Puberty-suppressing Hormones
Judith Cummins Excerpts(1 week ago)
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The Secretary of State for Health and Social Care (Wes Streeting)
With permission, Madam Deputy Speaker, I shall make a statement on puberty blockers.
At the outset, I wish to make clear the principles that drive the Government’s approach to this issue. First, children’s healthcare must always be led by evidence. Medicines prescribed to young people should always be proven to be safe and effective. Secondly, evidence-led, effective and safe healthcare must be provided to all who need it, when they need it. Thirdly, this Government believe in the dignity, worth and equality of every citizen, and recognise that trans people too often feel unsafe, unrecognised and unheard, and that must change. None of these simple ambitions has been achieved in recent years. Medicine has been provided with insufficient evidence, and young people have been left to go without the support and care that they need. This Government are determined to change that.
The Cass review made it clear that there is not enough evidence about the long-term effects of using puberty blockers to treat gender incongruence to know whether they are safe or beneficial. That evidence should have been established before they were ever prescribed for that purpose. It is a scandal that medicine was given to vulnerable young children, without proof that it was safe or effective, or that it had gone through the rigorous safeguards of a clinical trial.
Following the Cass review, the NHS ceased the routine use of puberty blockers to treat gender incongruence in children. In May, the previous Government issued an emergency order to extend these restrictions to the private sector. In Opposition, my party and I, as shadow Health and Social Care Secretary, supported those decisions. Since coming into office, I have renewed this order twice, continuing restrictions until the end of this year. That was done jointly with the Health Minister in Northern Ireland, and I updated the House via a written statement.
While the temporary ban was in place, I asked the Commission on Human Medicines to look at the current environment for prescribing puberty blockers, and we launched a targeted consultation. The commission is an independent body, made up of leading clinicians and epidemiologists, that advises on medicine safety. It took evidence directly from clinical experts, consultant paediatric endocrinologists and patient representatives, including representatives of trans people, young people and their families. After thoroughly examining all the available evidence, it has concluded that prescribing puberty blockers to children for the purposes of treating gender dysphoria, in the current prescribing environment, represents “an unacceptable safety risk”. Of particular concern to the commission was whether these children and their families were provided with enough time and information to give their full and informed consent. The commission found that children had received prescriptions after filling out online questionnaires and having one brief Zoom call with prescribers from outside the UK.
Consequently, the commission has recommended that the Government extend the banning order indefinitely, until a safe prescribing environment can be established for these medicines. On the basis of those findings, I am acting on the commission’s advice and putting in place an indefinite order to restrict the sale or supply of puberty blockers to under-18s through a prescription issued by either a private UK prescriber, or a prescriber registered outside the UK. This is on the advice of expert clinicians, the independent Commission on Human Medicines—advice based on the best available evidence—and follows the cautionary and careful approach recommended by Dr Cass. The legislation will be updated today, and will be reviewed in 2027, when there will be an updated assessment of the safety of the prescribing environment for these medicines.
We are working to grow a thorough evidence base for puberty blockers. The National Institute for Health and Care Research is working closely with NHS England to establish a clinical trial on puberty-supressing hormones. The NIHR is now contracting the team that will deliver the study and is working tirelessly towards recruiting the first patients by spring. The trial is the first of its kind the world over. It will help us better understand the effects of puberty-suppressing hormones on young people, providing the robust evidence required.
The Cass review also made clear recommendations to the Government and NHS England on improving healthcare services for children with gender dysphoria. I will now provide an update on the progress made. NHS England has published its implementation plan, which will transform its services. It has also published a new services specification, to ensure that children and young people experiencing gender incongruence have an appointment with a paediatrician or mental health professional before being referred to specialist services. Dr Cass was clear on the need for the model of care to change and take account of children and young people’s holistic needs.
Since April, NHS England has opened three new gender identity services—in the north-west, in London and in Bristol—with a fourth expected in the east of England by the spring. That puts us on track to open services in every region by 2026. These services offer a fundamentally different clinical model. They bring together clinical experts in paediatrics, neurodiversity and mental health, so that care can be tailored to patients’ needs. At first, the new services were prioritising patients registered with the old Gender Identity Development Service, but I am delighted to report that the north-west and Bristol services are now taking patients off the general waiting list.
