Healthcare Provision: East of England

Clive Lewis Excerpts

Tuesday 3rd September 2024 Westminster Hall

[Clive Lewis (Norwich South) (Lab)]

I beg to move,

That this House has considered healthcare provision in the East of England.

It is an honour to conduct this debate with you in the Chair, Sir Christopher. Before getting into the meat of the debate, I will give a brief overview of the broad context. The beating heart of healthcare provision in this country is of course the national healthcare system, arguably the closest thing to socialism that this country has ever seen, based as it is on the provision of healthcare by need, not the size of someone’s wallet. That is pretty unique, not just in this country but around the world. One could argue that this far-sighted policy has changed the very nature of our everyday reality.

Our health is everything. Without it, we are more insecure, less productive and less happy. The security of good health and of access to care free at the point of use has revolutionised our society, helping us to live longer, more secure lives, and arguably creating social stability that affects economic productivity and perhaps even the strength of our democracy itself. Or at least it did so until about 60 years ago, when it began to be picked apart.

[George Freeman (Mid Norfolk) (Con)]

I am grateful to the hon. Gentleman, who is my friend as well, for giving way. How wonderful it is to see so many people present for this debate at the beginning of term.

I point out gently that the NHS has also thrived under successive Conservative Governments and that, although it may be a great socialist idea, I believe it has come to be part of the fabric of our whole country and I think all parties present want to improve and support it. Does the hon. Gentleman agree that the NHS also underpins our enterprise economy? In America and other places, it is difficult to start a company when the healthcare costs of the staff have to be thought about; here, by underwriting the cost, we help entrepreneurs to start businesses. That point is often overlooked.

[Clive Lewis]

On the hon. Gentleman’s first point, yes, successive Governments have presided over the NHS, but with differing intentions. Until the mid-1970s, say, there was a broad consensus—I will come on to this—on what the welfare state was and how it operated. That has changed substantially in the past 60 years. The implementation of different policies by different Governments, including Conservative ones, has not always been in the best interests of the NHS. On enterprise, yes, a secure welfare state, good social security and the ability to give people good health—the NHS has been integral to that—have implications for our economy, as I have already pointed out.

I am sure I am not the first or the last to suspect a direct connection between the rise of angry and anti-democratic right-wing politics and the demise of the NHS’s ability to look after us all effectively. The sheer far-reaching impact of the NHS and its crisis cannot be underestimated. One needs only to look at the US, where free universal healthcare does not exist, as the hon. Member for Mid Norfolk (George Freeman) just mentioned, to see the state of politics, crime, drug addiction and social breakdown there. The free market in healthcare provision and medicines has led to a country with one of the least efficient and most high-cost healthcare systems in the western world, and where millions are hooked on drugs that are as heavily advertised as if they were cans of coke. Let us not indulge too much in English exceptionalism, though. We need only to look at dentistry and adult social care in this country to see what happens to healthcare provision that is, to all intents and purposes, privatised or well on its way to being so—the consequences of which I hope colleagues will discuss later in the debate.

The foresight of the 1945 Labour Government cannot be underestimated. When the NHS was launched in 1948, it was done in tandem with the advent of the welfare state, because Beveridge, Keynes and Bevan understood the three pillars necessary for a healthy nation. The first pillar—the NHS—would be there for people if they became sick, but it was the second and third pillars that meant the NHS would not be overburdened. They would work in tandem with it to prevent sickness.

The second pillar was, of course, the welfare state, providing a network of social institutions that would protect citizens from the market risks associated with unemployment, accidents and old age. The third pillar was an economic system that prioritised full employment in secure, well-paid, unionised jobs—a system that sought to reduce all forms of inequality, from wealth to health.

Over the last 60 years, the three pillars have been systematically smashed. The second and third pillars are in tatters, while the first—the NHS—is wobbling precariously. It is testament to the enduring nature of the national healthcare system that it has managed to survive as an almost solitary pillar for as long as it has. If a Labour Government are truly to fix the foundations of our broken healthcare system, they must acknowledge the nature of the three-pillar foundation, and acknowledge that the NHS cannot be fixed if we do not rebuild and replace the other two pillars as well.

The situation in the east of England—from dentistry deserts to sky-rocketing rates of mental health referrals and some of the worst ambulance waiting times in the country—is beyond one malfunctioning organisation. Norwich and the wider region are experiencing a systemic crisis that is institutional, social and economic. Healthcare reforms such as devolution to the integrated care boards have become about devolving who gets to wield the axe to make savings—known to many people as cuts. I will give an example. Our ICB in the east of England, part of NHS Norfolk and Waveney, has been told by national health bosses to cut its running costs by 30% by 2026. My first question to the Minister is: how will our Government deliver improved healthcare outcomes while simultaneously implementing the previous Government’s frankly destructive cuts?

