Health and Care Bill

Debbie Abrahams Excerpts

Consideration of Lords amendments
Wednesday 30th March 2022 Commons Chamber

[Edward Argar]

I will make a little progress, then I will give way to the hon. Lady, as I tend to do. She is a regular participant in health debates.

We are already committed to improving workforce planning. In July 2021, as I said, we commissioned that important work with partners to review long-term strategic trends. It is also important to note in that context that my right hon. Friend the Secretary of State announced that we are merging NHS England and Health Education England, which is a hugely important move that brings together the workforce planning and the provision of places and of new members of the workforce with the funding available for that and the understanding of what is needed in the workforce. It brings supply and demand considerations together.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

Will the Minister give way?

[Edward Argar]

I will make a little more progress, then I will give way to the hon. Member for York Central (Rachael Maskell) and then, if I have time, I will give way to her. I want to address the points of the hon. Member for Lewisham East (Janet Daby) in good time and I am conscious that the votes took up a chunk of the time allowed for this group of amendments.

We are also committed to increasing transparency and accountability. The unamended clause already increases transparency and accountability on the roles of the various actors within the NHS workforce planning system.

[Edward Argar]

The hon. Lady will be pleased to know, or will I hope be reassured to a degree to know, that underpinning our strategy to grow the workforce—for example, the nursing workforce or other specialisms—is the fact that we have multiple strands to the strategy. Those coming from overseas who wish to work in the NHS are always going to be an important and valued part of our NHS workforce, but of course we are also committed to growing the number, for want of a better way of putting it, that we grow at home through training places and medical schools. Crucially, however, a key element here is retention of our existing staff, so that we are not simply recruiting and training lots more staff to replace those who are leaving. All of those factors are important.

[Debbie Abrahams]

Does the Minister want to comment on the fact that 100-plus organisations—and not just those 100 organisations, including the BMA, but former chief executives of NHS England—are still very concerned that the Government’s measures on workforce planning do not go far enough?

[Edward Argar]

I am grateful to the hon. Lady, and she and I have worked together on a number of issues in the past. We always engage—and the since the inception of the Bill and throughout its passage, we have engaged collaboratively—with a whole range of organisations, such as professional bodies and trade unions, including some of those she mentioned. We believe that the approach we have adopted in the commissions from the Secretary of State, coupled with the merger with Health Education England, will be a significant step forward, and we believe it is the right approach to take. I suspect that the hon. Lady may disagree, and I always respect her opinion, although I may not always agree with it.

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[Edward Argar]

I can reassure my hon. Friend that under the changes we are putting in place through the integrated care systems, ICBs will continue to be able to commission services and to send patients to hospitals outside the ICS area. They will also be obliged to co-operate and work with other organisations in the patient’s best interests. We are setting this alongside the broader work that we are doing in the Department on the interoperability of data. I hope that that has reassured her to a degree.

We are also committed to supporting research, and I ask the House to agree to Lords amendments 6, 15, 26 and 28, which further embed research and provide increased clarity, transparency and oversight in respect of ICBs, NHS England and the Secretary of State’s research duties.

[Debbie Abrahams]

I want to ask the Minister about two matters. First, why are health inequalities not explicitly mentioned among the triple aims of the Bill? Secondly, on the membership of ICBs, I am sorry if I misheard, but I did not hear him discuss the amendment on how to avoid any conflict of interest involving private providers on those boards.

[Edward Argar]

The reason for that is that an amendment was brought forward on Report, and the matter was settled at that stage; things have not changed since. In lieu of what had been tabled, we tabled our own amendment on Report, which—even though in our view it was unnecessary—we felt further clarified how to avoid conflicts of interest. In the previous group of amendments, we tabled an amendment to extend that conflict of interest policy and approach to the sub-committees of the boards, in order to ensure that it is explicit that the policy applies to both. It is essentially the same principle, but widened out to the sub-committees to avoid them being inadvertently left out of the legislation.

[Edward Argar]

I can give my hon. Friend an assurance that we expect that to be the case. I will turn to palliative care in the context of other amendments shortly, and I might address some of his points then.

We are also committed to tackling climate change. Lords amendments 9, 18, 33 and 40 place duties on NHS trusts, foundation trusts, ICBs and NHS England to have regard to the Government’s key ambitions on climate change and the natural environment in everything they do. The amendments include a guidance-making power for NHS England that will assist in the discharge of these duties by different bodies.

There are also a number of amendments relating to how integrated care boards should operate as statutory bodies. Amendments 19 to 21 and 23 require an ICB to consider the skills, knowledge and experience it needs to discharge its functions and, where there are gaps, to consider what steps it can take to mitigate them. The amendments also require the forward plan to include detail on how the ICB intends to arrange for the provision of health services, as well as its duties under sections 14Z34 to 14Z45. The annual report must also include an explanation of how it has discharged these duties.

The hon. Member for Oldham East and Saddleworth (Debbie Abrahams) mentioned conflicts of interest. We amended the Bill in this place, and the Lords amended it further with Lords amendment 11. We understand the motivation, but the drafting does not fulfil the stated aim, which is why we tabled an alternative amendment in lieu of that amendment.

[Debbie Abrahams]

Will the Minister give way?

[Edward Argar]

I want to make a little progress. If I make good time, I may be able to give way, but I am conscious of the need to give the shadow Minister and other colleagues plenty of time to speak—about, I suspect, one aspect of this group of amendments in particular, but we will see.

We commend a number of additional amendments to the House. Lords amendments 34 to 37 limit the powers to set capital expenditure limits for NHS foundation trusts, so that they cannot apply for periods longer than a financial year. I reaffirm my commitment to ensuring that these powers on expenditure limits are used only as a last resort, as NHS England agreed with NHS Providers. I also ask the House to accept Lords amendments 50, 65, 104, 106 and 107, which are minor and technical changes required to ensure that the Bill functions as intended.

