and education around first aid training is key to improving survival rates from cardiac arrest. I am pleased that NHS England has partnered with St John Ambulance to, in effect, co-ordinate skills development to significantly increase the use of AEDs by individuals in community settings. That includes a national network of community advocates to champion the importance of first aid training. The plan is to reach 60,000 people, which will help to save up to 4,000 lives each year by 2028, empowering local communities to act more quickly to save people’s lives.

Finally, I cannot speak about cardiac arrest without speaking about prevention, which the hon. Member for Plymouth, Sutton and Devonport referred to. The prevention of heart disease is critical to reducing the number of sudden cardiac arrests. I will set out some of the work that NHS England is doing to reduce preventable deaths from heart disease. Currently, £2.3 billion is being spent to increase the number of centres diagnosing heart disease to at least 100 sites by March 2025. NHS England has developed a new fast-track echocardiography training scheme, which has led to 150 additional echocardiographers, with further support available in 2023-24.

The NHS health check programme, which the Secretary of State recently spoke about, is a core component of NHS England’s CVD prevention pathway. Over 15 million people are eligible for a NHS health check every five years. For every 1 million checks delivered, the NHS health check could prevent an estimated 400 heart attacks and strokes. Something like 10.8 million checks have been delivered between 2013 and December 2022, but it is important that we work hard to ensure that more people benefit from that lifesaving service and get a health check. I am keen that we make it easier and more convenient for people to do so.

I hope that today I have demonstrated the Government’s commitment to increasing the number of AEDs in our local communities. I am keen to see how we can turbocharge that and work with businesses and local communities to go much further. We can all agree that this agenda really matters. Once again, I thank the hon. Member for Erith and Thamesmead for highlighting this vital issue. I look forward to working with her to bring about the change in this area that we all want to see.

[Sir Charles Walker (in the Chair)]

I invite the hon. Member who secured the debate to wind up for up to two minutes.

National Strategy for Self-Care

Charles Walker Excerpts

Tuesday 26th April 2022 Westminster Hall

[Sir George Howarth]

As the hon. Lady is aware, I spoke to her constituent about that point earlier today. She makes a good point and I agree with her, and I would add that it is important that those who use technology are properly trained in how to use it best. The devices need to be reliable, so that technology can provide effective help with these conditions.

Those with type 1 diabetes who also struggle with eating disorders experience problems if they omit to take their insulin in order to lose weight. I know that you are familiar with this issue, Sir Charles. The right hon. Member for Maidenhead (Mrs May) and I will shortly carry out an inquiry into this growing problem, with the support of JDRF. We hope to point to how self-care can play an important role in dealing with this worrying trend. Hon. Members may be aware that there is a storyline in the soap opera “Coronation Street” that covers this subject. It has not yet concluded, but it offers a helpful perspective of how the problem has arisen, what it is and what the dreadful consequences can be.

I will refer to the recommendations from the report following the roundtable I chaired in October 2019. First, the Department of Health and Social Care should develop a national self-care strategy. Secondly, NHS England and Improvement should explore the implementation of self-care recommendation prescriptions, to support clinicians to discuss self-care with patients and refer them towards it. Thirdly, primary care networks should consider ways to improve self-care in local populations as part of the development of the network across the local health system. Fourthly, NHS England and Improvement should enable community pharmacists to refer people directly to other healthcare professionals. That has become even more apparent during the covid-19 pandemic.

The fifth recommendation is that NHS England and Improvement should support moves towards community pharmacists being granted read and write access, to give them full integration and interoperability of IT systems as part of local health and care records partnerships, and promote national support for such data-sharing agreements. That would unlock the door to a hugely increased, positive role for community pharmacies. Sixthly, the Government and royal colleges should include in the healthcare professional curriculum and the national curriculum self-care modules that can be delivered sustainably by schools. Finally, NHSX should explore technologies that could be used to promote self-care and manage demand on the NHS.

Before concluding, I would be grateful if the Minister, or his colleague, could consider some questions. It is not necessary for them to be answered today; theyj could respond by letter if that would be more effective. First, will the Minister undertake to look closely at the recommendations for a new self-care strategy? Secondly, will he give consideration to the report’s seven recommendations, which I referred to earlier? Thirdly, will he agree to meet a representative group of healthcare professionals, other interested parties and me to discuss potential ways forward? Finally, will he meet diabetes charities, the right hon. Member for Maidenhead and me to discuss the relevance of the two conditions—it is often overlooked that type 1 and type 2 diabetes are two distinct conditions—and to explore how the condition can serve as an example for self-care management? I look forward to the Minister’s response.

[Sir Charles Walker (in the Chair)]

I thank the right hon. Gentleman for his speech and for the support that he has given to two of my constituents—Neal and Lesley Davison. Perhaps I might tag along to one of those meetings with him.

[Peter Dowd (Bootle) (Lab)]

It is a pleasure to be under your stewardship, Sir Charles. I thank my right hon. Friend the Member for Knowsley (Sir George Howarth) for securing the debate.