We know that vast areas such as dentistry and social care are largely privatised, with spiralling costs, and that undermines the NHS’s central commitment to care being free at the point of use. Tendrils of the crisis extend into social care. It is often said that if social care is cut, the NHS bleeds too. Norfolk county council acknowledges a crisis in social care. With soaring demand and struggles to recruit staff, there is a backlog of hundreds of vulnerable people waiting to get their care needs assessed, and care providers fold on a regular basis. My second question to the Minister, then, is: what news can she give us on the last Government’s unimplemented cap on care costs? Is it being implemented, as the Secretary of State implied during the general election campaign, or being dropped? If it is dropped, what plans are there to help those facing ruin given their complex care needs?

One consequence of the situation in Norfolk is that there are regularly hundreds of hospital patients who are medically fit to leave but unable to be discharged. It is clear that our healthcare system is struggling to respond to today’s crisis, but it is also unprepared for the challenges of the future. East Anglia is the UK region most at risk from early climate impacts, and there is clear evidence of the link between climate breakdown and ill health. For example, from 2022 to 2023 the number of flood reports in Norfolk doubled, and stretches of Norwich are predicted to flood year after year. Victims of flooding in the UK are nine times more likely to experience long-term mental health issues, and flooding is linked to a greater instance of respiratory diseases because of dampness.

Prevention is better than cure—it is about treating the causes, not just symptom alleviation. We know that the Prime Minister is keen on the so-called preventive state and we have seen some early policy announcements, so my third question is: will the Minister elaborate on what that will look like? What does healthcare provision that prioritises prevention look like in the east of England?

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for bringing this issue forward. I know the debate is about the issues particular to his constituency, but they are ones apparent to all of us across the United Kingdom of Great Britain and Northern Ireland. First, does he understand and perhaps agree that the Minister and Government could look at pharmacies having a bigger role in treating minor ailments? Secondly, there is the issue of how people, particularly elderly people, can access GP appointments regularly. Thirdly, when it comes to cataract surgery there is a postcode lottery across the whole United Kingdom. If people get the surgery early, it stops them losing their sight. Is the hon. Gentleman experiencing issues in his constituency similar to those in mine?

[Clive Lewis]

I thank the hon. Gentleman for his input, and his points were well made. When researching this debate, I probably spent more time working out what I did not have time to say than what I could actually put into the debate, so I have tried to do a broad overview. Many of the issues the hon. Gentleman raised are also of concern in my Norwich South constituency and across the eastern region. I am sure that during the debate many of those issues will be raised and dealt with in more detail.

Our Government have said they are a Government of service, but a legitimate fourth question that I ask the Minister is: in service of whom and to what end? It is clear to many that the interests of big business, of big tech and data companies and of private finance do not always sit well with the public interest, particularly when it comes to health. There are areas where they do, but there are also areas where they do not. We know with whom the last Government sided; whom will ours back when push comes to shove—big business, big tech, the finance industry or Joe public?

I want to briefly provide a snapshot of the scale of the crisis in the eastern region. Ambulance response times in the east of England are significantly worse than those in the rest of England. In 2023, response times for category 1 cases—that is, severe cases—were nearly 12 minutes in East Anglia, while the national target is seven minutes. They were nearly the worst on record. The Care Quality Commission, now under inquiry and investigation itself for its capability to do its job, has described Norwich university hospital as the

“worst in the East of England”

for ambulance handover times.

Referrals to mental health services increased by 18% between 2018 and 2020. Compared with the rest of England, Norwich and Norfolk have higher rates of self-harm, death by suicide and mental health issues among young people, as well as more self-diagnosed mental health issues generally. Our mental health trust—Norfolk and Suffolk NHS foundation trust—is notorious for being the worst in the country, and I do not think that can be said enough.

Norwich is a dental desert. In July, the Secretary of State branded Norwich North the “Sahara of dental deserts”. That is a rather romantic notion, but it is a desert where people pull their own teeth out in this burgeoning phenomenon of a do-it-yourself dentistry industry. Indeed, some of my Ukrainian constituents have told me that they find it preferable to dodge Russian missiles and artillery to use Ukrainian dentists. Ukraine arguably has a better dental system in the middle of a prolonged war. That is unsurprising given that in the east we have one NHS dentist—no, it is not even one NHS dentist; it is one dentist—per 2,600 people. Just picture that in your head: one dentist with their tools with 2,600 people queued up. That is what it feels like to many of my constituents.

For the second year running, no dental practices are accepting NHS patients. Norfolk children under five have some of the worst tooth decay in the entire country. Thousands of people have had to go to hospitals in Norwich and Norfolk for abscesses that should have been prevented. The list goes on and on. I am sure that many of my colleagues from the eastern region will also outline some of the issues and stories that they know are taking place on a daily basis, and that have been for many years now.

[George Freeman]

I am grateful to the hon. Gentleman for making the point about dentistry that I think we all understand, particularly in the east. Does he agree that the real cause is threefold—the tariff did not keep up with costs and inflation, we have not been training enough dentists and we have been losing too many—and that the previous Government’s dental plan was a big step in the right direction? Does he support that plan? I am interested to know whether the Opposition intend to continue to implement it.

[Clive Lewis]

I thank the hon. Gentleman for his intervention but will leave the response to the Minister, because it is a question that she would be better able to answer. Frankly, given that the last Government had 14 years to sort out that mess and have handed it over, pretty much complete, to the new Labour Administration, I will not be singing their praises when it comes to dentistry. That will not be going on the record.