Although we have made progress on a number of amendments, we urge the House to disagree with the other place on others. First, we ask the House to disagree with amendment 90 on dispute resolution in children’s palliative care, and instead support the amendment we tabled in lieu. Our approach will require the Secretary of State to commission a full independent review of the causes of disagreements between the providers of care and persons with parental responsibility on the care of critically ill children, how these disagreements can be avoided, and how we can sensitively handle their resolution.

We also seek to reject Lords amendment 81. Although we agree on the need to make good progress on the Care Act 2014, it is not in the interests of good government to be forced to implement reform of this complexity and scale through a deadline set in primary legislation. We are getting on with implementing social care reform, and operational guidance is out for consultation. We have announced a small number of local authorities that will act as trailblazers to test the reforms from January 2023, but we must take time to engage with local authorities as they build the necessary infrastructure, and use these trials to refine delivery systems and guidance ahead of the national roll-out. We encourage the House to reject Lords amendment 81, which we believe affects the financial arrangements to be made by this House and, as such, is subject to financial privilege.

[Debbie Abrahams]

I would be grateful if the Minister answered my question about the triple aims, and the impact of not including in them an explicit reference to health inequalities. The Bill refers to health and wellbeing, but not to health inequalities. My main point is on the care cap. More than one in six of my constituents with dementia will not reach the cap, as it stands. The Lords amendments mean it would be one in five, so I would be grateful if the Minister could say exactly why he is prepared to let one in six of my constituents not reach the care cap.

[Edward Argar]

I will address the care cap, because there is a fair bit to say. I was just addressing the noble Lord Lansley’s amendment. I apologise for missing the hon. Lady’s first point. We do not think it is necessary to have health inequalities explicitly among the triple aims, as we believe that the issue runs through everything that ICBs do and everything the Bill sets out. We therefore feel that the Bill is effective, and that each ICB’s ICS will have regard to health inequalities and will see them as central to its objectives.

Before I turn to Lords amendment 80, I will briefly address Lords amendment 51, which relates to consultation with carers during hospital discharge planning. We have heard about the strength of feeling in the other place on that issue. We wholly agree that we must ensure that, where appropriate, unpaid carers are involved in planning around discharge. Although the Government appreciate the intention behind the amendment and want to address the concerns raised, we want to do so in the most effective way, and in a way that does not create unintended delays to discharge. I ask Members to support our amendment in lieu, which would achieve much of what Lords amendment 51 sought to achieve. It will introduce a new duty on trusts and foundation trusts to involve carers during adult discharge planning. Unlike schedule 3 to the Care Act 2014, this duty applies to all carers where the patient has care and support needs following discharge; and it applies to young carers as well as adults. Our amendment in lieu and the new statutory guidance will ensure that patients and carers are involved in discussions about post-discharge care as soon as they start.

Civil Proceedings

Debbie Abrahams Excerpts

Tuesday 29th March 2022 Commons Chamber

[Maggie Throup]

Throughout the pandemic, the Government have done everything in our power to protect the lives and livelihoods of people across the country .The Coronavirus Act has been a vital tool, allowing us to do that. Last week marks two years since the Act gained Royal Assent and the automatic expiry date for its temporary provisions. This is an opportunity to reflect on the progress we have made in our fight against covid-19 and on how the Act has supported us in that fight, as well as in encouraging important innovations in some of our public services, which we want to take forward.

First, I come to the support the Act has given us. It was an extraordinary piece of legislation for an extraordinary time in this country’s history, giving us the powers we needed to keep the country safe, and the economy and public services open at the time of need. It helped us to bolster the health and social care workforce by suspending rules in the NHS pension schemes for England and Wales, and allowing the creation of temporary registers enabling recently retired NHS and social care staff to return to the workforce and play their part. Almost 15,000 nurses, midwives and, in England, nursing associates joined these temporary registers to help deal with the impact of the pandemic, as well as more than 10,000 paramedics, operating department practitioners and other professionals, and about 6,500 social workers.

The Act also helped the Government to offer unprecedented economic support and to help people and businesses at a time when so many businesses faced disruption. That includes the coronavirus job retention scheme, also known as furlough, which has supported 11.7 million jobs.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

Will the Minister comment on the figures released by the Office for National Statistics today, which state that men and women living in the most deprived parts of the country were five and six times more likely to die from covid than those in the least deprived areas? What can she say about the adequacy of the regulations for those people?

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[Andrew Gwynne]

I thank my hon. Friend for his kind remarks. I have met numerous groups representing the clinically vulnerable, the clinically extremely vulnerable and the immunosuppressed communities, and the level of anxiety and worry in those communities is clear. While we have all, to some extent, been able to get back to as near a normal life as possible, those communities still feel isolated, under pressure and incredibly concerned about what mixing and social interaction would mean for them, were they to get coronavirus.

[Debbie Abrahams]

On top of those groups, which my hon. Friend is right to mention, there are also family carers, who are concerned that they may be prevented from having access to their family members in care homes without adequate testing, which they will be forced to pay for if it is not clear that they are included in the free testing.

[Andrew Gwynne]

My hon. Friend is absolutely right. Many of the people who are classed as clinically vulnerable, clinically extremely vulnerable or immunosuppressed are looked after by members of the family or friends who will come into the house to look after them, rather than by paid carers. Were free lateral flow testing to be extended at least to the CV, CEV and IS communities—not for those people themselves, but for the people coming in to communicate and interact with them—it would at least give them some degree of confidence that coronavirus is not being brought through the front door.

