Tobacco and Vapes Bill (Fifth sitting)

Danny Chambers Excerpts

Committee stage
Tuesday 14th January 2025 Public Bill Committees

[Andrew Gwynne]

That is precisely the point I was coming to. We will take the argument away because it is a reasonable argument, and we will perhaps consider returning to this issue on Report.

I know that the shadow Minister has every sympathy with the fact that cigarette papers are dangerous when used for the consumption of tobacco, which is what we want to bear down on. As I have said, there are powers in part 5 to restrict the flavours of cigarette papers, but we want to get the balance right so we will take the argument away and consider it.

[Dr Danny Chambers (Winchester) (LD)]

I am reticent to extend the discussion about cigarette papers; I was unaware it was possible to discuss something to such an extent. I am not legally trained, so I ask this for my own understanding as someone who is not a learned Member. If the exact same product was renamed and rebranded as model paper or musical instrument paper, would this law still apply to it?

[Andrew Gwynne]

That is a good question. Of course, if it was to be used for the consumption of tobacco, it would come within the scope of the Bill. We have to be clear that many of these products have dual uses, as we have heard. I am as guilty as anybody of making pipe-cleaner characters for my children and grandchildren—grandchild, rather, because I have only one so far.

We want to make sure that those who want to continue smoking are able to do so, but that obvious restrictions and boundaries are put in place regarding the accessibility of these products, so that no child born after 1 January 2009 will ever legally be sold them.

Tobacco and Vapes Bill (Sixth sitting)

Danny Chambers Excerpts

Committee stage
Tuesday 14th January 2025 Public Bill Committees

[Dr Johnson]

I thank my hon. Friend for his intervention. Last Tuesday, we heard in evidence from various medical sources, and both the Select Committee and our processor Bill Committee heard in evidence that nicotine is, of itself, harmful, and that the chemicals added to vapes are harmful. In some cases, they are extremely harmful. I will talk more about vaping chemicals later. Indeed, sometimes the products do not contain what they are expected to contain, and that can be worse still. I will return to that subject later, too.

Nicotine is highly addictive and can permanently affect the development of the adolescent brain. We have heard how the industry targets young people, and that is because the adolescent brain is particularly vulnerable. Nicotine can permanently affect its development. Nicotine also fulfils all the criteria for drug dependence. Giving it up is very difficult, and withdrawal symptoms can include cravings, irritability, anxiety, trouble concentrating, headaches and other mental symptoms. Symptoms associated with nicotine and dependence are often not recognised by novice smokers, particularly if they are young.

[Dr Danny Chambers (Winchester) (LD)]

On the subject of how nicotine affects the brain and brain development, one thing we have not really touched on—and we have touched on many physical health issues—is the incidence of smoking among people with mental health issues. One submission was from the Mental Health and Smoking Partnership, which said that 45% of people with a serious mental health issue smoke, and around 25% of people with clinical anxiety. It would stand to reason that the impact on a young person’s brain could also start to lead to serious mental health issues, as well as all the physical health and development issues.

[Dr Johnson]

The hon. Gentleman is right to raise the importance of managing nicotine dependence for those with mental health conditions. We know that smoking, in particular, is more likely to take place among people with mental health conditions or those who are in mental health in-patient units. I am sure we will go on to discuss the issue of vending machines.

Last May, in the previous Bill Committee, we heard evidence from the Mental Health Foundation about the myth that tobacco helps with anxiety, and how that myth needed busting. We also heard about the importance of giving extra support to people with mental health conditions to enable them to kick the habit of nicotine—whether that habit is smoking or vaping—because it will help both their physical and mental health. However, it can be more challenging for them to complete. I am grateful to the hon. Gentleman for raising that important issue.

Returning to clause 10, a study considering the effects in adolescents of nicotine dependence after the initiation of smoking cigarettes found that the symptoms of nicotine dependence can appear only a few days after initiation. Given that oral nicotine pouches contain similar or higher levels of nicotine, similar symptoms may appear following initiation of oral nicotine pouch use, which is why it is particularly important for children that we pass clause 10 and ensure that children are protected from these nicotine products.

Tobacco and Vapes Bill (Third sitting)

Danny Chambers Excerpts

Committee stage
Thursday 9th January 2025 Public Bill Committees

[Dr Johnson]

Wisdom or age, but I shall be cautious not to answer too closely.

[Dr Danny Chambers (Winchester) (LD)]

I accept the view that having to provide ID will be inconvenient and frustrating for some people, but all the expert witnesses on Tuesday pointed out that many smokers do not wish the younger generation to continue smoking. I think that most of them would probably be of that view that the slight infringement of their civil liberties in having to carry ID is a small price to pay for the knowledge that they are preventing smoking from being taken up.

[Dr Johnson]

The hon. Gentleman is right that the measures have broad support. Certainly, the pollsters who have investigated people’s views of this legislation—that proposed by the previous Government and the legislation as it is now, with some tweaks to it—have found the public to be overwhelmingly positive. We legislate because we are elected by those people. On the basis of their opinions and given that policing in this country is done by consent—

Tobacco and Vapes Bill (Second sitting)

Danny Chambers Excerpts

Committee stage
Tuesday 7th January 2025 Public Bill Committees

[Euan Stainbank (Falkirk) (Lab)]

Q Do you believe that the generational smoking ban might cause an increase in the use of other nicotine products such as vapes, smoke-free tobacco or even illicit products?

Alison Challenger: We are ultimately trying to reduce the harm caused by smoking—that is the big killer, and we really would not want to lose sight of that. The Bill also brings in elements around the second-hand smoke agenda. It is important to recognise that there are many vulnerable people who would potentially be harmed by breathing in second-hand smoke, so we welcome the fact that the Bill includes that element. As for whether it will increase vaping, it is really hard to know at the moment how that will work out. Potentially more people might switch to vaping, but ultimately, the Bill brings in a progressive approach to taking out smoking tobacco, which is to be welcomed.

[Dr Danny Chambers (Winchester) (LD)]

Q You might not have the answer here, but do you have a rough estimate of what it costs the NHS financially to deal with passive smoking and second-hand smoking every year?

Alison Challenger: I do not have the actual figure, but it is significant. One of the early benefits of the Bill going through will be the impact on children, particularly around asthma. Obviously, second-hand smoke will be exacerbating some of those respiratory illnesses, particularly for children. There is a considerable burden on the NHS as a result of breathing in second-hand smoke. We must also consider those who have cardiovascular disease and those who have existing respiratory illness. It is not always evident that somebody is vulnerable, so it is really important that the measures in the Bill serve to protect those who are vulnerable from inhaling second- hand smoke.

[Dr Chambers]

Q I am assuming that from a public health point of view, looking at the epidemiology, certain communities and demographics will be more greatly affected by this. Is that something that you are mindful of? How do you see the Bill changing health inequalities?