We all know that people have self-cared in one fashion or another for thousands of years. Personally, I think that self-care starts with mental health, which can often be forgotten in strategies. The old Hippocratic approach was to be in a good frame of mind: a healthy mind produces a healthy body, and that is as pertinent today as it was more than 2,000 years ago. A self-care strategy should take a holistic approach that covers lifestyle, diet, as my right hon. Friend has said, and exercise, and a person’s state of employment is also a factor. They must all be taken into account by strategies dealing with self-care, because this is about not just people’s physical health, but their social and economic health.

On the point made by the hon. Member for Glasgow Central (Alison Thewliss) about self-care, I do not think that self-care means self-isolation as far as healthcare is concerned. It is about sharing care. It is also important that people use the healthcare system responsibly. Some referrals to GPs and hospitals could be considered inappropriate—I think my right hon. Friend the Member for Knowsley touched on that—with people turning up and putting a strain on the system. We have a personal responsibility to ensure that the health service is used in the most appropriate way. That is not to dissuade people or tell them not to go to the GP, but it is a factor that must be taken into account. There must be a system that assists in self-care so that people feel empowered and, crucially, safe, as the hon. Member for Glasgow Central referred to, when making decisions about self-care.

We have also got to take into account those people who cannot self-care and need support from family or carers who are, in effect, proxy self-carers, if I may use that phrase. A strategy must also include a safety net for people who are not in a position to self-care as much as they would like.

The World Health Organisation has an excellent prospectus on self-care. It straddles many different cultures and countries, but broadly talks about self-management, the use of self-testing and, importantly, self-awareness, which goes back to one or two of my earlier points.

I welcome the 2019 clinical consensus statement on self-care, which sets out seven recommendations, as touched on by my right hon. Friend the Member for Knowsley. More recently, “Realising the potential: Developing a blueprint for a self-care strategy for England” sets out nine themes.

In the current climate there are huge stresses on the health service and on people’s mental health and, subsequently, their physical health, partly because of covid and partly because of their individual social and economic circumstances. A care strategy must take into account societal movement and those social and economic factors that impinge on people’s health, so that, in helping people to self-care, we must also have a net in place to ensure that that self-care is safe.

[Sir Charles Walker (in the Chair)]

I will call the shadow Minister shortly. There is usually a five-minute limit for the Opposition spokesperson, but as we have quite a long time left, if the hon. Lady would like to speak for longer, she can do so, although she is under no obligation to do that. I am sure the Minister would not mind either.

[The Minister for Health (Edward Argar)]

It is like being back in Committee.

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[Karin Smyth]

Absolutely. I refer back to one of my favourite pieces of legislation, the Health and Social Care Act 2012; one of the many terrible things that that Act did was to demote the role of pharmacists in local communities and affect the support they were given by primary care trusts. In my area, we had a huge team supporting pharmacies who were very much part of that local community offer. I hope that the integrated care systems recognise that that was a mistake. We have lost a decade and really should be working much more closely together. Pharmacies exist in most areas and are easy for local people to access. They can give people confidence to look after themselves and the literacy that I mentioned.

It is vital that people receive a consistent message about self-care when they look at NHS services online, call 111, or visit a GP or local pharmacist, and that requires local systems to work together. A national self-care strategy would help to embed consistency across the country. As has been mentioned, self-care is a continuum that covers adopting healthy lifestyle choices and managing long-term health conditions, be they mental or physical. We must ensure that health literacy and targeted actions to tackle health inequalities take account of the systemic barriers in place for many people who wish to live a healthier lifestyle, particularly given the rising cost of living. I look forward to hearing from the Minister about how the Government’s upcoming White Paper on health inequalities will consider the issue.

We need to remember that self-care is for everyone at all stages of life. Educating children through programmes in school is an important part of that. As I said earlier, the confidence to manage our own health with appropriate support is as important for someone in a care home as it is for a parent looking after a new baby or for children growing up, particularly those growing up with long-term conditions.

Empowering and enabling us all to take charge of our health, be that through using digital interventions, improving health literacy or providing greater support for self-care, is important not only for the long-term sustainability of the health and care service, but for patients. We must ensure that the system does not inadvertently disempower people or result in gaps in the care pathway. I very much look forward to hearing the Minister’s thoughts on this.

[Sir Charles Walker (in the Chair)]

Minister, you have been seeing rather a lot of the right hon. Member for Maidenhead (Mrs May) recently, so no doubt you are looking forward to your next meeting with her.

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[Edward Argar]

I am grateful to the right hon. Gentleman for that typically courteous intervention. A lot of what we are seeking to do in this area comes back to the refresh of the NHS long-term plan, which will have to happen in the context of what we have seen during the pandemic. The hon. Member for Bristol South highlighted the health inequalities White Paper, which will come forward in due course. There is a genuine opportunity to use that White Paper to draw a number of these elements together.

I am conscious that the right hon. Member for Knowsley had six other key recommendations, which I will address briefly. I will say a little bit about community pharmacy before I turn to meetings. He raised the issue of building on the successful community pharmacist consultation service, and exploring additional pathways to access that service through the implementation of self-care recommendation prescriptions to support GPs and other professionals to appropriately refer patients to self-care. Rather than taking the issue of community pharmacy separately, I will address it in response to this point, because that is probably the neatest way to do so.

