Essex Mental Health Independent Inquiry

Geraint Davies Excerpts

Tuesday 31st January 2023 Westminster Hall

[Geraint Davies (in the Chair)]

I will call Vicky Ford to move the motion. John Whittingdale will also speak for two minutes before the Minister responds.

[Vicky Ford (Chelmsford) (Con)]

I beg to move,

That this House has considered the Essex Mental Health Independent Inquiry.

It is a pleasure to serve under your chairmanship, Mr Davies. Today’s debate is important for the future of mental health services across the country and ensuring that the tragic stories that I and many of my Essex colleagues have heard from the families affected by the failings in mental health services in Essex are not repeated. This is not the first time that mental health in Essex has been debated, and I pay tribute to my hon. Friend the Member for South Suffolk (James Cartlidge) for his previous Adjournment debate. Before I start, I ask everyone to take a moment to think about all those who have died, those who have suffered, those who love them and those who care for them.

As well as other in-patient facilities, many concerns have been raised about the Linden Centre in Chelmsford, where there have been a significant number of in-patient deaths, both on the wards and while vulnerable patients were on section 17 leave or had absconded. The Linden Centre lies just outside the boundary of my constituency, but the patients treated there come from across Chelmsford and, indeed, Essex. For example, Jayden Booroff was suffering from acute psychosis and known to be at high risk of absconding. In October 2020, he was killed by a train just a few hours after he had been able to tailgate a staff member out of the Linden Centre. The inquest concluded that Jayden died following inconsistencies in care at the Linden Centre run by Essex Partnership University NHS Foundation Trust, or EPUT. Jayden’s mother, Michelle, is one of my constituents. She has told me of her wish to achieve accountability, for responsibility to be accepted and for long-term lasting improvements to services.

I and many of my Essex colleagues represent family members of mental health in-patients who have died under the care of EPUT, which is responsible for the provision of adult NHS mental health services in Essex. Many inquests and investigations have taken place, but it has been very clear for a long time that a fuller inquiry was necessary to understand why so many deaths have occurred and to try to prevent future tragedies.

In January 2021, the Government set up an independent inquiry, to be chaired by Dr Geraldine Strathdee, to investigate matters surrounding the deaths of mental health in-patients in Essex between 2000 and 2020. At the time, when local MPs were briefed on the issues, Ministers believed that a non-statutory inquiry was more appropriate, more likely to get to the truth and more likely to make recommendations for improvement in a timely manner, whereas a statutory inquiry was likely to take much longer to set up and report. It was made clear that, while the inquiry did not have statutory powers, witnesses were expected and would be encouraged to come forward and give evidence.

On 12 January 2023, I and many other Essex MPs were deeply concerned to receive the open letter published by the inquiry chair, Dr Strathdee, stating that she felt that the non-statutory inquiry into EPUT was unable to fulfil the terms of reference due to the extremely low engagement of EPUT staff. We also heard that rather than the 1,500 deaths we had been informed of, close to 2,000 fall within the scope of the inquiry. It is incredibly disappointing that, of the 14,000 members of EPUT staff whom the inquiry had written to, only 11 had agreed to give evidence. In the specific cases that the inquiry is investigating, only one in four responded. That is a shockingly low figure. It is abundantly clear that, with this extremely small pool of staff witnesses, it is highly unlikely that the full truth would be heard.

Upon receipt of Dr Strathdee’s letter, my right hon. Friends the Members for Maldon (Sir John Whittingdale) and for Witham (Priti Patel) immediately wrote to the Health Secretary to raise their serious concerns that the powers available to the inquiry did not go far enough. I have also written to the Health Secretary to underline my agreement with all the points they raised. Dr Strathdee’s unequivocal view, as stated in her open letter, is that the inquiry will not be able to meet its terms of reference with a non-statutory status. I want to put it on the parliamentary record that I join those calls for this to be converted into a statutory inquiry, which will compel witnesses to give evidence, to ensure full transparency and greater public scrutiny of its progress.

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[Vicky Ford]

I thank my right hon. Friend for making that point. It is important that the voices of the families are heard. I am about to come on to the point that it is also important that the voices of the survivors are heard. Anything we can do to help to ensure that those voices are heard is vital. In calling for a statutory inquiry, I am not just supporting the calls of the bereaved families, but those of the group that I strongly feel has not, until now, been mentioned often enough. That is the group who, although they did not lose their lives, have been victims of appalling care: they are the survivors. That group also falls within the scope of the inquiry, which is investigating issues beyond in-patient deaths, including the management of self-harm and suicide attempts, sexual safety on the wards, the use of restraint and restrictive practices with in-patient units, medication practices and management, and various other issues, as outlined in the inquiry terms of reference, which were published in May 2021.

One of my constituents shared with me the testimony that she has given to the inquiry. She describes how during her time at the Linden Centre in the mid-2000s, she was raped by another patient, and when she asked for support, she was laughed at by staff members. She describes being able to make suicide attempts, including absconding from the ward and overdosing, as well as being able to ligature on the ward. She has told me of times when staff refused to treat her self-harm injuries and how she herself treated her own serious injuries and the injuries of others. She has also described to me how she was repeatedly restrained, often held on the floor by a number of staff, and forcibly injected.

This survivor reflected to me that she had hoped things might have changed in the years since she was an in-patient, but the recent “Dispatches” documentary suggests to her and many others that that is not the case. This is just one of the appalling stories shared by survivors of the horrific treatment they suffered while in the care of mental health services in Essex. This survivor is absolutely clear about the need to establish answers and uncover the truth of the situation to ensure that nobody else has to suffer the trauma she faced, which will live with her for the rest of her life. This survivor and others who have worked with the inquiry simply want to ensure that this never happens again.