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[Andrew Gwynne]

It does stick in the throat a little hearing “personal responsibility” regurgitated time and again when we now know what happened in Downing Street, that the rules were broken and that the laws made in this House were broken. [Interruption.] The Minister says, “We don’t know that”, but we do, because 20 people have just received fines, and that means the law was broken.

We must not simply turn the clock back and pretend that covid never happened. Over the past two years we have seen the impact of painfully inadequate sick pay, and we have seen the benefits of access to free testing. We must learn from both those things. We have also lost more than 160,000 citizens in the course of this pandemic. I fear that, although the numbers are much smaller than they were, that toll will rise day on day, week on week, and year on year. We have real lessons to learn.

[Debbie Abrahams]

We would also make sure that we fulfilled our commitment to the international community on providing the vaccinations that it needs. There are still more than 2 billion people who are unvaccinated, and that will accelerate the risk of new variants that may be even more lethal.

[Andrew Gwynne]

My hon. Friend is absolutely right.

Although we will continue to hold this Government to account, we will not oppose these measures today. There are real questions about covid that have to be asked by us and answered by Ministers, because too many are still unanswered. We owe that to the families of those who did not survive the pandemic, and we owe it to the whole country that stood by the rules throughout thick and thin to get us to where we are today, even when some in Government were not doing that. It is time for the Government to get serious. It is time for the Government to treat the British public with the respect that they deserve. It is time for a proper plan to live with covid.

Public Health

Debbie Abrahams Excerpts

Tuesday 1st March 2022 Commons Chamber

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

The all-party parliamentary group on coronavirus took evidence this morning from SAGE—the Scientific Advisory Group for Emergencies—academics and clinicians. They were clear in their concern that the living with coronavirus strategy does not include what needs to happen. It tells us what needs to stop, but it does not say what needs to happen. I am thinking particularly about the surveillance of new variants and the impacts on the communities that will be most detrimentally affected. Will the Minister expand on how the Government will ensure they keep us safe?

Dementia Research in the UK

Debbie Abrahams Excerpts

Thursday 10th February 2022 Commons Chamber

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

I beg to move,

That this House has considered dementia research in the UK.

I thank the Backbench Business Committee for granting this important debate, the all-party parliamentary group on dementia, of which I am the co-chair with the wonderful Baroness Sally Greengross, and the Alzheimer’s Society for all its work to support the APPG. I also thank the many Members who agreed to sponsor the debate, although being just before recess it is obviously a difficult slot to fill.

Dementia is one of the biggest health challenges that we face today. It is the UK’s biggest killer and, with an ever-aging population, the number of people living with dementia in the UK and around the world is set to grow. Indeed, figures from the Alzheimer’s Society show that around 900,000 people are currently living with the condition in the UK, and that number is set to grow to 1.3 million by 2030. There will be few of us who do not know somebody who is either living with dementia or affected by it.

That includes me. My mum was 64 when she was diagnosed with Alzheimer’s disease and unfortunately she died 10 years later. The work I do on the APPG is in her memory, and in recognition that there are millions of families affected by dementia and who are currently caring for people they love who have one of the many degenerative brain diseases that cause dementia. We frequently talk about dementia as though it was just one disease, but it is not. Dementia is a set of symptoms, but there is an array of degenerative brain diseases that make up dementia, of which Alzheimer’s disease is probably the best known.

[Dr Rupa Huq (Ealing Central and Acton) (Lab)]

My hon. Friend talks movingly about her mum. My mum also had frontotemporal dementia as the cause on her death certificate in 2017, 10 days before polling day—thanks, mum! Towards the end they have a mixture of intransigence, stubbornness, regression and paranoia. A minibus from Ealing Council used to come and take her to a memory clinic in Acton, but it was largely old chaps playing dominoes, and that was not really her scene. She loved entertaining, and it was so sad that someone who used to cook for so many forgot how to swallow by the end. Does my hon. Friend agree that, as well as the shocking “moonshot” that we were promised in the 2019 Conservative manifesto, which has never happened, research should look at culturally and gender-appropriate solutions to this awful disease? As she says, so many of us know people who are afflicted by it.

[Debbie Abrahams]

I thank my hon. Friend, who makes a powerful point about her own experience with her mum’s frontotemporal dementia and the importance of ensuring that we understand, from different cultural perspectives and different ethnicities, the impact of dementia and how we care for our loved ones who have it.

I want this debate to be about hope. That is so important. My hon. Friend has just spoken about her mum, and it was very hard for my mum. She could not speak and could barely move. She could not feed herself. It was a very sad state. However, there is huge optimism and reasons for hope, and that is what I want this debate to be about. I firmly believe that, as with many other conditions, research will find a cure for dementia.

We have one of the best life sciences sectors in the world, as we have seen over the past few years with the work that the University of Oxford and others have undertaken with the covid vaccination programme. Our researchers are rarely talked about, but they are our unsung heroes and we should be immensely proud of the work they do and the significant contribution they make to the economy. I believe it is a matter of when, not if, we will see the breakthroughs that are desperately needed for therapies in dementia research.

However, that is fundamentally dependent on adequate investment. Despite the ever-increasing prevalence of dementia, research into it is consistently and disproportionately underfunded. There is news from the United States of treatments such as aducanumab, which has just been approved by the Food and Drug Administration and is expected to help people when they are diagnosed with dementia. This is a great and exciting opportunity for the Government to support the field and cement the UK’s place as a world leader in dementia research.

As my hon. Friend has just mentioned, we know that during the 2019 general election the Conservative party promised to double dementia research funding from £83 million to £166 million a year over a 10-year period—the “dementia moonshot”. Similarly, the Labour party has committed to that. We have cross-party consensus, but we are still waiting for the Government to bring forward any of that additional funding. Last year, in fact, there was a 10% fall in the amount of funding provided to dementia research, so it received only £75 million instead of £83 million. That is a huge missed opportunity to expand our research capabilities in that area, to support the inspiring academics working in the field and to provide hope to the millions of people affected by dementia across the UK. It also does not make economic sense, as I will move on to later.

