Infected Blood Inquiry

Clive Efford Excerpts

Tuesday 19th November 2024 Commons Chamber

[The Paymaster General and Minister for the Cabinet Office (Nick Thomas-Symonds)]

I beg to move,

That this House has considered the Infected Blood Inquiry.

I am grateful for this opportunity to come before the House to update it on this vital issue and discuss the findings of the infected blood inquiry’s final report. We are now almost six months on from the publication of that report. I am pleased to have the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Gorton and Denton (Andrew Gwynne) with me on the Government Front Bench today. He will lead on the elements of the inquiry report that are matters for the Department of Health and Social Care. We are as one in our determination to drive forward this vital work and deliver action on the findings of the infected blood inquiry’s report. That is the very least that the infected and affected victims of this appalling injustice deserve.

As right hon. and hon. Members will be aware, I have made a number of statements to this House regarding the progress the Government have made on the compensation scheme. Today is an opportunity to go beyond that and cover the wider issues raised in Sir Brian Langstaff’s report. I am grateful to colleagues across the House for their engagement on this matter. I know that we are united as a House in seeking to deliver justice, in so far as it is possible, for this terrible scandal. We will not shy away from the appalling findings of the inquiry’s report and the horrors that have been inflicted on the infected blood community. I reiterate my thanks today to Sir Brian Langstaff and his team for that comprehensive report. Crucially, I thank the community themselves. I recognise the anger and the mistrust that many, quite understandably, hold towards public institutions that have let so many people down so badly.

When the infected blood inquiry reported in May, the now Prime Minister and I were clear that an apology is meaningful only if it is accompanied by action. It is action that we are taking. That is why I was so determined to move quickly to establish the infected blood compensation scheme and why I expect to see payments begin by the end of this year. The Prime Minister committed to delivering the Hillsborough law to help address the institutional defensiveness so powerfully exposed by Sir Brian’s report.

Today, I want to update the House on the work we are driving forward across the other key findings of the report to do everything possible to ensure that an injustice such as this is never allowed to happen again. I welcome the fact that my right hon. Friend the Chancellor provided, for the very first time, specific funding for the compensation fund: £11.8 billion in the Budget. That makes clear the scale of this Government’s commitment to justice, and I am proud that we are driving that work forward. Compensation delayed for generations will be delivered.

[Clive Efford (Eltham and Chislehurst) (Lab)]

My right hon. Friend rightly pays tribute to Sir Brian Langstaff. Everyone should be grateful to him for what he has done. In recommendation 14 of his second interim report, he was quite clear that the compensation body should be at arm’s length from Government and chaired by a completely independent judge with sole decision-making powers. Do the Government accept the core of that recommendation?

[Nick Thomas-Symonds]

The Infected Blood Compensation Authority has operational independence. The Government have stewardship over the amount of money allocated. As my hon. Friend will appreciate, the £11.8 billion is a huge and substantial commitment. I do not pretend for a moment that any amount of money can actually provide recompense for the scale of the injustice, but at the same time it is an indication of the commitment—from the Prime Minister, the Chancellor and across the Government—to deliver justice.

In saying that, I should say that I am grateful for the work and co-operation of hon. Members across the House. In particular, I once again thank my predecessor as Paymaster General, the right hon. Member for Salisbury (John Glen), for his efforts in government. As I indicated in the debate last week, I look forward to continuing to work in that spirit with the new shadow Paymaster General, the right hon. Member for Basildon and Billericay (Mr Holden), on this hugely important issue. I also thank my ministerial colleague, my right hon. Friend the Member for Kingston upon Hull North and Cottingham (Dame Diana Johnson), and the former Member for Worthing West. Their tireless campaigning and representation of the community’s interests over so many years has been invaluable.

Much progress has been made in responding to Sir Brian’s report, but much more remains to be done. I will set out the Government’s fuller response to the recommendations to the House in line with the timetable Sir Brian set out, but I hope in the course of this debate to assure right hon. and hon. Members, and most importantly those in the community, that we have listened, we have learned and we are taking long overdue action.

The inquiry’s report is persistent in uncovering the truth, unshakeable in its honesty and damning, frankly, in its criticisms. It is absolutely clear that fundamental responsibilities of patient safety in healthcare were repeatedly ignored, and that

“what happened would not have happened if safety of the patient had been paramount throughout.”

The culture of wilful ignorance runs through the report, and continued to proliferate as the scandal developed. It speaks to Governments across decades and a state more focused on discharging its functions, whatever the risk and whatever the cost. The report chronicles suffering of almost unimaginable scale: thousands of people died prematurely and continue to die every week; lives completely shattered; evidence destroyed; victims undermined; families devastated; and children used as objects of research.

It is a truly horrifying injustice.