I fully recognise the value of community pharmacy, and the hon. Member for Bristol South also rightly highlighted its importance. My first official engagement when I took on this job in 2019 was to attend, in lieu of the Pharmacy Minister at the time, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), the Pharmacy Business Awards ceremony, which recognised community pharmacies that had done amazing work in their communities, such as the one the hon. Member for Bristol South highlighted.

As constituency Members of Parliament, we all know the depth of expertise and local knowledge that our community pharmacies bring to the communities they serve, and we know just how well regarded they are by our constituents as friendly, accessible sources of advice. Constituents do not have to be there first thing in the morning, and they do not have to make an appointment. They can stroll in and talk to a pharmacist who can give them genuinely helpful advice, without having to wait. I put on record my gratitude, and I suspect that of all hon. Members, to community pharmacies.

We are increasing our potential to expand the Community Pharmacist Consultation Service to urgent treatment centres and A&E departments. It has already taken just shy of 184,000 referrals from GPs, which, as hon. Members have suggested, is of benefit to our general practitioners, who can better manage their workload, given that some people do not need to see a GP. We are promoting the uptake of that service and incentivising its use through the GP contractual arrangements. Negotiations with the PSNC on what community pharmacy will deliver in 2022-23 as part of the five-year deal are ongoing, and hon. Members would not expect me to prejudge those negotiations. As soon as they conclude, we will announce the arrangements so that Members can consider and scrutinise them as they see fit.

The right hon. Member for Knowsley talked about primary care networks. I know the value of primary care networks. My own GP in Leicestershire is actively involved in the PCN. We saw their potential to do amazing things during the pandemic when they supported our communities with the vaccination programme and in a whole range of ways. He is right to highlight their potential to consider ways to improve self-care in their local populations as part of their network development. I hope that the soon-to-be-statutorily-constituted ICSs and ICBs will also take that very seriously, obviously subject to the other place and their deliberations later this evening.

I know from my own GP, who I regularly speak to, that many local health systems are proactively exploring upstream prevention initiatives across the health and care system and looking for further partnership opportunities to support people to improve their overall health and care outcomes. Clinical commissioning groups—soon to be ICSs—and NHSEI regionally also have the option to commission a local minor ailments service in addition to CPCSs. I hope they will explore those options as they go forward—particularly ICSs.

The fourth recommendation was that NHSEI should enable community pharmacists to refer people directly to other healthcare professionals where self-care is not appropriate, enhancing the role of pharmacists as a first port of call for healthcare advice. I entirely agree with that. There is an educational point as well in making people aware that they can go to their pharmacists. Equally, all community pharmacists are required under the terms of service to signpost people to other health and social care providers and support organisations as appropriate. There is, I suspect, more we can do in that space, but I think we have an extraordinary resource there at our disposal. NHSEI is accelerating efforts to enable community pharmacists to populate medical records and give them full integration into operability of IT systems as part of LHCR partnerships and national support for data sharing.

Data and the sharing of data in this space is, as all hon. Members know, a vexed and complicated subject, but when got right, it holds incredible potential for improving health outcomes and care. NHSX is leading the Government’s plans that will see the development of interoperable NHS IT systems that integrate health and care records, while of course considering issues that the hon. Member for Bristol South brought up in Committee when we were discussing similar matters—issues such as patient consent and data security.

We are very clear in our view that community pharmacy must play an enhanced role in the healthcare of our country, and it is our responsibility and NHS England’s responsibility to help support that. The right hon. Member for Knowsley made two final recommendations about meetings. The Government should promote a system-wide approach to improving health literacy, including working with royal colleges to include self-care modules in healthcare professionals’ training curricula and continuous professional development. I touched on that point in my response to his intervention. I have had many helpful and positive meetings with the royal colleges. I seek to meet them regularly—perhaps not as regularly as I would like, given the pressure of business in this place at times—because they have a depth of knowledge that is incomparable and incredibly useful.

Public Health England, when it was around, undertook a programme of work to improve health literacy across the country, and the Office for Health Improvement and Disparities will continue to work on that issue. The pharmacy integration programme will deliver a further almost £16 million-worth of post-registration training. That investment will equip pharmacy teams across primary care so that they are better prepared to support wider integrated healthcare delivery and expand their role in providing clinical care to patients. A pharmacist independent prescriber can provide autonomously for any condition within their clinical competence, with the exception of certain controlled drugs, particularly for the treatment of addiction. To become an independent prescriber, pharmacists must complete additional qualifications, which last typically six months, before they can prescribe.

In 2021, the General Pharmaceutical Council introduced new professional standards for initial education and training to ensure that the next generation of pharmacists is equipped with essential clinical skills. A key theme running through all the contributions today is that, when a resource is used, there can still be an untapped element of it that can be better utilised to provide support, alongside education, self-care and all the things we can do as individuals, to provide confidence and professional expertise.