Before Christmas, I spoke in the Chamber of the House of Commons about my own lived experience. I explained that it is very hard to talk about one’s own experiences of mental illness. It brings back all the horrors. The survivors who have shared their testimony are extraordinarily brave. I have asked what support is available for them, and I understand a contract is in place with Hertfordshire Partnership University NHS Foundation Trust, while psychological support is available to anyone involved in the inquiry. I understand also that some survivors might not be aware of that. EPUT has promised to publicise it, and I will ask the inquiry to ensure that it publicises it too.

Based on all that I have said, the words of the chair of the inquiry herself, and the devastating testimony of bereaved families and survivors, I believe that there is an urgent need to revisit the powers available to the inquiry and reconvene it on a statutory footing to ensure accountability and learning, and, most importantly, to embed long-lasting changes to safeguard lives in the future.

[Geraint Davies (in the Chair)]

Thank you, Vicky. I invite John Whittingdale to speak for two minutes.

Covid-19: PPE Procurement

Geraint Davies Excerpts

Thursday 24th November 2022 Commons Chamber

[Neil O'Brien]

I mentioned that due diligence was done on more than 19,000 companies—a huge number of companies and people got in touch to offer to help—but let us continue that conversation. I am happy to talk about the particular issue that the hon. Lady raised.

[Geraint Davies (Swansea West) (Lab/Co-op)]

The Welsh Labour Government received £874 million for PPE as its population-proportionate share, but spent only £300 million—about a third of the money given. That suggests, says Cardiff University, that the UK Government could have saved £8 billion, or £300 a household across the UK, had they used public authorities, health authorities and councils instead of private profiteering contractors known to Ministers. Will the Minister look carefully at the Welsh model and, in future, use the public sector rather than private sector cronies known to Ministers such as the former Health and Social Care Secretary, the right hon. Member for West Suffolk (Matt Hancock), who is out in the jungle making more money for himself?

[Neil O'Brien]

Inevitably, a huge amount of the PPE that is produced in the world is produced by private companies. There is no world in which we could avoid the use of private companies to supply PPE.

Bereavement Charities

Geraint Davies Excerpts

Tuesday 5th July 2022 Westminster Hall

[Dr Rosena Allin-Khan (Tooting) (Lab)]

It was approximately six years ago that you sat next to me when I made my maiden speech, Mr Davies, and today is the first time I have had the pleasure of serving under your chairmanship. I thank the hon. Member for North Devon (Selaine Saxby) for securing this important debate, and all hon. Members for their thoughtful contributions.

People, including us in this place, are growing more comfortable about sharing their own experiences of loss and grief. I thank the hon. Member for Strangford (Jim Shannon) for kindly mentioning my professional experience with those needing bereavement support. Last year I had the very painful personal experience of losing my father after a long, protracted, difficult and painful battle with dementia, which came on when he was very young. No one can prepare someone for how they will cope with the loss, and everyone will react incredibly differently. The only sure thing we know is that everyone will go through it at some point.

It is important to remember that everyone deals with loss differently. I threw myself into exercise and relied on a support network of my friends and family. Together, we mourned for the life lost and the experiences we were never able to have. Others require professional help.

I will take this opportunity to thank the palliative, neurological and bereavement support charity Sue Ryder, for the assistance it provides to so many families, and Lottie Tomlinson, who has done so much to break down the stigma that still exists around bereavement. Lottie speaks from the heart about navigating the loss of both her mother and her sister, and the different experiences she had in getting informal support from her family and professional support after the loss of her sister.

There is no one-size-fits-all approach to bereavement. Indeed, it is different for everyone, depending on whether they have lost a child or even, in the case of the hon. Member for North Devon, a grandmother—I am so sorry to hear about the hon. Lady’s loss. No amount of comments such as “She had a good innings” can take away from the pain and loss that she feels, because the family had her in their lives for 98 years and that really counts for something. All our love and support go to the hon. Lady’s family at this time.

The pandemic robbed so many families of the opportunity to say a final goodbye. That has had a profound impact on people’s ability to grieve. The mental health impact of that is enormous. Around one in 10 people bereaved will suffer from prolonged grief disorder, resulting in severe mental health conditions, such as post-traumatic stress disorder.

In the report released by Sue Ryder last week, 70% of respondents reported that they could not access the type of support they would have liked after a close bereavement. The most common barriers to accessing support were that it was not culturally specific, or not provided in the recipient’s language. That has to change. There is a postcode lottery on bereavement support, and that should not be the case. Some local authorities do a fantastic job with limited resources, but it should not have to be that way. So much for levelling up if some areas cannot even afford dignity in death.

Bereavement charities and local authorities should not be living hand to mouth when it comes to bereavement support. The Government must have a clear strategy that tackles the social isolation and loneliness that people often experience after a death. It must ensure that all family members are provided with information about bereavement support services in all appropriate languages.

In A&E, where I work, when a patient dies, there is all too often little joined-up working. I know local bereavement organisations and am able to signpost loved ones to them, but not everyone is able to do that. That is where the development of a specific bereavement pathway would be incredibly useful for frontline workers. It could ensure that relatives are given the information that they need at a time of crisis by hospitals, GPs and charity services. That would help healthcare professionals to find the right support for anyone who has experienced a bereavement, and should be supported by a public health campaign to promote awareness of the different services available.

I would again like to thank everyone who has shared their experiences in order to help to tackle the pernicious stigma still associated with bereavement. It is clear that there is a long way to go to ensure that bereavement services get the support they need to support all of our communities at their darkest hour. I urge the Minister to take the comments made today into account. I know that the UK Commission on Bereavement is currently working to analyse and understand all the evidence that it has received, and I look forward to its report this year.

Experiencing the death of a loved one is one of the hardest things a person will go through. Unfortunately, the last couple of years have made that an all too stark reality for too many people. The humanity was stripped out of grieving; it is high time that it was put back.

