Under-age Vaping

Daisy Cooper Excerpts

Wednesday 12th July 2023 Commons Chamber

[Andrew Gwynne]

My hon. Friend is absolutely right. There is a place for banana, custard and even doughnuts, but that is not on a vape package. She is right that we need to close the loophole and protect children’s health. That is why we have tabled this motion.

In a recent evidence session on youth vaping, Laranya Caslin, the headteacher at St George’s Academy in Sleaford, told the Health and Social Care Committee:

“we have a significant proportion of students vaping. They vape regularly”.

The problem is so bad that St George’s has had to change smoke sensors to heat sensors, to clamp down on young people leaving the classroom to vape.

I would love that to be an isolated case, but we all know, across the House, that it is not. In Hartlepool, concerns have been raised about an increase in primary school children using vapes—that is just shocking. In Devon, schools have reported confiscating e-cigarettes from children as young as seven. Those claims seem to be reinforced by the fact that last year 15 children aged nine or under were hospitalised due to vaping, with health experts warning that the excessive use of e-cigarettes in children could be linked to lung collapse, lung bleeding and air leak. In Yorkshire and the Humber, it is estimated that 30% of secondary school students have tried vaping, which equates to around 109,000 children. It is just staggering.

[Daisy Cooper (St Albans) (LD)]

I am grateful to the shadow Minister for giving way. I have heard really shocking reports from parents and teachers in my constituency that children as young as 11 are using vapes and that one young person, at the age of 17, is now addicted. In the worst cases I am hearing, some young children are being targeted and are taking the vape apart to carry much harder drugs on the inside, which is causing an even bigger problem. Does the hon. Gentleman agree with me that we simply cannot wait any longer? We need urgent action from the Government to stop that happening.

[Andrew Gwynne]

The hon. Lady makes a powerful case. Those are precisely the reasons why we have called this debate. It should shock each and every one of us. The ease of access to e-cigarettes for children, many younger than the ages she gave as an example, just cannot be allowed. We must be doing all we can on e-cigarettes, as we did to tackle the packaging and advertising of actual cigarettes, to ensure that children are weaned off their nicotine addiction and that other children do not start vaping in the first place.

--- Later in debate ---

[Daisy Cooper]

The Minister said that this is “literally illegal”. According to the director general of the UK Vaping Industry Association, 40% to 50% of the disposable vapes market is made up of illicit products. So does the Minister agree that as well improving the regulation of vapes within the legal market that we have heard about so far, we must also see improvements to border security, to clamp down on illicit vape sales?

[Neil O’Brien]

I completely agree with the hon. Lady on that point; this is exactly what our enforcement squad is doing, and I completely agree about the importance of doing it.

On the call for evidence, we will be producing our response in early autumn, identifying and outlining areas where the Government will go further. The key point is that we need evidence to take effective action to stop children vaping. While that call for evidence has been running, we have already taken further steps. At the end of May, the Prime Minister announced several new measures to support our efforts to tackle youth and kids’ vaping. That included closing the loophole in our laws that has been allowing companies to give out free samples of vapes to under-18s, which ASH estimates could total as many as 20,000 a year. He also announced that we will overhaul the rules on selling nicotine-free vapes to under-18s and on issuing fines to shops selling vapes to the under-18s.

The Prime Minister also announced that we will update the school curriculum, to emphasise the health risks of vaping within relationships, sex and health education lessons, just as schools currently do for smoking and drinking, so that kids understand the risks of vaping. We will be writing to police forces to ensure dedicated school liaison officers across the country are using the new resources available to keep illegal vapes out of schools.

I want to use this opportunity to outline the work we are doing to successfully reduce smoking, not least because the Opposition Front-Bench spokesperson touched on it. In the 1970s, more than 40% of people smoked, and it was still 21% in 2010. Since then, we have taken a series of steps, including doubling excise duties and introducing a minimum excise tax on the cheapest cigarettes, that have helped to drive down smoking to a record low of just 13% in England.

We have gone from 21% to 13%, but of course we want to go further. In 2019, we announced our ambition for England to go smoke-free by 2030, which is considered to be 5% or less. Over the past decade, we have made significant progress towards making England smoke free. We have continued to invest in local stop-smoking services, to help smokers get the right support for them. We continue to work in support of the NHS. Last year alone, we provided £35 million to the NHS long-term plan commitments on smoking.