NHSX should evaluate the use of technologies that have been developed during the covid-19 pandemic, and develop them to cover a wider range of minor ailments to promote self-care and manage demand on the NHS. I alluded to one example that we are working on. The Department is working with NHS Digital and NHS England and Improvement to encourage innovation and enable new approaches and organisations to support services and collaborate effectively.

I hope that, as someone whose policy area this is not, I have addressed at least in outline some of the right hon. Gentleman’s key recommendations. He made specific requests about meetings. I am always wary about that, because I have discovered that when I have meetings with my right hon. Friend the Member for Maidenhead (Mrs May) and you, Sir Charles, I come out having agreed to something or changed the direction of a policy, after being persuaded by both of you. I know that the right hon. Member for Knowsley is equally persuasive. With that in mind, I am happy to ask the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes, to arrange to meet the right hon. Gentleman, my right hon. Friend the Member for Maidenhead and you, Sir Charles, to discuss this issue more broadly.

The right hon. Member for Knowsley also asked for a meeting with Diabetes UK and the relevant Minister. I will certainly pass that on to the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes. In the context of the elective recovery work and my work with the NHS more broadly, I have met a number of charities in the course of developing the elective recovery plan and since we published it. I am always happy to meet charities and other organisations that do so much not only to educate people and campaign on issues, but sometimes to press us in particular directions. They always do so with good intentions and to support people. In that context, I have also met trade unions and other bodies, because I believe that a collaborative approach in this space is useful. I will pass the request on to the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes, but if the right hon. Member for Knowsley feels that this could also fall within the ambit of elective recovery or of my role as Minister sponsoring the NHS long-term plan, I will of course, framed in that way, also be happy to meet Diabetes UK—I have met many charities in recent months.

If that does not provide the right hon. Gentleman with immediate agreement on what he called on the Government to do, I hope it provides him with some reassurance of just how seriously we take this issue and the recognition of just how important self-care is for each of us as individuals, for our constituents, for our healthcare system and indeed for this country. And I am very grateful to him for bringing the matter before the House today.

[Sir Charles Walker (in the Chair)]

I call Sir George to sum up, for no more than two minutes.

[Sir George Howarth]

Thank you, Sir Charles, for calling me to sum up.

First, I thank everybody who has taken part in this debate: my hon. Friend the Member for Bootle (Peter Dowd), the hon. Member for Glasgow Central (Alison Thewliss), my hon. Friend the Member for Bristol South (Karin Smyth), who is the shadow Minister, and the Minister himself. As I had hoped it would be, it has been a constructive debate. Although the Minister did not quite go as far as agreeing with me on every single point that I made, he showed a degree of understanding and presented what he had to say as constructively as everybody else’s contribution was. He was unfailingly polite, although I have learned through bitter experience that Ministers can be unfailingly polite and then go away and forget all about the matter that has just been discussed. However, I am sure that will not be the case now.

I am grateful and I see this debate not as the end of a process but as its beginning, and I am pleased that the Minister has nodded in agreement with that comment. And believe me, we will take up his offer of various meetings to progress these matters, including with your good self, Sir Charles.

[Sir Charles Walker (in the Chair)]

Well, that debate was a pleasure to chair; it really was.

Question put and agreed to.

Resolved,

That this House has considered the potential merits of a national strategy for self-care.

Oral Answers to Questions

Charles Walker Excerpts

Tuesday 19th April 2022 Commons Chamber

The Secretary of State was asked—

[Sir Charles Walker (Broxbourne) (Con)]

1. What steps his Department is taking to meet its target of England being smoke-free by 2030.

[The Secretary of State for Health and Social Care (Sajid Javid)]

I know that my hon. Friend has long been a passionate advocate for a smoke-free England, and I read his recent Westminster Hall debate with interest. Some 64,000 deaths a year are attributed to smoking and it is one of the greatest drivers of health disparities in our country. I am personally determined that we should do everything we can to reach the Government’s ambition of a smoke-free 2030. That is why, in January, I asked Javed Khan to lead an independent review into tobacco control. Once that review is complete, the Government will set out their next steps.

[Sir Charles Walker]

To get to a smoke-free 2030, for every 100 people smoking today we need to reduce that figure by eight, because “smoke-free” actually means 5% or less of the adult population smoking. Can I ask the Secretary of State to ruthlessly target the barriers that stop people stubbing out their last cigarette? We need to get the numbers of smokers down; otherwise, 2030 will be an ambition that is not achieved.

[Sajid Javid]

My hon. Friend is absolutely right. The smoking rate is currently 13.5%, which is the lowest on record. However, smoking remains the largest driver of health disparities in our country. The new tobacco control plan, which will be informed by the new independent review, will be looking to do exactly what my hon. Friend says.

Health and Care Bill

Charles Walker Excerpts

Consideration of Lords amendments
Wednesday 30th March 2022 Commons Chamber

[Edward Argar]

Let me repeat, quite legitimately, what I said in opening the debate on the previous group of amendments. It is a pleasure to serve opposite the shadow Minister, the hon. Member for Bristol South. It was also a pleasure to serve opposite her in the Bill Committee. She was not the shadow Minister then, but she brought her expertise and, as I said earlier, her forensic knowledge of these areas of the Bill—occasionally to my slight discomfort—and, overall, a degree of informed deliberation to our proceedings.