Alison Challenger: We are very mindful of that. Some of the statistics we give around smoking prevalence are an average smoking prevalence for often quite large geographical areas. For my own area in west Sussex, our local survey suggests there is a variance of 4.3% in our most affluent area compared with 16% in our least affluent area. Those are still averages. We also know that in households in the most deprived part of our area, 40% of children are exposed to cigarette smoking from a parent or carer. That is through our own survey.

The point I am trying to make is that there is very much a health gradient, and in those who are most disadvantaged and living in our most disadvantaged areas, we see both higher rates of smoking and more children exposed to that smoking. Those children are more likely to take up smoking if they have been exposed to it.

[Jim Dickson (Dartford) (Lab)]

Q This is to Councillor Fothergill. Are there any circumstances you can envisage where local enforcement would not be enough and the Secretary of State would need to utilise the powers granted in the Bill under clauses 130 and 131 to intervene?

David Fothergill: We have discussed this outside the room, and I think the area we would be most concerned about is illegal sales online. Our local teams could not get into those, and therefore we might need more national resources to break into how people are bringing illegal substances into the UK.

--- Later in debate ---

[Dr Chambers]

Q Dr Ahmed asked almost word for word what I was going to ask, but from a population medicine point of view, do you have a rough estimate of how much smoking is costing the NHS and how much would be saved if the measure was implemented properly?

Professor Linda Bauld: I do not have in front of me the cost to the NHS—other witnesses will probably have it at the tip of their tongue—but it is substantial. If you look at the number of admissions to hospital from smoking, there are over 500,000 every year in England, and we still have over 75,000 deaths. By reducing smoking prevalence, you are going to see very significant impacts and cost savings.

The other thing we know from our research, as previous witnesses have said, is the effect on productivity and workplace absence. As you all know from your constituencies, smoking is also driving some of the loss of people from the workforce in their 50s, early 60s or even younger that we have seen recently. I think that you will see cost savings and an impact on productivity.

The final thing that I would say on that, despite not having the figures in front of me, is that this is an area that causes such a burden to the NHS. One of the things that our CMOs did not make clear earlier, although they said it indirectly, is that if you look at non-communicable diseases in the UK, smoking is the only risk factor that is linked to all four of our NCDs—respiratory conditions, cancer, diabetes and heart disease. It is the only one that is directly linked to all of those. If you think about all of those diseases, and the burden of disease that Sir Gregor mentioned, of a 21% increase by 2040 in my own nation of Scotland, we are going to make an impact on that, and that will achieve cost savings for the NHS—and, importantly, for social care.

[Dr Chambers]

That is well articulated. Thank you.

[Dr Cooper]

Q Thank you for coming along this afternoon. You mentioned the New Zealand case. Could you talk briefly, in case anybody does not know, about what happened and why the standards were dropped? What learnings might we take from that for our legislation?

Professor Linda Bauld: I think there are political aspects to that, which I will not comment on, but obviously the understanding was that it was a very comprehensive and ambitious set of measures that was introduced. Like this Bill, it was about not just the smoke-free generation but other measures as well, including, interestingly, on the density of retail outlets, which might be something for another day or another, potential future measure. A new Government came in and decided not to take it forward.

The learning that we need to take from that, from my understanding and from speaking to colleagues there, goes back to the CMOs’ evidence about the lobbying that is going to occur. The tobacco industry and partners around the industry are very powerful, so persuading colleagues that this is undermining choice and that it will be a burden in terms of regulation, cost to retailers and so on—those were the arguments that were used in New Zealand.

We need to keep a watchful eye, as we think ahead to the regulations and the next steps for the legislation, that we do not open that door too widely and allow those arguments to become too powerful. As you heard earlier, that industry is continually looking for new recruits to replenish those it loses through morbidity and mortality, and that will happen in the UK as well unless we get this right.

--- Later in debate ---

[Andrew Gwynne]

Q The Bill seeks to reduce youth vaping. How do you think we can best achieve that while not deterring adult smokers from quitting?

Professor Steve Turner: That is a really good question. I think that the balance in this Bill—between supporting the 6 million smokers to quit and not engaging children in nicotine addiction—is the right balance. Going back to what I was saying earlier, getting the message across to young people is a multifaceted intervention that requires education as well as legislation. It is a really difficult balance, but I do believe that the Bill, as it is, has that balance just right.

[Dr Chambers]

Q Thank you for coming all the way down from Aberdeen; I worked there for a few years, so I know it is a long way. We have been trying to ask some panellists approximately what this issue is costing the NHS. As a consultant, in your clinic, doing respiratory paediatrics, what proportion of your patients are in some way involved with smoking or second-hand smoking?

Professor Steve Turner: The impact on the whole of society of second-hand smoking in children is complex, but there are various pieces of the jigsaw. First of all, children come to the clinic, are admitted to hospital, come to the emergency department, or go and see the GP, so there is that healthcare side. If any of you have children, however, when your child is off school, that has implications for you as a family; there are some difficult discussions over breakfast about who is going to work and who is not. Therefore, there are a number of different impacts on us as a society, economically and to the NHS from second-hand smoking.

I am not clever enough to put a number on it, but it is a lot bigger than I think people know. I do know that £46 billion is the number cited as the direct health cost to the NHS of smoking—it is almost too big to consider—but I suspect that the wider societal cost will probably be a magnitude greater than that.

[Dr Chambers]

Q Is there a ballpark figure for a general day? When you have a list of paediatric respiratory cases, are maybe 10% or 20% due to this?

Professor Steve Turner: The children who are exposed to second-hand smoke in the home are over-represented among children with respiratory symptoms. Parents do not want their children to smoke, so they feel torn. They are conflicted: they are addicted to nicotine, but they do not want their children to smoke, and having a smoke-free generation will address that almost impossible parental conflict.

[John Whitby]

Q The Bill makes it illegal to sell vaping products to under-18s, and to proxy-buy vapes for children, but it does not make it illegal for under-18s to buy vapes. What is your view on that?

Professor Steve Turner: I support the Bill as it stands. I think that the onus has to be on the vendor not to sell, not on criminalising the customer or the child.

Winter Preparedness

Danny Chambers Excerpts

Wednesday 18th December 2024 Commons Chamber

[Karin Smyth]

I am working very closely with the UK Health Security Agency to make sure that, week on week, we are aware of the movement of different diseases and viruses through the system, and we will continue to publicise the campaign to get people vaccinated. Anything that hon. Members can do to support that campaign, and to make sure that people support themselves and their loved ones, will be gratefully received by the entire system. The campaign is something that everyone can get behind.

[Dr Danny Chambers (Winchester) (LD)]

While we all pay tribute to the NHS staff who work over Christmas, we should remember that they are not only missing Christmas with their families, but putting their own health at risk in caring for us.