However, Sir Brian’s report goes much further. He lays bare the institutional defensiveness that existed within the Government, and indeed the civil service, which led to the truth being hidden for so long, compounding the pain and the injustice. Sir Brian highlights

“the consequences of civil servants and ministers adopting lines to take without sufficient reflection, when they were inaccurate, partial when they should have been qualified, had no proper evidential foundation…or made unrealistic claims that treatment had been the best it could be.”

These actions are the very antithesis of public service, and that is why I know there is such collective determination to learn the right lessons and to act on them.

There is so much that can be said about the volumes of evidence that Sir Brian has uncovered, and I know that during this debate many Members will raise vital issues, but let me be absolutely clear: the report details utterly unacceptable failings on a chilling scale, and this Government will do everything in their power to address them. Through acting on these lessons, we must ensure that all those who have suffered, and those who have campaigned, have not done so in vain.

Let me now turn to the 12 recommendations that the inquiry made in its report. First, I will touch briefly on the progress that has already been made. I know that Members on both sides of the House are keen to hear the details of what the Government intend to do in response. The recommendations are wide-ranging, and are being given full consideration. As I have said, I will provide an update to Parliament by the end of the year against each and every one of those recommendations.

I will begin with compensation. I have already updated the House on a number of occasions on the progress that is being made. I am grateful to Members on both sides of the House for their contributions to the debate on the regulations that we have made to establish the Infected Blood Compensation Authority and the core route for compensation for infected people, but I am also grateful, crucially, for the support there has been throughout the House to ensure that the delivery of compensation is not delayed in any way by Parliament.

--- Later in debate ---

[Clive Efford (Eltham and Chislehurst) (Lab)]

I pay tribute to my hon. Friend the Member for Gedling (Michael Payne) for his maiden speech. It is clearly special for him to represent the area in which he grew up. He has so much personal experience and memories, and he spoke passionately about his family. I am sure they are very proud of him today, and that he will be an excellent representative for Gedling. I remember his Labour predecessor well. We were both elected on the same day, and perhaps I can challenge my hon. Friend a little and say that he has big boots to fill as his predecessor was an excellent Member of Parliament.

It is worth reminding ourselves of how we got to this stage. In spite of everything we have heard about the excellent progress being made in response to Sir Brian Langstaff’s report, there is still an enormous amount of frustration out there among victims and their families. In the 1970s and 1980s, as many as 6,000 people with haemophilia and other bleeding disorders were treated with factor concentrates contaminated with HIV and hepatitis viruses. Almost all of them were infected with hepatitis C, and around 1,250 people, including 380 children, were also infected with HIV. Some of those unintentionally infected their partners or other family members. More than three quarters of those infected with HIV have since died, as have around one third of those infected with hepatitis C. Of those still alive, many are in poor health due to liver damage, or from living with long-term HIV. Additionally, around 26,800 people were given blood transfusions that were infected with hepatitis C. All that was avoidable.

By the 1970s, blood and blood products were already known to transfer viruses. It was known that the use of pooled blood products significantly increased the risk of infections. Those risks were ignored by leading clinicians, Ministers and civil servants, and they failed to take appropriate action to end the use of those products and ensure the use of safer products. Pharmaceutical companies and leading clinicians did not share appropriate information about risks with patients and patient groups. They failed in their duty of candour. It is no wonder that the victims of those crimes mistrust the state—the state that should be there for them, to protect them and be on their side.

We are here because, despite many dying along the way, and with one victim dying every four days, the surviving victims refused to give up. They refused to be defeated. They won their battle, and over and above that they won the right to be included in the decisions, as Sir Brian Langstaff made clear in his report. All along, the victims have been lied to, refused access to information, their records have mysteriously gone missing, and more recently they have found themselves repeatedly let down by the Government, it has to be said, in the form of the Cabinet Office.

The Cabinet Office controls the decisions of the Infected Blood Compensation Authority. I hear what the Paymaster General and Minister for the Cabinet Office said to me earlier about operational independence, but ultimately the Cabinet Office is making the decisions and victims are not included in the way that Sir Brian recommended. Victims feel that decisions are being made without their involvement. Those suffering with hepatitis C feel particularly excluded and do not feel that their suffering has been fully recognised in the compensation scheme.

In his interim report, Sir Brian Langstaff said that there should be an arm’s length body. I will not read the whole recommendation, but he said:

“I recommend that an Arms Length Body…should be set up to administer the compensation scheme, with guaranteed independence of judgement, chaired by a judge of High Court or Court of Session status as sole decision maker”.

The report goes on to state that the body should

“involve potentially eligible persons and their representatives amongst those in a small advisory panel, and in the review and improvement of the scheme; and…permit the hearing of applicants in person.”

None of that is part of the compensation process, yet it is clearly there in the report, and it was Sir Brian Langstaff’s intention that the victims should be involved much more.