The amendments in this group relate to integration, commissioning and adult social care. The Government’s amendments strengthen our expectations of commissioners, especially in relation to mental health, cancer, palliative care, inequalities and children. Lords amendments 1, 25, 27 and 49 strengthen our approach to mental health. Amendment 49 makes it clear that “health” refers to both physical and mental health in the National Health Service Act 2006.

[Sir Charles Walker (Broxbourne) (Con)]

Will my hon. Friend give way?

[Edward Argar]

Of course I will. I cannot say no to my hon. Friend.

[Sir Charles Walker]

I want to thank my hon. Friend for making that clear, because there was some concern that the Bill broke with parity of esteem by not recognising that mental health was as important as physical health. A number of Members raised concerns about that, and I want to thank my hon. Friend and his team for getting it right. They should be congratulated.

[Edward Argar]

I am very grateful to my hon. Friend. He has come in at just the right time, because I was about to thank and pay tribute to him and, indeed, to my right hon. Friend the Member for Maidenhead (Mrs May). Both of them have, in their typically determined and persistent but very courteous way, pressed this issue and highlighted the need for it to be explicit in the legislation. I think we have made the Bill stronger and clearer through Lords amendment 49, and I pay tribute to my hon. Friend for that.

Lords amendments 1, 25 and 27 also require the Secretary of State to publish, and lay before Parliament, a document setting out the Government’s expectations for mental health spending for the financial year ahead. Lords amendment 105 requires a member with experience of mental health to sit on each integrated care board. Although we have adopted a permissive rather than a prescriptive approach throughout, we are persuaded of the need and the benefits—given the parity of esteem—of having that experience on the ICBs, and, while we are proposing some changes in the drafting, we agree with the principle. I hope that the shadow Minister shares that view.

I pay tribute to my hon. Friend the Member for Basildon and Billericay (Mr Baron), and to Members of the other place, for their engagement and continued support in relation to Lords amendments 2, 3 and 4, which relate to cancer objectives in the NHS mandate. The amendments change the focus of the cancer outcomes objectives so that they capture all cancer interventions. Those objectives will have priority over any other objectives relating to cancer, not just those relating specifically to “treatment”. I also pay tribute to Baroness Finlay, who has long campaigned to add explicit reference to palliative care services to the list of services that an integrated care board must commission. That is why we are accepting Lords amendment 12.

Lords amendments 22, 83, 102, 103 focus on addressing the needs of babies, children and young people. Lords amendment 22 would require the ICB to set out any steps it proposed to take to address the particular needs of children and young people, while Lords amendments 83, 102 and 103 specify that the Government must publish a report describing the Government’s policy on information sharing by or with public authorities in relation to children’s health and social care and the safeguarding of children. I pay tribute in that context to my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom), who has long taken a keen interest in these issues.

--- Later in debate ---

[Margaret Greenwood (Wirral West) (Lab)]

I rise to speak in support of Lords amendments 51, 11 and 105. With this Bill, the Government are legislating so that a controversial approach known as “discharge to assess” can be used when discharging patients from hospital. This would see patients discharged from hospital before their social care needs have been assessed, with vulnerable patients potentially sent home without the support that they need in place, leaving families to pick up the pieces and those without family at risk of neglect. Lords amendment 51 is important in relation to that.

The amendment would retain the principle and duty on a hospital, whether an NHS hospital or an independent hospital, to ensure that a patient must be safe to discharge from hospital, and it mirrors carers’ rights established by the Community Care (Delayed Discharges etc.) Act 2003. This important amendment would recognise the vital role played by carers across the country in looking after their loved ones. However, it does not stop the Government from legislating for discharge to assess, a policy that has been piloted and was included in the Coronavirus Act 2020 as a temporary measure. I am concerned that the Government are not only going ahead with an approach fraught with risk for vulnerable patients, but are doing so in the knowledge that an independent evaluation commissioned by NHS England of the implementation of the hospital discharge policy has still not been published, despite the Government promising that the evaluation was due to report in autumn last year.

I am concerned, too, that the Government do not even understand the clinical outcomes of discharge to assess. When I submitted a question last year asking the Government how many patients discharged in this way were readmitted within 30 days, the Government said that they did not hold the data. I believe that to be a dereliction of duty.

Lord amendment 51 would put in place important rights for patients and carers at what can be a very difficult time. I note that the Government disagree with the amendment and have tabled an amendment in lieu, but I believe that it waters down carers’ and patients’ rights. It merely proposes that

“the relevant trust must, as soon as is feasible after it begins making any plans relating to the discharge, take any steps that it considers appropriate to involve…the patient, and…any carer of the patient.”

That gives inappropriate levels of discretion to trusts over patients’ and carers’ involvement, instead of guaranteeing their rights.