[Geraint Davies (in the Chair)]

Last but not least, I call the Minister.

Health and Care Bill

Geraint Davies Excerpts

Consideration of Lords amendments
Wednesday 30th March 2022 Commons Chamber

[Wes Streeting]

It was a great pleasure to see the Minister at the Dispatch Box, but I must warn him and the Minister for Care and Mental Health, the hon. Member for Chichester (Gillian Keegan), that the Government will not convince us that their position on workforce is right even by sending out the most charming members of their Health team. I will go into the reasons for that. I start with enormous thanks to Members of the House of Lords for the enormous amount of work that they put into making the Bill much better than it was when it left the House of Commons. In particular, I thank my noble Friends Baroness Thornton, Baroness Merron and Baroness Wheeler who showed great wisdom and stamina in forging huge alliances in the other place to get the consensus needed to make the improvements that we are discussing. I also thank Liz Cronin and Richard Bourne for supporting the shadow Lords team.

The NHS is facing the greatest crisis in its history. Covid has not gone away, and the covid pressures on the NHS certainly have not gone away. Instead, it is in the unenviable position of having to deal with those ongoing challenges at the same time as trying to address the significant backlog that existed before we went into the pandemic, when a record 4.5 million people were already on NHS waiting lists.

Today, we see that there is a staff shortage of 110,000 across the NHS as well as 105,000 vacancies in social care. Six million people are now waiting for NHS treatment—the longest waiting lists on record—and they are waiting longer than ever before. Cancer patients are not being seen by specialists on time; they are waiting too long for diagnosis when every day matters. Stroke victims are being left to wait hours for an ambulance—except in the north-east, where over the winter heart attack patients were told to phone a friend or call a cab. It is therefore no surprise to learn today that public satisfaction with the NHS is at its lowest level in 25 years, since 1997. Of course, that was the year when Tony Blair led Labour to victory at the general election and delivered shorter waiting times and the highest patient satisfaction in the history of the NHS. The Government could do a great deal of good by learning from the example left by the last Labour Government and trying to rebuild the legacy that they have trashed over the last 12 years.

It is not just patients who are dissatisfied with the NHS. I know from speaking to frontline staff and NHS leaders across the country that they are exhausted after their heroic efforts of the past two years. They are burned out, they are overstretched, and there are simply not enough of them. They are proud of the NHS and proud to work for the NHS, but, in too many cases, people are going home at the end of a long shift and agonising about whether they did the right thing, agonising about whether they made the right decisions for their patients and agonising about whether they had forgotten a crucial detail. It is getting worse, not better. Some 27,000 NHS workers voluntarily left the health service in just three months last year, the highest on record. The Health Secretary has admitted that the Government will not meet their manifesto commitment to recruit the 6,000 GPs we need to get people seen on time and we know that many cases will simply present in overstretched accident and emergency departments. Today, we heard about the consequences of the failure to safely staff our health service.

On that note, I want to place on record my thanks to the Secretary of State for Health for his response to the Ockenden review—and to his predecessor, the Chairman of the Health and Social Care Committee, the right hon. Member for South West Surrey (Jeremy Hunt) for commissioning the review in the first place—and the commitment to implement in full not its recommendations, because Donna Ockenden has not made recommendations, but the must-dos she has set out. I cannot imagine the trauma of losing a child and we owe it to mothers who have been through that suffering to ensure that they are never let down again. This is not a party political point. The review spans two decades under Labour and Conservative Governments. I want to acknowledge that and be honest about that. The clear finding is that we must safely staff our maternity wards. Today, midwives are leaving the NHS in greater numbers than it is able to recruit them. That is just one of the reasons why we need a workforce plan for the NHS.

[Geraint Davies (Swansea West) (Lab/Co-op)]

I have just returned from Lithuania, where I was speaking to the head of migration in a refugee centre who said that they are welcoming their neighbours not just because they should but because they are providing a very valuable addition to their workforce. They are taking tens of thousands of people. Given that 1.4 million EU citizens who are registered to work in Britain have decided to stay in Europe, should we not be opening our hearts and homes and recognise the benefits some of them would bring by working in the NHS?

[Wes Streeting]

I thank my hon. Friend for his intervention. It is certainly the case that refugees fleeing Ukraine—indeed, other conflict zones around the world—bring enormous skills to our country. For as long as they are here and living with us, we should enable them to make whatever contribution they wish. If some of the people from Ukraine or elsewhere want to work in the NHS, we should absolutely welcome them with open arms.

--- Later in debate ---

[Geraint Davies]

It is, of course, 125 years since the birth of Aneurin Bevan, who famously said:

“Illness is…a misfortune the cost of which should be shared by the community”.

That cost, as the right hon. Member for Chingford and Woodford Green (Sir Iain Duncan Smith) said, should not be borne by the victims of genocide, abuse or slavery, so I support amendment 48 and, indeed, amendments (a) and (b).

I am the trade rapporteur of the Council of Europe in respect of safeguarding human rights, democracy and the rule of law. I very much hope that where there is abuse or slave labour, we pursue filtering out such imports from procurement in general. Curing illness should not be at the cost of creating illness and harm abroad.

Obviously we need security of supply. We have seen China use embargoes and trade sanctions against Australian wine and Lithuanian products, or whatever, so we need a safe supply, much of it home-grown, for when we face such a problem or a pandemic. I put it to the Minister that we need to look much more at generating production and procurement in the public sector. It is no good going to the pub landlord of the right hon. Member for West Suffolk (Matt Hancock) to get expensive PPE. We need both value for money and ethical sourcing.

Some of the proposals for integrated care boards involve corporations that have a vested interest. If we remove competitive tendering, waiting lists and costs would both go up. It is critical that we get value for money.