[John Nicolson (Ochil and South Perthshire) (SNP)]

My mum died of dementia at the start of the covid outbreak. She formed a great attachment to Madam Deputy Speaker, of whom she was very fond, and Madam Deputy Speaker was very fond of her. Her name was Marion. She went from being a sparkling presence to somebody who, at the start of the pandemic, was locked in for her own protection and I was not able to go and see her. I had never before understood the whole idea of somebody turning their face to the wall, but she just stopped eating and drinking, and within a week, she was dead. I hope that when the story of the pandemic is written, we will remember all those people who died because of it and who will never be recorded as having died of covid. They died through loneliness, which is so important for us all to remember.

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[Debbie Abrahams]

I similarly add my sincere condolences to the hon. Member. I could not agree more with his sentiments. It does affect everybody and it is moving to hear how different hon. Members have been affected by their loved ones. I want to provide hope as well, and I hope that what I go on to say will provide a bit of comfort to him. We must do more on it, though, must we not?

The Government have said that we can expect to see their plans on dementia research in the national dementia strategy. I am grateful to see the Minister in his place, because we have worked together on dementia in the past and I know that he feels as passionately about it as I do. Given that there has been a real hiatus from the manifesto in 2019 to where we are now, and that we have actually slipped backwards, I would be grateful if he could commit to discussions with the Treasury about an announcement in the spring statement next month. That is way overdue and we must provide hope to hon. Members on both sides of the Chamber.

It would be remiss of me not to mention the success of previous Governments in the last 15 years. We had our first dementia strategy in 2009. My right hon. Friend, now the Mayor of Greater Manchester, was the author of that fine strategy. We must also pay tribute to the former Prime Minister David Cameron for his work on it. He managed to increase dementia research from just over £28 million to £82 million during his incumbency. Government-led initiatives, such as his challenge on dementia, establishing the UK Dementia Research Institute, and leading the world during our 2014 G8 presidency by hosting the world’s first dementia summit, put us on a good footing to lead the world in this field. We need to build on that, but as I say I fear we are slipping backwards.

I mentioned the importance and urgency of fulfilling that commitment, but I also want to stress the economic argument. We heard last week, in the Government’s levelling-up White Paper, about the huge potential economic benefits of investing in research and development, particularly in the life sciences. Our life sciences sector in the north-west, spanning from Liverpool all the way to Hull, has magnificent research institutes and organisations. We know that extra Government investment acts as a catalyst to unlock private funding. A study conducted by Oxford Economics in 2020 found that each £1 of public money—Government money—is at least doubled. If we look at what that would mean for dementia research, a moonshot investment of £800 million over the next decade could unlock £1.6 billion to £1.8 billion of additional private investment. This is an answer to the levelling-up issue to which the Government have said they are committed. I urge them. This is a source of addressing some of the issues they are facing on that particular policy promise.

It was because of the lack of Government movement on the issue that last year the all-party parliamentary group decided to undertake a dementia research inquiry. As well as making the case for the moonshot, the resulting report, “Fuelling the Moonshot”—do look at it on the Alzheimer’s Society website—set out how the money could be best used to support the sector. Throughout the inquiry, we sought to look at the entire dementia research system. It is important to recognise that, when we talk about dementia research, we do not just mean exploring for cures and treatments, although that is obviously vital; it is also about researching diagnostic methods, how dementia can be prevented and exploring how people with dementia can best be cared for.

Over the course of the inquiry, we took written and oral evidence from hundreds of people living with and affected by dementia, academics, charities, research institutes and research participants. I thank everybody who took part. We could not have produced the quality report we did without their input. They ranged from Exeter, where researchers are investigating how we can improve the quality of life for people with dementia, to Edinburgh, where leading academics are researching the links between dementia and head traumas in sport. What we found was a rich, diverse and passionate set of people working tirelessly to improve the lives of people with dementia and their families, but they need our support and they need Government support.

[James Sunderland (Bracknell) (Con)]

I was not going to speak today because of a clash with a Bill Committee, but I have been asked by several constituents to come in to listen to the debate. The hon. Lady is putting forward a persuasive case. I want briefly to pay tribute to the hidden army of carers across the UK: the current estimate is that there are about 6.5 million of them. They are perhaps saving the Treasury over £100 billion in lost wages. Does she agree that we should do more to increase carer’s allowance and to formally recognise those very selfless and diligent people?

[Debbie Abrahams]

I thank the hon. Member for his intervention. I am very grateful to him for coming here. I agree totally with the points he has made to acknowledge the army of family carers who support people living with dementia and the fact that they are supported by a pittance. We need to do much, much more in that regard.

I was coming on to talk about the importance of the work of charities such as Alzheimer’s Research UK and the Alzheimer’s Society. About half of all the research undertaken is as a result of the funding raised by the Alzheimer’s Society. As many would expect, like other charitable sectors, medical research charities were hit particularly hard as a result of the pandemic. The Association of Medical Research Charities estimated that the pandemic has caused a shortfall of UK medical research investment of at least £310 million. That huge loss of income has of course impacted on funding decisions for these charities. The Alzheimer’s Society had planned to fund two research calls last year, but it was unable to do so because of its financial situation. The same thing was felt across the entire research community. An Alzheimer’s Society survey found that 85% of researchers reported that the pandemic had led to fewer funding opportunities being available for them.