On the waiting list, Dr Cass’s review painted a picture of a service unable to cope with demand. Children and young people face unacceptably long waits for care, with some children passing into adulthood before their first appointment, leaving them facing a dangerous cliff edge. I am pleased to tell the House that NHS England is working with potential partner organisations to explore establishing a much-needed follow through service for 17 to 25-year-olds, as Dr Cass recommended. Young people’s distress or needs do not vanish when they turn 18, and neither should their healthcare.
We do not yet know the risks of stopping pubertal hormones at this critical life stage. That is the basis on which I am making decisions. I am treading cautiously in this area because the safety of children must come first. There are some who have called on the Government not to go ahead with the clinical trial recommended by Dr Cass. Others on the opposite side of the debate want the Government to ignore the recommendations of the independent expert Commission on Human Medicines. We are taking a different approach. The decisions that we take will always be based on the evidence and the advice of clinicians, not on politics or political pressure.
Finally, there are many young people in this country who are desperately worried and frightened by the toxicity of this debate. This has not been helped by some highly irresponsible public statements, which threatened to put vulnerable young people at risk. In the past few months, I have met young trans people, who either have been, may be, or will be affected by the decisions that I and my predecessor have taken. I have listened to their concerns, fears and anxieties, and I want to talk directly to them. I know it is not easy being a trans kid in our country today. The trans community is at the wrong end of all the statistics for mental ill health, self-harm and suicide. I cannot pretend to know what that is like, but I do know what it is like to feel that you have to bury a secret about yourself, to be afraid of who you are, to be bullied for it, and then to have the liberating experience of coming out. I know it will not feel like it, based on the decisions that I am taking today, but I really do care about this, and so does this Government.
I am determined to improve the quality of care and access to healthcare for all trans people. I am convinced that the full implementation of the Cass review will deliver material improvements in the wellbeing, safety and dignity of trans people of all ages, and the Government will work with them to help them live freely, equally and with the dignity that everyone in our country deserves. I commend this statement to the House.
Wes Streeting
I can certainly give my hon. Friend that assurance. Better-quality evidence is critical if the NHS is to provide reliable and transparent information and advice to support children and young people, and their parents and carers, in making potentially life-changing decisions. That is why we support the setting up of the study into the potential benefits and harms of puberty-supressing hormones as a treatment option. The study team’s application for funding is going through all the usual review and approval stages ahead of set-up—including peer review, consideration by the National Institute for Health and Care Research funding committee, and ethical approval processes. We want the trial to begin recruiting participants in spring 2025. I am confident in the robust, appropriate and ethical way in which the trial is being established.
Helen Morgan (North Shropshire) (LD)
I thank the Secretary of State not only for the content of his statement, but for its tone and his recognition of the importance of such a tone in this place. For too long, children and young people who are struggling with their gender identity have been badly let down by low standards of care, exceptionally long waiting lists and an increasingly toxic public debate.
Before GIDS closed, more than 5,000 young people were stuck on the list for an appointment and waited, on average, almost three years for their first appointment. For teenagers going through what is often an incredibly difficult experience, three years must feel like an eternity, so change is desperately needed.
The Liberal Democrats have long pushed to ensure that children and young people can access the high-quality healthcare that they deserve. We welcome the NHS move to create multiple new regional centres, but those centres must get up and running as quickly as possible. Will the Secretary of State outline what steps the Government are taking to ensure that happens in every region, and will he give a timetable for that work? Tackling waiting lists and improving access to care must be priorities.
I understand why today’s news is causing fear and anxiety for some young trans people and their families, who have been badly let down for so many years—not least those I have met in my constituency, who have highlighted the catastrophic mental health impacts of the situation. It is crucial that these sorts of decisions are made by expert clinicians based on the best possible evidence. Will the Secretary of State publish all the evidence behind his decision, including the results of the consultation, to give those families confidence that this is the right move for them?
We welcome the announcement of a clinical trial. We need the NHS to build up the evidence base as quickly as possible, and the Government to provide certainty that they will follow evidence and expert advice on behalf of those children.
Tobacco and Vapes Bill
Judith Cummins ExcerptsTuesday 26th November 2024
(3 weeks, 1 day ago)
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Mary Kelly Foy (City of Durham) (Lab)
I declare an interest as the co-chair of the all-party parliamentary group on smoking and health. Just over a year ago, I welcomed the previous Government’s Tobacco and Vapes Bill. As the House may know, I have called for a smokefree generation for many years. I was not best pleased when the Conservatives voted down my amendments to the Health and Social Care Bill in 2021. Those amendments called for a ban on flavours and packaging targeted at children, which the shadow Secretary of State has just brought to the House’s attention. If they had not been voted down, we would already have regulations to protect children from smoking and vaping.