[Nick Thomas-Symonds]

In terms of listening to the victims, there was an extensive consultation exercise during the general election campaign. My predecessor set that up, and it continued under the aegis of civil servants in that period. Afterwards, 74 recommendations were made, having listened to the community about changing the scheme. The Government accepted the implementation of 69 of those 74 recommendations. I suggest to my hon. Friend that that shows listening to the concerns about the scheme’s original formation. In respect of the Infected Blood Compensation Authority, I strongly recommend that he, as chair of the APPG, meets Sir Robert Francis and David Foley. He can speak to them about precisely the involvement of the infected blood community, which is hugely important.

[Clive Efford]

I am fully aware of the consultation that took place, but what Sir Brian Langstaff describes is the ongoing involvement of the victims in the process, by their being part of an advisory panel and continuing to advise the compensation board.

I know that David Foley was at the conference at the weekend for the organisation that represents people with hepatitis. That organisation was pleased with the discussions it had with him, but none the less and in spite of that, people who were at that conference have since made clear to me that they feel frustrated and that, ultimately, the Cabinet Office is in control of the decision-making process. My right hon. Friend may take issue with that, but he should take note of the fact that that belief is out there, and we need to deal with it.

[Pete Wishart (Perth and Kinross-shire) (SNP)]

The hon. Gentleman is right to labour the point. All that we are hearing from the representative groups—those who make sure that they represent all those in the infected or affected communities—is that they want consultation with Government. They just want to be listened to and properly consulted as all these regulations are designed going forward. The hon. Gentleman is absolutely right. I do not understand the Minister’s sensitivity around all this. He has to be aware—I am pretty certain that he is—that there is this sensitivity when it comes to the community.

[Clive Efford]

I could not agree more with the hon. Gentleman. I am trying to make my right hon. Friend the Paymaster General aware of the strength of feeling out there that needs to be addressed. We will not satisfy people about the process unless we address those concerns.

One thing driving that concern is that the current process is not what was described in Sir Brian’s report, and it is not what was expected at the time he published his reports. The victims and their representatives feel excluded. On top of that, they feel enfeebled because of the lack of resources for advice and advocacy. There is further to go, if the victims are to have complete faith in the process. There is frustration that the people they have been battling against have been put in charge of the reparations. Surely my right hon. Friend can see their concerns. The death rate is now one every three days, and the increase in the rate is largely due to the fact that those with hepatitis have been suffering with long-term chronic liver disease. The Red Book for the Budget sets out that compensation will be paid over five years. At that rate, another 600 people will die without getting justice. The Treasury must not become another reason for justice for victims being delayed. Will my right hon. Friend guarantee that that will not be the case?

I am aware that Sir Brian Langstaff has written to my right hon. Friend about the rule on siblings of 18 years of age at the time the sibling passed away. Will he explain to the House—or write to me on this—exactly where that ruling came from? It does not seem to appear in any of the recommendations or in Sir Brian’s report.

I have spoken before about the £15,000 offered to former pupils of Treloar school, which they consider derisory. It is another example of what happens when victims are excluded from the process.

I also draw my right hon. Friend’s attention to the report of the Secondary Legislation Scrutiny Committee, which is an excoriating criticism of the Cabinet Office. It exposes what it describes as a lack of clear and understandable information in the explanatory memorandum and a lack of preparedness for delivering the compensation scheme. The Committee doubts that the Cabinet Office will be able to pay compensation by the end of the year. Is he confident that the Committee is wrong and that payments will be made by the end of the year?

Lastly, large amounts of money were made by pharmaceutical companies and others while victims were being exploited and, in some cases, even being experimented on. That did not come about because of mistakes; they were deliberate actions, which in many instances were criminal. The British taxpayer must not pay the full cost alone. Those who made money from this appalling scandal should be required to make a significant contribution. In spite of what my right hon. Friend may consider a negative speech, I welcome the progress that we have made, but there is much further to go to deliver the justice that Sir Brian Langstaff set out in his report.

--- Later in debate ---

[Andrew Gwynne]

I can assure the hon. Gentleman that the Minister for the Cabinet Office is carefully considering this matter. If the hon. Gentleman would like, the Minister for the Cabinet Office will write to him, but he is considering it.

We expect the Infected Blood Compensation Authority to begin making payments to people who are infected under the infected blood compensation scheme by the end of this year. Payments to the affected are expected to begin in 2025, following a second set of regulations.

Turning to a question raised by the hon. Member for Perth and Kinross-shire about the independence of IBCA, it is rightly operationally independent. Parliament would clearly expect the Government to have oversight of a scheme of this size and for there to be proper management, given the amount of public money going into the scheme. It is true that there are only two non-departmental public bodies that are independent of the Government: one is IBCA and the other is the National Audit Office. It is absolutely right for IBCA to have that independence.