Looking at what happened in Wales during the pandemic, we find that the cost of PPE was, in fact, half the cost of PPE in England. The £1.1 billion given to Wales for test and trace was a Barnett consequential, but we spent only half of that, £533 million, because we used public sector procurement and production effectively.

Through a combination of ethical procurement and public sector provision, we can keep the light of the health service shining, we can keep the faith and we can build a stronger, more successful and cost-effective health service.

[Jeremy Hunt]

Like the shadow Health Secretary, I rise to speak in support of amendment 29, which the Government plan to vote down. This wholly innocuous amendment simply asks them to publish, every two years, independent projections of the number of doctors and nurses we should be training. The Government are rejecting the amendment because they think it would compel them to train more doctors, which is true, but it ignores the fact that this is the best way to reduce the £6.2 billion locum bill that is currently devastating the NHS budget.

The shadow Health Secretary was very generous to me, and I return the compliment by saying that I think he is doing an excellent job. I hope he remains shadow Health Secretary for many years.

I ask the House, in the nicest possible way, to reject the compromises proposed by the excellent Minister. The Government are publishing a 15-year framework, but he knows and we know that it will simply detail the number of doctors that the Government think they can afford, not the number of doctors we actually need. In the past—even last year—when the NHS has tried to publish the number of doctors it thinks it needs, it has been stopped by the Government. Why is there this reluctance to publish the number of doctors we are going to need in 15 years’ time, given that 97% of hospital bosses say that staff shortages are having an impact on the quality of care they are giving and there are 110,000 vacancies? The answer is simple: it is because the Government know we are not training enough right now. What message does it send to young doctors, newly qualified midwives and newly qualified nurses, who are incredibly stressed and pressured by the situation on the frontline, if we are saying to them, “Look, it is really tough now, but we are not even prepared to train enough doctors, nurses and midwives for the future to relieve that stress and pressure later on in your career”?

Children’s Mental Health

Geraint Davies Excerpts

Tuesday 8th February 2022 Commons Chamber

[Dr Allin-Khan]

The hon. Member highlights the point that mental health should not be a political football, which is why we hope that he will support the Opposition’s recommendations. I should be delighted if he sent me his report; I will read it with interest.

It is crucial that when a child comes to A&E or a hospital, doctors and nurses take the time to build trust with them as a patient so that they feel safe talking about their condition, but with waiting lists growing and the staffing crisis deepening, it is becoming all too difficult to find the time to build the trust and respect that every patient needs and deserves. That is the human cost of more than a decade of decline caused by under-resourcing and under-investment in our NHS and by the lack of a proper NHS workforce plan for the future.

The impact on entire families is crushing. Time out of school affects a child’s ability to learn and their later life choices and chances. Parents have to take time off work and sometimes leave their jobs as a result, and siblings are deeply affected. It should be a badge of shame for the Government that three quarters of children were not seen within four weeks of being referred to children’s mental health services.

[Geraint Davies (Swansea West) (Lab/Co-op)]

No doubt my hon. Friend is aware of the relationship between children’s mental health and air quality. Poor air quality can give rise to anxiety, depression, lesser focus and dementia, as well as mental health problems in unborn foetuses. Does she agree that more needs to be done, particularly in the most diverse and deprived areas where air pollution is worse? It is directly hitting children’s mental health.

[Dr Allin-Khan]

My hon. Friend is right to remind us that adverse childhood experiences and inequalities, including health inequalities, lead to worse mental health outcomes in later life and stop children from achieving their full potential.

Imagine being a mum or dad whose child is self-harming or presenting with symptoms of depression, anxiety or phobia, and being without specialist support for extended periods. We all agree that the pressure that that puts on families and parents is just so crippling. The number of children who needed specialist treatment for severe mental health crises between April 2021 and October 2021 was 77% higher than in the same period in 2019.

This is the UK in 2022. The bar to being seen by a specialist is high, the delays are long and three quarters of children were not seen within four weeks of referral. That time is one of anguish for them and their family. Does the Minister believe that making 369,000 children wait for vital mental health support is acceptable?

According to the latest report by the Children’s Commissioner, waiting times depend on where people live—so much for levelling up—and when they are eventually seen, services may be hundreds of miles away. It is making the situation so much worse. Ask any parent or any young person; they will tell us that the uncertainty and paucity of mental health services damages mental health, exacerbates mental health conditions, allows symptoms to persist and makes conditions harder to treat down the line. Ultimately, it also costs more.

Social Prescribing: England

Geraint Davies Excerpts

Tuesday 1st February 2022 Westminster Hall

[Geraint Davies (in the Chair)]

I remind Members to observe social distancing and to wear masks. I will call Alexander Stafford to move the motion; I will then call the Minister to respond. There will not be an opportunity for the Member in charge to wind up, as is the convention in 30-minute debates.

[Alexander Stafford (Rother Valley) (Con)]

I beg to move,

That this House has considered social prescribing in England.

I wish first of all to make clear to the House my interest as chair of the all-party parliamentary group on health and the natural environment. I am delighted to be sponsoring what is, to my knowledge, the first dedicated debate in the UK Parliament on social prescribing. There is no doubt in my mind that this debate is timely, if not overdue, given that social prescribing as an effective and respected field of medicine has come to the fore in the past few years and accordingly has an important role in the future of our health system.

So what is social prescribing? Put quite simply, social prescribing embraces the need for psychosocial support to be considered alongside biomedical interventions, to take us back to a more natural way of keeping well and improving our health when things go wrong. Importantly, social prescribing is about being connected to activities in our communities to improve health and wellbeing, whether by joining a community choir or running group or volunteering at a local nature reserve.

To understand why social prescribing is crucial to the future of care, we must understand its place in the health and social care context. All Members can agree that biomedicine is brilliant, and there is no better example than the Government vaccination programme for covid-19. Biomedicine will always play a crucial role in supporting people’s health and wellbeing. However, we have also known for a long time that what determines our health is not what goes on inside hospitals and GP practices. We also know that biomedicine has limitations—for example, addiction to opiates.