Similarly, like those in nearly every UK sector, dementia researchers have been hard hit by the effects of the pandemic. For many, lockdowns meant that their labs had to close and participants could no longer take in part in trials. I spoke to a researcher in Manchester who had spent months growing brain cells for her research, only for them to have to be thrown away—months of work wasted. The pandemic also had an impact on the work of researchers who worked outside labs. For example, it affected those working in areas that require face-to-face contact with participants—including people with dementia—such as drug, clinical and care intervention trials.

Understandably, many clinical staff were redeployed to work in the frontline NHS throughout the pandemic, and that heavily impacted on the progress of dementia research. An Alzheimer’s Society survey from April 2021 found that almost a quarter of its funded researchers said that they or another team member had been redeployed in the NHS or in frontline services during the pandemic. We know that much of the clinical research that is undertaken depends on the effective clinical running of routine NHS dementia services, and many of those were seriously affected during covid.

One area I was particularly concerned to hear about during the inquiry was the impact of the pandemic on early career researchers. These are researchers who are at the PhD or post-doctoral stage of their careers. For many of them, much of their time and focus is taken up with concerns about where their funding will come from, or whether they will be able to progress any further. One researcher told the all-party group that

“typical…contracts go on for 3 years, and you have to spend a lot of your time in year 3 applying for your next tranche of funding—affecting your productivity.”

She went on to say that

“instead of concentrating on research, academics are having to worry about their mortgage.”

Of course, that has only been exacerbated by the pandemic.

There was a concern that having to suffer a break in their research left today’s early career researchers uncompetitive in the job market. There is a fear among those researchers that, when they apply for funding for the next stage of their career, they will not be looked on as favourably as others. In May 2021, the Government announced a fund of £20 million to support those charity-funded ECRs. I would be grateful if the Minister, in his closing remarks, responded to the recommendation that we made in our inquiry report on how we can further support these important researchers, without whom we will not see the next breakthroughs. They are absolutely vital and should not be overlooked.

Throughout my time as co-chair of the all-party group, and particularly during the inquiry, I have been lucky enough to hear at first hand from people living with dementia, and from their families. During the inquiry, I spoke to inspiring people who live with dementia or who have cared for people with dementia, and who gave up their time to participate in dementia research. I was struck by the sense of empowerment that this gave them. They know that the activities that they are undertaking may not help them directly, but they recognise that the research may support better care, treatments and even a cure for someone in the future.

To ensure that the UK is a world leader in dementia research, we must be able to attract participants to take part in trials. As one research participant put it:

“Too often research feels something that is just done to someone, rather than something that people can be a part of.”

People often do not know how they can be involved in dementia research. I want to draw everyone’s attention to Join Dementia Research UK. I encourage everyone, including hon. and right hon. Members, to sign up to it. It can link them up to research projects happening across the UK, and that is how we will help to make progress. The service is currently trialling writing to people with dementia after their diagnosis to invite them to participate in research. I would be grateful if the Minister said a little bit about how his Department could support Join Dementia Research UK with its pilot and help to roll it out.

Former England rugby union player Ben Kay is one such research participant who has also taken part in our inquiry. He has spoken quite openly about how important it is for him to be involved in the Alzheimer’s Society’s funded research programme that investigates the links between rugby and dementia. I am sure many Members here will be familiar with this not just in rugby, but in football. Nobby Stiles springs to mind, but we also know that Bobby Charlton, a particular hero of mine, has been affected. We need to understand head trauma in all forms of sport: not just those that use the different shaped balls that boys in particular play on football and rugby fields, but other sports as well. That issue, the Minister will know, has been of growing interest, particularly in the media. Again I would be grateful if he said how, with his cross-departmental work, he has been able to support this. Extra funding through the moonshot could really expand our knowledge of that area, so we can ensure that everybody can participate in sport safely. It is also important to ensure that people understand the risks and what steps they can take to minimise them, which is another area of research being undertaken.

One of the most exciting areas in dementia research at the moment is diagnosis. There is a real prospect that very soon we could see blood biomarker tests readily available to help to ensure people receive not just an accurate, but an early diagnosis, and I am talking many decades before we actually see the physical, behavioural and cognitive symptoms that we are familiar with in dementia. These can be cheap and easy to administer, much like the countless other blood tests that happen day in, day out. Again, I would be very grateful if the Minister responded on how we can make sure that, as those come on line, we can make them readily available.

Before I close my remarks, I would like to highlight some of the excellent research already taking place in the UK, particularly through the UK Dementia Research Institute. Set up 2017, this is the biggest investment the UK has ever made in dementia, thanks to the £290 million donation from founding funders the Medical Research Council, the Alzheimer’s Society and Alzheimer’s Research UK. I met the director of the institute during the inquiry and heard of the important work that it is doing.

The UKDRI has over 650 researchers working towards treatments and technologies to improve the lives of people living with dementia, with sites across all parts of the UK, including London, Cardiff and Edinburgh. The director, Professor Bart De Strooper, estimated that about a third of his researchers had been attracted to the UK from other parts of the world because of its infrastructure and research capabilities. That shows what a leading role the UK can be proud to play in this area—a world leader. With the Government funding for UKDRI running up to 2023, at which point progress will be reviewed, it is important that this vital asset in the UK’s dementia research system is supported to continue its work. We are only a year away from that, so I hope the Minister is able to say more about that.

There is also great research happening across the UK in the area of care research. We heard from Professor Dame Louise Robinson, who leads an Alzheimer’s Society-funded centre of excellence in Newcastle University. These centres of excellence, which also have sites in Exeter and London, bring together leading researchers to investigate how people with dementia can best be cared for. I am conscious of the interventions that hon. Members made earlier. That research is valuable to those people who currently have dementia in looking at how we can make sure they are properly cared for.