[Clive Efford]

On that point, the National Audit Office is directly accountable to Parliament through the Public Accounts Commission. Is the intention to create a similar sort of arrangement, as envisaged by Sir Brian Langstaff, in which there is direct accountability to Parliament, rather than to the Department?

NHS: Independent Investigation

Clive Efford Excerpts

Thursday 12th September 2024 Commons Chamber

[Mr Speaker]

This statement will run for an hour, so please help each other. Let us try Clive Efford as a good example.

[Clive Efford (Eltham and Chislehurst) (Lab)]

Thank you, Mr Speaker. I will rise to the challenge.

I welcome the Secretary of State’s statement. In 2008, the previous Labour Government commissioned a report from Sir Michael Marmot on the state of society and health, and he found that there was health inequality, particularly in deprived areas. Ten years on, his second report found that health inequality had become even worse against the backdrop of an underfunded NHS. Does that not demonstrate the urgency of the need to invest in those communities under this Government? What can my right hon. Friend do to direct resources into the most deprived communities in order to turn around those health inequalities?

[Wes Streeting]

My hon. Friend is absolutely right that our country has stark health inequalities. It is not right that people who live in different parts of the country have such different chances of living well. A girl born in Blackpool can expect to live healthily until she is 54, whereas a girl born in Winchester can expect to live healthily until she is 66. That is why, with the Prime Minister’s mission-driven approach, we will not just get our NHS back on its feet and make sure it is fit for the future; we will also reduce the cost and burden of demand on our national health service by attacking the social determinants of ill health.

Government Policy on Health

Clive Efford Excerpts

Monday 9th September 2024 Commons Chamber

[Madam Deputy Speaker (Ms Nusrat Ghani)]

The urgent question has just started, so there will be ample opportunity to continue to hold to account the Secretary of State, who no doubt believes that his answers are responding to the UQ. We have some time to go, so if Members bob, I will endeavour to ensure that they are called to do so.

[Clive Efford (Eltham and Chislehurst) (Lab)]

The sheer brass neck of the Conservatives to turn up on the very day that Transparency International UK published its report showing that £15 billion of contracts were red-flagged during the covid epidemic—[Interruption.] I am not reading. Those contracts have been red-flagged and are worthy of further investigation, and £500 million of them were given to companies that had not even lasted 100 days. Should the Conservatives not have taken that into consideration before coming here with this urgent question?

[Wes Streeting]

I wholeheartedly agree with my hon. Friend. Frankly, every single contribution from the Opposition Dispatch Box should begin with a grovelling apology for the way they conducted themselves in government, but they will not apologise: they have learnt nothing and they show no humility. To my hon. Friend’s point, when it comes to covid corruption and crony contracts, the message from the Chancellor is clear. We want our money back and the covid commissioner is coming to get it.

NHS Dentistry: Recovery and Reform

Clive Efford Excerpts

Wednesday 7th February 2024 Commons Chamber

[Victoria Atkins]

I understand my hon. Friend’s point, and I commend him for his work to ensure that his constituents receive the care and help that they deserve. On training, I hope he has drawn out from the plan the emphasis that we are putting on long-term ambitions. We understand that we need to train more dentists and get internationally trained dentists registered in our system. We recognise the critical role that dental hygienists and therapists can play as well.

[Clive Efford (Eltham) (Lab)]

If the Tories cared about the NHS, we would not have 7.6 million people on the NHS waiting list and dentistry in crisis. The answer that the Secretary of State gave to my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) demonstrates why we are in this situation. It is not about people turning up at A&E; the inability to access NHS dentistry services leads to people being in a crisis situation and needing emergency care. After 14 years of the Tory Government, why do we need a recovery plan for dentistry?

[Victoria Atkins]

The hon. Gentleman was obviously asleep at the beginning of my statement, because I set out what I hope is a fact agreed across the House about the pandemic—the real problem. People who had a relationship with a dentist before the pandemic do not face quite the same pressures as people who may have moved home or whose dentist may have moved practice. That is the cohort of people who we are trying to help. It really would help if Labour Members focused their arguments a little more on the facts, rather than on the scripts that their Whips have given out.

Pharmacy First

Clive Efford Excerpts

Wednesday 31st January 2024 Commons Chamber

[Dame Andrea Leadsom]

I can assure my hon. Friend that pharmacists are highly skilled and better trained than ever before in this country. They are fully equipped to meet the demands of their new prescribing role.

[Clive Efford (Eltham) (Lab)]

I welcome the Pharmacy First initiative—its roll-out is long overdue—but what expectations are we creating in the minds of patients attending pharmacies? Will pharmacists be trained in denying medication to people who turn up expecting to be given a prescription of some sort? Clearly, the initiative will encourage more people to present in order to get medication when it may not be necessary.