I will conclude by looking at the social and economic roots of the healthcare crisis, which are the elephant in the room. As I have outlined, many of the causes of ill health are socially determined. Waiting lists, ill health and mental health issues are signs that our healthcare system is breaking down, but also that we have an economy with a degrading social fabric—one need only look at the race riots this summer to understand that. But do not take my word for it; listen to civil society organisations in my constituency that are at the coalface of this crisis. The Norfolk Care Association says:

“Around 10% of health outcomes result directly from healthcare delivery, with a more significant proportion derived from the physical, social, and economic factors that people experience day to day. The government must do more to tackle poverty, ensure quality housing, and create safe communities, as these are fundamental to improving health outcomes.”

Age UK Norwich says that the key healthcare issue older people face is

“chronic health conditions and limited spend/focus on prevention: around 55% of Norfolk’s older population have one or more long-term health conditions; however, most are treated independently”.

That organisation points to the need for

“Rebalancing healthcare focus and investment to underlying causal factors”—

the “wider determinants” that make up 80% of a person’s overall health status.

Let us have a quick look at some more drivers of ill health. Take, for example, fuel poverty: 10% of people in the east of England live in fuel poverty, and it is almost 12% in Norwich South. Fuel costs in the UK are on average 30% higher than the EU average.

[Jerome Mayhew (Broadland and Fakenham) (Con)]

The hon. Member makes an important point about fuel poverty and its direct link with illness, so will he support his Government’s removal of the winter fuel allowance?

[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 ---

[Clive Lewis]

I thank everyone who has taken part, as well as those who could not speak in the debate. I was hoping that—

Motion lapsed (Standing Order No. 10(6)).

Oral Answers to Questions

Clive Lewis Excerpts

Tuesday 17th October 2023 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O'Brien)]

We have already brought in restrictions on the places that unhealthy food can be sold to stop pester power. That is on top of other measures that we are taking on obesity such as the sugar tax, calorie labelling, the extra money for school sport, and the extra facilities for young people. It is a serious issue and one on which we are taking urgent action.

[Clive Lewis (Norwich South) (Lab)]

I was going to ask a question about the shocking statistic of 85,000 people on the waiting list at Norfolk and Norwich University Hospital, but so poor was the Secretary of State’s response to the question of my hon. Friend the Member for Ilford North (Wes Streeting) about the dental desert that I will tell him a quick story. Ukrainian refugees who come to my constituency are travelling back to war-torn Ukraine to have their teeth seen to because there is a better dental service there than in Norfolk and Norwich. What does he have to say to that?

[Steve Barclay]

As I have said, we have 6.5% more dentists now than when we came to power. There is also a quarter more dental activity this year compared with last year. I understand why the hon. Gentleman does not want to talk about the investment that we are making on the elective programme in Norfolk, because it includes funding for two new hospitals in Norfolk through our new hospitals programme and significant funding into diagnostic capacity, with a number of diagnostic centres being opened in Norfolk, which he does not want to mention.

NHS Staffing Levels

Clive Lewis Excerpts

Tuesday 22nd November 2022 Westminster Hall

[Peter Dowd]

My hon. Friend is right: it is crucial that we do that. A whole range of issues are beginning to affect staffing. For example, there is a £9 billion maintenance backlog in the NHS. Patients are being treated in hospitals that are not, in certain situations, fit for purpose and, importantly, staff have to work in those environments. In many cases, radiology equipment is not up to date, so staff and patients are either working or being treated in an environment in which the conditions and the equipment are not good. That goes to the heart of the staffing crisis as well.

There are lots of suggestions about how the Government could get to grips with the situation. Community Pharmacy England has plans to “resolve the funding squeeze”, which seems pretty straightforward, to

“tackle regulatory and other burdens”

that are affecting staffing, to

“help pharmacies to expand their role in primary care”

and to

“commission a Pharmacy First service”.

All those things go to the heart of enabling staff to feel wanted and that they are working in an environment where they are treated properly.

Of course, we then get people leaving in droves because of pay. I looked at some of the figures in relation to the pay restraint that we have had for the past few years: since the Government came to power in 2010, for all intents and purposes there has been either no pay increase or an increase of 1% here and 2% there.

[Clive Lewis (Norwich South) (Lab)]

I thank my hon. Friend for making such an excellent speech. Will he comment on the fact that at the University of East Anglia medical school we saw a fifth of new nurses, or training nurses, drop out of the course after the Government cut the nursing bursary? With the low pay, crisis of staffing and pressure that is going on, we expect those nurses to work in the NHS as they are training and rack up debt at the same time. If we are going to get the numbers back up, we must surely reintroduce the bursary.

[Peter Dowd]

Yes, we must. When these professionals come into the NHS and work their socks off, for all the hours that God sends, they do not even get a decent pay rise. They have had to pay to do the job, then they pay to do the job again because we are not giving them enough money. My hon. Friend is absolutely right. The amount of funding the NHS gets falls well short of our international competitors in terms of revenue and current and capital expenditure. We spend about £3,055 per person on health; in our competitor countries, which are similar economies with similarly sized populations—such as France and Germany—the figure is £3,600. That difference, of the best part of £600 per person, is absolutely significant. We are falling further behind as the years go by.