What is concerning is that, although there is a plethora of evidence of how effective care research is, it is not being used. In contrast to the principle of evidence-based medicine and evidence-based care, it is not actually being used, which is staggering. Again, I would be very grateful for the Minister’s thoughts on that. Can I just mention this figure? In a review of 170 training manuals for person-centred care in dementia, researchers found that just four—four—provided evidence about what methods worked when tested in a research setting. That is what we are using to train our carers. There is an evidence base, yet it is not being used to underpin that training. We need to do much better on that.

The UK has come a long way in improving our dementia research sector, but it is imperative that we build on that. People living with dementia and their families deserve to see the Government delivering on their general election commitment to dementia moonshot funding and leadership in dementia research such as we saw with the covid vaccine development. I urge the Minister to liaise with the Treasury in the run-up to the spring statement next month and to deliver for the dementia research community and for the country. We can be a world leader in the field, but that will need the Government to fulfil their commitments.

--- Later in debate ---

[Andrew Gwynne]

My hon. Friend makes a crucial point. There has been a perfect storm. As we have heard, there is a growing list of people waiting to be diagnosed properly with dementia as a consequence of the covid pandemic, and, as she rightly says, the very research groups doing in-depth analysis and research into this disease are largely reliant on charitable sources of funding, which have almost completely dried up over the course of the pandemic.

[Debbie Abrahams]

I was going to mention this when I wind up, but I could not agree more. Funds to medical research charities, such as Alzheimer’s Research UK and the Alzheimer’s Society, have more or less halved—an awful impact.

[Andrew Gwynne]

Absolutely. This is a crucial point and it is why the Government really must come good on their promises.

I also hope the Minister will update the House and give us a timetable for the publication of the dementia strategy. Patients living with dementia, and their loved ones, cannot wait for the Government to get their act together. We need a plan and we need it to go much faster to develop treatments to change lives. The Government must deliver now on their 2019 dementia moonshot manifesto promise to double Government funding into dementia research. No more excuses: that promise needs to be kept. As we have heard, funding is needed now more than ever in a research landscape that has been decimated by covid. Not only have charitable donations dried up, but a survey from Alzheimer’s Research UK found that more than a third of dementia researchers were considering leaving, or had left, academic research due to uncertainty around funding opportunities.

I want to raise the point made by my hon. Friend the Member for West Ham (Ms Brown) in an intervention on the hon. Member for Rutherglen and Hamilton West. She rightly made the point that too often these research projects are not necessarily seen as sexy. We have to make sure that that is not the case, because as I have said, they are so crucial. Labour is committed to doubling dementia research spending to over £160 million a year and to playing our part in finding a cure for this cruellest of diseases. That is a part of our commitment to not only protect but enhance the UK science base and achieve 3% of GDP spending on science and research across the economy.

Patients and their families must be a priority. That starts with dementia research, improved early diagnosis and world class clinical trials. Our goal must be to prevent, treat and ultimately cure this complex and often heartbreaking condition. That is why Labour’s suggestion of a 10-year plan of investment and reform for older and disabled people, including those with dementia, is so important. It would ensure that more people could access care and live in their homes for longer, while being supported by carers paid a proper living wage of £10 an hour.

British people deserve better. We need to meet the challenges of this century of ageing. We need to learn from the pandemic, because there are so many lessons that we can put into ordinary life. We need to treat those who are diagnosed with dementia with the respect that they deserve. This is not a party political point; there is unanimity across this House of Commons. We must redouble our efforts on research for dementia to improve care and support and, ultimately, to find a cure for this dreadful disease.

--- Later in debate ---

[Debbie Abrahams]

Let me start with some thank-yous. I thank all the speakers who contributed to today’s debate on dementia research, which is absolutely essential for the reasons that many of us have discussed. I am very grateful to every Member who shared their personal stories and experiences.

This is not something that will go away. We will see an increase in people with dementia, but it does not need to be that way. Before I go on to what we need to do and comment on the Minister’s winding-up speech, I pay tribute to my constituency, where we have 3,000 dementia friends. I was the first MP to train as a dementia friends champion; I deliver sessions on the subject across my constituency, and our youth council has taken part in this, too. It is an important way that we can drive up awareness, because so many people have personal experience of the effects of living with dementia. We have an annual memory walk, and many of our retailers have undertaken training, so that when someone gets to a checkout but does not know what they are there for, or what money they need to pay for the goods, there is understanding, rather than tut-tutting.

I worked hard with the Minister over a number of years when he was co-chair of the APPG. There is absolutely unanimity here—my hon. Friend the Member for Denton and Reddish (Andrew Gwynne) referred to it. Members on both sides of the House need to do more. Unfortunately, what has happened so far is not enough. We need to ask the Government to stump up for the commitments that they made in the 2019 general election.

The money that has gone on neurodegenerative diseases research covers a much broader spectrum of diseases than those that contribute specifically to dementia. The early career researchers fund covers all diseases, not just those specifically focusing on dementia. The families of people with dementia deserve better. They deserve delivery on a promise that was made to them more than two years ago. The impact that dementia is having on people’s lives cannot be underestimated.

There is a lot more that can be done. We can have screening programmes, like those that we have for breast, cervical, prostate and bowel cancers, for people in their early 20s and 30s. Diagnostic tools have been developed to enable diagnosis to happen sooner, rather than later, so that dementia does not have an impact on people as they grow older and it is picked up early. It is not good enough for the Government to say, “This is what we are doing.” They really need to deliver.

I hope the Minister will take this message back to the Treasury, so that there is an announcement in the spring statement. I know the Minister is personally committed to this issue, but the Government need to back him up.

[Mr Deputy Speaker]

As the Minister said, this has been a significant debate on the last day before the week’s recess. I have been an MP for 30 years and I remember that one of my first surgery cases was a lady who came to see me. Her husband had a very senior position and was well respected throughout the community but he had succumbed to the cruelty of dementia. She broke down in tears as she told me how she had had to put post-it notes all around their home in order for him to know where the cups were and things like that. My eyes welled up listening to her story. It is such a cruel condition, and we wish everybody working in dementia research in the UK and throughout the world well in order that they can protect lives in the future.