[Dame Andrea Leadsom]

The hon. Gentleman raises a good point. Of course, pharmacists will be prescribing for seven common conditions. Plenty of referrals will be made to GPs, and from GPs to pharmacists, to give patients the accessibility and the appropriate level of assessment for their needs.

Oral Answers to Questions

Clive Efford Excerpts

Tuesday 23rd January 2024 Commons Chamber

[Maria Caulfield]

I thank my hon. Friend for raising this issue. We were holding regular meetings with Norfolk and Suffolk MPs, the trust, the Care Quality Commission and NHS England, and with the new management team, that trust did appear to finally be turning things around. However, I am concerned to hear the points that my hon. Friend has raised. I am very happy to restart those meetings and will ask my office to arrange them as quickly as possible.

[Clive Efford (Eltham) (Lab)]

8. What steps she is taking to increase staff recruitment and retention in the adult social care sector.

[The Minister for Social Care (Helen Whately)]

Care is a skilled profession, and I want care workers to get the support and recognition they deserve. This month, we took the next step in our ambitious care workforce reforms, publishing the first ever national career structure for the care workforce alongside our new nationally recognised care qualification.

[Clive Efford]

Ambitious care workforce reforms—it is all blah, isn’t it? We have had 14 years of Conservative Government, and we have a crisis in every area of the NHS. Job insecurity, poor working conditions and low pay—one in five care workers is living in poverty—are all reasons why we have a recruitment and retention crisis in social care. Is not the truth that that is a damning indictment of 14 years of Conservative Government, and the only thing that is going to sort out social care and the crisis in recruitment and retention is a general election?

[Helen Whately]

I am actually really shocked by the way the hon. Member referred to the care workforce, with terms like “It is all blah”—very shocking. I am determined that care workers should get the recognition they deserve. We have a 10-year plan for social care, and it is working: the care workforce grew by over 20,000 last year, vacancies in social care are down, and retention is up. We are reforming social care so that it works as a career. That is why, as I said a moment ago—I wish the hon. Member had been listening—we have introduced the first ever career pathway for social care workers and a new national care qualification.

NHS Winter Update

Clive Efford Excerpts

Monday 8th January 2024 Commons Chamber

[Victoria Atkins]

I thank my hon. Friend for all his work in making that happen. He worked very hard on virtual wards when he was a Health Minister, and they represent a real step change in how we treat people with long-term conditions who can be monitored safely at home. They mean that people do not have to spend time in hospital, with all the pressures that can mean for us as individuals. Importantly, that also frees up beds for other patients who need them. I am keen to roll the scheme out further. Indeed, we have not just met but exceeded our initial ambition, which is why I can confirm that we have delivered 11,000 places in the virtual bed ward category.

[Clive Efford (Eltham) (Lab)]

The BMA says that junior doctors’ pay has been cut in real terms by 26% through consistent below-inflation increases. If the Tories really cared about this strike and about the NHS, would they not have avoided creating the circumstances that made junior doctors so angry that they felt the need to go on strike? Does that not just show that you cannot trust the Tories with the NHS?

[Victoria Atkins]

The figure that the BMA relies on is in fact from 2008, when the Labour party was in government for the first two years. The BMA cites a 35% pay rise. Just to clarify, independent organisations such as Full Fact and the Institute for Government rely on the consumer prices index measure, which shows a difference of 11% to 16%. I am sure that the hon. Gentleman will take into account the fact that we have already given graduate doctors, in their first year out of medical school, a rise of 10.3%, and I was willing to negotiate further and consider additional settlements that are fair and reasonable to the taxpayer.

NHS Long-term Workforce Plan

Clive Efford Excerpts

Monday 3rd July 2023 Commons Chamber

[Steve Barclay]

My hon. Friend is absolutely right. As we boost our domestic workforce training, there will be scope to reduce the number recruited internationally. From 1948 onwards, international recruitment has always played an important role in the NHS, and we are hugely grateful for the service offered by those recruited internationally, but we also recognise that as demography changes in other countries, there will be increasing competition for healthcare workers around the world, so it is right that we boost our domestic supply. That is what this plan does, and it is why this is a historic moment for the NHS in making that long-term commitment that will in turn reduce the demand on the international workforce.

[Clive Efford (Eltham) (Lab)]

I, too, add my condolences to the family of Bob Kerslake, who did excellent work in my borough tackling poverty. I would congratulate the Secretary of State on this announcement if it did not come 13 years into a Conservative Government. It is a bit like Bobby Ewing coming out of the shower, the way the Secretary of State is saying, “I’ve just realised there’s a crisis in the NHS.” We went into covid with 2.4 million people on waiting lists, which was a record. It is now up to 7.4 million. The report itself says that we have 154,000 fewer staff than we need today in the NHS. After 13 years in government, if the Tories really cared about the NHS, it would not be in the state it is in, would it?