On Monday, Winchester hospital declared a critical incident, saying that it could admit no more patients and asking people to seek treatment elsewhere. For years, the chief executive officer of the hospital has been requesting 160 extra social care packages, because the lack of social care is stopping the flow of patients through the hospital. She said that providing such packages is the single biggest thing that would help deal with the winter crisis. In September, Winchester hospital applied for winter crisis funding to put an urgent treatment centre on the front of its A&E department to help deal with the anticipated extra caseload. It is now December, and the hospital has still not heard whether it will get the funding. Given the number of critical incidents being declared, will the Minister meet me and the CEO to discuss how we can support the hospital through this situation, and how we can avoid having a planned crisis next winter?

[Karin Smyth]

As I said earlier, different systems have different issues. Funding has been allocated in advance to the NHS so that it understands which systems require funding, and that has now been baked in for this year. I cannot address the hon. Gentleman’s points directly from the Dispatch Box, but I am very happy for officials to take note of them and to check with the system on what is happening in his particular community. Obviously, it is important that Winchester hospital works closely with its local authority with regard to discharge. We want to improve the better care fund, and I am sure that he will work with the local authority and his hospital to make sure that it works better.

Community Pharmacies: Devon and the South-west

Danny Chambers Excerpts

Tuesday 17th December 2024 Westminster Hall

[Dr Danny Chambers (Winchester) (LD)]

I pay tribute to my hon. Friend the Member for Tiverton and Minehead (Rachel Gilmour) for securing this debate, which is very timely because just yesterday the hospital in Winchester declared a critical incident. It has had so many infectious patients come in with various flus, the norovirus and other infectious diseases that it is short of beds. It has asked people to seek other healthcare arrangements, and has specifically mentioned pharmacies as a place to go for advice.

Alongside providing more social care packages to free up beds, one part of the solution to prevent the yearly NHS winter crisis is to increase the delivery of flu and covid vaccinations well before winter. We have seen that, with the right Government support, our community pharmacies are well placed to deliver vaccinations; they are not just accessible but convenient, and they deliver care right in the heart of a community.

I have been to many pharmacies in and around Winchester, including the Springvale pharmacy in Kings Worthy, the Wellbeing pharmacy on Winchester High Street and the Colden chemist in Colden common. I have spoken to the staff who work there and have heard at first hand that the NHS funding model really isn’t working for them. I was saddened to hear that, although those pharmacists are passionate about their work, they struggle to see how they will remain open for the next 12 to 24 months.

[Caroline Voaden (South Devon) (LD)]

Pharmacies in two of the major GP surgeries in my constituency, Leatside in Totnes and Compass House in Brixham, have closed in the past year because the private operators could not make a profit. Does my hon. Friend agree that it is urgent that we revise the funding model for prescriptions so that pharmacies, particularly in GP surgeries, can survive?

[Dr Chambers]

I completely agree. As other Members said, in some cases it costs pharmacies money to dispense NHS prescriptions. That is clearly not viable, especially given that the core NHS funding for pharmacies has been reduced by about 30% since 2015.

Some healthcare providers are really struggling and are on the brink of financial viability. They include pharmacies, hospices and some social care providers. The increase in national insurance contributions will cost the pharmacy industry approximately £50 million extra this year. Once again, we urge the Government to exempt some healthcare providers from the increase in national insurance or potentially repay that money through another mechanism, because it could be a death blow to social care providers, pharmacies and hospices that are on the brink of financial viability.

I thank hard-working pharmacists, such as the hon. Member for North Somerset (Sadik Al-Hassan), who really are part of the community. People come in; they trust them. Pharmacists have a really good personal relationship with their communities. Through the work they do and the hours they work, pharmacies are a lifeline for millions. They provide nearly a third of consultations outside normal working hours. They are often the only point of care for people living in rural areas. As our population grows older and faces increasingly complex health challenges, pharmacies must be empowered to step up and deliver the reliable, flexible care solutions that our communities desperately need.

As we talk about the strain on the public finances and the NHS budget, we cannot be tempted to see primary care—GPs, mental health provision, pharmacies or dentists—as a cost to be cut. We must invest in them and ensure we keep them viable, because it is always more cost-effective to treat people in their communities and prevent them from getting ill than it is to treat them when they end up in hospital.

Tobacco and Vapes Bill

Danny Chambers Excerpts

2nd reading
Tuesday 26th November 2024 Commons Chamber

[Simon Hoare]

My hon. Friend makes an important point, and I readily accept that it has a huge intellectual underpinning, but we have had public health campaigns for years on the dangers of smoking tobacco. In some instances, it has worked. We have also used taxation and the pricing mechanism. My late father told my mother that he would give up when cigarettes reached 10 shillings a packet. He eventually gave up when smoking was banned in public buildings and the like. The question that remains is: do we allow unfettered freedom if it harms only the individual who is exercising it, and step in when the exercise of that unfettered freedom has negative impacts on society?

The Secretary of State and others have dilated, perfectly correctly, on the impact on demand and supply in the national health service. A disproportionate amount of resource goes to dealing with smoking-related diseases, illnesses and conditions. We can do something about that. We know full well the negative impact of passive smoking on other people’s health, so the impact of the exercise of that liberty is not limited to the individual. I suggest respectfully that my hon. Friend the Member for Romford (Andrew Rosindell) would have a stronger point if it was limited to the individual. Then we could say, “Provide the information and let the individual take the decision.” However, that decision impacts many other people. It affects the productivity of the nation and the national health service, and the health of family and society.

I suggest to my hon. Friend that it is an entirely Conservative instinct to say, when all the levers have been pulled and buttons pushed—when there has been public information, education and some forms of prohibition—“It has worked up to a point, but not enough and not at the right speed. We will have to do something else.” I accept that not everybody who describes themselves as a Conservative, as my hon. Friend and I both do, will make the same analysis and arrive at the same position as me. I voted for the Bill in its last iteration, and I will vote for it again today, because I think it is the next lever that we need to pull and the next button that we have to push.

[Dr Danny Chambers (Winchester) (LD)]

Does the hon. Gentleman agree that we have an NHS and a Government who are expected to provide and pay for treatment when people are ill, so there is a duty and an onus on the Government to try to keep people healthy, and to provide information about well-known dangers to people’s health? This is not about having a nanny state, but about nudging people to make the right choices, because it costs money to treat people, and we want to save money as well.

[Simon Hoare]

The hon. Gentleman makes a valid point. One can nudge, prod, push and exhort as much as one can, but the Bill is probably the final stepping stone in quite a long line of stepping stones to try to wean people off their dependency on tobacco.