The Government say, “Well, this year we have accepted the independent NHS pay review body’s recommendation.” I suspect that this is the first time in many years that they have accepted, championed and blown the bugle for it. Let us look at the detail and analyse it. The terms of reference include

“the need to recruit, retain and motivate suitably able and qualified staff”.

That is not happening, is it? That is nowhere to be seen. They also mention

“regional/local variations in labour markets and their effects on the recruitment and retention of staff”.

That is not working either, is it?

The terms of reference mention:

“The funds available to the Health Departments, as set out in the Government’s Departmental Expenditure Limits”.

In effect, the Government tell the pay review body what it can do, because of the amount the Department has, and then, when the body agrees with what the Government say, they say it has been an independent assessment. It is not as simple as that.

Here is another one: “the Government’s inflation target” is a factor. We all know where that is—whose fault is that? It is not the Government’s fault; it is the Bank of England’s fault.

The terms of reference mention:

“The principle of equal pay for work of equal value in the NHS”—

which was referred to earlier and is not happening. They talk about:

“The overall strategy that the NHS should place patients at the heart of all it does”—

but it is far from putting them at the heart of the service. In conclusion, staff need a pay rise and better working conditions; the only way they will get that is with a Labour Government in two years’ time.

Draft Mental Health Bill

Clive Lewis Excerpts

Monday 27th June 2022 Commons Chamber

[Clive Lewis (Norwich South) (Lab)]

I think the whole House will welcome many of the changes that the Bill represents. I especially welcome the section on black mental health and on the situation of people who are being incarcerated in the mental health system, but many of my constituents have suffered the effects of eight years of systemic and catastrophic failure on the part of their mental health trusts. What provisions in the Bill will make a difference to them following nearly 1,000 excess deaths in our mental health trusts? I know that he has committed himself to meeting me to talk about this, but will he also commit himself to meeting many of the victims of those eight years of failure who will be coming to Parliament next Tuesday to discuss what has happened to them? Perhaps he will be able to tell them how the Bill will turn their lives around and make a difference to them and their families.

[Sajid Javid]

I hope the hon. Gentleman agrees with me—as I think he does, given the way in which he framed his question—that the Bill is a huge step forward, especially in respect of the important issue of dealing with some of the inequalities in provision which we all know have existed, and which he mentioned at the beginning of his question. The way in which we change things will be not just through the Bill but through continued investment, and by ensuring that, when trusts are failing, those failures are addressed. As the hon. Gentleman said, I will be meeting him, but the Minister for Care and Mental Health will be happy to meet the constituents he mentioned.

Vaccination: Condition of Deployment

Clive Lewis Excerpts

Monday 31st January 2022 Commons Chamber

[Sajid Javid]

That is another good question from my right hon. Friend. I will say two things. First, this is not about zero risk; it is about less risk. What I am saying is that, based on the advice that I have received and for the reasons that I set out in my statement, whether or not someone is immunosuppressed, omicron, in general, represents less risk. It is also right to ask whether other measures could be taken to provide additional support. Yes, they can, which is why I have asked the NHS to review its own policies on the deployment of staff in certain settings, and that would include interaction with the most vulnerable patients.

[Clive Lewis (Norwich South) (Lab)]

I thank the Secretary of State for today’s U-turn. I know that many of my constituents, both NHS staff and patients, will be deeply grateful for it. We all wanted to see as many NHS staff as possible take up the vaccine, but no one wanted to see people being forced to take the vaccine, especially after all that they have done for us. Can the Secretary of State promise the House that, if there are future outbreaks, he will listen to the overwhelming body of public health evidence, which says that carrot, not stick, persuasion, not enforcement, has better results when it comes to vaccine take-up?

[Sajid Javid]

This Government will always listen to the evidence and be guided by it, as they have been today.

Public Health

Clive Lewis Excerpts

Tuesday 14th December 2021 Commons Chamber

[Sajid Javid]

I am pleased that I took that intervention because I do not want people to think in the way my hon. Friend has suggested. I have to disagree with him. There is a big difference between those two ages, and the last time I looked the median can be described as an average. But I am pleased that he shared that because it highlights my point.

[Clive Lewis (Norwich South) (Lab)]

rose—

[Sajid Javid]

I do need to plough on, but I will take some interventions a bit later.

For the reasons that I have set out, I believe that the responsible decision is to move to plan B in England, drawing on the measures that we have held in contingency to give more time to get those boosters into arms. These are not steps that we would take lightly. I firmly believe in individual liberty and that curbs should be placed on our freedoms only in the gravest of circumstances. Not only that, but I am, of course, mindful of the costs that restrictions can bring to the nation’s health, to our education and to the economy. So it is vital that we act early and we act in a proportionate way, doing whatever we can to build our defences and to preserve greater freedom for the long term. I am confident that these measures are balanced and proportionate, and that they still leave us with far fewer restrictions than are in place in most countries in Europe. I can assure the House that we will keep reviewing the measures that we have put in place and we will not keep them in place for a day longer than we have to.

