Tobacco and Vapes Bill

Christopher Chope Excerpts

2nd reading
Tuesday 26th November 2024 Commons Chamber

[Wes Streeting]

I will certainly come on to the action that we are taking on vaping, and the case for it. I welcome the contribution that my hon. Friend has made in his first few months as a Member of this House. He brings enormous expertise and experience, particularly on health, which we very much value here in the Chamber.

One choice would be to continue paying an ever heavier price for failure. That is the road that we were heading down, under the previous Government. Our NHS already takes £4 for every £10 spent by the Government day to day. We are on course to go from being a nation with a national health service to a health service with a nation attached to it. It is projected that by the end of this Parliament, 4.3 million people will be on sickness benefit if we fail to act. Smoking could cause 300,000 patients to be diagnosed with cancer over the next five years, including 3,000 for whom that is the result of exposure to second-hand smoke. That is what happens if we only ever treat the symptoms of ill health. We end up spending more on the NHS than ever before, but with worse care for patients, a ballooning welfare bill due to more and more people being out of work, stagnant economic growth, and the heaviest tax burden in 70 years. In short, we will be paying more, but getting less.

Britain is like a ship with a hole. We are constantly battling to chuck enough water overboard to keep us afloat, as more and more floods in. We must break out of this cycle. Britain can break out of this cycle, but only if we are serious about tackling the causes of ill health, and shift our focus from treating the symptoms to preventing them. Plugging the hole in the ship is how we get back to growth, how we reduce the burden of taxation, and how we ensure that this Government can intrude more lightly on people’s lives.

[Sir Christopher Chope (Christchurch) (Con)]

The argument that the Secretary of State puts forward is essentially one for banning smoking altogether. What he said earlier was misleading; he suggested that people of a particular age group will not be able to smoke. They will not be able to buy cigarettes, but they can still smoke. They can cadge cigarettes off other people. Is this not a half-baked measure?

[Wes Streeting]

I am sure that the hon. Gentleman was not accusing me of misleading the House. The argument that he puts forward is used against all sorts of laws and prohibitions. Most people in this country are law-abiding citizens who follow the law. In my constituency today, there will be people dumping fridges and mattresses on street corners—fly-tipping—because they are irresponsible and not law-abiding citizens. We will not always catch them, either through closed-circuit television or local authority enforcement, but that does not mean that we should not tackle them when they do those things.

By phasing in a generational smoking ban, we are taking a measured and reasonable way of creating a smokefree country. That is the right way to proceed, and it is sensible. I know that he does not agree, but he must accept the trade-off—the choices that he is making for the Opposition. First, he is accepting that people will pay a higher price for their healthcare, either through taxes, if he still believes in the national health service, or through the cost to the individual of their healthcare. Secondly, he must concede that, through the harm caused by smoking, he is fuelling welfare dependency. My right hon. Friend the Secretary of State for Work and Pensions had a point when she said earlier that Labour is the party of work, and the Conservatives are the party of welfare. That is the logical conclusion of the hon. Gentleman’s opposition.

Maternity Services: Gloucestershire

Christopher Chope Excerpts

Wednesday 9th October 2024 Westminster Hall

[Clive Jones (Wokingham) (LD)]

My local hospital, the Royal Berkshire hospital, is where my two children were born and many of our friends’ children were born. It has recently received an upgraded rating of good from the Care Quality Commission, and it is one of only nine organisations, out of 131, that got an upgrade to good over the last year, so I commend the Royal Berkshire leadership and staff for their diligence and dedication, and congratulate them on that result. Does my hon. Friend agree—

[Sir Christopher Chope (in the Chair)]

Order. Interventions should be short. If the hon. Gentleman wishes to make a speech, he can do so later. Let us hear the response to the intervention.

[Max Wilkinson]

I am sure that I would agree with whatever my hon. Friend was about to say. He was making the point, I think, that it is easy to be down on our NHS and its staff. That is not the purpose of this debate at all; its purpose is to ensure that we give the support that is needed to our midwives, other NHS staff and, indeed, NHS managers, who are often maligned but, like other NHS staff, work long hours and are in it for the betterment of health services.

On a personal note, I offer my wholehearted thanks to the staff at Gloucestershire hospitals, who were there for my wife and me when our daughter was born in Gloucestershire Royal hospital in 2022. It was an important day for my family and for the country when we went into the operating theatre for the C-section: this country had no Prime Minister, and when we came out we had my daughter, Elodie, and we had Liz Truss. That is a memory that will live long for me. I particularly thank Fiona Liddle, the midwife who gave us the most care during my wife’s pregnancy, as well as all the doctors, nurses and healthcare workers who helped to make the experience so joyful for us.

--- Later in debate ---

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairmanship, Sir Christopher.

With your leave, I will start with a few words to mark Baby Loss Awareness Week. Many mums and dads across the country have suffered the heartbreak of losing a baby. Everyone deals with grief in a different way, but it has been moving to hear from parents how baby loss certificates have allowed them to process what they have gone through and have helped give them closure.

That is why this week we launched an extension to the baby loss certificate service, which is a voluntary scheme to enable parents who have experienced a pregnancy loss to record and receive a certificate to provide recognition of their loss, should they wish. Until now the service was only open to parents who had experienced a loss since 1 September 2018, but today we are removing that restriction, making the certificates available for every parent who has lost a child. We will update the House with a formal written statement shortly. The Government are committed to delivering compassionate care for women and support for parents who have suffered a baby loss. It is the right thing to do.

I think this has been a genuinely good debate. We have heard from experts—I commend the Opposition spokesperson the hon. Member for Sleaford and North Hykeham (Dr Johnson) and my hon. Friend the Member for Stroud (Dr Opher) for the work they do—and others have shared experiences. I knew that the hon. Member for Cheltenham (Max Wilkinson) would bring forward good points too, so I contacted the trust myself so that I could give the hon. Gentleman and hon. Members present my frank assessment of what is happening on the ground.

To reiterate, as of August 2024 the midwifery vacancy rate in the Gloucestershire hospitals NHS foundation trust stood at 13%—the equivalent of 32 full-time midwives. That level is high for the south-west, though roughly in line with the national average. In April 2022, the Care Quality Commission gave the trust a warning notice for the maternity service, and rated it “inadequate” a year later. In May this year, the CQC issued the section 31 notice—a severe warning that requires at minimum an immediate action and improvement plan, which, as colleagues will know, in some other settings could result in a closure. It issued that after seeing postpartum haemorrhage rates, poor foetal monitoring and high levels of agency staffing.

The hon. Member for Cheltenham and others from the area are right to be concerned. We can all agree that it is unacceptable when new mothers do not receive the highest possible standard of care. As my right hon. Friend the Secretary of State has said, we should be honest about the problems in our NHS and serious about fixing them. Maternity services are very far from where we want them to be. Childbirth should not be something that women fear or look back on with trauma. Safety is obviously paramount. As the hon. Member for Cheltenham said, it should be a special moment.

I thank the hon. Member for Thornbury and Yate (Claire Young) for sharing her experiences. I was in hospital for two weeks after having my first child, and it is a traumatic time, so the length of time she mentioned must have been very difficult. My second came out so quickly that I was in and out of hospital before we knew it. My third child, as has been mentioned, was almost delivered at home by my husband after we had chosen a home birth. He is not medically qualified, so I can tell you that the sound of the doorbell ringing for the midwives’ arrival was the best sound I have heard in my life.

To the second question asked by the hon. Member for Cheltenham, I will outline the steps the trust is taking to improve the situation. They include a new director of midwifery, an education and training midwife and a perinatal quality and governance lead. To improve retention, the new leadership has introduced a retire and return scheme and is holding monthly events for senior leadership to listen to staff and address their concerns. The trust has recruited 33 new midwifery starters since 2023, including from overseas. Ten midwives are due to start this month, with a further 10 expected in January. But there is still a gap. That is why the Aveta birthing unit and the postnatal beds at Stroud maternity will remain temporarily closed until they reach safe levels of staffing. The trust clearly felt that it could not continue those services without putting new mothers at risk, which is an impossible situation to be in.

I am pleased that the birthing unit at Stroud remains open, but the other closures have had an impact on women, their families and the local community, as has been eloquently expressed by my hon. Friend the Member for Gloucester and mentioned by my hon. Friend the Member for Thornbury and Yate. The impact goes further afield to my own city of Bristol. In addition to those measures, the trust is developing new apprenticeship schemes; building partnerships with universities, including Worcester and Oxford Brookes; and launching a midwifery attraction campaign in the autumn.

Although the trust has had positive feedback from last year’s new starters, I am pleased that it is carrying out regular assessments, as per the recommendations in the Ockenden review, to ensure that midwives have the right skills to serve the people of Gloucestershire. The turnover rate is now settling, and I know the hon. Member for Cheltenham and other colleagues will do everything they can to help convince midwives that his county is a great place to live and work. The passion for those units is very evident here today, which I am sure will be welcome to those trusts.

I know from my career in the NHS that such changes take a long time. It is too soon to make an assessment until all the new midwives have started. However, we are not waiting for the CQC to do the rounds to ensure that the picture is improving. The local maternity and neonatal systems team and the regional NHS England team are meeting with the trust on a fortnightly basis to review progress. The trust’s monthly board reports will report on progress; I know hon. Members will be watching carefully.

It is important to give the new team space to prove themselves. I am hopeful that we will see improvements in time. At a national level, whenever trusts and maternity units do not perform on our watch, we will steer them back to safer ground. That is why we are supporting Gloucestershire maternity services through the national maternity safety support programme. That means that the trust is supported by a maternity improvement adviser for midwifery and obstetrics, who helps the trust to embed the maternity improvement plan.

I know that the hon. Member for Cheltenham and others will continue to hold the trust to account, until it is delivering for women in their constituencies. I am grateful to him for obtaining this debate and giving me the chance to put the Government’s position on the record. With regard to his third question, like many trusts in this position, the trust does have the budget for establishment; it is the recruitment and retention of midwives that is the issue. Some trusts do different things with incentives; I do not know whether this trust is particularly doing that. That might be something he would wish to pick up with the trust at another time.

On more general maternity improvements, in September the CQC published a report that demonstrated how much the previous Government let down new mothers in this country. Lord Darzi’s report has shown that, despite some improvements, there is still a disgraceful inequality of outcomes for black and minority ethnic women, as we have heard again today. We will look at every recommendation in the CQC report, and if officials object to any of them, I expect to hear a very good reason why.

There is ongoing work to improve maternity and neonatal services across England. The NHS put in place a three-year delivery plan to make maternity and neonatal care safer, fairer and more tailored to every new mother’s needs.

I shall now discuss the Government’s wider ambition. Choice—which was mentioned today by my hon. Friend the Member for Stroud and the hon. Member for Thornbury and Yate—is for us absolutely a key part of maternity care. As the hon. Member for Winchester said, our NHS must listen to and work with women and families on how their care is planned and received, based on what matters to them.

To get maternity care back on its feet, we need to train thousands more midwives as part of the NHS workforce plan, while encouraging experienced midwives to stay in the NHS. Many hon. Members, including the hon. Member for Cheltenham, spoke of recruiting midwives, with regard to morale and workload. That was also mentioned by the hon. Members for Tewkesbury (Cameron Thomas) and for Carshalton and Wallington (Bobby Dean). The NHS will deliver the people plan, giving a stronger focus to a modern, compassionate, inclusive culture, which absolutely has to be part of our forward look in the 10-year plan.

We will ensure that trusts failing on maternity care are robustly supported into rapid improvement. We are setting an explicit target to close the black and Asian maternity mortality gap. NHS England is on the right track, boosting the workforce through training, apprenticeships, postgraduate conversion, return to midwifery programmes and international recruitment. I have been clear that the Government will build on those programmes, not replace them.

Finally, I want to end by restating our unwavering commitment to maternity services across the nation, including in Gloucestershire. We are actively working to improve staffing levels and are planning for the future needs of Gloucestershire’s maternity services. I say to the constituents of the hon. Member for Cheltenham that I hear his concerns and completely understand them, and I will work with him to set this right.