I join the Secretary of State in congratulating the former Prime Minister, the right hon. Member for Richmond and Northallerton (Rishi Sunak) on bringing the Smoking and Vapes Bill forward, but it was regrettable that the previous Government did not fast-track it in the wash-up before the general election. Nevertheless, I am grateful to the Labour Government for bringing this Bill forward. It is stronger than the previous legislation, and it responds to many of the issues that I and others raised in Committee with the previous Bill.
The comprehensive regulation of all vaping and nicotine products is important for addressing the concerns that vaping has become too widespread among young people. I strongly support regulations to reduce the appeal of such products, but we must ensure that the regulations are enforceable, robust and fit for purpose. My first of many questions to the Minister is this: will he confirm that a detailed policy paper will be forthcoming, setting out the policy objectives on vaping and how the new regulations will deliver against the objectives?
The Labour manifesto made a bold commitment on halving the gap in healthy life expectancy between the richest and poorest regions in England. Tobacco control is the best way to close the gap. We cannot say it enough: the range of diseases that smoking causes is extraordinary, from stillbirths and asthma in children to heart disease, stroke, dementia in old age, poor mental health and many cancers.
It will never cease to amaze me that there are people in this place who are happy to be lobbied by the tobacco companies—including, I am guessing, the shadow Secretary of State—some of whom we have heard from already, knowing full well the damage caused to individuals, families and communities, as well as to our health services. That includes communities such as mine in the north-east of England, where smoking is still the key driver of health inequalities and has been the cause of 26% of all deaths in the last 50 years and the cause of 125,000 deaths since 2020.
In my constituency of City of Durham, smoking costs us over £95 million a year, and more than £3 million is spent on healthcare. In County Durham, smoking costs us over £500 million a year, and over £21 million is spent on healthcare. In the north-east, the cost is over £2 billion, with healthcare costs at over £93 million. Nationally, smoking is still the greatest cause of preventable death, still the leading cause of premature death and disability, and still responsible for half the difference in healthy life expectancy between the rich and poor. That is why I have asked time and again in this Chamber for action.
It is a tragedy when we consider the further health implications. According to Cancer Research UK, the most deprived communities will not be smokefree until 2050. I urge the Government to restate their intention to publish a road map to a smokefree country and outline how support will be targeted at those who most need to quit. Smoking is also directly and indirectly linked to poor mental health. Nearly 40% of those who have a severe mental health problem smoke, and smoking accounts for two thirds of the reduction in life expectancy among that group.
I want to touch on the “polluter pays” levy. The Darzi review found that our health service is in real trouble. The Secretary of State is right that to rebalance supply and demand in our healthcare system, we need a major shift from sickness to prevention. The Khan review and the all-party parliamentary group on smoking and health have advocated for a “polluter pays” levy, which could raise £700 million a year to create a smokefree fund. That would ensure that the tobacco companies—not the public—pay for the harm that they inflict. Will the Minister consider that approach to fund the work needed to reduce smoking across society and to protect the NHS?
I should add that public health initiatives to tackle smoking are remarkably good value for money and that failing to fund efforts to tackle smoking is a false economy. Initiatives such as Fresh—the north-east’s tobacco control programme—have led the way in tackling smoking in our region. Fresh and others could provide best practice for the Department.
The Minister will know that the UK Government are party to the World Health Organisation framework convention on tobacco control. Article 5.3 seeks to protect policymaking from industry influence, but we have already seen that influence even at this stage of the Bill. Will the Minister confirm that the Government will live up to their obligations under the FCTC and commit to protecting the Bill from industry influence throughout its parliamentary process and the following regulations?
I am proud to vote for a Bill that will improve people’s lives and extinguish the injustice that smoking causes to individuals and society. Smoking is never about choice, and it is pathetic that some Members have argued that this is an issue of freedom; it is absolutely nothing of the sort. Tobacco companies target children and young people. Smoking is an addiction, and the only free choice is that first cigarette. When someone is in hospital, struggling to breathe because of smoking-induced lung cancer, where is their freedom? Today, we have the opportunity to give people the freedom to live healthy lives, free from disease and the inequalities that smoking causes.