The House has been generous with its time, as have you with your patience, Madam Deputy Speaker. In closing, I echo and endorse the point made by the Secretary of State and other contributors from the Government Benches: people who have an addiction are not free. They are trapped by their addiction, and that affects many areas of their life. If someone is terribly well off, they can afford the addiction to tobacco, and it will make not a jot or tittle of difference to the household budget or income, or to their standard of life—

Healthcare: Hampshire

Danny Chambers Excerpts

Wednesday 20th November 2024 Commons Chamber

[Dr Danny Chambers (Winchester) (LD)]

Whether I am door-knocking at the general election or reading my inbox, the NHS and healthcare services are, by a long way, the single biggest worry that people talk about. After 14 years of Conservative mismanagement of both the economy and the NHS, I have heard from many people about how they are struggling to access NHS services not only for themselves but for their children, which causes huge stress for the family and friends of those involved.

In 2019, Boris Johnson announced that Hampshire would have one of 40 new hospitals. In 2024 the sitting Conservative MP I stood against repeated once again that there would be a new hospital in Hampshire. It was frustrating, although possibly not surprising, to find out after the general election that not only had there never been any money assigned to the new hospital in Hampshire but that there is a £22 billion deficit that we had not previously known about.

Hospital managers, along with the chief executives of hospital trusts and integrated care boards, are trying to plan the future of healthcare in Hampshire, which becomes difficult when the goalposts keep moving and when they do not know whether there will be a new hospital. It is also causing huge stress for the residents around Winchester, especially those south of Winchester, who have been told that they might lose their accident and emergency department and their consultant-led maternity services as part of the new hospital plan. I have heard from thousands of people, including up to 30,000 who signed a petition, about the importance of keeping our A&E and consultant-led maternity services in and around Winchester. I have heard from many people whose lives were saved at Winchester and who are worried that they might have to travel further.

There has been a public consultation on the location of a new hospital, and it is currently being reviewed. Winchester residents are very concerned that none of the suitable potential sites in Winchester was included as an option. People had to choose between north or south of Basingstoke. This is not only a concern for people in Winchester, who will have to travel further for emergency healthcare; it is also a concern for the management of Southampton hospital, who are concerned that the further north a new hospital is built, the more that people will go to Southampton because it is closer. At the moment, Southampton hospital is operating at capacity and would need significant new resources if the hospital were built too far north.

When we look at the future of healthcare in Hampshire, we should seriously consider why we would build a new hospital so close to Frimley Park, which is going to be rebuilt because it has reinforced autoclaved aerated concrete and is only 20 minutes away along the A3. Why would we have two new hospitals so close to each other? I would appreciate having a meeting with Minister to discuss the potential location of any new hospital, so that we can ensure everyone in Winchester can access healthcare in an appropriate place.

The location of any new hospital is key to the future of healthcare in Hampshire because it will provide healthcare for decades to come. However, we are aware that the proposed new hospital may not be included in the new hospital programme after the review, so we need to focus on our current hospital. The NHS staff at that hospital are fantastic, but we need to look at how we can support it now and in the decades to come.

[Paul Holmes (Hamble Valley) (Con)]

I apologise for intervening on the hon. Gentleman without notice; I appreciate him giving way. He outlined the case for a new hospital at junction 7 of the M3, but he is slightly muddling the argument. Clinical professionals recommended a location for that hospital, with replacement services that were being taken from Winchester hospital, while maintaining a Winchester hospital with certain services. Blue light times showed that there would be no significant difference in accessing healthcare for someone living in the north half of my old constituency of Eastleigh and someone living the part of his constituency that he mentioned. The hon. Gentleman and his hon. Friend, the new hon. Member for Eastleigh (Liz Jarvis), opposed the new hospital, so is it not a little bit awkward for him to say that the Government had no funding plans, when he opposed the location and that hospital being created? That meant there was a muddling of decision making because he and his colleague opposed that hospital being created in the first place.

[Dr Chambers]

We never opposed a new hospital—that was something the Conservatives were saying about us. We support a new hospital, we want a new hospital, and we want modern healthcare services in Hampshire. However, we were very concerned that the proposed location of the new hospital is not suitable when we look at how healthcare is delivered throughout Hampshire. Sites just north of Winchester were identified as suitable; when we look at a map of Hampshire, it is clear that those proposed locations would be much more suitable for people throughout Hampshire, including those in the hon. Gentleman’s constituency, to reach emergency services.

Our current A&E department, like other A&E departments, is hugely busy, especially as we head into winter. We know that many people attend A&E because they cannot get the primary care they need. Up to 20% of people who turn up at A&E are there because they cannot get a doctor’s appointment. People who are in a mental health crisis—many are often already on a waiting list—are going to A&E. They take up a huge amount of time and staff resources, often needing 15 to 18 hours of constant monitoring before they can be taken to a place of safety. We also have people turning up with dental issues because they cannot access an NHS dentist.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for securing the debate. While there are other hon. Members in the Chamber know the issues well, does he agree that the ability to bring healthcare into communities is vital, particularly for people in isolated communities who cannot hop on a bus every 15 or 20 minutes, or even every hour, to get to their appointments? Some areas simply cannot have centralised care or a new hospital; they do need localised facilities. If the hon. Gentleman is asking for that, then he is asking for the right thing.

--- Later in debate ---

[Dr Chambers]

I completely agree with the hon. Gentleman. As a vet who has worked in public health programmes around the world, I know that it has been proven time and again that it is always more cost effective to treat people in their communities and keep them healthy, than to treat them in hospital when they get sick. We need to focus on that. I know the Government have said that they want to move treatment from hospitals into the community.

[Gregory Stafford (Farnham and Bordon) (Con)]

I suspect the hon. Member understands that I probably will not agree with him on the thrust of his argument about Basingstoke hospital. However, on the point about local community services, in my seat, in Whitehill and Bordon, there is a debate about whether we should keep the old Chase community hospital or build a new health hub. There are arguments on both sides, but the one thing that unites the two is the lack of communication from the Hampshire and Isle of Wight integrated care board. Does the hon. Gentleman find it as frustrating as I do that that ICB seems to not want to communicate with residents across the county?

[Dr Chambers]

I agree with the hon. Gentleman; when there is a lack of communication with residents, decision makers and any other interested stakeholders, that is when there are difficulties, such as rumours and unnecessary anxiety. Improved communication, whether in healthcare or in any Government Department, solves a huge number of problems.

On the point made by the hon. Member for Strangford (Jim Shannon) about accessing healthcare when people live in rural areas, I have a story about Margaret, who lives just south of Winchester and who wrote to me saying that she had been given an appointment at Basingstoke for a particular type of X-ray. Her journey to Basingstoke hospital took well over an hour and involved multiple buses and a train, plus considerable walking time. Margaret has chronic obstructive pulmonary disease and gets exhausted walking long distances, and she cannot easily afford a taxi all the way from Basingstoke back to Winchester. She asked me whether people without cars were to become second-class citizens and be denied access to decent healthcare options. We have to look at individuals’ situations, and that can include needing really good public transport. The more community care we have in people’s towns and villages, the quicker they can get there from their homes.