Lords amendment 11 is a step in the right direction, although it does not go far enough. It would ensure that conflict of interest rules that apply to integrated care boards would apply to commissioning sub-committees of integrated care boards. The Government have said that they disagree with the amendment and have proposed an amendment in lieu that would prohibit a chair of an ICB from approving or appointing someone as a member of any committee or sub-committee that exercises commissioning functions

“if the chair considers that the appointment could reasonably be regarded as undermining the independence of the health service because of the candidate’s involvement with the private healthcare sector or otherwise.”

I am concerned that the phrasing is clearly open to interpretation, and it by no means rules out people with interests in private healthcare from sitting on these sub-committees.

It is wrong, too, that the power should rest with one person, namely the chair of the ICB. If we are serious about providing governance that rules out the possibility of the private sector influencing the expenditure of public money, an organisation carrying out the functions of an ICB on its behalf should be a statutory NHS body. It is a great pity that the Government have not legislated for that.

We cannot forget that NHS guidance last year stated that the Health and Care Bill, if enacted, would enable ICBs to devolve budgets to provider collaboratives, which are one of a complex array of sub-committees that could take on commissioning functions. Representatives of private companies, which are accountable to shareholders, should not be able to influence these commissioning sub- committees in any way. Lords amendment 11 at least improves the original Bill, and I therefore welcome it.

I also welcome Lords amendment 105, which would mean that the membership of an ICB must include at least one member with expertise and knowledge of mental health in the integrated care board’s area. The fact that the Government did not provide for that originally shows that they are still not treating mental health with the level of seriousness it deserves. It is disappointing that the Government have indicated that they disagree with the amendment.

The amendment in lieu that the Government have proposed makes provision for the chair of an ICB to act

“with a view to ensuring that at least one of the ordinary members has knowledge and experience in connection with services relating to the prevention, diagnosis and treatment of mental illness.”

The Government have watered down the amendment, and it is regrettable that they have removed expertise in mental health as a characteristic that this member of an ICB must have. It is feasible that that person could be a manager who once dealt with mental health rather than a mental health clinician or health professional. I noticed that in the Minister’s opening remarks, he commented that ICBs would be able to commission out of area. I would be grateful if he gave some clarity about how A&E services will be guaranteed to people should they happen to fall ill out of area.

This is a devastating piece of legislation and it is all the more shocking that the Government have pressed ahead with it at a time when NHS staff are exhausted and patients and people across the country are still struggling with the pandemic. It will embed a postcode lottery and open up the NHS to widespread privatisation. In so doing, it does a disservice to patients in England and to NHS staff.

The Bill provides for the scope of “Agenda for Change”, the pay and terms and conditions of about a million people who work in the health service, to be undermined; it allows for NHS professions to be taken out of regulation; and, as I have mentioned in relation to Lords amendment 51, it will allow for vulnerable patients to be discharged from hospital before their social care needs assessments have been carried out. The NHS is our most treasured institution and I pay tribute to all those campaigners across the country who have fought hard to oppose the Bill.

[Sir Charles Walker]

I congratulate the Government on their amendments on mental health. As a former Minister with responsibility for mental health, Madam Deputy Speaker, you know that I have long taken an interest in the subject, so I am delighted that parity of esteem is included in the legislation. It is a very important amendment.

Parity of esteem must mean something, however, and should not be a jumble of words. It was the case that too many voices on both sides of the House fell silent during the covid pandemic. That may have been due to the fog of war, but the scarring of that silence runs deep in the communities that we represent—there are some very ill and damaged people out there. It is fine for us to talk about parity of esteem, but we have to live it and deliver it, and I am afraid that we fell short for 18 months.

I welcome the amendment and the recommitment of hon. Members, but we were all found wanting when it counted. I have the witness statements of more than 2,000 people who suffered with mental health problems during the pandemic and who wrote to me detailing what that was like. One day, I will make those statements available to the Government and to the inquiry, but today, I just thank the Minister and my right hon. Friend the Member for Maidenhead (Mrs May), who joined me in initiating the amendments. I hope that the next time that the country and this place are challenged, we rise to it, because mental health is as important as physical health.

[Liz Twist]

It was not my intention to speak in the debate, but I need to ensure that the point that has been raised about Lords amendment 80 and the cap is not missed. The Minister talked a great deal about fairness, but how can it be fair that my constituents and people across the north-east and the north generally will face what the King’s Fund described as

“people with low levels of wealth”

being

“exposed to very high care costs”?

It cannot be right that the northern regions and other areas will face that unfairness. The Government should reconsider the issue and come forward, as other hon. Members have said, with further discussions about how to resolve it. The proposal in the Bill is very different from that originally presented to the House on care costs.

On carers, I agree with other hon. Members who have raised the issue. As I mentioned earlier, we need much more detail and certainty for those carers and we need to be able to take part to ensure that the guidance issued is effective and represents and meets their need.

Smoke-free England

Charles Walker Excerpts

Tuesday 29th March 2022 Westminster Hall

[Christina Rees (in the Chair)]

I will call Sir Charles Walker to move the motion, and I will then call the Minister to respond. As is the convention for 30-minute debates, there will not be an opportunity for the Member in charge to wind up.