Several hon. Members rose—
Madam Deputy Speaker (Judith Cummins)
After the next speech, I will impose a six-minute time limit.
Infected Blood Inquiry
Judith Cummins Excerpts(4 weeks, 1 day ago)
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John McDonnell (Hayes and Harlington) (Ind)
On a point of order, Madam Deputy Speaker. I apologise for raising a point of order out of sequence, and I will explain why I am doing so. It relates to the case of Mr Alaa Abd el-Fattah and a point of order that I raised over a week ago. Some Members may recall that he is a British citizen who was imprisoned for his human rights campaigning in Egypt. He has served his sentence of five years and should have been released in September, but was not. His mother, a well-known academic at Cairo University, has been on hunger strike for 50 days. Anyone who has had any experience of hunger strikes knows that this is a critical period.
A number of us wrote to the Foreign Secretary over 10 days ago about this case, urging him to make further representations to the Egyptian Administration to secure Mr el-Fattah’s release. As of close of play today, we have not received a response. Through you, Madam Deputy Speaker, could I urge the Foreign Secretary to respond and, more importantly, take action? I am now fearful for the life of Laila, Mr el-Fattah’s mother, because as I said, the hunger strike has entered its 50th day.
Madam Deputy Speaker (Judith Cummins)
The very serious matter raised by the right hon. Member is not one for the Chair, but he has placed his concerns on the record in the hearing of the Foreign Office.
Income Tax (Charge)
Judith Cummins Excerpts(1 month, 1 week ago)
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Jas Athwal (Ilford South) (Lab)
Our NHS is literally a lifeline for so many of us across the country. Last year, I witnessed that at first hand. From riding 85 miles on a Sunday, I went for precautionary tests on the Monday. To my horror, the arteries around my heart were completely blocked. It was an incredibly difficult time for me and my family, but the NHS was there for me: the doctor, the cardiologist who told me the news in such a nice way it felt as if nothing was wrong, the surgeon who operated on me very urgently because that needed to be done quickly due to the potential impact it could have had on me, and the nurses who nursed me back when I needed the care the most. Like so many in this Chamber and across the country, the healthcare professionals—the doctors, nurses and administrative staff—are the reason I am able to stand here today in good health to address the Chamber. Among them are the very neighbours who took care of me during my time in hospital.
As Members are all too well aware, however, the NHS is far from perfect. Tory austerity decimated the NHS and the covid mismanagement added fuel to the burning fire engulfing the NHS. Our waiting lists are at record levels: 7 million people waiting for elective treatments; 10% of patients now waiting 12 hours or more in A&E; and 350,000 people a year waiting for mental health support. This is the worst crisis for our NHS since its formation 76 years ago.
Protecting our NHS is crucial, so that people can get the treatment they need, when they need it. Whether it is a heart bypass like mine, a transplant or cancer treatment, this Labour Budget delivers a decisive shift from the disastrous—
Several hon. Members rose—
Madam Deputy Speaker
Order. Before I call the next speaker, I gently remind Members that we are on a three-minute time limit. Also, when I am standing, Members should please sit down.
Mr Angus MacDonald (Inverness, Skye and West Ross-shire) (LD)
It is appropriate that I am following the words of the hon. Member for Stafford (Leigh Ingham) about the palliative care sector. I am grateful for the substantial settlement for the NHS, especially as Scotland will get £3.4 billion, which will make an enormous difference. The Belford hospital in Fort William has been condemned, effectively, for 25 years. Unfortunately, I have very little confidence in the Scottish Government to spend that £3.4 billion well.
I recently spoke with Kenny Steel, the chief executive officer of Highland hospice in Inverness, who told me that the changes to employer national insurance are expected to add an unaffordable £177,000 to its annual salary bill. That comes on top of the need to remain competitive with the 5.5% salary increase awarded to NHS staff. Marie Curie anticipates that the NI increase will cost it £3 million a year—money it does not currently have.
The Government’s planned increase in employer NI contributions to 15% from April 2025 is an impossible amount for the palliative care sector. If those essential care providers cannot absorb the additional cost, their survival is at risk. If hospices fail, the patients they support will inevitably turn to the NHS, placing greater pressure on an already overstretched system. If the Minister could listen to me and put his phone down for a moment, I would be grateful—can you listen to me, just for a second?