Question put and agreed to.

Resolved.

That this House has considered dementia research in the UK.

Health Inequalities: Office for Health Improvement and Disparities

Debbie Abrahams Excerpts

Wednesday 26th January 2022 Westminster Hall

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

I will keep my mask on because I have a wound, unfortunately, which I need to keep covered. It is an absolute pleasure to serve under your chairmanship, Mr Twigg. I remember that we served on the 2012 Health and Social Care Bill Committee together, so this is bringing back memories.

I congratulate my hon. Friend the Member for Bootle (Peter Dowd) on his excellent speech, and particularly on his focus on the wider health determinants and the need for an intergovernmental strategy and co-ordination. He is absolutely right.

I sought to become an MP because of my work on health inequalities. I was at the University of Liverpool for 10 years. Prior to that, I was a jobbing public health consultant. My hon. Friend mentioned the Black report. We must not forget that Margaret Whitehead at Liverpool was the first person to identify the health divide between the north and south. I am grateful to her. I learned so much under her and my other colleagues at Liverpool.

In the time that you have made available to me, Mr Twigg, I want to make three points. First, health inequalities are not inevitable. We hear “Oh, it’s always been there; it’s never going to change”. They are not inevitable but a consequence of political choices. As my hon. Friend said, those choices relate to whether or not we want socioeconomic inequalities to continue. It is also about—and this is rarely talked about—inequalities in power. We must ensure that that is addressed and brought into the debate.

Secondly, the structural inequalities across our country have been exposed and exacerbated by covid, resulting in, as Professor Sir Michael Marmot has said,

“the high and unequal death toll from COVID-19”,

which was one of the highest in the world. Thirdly, tackling health inequalities involves every single Government Department, not just the Department of Health and Social Care.

The term “health inequalities” refers to the increasing mortality and morbidity that occurs with declining socioeconomic conditions. In my Oldham East and Saddleworth constituency, the health inequality gap is more than 12 years. Those health inequalities are systematic and socially produced, and are a result of the differential distribution of income, wealth, knowledge, social status and connections. There is overwhelming evidence that those factors are the key determinants of health inequalities, influenced by written and unwritten rules and laws across our society, rather than biological and behavioural differences. I have always been disappointed by the focus always being on the individual: “It’s your fault if you get ill; it’s your fault if you get a disease. It’s your lifestyle choices.” It is not. There is overwhelming evidence on that.

There is no law of nature that decrees that the risk of a baby dying is 94% higher for children born into poor families than for those born into rich families, but that is the reality. We know that infant mortality, which had been declining for nearly a century, has started to rise again. As my hon. Friend has said, there are consequences to inequality and the austerity that has been imposed on so many families.

To my first point, given that health inequalities are socially produced, there is hope because that means that they are not fixed or inevitable—we can do something about them. If the Government are committed to levelling up, will the Minister comment on why the Gini coefficient has increased over the past few years? As my dear friend Frank Dobson famously said, nothing could be more unjust than someone knowing that they are going to die sooner because they are poor. Will the Minister comment on the socioeconomic factors that are driving health inequalities? Why they have they got worse over the past two years?

On my second point, Sir Michael Marmot was very clear in his analysis of the covid death rate that there have been four drivers of the high and unequal death toll in the UK: the governance and political culture detrimentally affecting social cohesion and inclusivity; the widening inequalities in power, money and resources; the regressive austerity policies over the past decade; and the declining healthy life expectancy of the poorest, particularly women, which is among the worst of all comparable economies. Deprived communities have also been hit particularly hard in that regard.

On my third point, as important our NHS is in treating and caring for us when we get ill, reducing inequalities must involve all Government Departments, as my hon. Friend has said. That was reflected in Sir Michael’s recommendations to address those inequalities. He said that we must build back fairer from the pandemic, with multi-sector action from all levels of Government, and increase investment in public health. Since 2015, there has been a 24% cut in public health budgets.

One thing we know about the NHS and its impact on inequalities relates to the privatisation and marketisation of health services. We know that that helps to reduce access to health services for those on lower socioeconomic groups. On top of that, there is the inequality in health outcomes. I fear that the 2021 Health and Care Bill will make a bad situation even worse, adding to the issues resulting from the Health and Social Care Act 2012.

Not only do countries in which there is a narrow gap between rich and poor have high life expectancy; they also have better educational attainment, social mobility and trust, lower crime and a fairer society as a whole. I appreciate that I have gone over time and apologise for that.

--- Later in debate ---

[Debbie Abrahams]

I refer back to my point about not victim blaming, but in relation to the NHS resource allocation formula, can I ask the Minister whether the Government will be reinstating the health inequalities weighting that the previous Administration scrapped?

[Maggie Throup]

If I may, I will write to the hon. Lady on that so I can make sure that my facts are completely clear, rather than giving her an answer that may not be quite accurate.

In recognition of the strong relationship between work and health, the joint work and health unit was established in 2015. It has invested in a programme of trials and tests to identify effective models of health and employment support, and it is now using that learning to develop and/or roll out services to support disabled people and people with long-term health conditions to enter and stay in employment. The 2021 spending review confirmed that the public health grant will be maintained in real terms for the spending review period, so local councils can continue to invest in prevention and essential public health services. The distribution of that grant is heavily weighted towards the areas that face the greatest population health challenges, with per capita funding almost 2.5 times greater for the most deprived authorities than for the least deprived. The allocation at local authority level will be announced shortly.