[Sir Charles Walker (Broxbourne) (Con)]

I beg to move,

That this House has considered progress towards a smoke-free England.

I will start by reading a couple of paragraphs from an excellent Government document published in July 2017, entitled “Towards a smoke-free generation”. I will not detain the Chair too long, but there are a few sentences that I want to read into the record. The document says:

“Over 200 deaths every day are still caused by smoking…Smoking rates have remained stubbornly higher amongst those in our society who already suffer from poorer health and other disadvantages. Smoking rates are almost three times higher amongst the lowest earners, compared to the highest earners…Smoking accounts for approximately half the difference in life expectancy between the richest and poorest in society. This injustice in the variation in smoking prevalence can be seen across England; from places where adult smoking is as low as 5% to others where smoking remains above 25%. The prevalence remains even higher in people with mental health conditions, where more than 40% of adults with a serious mental illness smoke. We want to address this. Our vision is nothing less than to create a smokefree generation…the government will provide leadership and guidance on the most effective interventions.”

There we have it: a bold statement of intent. So what does a smoke-free 2030 look like? First, it is not smoke-free. When we talk about a smoke-free 2030, we are actually talking about 5% or less of the adult population smoking—that is recognised by The Lancet. Currently, more than 14% of the adult population smoke, and it could actually be higher than 14%, because lockdown may have increased the prevalence of smoking as people turned to cigarettes as a way of releasing and relieving stress. Cancer Research UK is not optimistic about the 2030 date, which will not come as a surprise to anyone here. Its best guess is that 2037 is when we will achieve 5% or less, and I am afraid the general view is that 2037 now looks optimistic.

To put it in context, what is 200 deaths a day? That is 75,000 deaths a year and, on top of that, 500,000 admissions to hospital every year for smoking-related illnesses. Over 10 years, 750,000 people will die from smoking. That is approximately the population of Birmingham every 10 years, and 5 million people will be admitted to hospital.

The Government touch on the huge disparities in smoking between richer and less well-off areas. In some of the most deprived wards in seaside towns in the north-west, smoking rates are above 22%. In the leafy parts of Surrey, they are less than 5%—in essence, parts of Surrey have achieved smoke-free status. What does 22% versus 5% look like? That translates into about an eight-year differential in life expectancy. Of course, not all that eight-year differential will be linked to smoking but, as the Government identified in their report in 2017, about 50%—four years—of that differential will be linked to the fact that more people smoke in more deprived areas than wealthier ones.

Look, the Government have made great strides. I will not be churlish with the Minister—I would not be churlish with her, because she is a very nice woman and she is very committed to this cause, which is more important than being nice.

I understand that a pack of cigarettes now costs more than £10, although that is not something I have bought for 17 years. Some might be pushing £14, so this is becoming an expensive habit. Even at that price, 14% or more of the population are smoking. We are down to some really tough nuts to crack, if we want to reach that 5%. I remind the Government of the part of the report entitled, “Backing evidence-based innovation”:

“Despite the availability of effective medicines and treatments to support quit attempts, the majority of smokers choose to quit unassisted, by going ‘cold turkey’. This has proved to be the least effective method…The best thing a smoker can do for their health is to quit smoking. However, the evidence is increasingly clear that e-cigarettes are significantly less harmful to health than smoking tobacco. The Government will seek to support consumers in stopping smoking and adopting the use of less harmful nicotine products.”

[Mary Glindon (North Tyneside) (Lab)]

I congratulate the hon. Member on this Adjournment debate. He may know that I have never smoked, but I am a strong advocate of vaping. Does he agree that, if the Government are serious about reducing smoking prevalence, they must ensure that medical professionals have access to the latest evidence on e-cigarettes and are encouraged to signpost patients to appropriate guidance about harm reduction, as well as information about how to switch successfully, if they cannot quit?

[Sir Charles Walker]

Of course, I agree with and endorse what the hon. Lady said—on this occasion, let me call her my hon. Friend—because what we are talking about today is harm reduction.

Let me read two more sentences, from page 15 of the report, which I am sure will be of interest to the hon. Lady:

“The Government will therefore continue to evaluate critically the evidence on nicotine-delivery products, providing clear communication about what is known and unknown about the short and long-term risks of using different products relative to smoking and the absolute risk to children, non-smokers and bystanders.”

Remember that that was written five years ago, so there has surely been time to do this.

What I do not understand is why the Government are so squeamish when it comes to looking at harm reduction. The hon. Member for North Tyneside talks about vaping, but there are nicotine pouches, “heat not burn” products and something called snus, which I understand is used in parts of the world. Before we cast these alternatives aside, let us remember that they reduce the harm caused to the user. There is nothing more harmful than smoking burnt, lit, combustible tobacco—nothing. Sweden has taken an enlightened approach. It has embraced science and looked at harm reduction. Smoking rates are now well below 10%, and some independent experts reckon they are nearer 7%. It looks like Sweden is going to be the first country in Europe to meet the magical 4.99% and be a smoke-free European country.