[Steve Barclay]

The hon. Gentleman ignores the fact that since 2010, there has been a 25% increase in the NHS workforce. More than a quarter of a million more people now work in the NHS than was the case in 2010. There is a 50% increase in the number of consultants working in the NHS today compared with 2010, but the reality is that demand has increased as a result of an older population, advances in medicine and in particular the demands of the pandemic, and that is what we are responding to. We are also taking measures in parallel. We are on track to deliver our manifesto commitment for 50,000 more nurses, with 44,000 now in place. We also have beaten our manifesto target on primary care, with 29,000 additional roles in place. That means that people can get to the specialist they need, which in turn frees up GPs for those things that only GPs can do and ensures that patients can access care much more quickly.

Oral Answers

Clive Efford Excerpts

Tuesday 25th April 2023 Commons Chamber

[Steve Barclay]

As the House knows, I am extremely committed to modern methods of construction and modular building capacity. We are using that as a central component of our new 40 hospitals programme. My hon. Friend will know that the RAAC—reinforced autoclaved aerated concrete—hospitals are very much part of that discussion, not just at Frimley but at King’s Lynn, at Hinchingbrooke and in a whole range of other settings. He will also know that we are in a purdah period, so we are constrained in what we can say, but we will have more to say on this very shortly.

[Clive Efford (Eltham) (Lab)]

We have had 13 years of Conservative government. There are record numbers of patients on waiting lists, record numbers of vacancies in the NHS, and a crisis of vacancies in social care. As for emergency care, the Government cannot meet their 18-minute target for category 2 ambulance responses. If the Conservatives were really concerned about the NHS, would we not be in a better position than this after 13 years?

[Steve Barclay]

The hon. Gentleman talks of 13 years. People are nearly twice as likely to be waiting for treatment in the Labour-run Welsh NHS as people seeking treatment in England, and, indeed, waits are longer in Wales: we have virtually eliminated two-year waits in England, whereas more than 41,000 people in Labour-run Wales are waiting more than two years.

National No Smoking Day

Clive Efford Excerpts

Thursday 9th March 2023 Westminster Hall

[Mr Virendra Sharma (Ealing, Southall) (Lab)]

It is a pleasure to speak under your chairmanship, Mr Efford. On No Smoking Day, I am delighted to welcome the progress we have made as a country, and I am grateful to the hon. Member for securing the debate. I must declare that I am a non-smoker. In only a few years, smoking policy has worked. It has massively reduced prevalence, and people are healthier, fitter and living longer. Given how few Members are present, Mr Efford, I understand that I can talk a little longer, rather than having to intervene two or three times.

[Clive Efford (in the Chair)]

Order. Interventions should be short. Why not just make a short contribution?

[Mr Sharma]

I accept that. Working-class and black and minority ethnic communities are struggling to quit, and need more complex solutions. Does the hon. Member agree that vaping represents a less harmful alternative?

[Several hon. Members rose—]

[Clive Efford (in the Chair)]

I remind Members that it helps the Chair determine who wants to speak if they bob in their places. I do not intend to impose a time limit; we have plenty of time for Back-Bench speeches. If my hon. Friend the Member for Ealing, Southall (Mr Sharma) has more of his intervention that he wants to use, perhaps he will make a speech when we reach the end of the list of speakers. I call Mary Glindon.

--- Later in debate ---

[Liz Twist (Blaydon) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Efford. I thank the hon. Member for Harrow East (Bob Blackman) for securing this important debate.

As we have heard, smoking is the biggest driver of preventable lung disease and health inequalities. According to the charity Asthma + Lung UK, it is responsible for half of the difference in life expectancy between the richest and poorest. In particular, smoking causes nearly twice as many cancer cases in England’s most deprived areas as it does in the least.

I want to acknowledge the progress that has been made, specifically in my region of the north-east. The north-east has seen the biggest decline in adult smoking rates since 2005, when our region became host to the UK’s first ever dedicated regional programme for tobacco control, Fresh; but smoking remains a key driver of health inequalities in our region, where four out of 10 households with a smoker are living in poverty.

In my local authority area of Gateshead, where 17% of adults still smoke, healthy life expectancy is just 58 years. That is five years lower than the national average, and there is an even wider gap between Gateshead and more affluent areas. That is a real problem. I see too many constituents suffering from chronic obstructive pulmonary disease, of which smoking is the leading cause. Their lives are limited and cut short by COPD—by the effects of smoking. Some of us on the all-party parliamentary group on respiratory health have raised this issue in debates on COPD.