The role that local authorities play in improving public health is far broader than simply the important services and interventions funded through the public health grant. That grant is part of a wider package of targeted investment in improving the public’s health over the spending review period, including £300 million to tackle obesity; £170 million to improve the “best start in life” offer available to families, including breastfeeding advice and parent-infant mental health support; and an additional £560 million to support improvements in the quality and capacity of drug and alcohol treatment, which was announced as part of the drugs strategy. In addition, we have made over £12 billion available to local councils since the start of the pandemic to address the costs and impacts of covid-19. Of this money, £6 billion was non-ringfenced, because we recognise that local authorities are best placed to decide how to manage the major covid-19 pressures in their local areas.

Covid-19 Update

Debbie Abrahams Excerpts

Wednesday 8th December 2021 Commons Chamber

[Sajid Javid]

My hon. Friend is absolutely right that South Africa has a much lower level of vaccination—I believe it is around 25%—but there are other differences between South Africa and the UK, including that the vast majority of South Africans have antibodies against covid through infection. Not only do they have antibodies through infection, but a huge number of South Africans have antibodies through infection from the beta variant. It is important to know that the beta variant is much closer to the omicron variant, and it is quite possible that it might be giving an even higher degree of protection than people have in countries such as the UK, with vaccination against the Wuhan strain.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

I welcome a precautionary response given the emerging data. By introducing these measures to slow down the doubling of the rate from two to three days to five to six days, we will enable more people to get vaccinated, which is very important. Will the Secretary of State authorise the immediate roll-out of the directors of public health float stock PCR pilot to help tackle omicron clusters before they become significant outbreaks?

[Sajid Javid]

I am pleased that the hon. Lady welcomes these measures, which will certainly help to slow down the growth of omicron. I will look at the measure that she referred to.

Covid-19 Update

Debbie Abrahams Excerpts

Monday 29th November 2021 Commons Chamber

[Sajid Javid]

My hon. Friend is right to raise the importance of vaccine delivery mechanisms. If there was an approved nasal vaccine delivery mechanism, it would be helpful. He will understand that we have to allow the regulators the time to assess new delivery mechanisms, but we do take this very seriously.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

I wholeheartedly agree that no one is safe until we are all safe, and the UK and other G7 countries need to take some responsibility for the emergence of this variant. I just wanted to touch on the fact that we already have community spread of this variant. If we are to contain it, we must ensure that contact tracing is relevant and as widespread as possible. Can the Secretary of State confirm—I have asked him about this in the last few weeks—that the contain outbreak management fund will be extended beyond March; that those places that do not have it will have it; and that those that have already spent it will be properly resourced?

[Sajid Javid]

The hon. Lady makes an important point about contact tracing. On the contain outbreak management fund, especially given the emergence of this variant, we are actively reviewing it.

Oral Answers to Questions

Debbie Abrahams Excerpts

Tuesday 23rd November 2021 Commons Chamber

[Sajid Javid]

I agree that we want more and more full-time doctors, which will mean that there is less demand for locums and is, of course, very good for the NHS. I also agree that there should be more focus on the workforce, and I hope that my right hon. Friend welcomes the measure that I took yesterday of merging Health Education England with the NHS, so that we can have a much more joined-up workforce plan.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

Andrew Dilnot, whose commission undertook the inquiry into social care nearly 10 years ago, says that the impact of the Government’s social care plans on working-age disabled people will be “catastrophic”. What is the Government’s assessment of the impact?

[Sajid Javid]

The hon. Lady is right to raise the importance of doing everything we can to look after working-age people who need social care. As she will know, the total funding of social care from the state now constitutes most of the funding, and it is right that all needs are met through those funds. As for the new plan, everyone will benefit—no one will lose out from this versus the current system—so the vast majority of people will be better off, including working-age adults.

Randox Covid Contracts

Debbie Abrahams Excerpts

Wednesday 17th November 2021 Commons Chamber

[Gillian Keegan]

Let me just finish this point and then I will give way, because I am sure that the hon. Gentleman is listening carefully and wants to hear these words.

Hon. Members will be aware that we have established an independent public inquiry that will begin work in the spring, with full powers under the Inquiries Act 2005, including the ability to compel the production of all relevant materials. We expect that the inquiry will be a valuable opportunity for us all.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

May I just correct a couple of things that the Minister has said? First, Exercise Cygnus and Exercise Alice both identified shortages of PPE should there be a global pandemic, although it was never a question of if; it was always a question of when. Secondly, on the procurement disaster, the Minister should not forget that the Government were found to have acted unlawfully in the publication of their contracts in the action that I took with the Good Law Project and other hon. Members.

[Gillian Keegan]

I said that I would also give way to the hon. Member for Warwick and Leamington (Matt Western).

Covid-19 Update

Debbie Abrahams Excerpts

Monday 15th November 2021 Commons Chamber

[Sajid Javid]

My hon. Friend will not be surprised to hear that we work very closely with our colleagues in the Department for Education, especially with regard to that particular age group. The issue on asymptomatic testing is something we keep under review and, as soon as we can remove that, we will.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

I want to pass on my thanks to the NHS and all its staff for all that they are doing on the covid vaccination programme. I particularly want to thank my local public health team, who called me after I contracted covid 10 days ago. They were incredibly supportive and thorough, which contrasted with the national team, who put the phone down on me; they expected me to pick up after one ring, which I did, but they put the phone down on me. Is the Health Secretary aware that the national Test and Trace team are expecting the local public health department to pick up the slack during the Christmas holidays as that team go on holiday—the public health department is going to have to pick up the slack when they are not doing their job?

[Sajid Javid]

The hon. Lady, like so many in this House, is right to point out the phenomenal work the NHS has been doing, particularly on the vaccination programme, the work NHS Test and Trace does and the work of the UK Health Security Agency on the testing programme.