I am concerned that we are not going at this problem as hard as we should as a nation, but there is hope, which I am sure the Minister will refer to in her speech. There is the independent review of smoke-free 2030 policies, led by Mr Javed Khan OBE. The review offers reasons for optimism. In its objectives it states:

“The review will make a set of focused policy and regulatory recommendations in 2 areas, and will consider…the most impactful interventions to reduce the uptake of smoking, particularly among young people.”

It will also consider

“the top interventions to support smoking cessation, particularly in deprived areas of England where there are significant health disparities”.

That sounds like a call to arms. On outputs, the review says:

“The review will provide a far-reaching report focused on the key policy and regulatory recommendations that give the government the best chance of achieving the Smokefree 2030 ambition and addressing the health disparities associated with smoking.”

Can I make a plea to the Minister and her Department? This issue is harm reduction. It is about reducing the 75,000 deaths a year. It is about reducing the 500,000 people who go into hospital. It is not about banishing nicotine.

In a perfect world, nobody would even chew nicotine gum, but the fact is that they do. We do not live in a perfect world. People become addicted to nicotine, and it becomes part of their day. It is far better to consume it in a way that offers a much lesser chance of either shortening someone’s life or putting them in hospital. Let us use the regulatory and tax environments to differentiate harms, so that the highest harm is combustible tobacco and we can gradate the level of harm going down. We can use the tax system to signpost people to the least harmful nicotine product.

I would like to conclude by saying one thing. Levelling up has to mean reducing the disparities in people’s life expectancy. One of the greatest disparities is in those who suffer from a diagnosis of psychosis/schizophrenia. By the Government’s own reckoning, 40% of people with the diagnosis—possibly more—smoke. I know about this because I have been deeply involved in the issue of mental health since I entered Parliament 17 years ago. Smoking is often linked to the treatments used to help people with psychosis/schizophrenia—sadly often still called the chemical cosh. The treatments tend to enhance appetite, so people experience massive weight gain. They also tend to depress the person in receipt of the medications, which drives them to smoking. On average, if someone has a diagnosis of psychosis/schizophrenia, their life expectancy is reduced by 15 years—the Government say in their document that it is between 10 and 20 years. This is a real issue for so many people. This is not a “nice to have” harm reduction; it is an absolute necessity. I thank you, Ms Rees, and the Minister for allowing me to make the case for harm reduction today.

Allergy Research and Treatments: Government Support

Charles Walker Excerpts

Wednesday 9th March 2022 Westminster Hall

[Sir Charles Walker (in the Chair)]

Order. I will call on Christian Matheson to move the motion, then on the Minister to respond. As is the convention for 30-minute debates, there will not be an opportunity for the Member in charge to wind up. However, I understand that there might be interventions from a couple of colleagues, which I shall take during Mr Matheson’s speech.

[Christian Matheson (City of Chester) (Lab)]

I beg to move,

That this House has considered Government support for allergy research and treatments.

It is a great pleasure to see you in the Chair today, Sir Charles. I was at the Chester gang show not long ago, and was looked after very well on an excellent evening by a gentleman called Tim McLachlan. Tim, it turns out, runs the Natasha Allergy Research Foundation, a memorial foundation that campaigns on allergy research. The House will remember that Natasha Ednan-Laperouse was the victim of an allergy. She ate a sandwich with sesame in it and died on an aircraft. It was an utter tragedy. In memory of her, her parents set up the charity that Mr McLachlan now runs, which really caught my imagination.

Vaccination: Condition of Deployment

Charles Walker Excerpts

Monday 31st January 2022 Commons Chamber

[Sajid Javid]

I am happy to answer those questions. First, the Government’s decision is to revoke both statutory instruments; I am happy to confirm that. On those who, following the statutory instrument on care home settings, chose not to get vaccinated and preferred to leave their job than do the professional thing and get vaccinated, that was their choice, and that does not change. That policy was right at the time—I have set out the reasons why—because the dominant variant was delta. Should those people choose to apply for a job in a care home once the restrictions have been lifted, that is a decision for them. However, I continue to encourage them to make the right positive decision and get vaccinated.

[Sir Charles Walker (Broxbourne) (Con)]

I promised my wife that I would stop being angry, but I just cannot. Long before vaccines existed, these people who we cast as pariahs were day in, day out, coming into hospitals and care homes and holding the hands of the dying because their children and grandchildren could not. They were doing that while most people in this House were sitting on their backsides safely at home. Now, by all means, let us encourage people to get vaccines, but the language used, suggesting that these people who, for whatever reason—they may have needle phobia, like me—have chosen not to get vaccinated are somehow deserving of our bile is a disgrace. It does not reflect badly on them; it reflects badly on us.

[Sajid Javid]

What I hear from my hon. Friend, and I very much agree, is that vaccines are safe and effective. They remain our most important weapon in fighting the pandemic and, as more people come forward and choose to get vaccinated, that is not only good for them but right for the rest of society, their loved ones and everyone else around them. That is especially so if the people around them—they might be in a care setting or a hospital—are more vulnerable than most of the population. The best way forward is therefore to encourage everyone now to continue to think of the vaccine in that positive, sensible way and to come forward.