The Government have promised to extend healthy life expectancy by five years by 2035. Last year, the Khan review argued that the smoke-free 2030 target was vital for achieving that objective, as we have heard, but the review also found that without further action England will miss the smoke-free target by at least seven years, and the poorest areas will not meet it until 2044.

It has now been nearly a year since many of us went over to Church House to hear Javed Khan present the findings of his review, which were widely welcomed. Many of them, indeed, picked up on the report of the all-party parliamentary group on smoking and health from the previous year. The Government have had a few other things on their mind since then, with the ministerial merry-go-round of the summer and a revolving door of Ministers, but they must now focus on implementing the recommendations of the Khan review.

The indoor smoking ban in 2007 demonstrated that policy can change social norms and, in doing so, save lives. That is why we should look on smoking not only as a problem to be tackled but as an opportunity. Smoking helps to sustain deprivation, just as deprivation helps to sustain smoking. By tackling that connection, we can allow people to lead more healthy and fulfilling lives. Most people who smoke began as children; for every three young smokers it is estimated that only one will quit, and one of the remaining smokers will die prematurely from smoking-related disease or disability. In the north-east, the average age of smoking onset is just 15 years old.

The Khan review also outlined steps to facilitate a smoke-free generation by implementing a gradual rise in the age at which it is legal to purchase tobacco. The ambition of the recommendation is welcome, but its success will rely on tackling the illicit tobacco trade as well. Almost three quarters of young smokers in Tyne and Wear, County Durham and Northumberland have been offered illegal tobacco, and just under half have bought it. If we prevent children from ever starting to smoke, we can close gaps in healthy life expectancy for years, and generations, to come.

Children are four times more likely to start smoking if they live with an adult who smokes, which gives us all the more reason to tackle smoking in pregnancy. Unfortunately, since 2017, the number of mothers smoking at delivery has fallen by only two percentage points. The Khan review recommended financial incentives to support all pregnant women to quit. It also advocated the appointment of a stop-smoking midwife in every maternity department to provide expert support on the frontline. That will help to tackle another key driver of health inequalities. Currently, smoking in pregnancy is five times more common among the most deprived groups than among the least deprived. Rates are also much higher among people with a mental health condition. In my local authority area of Gateshead, more than 40% of people with a diagnosed serious mental health condition are smokers. The Government must do more to support high-risk groups who are disproportionately impacted by smoking and therefore most likely to bear the brunt of those inequalities in the future.

Smoking perpetuates inequality via its impact not only on health, but on personal finances. As we have heard, the average smoker spends just under £2,000 on tobacco. In Gateshead alone, almost 10,000 households are driven into poverty when income and smoking costs are taken into account. Meanwhile, more than 1,000 households are economically inactive due to smoking-related disease and disability. Put these financial effects together with the impact at the macro level, where local economies lose out by billions of pounds each year, and the impact is even more clear.

So what can we do? As the Khan report demonstrates, it is clear that comprehensive investment is needed to tackle smoking in our communities and address the scourge of health inequalities that result—but over the past decade, drastic cuts have undermined efforts to support people to quit smoking, particularly in the most deprived areas.

The public health grant, from which local authorities allocate funds for smoking cessation services, has been cut by almost half since 2015. That has been accompanied by a 60% fall in the number of people supported to stop smoking over the same period. Meanwhile, as we have heard, the four largest tobacco manufacturers make around £900 million of profit in the UK each year.

I am pleased that in the north-east all 12 councils and the North East and North Cumbria integrated care board have pledged funding to the Fresh programme for the next two years so that it can continue that really important smoking cessation work. I am glad to see that its latest campaign, “Don’t be the one”, will be launched on our north-east media on 20 March. If they and other smoking cessation services are to be able to continue their work effectively, to get out that message about not smoking, not least in the media, what is needed is much greater national funding.

When used as recommended by the manufacturer, cigarettes are the one legal consumer product that will kill most users. Two out of three people who smoke will die from smoking. A “polluter pays” tax will force the corporations to take responsibility for the social outcomes of their products and raise the money that is so desperately needed to fund easily accessible, high-quality support. Smoking costs the NHS £2.4 billion per year. This is a matter of invest to save. In particular, we need a specific approach for the most deprived communities and at-risk groups, including distribution of free swap-to-stop packs.

We have the opportunity now to prevent inequalities for the future. The Government must act to implement the recommendations of the Khan report and must urgently produce a tobacco control plan for England. Frankly, I do not want to be in this debate again next year, as I have been for the last three or four years, asking for a tobacco control plan again. My big ask for today is quite simple: that the Government get on with the tobacco control plan, incorporate the Khan recommendations and, simply, stop more people dying and becoming ill from smoking.