Youth smoking rates are now at their lowest rates on record. In 2021, just 3.3% of 15-year-olds were regular smokers, although of course we want to reduce that figure even further. Through the new measures I announced in April, the Government will be supporting many more smokers to quit through the tobacco reduction strategy. Some 1 million smokers will be encouraged to Swap to Stop, swapping cigarettes for vapes under a new national scheme that targets those who are most at risk and gives them free vapes. That is first scheme of its kind in the world. It is based on experience from the successful local pilots, and is an evidence-based initiative.

Likewise, we will offer innovative, but evidence-based, financial incentives for all women to stop smoking in pregnancy. Again, this is based on evidence that has been gathered during local pilot schemes and the strategy will be implemented at a national level. Shortly, we will launch a consultation on cigarette pack inserts to provide further information to support smokers to quit, which is something Canada has done successfully.

Further, those who supply tobacco for sale in the UK must be registered for tobacco track and trace, and obtain an economic operator ID. We brought in that scheme to tackle illegal tobacco, but we now want to use the existing system in a new way, to help strengthen enforcement and to target the illicit market. From now on, when people are found selling illicit tobacco, we will not just seize their products but remove their economic operator ID, so they will no longer be able to buy or sell tobacco. We are exploring how to share information with local partners about who is registered on the track and trace system, so that they know who is and who is not legally entitled to sell tobacco in their areas, helping to drive enforcement.

We are committed to doing all we can to prevent children from starting to vape and we are already taking robust action in a range of areas. We are actively working on ways that we can go further, but it is essential that those methods are evidence based and that we have measures that will be effective.

--- Later in debate ---

[Neil O’Brien]

Act robustly? I think we all want to act robustly. The shadow Minister said in his speech that he did not like banana-flavoured vapes, but would they be banned? I am happy to take an intervention if the shadow team have an answer. I do not think that we have an answer. That, ladies and gentlemen, is why we need to have evidence. We need to have an evidence-based approach, and we need to have not just the evidence about what drives these things, but clear definitions of these things on which we can actually take action. We have to be clear about what we are and are not doing within all these fields.

All I was trying to do is to demonstrate that, while we are committed to taking action—I feel very strongly about taking action on this—and while we have done a whole range of different things on this point, we need evidence to make good policy, which is why we are having a call for evidence.

[Daisy Cooper]

The Minister will know that the Government commissioned the Khan review, which reported on 9 June 2022—a year ago. The Khan review took the evidence. It had the consultation and it made very firm recommendations about certain things that the Government should do. Why are we here again? Why are we consulting? Why can the Government not just follow the recommendations in the Khan review?

[Neil O’Brien]

On driving up support for people to Swap to Stop, we are following the recommendations. On the things that we have been discussing in this debate, a whole set of other questions have been raised, on which our call for evidence explicitly invited evidence, because we want to have an evidence-based policy.

Oral Answers to Questions

Daisy Cooper Excerpts

Tuesday 11th July 2023 Commons Chamber

[Steve Barclay]

Again, I agree that disposable vapes are a particular concern: in our view, the growth in youth vaping is largely due to the growth in the use of disposable vapes. That is why we have particularly focused on that issue in our call for evidence, and that is what we are considering.

[Daisy Cooper (St Albans) (LD)]

6. What assessment he has made of the potential impact of guidance issued by District Valuer Services on the availability of city-centre GP premises.

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

While it is a very long-standing system, we keep the approach to funding for GP premises under review. We have taken action in the primary care recovery plan to improve access to section 106 funds, so that new homes always come with the GP infrastructure that is needed.

[Daisy Cooper]

The Secretary of State and his Ministers will know that I first raised this issue in the Chamber on 6 June this year. Integrated care boards, GPs, and now the medical property sector are all telling me that the Treasury rules are out of date and are a massive block to securing much-needed primary care premises in the right places, particularly in city centres such as St Albans. When I have asked the Department via written parliamentary questions for its assessment of how much of a problem this issue is, the Department has told me that it just does not know. Could the Minister please tell us when he will be speaking to colleagues in the Treasury to resolve this issue, so that we can make sure that GP premises are secured where people need them most?

[Neil O'Brien]

We talk all the time. I am conscious that there are 60% more full-time patient-facing staff in the hon. Lady’s constituency than there were in 2019, which of course puts pressure on premises. The capital allocation for her local ICB between 2022-23 and 2024-25 was £200 million, so the money is there, but I am happy to continue the conversation about how we get the premises in the places where we need them.