The other side of emergency care and A&E departments is social care. We have said many times that we cannot fix the NHS without fixing social care. We know that in the Hampshire hospitals NHS foundation trust, there are between 160 and 200 people at any given point who are well enough to be discharged and more appropriately cared for in the community with social care packages, but who are currently stuck in a hospital bed and cannot be discharged. That means that patients cannot be moved out of A&E and people cannot be removed from ambulances as quickly as they could be, which means that ambulance waiting times are longer.

When I spoke to the CEO of Winchester hospital, he said that the single biggest help they could get from Government would be another 160 social care packages. Although people ask where the money will come from, we know it is more expensive to keep someone in a hospital bed than to give them a social care package. We have winter pressures coming up—indeed, winter has already started—and the CEO has told me on more than one occasion that, to help with those winter pressures, more social care packages would probably be the single biggest intervention that would make a huge difference. Local authorities struggle to afford social care packages and the NHS trusts have to fund some of those packages out of their NHS budget, which is primarily meant for treating people in hospital.

One of the biggest concerns raised by Winchester residents is the potential removal of consultant-led maternity services at Winchester hospital. That means that if a woman were to haemorrhage or require an emergency C-section during labour, she would need to be transferred. To put that into perspective, in April 2024, 22.7% of births were performed via emergency C-section at Winchester hospital. It is clear that surgical interventions are not an unusual eventuality, but something that will affect more than one in five mothers.

An emergency transfer in such a situation would inevitably put the lives of some women and babies at serious risk and, tragically, some could be lost. A constituent wrote to me about her daughter, who had recently haemorrhaged badly after giving birth to a baby who was in a breech position. The blood transfusion and lifesaving surgery to remove her placenta needed to happen within minutes, and it is unthinkable what would have happened had there been no consultants on hand. As someone who has performed many emergency caesareans—on animals rather than on humans—I know that time is of the essence, and anything that delays surgical intervention can make a huge difference, not just to whether the person and the baby survive but to whether the baby has potential brain damage and other life-changing complications.

As the Liberal Democrat mental health spokesperson, I see this debate as a chance to highlight how desperately we need more resources put into mental health, alongside a more holistic approach to treatment. When speaking to residents in Winchester, one of the most common concerns is the difficulty in accessing mental healthcare, and that is especially true for parents who are struggling to access mental healthcare for their children.

I spoke to a constituent near Swanmore who was struggling to access the mental healthcare and support they needed for their child who was anorexic and had an eating disorder. They had been informed that their child had to reach a lower BMI to qualify for the threshold to get treatment, because resources are so stretched. That would not be considered even remotely acceptable for any other disease. A person with cancer would never be told that they needed to reach stage 4 before they qualified for treatment. We know that outcomes with delayed treatment for mental and physical health disorders, of which eating disorders are a combination of both, will be much less successful and much less cost-effective, requiring longer and less successful treatment the longer that the condition is left. I urge the Minister to look with particular concern at the mental health of young people and children. Delays in mental health treatment for anyone can be catastrophic, but a three-year delay for someone who is only 13, 14, or 15 is a huge chunk of their life.

As part of that, we urgently need to invest in primary care. Failing to address this will only place greater pressure on our already overstretched hospitals. I have spoken to people who have spent extended amounts of time in hospital beds, because they cannot get the mental healthcare that they need.

Similarly, the lack of NHS dentists often forces patients to turn up to hospital, sometimes needing a general anaesthetic, to sort out tooth root abscesses, which costs more than providing NHS dental care. It seems as though all the dentists I speak to say that their current contract for performing NHS care is not fit for purpose. I urge the Minister to look at this as an urgent priority, because so many people are not receiving the dental care that they need. It seems as though this whole issue will not be resolved until the NHS contract is looked at.

The other issue that affects people getting healthcare in their communities, especially around Hampshire, Winchester and the Meon Valley, relates to struggling pharmacies. The situation for pharmacies seems to be very similar to that of the dentists in that their arrangement with the Government for providing prescription services does not seem to be fit for purpose. It seems to be costing pharmacies money to provide prescription drugs, and they are telling me that their businesses are no longer viable. The more pharmacies that we lose, the further people will have to travel to not only collect drugs, but get medical advice and vaccines.

In conclusion, I wish to pay tribute to NHS staff. I imagine that they dread the winter coming up. Every year, it is a stress for them. Every year, they are overworked. And every year, we know that both clinical and non-clinical staff will work longer hours than they are contracted to do. I know that they will be bracing themselves right now. They will be busier, and they will be putting themselves at risk from getting things such as flu, covid and the other respiratory diseases that we see in the winter. One thing that we can all do, both as the public and the Government, is to encourage everyone to get vaccinated ahead of these winter pressures. Anything we can do to prevent a trip to hospital will make their job easier and make it less likely that they will get sick.

[Joe Robertson (Isle of Wight East) (Con)]

The hon. Gentleman speaks eloquently on a wide range of healthcare challenges in Hampshire. Does he agree that our shared integrated care board for Hampshire and the Isle of Wight must do all that it can to make the best of the situation, particularly in relation to NHS dentistry and funding for hospices across Hampshire and the Isle of Wight?

[Dr Chambers]

The hon. Member makes a good point about hospices in particular. Only about a third of hospice funding is provided by the Government. It is a hugely emotive subject, which affects not only the people in the hospice but the whole family, who are trying to care for a loved one who often has only weeks or months left to go. We have two hospices in Winchester, one of which is a children’s hospice, Naomi House. Some of the most moving visits I have ever done have been to hospices, where the staff and patients are incredibly brave. We have a debate coming up on assisted dying. We will really have to look at palliative and hospice care and how it is funded, and how we make it sustainable and fit for purpose. I thank him for that important intervention.

Many constituents write to tell me about the excellent care that they receive in hospitals, and how much they appreciate the hard work of NHS staff. A Winchester resident called Owen wrote to tell me that he honestly does not believe that he would be alive today were it not for Winchester hospital. Owen sadly suffers from a brain tumour in the pituitary gland, and has needed many emergency treatments. Owen lives five minutes from the hospital and has managed to have lifesaving treatment there on multiple occasions.

We need to avoid the trap of cutting short-term costs, such as by not investing in social care, which has ended up costing the state so much more money in the long run. We need a comprehensive plan to give people adequate local healthcare throughout their lives, and escape the endless cycle of crisis after crisis. We know that winter is coming this year, and coming next year. What are we doing to ensure that we will not have an NHS crisis in Hampshire next winter as well?

--- Later in debate ---

[Andrew Gwynne]

Absolutely. I will try to be as unpartisan as I can, but the hospital programme that we inherited from the right hon. Member’s Government did not have anything like the money it needed to back it up. Conservative Members can shake their heads, but it is true. It had nothing like the money needed to bring forward those hospitals. As I have said, we will review that. Our intention is to bring forward those schemes, but that has to be done in an achievable programme, with the finances to back it up. When we announce to the House how we will schedule the hospital programme, I expect that all the answers he wants will be there. We intend to introduce the hospital building programme, but it must be done with money—we cannot build them with fresh air.