Madam Deputy Speaker (Judith Cummins)
I remind the hon. Member not to address other people in the Chamber as “you”, as he is actually addressing me. Please continue.
Mr Angus MacDonald
Palliative care charities are essential partners that deliver compassionate, dignified end-of-life care on behalf of, and much cheaper than, the NHS. Organisations that provide healthcare for the NHS should be treated like NHS bodies in these decisions. Increasing NI contributions for hospices but not the NHS places those providers in a critical financial position, and firmly indicates that the Government regard organisations such as Highland hospice as second-class.
Access to Primary Healthcare
Judith Cummins Excerpts(2 months ago)
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Monica Harding (Esher and Walton) (LD)
I am proud to speak today about our NHS, which looks after my constituents in Esher and Walton—young, old and in the middle—every day. But after years of neglect and failure by the previous Government, my constituents too often struggle to access primary healthcare, which we believe should be a right. The NHS was denied necessary reforms and resources, and it has not been prepared for an ageing population with increasing rates of chronic and complex conditions. The extra strain is demonstrated in the ratio of patients per GP and in the daily lives of my constituents, who suffer long waits or are unable to get appointments. I recently received a letter describing how a GP appointment for a constituent’s elderly mother was cancelled at short notice and had not been rescheduled after a month, despite several emails. Problems like this are far from being one-offs.
In my constituency, residents often struggle to get same-day GP appointments, and too many wait more than a week. Our personal citizen contract with the NHS is implicit in being British, but that contract is fraying. Being able to access a GP in a timely manner is an essential expectation that my constituents still have, which is why enshrining the Liberal Democrat guarantee of access to an appointment within seven days as a right in the NHS’s constitution is so important. It reflects the duty of the Government to ensure that one’s local GP is always accessible.
The excessive wait times are intimately connected with the Conservative failure to recruit and retain GPs. In the previous Government’s 2019 manifesto, they committed to recruit more than 6,000 GPs; instead, there are fewer GPs than there were five years ago. Since then, however, the population has continued to rise and age, and conditions have become more complex. The broken Conservative promise—yet another failure—means that in the last eight years, the number of patients per fully qualified GP in the Surrey heartlands has risen to 2,163, even though the UK has one of the lowest ratios of doctors to people, recently ranking 22nd out of 33 OECD countries. Even when people can get an appointment, it is often not with a GP, often unknowingly.
As my hon. Friend the Member for Westmorland and Lonsdale (Tim Farron) pointed out, the policies pursued by the previous Government, including the restrictions on the recruitment of GPs under the additional roles recruitment scheme, have resulted in incidents of GPs in Esher and Walton being offered voluntary redundancy, even as residents struggle to get an appointment. Our most vulnerable patients have a particular need for security and stability, and this belief under- pins the Lib Dem conviction that everyone over the age of 70 or with a long-term physical or mental health condition—
Madam Deputy Speaker (Judith Cummins)
Order. I call the Liberal Democrat spokesperson.
NHS Performance: Darzi Investigation
Judith Cummins Excerpts(2 months, 1 week ago)
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Wes Streeting
I strongly agree with the Chair of the Select Committee and commend the work of the previous Committee, to which she refers. She has certainly given me some revision for the first meeting that I will attend. To answer her question, she is absolutely right that digital transformation and place-based healthcare planning are key. This Government will have a much sharper focus on health inequalities than the previous Government did. In fact, if we consider the NHS over the past 30 or 40 years, even when it has performed well overall, and patients in every part of the country have received access to timely care, some health systems have still been more challenged than others. We need to be honest about the structural challenges in those areas. Secondly, she is absolutely right that, if we are serious about health and prevention, we need a serious cross-Government approach. That is why I am delighted that the Prime Minister’s mission-driven approach has already seen Departments coming together with a focus on prevention. That will deliver fruit.
This is the major surgery that our national health service needs over the next decade to make it fit for the future. There is no time to waste, so we have hit the ground running. We inherited a Care Quality Commission that is not fit for purpose. I was genuinely stunned to learn that one in five health and care providers has never been inspected; some hospitals have been left uninspected for a decade; and inspectors were sent to care homes when they had never met someone with dementia. The Conservatives did not think that patients would like the answers, so they stopped asking the questions. This Labour Government are different: we will be honest about the problems facing the health service, and serious about solving them. Our policy is radical candour.