[Sajid Javid]

If my hon. Friend allows me, I will come to that point shortly.

I said a moment ago that we will not keep measures in place for a moment longer than we need to. For example, now that there is community transmission of omicron in the UK and that omicron has spread so widely across the world, the travel red list is less effective in slowing the incursion of omicron from abroad, so I can announce today that, while we will maintain our temporary testing measures for international travel, we will be removing all 11 countries from the travel red list, effective from 4 tomorrow morning.

I wish to turn to the details of some of the regulations before the House. Regulation No. 1400 proposes extending the use of face coverings. In October, UKHSA published an updated review of the evidence on the effectiveness of face coverings and concluded that there is good evidence that they can help to reduce the spread of covid-19 when worn in the community. The regulation proposes extending the legal requirement to most indoor settings, including theatres and cinemas. They are not required in places where it would not be practical—for example, in hospitality settings such as cafés, restaurants, pubs, nightclubs or other dance venues, or in exercise facilities such as gyms.

Regulation No. 1416 would mean that anyone over 18 would need to show a negative lateral flow test to get into a limited number of higher-risk settings, unless they were double vaccinated. As I announced to the House yesterday, however, in the light of new data on how vaccines respond to omicron, our intention is that boosters will be required instead of two doses as soon as all adults have had a reasonable chance to get their booster jab.

[Clive Lewis]

I thank the Secretary of State for being so generous in taking interventions. Does he agree that, if we are to get on the front foot in tackling the pandemic, we have to acknowledge that it is like our house being on fire and dealing with just one room rather than the rest of the house? Surely the TRIPS waiver, which gives other countries across the developing world and beyond the ability to produce the vaccine themselves, to increase the supply at a cost-effective rate and to stop big pharma from excessively profiteering, is the way to get on to the front foot in vaccinating the rest of the world and ensure that new variants do not continue to flourish.

[Sajid Javid]

As I said in response to an earlier question, in terms of getting vaccines to the developing world, donations through COVAX and bilateral donations are important. I must strongly but respectfully disagree, however, with the hon. Gentleman’s suggestion that waiving intellectual property and patent rights will help. That will not help. That will undermine the world’s ability to deal with the pandemic, because it will remove the incentive for pharmaceutical companies to develop these valuable drugs in the first place.

Health and Care Bill

Clive Lewis Excerpts

Report stage
Tuesday 23rd November 2021 Commons Chamber

[Paul Bristow (Peterborough) (Con)]

I rise to speak to amendment 10 in the name of my right hon. Friend the Member for South West Surrey (Jeremy Hunt). I refer Members to my entry in the Register of Members’ Financial Interests.

I have spoken in the House before about being involved in health policy for about 20 years. The same thing tends to happen every three or four years: the NHS says it needs more money, it needs more capacity and it needs a plan, and that is what we are doing again in the Bill. When we talk about more capacity, we mean not just more hospitals, more theatres and more diagnostics, but a bigger workforce. Thanks to this Government and the investment that has been made, I do not think anyone with any credibility can now say that the NHS does not have enough money. NHS England’s resource budget will rise to £162.6 billion in 2024-25—a 3.8% average annual real-terms increase. The Government also plan to spend a further £8 billion to tackle the elective backlog. This is the biggest ever catch-up programme in our NHS for elective surgery. Department of Health and Social Care capital spending will rise to £11.2 billion by 2024-25. I repeat: I do not think that anyone can say with any credibility that our NHS is now underfunded. We have the new diagnostic centres. We have the new pathways that should be adopted to increase NHS productivity. A long-term deal with the independent sector can ensure that we have the capacity to power through the elective backlogs—the hip and knee, hernia and cataract procedures that make up the vast majority of cases.

Of course, we need the nurses, the doctors and the consultants—the workforce—to carry out those procedures. This is a historical problem; it did not just happen overnight. All past Governments and, I dare say, past Secretaries of State for Health and Social Care have a degree of responsibility for this. As my right hon. Friend the Member for South West Surrey said, there are an estimated 93,000 vacancies in our NHS—consultants, GPs, nurses and allied health professionals. I was proud to stand on a manifesto at the last election that pledged to increase the number of healthcare workers in our NHS, and I know that considerable progress has been made, but just as the Government are doing with social care by putting in place a plan that focuses, laser-like, on resolving some of the long-term issues we face in that sector, we need the same laser-like focus to deal with some of the challenges with our NHS workforce. Any changes we make to our NHS workforce, or any long-term plans, need to reflect the real needs of our NHS. That is incredibly important. Some sort of duty to report independent figures about how we will make up the workforce is a very sensible measure.

Many years ago, I worked with the British Society of Interventional Radiology. The proposals we made and the work that we called for then were about workforce. Some argued that a lot of people were reaching the end of their professional career and retiring and there was a lack of new people coming through, so ultimately this would have an impact on patient care—on the number of procedures that could be carried out. The same arguments are now being made across a number of disciplines. Since I became an MP, I have met the Royal College of Surgeons and the Royal College of Physicians, and the same arguments are being made there. It is sobering to think about these challenges, and that is why this laser-like focus has to be considered very carefully.