[Dr Chambers]

any potential new hospital is decades away, while the hospital we have needs to be maintained and improved. The quickest way forward is to provide 160 new social care packages for Winchester hospital. Will the Minister meet me and the chief executive officer of Winchester hospital to work out how we can deliver those packages as quickly as possible, and provide good A&E, hospital and social care services for everyone in and around Winchester?

[Andrew Gwynne]

It is crucial that we have the best possible health and care services in place for today’s needs while we plan for the future. I understand the hon. Gentleman’s concerns, and I will ensure that they are communicated back to the Minister for Secondary Care, so that she can consider them. I will ask her to report back to him on that. Ultimately, all decisions are best made locally, so that they can cater to local interests, and are clinically led. This is no exception. I know that the hon. Gentleman’s trust will consider all feedback from the public consultation held earlier this year, including from those who will access the new facilities, as well as wider bodies of evidence. The result of the public consultation on location and services will be put to the local integrated care board, and we look forward to hearing the outcome of that.

[Dr Chambers]

I apologise for intervening again so soon. One of my main concerns about the public consultation is that the NHS had assessed sites in Winchester as suitable, but they were not then included in the consultation. The people of Winchester want to know why those suitable sites were not included in the consultation. Can the Minister assure me that that will be addressed by the ICB, and anyone else publishing the consultation?

[Andrew Gwynne]

As I said before the hon. Gentleman’s intervention, ultimately these are local decisions, and they must be clinically led. If the trust has decided that certain outcomes that he would like to see are out of scope of the consultation, we must take it as read that there are sound clinical reasons for that. If he thinks otherwise, I am sure that he can bring that up with my hon. Friend the Minister for Secondary Care, but ultimately we must be guided by the clinicians. They know, more than we Ministers in Whitehall will ever know, what the better outcomes for their areas are.

The hon. Gentleman mentioned primary and community care. We know that patients nationally and in Hampshire find it increasingly difficult to see a GP. We are committed as a Government to fixing the front door to the NHS, to ensure that patients receive the care that they deserve. If patients cannot get a GP appointment, they end up at accident and emergency, which is worse for them and more expensive for the taxpayer. That is why we will shift the focus of the NHS out of hospitals and into community. One of our three big shifts is from hospital to community; the others are from analogue to digital, and from sickness to prevention. Those three things, taken as a whole, could be quite transformative in how we deliver primary care.

Respiratory Health

Danny Chambers Excerpts

Thursday 14th November 2024 Westminster Hall

[Dr Danny Chambers (Winchester) (LD)]

I pay tribute to the hon. Member for Strangford (Jim Shannon) for all his work on the APPG for respiratory health. As has been said, it is a hugely important issue, given the sheer number of people affected and killed every year and the huge amount of resources taken from the NHS.

It was good to hear everyone talk about a holistic approach, because this issue is not purely about NHS services. Most people have discussed the importance of air quality and pollution, and the hon. Member for Blaydon and Consett (Liz Twist) acknowledged that people living in poverty are more likely to suffer. I think they are five times more likely to die from COPD and about three times more likely to die from asthma. There are a whole variety of reasons for that, one being air pollution. In the village of Twyford near Winchester, one of our fantastic Lib Dem councillors has been campaigning for years to improve air quality and reduce pollution due to traffic. She is a former doctor, and one of her main motivations is to try to improve outcomes for asthma and children’s respiratory health.

The Minister and I were in this Chamber about a week ago to discuss housing. It was acknowledged that the UK has the oldest housing stock in Europe, with a lot of it have been built before world war two. Again, the link between people living in poverty and living in substandard housing is very strong. I am probably not the only Member who receives correspondence from individuals in private housing association accommodation who struggle to get a response from organisations when they encounter problems such as mould.

Living in substandard housing is bad not only for physical health, but for the environment and carbon dioxide emissions. Last week, we discussed a huge programme to try to improve the housing of people living in poverty, because it is good for the environment and for people’s health. We should remember that the NHS spends about £1.5 billion a year dealing directly with issues, such as damp and cold, that have arisen from people living in poor and substandard housing, so the comorbidities are huge.

I am mindful talking about the clinical treatment of respiratory diseases when the shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans), is actually a doctor and I am a rudimentary veterinary surgeon, but respiratory disease is a common disease that we treat in horses. By improving the surroundings they are in—by getting rid of dust and improving ventilation—we can get the huge majority of them off medication entirely. It is the same with groups of cattle, which are housed over the winter. Respiratory diseases have a huge impact on farmers’ productivity, but through a combination of improving accommodation, improving ventilation and vaccination, we can get fewer illnesses and better productivity. That would be more cost-effective for the farmer and we would use fewer antibiotics.

It is exactly the same with public health. Treating people who have got sick because they live in substandard conditions is an endless task, but getting to the root cause of the problem will have huge knock-on effects throughout society.

Vaccines in human and veterinary medicine are always the most cost-effective health intervention. They are better for patients and the taxpayer and, importantly, they help us to avoid using antibiotics unnecessarily. The World Health Organisation has noted that antimicrobial resistance is one of the biggest health challenges facing the world right now. Interestingly, vaccine hesitancy is another, so we should monitor levels of vaccination uptake, because the tripledemic, as people call it, of flu, covid and respiratory syncytial virus affects people all year round, but especially in the winter.

Slightly concerningly, it seems that 280,000 fewer NHS staff have been vaccinated this year compared with 2019, even though there are now slightly more frontline staff. Will the Minister explore why that is the case? Is it due to concerns about the vaccination or a lack of access to it? For example, I want to get vaccinated, but I just have not had the time yet this year, and that could be the problem for many people.

Vaccinating pregnant women against RSV is a hugely important intervention that helps to prevent babies under six months old from getting really sick. Most people just get a cold from RSV, but tens of thousands of babies every year are admitted to hospital with it, and it can be hugely damaging in the long run.

I have touched on holistic approaches to respiratory disease, but it is worth looking at other health conditions. The hon. Member for Strangford mentioned the work on smoking cessation, which is hugely important, but it is also worth noting the work on obesity. If a person is obese, any underlying respiratory issues are much more difficult to manage and treat, and the symptoms can often be exacerbated. We need to focus on public health interventions such as improving the quality of our food, including free school meals. I hope that, given the financial constraints the NHS is currently working under, we do not view public health as a cost to be cut, because in the long run we desperately need to invest in it to stop people getting sick and ending up in hospital.

We will not prevent every disease, no matter how hard we try. People will still get sick for a whole variety of reasons, including with COPD, asthma and lung cancer, and they will need long-term management. In our manifesto, we called for people with long-term conditions to be able to see a named GP so that they get continuity of care from someone who is very familiar with their case. Seeing someone different every time causes patients a lot of stress and sometimes results in miscommunication.