The Opposition spokesperson is an assiduous writer, and I have answered a number of her letters, but if I have not responded to particular points from the previous debate before recess, I apologise, and will ensure that that happens after this debate. She has raised important questions.

In the constituency of the hon. Member for Cheltenham and in mine, women have had to bear the brunt of inaction for the past 14 years, but this Government will deliver for women, not just in the south-west but in the country as a whole.

[Sir Christopher Chope (in the Chair)]

I call Max Wilkinson to respond to this very well-informed debate.

Sepsis Awareness

Christopher Chope Excerpts

Wednesday 9th October 2024 Westminster Hall

[James McMurdock (South Basildon and East Thurrock) (Reform)]

I thank my hon. Friend the Member for Ashfield (Lee Anderson) for this debate. It is hard to think of a more appropriate topic. I also thank Abbi—who has shared with us the warmest smile that I have seen in a long time—and her husband for being here; it is a privilege to meet them.

I want to take a moment to share a personal story, to show why drawing attention to this subject is one of the most appropriate things we can do as Members of Parliament. I have four young children at home. After the birth of the most recent one, my wife began to suffer some of the symptoms we have discussed today, but—very much like the hon. Member for Kingswinford and South Staffordshire (Mike Wood)—tough Brits do not easily give in to the hospital. As fate would have it, though, we had a meeting that morning with a carer who was checking on women who had recently had children. She popped round to check on the welfare of baby and mother, and although my wife and I were adamant that everything would be fine, this skilled professional spotted the symptoms immediately and demanded that we were rushed to hospital. We were there within half an hour and, within another 20 minutes, there were around a dozen doctors, nurses and support staff rushing around like maniacs. Although I cannot remember the specific number of signs, they were tenfold, fifteenfold, twentyfold what they should be in a healthy person. The staff may have saved my wife’s life in very real terms.

That is why I wanted to take this moment to recognise why this issue is extremely appropriate. The consequences of catching sepsis are minor, but the consequences of not catching it are extraordinarily severe. The difference is cheap: it is education; it is information that we can all carry with us for free, but which can potentially benefit someone’s life.

I want to take one last moment to again thank Abbi for sharing her story and my hon. Friend the Member for Ashfield for allowing us to hold this debate, and to thank the extraordinary staff at Basildon University Hospital.

[Sir Christopher Chope (in the Chair)]

There are two more speakers and six minutes to go, so that is three minutes each.

--- Later in debate ---

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

It is a pleasure to serve under your chairmanship, Sir Christopher. I congratulate the hon. Member for Ashfield (Lee Anderson) on securing a debate on this very important topic. I should also declare an interest as an NHS consultant paediatrician. I have cared for and continue in my work to care for people with this condition.

I would like to thank Abbi for coming today. It was an honour to meet earlier today and to hear her story from her MP, which highlighted both the difficulties she faced in getting good immediate care for sepsis and the consequences of that. I commend her for the bravery she has shown in coming today and for raising this issue for the benefit of other people. This debate will increase awareness, which is a very positive thing.

I remember sitting in the Chamber earlier this year when the former hon. Member for South Thanet re-entered Parliament to a standing ovation—an exceptionally rare occurrence in the House of Commons. It is truly humbling to reflect on the journey that he has been through in such a short space of time. Little over a year ago, he had no outward signs of sepsis at all. He has now become one of the most well-known advocates for people with it. His case brought renewed attention to this disease, which kills nearly 50,000 people in the UK every year. As the hon. Member for Ashfield said, that is around the same number of people who die from bowel, breast and prostate cancer combined.

The case of our former colleague speaks to not only a remarkable recovery but the suddenness with which sepsis can utterly change someone’s life. As many people have said today, early identification is vital. Under the previous Government, awareness of sepsis improved significantly, as did the clinical recognition of symptoms, screening rates and the administration of antibiotic treatment, but there is much more to do.

I want to commend the UK Sepsis Trust and other public campaigners who played a significant role in improving awareness among the general public. A recent YouGov survey showed that the UK has high levels of public awareness compared with other countries. Will the Minister say what steps the Government will take to work with NHS England and patient groups such as the UK Sepsis Trust to raise public awareness, so that people can more easily identify the signs of sepsis? I have also asked this of another Minister, but have not yet received an answer. The Chancellor said that she was cutting the communications budget—can the Minister confirm that those cuts will not affect the important public health messaging for campaigns like this? It is important that we do not cut budgets that will save people’s lives and, indeed, save the NHS money. It is also important to raise awareness not just across the general public, but among health professionals, including medical staff in both hospitals and communities.

The national early warning score has been introduced and is being rolled out, along with the sepsis six, which was developed with the UK Sepsis Trust. The six—oxygen, cultures, antibiotics, fluids, lactate management and urinary output monitoring—must all be carried out within the first hour. Has the Minister established how well those measures are being rolled out across the UK, and what is he doing to ensure that is being done effectively? The National Institute for Health and Care Excellence updated its guidance earlier this year. Will the Minister update the House on how effectively that guidance has been implemented across the UK? Martha’s rule was introduced before the election; the rule relates to the ability for people to get a second opinion from another health professional if they remain concerned about their loved one or themselves. Will the Minister update the House on the work the NHS is doing to roll that out, too?

Research is the cornerstone of transforming sepsis care, and the last Government invested more than £1 billion through the National Institute for Health and Care Research. It is important that we research the causes of and treatment for sepsis, but we must also research new antibiotics, because we are starting to see antibiotic resistance to infections. If we do not invest in antibiotic research, new antibiotics will not be developed—we are essentially asking people to develop a drug to be kept on the shelf for when we need it, and there is no money in that, so it will not get commercial take-up. It is therefore important that the Government invest in that.

The UK Sepsis Trust is calling on the Government to publish data on the sepsis care pathway so that we can see where it is performing well and where it is performing less well. I urge the Government to do that. It would be helpful if the Minister could confirm today that they will do so.

As we close the debate, let us remember what we are fighting for. Sepsis takes the lives of 50,000 people every year. It strikes suddenly and often without warning, as Lord Mackinlay’s case reminds us so powerfully. Early identification and rapid treatment are the keys to saving lives; we have made strides, and awareness is growing, but we must do more. We must continue to improve recognition, strengthen control and push forward with life-saving initiatives. I urge the Government today not just to maintain their commitment but to strengthen it by partnering with NHS England, publishing more data, researching the causes of sepsis and ensuring we can fight this disease together.

[Sir Christopher Chope (in the Chair)]

I thank the Front Benchers for sticking to their five minutes, which means the Minister now has 10 minutes; there will hopefully also be a couple of minutes for the proposer to reply.

Healthcare Provision: East of England

Christopher Chope Excerpts

Tuesday 3rd September 2024 Westminster Hall

[Clive Lewis]

I thank the hon. Gentleman for his interesting question. I am not happy with the removal of the winter fuel payment—of course I am not—and I do not think anyone on this side of the House will be happy with it, but I also understand that there are two points in the year when you support your Government: the King’s Speech and the Budget. I am not looking to break that, but like many of my colleagues I have severe concerns about the impact this proposal will have on people’s health and wellbeing and on their pockets. I have every confidence that my Government will put in place the best possible response to the £22-billion hole left by Conservative Members. I just do not think that the removal of the winter fuel allowance is necessarily the right way forward, but we shall see what happens in the days and weeks ahead. My question to the Minister is this: does she believe—this almost pre-empts the question asked by the hon. Member for Broadland and Fakenham (Jerome Mayhew)—that the cut to winter fuel payments will improve the situation in terms of fuel poverty and its impact on health?

Another example is financial insecurity. Age UK Norwich told us that 35% of Norwich wards fall within the top 10% of the most deprived areas in England. There has been a 35% rise in food bank use in the city, fuel poverty is at nearly 16%, and 68% of Age UK Norwich inquiries are about money, debt or bills.

Another example is poor housing and malnutrition. We have quite extreme malnutrition in Norwich. Norfolk has the highest malnutrition rate in England; malnutrition affects one in five people in Norfolk and Waveney. Jade Hunter, the headteacher of West Earlham infant and nursery school, told The Guardian:

“We do get a lot of bad chests because they’re in damp homes that are maybe mouldy, and we get a lot of sickness and diarrhoea because the quality of the food they’re eating isn’t great”.

She told me that one way teachers know children are hungry is that they chew their pens and chew sand. That shows that they are not being given what they need to thrive at school.

Before I conclude to allow others to contribute, I would like to ask the Minister some more questions. We know there will be a Government review of NHS England structures. There is an incomprehensible patchwork of bodies covering different geographical areas, including the Norfolk and Suffolk NHS foundation trust, the East of England ambulance service, the NHS Norfolk and Waveney integrated care board—the list goes on. Are there plans to simplify those structures and make those bodies more accountable? I understand that NHS reorganisations and reforms are not always popular, particularly with staff, but I wanted to ask that question.

Secondly, before the general election, all Norfolk MPs called for an undergraduate dental school to be established at the University of East Anglia. With my hon. Friend the Member for Norwich North (Alice Macdonald) and many others across the region, I have been working on that proposal, so will the Minister tell us whether there has been any news or developments? Such a school will be critical to beginning to end the dental desert in Norfolk and Waveney—dentist provision in Suffolk is in almost as bad a state.

Finally, I campaigned for mental health before I was an MP, I and continue to do so to this day, despite the difficulties. Despite the past 15 years of so-called change and reform in our local mental health service, it is still arguably the worst in the country. Will there be a statutory public inquiry into the systemic failure of mental health services in Norfolk and Suffolk? This scandal—this slow-motion disaster—has gone on too long, disrupted and ruined too many lives, led to people dying unnecessarily, and caused much grief. People need answers, and if we are to learn lessons from what has happened in the past 15 years, we need an independent public inquiry to get to the bottom of these issues.

[Sir Christopher Chope (in the Chair)]

Before I call the next speaker, let me say that about 10 people have indicated that they wish to speak. The winding-up speeches will start just before 10.40 am. I believe in self-regulation, so I hope people will contain themselves so that their speeches meet the overall need.

--- Later in debate ---

[Adrian Ramsay]

I totally agree with the hon. Member’s point. I have had family experiences in recent months that have shown me, starkly and at first hand, just how much we need to address the crisis in social care and the lack of integration with the health service.

I want to highlight that on the Norfolk-Suffolk border, in towns such as Eye and Diss, people are 20 miles from the nearest big hospital in Norwich, Bury St Edmunds or Ipswich—and in towns such as Halesworth, which does not have a local community hospital at all, people are even further away. I ask the Minister to consider what support can be given to rural hospitals to provide more services, and particularly to encourage cross-county border working in the health services that will enable us to look at how services can be provided in a way that benefits communities straddling the county border, as they do around Diss and Eye in my constituency.

Secondly, is no surprise that we have heard about dentistry from nearly every hon. Member who has spoken in this debate. We have the Sahara of dental deserts in the east. In the winter, I conducted a survey of residents in Waveney Valley to which more than 800 people responded. A quarter had given up on dentistry treatment altogether because of lack of NHS provision, others were driving long distances to access a dentist and some had even pulled out their own teeth. That is just not tolerable in the 21st century.

I welcome the Government’s commitment to reforming the dental contract. From my discussions with dentists and dental organisations such as the British Dental Association, it is clear that reform of the dental contracts is the root cause of the big exodus of dentists from the NHS. Dentists are not being paid appropriately for the work they do. Can the Minister set out the timescale for reviewing that contract? Health organisations have told me that for every effort they put in to getting new dentists into the NHS, dentists are leaving at a greater rate. We must address the root cause of the problem.

Thirdly, I want to highlight optometry. I received correspondence from an optometrist in Norfolk concerned about the lack of post-operative aftercare, particularly for operations such as cataract surgeries. They highlight that private companies are operating services of that kind and then discharging members to the community without aftercare, which is having a knock-on effect on A&E. Can the Minister ensure that, where private companies provide such services, the proper aftercare is also provided? Will she commit to looking at whether that highlights the problem of relying on private companies, which might seek to cut corners in the name of profit, to provide services?