We have talked about overseas recruitment. I heard what my right hon. Friend the Member for Sutton Coldfield (Mr Mitchell), who is no longer in his place, said about that, and he made a very powerful argument. In some ways, we are going to have to use overseas recruitment to plug the gaps in our NHS, but there are other solutions. We have heard hon. Members talk about retention. I was alarmed and shocked by the number of healthcare professionals who—understandably—wish to work part-time because they are parents and they have childcare responsibilities. I understand that, but it is going to leave our NHS with recruitment challenges.

When I speak to clinicians—members of the Royal College of Surgeons and others—they talk to me about the ability to work independently and autonomously. Many clinicians want that ability, but do not feel that they have it. There is also the idea that they want to be part of something bigger than their own small team. It is not that they want to be part of this thing called the NHS and that they are all working towards that goal; it is more that, once we have come through the challenge of the pandemic—once we have got ourselves over that mountain—there is an even bigger mountain ahead of them, which is dealing with the elective backlog, where they feel that things never change. That is what I have been told, and those are very powerful things.

What are the solutions to this problem? Ministers need to think about how we can encourage our consultants, our GPs and our medical professionals to practise at the top of their licence. Speaking to medical professionals, I have been told alarming things. About 40% of a GP’s time is spent on sickness notes or providing medical records to insurance companies and other people. That is admin staff work. As valuable as those admin staff are, that is not what GPs and medical professionals went into their professions, and went to medical school for all that time, to do. It is absolutely right that that burden be lifted from our medical staff and placed elsewhere. Nurse-led prescribing has existed for quite some time, but we have not really had the push and the drive there that we should have. GPs should not be spending their time prescribing very simple things such as the pill. We can certainly be doing a lot better and working a lot more productively, as my hon. Friend the Member for North East Bedfordshire (Richard Fuller) said. This is not about working harder; it is about working smarter.

[Clive Lewis (Norwich South) (Lab)]

Listening to the hon. Member’s speech, I think he is giving the game away in some ways, because what I am hearing, if I understand him correctly, is that he wants to see a core of healthcare provided by the NHS and then the more lucrative parts of the NHS—administration and other parts—siphoned off to the private sector, which is a model we have seen in the US and which this Bill makes so much easier.

[Paul Bristow]

I would ask the hon. Member to listen a bit more carefully, because nowhere have I said admin should be carried out by the private sector. I said that it should not be carried out by medical professionals. They did not go to medical school to work in admin; they went to medical school to treat the sick. That is what we want our medical professionals doing—operating at the very top of their licence.

I also do not want to see situations where untold numbers of consultants are spending just one day a week in the operating theatre. I understand that consultants need the opportunity to train junior colleagues and to continue their own professional development, but they should be operating in our theatres a lot more frequently than that.

Health and Care Bill

Clive Lewis Excerpts

2nd reading
Wednesday 14th July 2021 Commons Chamber

[Clive Lewis (Norwich South) (Lab) [V]]

With the climate crisis and the reality of an ageing population, there has never been a better time for the Government to centre the wellbeing of people and planet and the way in which public services and the economy are run. Sadly but unsurprisingly, the Bill fails in this context, so I will vote against it, because it does not fundamentally deal with the very real issues facing our healthcare system. It does not address the desert of NHS England providing oral and dental healthcare, which has made it impossible for my constituents to get an appointment. It does not guarantee fair pay and conditions for the key workers who have seen us through the pandemic, and it does not deal with the scandalous state of mental health- care. Patients in my constituency are in crisis, are discharged too early, or not admitted at all, while for a decade, Norfolk and Suffolk NHS Foundation Trust has failed to end the practice of sending patients out of area.

What the Bill does do is transfer yet more centralised power to the Executive—rightly described as a power grab by my right hon. Friend the Member for Leicester South (Jonathan Ashworth)—and, of course, to the private sector. Clause 13, which provides for the establishment of integrated care boards, opens the door to private companies having a say in where funding is allocated and what services are delivered. Clause 3 gives greater political control to the Secretary of State over the NHS England mandate without creating a duty to provide universal, comprehensive and free healthcare to all. Clause 38 empowers the Secretary of State to intervene in the reconfiguration of services, opening the door for politicised interference and gridlocks on decision making.

Where is the democracy, accountability and transparency in the Bill? How will the right of my constituents to healthcare be guaranteed over and above the interests of private companies and the political whims of the Secretary of State? To see what happens when private companies have any role in delivering care, we need only look at the social care crisis. In England, 84% of care home beds are managed by private companies, and three of the five largest care home companies are owned by investment firms whose main priority is economic rent seeking, not the long-term care of our elderly. That model has, unbelievably, led to a cut in the number of care home beds, despite an ageing population, meaning that demand is only growing.

I therefore urge the House to vote against this legislation on what remains of NHS England. It extends the same failed ideology that puts profit before people and which has driven our planet and public services to breakdown.