NHS Long-term Workforce Plan

Daisy Cooper Excerpts

Monday 3rd July 2023 Commons Chamber

[Steve Barclay]

My right hon. Friend makes a valid point about the integration between health and social care, and that was a flagship part of the reforms in 2022, which brought the NHS and social care together through the integrated care system. I join him in welcoming the news about William Harvey Hospital, which is extremely important to the local area. On social care more widely, we must also be cognisant of the differences. The NHS and social care employ roughly similar numbers at around 1.5 million people, but one is one employer and the other is 15,000 employers, so the dynamics between the two are different. The prioritisation of that integration is exactly right. That is why my right hon. Friend the Chancellor announced up to £7.5 billion for social care in the autumn statement, recognising that what happens in social care has a big impact on discharge in hospitals and hospital flow, which in turn impacts on ambulance handovers.

[Daisy Cooper (St Albans) (LD)]

After promises of new hospitals that have not got off the ground and 6,000 more GPs that never came to pass, it is fair to say that the British public will judge the Government on their actions not their words. Let me press the Secretary of State further on social care. He will remember that at the start of this year, people were dying in the back of ambulances and in hospital corridors, in part because people could not be discharged from hospitals into social care. If the Government believe, as I do, that we cannot fix the NHS if we do not fix social care, will he also bring forward a workforce plan for our social care sector?

[Steve Barclay]

That repeats the previous question, so I will not repeat the answer. It is slightly ironic to call for a plan for a new hospital programme and for a long-term workforce plan, and then criticise us when we deliver on both of those, as we have done with more than £20 billion of investment in the new hospitals programme, which we announced last month, £2.4 billion in the first ever long-term workforce plan and the biggest ever expansion of workforce training in the history of the NHS. Of course we need to take action in the short term to deal with the consequences of the pandemic. That is what our recovery plan does. The urgent emergency care plan that I announced in January takes specific action on demand management in the community. There are measures upstream on boosting capacity in emergency departments and downstream on things such as virtual wards. A huge amount of work is going on. We are putting more than £1 billion into 5,000 more permanent beds to get more bed capacity into hospitals. On social care, in the autumn statement the Chancellor committed up to £7.5 billion of further investment over two years, and it was part of our reforms to better integrate health and social care.

Mental Health In-patient Services: Improving Safety

Daisy Cooper Excerpts

Wednesday 28th June 2023 Commons Chamber

[Steve Barclay]

Having discussed that harrowing evidence with my right hon. Friend, I do not think any Minister could either forget it or not be moved. I found it an extremely moving experience to hear her talk about the experiences of a number of her constituents. She is right to praise those who come forward, and to recognise that it is often a difficult ask to relive the most awful circumstances, but it is important that families come forward so that we learn lessons and ensure this is not repeated.

My right hon. Friend is also right to highlight the two broad elements of learning the lessons of what happened in the past and maintaining services for the future. I am therefore happy to give her an assurance that we will work closely with her on support for Essex as lessons are learned through the statutory inquiry and as services continue to be delivered. We are working closely on that with the chief executive.

[Daisy Cooper (St Albans) (LD)]

My thoughts are, first and foremost, with the bereaved families and all those involved, because this process must be utter agony for them. It is right that the inquiry is put on a statutory footing.

In his statement, the Secretary of State quoted from a letter he received from Dr Strathdee, in which she said:

“I am very concerned that there are serious, ongoing risks to patient safety.”

The Secretary of State did not expand on that, and I do not know whether he is able to do so. If I may extrapolate, we know that, more broadly, there are risks to patient safety when there is not enough workforce and when there are not enough beds. Hertfordshire is the most under-bedded area of the country. When we see the workforce plan, potentially this week, will it include estimates of the number of qualified mental health staff we need in in-patient settings, NHS community settings and schools? Will he meet me and my local mental health trust to discuss the number of beds we have in the county and our plan to expand them?

[Steve Barclay]

Dr Strathdee did not particularly focus on staffing numbers, as far as I recall; she focused on some of the issues with care from staff. That was the nature of the concerns. On the ongoing risk, part of the reason why we commissioned the rapid review was to look, in particular, at the quality of data. There was a quantity of data that was not effective, and that often distracted staff from spending time with patients. There were also gaps in the quality of data that needed to be filled, and the document that will be placed in the Libraries of both Houses speaks to that point. That is why we are so keen to move at pace on learning lessons.

Mental Health Treatment and Support

Daisy Cooper Excerpts

Wednesday 7th June 2023 Commons Chamber

[Daisy Cooper (St Albans) (LD)]

I welcome this debate because, like every other Member, my inbox is often full of cries for help from people who are suffering mental ill health or from family and friends trying to help them. Looking through recent cases I have had in St Albans, I see a litany of problems with the system. Many constituents have told me that they have had to wait for more than a year for diagnosis. Some have needed an urgent medication review. One parent told me they feared for their and their child’s safety while the child was on a particular medication. They sought an urgent medication review, had an urgent referral from their GP, but the matter then sat with the psychiatrist for weeks and weeks. They were terrified during that time, waiting for a decision.