Recent guidance from the National Institute for Health and Care Excellence promotes the use of exercise for pain, alongside drugs. In fact, the NHS chief pharmacist’s recent report into over-medicalisation demonstrated that one in five over-65s are in hospital not for a condition they have, but due to the medicine they take, while 10% of prescriptions dispensed address the symptom and not the cause of a person’s depression. Evidence also shows that one in five GP appointments are for non-medical needs, such as mental health, relationships, housing, loneliness, social isolation, managing a long-term health condition and debt.

Covid-19 Update

Geraint Davies Excerpts

Wednesday 8th December 2021 Commons Chamber

[Geraint Davies (Swansea West) (Lab/Co-op)]

In the United Kingdom, there are 45,000 infections a day. In Japan, there are just 200 infections a day, because people in Japan understand that they do not have the right to put other people at avoidable risk. Will the Secretary of State consider extending what he is saying to introduce vaccine passports and testing at pubs, because I for one do not want to go into a pub where I can be infected by someone who is not vaccinated. Secondly, will he look to introduce masks into schoolrooms for older children? Let us get to grips with this.

[Sajid Javid]

When it comes to case numbers, we should be cautious about making straightforward comparisons between countries, not least because different countries have different ways to measure infection and different capacity. Regarding the measures to which the hon. Gentleman has just referred, what we have set out today is proportionate and balanced.

Health and Care Bill

Geraint Davies Excerpts

Report stage
Tuesday 23rd November 2021 Commons Chamber

[Matt Hancock (West Suffolk) (Con)]

I rise to support new clauses 60 and 61, which relate, like the amendments that the hon. Member for Central Ayrshire (Dr Whitford) spoke about, to the UK-wide application of the Bill.

Health is rightly devolved, and as Secretary of State I worked very closely with Ministers in the three devolved nations, but there are nevertheless areas in which it is vital that the NHS, as a British institution, supports all our constituents right across this United Kingdom. Two areas in particular are critical and, in my view, need legislative attention.

The first area is the interoperability of data. As well as being vital for stronger research, it is necessary not least so that if you travelled to Caerphilly or Glasgow and were ill, Mr Deputy Speaker, the NHS could access your medical records to know how best to treat you. We can see right now, in the application of the NHS app for international travel, what happens without the data interoperability that new clause 61 would require.

[Geraint Davies (Swansea West) (Lab/Co-op)]

Is the right hon. Gentleman aware that there is concern in Wales, where we are protecting the private personal data of people receiving medicine and healthcare, that in England there will now be a gateway for the private sector to take people’s data and use it for its own reasons? That is one reason that we would not want to give the English our data.

Health and Care Bill

Geraint Davies Excerpts

Report stage
Monday 22nd November 2021 Commons Chamber

[Geraint Davies (Swansea West) (Lab/Co-op)]

My hon. Friend will know that two thirds of people in Britain are overweight and that one in four is obese. An enormous amount of added sugar is put into processed foods that people do not know about. Men, for instance, are not supposed to have more than nine teaspoons of added sugar, and women six, which is the equivalent of a can of coke and a light yoghurt. Does he not agree that this Bill is tremendously light on the killer that sugar is, and that not only should we be labelling it, but that the Budget should tax added sugar in processed food to reduce the waiting list?

[Alex Norris]

My hon. Friend will be delighted to hear that I will be coming on to the modesty of the Government’s plans for tackling obesity, but I have to finish my remarks about new clause 16.

New clause 16 compels the Secretary of State to publish an annual statement about the spend and impact of alcohol treatment funding. After a decade of reduced commitment in this vital area, the Secretary of State should seek to embrace this opportunity. At the moment, national Government cannot say they are meeting their responsibility to tackle alcohol harm with the requisite financial commitment and in the right place, which should discomfort them greatly. New clause 17 would replicate in England the minimum unit pricing restrictions that we see in Scotland and Wales, and we are all watching with great interest as evidence gathers as to their impact.

Let me now turn to the amendments and new clauses relating to advertising. The Government have included a couple of elements of their obesity strategy in the Bill. As I have already said to the Minister—in Committee and upstairs in the delegated legislation Committee—I wish that they had put the entire obesity strategy in this legislation, because there are bits that could have been improved by amendment, by debate and by discussion, as we heard in the contribution of the hon. Member for Buckingham (Greg Smith), and as I dare say we will in that of the hon. Member for North East Bedfordshire (Richard Fuller). We should have taken that approach to the entire document, and it is sad that we did not.

On the obesity strategy itself, it is too modest and it fails to attack a major cause of obesity, which is poverty.

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[Bob Blackman]

I thank my right hon. and learned Friend for raising that point. Clearly, the fact that people can no longer smoke in public houses or restaurants has dramatically reduced the incidence of smoking. Someone has to make a deliberate decision to go outside and inflict their smoke on the outside world rather than on the people in the public house or restaurant.

We who support these amendments tabled them in Committee—we sought Government support and we debated them in Committee—and now we are debating them on Report. I understand that we may not be successful tonight, but I give fair warning that these amendments, in another form, will be tabled in the other place, and we will see what happens. We know that there is very strong support in the other place for anti-tobacco legislation. In July 2021, the Lords passed by 254 votes to 224 a motion to regret that the Government had failed to make it a requirement that smoke-free pavement licences must be 100% smoke free. That is smoking in the open air; we are talking about measures to combat smoking overall.

Finally, if we look back over the years, the measures on smoking in public places, on smoking in vehicles, on smoking when children are present and on standardised packaging of tobacco products were all led from the Back Benches. Governments of all persuasions resisted them, for various reasons. I suspect that my hon. Friend the Minister, whom I know well, may resist these measures tonight, but we on the Back Benches who are determined to improve the health of this country will continue to press on with them, and we will win eventually. It may not be tonight, but those measures will come soon. I support the measures that are proposed.