Oral Health and Dentistry: England

Clive Lewis Excerpts

Tuesday 25th May 2021 Westminster Hall

[Clive Lewis (Norwich South) (Lab) [V]]

Thank you very much, Ms Bardell, for your chairmanship today.

I, too, congratulate my hon. Friend the Member for Bedford (Mohammad Yasin) on securing this timely debate. Like others who have spoken, I have heard countless stories from my constituents in Norwich South that show the very human cost of chronic and long-term underfunding of NHS England services. What I have heard has led me to conclude that the state of NHS England’s dental services can only be described as a scandal. Simply put, this is a service that is broken.

Many constituents now face insurmountable barriers to accessing basic healthcare. They face extreme delays in getting an appointment, if they can secure one at all. They are then faced with prohibitive treatment costs, even for NHS services, which some simply cannot afford. Constituents tell me it is impossible to get an appointment, let alone with an NHS dentist, and that they have been turned away despite being in pain.

One constituent had dental treatment delayed by a year; others had treatment cancelled, only for their oral health to deteriorate. Some constituents tell me that when they do manage to get an appointment, sometimes after weeks or months of waiting, they are told that the treatment they need can be done only at a private clinic, at a cost of thousands of pounds, which they simply do not have.

Delays, cancelled appointments and treatments so expensive that they are unattainable lead to agony, disfigurement and a range of other healthcare problems. Someone with a business in my constituency was forced to pull out 18 of his teeth when receding gums had left him in agony and the broken dental care system left him no other options. Perhaps the hon. Member for Mole Valley (Sir Paul Beresford) would like to tell that businessman that his agony is his own fault and due to his diet. I suggest that the hon. Gentleman change his dental bedside manner when talking to patients, because I do not think that patient would agree that the situation was entirely on his own head, given that he could not receive timely treatment from the NHS.

Scandalously, my constituents’ experience, far from being exceptional, is reflected up and down the country. Yesterday, Healthwatch England said that people are faced with a wait of up to three years for dental appointments. Four in five people are struggling to access timely care. Even when they get an appointment, a staggering 61% find treatment too expensive. Who is bearing the burden of this chronic Government failure to provide healthcare for all? Surprise, surprise: it is, as ever, those on low incomes and from ethnic minority groups who are affected the most by the lack of appointments and the soaring costs for treatment.

Healthwatch England revealed that almost twice as many people from lower socioeconomic groups struggle or cannot afford to pay NHS dental charges as those from higher socioeconomic groups. The cause of this crisis is no secret. NHS dental services, as is the case with our public health service at large, are chronically underfunded by the Government.

No doubt the Minister will reel off a long list of figures about how much the Government are spending on dentistry, but the reality speaks for itself. According to the British Dental Association, NHS general dental practice is already the only part of NHS England operating on a lower budget in cash terms than in 2010. That means that in real terms, net Government spending on general dental practice in England has been cut by more than a third in the last decade. Those problems are set to get worse. According to the British Dental Association, around a quarter of dentists plan to stop providing NHS services and move to fully private provision. More than a third plan a career change or early retirement in the next 12 months.

I will finish by stating the obvious. Dental care is healthcare. If my constituents cannot access the healthcare they need when they need it, I am afraid that we have a national health service in name only. We must not forget that it is the principles of care and universalism that make so many people rightfully proud and defensive of the NHS. The Government must not continue to treat dentistry and oral health as an afterthought, or as a service that can be quietly privatised. It is part and parcel of preventive healthcare, a building block in a society that values wellbeing.

Oral and dental care must be fully provided for by the NHS. In the immediate future, support must be given to practices to enable them to open safely and see more patients. Longer term, we need dentistry and oral health services to be provided equitably. The Government have an opportunity in the upcoming health and social care Bill to do just that. I hope they take that opportunity, for the sake of my constituents and many others around England.

Cystic Fibrosis Drugs: Orkambi

Clive Lewis Excerpts

Monday 10th June 2019 Westminster Hall

[Clive Lewis (Norwich South) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Hanson. I add my thanks to the hon. Member for Sutton and Cheam (Paul Scully) for securing this debate.

I will focus on two key things: asking the Minister a series of questions on potential remedies for this situation, but also using my time to speak about Rachael and Ethan, a mother and child in my constituency who are forced to live with the realities of cystic fibrosis every day, and the adverse impact that the actions of the company Vertex are having on their lives. Ethan is 11 years old. He has a big smile and loves pizza, trampolining and spending time with his friends, but sadly that is where the similarity to other 11-year-olds ends, since every day his life and that of his mum Rachael are dominated by the strain of dealing with cystic fibrosis.

To put this in context, because his lung function has declined to just 54%, in the past four weeks alone Ethan has coped with two separate full-day hospital admissions, 14 days of intravenous antibiotics, which are administered by his mum twice a day at home and take 45 minutes each time, and two sessions with a psychologist to help him to overcome needle phobia brought about by years of blood tests. All that is on top of his regular daily cocktail of medication and a physio session of a minimum of 22 minutes every day. Yet none of those treatments are designed to cure Ethan. They are simply designed to treat his symptoms—symptoms that are expected to get worse the older he gets. They attempt to slow down the irreversible lung damage that will slowly cause him to suffocate. He knows that. In 2017, half of all people who died with cystic fibrosis were under the age of 31, as has already been stated. It is a statistic that his mum Rachael is only too aware of as she spends the majority of her time caring for her son.