[Clive Efford (in the Chair)]

I intend to move to Front-Bench speeches at 2.28 pm. We have two speakers left. That should give you some idea of how long you have to speak, in order to allow 10 minutes for each of the Front-Bench speakers and two minutes for Bob Blackman to sum up. I now call Rachael Maskell.

--- Later in debate ---

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

It is a pleasure to serve under your chairmanship, Mr Efford. I congratulate the hon. Member for Harrow East (Bob Blackman) on securing this really important debate to mark national No Smoking Day. For the record, I am vice-chair of the APPG on smoking and health and was Gateshead Council’s cabinet lead on public health for 10 years, so I am passionate about making smoking history. It is telling that a number of Members present are from the north-east, and we will be reiterating the same messages.

The last tobacco control plan expired at the end of last year, and we are still waiting for the response from the Government to Javed Khan’s independent review on tobacco control. While we wait, thousands of people are getting sick and dying from smoking-related illnesses that are wholly preventable. Since 2000, more than 113,000 people in the north-east have died from smoking, and one person is admitted to hospital in the UK every minute due to smoking.

Although there is rightly a lot of discussion about smoking being the No. 1 cause of cancer, it is important to recognise the host of life-threatening and life-altering illnesses caused by smoking, including COPD, heart disease, dementia, stroke and diabetes. I am therefore delighted that this year’s No Smoking Day campaign is shining a light on the link between smoking and brain health. Smoking has been identified as one of the 12 risk factors that, if eliminated, could collectively prevent or delay up to 40% of dementia cases. Alzheimer’s Research UK found that dementia is the most feared health condition for people over the age of 55. However, only one in five people who smoke in the north-east are aware that smoking raises the risk of dementia. It is therefore vital to get that message out there. It is great that Fresh’s radio ad on this issue is estimated to reach more than 670,000 people in the north-east. I am proud that the north-east has been a trailblazer on this issue, with local authorities across the region working together to fund Fresh, which is a highly effective tobacco control programme. It has nearly halved the smoking rate in the north-east since it was set up. I am pleased to hear that Fresh will once again be funded by all 12 local authorities in the region.

Although it is great to see that work happening locally, it is vital that it is supported by much more investment at a national level. It is shocking that England is on track to miss the smoke free 2030 ambition by nine years, while projections by Cancer Research UK suggest that it will take a further 20 years to get smoking down to 5% in England’s poorest communities. The north-east is the most disadvantaged region in England. With that come high rates of smoking, which means there is further for us to go to become smoke free. The fact that smoking rates are disproportionately high among deprived communities highlights the fact that smoking is one of the leading drivers of health inequalities in our society. As we have heard, smoking during pregnancy is five times more common in the most deprived communities than in the least deprived. In County Durham, 704 women a year are smokers when they give birth, while 41,233 children live in households with adults who smoke. That not only has severe health consequences for children living in deprived areas, but increases fourfold their chance of taking up smoking and remaining a smoker in adulthood.

As well as having a shorter life expectancy overall, men and women in the most deprived areas also suffer from ill health for more of their lives. The levelling-up White Paper identified addressing health inequalities as a priority, yet little has been done so far. The Government’s lack of action and their delay in responding to the Khan review threaten our ability not just to achieve the 2030 smoke free goal but to level up. They must take action now and look urgently to implement the recommendations in the report from the APPG on smoking and health and in the Khan review to tackle the prevalence of long-term illness in areas of deprivation.

We all know that smoking is our biggest preventable killer and, as we have just heard, it is devastating for the thousands of families who lose loved ones each year. It also has significant implications for our economy, our local authorities and our health service. It is estimated that smoking costs County Durham £211.9 million each year, £26 million of which is spent on healthcare. Preventing ill health is key, and it is clear that effective Government action on the issue would relieve the significant pressure that smoking places on our health and social care services. There is no time to waste when we consider that our NHS is in crisis as resources are stretched to the absolute limit.

We must also ensure that smokers have the best chance of success when they attempt to quit, whether that is through support from local stop smoking services or access to alternatives. At the same time, we must prevent children and young people from taking up smoking in the first place, reduce the demand for and supply of illegal tobacco, and support further enforcement around illicit tobacco.

Four years ago, the Government set out their ambition for England to become smoke free by 2030. In April 2022, I asked the Government to ensure that the tobacco control plan would deliver their ambition and that it would be published no later than three months after the Khan review. Here we are, nearly 12 months on, and I am still asking the same question and we are still waiting for action. The chair of the Durham health and wellbeing board even wrote to the Secretary of State about the Khan review, but she received a non-committal response. With that in mind, will the Minister tell us when he plans to publish the tobacco control plan and what the Government intend to commit to on the back of the Khan review? Every day that we wait, too many people are dying needlessly.

[Clive Efford (in the Chair)]

Absolutely impeccable. Thank you very much—you have made it very easy to chair.