Today I am delighted to announce that Sir Julian Hartley has been appointed the new chief executive of the CQC. He is a proven reformer with a track record of turning around large organisations, and I am confident that he will provide the leadership that staff in the CQC need to address this crisis, improve patient safety and restore confidence in the regulator. Sunlight is the best disinfectant, so this Government are taking action to turn the regulator around. That is the difference a Labour Government make.
We inherited the farce of newly qualified GPs facing unemployment. Patients could not get a GP appointment, while GPs could not get a job, so we cut red tape, found the funding and are recruiting an extra 1,000 GPs. That is the difference a Labour Government make. We have tabled a motion to ban junk food ads targeted at children —our first step towards making our country’s children the healthiest generation that has ever lived. That is the difference a Labour Government make. Just this week, the Secretary of State for Science and Technology and I announced funding to produce new cutting-edge cancer treatments: a new blood test that can detect 12 different cancers. We are backing Britain’s scientists to save lives. That is the difference a Labour Government make.
Of course, strikes in the NHS have cost taxpayers billions. Patients saw 1.5 million operations and appointments cancelled. The Conservatives saw strikes as an opportunity to scapegoat NHS staff, so they let the strikes rage on. In fact, the shadow Health Secretary had not even bothered to meet the junior doctors since March. This Government do not exploit problems; we solve them. I called the junior doctors on day one and met them in week one, and in just three weeks, we had negotiated a deal to end the strikes. That is the difference a Labour Government make.
Those are just our first steps. Rebuilding the NHS will not be easy and it will take time, but we have done it before and we will do it again. Along with the millions of dedicated staff in health and social care across our country, this can be the generation that takes the NHS from the worst crisis in its history to build an NHS fit for the future—an NHS that is there for us when we need it, with world-class care for the many, not just the few. That is the change that Britain voted for; that is the change we will deliver together; and that change has already begun.
Madam Deputy Speaker (Judith Cummins)
Before I bring in the Opposition Front Benchers, the House should be aware that over 50 Members wish to speak in the debate, so I ask you to help each other. On this occasion, I will impose a three-minute limit on Back-Bench speeches, with the exception of maiden speeches and that of the Chair of the Health and Social Care Committee. I call the shadow Secretary of State.
Debbie Abrahams
As a former public health consultant, I would obviously agree with my hon. Friend. I have similar health inequalities across Oldham. I was about to talk about the impact of other issues, such as social security cuts, which meant greater poverty, including in-work poverty and children from working families living in poverty. That has had a consequential impact on our health as a whole. We have flatlining life expectancy, and in areas such as mine, life expectancy has got worse. That impacts on our productivity and the wealth of our country.
I will briefly mention a couple of points that I know my right hon. Friend the Secretary of State recognises, and might want to consider. An annual report on the state of our health and the state of our NHS, presented to Parliament before each Budget, would pick up on the points that have been raised about cross-departmental impacts on health. We should have a prospective assessment of the impacts of the Budget and the Finance Bill on poverty and inequality, and subsequently on health and the NHS. That can be done; others are doing it. We should have a strategy to identify and address health equity issues in the NHS. We have seen a bit of that through covid, in the inequity around the use of oximeters. We should introduce something like “Improving working lives” for our staff. That had a massive effect on staff when I worked in the NHS. We need a clear commitment to the 1948 principles of the NHS, under which it is funded from general taxation, and a funding allocation based on need.
Points of Order
Judith Cummins Excerpts(3 months ago)
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The Secretary of State for Health and Social Care (Wes Streeting)
Further to that point of order, Madam Deputy Speaker. I like the hon. Lady very much, and I will just say two things in response: first, she has been around in this Chamber a long time. Conservative Members cannot sit and heckle, then get cross when Ministers respond robustly. Secondly, I think that was a perfectly legitimate analogy; indeed, I might say that the arsonists should not complain about the fire brigade.
Madam Deputy Speaker (Judith Cummins)
I remind all hon. Members that good temper and moderation are the characteristics of a good debate.
Sir John Hayes (South Holland and The Deepings) (Con)
On a point of order, Madam Deputy Speaker. You will recall that I have raised in the House the use of crossbows by criminals. These are lethal weapons. The previous Government added to the list of weapons that are banned, and the current Government are implementing those measures. Have you had any notice of a statement being brought to the House by Ministers to respond to the increasingly pressing cries from those who want to see crossbows added to that list of banned weapons?