[Geraint Davies]

It is a great pleasure to follow the hon. Member for Harrow East (Bob Blackman), who gave an eloquent speech about smoking. What he did not include, and what the Minister is not considering, is the mass passive smoking from air pollution, which causes 64,000 deaths a year. I know that I am in danger of being outside the scope of the Bill, but I will make this point just briefly, because it is about public health.

Indoor and outdoor air pollution is endemic. It costs £20 billion a year. We could simply ban wood-burning stoves, which 2.5 million people have and which contribute 38% of the PM_2.5 emissions in our atmosphere. That is particularly problematic in poorer areas. I make this point partly as I chair the all-party parliamentary group on air pollution, but this is a critical public health issue, so I feel that the Department of Health and Social Care should look at it centrally, rather than leaving it to the Department for Environment, Food and Rural Affairs as an air quality issue.

I turn to the comments by the hon. Member for North East Bedfordshire (Richard Fuller), who sadly is not in his place, about free choice in advertising. Advertising is not about free choice; one would not need to advertise unless one was trying to convince somebody to do something they would not otherwise do. That is not to say that advertising is always bad—good things and bad things can be advertised—but let us be straightforward.

As it happens, I have a background in multinational marketing; I have been involved with PG Tips and Colgate toothpaste—good products. However, the reality is that if someone wanted to make money from a product such as a potato, which is intrinsically good for people, they could impregnate it with salt, sugar and fat, make it into the shape of a dinosaur, get a jingle and call it “Dennis’s Dinosaurs”, and make a lot of money out of that simple potato. That is the way a lot of processed foods work.

Going back to the point about diabetes and added sugar, it is important to remember that diabetes in Britain costs something like £10 billion a year. There is a compelling case for the Government to do more about added sugar, as opposed to natural sugar; obviously, we could discriminate between the two, though a lot of manufacturers will say, “Are you going to tax an apple?”. Clearly, when a child or adult can find a huge bar of chocolate in a shop for £1, we have problems, in terms of the amount of sugar we are supposed to have. Henry Dimbleby put forward a national food strategy, which is worth a read. He makes the key point that reducing the overall amount of money people have—for instance, through universal credit—has a major impact: we find that when universal credit goes down, consumption of alcohol and smoking go up.

It is important for the Department of Health and Social Care to have an idea of how the nutrition of particular natural foods can be increased through better farming. An app will be available next year that will enable people to test a carrot in their local shop. The carrot will have different levels of antioxidant, depending on how it is grown. If it is organic and not impregnated with all sorts of fertiliser and chemicals, it develops a natural resistance to pesticides and is much better for human health. The Government should, in this post-Brexit world, be actively encouraging local high-value, high-nutrition products for export and local consumption.

A whole range of public health measures that need to be moved forward are not in the strategy; but some are, such as those raised by the hon. Member for Harrow East.

[Mr Deputy Speaker (Mr Nigel Evans)]

I call Christian Wakeford. Do you wish to remain seated?

--- Later in debate ---

[Edward Argar]

I fear that I have only a few minutes left, and I have already taken a number of interventions on this. I want to conclude by covering the tobacco amendments as well, which I know that some colleagues are keen to see a response to. I apologise to the hon. Gentleman.

Less healthy food and drink products are not age restricted at the point of purchase, unlike alcohol. Finally, the 2019 and 2020 consultations on advertising restrictions for less healthy food and drink did not consult on alcohol within the restrictions, either online or on TV, so we cannot be sure of the impact these amendments would have on the industry more broadly.

Turning to tobacco in the time I have left, because I know the shadow Minister, the hon. Member for Nottingham North (Alex Norris) , has taken a close interest in the issue, I thank the hon. Member for City of Durham (Mary Kelly Foy) and others, including my hon. Friend the Member for Harrow East, who have tabled a number of amendments that seek to address the harm caused by smoking in this country. I reassure the hon. Member for City of Durham of the Government’s commitment to becoming smoke free by 2030.

We have successfully introduced many regulatory reforms over the past two decades, and the UK is a global leader in tobacco control. Our reforms include raising the age of sale from 16 to 18, the introduction of a tobacco display ban, standardised packaging and a ban on smoking in cars with children, which all place important barriers between young people and tobacco products. The Government are currently developing our new tobacco control plan, and I reassure the hon. Lady that that will reflect carefully on the APPG’s findings and report.

I am afraid I cannot be tempted to go further than the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Erewash (Maggie Throup), did in the recent Westminster Hall debate on this question, but I can reassure the hon. Member for City of Durham that we remain committed to bringing forward the tobacco control plan.

[Geraint Davies]

rose—

[Edward Argar]

Forgive me; I only have a few minutes and I want to cover the amendments from the hon. Member for City of Durham. The hon. Member for Swansea West (Geraint Davies) did manage dexterously to shoehorn air quality more broadly within the scope of these debates, and what he said will have been heard.

New clause 2, which seeks to provide powers for the Secretary of State to impose a requirement for tobacco manufacturers

“to print health warnings on individual cigarettes and cigarette rolling papers”,

is intended, as I understand from the hon. Member for City of Durham, to further strengthen our current public health messaging and encourage smokers to quit. We strongly support measures to stop people smoking, to make smoking less attractive to young people and to educate smokers of its dangers, as we have done through graphic warnings on cigarette packs.

We would need to conduct further research and build a further robust evidence base in support of any such additional measures before bringing them forward. To date, no country has introduced such a measure, so there is currently limited evidence of its impact in supporting smokers to quit. If evidence showed that the requirement would not be effective, it would not be an appropriate power to have in place.