Other constituents have told me of their relief when they finally secured a mental health care package, only to find that it takes many weeks or months before the package can be put in place in practice. Those who have mental ill health and are also neurodiverse or have learning difficulties have told me about the hoops that they have to jump through. In some cases they have been told, “We can offer you mental health support, but it is not tailored or suitable for you because of your neurodiversity or your learning difficulties.” I have heard about the frustration that those individuals feel because those services are not tailored to them as a person.

Then we have the emergency A&E admissions. Again, just a couple of weeks ago, I had a parent email me in total desperation from a hospital corridor because one of their children had attempted suicide and had been rushed to A&E. They were not safe to be left unsupervised, but they were supervised by somebody who was inappropriate to supervise them. The family were desperate to get their child to a safe place, but that did not happen for days and days—it was only with my intervention that it happened. As I am sure many Members know, it is really pleasing to be able to make a difference in those cases, but it is worrying to think about all those families who have not got in contact—others out there who are struggling alone.

There are real problems with A&E pathways and with children’s mental health services. I hope that the Government will focus on those areas, but from speaking to my local mental health trust and hearing about the pressures that it is facing, is it really any wonder that we are having these issues? There were warnings at the start of the pandemic of an explosion of mental ill health, and I believe that the Government could have done a lot more to get ahead of that problem. For example, my local mental health trust has told me that there is not only an increased number of people looking for help but higher acuity. Therefore, instead of having a 2:1 staff-patient ratio, it often has to be 3:1. So even with the same staff headcount, there is less staff time for more people seeking help.

Those who work for the trust tell me of their frustration that the waiting lists are getting too long. They accept that medication reviews are often delayed because of staffing and resourcing issues, and there are huge pressures on the trust’s budget. Not only is there the demand; there is the cost of out-of-area placements, having to pay for private beds where none are available in the NHS, and paying for agency staff to cover vacancies that are not filled. Our mental health trust in Hertfordshire is the smallest bedded mental health trust in the country. We have huge ambition to open a new bed unit in the west part of the county, but we need the Government and the NHS to get behind that ambition.

So what do we need to see? We need to see prevention, and we need to see it early. Research from New Zealand, which is often cited here in the UK, indicates that three in four people with mental health problems show symptoms before the age of 25. That reinforces the need for prevention and the need to see it early, so I would like there to be a qualified practitioner in every single school. We need mental health community hubs in every community. We need to empower the charity sector—a sector that has barely been mentioned today. In St Albans, we have Time To Talk, Youth Talk and the OLLIE Foundation, which are all fantastic mental health charities that are working on tiny budgets. In Hertfordshire, we need support for mental health beds and, of course, we need to tackle the workforce problem. Until the Government publish their workforce plan, the lack of a workforce remains the biggest risk to service delivery in mental health in every single part of the country. I urge the Government to take action on those points.

Oral Answers to Questions

Daisy Cooper Excerpts

Tuesday 6th June 2023 Commons Chamber

[Daisy Cooper (St Albans) (LD)]

I recently learned that my local integrated care board is not allowed to spend the money it wants to spend on securing the best location for a new GP practice and health centre. The reason is that Treasury rules, which are used by the District Valuer Services, are not keeping up with market rents. Will the Secretary of State speak to his colleagues in the Treasury to fix that, before we face an epidemic of health centres and GPs leaving town and city centres, and moving to ring-road locations away from the populations they serve?

[Steve Barclay]

I am very happy to look at that specific issue and raise it with Treasury colleagues.

Patient Choice

Daisy Cooper Excerpts

Thursday 25th May 2023 Commons Chamber

[Steve Barclay]

Yes, I can. Part of this is allowing patients to choose according to a number of factors. Some may have had treatment previously and want to go back to a particular consultant-led team. Some may want to look at CQC ratings and other performance metrics. Some may want the convenience of not travelling—relatively small numbers say they are not willing to travel; far more are willing to do so. Patients will look at a range of factors when shaping their decision. The key is to have transparency and the technology that enables patients to take control.

[Daisy Cooper (St Albans) (LD)]

Of course we all want to see real patient choice, but for millions of people who are waiting in pain, a choice between travelling miles away or paying to go private is no choice at all. We all know that the key to unlocking millions of people from the NHS backlog is tackling the crisis in the workforce. Why on earth are we spending precious parliamentary time talking about the NHS app instead of the NHS workforce?