Madam Deputy Speaker
I thank Sir John for his point of order. It is not a matter for the Chair, but I can clarify that we have not had notice of a statement.
Bill Presented
Terrorism (Protection of Premises) Bill
Presentation and First Reading (Standing Order No. 57)
Secretary Yvette Cooper, supported by the Prime Minister, Pat McFadden, Secretary Ian Murray, Secretary Jo Stevens, Lucy Powell and Dan Jarvis, presented a Bill to require persons with control of certain premises or events to take steps to reduce the vulnerability of the premises or event to, and the risk of physical harm to individuals arising from, acts of terrorism; to confer related functions on the Security Industry Authority; to limit the disclosure of information about licensed premises that is likely to be useful to a person committing or preparing an act of terrorism; and for connected purposes.
Bill read the First time; to be read a Second time Monday 7 October, and to be printed (Bill 9) with explanatory notes (Bill 9-EN).
NHS: Independent Investigation
Judith Cummins Excerpts(3 months ago)
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Wes Streeting
I thank my hon. Friend for her question and congratulate her warmly on her election to the Chair of the Work and Pensions Committee. I am looking forward to sharing, through the Secretary of State for Work and Pensions, the work that our Departments are doing together, particularly on the link between mental health and unemployment and on integrating pathways. She is right about the social determinants of ill health. That is why I am genuinely excited that, through the mission-driven approach that the Prime Minister has set out, we are already bringing together Whitehall Departments, traditionally siloed, to work together on attacking those social determinants. The real game changer is genuine cross-departmental working, alongside business, civil society and all of us as active citizens, to mobilise the whole country in pursuit of that national mission, in which we will be tough on ill health, and tough on the causes of ill health, as someone might have said.
Sir Edward Leigh (Gainsborough) (Con)
I greatly respect the Secretary of State, and, as an older person who relies on the NHS, I support his radical zeal. I repeat what he said in his statement: cancer is more likely to be a death sentence for NHS patients than for patients in other countries. We have had this conversation previously, but can he at least look at the health systems in other countries, particularly those in the Netherlands, Australia, France and Germany? Those countries, which have wonderful health systems protecting the vulnerable, use a mixture of social insurance and public and private funds to maximise inputs into their health services.
Several hon. Members rose—
Madam Deputy Speaker (Judith Cummins)
Order. I am aiming to end this statement at 1 pm. I remind Members that anyone who was not in for the start of the statement will not be called.
Ms Polly Billington (East Thanet) (Lab)
A recent survey of staff at East Kent Hospitals University NHS foundation trust showed that less than half of employees would be happy for their loved ones to be treated at an east Kent hospital. That is a devastating verdict from staff, showing the impact on their morale and on confidence in the community for the care that people need. Does the Secretary of State agree, however, that a broken NHS is not the fault of staff like them, but down to the previous Government’s decade of austerity and top-down reorganisation of the NHS?
Several hon. Members rose—
Madam Deputy Speaker
Order. I ask Members to help each other with one or two-sentence questions.
Emily Darlington (Milton Keynes Central) (Lab)
To return to a subject close to the Secretary of State’s heart, does he agree that people’s actual experience is how we will measure whether the NHS has been improved? One of my children’s grandparents, who was diagnosed under a Labour Government, had 12 great years of cutting-edge treatments and 12 years with their grandchildren. Their grandfather, who was diagnosed under a Conservative Government, had 12 weeks.
Wes Streeting
My hon. Friend is absolutely right: the health of the nation and the health of the economy are inextricably linked. Under this Government, the Department of Health and Social Care is a Department for growth as well as a Department for health and care, and the Chancellor understands those linkages too. I can say to my hon. Friend and all of her friends at the King’s Fund—we were delighted to see them host the Prime Minister this morning—that unlike our predecessors, this Government cannot get enough of experts.
Madam Deputy Speaker (Judith Cummins)
That concludes the statement. We have had more than 45 contributions from Back Benchers, so I thank you for your patience.
Medicines
Judith Cummins Excerpts(3 months, 1 week ago)
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The Minister for Secondary Care (Karin Smyth)
I beg to move,
That the draft Human Medicines (Amendments Relating to Naloxone and Transfers of Functions) Regulations 2024, which were laid before this House on 29 July, be approved.