To conclude, our rural services, particularly in market towns and villages, are severely affected by the decline in health services. Whether it is dentistry or a lack of local hospital services, we need urgent action and I would welcome the Minister’s addressing my specific points.

[Sir Christopher Chope (in the Chair)]

Mohammad Yasin, you have one minute.

[Mohammad Yasin (Bedford) (Lab)]

Thank you, Sir Christopher. You said you would surprise me, and you really did. It is a pleasure to serve under your chairmanship.

Like those in many other areas, Bedford’s residents are suffering when it comes to GP and dentist appointments. One of the reasons my constituents are struggling is that we have shortages of GPs. We are trying to recruit from other countries, but we need local GPs. I am pleased that the Government have pledged to train more GPs locally.

Data from the 2021 census showed that the populations in each of the local authority areas covered by the Bedfordshire, Luton and Milton Keynes integrated care board grew much faster than average, ranging from a 10.9% increase in Luton to 17.7% in Bedford. The population in England only grew by 6.6% in that period—

[Sir Christopher Chope (in the Chair)]

Order. I am afraid I have to call the hon. Gentleman to order because we have run out of time. I am sorry that a lot of people will not be able to give their speeches.

I try to promote self-regulation, but it is worth reminding ourselves that paragraph 7 of the “Rules of behaviour and courtesies in the House of Commons” says that even if time limits are not imposed, Members

“should speak with reasonable brevity and be mindful of others. Brevity in debate will give other Members a greater opportunity to speak and increase…chances of being called early”,

on the next occasion on which a Member seeks to speak. I read that out as this is the first Westminster Hall debate of this Parliamentary Session. It is important that Members take into account that although I would prefer not to have to impose time limits, people then have to regulate themselves.

NHS

Christopher Chope Excerpts

Thursday 23rd May 2024 Commons Chamber

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. I am extremely grateful for all the terribly kind comments, which means that I am a bit reluctant to say this, but we need to crack on, so I ask for brief questions and brief answers. [Interruption.] It appears that the Whips agree with me. They know that we have the business statement and then the Finance Bill to get through. A good example will be set by Sir Christopher Chope.

[Sir Christopher Chope (Christchurch) (Con)]

Thank you, Madam Deputy Speaker, for giving such as good example to this House, as always.

My right hon. Friend was kind enough to meet me and our right hon. and learned Friend the Member for Kenilworth and Southam (Sir Jeremy Wright) to discuss the plight of people who are victims of covid-19 vaccine damage. She sounded very sympathetic at the meeting and promised to look into the vaccine damage payment scheme, so it was rather disappointing this week to be told in answer to a written question:

“Formal consideration of whether any reforms to the VDPS are necessary will form part of Module 4 of the COVID-19 Inquiry”.

The inquiry will not be heard until January next year, and it smacks of kicking the can down the road and ignoring the victims, who need help. The sum paid—£120,000—has not been increased since 2007.

[Madam Deputy Speaker]

Order. I fear that my authority is draining away, so I will make another plea for brief questions. I thought the hon. Gentleman was going to set a superb example. However, I am sure the Secretary of State will now respond briefly.

Public Health (Control of Disease) Act 1984 (Amendment) Bill

Christopher Chope Excerpts

2nd reading
Friday 26th April 2024 Commons Chamber

[Sir Christopher Chope (Christchurch) (Con)]

I beg to move, That the Bill be now read a Second time.

This is the Bill’s first outing in debate, because although it was presented in the 2022 Session, unfortunately the House was unable to debate it. It relates directly to the beginning of the pandemic and the emergency measures that were taken by the Government and Parliament in implementing the Coronavirus Act 2020. At the time, a lot of concern was expressed about insufficient scope for parliamentary scrutiny under the Public Health (Control of Disease) Act 1984, and how the level of scrutiny available under that Act compared unfavourably to that available under the Civil Contingencies Act 2004. Since that time, a number of academic and other articles have been written, and speeches given, in which the concern has been expressed that the Government used the wrong tool to implement restrictions on individual liberty during that pandemic, resulting in this House having an insufficient role in scrutinising that important legislation.

This issue was raised, very ably, by my hon. Friend the Member for Windsor (Adam Afriyie) during the original debate on the Bill that became the Coronavirus Act 2020. He said:

“the whole purpose of the 30-day provision in the Civil Contingencies Act was for the Executive to be accountable to Parliament.”

The Leader of the House, however, responded to a point that he had made earlier by saying:

“we cannot use the Civil Contingencies Act…If we have time to bring forward legislation, it is proper that we do that, and anything we did under the powers of the 2004 Act would apply for only 30 days.”—[Official Report, 23 March 2023; Vol. 674, c. 132.]

Well, that is exactly what the Civil Contingencies Act 2004 is there to do. It was implemented to deal with emergencies even graver than that caused by the coronavirus pandemic.

The Civil Contingencies Act was the subject of detailed discussion before its enactment. Section 28 is entitled

“ Parliamentary scrutiny: prorogation and adjournment”,

while section 27 provides for “Parliamentary scrutiny” in other circumstances, stating that

“Where emergency regulations are made”

under the Act,

“a senior Minister of the Crown shall as soon as is reasonably practicable lay the regulations before Parliament, and…the regulations shall lapse at the end of the period of seven days beginning with the date of laying unless during that period each House of Parliament passes a resolution approving them… If each House of Parliament passes a resolution that emergency regulations shall cease to have effect, the regulations shall cease to have effect…at such time, after the passing of the resolutions, as may be specified in them, or…no time is specified in the resolutions, at the beginning of the day after that on which the resolutions are passed… If each House of Parliament passes a resolution that emergency regulations shall have effect with a specified amendment, the regulations shall have effect as amended”.

The Civil Contingencies Act therefore enables the regulations introduced under its provisions to be amended, unlike the Public Health (Control of Disease) Act 1984. The Government took advantage of that during the pandemic, and I am trying to put it right by including in my Bill provisions to ensure that there is scrutiny so that there will no longer be a perverse incentive for the Government, when faced with a pandemic or similar emergency, to resort to the use of the 1984 Act rather than the Civil Contingencies Act, on the basis that it would suit them to use the former rather than the latter because it would be subject to less scrutiny.

Clause 1 of my Bill provides that section 45D of the 1984 Act should be amended so that

“the appropriate Minister must lay before Parliament a statement that the restriction or requirement is proportionate under subsection (1)”,

and that

“In the case of English regulations, that proportionality must be demonstrated by a regulatory impact assessment that has been laid before Parliament.”

The importance of such a regulatory impact assessment cannot be overstated. We now look back on that period three years ago, and consider the consequences that flowed from the over-zealous restrictions that were introduced by the Government. Almost every day we hear of the adverse consequences for a whole cohort of young people who were excluded from school for extensive periods. As a result, not only has their education been damaged but their health, welfare and, particularly, their mental health. In my view, that is a direct consequence of this House not having had the opportunity to consider the costs and benefits of introducing such draconian restrictions on people’s ability to participate in their school education.

A similar point can be made about businesses being able to carry on what they were doing normally. I visited a garden centre a few weeks ago. In the height of the pandemic it was verboten that people could visit garden centres. For a time people were not even allowed to go to the refuse disposal points to get rid of their rubbish. They were not allowed to venture out and meet their loved ones, even in open spaces. As a result, a whole mass of people lost their loved ones without really being able to say goodbye to them, because they were incarcerated in care homes. We must never allow such a situation to be repeated in another health or other type of emergency without the proper scrutiny.

When one looks back over the course of this Parliament, it is possible to say that if we had been able to scrutinise the social distancing regulations to a greater extent, the Prime Minister in office at the time of the pandemic would still be in office today. The regulations and restrictions of which he fell foul would not have been in place, because somebody would have asked some sensible questions. The Government would have been persuaded that the workplace regulations should have enabled people working during the emergency to try to deliver benefits for the public to be allowed have a cup of tea or a bun together without falling foul of the law.

The use of the Public Health (Control of Disease) Act 1984 may well have had the direct consequence—unintentionally, obviously—of depriving the former Prime Minister of his post. When the history books come to be written, these restrictions may be seen as a much more significant decision by the Government, though as the head of the Government, the Prime Minister himself at that time decided to use the 1984 Act rather than the 2004 Act regulations.

My Bill would ensure that we not only have proper parliamentary scrutiny of the regulations under section 45D of the 1984 Act, but that under section 45Q we introduce a provision that

“before such regulations may be made, a draft of the statutory instrument containing them shall be laid before each House of Parliament for a period of not less than twenty days on which that House has sat, and, if either House before the expiration of that period presents an address to Her Majesty against the draft or any part thereof, no further proceedings shall be taken thereon (but without prejudice to the making of a new draft statutory instrument) and that part of the draft shall not have effect unless both Houses by resolution approve it, or, if any modifications in that part are agreed to by both Houses, except as so modified.”

The consequence of that would be that there would be no incentive for a Government to introduce restrictions on freedom under the 1984 Act; instead, they would use the Civil Contingencies Act, which was of course set up for that very purpose.

I referred earlier to the public commentary about this issue. Most significantly perhaps, the noble Lord Sumption gave a lecture in which he expressed doubt about the legal basis for the draconian measures and argued strongly that we need proper parliamentary scrutiny. Another commentator, Tom Hickman KC, made the case not for using the 2004 Act but for having bespoke legislation to deal with such situations in the future.

The public health regulations that came into effect on 26 March 2020 set out criminal laws that required each person or household to remain in their homes until further notice. There were very narrow grounds on which people were able to leave their homes. The guidance that the Government issued was, as we eventually discovered through the courts, often over-claimed and overused by the enforcement authorities. We also found that those regulations essentially set up a system of false imprisonment, completely in breach of all principles of English common law. There were tremendous restrictions on people’s ability to go out and earn a living, and the reasonable excuses available to them to avoid the lockdown requirements were strictly limited.

Let us not forget the consequences for individual liberty, and for a whole generation of young and old people, who were particularly affected by these draconian laws, brought in by the Government under the wrong piece of legislation and insufficiently scrutinised by this House. Let that never happen again. Let us hope that Baroness Hallett, when she looks at this issue in the public inquiry, reaches the conclusion that the Government did indeed go too far in locking down, restricting freedom and preventing people from accessing education or seeing their loved ones in care homes. That inquiry will reach a conclusion in perhaps five or 10 years’ time—who knows?—but I hope that, if the Government do not support my Bill today, a future Government will be persuaded by Baroness Hallett’s report to do exactly the same thing and ensure the Public Health (Control of Disease) Act 1984 contains proper scrutiny provisions as safeguards.

[Mr Deputy Speaker (Mr Nigel Evans)]

The shadow Minister has indicated that she would like to make a very short contribution.

Tobacco and Vapes Bill

Christopher Chope Excerpts

2nd reading
Tuesday 16th April 2024 Commons Chamber

[Elizabeth Truss]

No, I am not giving way to the party that filibustered on my Bill and stopped us taking action to protect children. That was a disgrace.

[Sir Christopher Chope (Christchurch) (Con)]

Did my right hon. Friend hear the comments of Sir Chris Whitty on the radio this morning? He refused to apologise for or explain the failures of the NHS to deal with the issue of puberty blockers while, at the same time, he professed great support for these oppressive measures which are before the House.

[Elizabeth Truss]

My hon. Friend makes absolutely the right point. There are double standards in this debate. My view is that it is absolutely right that we protect the under-18s from these potential dangers before they have full decision-making capability, but we should allow adults to exercise that freedom. It seems to me that the medical establishment, the national health service and others working in the health industry have unfortunately been captured by this gender ideology, which is preventing them from seeing the truth of what is happening. That is why the Cass report is welcome. If only the hon. Member for Ilford North (Wes Streeting) had shown the same level of interest in dealing with the issue of young people and puberty blockers that he has shown in pursuing his crusade against smoking—he was not saying this a few years ago.