We know that Vertex drugs could change the lives of cystic fibrosis sufferers and their families, since they fix the underlying genetic mutations that cause the condition, but, as we have heard today, Vertex is more interested in 45% investor returns than in 20%. That seems to be its priority. Although the chronic underfunding of the NHS is a contributing factor in this story, it is by no means the only reason why a deal has not been reached. The unforgivable actions of Vertex Pharmaceuticals, which admittedly does important work in research and development relating to the treatment of cystic fibrosis, mean that it continues to put patients’ lives at risk as it seeks to extract the highest possible price from our NHS. When Alexander Fleming created penicillin, he had it publicly patented so that it was accessible to all, and it became a revolution in modern medicine. Should we not be legislating for pharmaceutical companies to do something similar and put patients, not profits, at the centre of their development?

I have a number of questions for the Minister. How do we approach this matter systematically, so that we are not back here time and time again, as we have heard? The reality is that we have a socialised—dare I say socialist—healthcare system, which treats people’s health on a collective basis, based not on their ability to pay, but on their need. That is quite revolutionary. However, that healthcare system operates in an international pharmaceutical industry based on rapacious profiteering. How do we square that circle? I suggest the answer lies at the European level, not the US level. Ultimately, the EU’s being one of the biggest healthcare markets in the world gives the European Union immense clout in imposing its will on international pharmaceutical companies; that is one of the reasons I want to stay in it.

My other question is a philosophical one: what is a fair price for years of investment and research? Who determines what is a fair price—our collective democracies, which enable these companies to exist, or a handful of corporate executives whose primary motivation is to maximise profit? Who determines that price? At the moment, I do not think that the balance is correct.

Finally, has the Minister considered the use of compulsory licensing, allowing a UK company or other company to make cheap generic copies? That is allowed under World Trade Organisation rules; the definition of an emergency is up to the host country that needs to use it, and from initial research it is something that could be used and has been used before. I know that is not something she would want to do initially, but ultimately, would she consider it if Vertex refuses to move?

I will leave hon. Members with a quote from Ethan, who had his 11th birthday on 5 June. He said:

“I want to live a long life, because then I get to see some things and do things, so please fund The Triple”.

--- Later in debate ---

[Seema Kennedy]

My hon. Friend makes a very good point. Members from across the House have told very moving stories of their constituents, the lives they lead, and the stresses and the strains put on them by the lack of an agreement on this matter. However, other drug companies are developing medications for rare diseases, and agreements have been reached on those. I will turn to them very shortly.

We can look at what happened in Spain earlier this year, when Vertex did not accept the terms of Spain’s health outcome-related proposal. The Spanish proposal, which is similar to the recent NHS England offer, is based on the ongoing collection and interpretation of real world data. Why is that not acceptable to Vertex? I also note that dialogue between Spain and Vertex has been ongoing for three years, which is similar to the situation here in England.

We will never walk away, but Vertex must now agree to engage with NICE and we urge it to accept all the flexibilities that NHS England has put on the table. There is nothing unusual about Vertex that means that this is not the right thing for it to do. Recently, we have seen deals reached as part of the NICE appraisal process, including that for ocrelizumab, which is an innovative multiple sclerosis drug, that for Spinraza, which is for people with spinal muscular atrophy, and that for axicabtagene ciloleucel chimeric antigen receptor t cell, or CAR-T, treatments.

Given that Vertex remains an extreme outlier in both pricing and behaviour, it is no wonder that patients and families have been looking at alternative solutions to secure access to this drug, and we have heard about the buyers’ club. Hon. Members have also talked about Crown use licensing, and the hon. Member for Bristol East (Kerry McCarthy) talked about large-scale clinical trials.

Unless Vertex changes its approach and behaves responsibly, I have a moral obligation to look at these other options. Of course NHS England and NICE will carry on the negotiations, because a negotiated outcome is the desired option. However, I have no alternative but to look at these other options on the table.

[Clive Lewis]

I thank the Minister for giving way. I raised the issue of compulsory licensing, which the Government have within their armoury. Of course it would be a measure of last resort, but given that we are dealing with people’s lives, the quality of their lives and a company that is quite simply being intransigent, and greedy, surely that option should be considered. That would send a message to those pharmaceutical companies—that global pharma industry—that if they are going to be greedy and put people’s lives at risk, despite being made fair offers, this option could be used by our Government.

[Seema Kennedy]

I thank the hon. Gentleman for his intervention. As my hon. Friend the Member for Sutton and Cheam said in his opening speech, which was very well made, we recognise the importance of British pharmaceutical companies and that companies invest hugely in developing new drugs. However, as the other examples of drugs for rare diseases that I have given show, it is possible to go through the NICE appraisal process and reach an agreement with NHS England. As one hon. Member who is no longer in their place said, this is an offer for a long-term agreement.

Vertex is an outlier, and I would like to put that on the record.