[Steve Barclay]

We are talking about the wider workforce. The hon. Lady mentions private capacity. This patient choice will enable people to make much better use of the independent sector and to do so free at the point of access. Given the size of the challenge of pandemic backlogs, the question is: how can we make full use of capacity across the NHS and in the independent sector?

New Hospitals

Daisy Cooper Excerpts

Thursday 25th May 2023 Commons Chamber

[Steve Barclay]

It is not just the Eden Project North on which my hon. Friend has been a vigorous campaigner: he has raised this assiduously as well. As he knows, the trust is at a very early stage in its consideration of what public consultation will be needed around the reconfiguration of services across Lancaster. We are not letting that stop our work to open a new surgical hub at the Royal Preston Hospital, for example. As he knows, I know the geography very well in terms of the interaction with Lancaster. There are a number of options on consolidation and expanding to two sites. I look forward to discussions with him as we take that forward.

[Daisy Cooper (St Albans) (LD)]

Having asked the Government 14 times to release funding to West Hertfordshire Hospitals NHS Trust and other hospital trusts, I am relieved that they now have approval to proceed, but the Secretary of State will know, as the rest of us do, that the construction industry thinks that the 2030 date is pie in the sky. The Government have not been looking after our hospitals, so we have lost huge parts of the workforce and of our supply chains. Building magazine says that the contract notice for a delivery partner will not even be published until September. Of course, as I understand it, none of the major construction companies has even started to put together project teams to bid for the work. For all the talk of 2030, could the Secretary of State tell us how much progress he is prepared to promise before the next general election?

[Steve Barclay]

The announcement and the manifesto commitment were to build by 2030. The hon. Lady touches on the engagement with industry; Lord Markham has been engaging with industry. We have had a significant team, both within the Department and in NHS England, working on the standardised designs. The whole point is that we have seen in other sectors how standardisation allows us to construct much more quickly. It will also allow internal processes in government to be much quicker because we are not looking at each scheme in a bespoke way; we will have much more standardisation. That is how we will move at a much quicker pace. It has required us to take a little more time over recent months as we have finalised the plan, but now that we have that plan and clarity about the RAAC hospitals in particular, we will be able to move with much more pace.

Recovering Access to Primary Care

Daisy Cooper Excerpts

Tuesday 9th May 2023 Commons Chamber

[Steve Barclay]

My hon. Friend raises a great point. I am extremely keen on how we can improve diagnostic testing and make it more accessible. As she knows from her time in the Department, early treatment is more effective and more cost-effective. Looking at more home testing, more testing at pharmacies and more work with employers to accelerate early detection is a win for patient outcomes and for delivering care in a more affordable way.

[Daisy Cooper (St Albans) (LD)]

Liberal Democrats and many others in this House have called for a pharmacy first approach for a long time, but there appear to be two major problems with today’s announcement. The first is that the Government’s own plan says that the money will be re-targeted; I would be grateful to know from the Secretary of State which other service will miss out.

In my constituency two pharmacies have already closed, and across England 16% of pharmacies have said that they do not think they will survive another year. How does the Secretary of State expect people to access a pharmacy first if their pharmacies continue to close?

[Steve Barclay]

As I said, there are more pharmacists than in 2010 and more people working in the pharmacy sector—the numbers have gone up by 24,000 since 2010—so to address the hon. Lady’s second question, there are more. On funding, as I said in my statement, this is new funding for primary care. That is the commitment that we made, and it should be welcomed in the primary care sector.

NHS Strikes

Daisy Cooper Excerpts

Monday 17th April 2023 Commons Chamber

[Steve Barclay]

I agree with my hon. Friend. The fact that even the Labour party does not support 35%—the Leader of the Opposition himself says that is not affordable —indicates how out of step the junior doctors committee co-chairs are on what is realistic to get the balance right in bringing down inflation and on the wider economic pressures we face. We stand ready to engage constructively with the junior doctors committee but, as my hon. Friend says, that has to be on the basis of a meaningful opening position.

[Daisy Cooper (St Albans) (LD)]

On 5 July, the British public will want to celebrate 75 years of our amazing NHS, but if they are still feeling the brunt of NHS strikes at that time, does the Secretary of State think it would still be right for him to be at the Dispatch Box?

[Steve Barclay]

We have agreed an offer with the Agenda for Change staff council. That is something that the staff council and the majority of trade unions have recommended to their own members, and that the largest health union has voted in favour of. I think we should allow that ballot to take place; it reflects meaningful and constructive engagement. That was reflected in the fact that trade union leaders themselves recommended the deal to their members. I hope that, when we come to the 75th anniversary, we can celebrate that.