Children’s Cancer Care: South-East

Christopher Chope Excerpts

Wednesday 13th March 2024 Westminster Hall

[Munira Wilson]

This is not about political interference; it is about ensuring that there has been a fair, balanced and transparent process. I will talk about the process in a moment, but that is the concern. The hon. Lady talks about clinical input. The consultation, albeit that it was run in a very flawed way, had 2,500 responses—some were from clinical experts, and many were from patients and their parents—and it provides very strong evidence that St George’s is best placed and that the Evelina has been predetermined. I have nothing against the Evelina, and in fact I was just about to sing its praises, because I have had personal experience.

To make myself clear, the Evelina is a brilliant hospital that does incredibly important work in treating children. My own daughter, who is nine, is currently undergoing treatment at the Evelina and has received outstanding care. This is not about pitting hospital against hospital; it is about looking at the process and the evidence before us. As the hon. Member for Vauxhall (Florence Eshalomi) has alluded to, I would like to personally thank the medical director at the Evelina, who showed me around its excellent facilities on Monday. However, as I have mentioned, the evidence overwhelmingly demonstrates that, in this case, St George’s is best placed to deliver for this highly specialist cancer service.

Before I come to that evidence, I want to raise serious questions about the decision-making process to date. [Interruption.]

[Sir Christopher Chope (in the Chair)]

Order. There is a Division in the House. I do not know whether there will be just one Division. If there is only one, we will come back in 15 minutes; if there are two, we will come back in 25 minutes.

--- Later in debate ---

[Munira Wilson]

Absolutely. There is the point about transparency, the fact that it has been predetermined, and the point about outcomes, which I will touch on briefly in my speech.

In a consultation response submitted by Healthwatch Richmond and Healthwatch Merton, the groups concluded that the consultation design was insufficient because it “fails the legal test” for consultation and appears to have no prospect of altering the decision to award the new service to the Evelina. I am therefore keen to hear from the Minister what assessment her Department has made of how NHS England has carried out this process. Further, can she give an absolute assurance to Members that the decision made tomorrow will have been made fairly?

Regardless of the way in which it was carried out, the consultation received over 2,500 responses from affected groups, such as patients, their families, clinicians and professional organisations. Those voices must be heard, and I will seek to ensure that they are. One of the most important themes raised was specialist knowledge and experience of children’s cancer care. It is undeniable that St George’s has invaluable experience to offer: it has already been treating child cancer patients, in partnership with the Royal Marsden, for over a quarter century. Not only is that experience highly valued by patients and their families, but it has resulted in excellent outcomes, as the hon. Member for Wimbledon (Stephen Hammond) said. According to national data collected from intensive care units, St George’s children’s cancer intensive care outcomes are the best for a large unit in the UK. All the institutional knowledge, specialist expertise and professional networks that have been built over decades risk being lost if cancer care were to move away.

Another key theme that was repeatedly mentioned in responses was that the centre should be conveniently located. Travelling via public transport with a vulnerable and immunosuppressed child is both stressful and very risky, so patients and families have repeatedly stressed that a new centre must be easily accessible by car. Anyone who has lived or worked in central London knows how difficult and unpredictable driving in and out of central London can be. However, located in Tooting, St George’s is much easier to access, and has strong road links to parts of the south-east. That is particularly appreciated by those travelling from afar.

Finally, responses highlighted the importance of having most specialisms on a single site. One service that is particularly vital to child cancer patients is neurosurgery, which is required by one in four of them. Currently, out of the two options, only St George’s offers neurosurgery. According to the Children’s Cancer and Leukaemia Group, the fact that the Evelina does not currently provide cancer surgery is not an issue that can be resolved quickly, and relocating surgery services comes with associated risks to both patients and staff. In its consultation response, the British Association of Paediatric Surgeons notes that where that has happened in previous cases, a lack of support and structure has resulted in staff “leaving the relocated unit.”

Further, clinicians have shared concerns that, if children’s cancer care were to move from St George’s, other services could be disrupted, which may create unforeseen consequences for the many areas served by St George’s. By contrast, placing the new centre at St George’s would ensure that NHS services are not overly centralised, but rather evenly distributed across the region. What assessment have the Government made of this crucial clinical evidence and the associated potential risks to the cancer service and other children’s services?

The decision is such an important one because at its heart are children with cancer: a group who have dealt with the most challenging and frightening of circumstances so early on in their lives. In many cases, the children can go on to lead full lives. One such example is Zoe, a teenager who was treated by St George’s when she was just four. She has since recovered and now has dreams of becoming a children’s nurse. She says:

“I’m so grateful to the paediatric staff at St George’s Hospital for looking after me, and for always being there for me throughout my life. Thank you to the nurses who told me to follow my dreams and never give up.”

The experience, expertise and convenience that St George’s offers are extremely valued by patients and those who care for them. That must be reflected in the final decision that is made tomorrow, and that is why it is so crucial that no doubt is cast over whether the decision is being made fairly and transparently. Yet, as I have set out, the way that NHS England has handled the process means that it is very difficult to make that judgment at this point.

Last week, together with my right hon. Friend the Member for Kingston and Surbiton (Ed Davey) and my hon. Friend the Member for Richmond Park (Sarah Olney) I wrote to the Secretary of State requesting that she uses her formal powers to call in this decision should NHS England press ahead tomorrow with awarding the children’s cancer service to the Evelina; and a group of cross-party council leaders from across south-west London and Surrey have done the same.

I conclude by urging the Minister in the strongest possible terms to join that call and to support us in saying that this decision must be called in tomorrow if the Evelina is chosen, because of the serious process and clinical arguments that I have laid out today.

[Sir Christopher Chope (in the Chair)]

Back Bench speeches in this debate will have to finish by 5.38 pm.

--- Later in debate ---

[Ed Davey (Kingston and Surbiton) (LD)]

I congratulate my hon. Friend the Member for Twickenham (Munira Wilson) on securing the debate. I should declare an interest of sorts, because my disabled son, John, has been treated at both these hospitals. A few years ago, he had a very successful operation at St George’s, and for most of the last two years he has been attending a weekly clinic at the Evelina. My wife and I are grateful to both hospitals; they are both excellent hospitals, and we regard them very highly. So the fact that I strongly believe that NHS England should choose St George’s is no reflection on the Evelina—not in the slightest.

I have approached this issue from the start by looking at the facts, talking to clinical experts and listening to both sides. I have also looked at the risks of each of the options, because that is what we really look at when we take big decisions: which is the least risky option to make sure we have the quality of services? I have looked at the facts and the evidence, and talked to clinical experts, and they suggest to me that St George’s is easily the less risky option for locating these specialist children’s cancer services—for my constituents and for people across south London, Surrey, Sussex and beyond.

I want to take everyone through some individual cancers and how risks lay for those. I will start with neurosurgery. Twenty-five per cent of children with cancer have a brain or spinal tumour, and many of those will need neurosurgery. St George’s currently delivers that; the Evelina does not. The Children’s Cancer and Leukaemia Group, which is the UK’s professional association for those involved in the treatment of children with cancers, said in response to the public consultation that if the Evelina was the option chosen, it

“would be the only Principal Treatment Centre in the UK where neurosurgery is not carried out on site”—

the only one—and that there is

“evidence that suggests that Principal Treatment Centres for childhood cancers should be co-located with neurosurgery.”

In other words, with respect to neurosurgery, the Evelina option is the most risky. The Evelina’s solution to that—to use King’s—defeats the purpose of uniting children’s cancer services.

Let us move to oncology surgery. Another 15% of children with cancer will have a neuroblastoma, renal tumour or germ cell tumour. Those children often require major surgery by a paediatric oncology surgeon to remove or reduce the tumour. That expertise is rare. There are around 20 such surgeons in the country, three of whom are at St George’s. The Evelina does not have that expertise at all and will need either to rely on surgeons from St George’s going to work at the Evelina or to build a new surgical team from scratch.

If St George’s surgeons were to travel to the Evelina to operate on children with cancer, there would remain the question of the wider, non-surgical expertise required to manage those children, including the specific anaesthetic skills. Furthermore, it would be much more challenging to manage post-operative complications. In other words, for oncology surgery, as for neurosurgery, the Evelina option is the most risky.

Let us go on to bone marrow transplants. Another 42% of children with cancer will have leukaemias, other blood cancers or lymphoma. For those children, bone marrow transplants and, increasingly, chimeric antigen receptor T-cell treatment, where a patient’s cells are modified to help fight cancer, are key treatments for any new primary treatment centres to be able to deliver. Those treatments are complex, high risk, heavily regulated and difficult to set up without experience. Indeed, the process to do that probably takes years, not months. St George’s has a bone marrow transplant programme for adults and is accredited to provide CAR-T for adults, so it is well placed to extend that offer to children. The Evelina partnership, including Guy’s and St Thomas’ Hospitals, does not currently have a bone marrow transplant programme and is not accredited to deliver CAR-T. Developing such a programme there and delivering it with the required quality, without the adult service, will cost much, much more and be much, much more challenging.

I could go on with other examples of specific cancer treatments for children, but I will end by focusing on some wider issues where, once again, it is clear that the Evelina option is just more risky. Which of the hospitals has the most experience with paediatric cancer? As my hon. Friend the Member for Twickenham said, St George’s has 25 years’ experience of caring for children with cancer. The Evelina does not have the experience of caring for children with cancer—nothing like the experience of St George’s.

On staff, where are the specialist cancer staff currently working, and what would they do if there was a change? There are 432 staff at St George’s who are involved in caring for children with cancer. They are from a wide range of specialities and professions. The vast majority of those staff and the expertise they have built up in caring for children with cancer over the years will not move to the Evelina if the primary treatment centre is moved there. Why? Because most spend only a proportion of their time caring for children with cancer and the majority of their time caring for children with other conditions. St George’s estimates that only four whole-time equivalents, out of 432 staff, would be likely to transfer under TUPE regulations. Not only would the skills be lost, therefore, but they would need to be redeveloped in another group of staff. At a time when the NHS is facing one of its most substantial staffing and skill shortages ever, is that really a risk that NHS England wants to run? That type of basic medical risk analysis points clearly to St George’s being the solution.

But let us look at the financial risk too. NHS England itself has assessed the St George’s proposal as involving lower capital costs—£13.5 million lower—representing better value for money and having a better revenue impact. By 2030-31, the St George’s option would be breaking even, whereas the Evelina option would be running a £2 million-a-year deficit. Even taking into account the charity funding envisaged for the Evelina option, it would cost the NHS £3.5 million more in capital funding than the St George’s option, and the charity funding could presumably be used elsewhere. If the PTC were moved to the Evelina, St George’s would lose the income but would not be able to lose the associated staff. The trust estimates that that would leave a £2.5 million financial gap to close in the first year. Given that NHS finances are under real strain, why take the capital and revenue risk of opting for the most expensive option?

I have listened to the counter-arguments brought forward by the Evelina, some experts and NHS England. A big focus of those arguments is on research into developing new treatments into the future, so let us look at that. Cellular treatments such as CAR-T are likely to be central to the future treatment of children’s cancer. St George’s is accredited and commissioned to provide CAR-T, whereas the Evelina is not. Research into using vaccines to treat cancer is at an early stage, but St George’s, University of London, co-located with St George’s, is an international leader in research into vaccines, infection studies and clinical trials, with the long-term potential for vaccine technology to be developed to support the treatment of cancer. The hon. Member for Carshalton and Wallington (Elliot Colburn) was right to point to the Institute of Cancer Research and the Royal Marsden being in close proximity to St George’s. Again, they are part of the research offer that only St George’s can provide.

To conclude, I think this is a no-brainer. I am staggered that anyone has any doubt about which is the right option. I listened to the hon. Member for Mole Valley (Sir Paul Beresford), and I take him very seriously. He is a great professional in dentistry—he offered my wife some treatment in a previous debate, and I was grateful for that. He is right that we are all looking in expectation to see what happens with tomorrow’s decision. However, having listened to the experts and spent a lot of time looking at the issue, I just do not think there is any doubt: yes, the Evelina is a fantastic children’s hospital, and my son goes there every week, but it is not an expert in cancer services or in children’s cancer services, which is the point of this decision. St George’s can offer those specialities and the expertise, and it can do it more cheaply and in a more accessible way. It is by far the less risky option. I am grateful to the Prime Minister for saying that I can meet the Health Secretary to discuss this issue, and I look forward to that. I hope that tomorrow, given the arguments set out in this debate and elsewhere, NHS England will decide for St George’s.