We discussed air pollution earlier. During the general election, we called for a new clean air Act, based on World Health Organisation recommendations and ideally enforced by a clean air agency. Will the Minister look seriously at that proposal, and consider other suggestions about working hard on local pollution levels, working to improve vaccination rates and housing standards, and working to ensure that anyone diagnosed with any type of cancer, but particularly lung cancer, sees a consultant within 62 days of being referred?

[Adam Jogee]

I omitted to put on the record earlier what a pleasure it is to serve under your chairmanship, Mr Rosindell.

Before my election to this House, I spent five years working with my hon. Friend the Member for Newport West and Islwyn (Ruth Jones), who shadowed the Minister responsible for air quality, so I spent a lot of time working on these issues, particularly in respect of the World Health Organisation guidelines. Will the hon. Gentleman find the time for a cup of tea with me, so that we can see what we can do together to make the progress we all want to see?

[Dr Chambers]

Yes, I will. I live off tea—it is the only way I get through the day—and I have a particular interest in air quality, so it could be a really enjoyable meeting. As this debate is not going on for as long as the hon. Member for Strangford would like, he could come and speak with us as well.

As I was saying, a clean air Act and a named doctor are among our proposals. We are heading into winter, which NHS staff must dread: it is always busier than other periods, and a whole load of respiratory issues add to the winter pressures on the NHS. I thank and pay tribute to all the NHS workers who are heading into this very difficult time. We must do whatever we can to support them, whether that is helping them to get their vaccinations or helping them in any other way.

NHS Winter Readiness

Danny Chambers Excerpts

Wednesday 30th October 2024 Westminster Hall

[Dr Danny Chambers (Winchester) (LD)]

I thank my hon. Friend the Member for North Shropshire (Helen Morgan) for securing this timely debate.

In Winchester, the NHS is the No. 1 issue for nearly everyone, and it will be the same for the rest of the country. Patients and staff are aware that we have a huge challenge every winter. Hospital managers and chief executive officers must be so frustrated that they have to face that challenge every year. From what I understand, having spoken to quite a few hospital managers and CEOs of hospital trusts, over the last few years, at about autumn time, they have applied for extra funding to deal with what will be a winter crisis, and by about November they have heard whether they will receive it and how much they will get. They have then received the money by about January, when we are already halfway through the winter, despite the fact that winter comes every year and we know that there will be a winter strain on the NHS.

In the spirit of constructive opposition, I will talk about four issues that we should consider when it comes to future winter challenges. The first, as has been mentioned by nearly everyone, is social care. In the Hampshire hospitals foundation trust, there are between 160 and 200 people at any given time who are well enough to go home but do not have anywhere to go, often because of the lack of social care packages. We have talked about the flow through hospitals; if A&E cannot take patients into hospitals because the beds are occupied, ambulances end up queuing outside hospitals, and the knock-on effect is a huge delay in ambulance response times.

My hon. Friend the Member for Chichester (Jess Brown-Fuller) mentioned that one in four people now worry about calling an ambulance over the winter because they are worried that it will be a long time until it arrives. The frustrating thing is that providing social care packages is more cost-effective than keeping someone in a hospital bed, so while not having social care packages in place so that people can be moved out of hospital in a timely way is not good for patients, it is not even cost-effective for the taxpayer.

Nearly every speaker has brought up primary care: everything from doctors and dentists to mental health and public health. Some 22% of the people who arrive at a typical A&E are there because they cannot get a GP appointment. People are turning up with tooth root abscesses, and often end up needing general anaesthetic to sort out dental problems that could have been avoided had they been able to get an NHS dentist.

Desperate mental health patients, who are often already on a waiting list, walking into A&E take up a huge amount—up to 30%—of an A&E department’s time and resources. People wait years after being referred for mental health care by their GP and then end up in A&E, taking up time and resources during the winter crisis. That is not a good use of taxpayers’ money, it is not good for the patients, and it is hugely stressful for the staff. It is always more cost-effective to keep people healthy in their community and treat them early than to treat them in A&E. It is not the place for people in a mental health crisis, people with severe dental issues, or people who just cannot get a GP appointment.

My hon. Friend the Member for North Shropshire mentioned vaccination and when we talk about public health, we talk about prevention and cost-effectiveness. Vaccines are the single most cost-effective health intervention that has ever been developed throughout the world for pretty much any disease, but it is concerning to hear that the number of NHS staff being vaccinated is dropping. That is dangerous both for their health and for patients’ health. We should certainly examine and unpick that, and try to explore why the number of NHS staff taking the flu vaccine has gone down. We need to engage with them to give them the confidence to take the vaccines as well as access to them to ensure that we have as high a vaccination rate as possible.

My hon. Friend the Member for North Shropshire also mentioned this, and we need to act in our communities because of flu, covid and RSV. The situation is always worse in winter. We know that it will be worse and the risk of immunocompromised people turning up to a hospital and waiting in an A&E department, surrounded by other patients who are infectious because they have not managed to get a vaccine, is a huge issue.

The hon. Member for Strangford (Jim Shannon) talked about pharmacies and community care, which are a huge part of the jigsaw in making vaccinations available to the general public. Local pharmacies need all the support that we can give them to ensure that they are open at convenient times—and that they stay open, because a lot of pharmacies have closed. Ideally people—especially vulnerable people—should be very close to a pharmacy so they can get the vaccinations that they need.

Finally, every other Liberal Democrat Members who spoke today talked about the Liberal Democrat winter taskforce and how we would really appreciate the Government looking into our proposals seriously. We are spending the money in bit-pieces every winter anyway, so we should have a much more joined-up and long-term plan about how we deliver healthcare over the winter and ease the pressure on our hospitals. That would be hugely beneficial.

I pay tribute to NHS staff. I imagine that they dread winter coming. This is the time of year when they will be bracing themselves, knowing that they will be busier, knowing that they will be working without the right resources and knowing that some of them will get sick with flu, covid and all the other diseases that come in. We thank them for putting their health at risk and for putting in their time and expertise to look after our health. As the Liberal Democrat mental health spokesperson, I acknowledge what a drain it must be on their mental health to work in such situations.

Finally, I have a question for the Government. We know that winter will come every year; it will come next year as well. What are we doing to ensure that we do not have a planned crisis in the NHS next winter?

--- Later in debate ---

[Karin Smyth]

I will come on to staffing to address some of those points. The hon. Gentleman makes an excellent point about staff recruitment and retention, which is a key part of our future look at the system.

On winter planning, the Government should not be micromanaging people in local systems as they do their job. Rather, we need to focus our efforts on where they are needed the most. Notwithstanding the excellent work of individual staff, let me repeat: the NHS is broken. None of us should underestimate how difficult this winter could be, but we are taking immediate steps to cushion the blow. First, we have set out our national winter planning priorities to NHS systems, local authorities and social care providers to support operational resilience over the coming months. Secondly, we are standing up the winter operating function seven days a week to respond to pressures in real time.