New clause 3, also tabled by the hon. Lady, seeks to provide a power for the Secretary of State to introduce a requirement for manufacturers to insert leaflets containing health information and information about smoking cessation services into cigarette packaging. As I set out in Committee, we believe this power is unnecessary, since the Department could legislate to do that already under the Children and Families Act 2014; inserts could be required for public health messaging through amendments to the Standardised Packaging of Tobacco Products Regulations 2015. We already have in place strong graphic images and warnings of the health harms of smoking on the outside of cigarette packs. As part of the Tobacco and Related Products Regulations 2016, the address for the NHS website, which provides advice for people seeking to quit smoking, is also required on packaging.

The current SPoT regulations prohibit the use of inserts, as there was limited evidence that placing public health messaging inserts inside cigarette packages was more effective than messaging on the outside of packs. Further research would need to be undertaken to help to establish the public health benefit if we were to go further.

Turning briefly to new clause 4, I am grateful again to the hon. Lady for tabling this clause. The Government are clear that they only support the use of e-cigarettes as a tool for smokers who are trying to quit, and we strongly discourage non-smokers and young people from using them. We are committed to ensuring that our regulatory framework continues to protect young people and non-smokers from using e-cigarettes.

Current regulations include requirements on the packaging and labelling of e-cigarettes, along with restrictions on their marketing and the prohibiting of advertising on mainstream media such as TV and radio. While we strongly support measures to protect young people further from cigarettes, we believe the current regime remains appropriate and has the powers in place within it to make changes where required, although I suspect my hon. Friend the Member for Harrow East may yet be proved right when he suggests that the other place may return to this at some point.

I have outlined the many steps this Government are taking to address some of the major lifestyle challenges to our health. The Bill represents another step in the direction of preventive healthcare and building a healthier society, an aim I know we all share. I hope the House will support the amendments we have tabled at this stage to strengthen those measures.

I also want to update the House at this point, in the context of the importance of an integrated approach and how it can improve public health measures, on two steps the Secretary of State has taken today that will put NHS staff and technology at the heart of our long-term planning and allow us to take forward the integrated approach that has proved so vital during this pandemic and is so vital to public health.

[Geraint Davies]

Will the Minister give way?

[Edward Argar]

I am afraid I will not. I suspect that point will be pertinent to the debate on the first group of amendments tomorrow.

First, we intend to merge Health Education England with NHS England and NHS Improvement, putting education and training of our health workforce at the forefront of the NHS. By bringing this vital function inside the NHS, we can plan more effectively for the long term and have clear accountability for delivery.

Secondly, we also intend to take forward the recommendations of the Wade-Gery report, which included merging NHSX and NHS Digital with NHS England and NHS Improvement, building on the huge progress made on digital transformation during the pandemic and bringing together the digital leadership of the NHS in one place. I take this opportunity to pay tribute to all our colleagues at Health Education England, NHS Digital and NHSX for their exceptional work. These changes build on that contribution and allow us to drive forward further integration and changes that will put the NHS on a firmer footing.

I hope I have reassured hon. Members of the Government’s commitment to improving public health. I urge those who have tabled amendments to consider not pressing them to a Division.

--- Later in debate ---

[Edward Argar]

I entirely understand the point the hon. Gentleman is making. I think he was careful, shall we say, given some litigation that may be going on, not to mention anything specific, but I know what he is talking about. We believe that our amendment will prevent private companies—whatever services they were providing for the NHS—with a significant private interest in this, or their lobbyists, from being able to sit on ICBs. The hon. Member for Bristol South (Karin Smyth) raised the need for transparency in Committee a number of times, and I suspect we may return to that point. We believe that the current transparency requirements on CCGs that will be carried across are sufficient to ensure transparency and public access to the information they need.

[Geraint Davies]

rose—

[Edward Argar]

I am afraid I am about to conclude. I suspect that the hon. Gentleman will come back in with a speech and I will endeavour to pick up on that in the wind-ups.

There are a number of similar amendments, such as amendment 101 in the names of the hon. Members for Wirral West (Margaret Greenwood) and for Brighton, Pavilion (Caroline Lucas). I hope they might feel, to some degree, reassured by our amendment and the intent behind it, but that is obviously for them to say. We believe that the Government’s amendment puts beyond doubt what we believe was already entirely clear but were determined to put beyond doubt—that ICBs will not and cannot be controlled in any way by the private sector, as NHS-accountable bodies guided by the NHS constitution and with NHS values at their heart. These principles, I believe, irrespective of other debates we may have this evening, command respect from both sides of this place. I therefore commend the amendments to the House.

--- Later in debate ---

Amendments 76, 77 and 78 deal with the issue and would limit the possibility for influence by vested interests, especially those of the private, for-profit sector. Crucially, they close the door on the possibility, left open by the Government’s amendment, of private providers sitting on sub-committees or place-based bodies of ICBs. Incidentally, that problem is of the Government’s own making by virtue of them leaving the level of direction for place-based Government arrangements deliberately vague in the Bill.

[Geraint Davies]

Perhaps my hon. Friend can illuminate me. I was going to ask the Minister who owns the assets of the ICBs. Can the ICBs sell some of those assets and rent them back as a service? What constraints are there to stop people on the board enabling that, because they have some strange link to the people buying the assets?

[Justin Madders]

At the moment, ICBs are not a legal entity, so they do not own anything. When the Bill comes into force, they will effectively take over mainly administrative buildings from the CCGs, and the trust will hold ownership of most of the assets. We hope that there will not be the risks that my hon. Friend outlines, although it is not impossible for ICBs to set up their own trusts at some point in the future.