[Sir Christopher Chope (in the Chair)]

I let the right hon. Gentleman finish his speech, but I am told that there are now going to be two Divisions, which means the sitting is suspended for 25 minutes.

--- Later in debate ---

On resuming—

[Sir Christopher Chope (in the Chair)]

In the absence of the Minister, but with the consent of the hon. Lady about to speak, I call Sarah Olney.

--- Later in debate ---

[Paul Scully (Sutton and Cheam) (Con)]

rose—

[Sir Christopher Chope (in the Chair)]

Order. We now have another Division in the House. I put on the record the fact that the Minister has profusely apologised for her absence; she was misled on whether there was going to be a gap between the Divisions. There was a gap, and although we have exploited it as much as we could, it is now time to suspend the sitting again. I am told that there will be two more Divisions, so it will be suspended for another 25 minutes. That means we will start again at 6.27 pm.

--- Later in debate ---

On resuming—

[Sir Christopher Chope (in the Chair)]

I call Sarah Olney, a few minutes early.

[Sarah Olney]

Thank you, Sir Christopher. I was on the verge of taking an intervention.

--- Later in debate ---

[Sir Christopher Chope (in the Chair)]

Before I call Karin Smyth, I should say that this debate has to end by 6.54 pm according to our new timetable. That includes a maximum of two minutes for a response to the debate.

[Karin Smyth (Bristol South) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Christopher—it has been severely tested this afternoon, but you have done remarkably well in getting us all to the end of this important debate, particularly for local people, on the issue of children’s cancer. I commend the hon. Member for Twickenham (Munira Wilson) on securing it. The hon. Members for Carshalton and Wallington (Elliot Colburn), for Richmond Park (Sarah Olney) and for Mole Valley (Sir Paul Beresford), my hon. Friend the Member for Mitcham and Morden (Dame Siobhain McDonagh) and the right hon. Member for Kingston and Surbiton (Ed Davey) all spoke on behalf of their constituents with the diligence that we would expect.

Receiving a cancer diagnosis is always distressing and deeply worrying for anyone; for a child and their family it can be particularly devastating. Watching a child go through that is a difficulty that most parents, fortunately, do not have to face, but my thoughts are with the many who do, who are being talked about today—particularly those who have lost a child to cancer. I pay tribute to the many families campaigning for good cancer care for children and young people.

Every year, 4,000 children and young people are diagnosed with cancer in the UK; sadly, it is still the biggest killer by disease of children and young people in our country. As we have heard this afternoon, the needs of children and young people with cancer are very different from those of adults. They can face real challenges in cancer care. It is crucial that they get the right treatment and family support. Often that treatment takes place in dedicated specialist treatment centres far from home: children can travel on average 350 miles to get their cancer treatment.

According to research by Young Lives vs Cancer, distressed and vulnerable children often travel across the country to receive care. As we have heard, the location of the centres is important for local people seeking the best care for their children. My city, Bristol, is home to the paediatric haematology/oncology programme, which serves the whole south-west region, working with shared care centres from Gloucestershire to Cornwall to ensure that children receive care as close to home as possible.

What should that care look like? We know that children receive the best care with early diagnosis and access to treatment from well-supported and trained staff, based on the latest research. Sadly, under this Conservative Government swathes of targets have not been met, and children are left waiting for a diagnosis when every second is vital. Those missed targets include the faster diagnosis standard, with three in every 10 patients waiting longer than 28 days for a diagnosis or to have cancer ruled out in 2022-23. Waiting lists have risen to a record high, with over 400,000 children awaiting consultant-led treatment. Prolonged waits have a detrimental impact not only on children’s health, but on their education and overall wellbeing. Although I welcome the children and young people cancer taskforce announced last month, without a properly functioning wider health system, children with cancer will continue to be vulnerable to those missed targets and delays in care.

The root of the crisis is the failure to provide the NHS with the staff it needs to treat patients on time. Indeed, the Royal College of Radiologists, which represents specialist paediatric radiologists, has said that after years of underinvestment, the workforce is stretched, causing backlogs and delay. That is why Labour is committed to providing the staff, the modern technology and the reform that are crucially needed to bring down those waits to safe levels. We will provide 2 million more appointments a year for planned surgery, diagnostics and out-patient care, and double the number of CT and MRI scanners, speeding up diagnosis and access to treatment for children.

We know and we have heard in the debate how important it is for people, and particularly for their families, to be confident that they will receive the right care in the right place. The guidelines produced by NHS England are very clear about the processes to be followed and the clinical case to be made for major service change. Indeed, that was much discussed in the Bill Committee for the Health and Care Act 2022, on which I sat. I look forward to hearing from the Minister—I will give her plenty of time—about any assurances that she can give to local people on the decision, and to the Members of Parliament who have spoken today on both the process and the substance of decision making in the NHS.

[Sir Christopher Chope (in the Chair)]

Minister, over to you.

Heart and Circulatory Diseases: Premature Deaths

Christopher Chope Excerpts

Thursday 22nd February 2024 Commons Chamber

[Andrew Bridgen]

Thank you, Madam Deputy Speaker. That is a 40% increase. Ask and ye shall receive.

The previous steady reductions followed major improvements in public health policy, reductions in risk factors such as smoking, and the controlling of blood pressure, as well as improvements in medical care. Although I am grateful to the hon. Member for Watford for securing this debate, and to the other Members who will contribute, there is an elephant in the room—indeed, there are so few speakers that there is probably room for a herd of elephants. Why has there been a significant uptick in cardiac deaths in recent years? What novel intervention in public health has occurred since 2019?

Some might think that covid is the cause. Not so. The same uptick in cardiac deaths was observable in Australia and Singapore before those countries got covid but after they rolled out the experimental messenger ribonucleic acid injection. Ah, the jab! I can see some Members tutting and turning away. Everyone knows that MPs with a science degree are few and far between, and that some Members’ eyes glaze over when science is discussed. Well, I am one of those MPs fortunate enough to have a science degree. Another was Margaret Thatcher, who was rather prouder of being the first Prime Minister with a science degree than of being the first woman Prime Minister, and rightly so.

Some Members appear to have prejudged the issue. It is often said that it is easier to fool someone than to persuade them that they have been fooled. For posterity, we must remember that it was 11 years after the thalidomide scandal was exposed in 1961 before the word “thalidomide” was mentioned in the Chamber. I refuse to let this new mammoth medical scandal be ignored in the same way.

We are witnesses to the greatest medical scandal in decades—perhaps in living memory, and possibly ever. It is bigger than thalidomide and bigger than the Tuskegee untreated syphilis scandal, in which some black people were deliberately not treated to see what would happen to their bodies over time. It might be bigger than the Vioxx scandal, hitherto the grandaddy of medical scandals.

I can see some Members looking puzzled. Vioxx was a new drug invented by Merck as an alternative to aspirin—a mild painkiller. A researcher first highlighted an issue to Merck’s senior management in 1997, two years before the drug was approved. One in 115 people who took Vioxx suffered a heart attack. Merck’s profits from Vioxx comfortably exceeded the criminal fine, the compensation and the litigation costs after the drug was pulled. It was a good business decision for Merck. Not one pharma executive went to jail for skewing the trial results, for deceiving the regulators or for recklessly causing the deaths of 60,000 ordinary Americans for profit. It is always for profit—lives tragically cut short, families destroyed and children devastated. Imagine the incentive structure in an industry where profits like that can be made, and the corporate greed where there is full immunity from prosecution. In 1986, pharma companies got immunity in the USA for all vaccines. The number of vaccines administered to children in America has exploded since then.

[Sir Christopher Chope (Christchurch) (Con)]

Does the hon. Member share my hope that the Minister, in responding to the debate, will address the article in The Daily Sceptic on 20 February this year by Will Jones, headlined “Covid Vaccines Linked to Large Increase in Heart, Blood and Neurological Disorders, Major Study Finds”?

[Andrew Bridgen]

I hope that the Minister will address that, and of course this will go on. Cardiac deaths were already the biggest killer in our country, but we have a mysterious 10% increase. I am sure that the hon. Gentleman, like others in the Chamber, has witnessed the horrifying sight of super-fit athletes keeling over on pitches around the world. A mountain of peer-reviewed evidence is emerging and hypotheses are being proposed. Numerous cardiologists have concerns, but unfortunately, many experts do not feel able to speak out openly about their concerns because of the climate of fear, and the consequences of whistleblowing or speaking out against big pharma, which has so often been found to be not operating in the public interest, and causing harm. I am afraid that we will see much the same, following the roll-out of the covid-19 vaccines, as we saw with Vioxx and thalidomide, and in so many other cases.

The evidence is mounting up so rapidly, and the only people who cannot appreciate what is going on in this country are those who really do not want to see. The public will be extremely harsh on this Parliament and our response to the covid-19 pandemic, including the roll-out of the vaccines. We were going to stop vaccinating after the over-70s, but we then decided that vaccination would include the over-50s. We then decided it would be for everyone. Then this House took the appalling decision, unsupported by the Joint Committee on Vaccination and Immunisation, in September 2021 to vaccinate children who were at very little risk, if any, of covid, but who have been harmed seriously by the vaccines.

Why ever did we use a systemic vaccine for a mucosal respiratory virus? One expert said last year:

“it is not surprising that none of the predominantly mucosal respiratory viruses have ever been effectively controlled by vaccines. This observation raises a question of fundamental importance: if natural mucosal respiratory virus infections do not elicit complete and long-term protective immunity against reinfection, how can we expect vaccines”

to work, when natural immunity does not give protection? And what is the name of this expert? Mr Anthony Fauci, the former head of the Centres for Disease Control and Prevention in America, who pushed the vaccines.

I wish I had more time, Madam Deputy Speaker; this is a huge issue and we need to debate it again. It is the biggest killer of our constituents, and our fear is that the rate of increase in cardiac deaths will not slow in the UK, or the rest of the world.

[Philip Davies (Shipley) (Con)]

It is a pleasure to follow the hon. Member for North West Leicestershire (Andrew Bridgen), as I often seem to in these debates, which often resemble Madame Tussauds: the same faces appear, time after time. As you will know, Madam Deputy Speaker, I have a reputation for brevity in my speeches, and I intend to support that reputation now.

I congratulate my hon. Friend the Member for Watford (Dean Russell) on securing this important and rather timely debate, and I echo the hon. Member for North West Leicestershire in saying that we enjoy seeing him looking so fit and healthy after the trauma that he had. This is a really important matter, and he is right to raise it today. As I highlighted in last month’s Westminster Hall debate on excess death trends, a recent article in The Lancet found that although the causes of ongoing excess deaths in the UK

“are likely to be multiple”,

Office for National Statistics data showed some clear trends—in particular, the “largest relative excess deaths” since the pandemic occurred in young and middle-aged adults, with the number of cardiac deaths happening outside hospitals being the most elevated. In other words, young and previously healthy people are dying at home from cardiac-related events, and we do not know why.

These are not just numbers and statistics—these are real people, loved ones, often from younger age groups, who are dying before their time. It is urgent and our duty to get to the bottom of the situation sooner rather than later. As I am sure we are all aware, there are many theories circulating about the causes of these excess deaths. One is the possibility of a causal link between the population-wide use of covid-19 vaccines and the marked increase in cardiovascular-related critical events, including heart attacks and strokes, among otherwise apparently healthy people. We do not know if that is the cause or not, because the data is not being released. Until certain data sets are released, it is impossible to rule that theory in or out.