Thirdly, we are expanding the operational pressures escalation levels framework to give us a clearer picture of what is happening on the ground in all our systems. The framework uses comprehensive data to keep track of hospital pressures, and this year we are expanding its scope to mental health, community care and 111. Fourthly, we are continuing to support systems that are struggling the most through the urgent and emergency care tiering programme. Those are direct interventions to help systems get back on their feet and make the necessary improvements in performance.

Fifthly, we are providing targeted, clinically-led support to 19 of the most pressured hospital sites across the country, to help long waits in A&E and avoidable admissions over winter. Those measures are in addition to the aforementioned meetings that I hold with NHS England and UKHSA every fortnight. I am chairing every one of those meetings to ensure that we identify risks as soon as they arise, while supporting NHS England to mitigate them.

The party of the hon. Member for North Shropshire has called on the Government to set up a winter taskforce to prepare for an NHS winter crisis. Some might describe what we are doing as a taskforce; I actually think that is my job and the Secretary of State’s job, which, as I have outlined, is why we meet regularly with NHSE. I know that the hon. Member and others are sincere in their efforts to be constructive. I am happy to take away any specific suggestions about what we are not doing to help the NHS, because we all want the system to work well.

[Dr Chambers]

There has been no mention of increasing social care packages. Today, I spoke to the CEO of Hampshire hospitals trust, which runs Winchester hospital, and she said the single biggest thing that would make a difference over winter for that hospital, and probably every other one in the country, would be increasing the number of social care packages and ensuring that those well enough to leave hospital can be treated and cared for elsewhere. Why is that not the main focus of the winter measures that the Minister is talking about?

[Karin Smyth]

I will come on to social care, but I will make the broader point that every system is different, and the pressures in every system are different. Some systems suffer worse from poorer levels of primary or community care. Others, particularly those across borders, struggle with discharges and packages of care. One thing I am keen to do, and we are doing it, is try to understand the different drivers of performance in different parts of the system. I think we all have a role to play in that.

I very much support constructive advice from local Members of Parliament, in consultation with their local trusts, about the real drivers in their systems, because we know that some systems are performing much better. We as a new Government want to address that issue, to ensure that taxpayers’ money is being directed to the best place to make the system work better. That is something for the hon. Member for Winchester to take back. The flow is affected for different reasons in different parts of the system.

Several hon. Members have mentioned vaccinations. A key part of winter planning is the annual vaccination campaign, which began on 3 October. I thank the hon. Member for North Norfolk (Steff Aquarone), the hon. Member for Winchester and the Opposition spokesperson, the hon. Member for Meriden and Solihull East, for mentioning their support for vaccination programmes, which is absolutely welcome.

People talk about verifying the figures, but my understanding—I am happy to be corrected—is that we cannot verify the actual figures now. We have started different vaccination rates at different times, so the figures are not directly comparable. We will not really know that until the year works through, which I think people understand. It is too early in the vaccination season to draw firm conclusions, but we all have a role to play in driving and encouraging people to uptake vaccinations across the piece. I recently visited a local hospital in my city of Bristol which has staff hubs and encourages staff to go into the clinics. All Members’ efforts to help with that is really helpful. Vaccination programmes play an essential role in protecting people, particularly the elderly, children and the clinically vulnerable from serious illness during the winter months and in relieving pressures on hospitals and the wider system.

Data from the UK Health Security Agency shows that last year people who received a covid vaccine were around 45% less likely to be admitted to hospital compared with those who did not receive one. That is why we are delivering our usual campaigns for covid and flu for the clinically vulnerable in addition to the RSV work that is going on.

With regard to elective activity, for patients who are referred to a hospital we want to do everything we can to bring down waiting lists, which stood at over 7.5 million in August. The NHS is prioritising patient safety, urgent and cancer care and will continue to do its best to maintain appointments and elective procedures by separating elective care facilities and diagnostics wherever possible. In the longer term, we are going to return to 92% of patients waiting no longer than 18 weeks from referral to treatment in our first term, a standard that has not been met consistently for patients for a decade.

Our hospitals do not operate in isolation. Improving resilience across the whole system, including social care, is essential to winter planning. On 17 September we wrote to all local authorities setting out our priorities for improving resilience across social care ahead of winter, emphasising the importance of close partnerships and joint planning between the NHS and local authorities. We want people to have fair access to locally delivered services that start at home and support them to live independently for as long as possible. That will include building bridges between the NHS and social care services, getting people home from hospital as soon as they are ready, and providing much-needed support to families and friends who are involved in a loved one’s care. We will also work to ensure that people are not stuck in hospital beds when they are well enough to go home.

We cannot forget that the backbone of social care is carers. We have made it clear to all local health and care systems that they must continue to support people providing care for their family and friends throughout the winter. I am sure all hon. Members will join me in supporting the Chancellor’s Budget announcement today to support our carers more widely. We want to make sure that carers can access the support they need to look after their own health and wellbeing, not just that of the people they care for. The better care fund includes funding that can be used for short breaks and respite services for carers. The Government are clear that people who draw on care and support, and their families and carers, should be closely involved in decisions about their care. However, in the long term we clearly need reform. That is why the Secretary of State has called for a new national consensus on social care.

The Government are committed to building a national care service. My hon. Friend the Minister for Care is introducing the first ever fair pay agreement for care workers. Again, we have seen today our commitment to further support carers with improvements to carer’s allowance. That is a start, but we know we have a long way to go.

We are working radically to reform the NHS through the 10-year plan, building a health service that is fit for the future and ready to face every winter confidently. Lord Darzi gave us the diagnosis; the cure can be found in shifting the NHS from treatment to prevention, hospital to home and analogue to digital. That is why last week we launched an extensive engagement exercise with the public, staff and stakeholders to inform that plan. Some right hon. and hon. Members might be keen to see some of the public’s wilder ideas, perhaps, but alongside some of those we have already had many considered and thoughtful responses, and we look forward to outlining our specific plans in the spring.

With regard to the point made by the hon. Member for Strangford (Jim Shannon) about individual training and bursaries and the large number of suggestions about the important issue of recruiting and retaining our staff, we will look closely at the long-term workforce plan—we are already doing that. We are open to suggestions. We need to build a workforce for the future that lines up with our three shifts. It will be a tough process to get right and to keep up with modern technology, but all those ideas will inform that.

I commend the hon. Member for North Shropshire for securing the debate today and colleagues for shining a spotlight on the difficulties that our constituents face. I hope colleagues are reassured. As someone who has worked on winter planning in the NHS, I am fully aware of the challenges that we face. That is why we have taken a strong grip of it from the get-go. I know we cannot go on as we have done for the past 14 years, limping from one winter crisis to the next, improvising and making do with sticking plasters. The Government are winter-proofing the NHS with long-term reform, but until that day we will put every hand on deck to tackle the problems as they arise this winter.