We do not believe that the question of private providers sitting on the place-based boards can be left open in this way, because this is really about who runs the NHS. There is a complete and utter incompatibility between the aims of private companies and what we say should be the aims of the NHS and the ICBs. I can do no better than refer to the evidence of Dr Chaand Nagpaul from the Bill Committee. He identified the concern perfectly:

“We forget at our peril the added value, the accountability, the loyalty and the good will that the NHS provides. We really do…I am saying that it does matter. Your local acute trust is not there on a 10-year contract, willing to walk away after two years. It is there for your population; it cannot walk away.”––[Official Report, Health and Care Public Bill Committee, 9 September 2021; c. 90, Q113.]

Those final words sum it up perfectly. Put a company on the board, and its interest lasts as long as the contract, and those interests will of course not be the same as the NHS’s anyway. A company’s primary concern is the shareholders, not the patients. With that clear and unanswerable concern about conflicts of interest, we invite the Government to withdraw their amendment and support ours.

We have already had some discussion of who goes on the ICB. Apparently, the answer is not the most appropriate people chosen by an independent external process or individuals directly accountable to the public; the answer is left to guidance that leaves open the risk that voices we think need to be heard will slip through the net. Our amendment 76 deals with that by setting out the requirements for ICB membership. Allocating scarce NHS resources should be robustly debated and will always be political. Tough choices have to be made, so we need people on the ICB who will be there to cover all the necessary interests for the wider good.

If Members look at what amendment 76 suggests, I hope nobody would argue that those interests do not have to have some voice. The public, patients, staff, social care, public health and mental health—which of those can be safely ignored and which has no part to play? As I have already mentioned, there is a major area of uncertainty because of the complete absence of anything that sets out how the much-vaunted place-based commissioning will work. Who will sit at the place-based table is, I am afraid, still completely opaque.

The next major area covered in the Bill is a further deconstruction of Lansley with the removal of compulsory competitive tendering for clinical services. We have seen the NHS proposals for a provider selection regime to replace the regulations under section 75 of the 2012 Act. That is to be regarded as a work in progress, so our amendment 72 covers the issue and would reintroduce some safeguards into how our money is spent. Since its inception, the NHS has always relied on some non-NHS providers, with the model developed for GPs being an obvious example. However, in recent decades there has been an increase in the use of private providers of acute care, most notably in diagnostics and surgery.

To be clear, we on the Opposition Benches believe that the NHS should be the default provider of clinical services. If it is not the only provider, it should be the predominant provider in geographical and services terms. Where a service cannot be provided by a public body because the capability or capacity is not there, there is still the option to go beyond the NHS itself, but that should be a last resort and never a permanent solution. Amendment 72 therefore sets out a clear framework for how we could achieve that. We hope that extra transparency and extra rigour would mean we avoid buying stuff that is unsuitable and sits in container mountains, stuff that does not meet specifications, and stuff made by companies that have no experience, but are owned by friends and family. In short, we would stop the covid crony gravy train.

The use of private sector capacity in the covid emergency turned out to be a farcical failure. It became very clear, very quickly that it was not there to support the NHS; it was there just to make profits. Use of private providers through dodgy deals during the PPE scandal has highlighted the need for greater transparency and greater capacity in the NHS. We can never allow a repeat of what we have seen there. We need the rigour set out in the amendment to be put into legislation, rather than left to guidance. We need to be able to challenge NHS bodies that do not comply, as well as Ministers who try to flout the rules.

I will now deal with new clause 49, saving the best—or more accurately, the worst—until last. Because of how Report stage works, it has fallen to me to express our opposition to this measure, rather than my expert colleague, my hon. Friend the Member for Leicester West (Liz Kendall), who shares my dismay at what has been produced and how it has been presented to us. Starting with the process, it is wholly wrong to bring such a fundamental change forward as a last-minute addition to this Bill. That means it cannot be debated properly today. There is no impact assessment and, as we have already heard, this change was not discussed in Committee at all. In fact, in 22 Committee sessions spanning some 50 hours, we never once heard mention of this amendment coming forward or discussion on the care cap. Indeed, when this Chamber was busy debating the social care levy, we were beavering away in Committee on the Bill, oblivious to the fact this measure was coming down the track. If the Government cannot even get their decision-making processes integrated, what hope is there for integrating health and social care?

As we know, the aim of the new clause is to remove means-tested benefits from the costs that count towards the care cap. As has been pointed out far and wide by Members from all parts of the House, that change adversely impacts some more than others. It is a wholly regressive measure, to say the least, to give support through means-testing, but then to penalise people later for receiving it in the first place. We will vote against this iniquity, and I hope many Conservative Members will vote with us. They should be used to the Prime Minister’s broken promises by now; this is their chance to make the point that he should stand by what he says.

Oral Answers to Questions

Geraint Davies Excerpts

Tuesday 19th October 2021 Commons Chamber

[Sajid Javid]

I absolutely agree with my hon. Friend, and I thank her for raising this issue. I share those concerns. Over the past year, the number of young people being urgently referred for eating disorders has doubled. In the light of that, I was astonished to learn that one of Facebook’s own internal studies, which was brought to light by Ms Haugen, found that 17% of teen girls said that their eating disorders got worse after using Instagram. Facebook did not think it was appropriate to inform parents, healthcare professionals and legislators. I do think it is time for Facebook to do the right thing and publish what it knows.

[Geraint Davies (Swansea West) (Lab/Co-op)]

T3. As a former Chancellor, the Health Secretary will know that air pollution kills 64,000 people a year at a cost of £20 billion a year, according to the Royal College of Physicians, and twice that according to the World Health Organisation. Will he urge the Government to ensure that there are legally binding WHO limits in the Environment Bill, which we will consider tomorrow, to save tens of thousands of lives and tens of billions of pounds, and to send a message to the world on combating the 8.7 million deaths a year from air pollution?

[Sajid Javid]

The Government have a proud record on combating air pollution. The hon. Gentleman is right to raise the ongoing challenges of that, and I know that the Government, including the current Chancellor and the Environment Secretary, take it very seriously.