That is why I, along with cross-party colleagues, wrote yesterday to the Secretary of State for Health and Social Care; Professor Steven Riley, the director general for data at the UK Health Security Agency; and Dr Alison Cave, the chief safety officer at the Medicines and Healthcare Products Regulatory Agency. We warn that by withholding official data, the Department, UKHSA and MHRA are helping fuel concerns and hesitancy about public health. We have asked that anonymised record-level official mortality data be released, alongside vaccination dates, doses and co-morbidities, without delay. We understand that the MHRA has collected and already shared this data with pharmaceutical companies to enable those companies to produce post-authorisation safety studies for their products, so I see no reason why it cannot also be shared with parliamentarians and the public right away. Will the Minister say whether that data has been shared with pharmaceutical companies? If so, why is not being shared with the rest of us?

As the Minister surely realises, repetitive generic assurances that the Government and the UKHSA take excess deaths “seriously” and monitor them “constantly”, and that the MHRA have

“systems in place to continually monitor the safety of our medicines”—[Official Report, 16 January 2024; Vol. 743, c. 235WH.]

do not serve to reassure anybody at all. Likewise, the news from the Office for National Statistics this week that it has revised its excess deaths methodology, and that there are suddenly 20,000 fewer excess deaths last year, has done little to quell public concern. If anything, it has done the exact opposite: people cynically see it as a convenient sleight of hand.

As we say in our letter, if the Government and their agencies are not willing to share the data we have requested, will the Minister explain to us why not? We are all on the same side and want to look after people. We are all concerned to do the best we can for everybody, but until we have all the data, we just do not know what we do not know. If there is any potential that public health interventions, such as covid-19 vaccines, are causing harm and premature death to some, we must act on that without delay. If the evidence shows that that there is no issue, then it is in everybody’s interest for that reassurance to be in the public domain as quickly as possible.

[Sir Christopher Chope]

If that information was in the public domain, then the Prime Minister would have been able to answer the question that he was asked in the GB News interview the night before last.

[Philip Davies]

My hon. Friend is right. It is in everybody’s interest that the information be in the public domain, so that we can reassure people, or at least let them know. Frankly, there is never any harm in giving people information and letting them make their own mind up about what has happened.

Opinions need to be put to one side, and the data need to be examined in the cold, hard light of day. Otherwise, we will do harm to people, and we will do even more and irreparable damage to trust in public health policy. I hope that the Minister will provide some reassurance that the data will be forthcoming as soon as possible, and that the Government do not give the impression that there is something to hide.

COP10: WHO Framework Convention on Tobacco Control

Christopher Chope Excerpts

Thursday 18th January 2024 Westminster Hall

[Andrew Lewer (Northampton South) (Con)]

I beg to move,

That this House has considered COP10 to the WHO Framework Convention on Tobacco Control.

It is a pleasure to serve under your chairmanship, Mr Vickers. I thank the co-sponsors of today’s debate, the hon. Members for Ealing, Southall (Mr Sharma), and for Linlithgow and East Falkirk (Martyn Day). I also thank all colleagues who have requested to speak, and the Backbench Business Committee for giving this application the urgent consideration that was asked for. The fact that Members wished to contribute to this debate, and to many others on similar topics of late, demonstrates how important this issue is across our United Kingdom.

I am pleased to see my right hon. Friend the Minister in her place, and of course I welcome her back to Government. I say that with no small amount of friendly bias, as she and I are constituency neighbours in Northamptonshire and have known each other for a very long time. We look forward to hearing from her later. I also welcome the shadow Minister, the hon. Member for Bristol South (Karin Smyth); I am keen for her to share her perspective on today’s proceedings. I state for the record that I have served as a vice-chair of the all-party parliamentary group for vaping.

I beg your indulgence, Mr Vickers, as I set the scene for why we are here today and outline the importance of what we are discussing. My co-sponsors and I were clear that this debate is not yet another opportunity to opine generally about smoking and vaping, or to merely rehash some of the well-known talking points that arise when we talk about these issues. Hopefully, it will not be a debate in which each side of the political divide claims to be cloaked in unique righteousness. I was pleased to have tripartite support for the debate application, and even more pleased that colleagues from a wide array of political parties, and from all four parts of the UK, have expressed a desire to speak in this and related debates.

It has been a stressful few days in Parliament. In some senses, the timing of this debate is very important, as it comes ahead of the 10th conference of the parties, but in other senses it is less fortunate, coming as it does straight after what we have been through over the past two or three days. Nevertheless, the debate is an opportunity for this mother of Parliaments to show our democracy at its best. We in the legislature can come together on a non-party basis to question the Executive and hold the Government to account. We should be conscious that many people from around the world will be watching these proceedings, given that the debate relates to international agreements and has a global perspective.

To the best of my knowledge, this debate is one of a kind. It is the only substantive discussion on next month’s meeting of the framework convention on tobacco control, COP10, taking place in any parliamentary democracy. It is my hope that we can shine a light on the World Health Organisation’s sometimes less than ideal proceedings.

I thank my hon. Friend the Member for Harrow East (Bob Blackman) for having secured the debate in this place on the WHO framework convention on tobacco control in March 2020. We all share a dislike, to put it mildly, of smoking. I pay tribute to the work that he and his colleagues do on the all-party parliamentary group on smoking and health to drive smoking cessation. Who in Parliament does not hate smoking? I do, and where we have differences, they are only on how best to drive it out. Since that debate nearly four years ago, we had one subsequent conference of the parties to the WHO: FCTC COP9, which took place in Geneva in November ’21. Today, of course, we are discussing COP10, which will be held in Panama in just over a fortnight.

We all know the term “COP”; it has become something of a household name, thanks to the United Nations climate change conference, which concluded its COP28 meeting in the United Arab Emirates last year, and which is heralded as a beacon of openness, transparency and engagement. The UK hosted COP26 in Glasgow in November 2021, which was expertly presided over by my right hon. Friend the Member for Reading West (Sir Alok Sharma). Ministers from Governments from all over the world attend these meetings. Indeed, our own Minister for Energy Security and Net Zero, my right hon. Friend the Member for Beverley and Holderness (Graham Stuart), was so enthusiastic about COP28 that he went to it twice. The conference sessions are open to the media, to civil society and to other interested stakeholders to participate in.

What a contrast that is with the FCTC and COP10. Despite smoking being one of the leading causes of death in the UK, killing about 80,000 people every year and causing one in four cancer deaths, there is likely to be no ministerial representation from the Government in Panama. It is unfortunate that such an important area of health policy is left to officials. Unlike the climate change COP, the FCTC COP meets and takes decisions behind closed doors, away from the scrutiny of Parliament and the press. The decisions taken in Panama next month will have wide-ranging influence over the UK Government’s approach to smoking cessation and the regulation of tobacco harm reduction products, which many smokers use to quit combustible tobacco.

For nearly a year, I have been asking the Department of Health and Social Care who will be in the UK’s delegation to COP10 in Panama. I have been asking what positions that delegation will take, and whether we will continue to stand up for Britain’s world-leading and evidence-based approach to tobacco control and smoking cessation. I know that a great many Members from across the House have made similar representations to the DHSC. Despite repeated oral and written parliamentary questions on the subject, Ministers have not yet set out the UK Government’s approach to COP10 in any detail. Clearly, none of us wants our Government to be as opaque as the World Health Organisation is on this and many other issues.

My first request of the Minister is that she asks my right hon. Friend the Minister for Energy Security and Net Zero to give serious consideration to attending COP10 in Panama next month. Members may ask why that is so important. The UK is one of the largest financial contributors to the FCTC, with millions of pounds of taxpayers’ money being shipped off to the WHO in recent years to support this agenda. That is whole streets-worth of residents of my constituency’s total contribution to the Exchequer. Every penny of tax that street after street of them pay goes to funding the WHO. We have an obligation to our constituents to ensure that the money is well spent, so we need to know who will be standing up in Panama on their behalf, and what policy positions will be supported or opposed.

What we do know is that the WHO takes a highly sceptical view of tobacco harm reduction products, including vapes, heated tobacco and oral nicotine pouches, arguing that they pose a risk to health. As I have mentioned, that is in direct contrast to the UK’s world-leading approach to tobacco control. It really is world leading, and we should be proud of what we have accomplished in recent years in driving down smoking rates and saving lives. Public Health England, which is now the Office for Health Improvement and Disparities, has been clear that vaping is at least 95% less harmful than smoking, and that heated tobacco products are considerably less harmful than conventional combusted tobacco cigarettes. That is independent, peer-reviewed evidence from a glittering array of public health experts, clinicians and scientists, not funded by players in the tobacco industry. Not only has it formed the bedrock of the UK Government’s approach to smoking cessation in recent years, but our model has been heralded by public health experts in countries and universities across the world as a beacon to follow. I therefore pay tribute to the Minister’s predecessor, my hon. Friend the Member for Harborough (Neil O'Brien), for the groundbreaking “swap to stop” scheme, which he announced early last year. For many of my constituents, vaping is a vital alternative that helps them to curb their smoking habits and quit, and the “swap to stop” scheme, which offers free vape starter kits to smokers, is a welcome tool in the arsenal.

When the Minister unveils her legislation later this year, we will have the opportunity to debate some of the fundamentals, including ensuring that children do not access nicotine products, and giving trading standards the enforcement powers that they need to tackle rogue traders who sell to minors or sell illegal products. However, we must not throw the baby out with the bathwater by introducing draconian measures that discourage adult smokers, whether deliberately or not, from making the switch to vaping. That is a fundamental point. Over-regulation and blanket bans are not the safe option; they could cost lives.

I agree with the Minister’s remarks in the debate last week that we must clamp down on packaging with cartoon characters, and vapes shaped like toys, but I discourage the misconception that flavoured vapes are not designed for 60-year-old smokers. There is very clear research on this: in a 2003 opinion poll by OnePoll, 83% of smokers stated that flavours helped them to quit smoking, and there is a definitive and widely available study on this matter by the University of Pennsylvania. Constituents tell me that it is precisely the availability of a wide range of non-tobacco flavours that enables them to make the switch away from harmful cigarettes. I oppose the suggestion from the hon. Member for Walthamstow (Stella Creasy) that adults are not interested in fruit-flavoured vapes. Why should adult smokers be discouraged from switching away from smoking, which will cost them their life, by a vaping market that is reduced to tobacco-only flavours that constantly remind them of smoking, and trigger their desire to smoke a cigarette?

There is also a danger that over-regulation will exacerbate the black market. In fact, as colleagues pointed out in the Westminster Hall debate on illegal vapes on Tuesday, the black market has flourished in recent years. Between 2020 and 2023, more than 2.5 million illicit vapes were seized by trading standards across 125 local authorities, and the enforcement agency warns that that is just the tip of the iceberg. Do we want to grow that iceberg, or reduce it as much as possible?

There is a tendency for us politicians to pass legislation or produce guidance from Whitehall so that we can say that we are taking robust action on an issue, without having regard to how it might be implemented. The UK already has stringent restrictions in place via the Tobacco Advertising and Promotion Act 2002, so much of the issue is really about enforcing the many existing laws, rather than a need for new ones. Speaking as a long-standing local government man—and I am still vice president of the Local Government Association—underpinning this issue is the new burdens doctrine, which this Government have signed up to and adhered to for many years. That doctrine states that all new burdens on local authorities must be fully assessed and funded. It is a cornerstone of Whitehall Departments’ preparatory work before they pass responsibilities on to local authorities, and I urge the Minister and her officials to keep that broader point in mind for discussions at the conference.

The real risk is that at COP10, the WHO will, as is expected, call for regulatory equivalence for tobacco harm reduction products, so that they are treated in exactly the same way as combustible tobacco products. That is not only counter to the UK Government’s position; if successful, it will significantly harm public health goals, not just in this country but across the world. Some countries have already banned vapes but not cigarettes, and that will cost huge numbers of their citizens’ lives.

Additionally, why bother to “swap to stop” at all if cigarettes and vapes are taxed in the same way and there is no price differential or flavour incentive to quit? That said, I am conscious that the Minister is still compiling her response to the recent consultation on smoking and vaping ahead of new legislation, which we await with interest.

There is one occasionally repeated fallacy that must be nailed and not repeated, given its harmful potential. It is not nicotine that causes lung cancer, and nor does nicotine itself kill its long-term users; rather, it is the constituent chemicals inherent in the combustion of tobacco within cigarettes that causes harm. Nicotine vapes, oral nicotine pouches, and indeed heated tobacco products—which are sometimes known as “heat not burn”, given that there is no combustion involved—are all essential in giving adult smokers a range of solutions for their smoking cessation journey. For the avoidance of doubt, I quote Cancer Research UK, which says that nicotine

“is not responsible for the harmful effects of smoking, and nicotine does not cause cancer.”

Tackling misinformation is at the heart of this debate, as we consider some of the measures that the WHO is proposing to enact at next month’s COP10 meeting, and the harmful effects they will have on public policy here at home.

As ever, the devil is in the detail, so I ask colleagues to forgive me if I take a few minutes to speak to some of the specific policies under consideration in Panama, and why the UK delegation must stand firm against them. The words of the Chief Medical Officer for England are ringing in my ears:

“If you smoke, vaping is much safer; if you don’t smoke, don’t vape”.

We need to consider how our public health bodies can effectively communicate that to adults who currently smoke.

One of the most worrisome proposals being put forward by the WHO is item 6.2 on the agenda, which covers tobacco advertising, promotion and sponsorship. It is widely understood that the WHO will push for an expansion of article 13 of the FCTC to include reduced-risk products—vapes, “heat not burn”, and oral nicotine pouches —within the restrictions on advertising, as if they were the same as combustible tobacco, when, as I hope I have already illustrated, they are not.

Like everyone else in this room—I cannot stress the importance of this enough—we have to ensure that children are not targeted by nicotine products, but successful uptake by adult smokers of these reduced-risk products as part of the UK Government’s strategy of tobacco harm reduction relies on the ability of responsible manufacturers and retailers to provide important and accurate information about the products’ health benefits when set against traditional combustible cigarettes. There are still 6.4 million smokers in the UK, and they are our constituents, our neighbours, our families, and—I am very sorry to say—for many of us, our friends.

Misinformation on this issue is not only dangerous; it is lethal. The best must not be the enemy of the good. The extent of misinformation is such that, according to Action on Smoking and Health, four in 10 smokers believe that vaping is as harmful or more harmful than smoking. That figure increased by a third last year. A recent YouGov poll also found that over 50% of people thought that vaping was more harmful or as harmful as smoking. Whenever there is an online newspaper article about this subject, to which I have obviously been paying particular attention in the last week or so, I am amazed by the extreme, contradictory and occasionally potentially dangerous views expressed.

The proposals under discussion at COP10 would limit the ability to tackle misinformation on relative harms, while simultaneously restricting the promotion of reduced-risk products to adult smokers. As I alluded to earlier, the UK delegation must challenge any attempt to bring about regulatory equivalence between combustible tobacco and reduced-risk products—in particular “heat not burn” products, which the Office for Health Improvement and Disparities has made clear are substantially less harmful than smoking.

There is a risk through item 6.3 on COP10’s agenda that the WHO will seek to do just that: to push Governments around the world to regulate vapes and other reduced-risk products in the same way as combustible cigarettes, leading to the concern that that could extend to proposals on taxation and price points. If the WHO is successful, any financial incentive to switch away from cigarettes will be removed. That point has been made by many colleagues on many occasions, and I know from our work together on the APPG for vaping that the hon. Member for North Tyneside (Mary Glindon)—my colleague and co-author of an article on the issue—has spoken passionately about it and her own personal experiences. Such measures would send the wrong message, and would only perpetuate the dangerous myth, believed by 40% of smokers, that vaping is as harmful as smoking, and would therefore obviously discourage them from switching in the first place.

Will the Minister undertake to confirm that the UK delegation will block any measures to restrict the ability to effectively communicate with adult smokers on the health benefits of switching away from combustible cigarettes? Will the UK delegation oppose any move towards regulatory equivalence, including on taxation and price points?

I am conscious that other colleagues wish to speak. Thank you, Mr Vickers, for indulging me in setting the scene more generally and outlining some of the concerns as the Government head into COP10.

[Sir Christopher Chope (Christchurch) (Con)]

My hon. Friend is making a brilliant speech, and I am grateful to him. Can he explain why we would be required to follow any recommendations that come out of COP10? As a sovereign country, surely we would be able to decide whether we wished to accept the recommendations.

[Andrew Lewer]

I will develop my hon. Friend’s point in my closing remark.

If the UK delegation attends COP10 and goes along with international agreements, even if they are not legally binding, there will be a mood music and atmosphere, as we have heard in recent days, that because we are a signatory and have agreed to go along with them, we therefore need to follow along. My hon. Friend the Member for Christchurch (Sir Christopher Chope), possibly more than anyone else, has been robust about the limitations of international bodies with respect to this Parliament and this country. However, as we discovered this week, their prevailing influence is great, and not standing up to proposals at such events therefore leads inexorably to their proposals being absorbed into British policy and lawmaking.

It would be hugely beneficial if the Minister attended COP10 in Panama and flew the flag for our world-leading public health strategies for smoking cessation. She is someone who passionately championed, when she stood astride that Wembley stage back in 2016, Britain’s great future as an independent, free-trading and outward-looking nation, having taken back control of our laws, borders and money. I do not believe for one moment that she wishes to see responsibility for our public health policy abrogated to another supernatural—sorry, supernational: a Freudian moment there—unelected body of bureaucrats. To assist in setting out the UK position, perhaps my hon. Friend the Member for Winchester (Steve Brine), in his capacity as Chair of the Health and Social Care Committee, might have the UK delegation appear before him and his colleagues to answer questions before COP10 gets away on 5 February, as well as afterwards.

Our constituents, many of whom have written to us about this in recent days, have the right to know what the UK delegation will or will not be doing on their behalf, let alone who is in it. I am sure that I speak for many Members when I say that we would welcome clarity on that point. I am grateful to the Minister for coming to respond to the debate. I am sure that she will use the opportunity to provide us with some of the answers we seek, and will undertake to keep the House and colleagues fully informed. I hope she will make a statement from the Dispatch Box at her earliest convenience after the conclusion of COP10 to update us on the outcomes from Panama.

I look forward to the contributions of colleagues from all parts of the House, and to the response from the shadow Minister, the SNP, and the Minister, who I know shares my passion for ensuring that our Parliament retains its status as the sovereign decision-making body.

--- Later in debate ---

[Mr David Jones (Clwyd West) (Con)]

May I say what a pleasure it is to serve under your chairmanship, Mr Vickers? I congratulate my hon. Friend the Member for Northampton South (Andrew Lewer) and the hon. Members for Ealing, Southall (Mr Sharma) and for Linlithgow and East Falkirk (Martyn Day) for securing the debate, and I thank the Backbench Business Committee for facilitating it. At the outset, I declare an interest as an honorary life governor of Cancer Research UK.

I agree entirely with my hon. Friend the Member for Northampton South that the stance the UK adopts at COP10 next month will be crucial to the future of tobacco harm reduction in this country. To their great credit, the Government have pursued a distinctive and very successful UK-made policy on smoking that has significantly reduced its prevalence in this country. Nevertheless, as we heard from my hon. Friend, 6.4 million people still smoke—around 12.9% of the UK’s adult population.

To help reduce smoking rates, the UK is taking a world-leading approach, supporting the principle of tobacco harm reduction. In particular, the UK takes the view that vapes can have an important role in reducing the prevalence of cigarette smoking. The Government have allowed vaping to develop on a market basis, and that has gradually taken 1.5 million people off smoking altogether.

As we have heard, the smoke produced by combustible tobacco represents the greatest threat to the health of smokers. The UK has therefore been keen to point smokers to alternatives to combustible cigarettes. As we heard from my hon. Friend, in April the Department of Health and Social Care announced that a pioneering “swap to stop” strategy would be rolled out across England, providing a million smokers with a vape starter kit, alongside behavioural support to help them quit. That approach has a history of success. The largest such programme to date was conducted in Salford in 2018, and it resulted in over 60% of participants being smoke-free after just four weeks.

While no one route can be said to be the only one to help smokers to quit, the fact is that, for many, vaping does work. I repeat the quote my hon. Friend mentioned from the chief medical officer for England, who said:

“If you smoke, vaping is much safer”.

However, he went on to say:

“if you don’t smoke, don’t vape.”

The 2022 Khan review made it clear that the Government should

“embrace the promotion of vaping as an effective tool to help people to quit smoking tobacco.”

However, one solution does not suit all smokers. It is important that the Government, and indeed the devolved Administrations, which have responsibility for healthcare in their areas, keep as many options open as possible to have the highest chance of success in reaching smoke-free status by 2030. That is the Government’s highly commendable ambition, and it must not be thwarted by the likely stance of the World Health Organisation in Panama.

The WHO opposes reduced-risk products, including vapes, heated tobacco and oral nicotine pouches, arguing that there is insufficient data to understand their effects. The WHO, to be entirely blunt, is being stubbornly backward. It does not accept any harm-reduction approach to smoking. It does not accept that smokers switching to vapes is a better choice. It does not accept British scientific consensus—for example, the Public Health England report stating:

“While vaping may not be 100% safe, most of the chemicals causing smoking-related disease are absent and the chemicals that are present pose limited danger”

and that

“best estimates show e-cigarettes are 95% less harmful to your health than normal cigarettes”.

The WHO’s stance, therefore, runs counter to the UK Government’s successful, evidence-based approach to tobacco harm reduction through the use of reduced-risk products to help to cut smoking rates. We must remember that the United Kingdom is one of the largest financial contributors to the FCTC, and the Government should not be afraid to remind the WHO of that. British taxpayers have in recent years provided millions of pounds to support WHO policies that are contrary to those operated by the United Kingdom.

The WHO’s approach is that nicotine products pose a risk to health and that the safest approach is not to use them at all. Well, of course—that is self-evidently the case. Non-smokers should never start using nicotine, but it is counterproductive to prevent adult smokers from accessing reduced-risk products in a world in which 1.1 billion people still smoke. That makes no sense at all.

As my hon. Friend the Member for Northampton South said, some of the proposals in the provisional agenda for COP10, published on its website, are a serious cause for concern. For example, item 6.2 aims to impose the same restrictions on the advertisement, promotion and sponsorship of reduced-risk products as on conventional tobacco products. That would limit the ability of the UK Government, the devolved Administrations and public health bodies to promote to adult smokers less harmful alternatives as part of a smoking cessation strategy. It should be noted that, in contrast, Sweden is set to become the world’s first smoke-free country, after seeing substantial reductions in smoking rates through the use of a wide range of reduced-risk products.

Item 6.3 on the agenda threatens to establish regulatory equivalence between combustible tobacco and reduced-risk products. That sends a dangerous, misinformed message that reduced-risk products are as harmful as, or more harmful than, combustible cigarettes.

[Sir Christopher Chope]

Is that not exactly what has happened in China? China is regulating vapes in the same way as tobacco, and we know that the WHO is controlled by Chinese interests. Should that not make us really alarmed?

[Mr Jones]

Yes, it certainly should, and it is another reason why the United Kingdom, which has significant influence within the WHO, should actually exert that influence, and I propose to discuss that a little later in this speech.

Misinformation about vaping is already an important and worrying issue. According to Action on Smoking and Health, four in 10 smokers in the UK now believe that vaping is as risky as, or riskier than, smoking. That is the consequence of the misinformation, and the WHO’s position simply compounds the misinformation.

In the teeth of this hostility on the part of the WHO, the Government should confirm what policy positions the UK delegation to COP10 will take, especially on the agenda items that I just mentioned. I hope my right hon. Friend the Minister, in her winding-up speech, will be able to assure us that the Government will challenge the WHO on the science head-on. Will she say, as my hon. Friend the Member for Northampton South has asked, whether a Minister will attend COP? I believe that a Minister should be there—I think she should take a slow boat to Panama. We need ministerial involvement at this conference. Will my right hon. Friend also say what policy positions she will be instructing officials to take, and will she undertake to provide a further statement to the House on the key outcomes—particularly where there may be an impact on health policy and smoking cessation strategies—after the closure of the conference? Critically, will she confirm that the UK delegation will oppose, and if necessary veto, any proposals that would impact on the UK’s world-leading and evidence-based approach to tobacco control through the successful use of reduced-risk products?

I repeat that we are a major funder of this organisation. If we are to meet our goal of being smoke-free by 2030, the Government, working with devolved Administrations, must ensure that adult smokers are provided with a wide range of reduced-risk products to help them to quit, such as vapes, including single-use vapes; heat-not-burn and heated tobacco products; and oral nicotine pouches. Different solutions will work better for different people. Japan, with heated tobacco, and Sweden, with snus, the organic form of nicotine pouches, have had even more success in reducing smoking than the UK, so vapes should not be the only solution. Indeed, these products have been even more successful in their home markets than vapes have been here. We should be learning from other countries’ experiences.

At this COP, there will be an attempt on the part of the WHO to create a global norm of treating harm reduction products, including vapes and heated tobacco, exactly like combustible cigarettes, as if they were equally dangerous, including by raising their excise duties to the same level. That would be a colossal disincentive to any smoker who might consider switching to a less dangerous choice. I hope my right hon. Friend the Minister can confirm that the UK will stand against what would be a reactionary and profoundly dangerous error.

The WHO should not be allowed to undermine the UK’s evidence-based and science-led approach to tobacco harm reduction. The UK’s successful use of vapes to reduce smoking rates is rightly seen as a model of success around the world. The UK delegation at COP10 must do all it can to oppose measures that may threaten that.

[Sir Christopher Chope (Christchurch) (Con)]

It is a pleasure to serve under your chairmanship, Mr Vickers. I had not expected to speak in this debate, but I think it is worth re-emphasising the point that the WHO is controlled by China in very dubious circumstances. The chairman and director general of the WHO were appointed under Chinese influence. We have debated several times in Westminster Hall the influence of China when it comes to other areas of activity with the World Health Organisation. Here we have a specific example of how Chinese leadership is trying to persuade this WHO body to introduce the same policies and regulations that it has already introduced in China.

We should be the world leaders in this. We should be out there explaining why tobacco harm reduction products are really well suited to the consumer and the battle against the harms caused by smoking, but we do not seem to be in a leadership role. I urge my right hon. Friend the Minister to show that leadership by leading the UK delegation in Panama. Otherwise it will seem as though we are diffident. There is even a danger that what we believe in this country and the pioneering work that has been done, to which reference has already been made, will count for nothing when it comes to the debates in Panama.

We know the extent of Chinese influence across the world. The next stage may well be that what is advisory for this WHO body will become mandatory. That is the Chinese agenda. They are trying to take over the these international bodies and get their way. What should we be doing? We should be fighting back robustly. We should not be naive about this. I fear that we are far too diffident.

I am disappointed that despite the number of constituents who have written to me and on whose behalf I have written to the Government, we have still not had clear answers about exactly what our position will be when the discussion takes place in February. My right hon. Friend the Minister has always been a champion of national sovereignty, but I urge her to demonstrate that by leading the way and telling the Whips that we can manage without her for a few days, while she raises the flag in Panama on behalf of the United Kingdom and all we are doing to improve our public health and reduce the harm that comes from smoking.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)]

It is a real pleasure to serve under your chairmanship today, Mr Vickers. I thank all colleagues who have taken part in this Backbench debate, especially my hon. Friend the Member for Northampton South (Andrew Lewer) for his leadership in organising it. It has been very interesting, and I can absolutely assure colleagues that I have learned some new things myself today.

To tackle the very first question, I do not intend to go to Panama for COP10. That is because I am preparing flat out for our smoke-free generation Bill, including the response to the consultation and the measures. I just do not think it would be a good use of my time to travel on 5 February. However, the Government will be represented by our excellent colleague from the civil service, Dr Jeanelle de Gruchy, who has done fantastic work representing the UK’s position.

I will give a rough overview of the UK’s position. There will be discussion about global progress on tobacco control. Of course, the UK is an outlier on the topic of vapes, and we will be putting forward our position that vapes are a very important tool for helping adults to quit. There will be some discussion on advertising and sponsorship. The UK has no plans to implement further restrictions on advertising and sponsorship, particularly in the COP’s desire to see further restrictions implemented. On novel and emerging tobacco products, different parties take different approaches. At the moment, the UK is still looking at issues around heated tobacco, so the UK delegation will be in listening mode. In terms of parties going further on tobacco control, certainly the UK Government would welcome other parties going further to protect people, but we will be monitoring the negotiations to ensure that nothing becomes mandatory. Finally, there will be discussions on whether there should be an increase in assessed contributions. The UK intends to press for contributions to stay where they are now. I am very happy to provide a statement to the House after COP10, giving feedback on exactly what happened. I think that covers a lot of the issues raised by colleagues. I hope that was clear, and I would like to again thank everyone for attending.

As has been pointed out, the framework convention on tobacco control was the first treaty negotiated through the World Health Organisation. However, as colleagues will appreciate, I am not one to get misty-eyed about international conventions, or indeed international regulatory frameworks. I am not terribly romantically attached to this, and I feel that the UK’s sovereignty is actually the most important aspect. My priority as the Minister will be to help us in the UK protect our citizens from harm. Is there not a song that goes, “I did it my way”? The UK has a world-leading approach to reducing harms from tobacco and nicotine, and we will continue to do that.

The conference of the parties has, however, been a helpful way of keeping strong tobacco controls at the top of the global health agenda. It is also, as I hope I have just illustrated, a very useful forum for sharing best practice. All papers are presented and all decisions made are published online via the dedicated COP10 website. The UK remains committed to the convention, because we are a world leader in tobacco control. Like many friends around the world, we want to see a tobacco- free future. Next month’s conference will be a fantastic opportunity for us to showcase the UK’s strength, being at the cutting edge of a smoke-free generation. As I have said, our deputy chief medical officer, Dr Jeanelle de Gruchy, is the chief delegate. I have every confidence that our team will encourage other countries to follow in our example.

Now, my hon. Friend the Member for Northampton South is a big fan of common sense, and so am I. I want to reassure everybody that our delegation will be bound by common sense, and not by conference decisions that run contrary to common sense, or indeed to decisions that run counter to our national interest. That includes the decisions we take in helping smokers to quit through quit aids such as vapes and nicotine replacement products. We are a sovereign nation, and it is not within the WHO’s remit to intervene in our internal affairs.

Last week, I was given a couple of opportunities to update the House on our progress towards a smoke-free generation. With permission, I would like to reiterate a few of the points I made then. Our new tobacco and vapes Bill will save lives. Unlike other consumer products, there is no safe level of smoking: it is a product that kills up to two thirds of its long-term users, causes 70% of lung cancer cases, and massively increases the risk of stillbirth. It causes asthma in children; dementia, stroke and heart failure in old age; disability and early death. Almost every minute of every day, someone is admitted to hospital because of smoking, and up to 75,000 GP appointments every month can be attributed to smoking. It takes a massive toll on both our health and our NHS.

Smoking also takes its toll on our economy. Detractors will say, “But what about the £10 billion a year the Treasury gets from taxes on tobacco—how will the Chancellor do without that?” But independent analysis shows that the overall cost of tobacco to society totals £17 billion a year, completely offsetting—and then some—whatever we receive in taxes. The cost of smoking is equivalent to the annual salaries of more than half a million nurses, almost 400,000 GPs, 400,000 police officers or 400 million GP appointments. Reducing smoking rates will bring down those costs and help our economy to become more productive. Our modelling suggests that the smoke-free generation policy we are looking to introduce will reduce smoking rates in England among 14 to 30-year-olds to close to zero by as early as 2040, and will provide cumulative productivity benefits of up to a staggering £85 billion over the next 50 years. That is why bold action is necessary. We are making history with this Bill.

I took up smoking at 14 and gave it up as my 21st birthday present to myself. It was not easy. To this day, I hate talking about smoking because I sometimes think, “I’d quite like a cigarette”, but I shall never be tempted. It is so hard to quit. To those hon. Members who mentioned that nicotine is not bad in itself—yes, it is; it is desperately addictive. When people try to give up nicotine, they suffer cravings and get irritable. It is really difficult to give up nicotine, no matter how it is consumed. Combustible tobacco certainly has all sorts of other horrendous health issues, but nicotine itself is not a harmless product by any means. There is no safe level of nicotine consumption.

Like so many smokers, I desperately wanted to give up this lethal addiction. We want to help more smokers than ever to quit through significant new funding and support. All smokers deserve our support to quit and lead a healthier, longer life, which is why we have announced we are doubling the funding to stop smoking services across England to a total of £138 million a year, to help around 360,000 people quit every year. We are also backing these efforts with substantial new money to support marketing campaigns. As my right hon. Friend the Member for Clwyd West (Mr Jones) and my hon. Friend the Member for Northampton South both pointed out, four in 10 smokers think vaping is as bad as, if not worse than, smoking cigarettes. With this substantial marketing support, the stop smoking campaigns will be common sense and easy to use, setting out the facts to help smokers to be able to quit. We will also provide vapes as a quit aid to those who want to stop smoking.

As colleagues will know, I am passionate about helping mums, mums-to-be and new families, which is why I have asked officials to redouble our efforts to tackle smoking in pregnancy. Women who smoke during pregnancy are two and a half times more likely to give birth prematurely. Smoking is also a significant driver of stillbirth. I want to do everything I can to spare parents the heartbreaking tragedy of losing a baby. One in 10 mothers smokes at the time of delivery; this figure rises to one in five in some parts of the country. Pregnant women who receive financial incentives are twice as likely to successfully quit in pregnancy as those who do not. We must also protect pregnant women and their babies from second-hand smoke. We are working to roll out a financial incentive scheme by the end of 2024 to help all pregnant smokers—and, crucially, their partners— to quit.

As I have said, vapes can be an effective tool to help smokers quit. That is why we have committed to providing 1 million vapes to smokers through our “swap to stop” programme. That is a different approach from that taken in the WHO proposals; we are proud to take it, because we know it works.

Along with millions of parents across the country, I am alarmed by the number of children using vapes, a device that should be used only by adult smokers who want to quit smoking. Youth vaping has tripled in the last three years, and one in five children has used a vape. We have a duty to protect children from under-age vaping while their lungs and brains are still developing, so we are taking decisive action to reduce the appeal and availability of vapes.

In our recent public consultation, we sought views on restricting flavours, point-of-sale displays and packaging, and on restrictions on disposable vapes. We will take tough new action to reduce the appeal and availability of vapes to children through the tobacco and vapes Bill.

I totally get the point that my hon. Friend the Member for Northampton South made about flavours. These are all areas that are being carefully looked at, but he will appreciate that Cherryade, Yazoo and bubble-gum flavours are not really designed for him and me. Packages that look like a little Coke bottle, or are brightly coloured, like a bubble-gum package, are marketed not at him, but at children. Of course we see the vape stand right next to the sweets stand, and vapes are sold, conveniently, at pocket-money price, so let us not be naive about this. A lot of the flavours and colours are specifically designed to appeal to children, and that has to stop. A strong approach to enforcement is a crucial part of making sure that it has a real-world effect.

Under-age and illicit sales of tobacco, and more recently vapes, are undermining the Government’s work to regulate the industry and protect public health. We are cracking down on this appalling illicit trade by backing enforcement agencies, including Border Force, His Majesty’s Revenue and Customs and trading standards, with £30 million extra per year. In the tobacco and vapes Bill, we will introduce powers to give on-the-spot fines, to tackle under-age sales.

[Sir Christopher Chope]

Will my right hon. Friend comment on the undue influence of China on the WHO, as exemplified in my remarks? China is trying to ensure that its policies are adopted by the WHO, and it seems to be funding the WHO and controlling it. Should we not be concerned about that?

[Dame Andrea Leadsom]

I will look into my hon. Friend’s concerns and respond to him in writing. That is probably the most helpful I can be, because that is not something that I have been briefed on. I am, as are all hon. colleagues across the House, concerned about the undue influence of China on public policy that finds its way into national policies. I am grateful to him for raising the issue.