I, too, congratulate you on your election, Madam Deputy Speaker; it really is a pleasure to see you in the Chair.
The draft statutory instrument will amend the Human Medicines Regulations 2012 to expand access to naloxone: a lifesaving medication that reverses the effects of an overdose from opioid drugs. In addition, the SI will keep the regulations current by updating references to Public Health England and the Health and Social Care Board, following the dissolution of those bodies.
Hon. Members will no doubt know of the devastating impact of illicit drugs. Drugs destroy lives, tear families apart and make our streets less safe. Almost 3,000 people died of drug misuse in England in 2022—the highest number since records began in 1993. Drug misuse deaths have doubled over the past 10 years, and people die from drug misuse at a tragically young age, often in their 40s. Almost half of drug misuse deaths in 2022 involved opiates such as heroin.
These deaths are avoidable. Dedicated drug treatment services provide the path to recovery, and my Department is continuing to invest in improvements to local treatment services, which have faced significant cutbacks. We also know that over half the people struggling with opiate addiction are not engaged in treatment at all. That means that significant numbers of an incredibly vulnerable population are at increased risk of accidentally overdosing and dying.
People who experience addiction often have multiple complex needs, and we know that there is a strong link between addiction and deprivation. The rate of drug misuse deaths in the most deprived areas of England is almost three times higher than in the least deprived. Nearly a third of people in treatment for drug or alcohol problems reportedly have a disability, around one in six have a housing problem, and around 70% have a mental health treatment need. Tackling this issue supports the Government’s health mission, ensuring that people can live longer, happier lives, as well as our collective efforts to break down barriers to opportunity and create a fairer society.
Naloxone is a highly effective antidote against opiate overdose. It can be administered quickly and safely by anyone in an emergency, but currently exemptions in the human medicines regulations targeted at specific providers enable supply only by drug and alcohol treatment services, which limits the reach of this lifesaving medicine. Widening the statutory framework will mean that more services and professionals are able to supply this medication. That means easier access to it for people at risk and their loved ones. In short, the legislation will save lives. We are already seeing the benefits of professionals outside the health service, such as police officers, being able to administer naloxone. North Yorkshire police have already saved seven lives since April, when naloxone was rolled out across the force.
The draft instrument proposes two key UK-wide changes to existing regulations. First, it will expand the list of services and professionals named in the regulations who are able to give out naloxone without a prescription. In short, that means that professionals such as registered nurses and probation officers will be able to provide take-home supplies of naloxone where appropriate, should they wish to do so. Secondly, we propose to establish national registration services across the whole of the United Kingdom. That will enable all other services and professionals who are unable to be named in the legislation, including housing and homelessness services, to register and procure naloxone, subject to the passage of this statutory instrument. I look forward to working with colleagues across the devolved Governments on this important issue; I thank them for their work to date, and their continued support.
I reassure hon. Members that we are not compromising on safety with these changes. This is an extremely safe and effective measure, even when administered by a layperson with no prior experience. It has an effect only if the person has taken opioids, and is already widely used across the UK and internationally. We are taking steps to mitigate any, very limited, risks associated with wider access. We will provide updated guidance for services in scope, and set out robust requirements for training and safeguarding. The new powers are enabling but not mandatory. The intention is not to create new burdens for services, but to provide an opportunity for provision based on local need. I am confident in the support for the changes across sectors, which was evident in the responses to my Department’s consultation earlier this year, over 90% of which were in support.
I recognise the long-standing calls for these changes among experts in this area. For instance, the Advisory Council on the Misuse of Drugs is an independent expert body that advises the Government on drug-related issues in the UK. In 2022, it published a review of naloxone implementation that called for more work to widen access to the medication. Similarly, Dame Carol Black’s independent review of drugs also highlighted expansion as a vital harm-reduction measure. I pay tribute to Dame Carol for the work that she has done to drive improvements in drug treatment and recovery, and express my gratitude for her continued advice and expertise.
The importance of this work only continues to increase as time goes on. Hon. Members may be aware of the growing threat posed by synthetic opioids. These synthetic drugs, such as nitazenes and fentanyl, are often more potent and more deadly. The Government are taking a range of steps to prevent the rise of these dangerous drugs in the UK, but the availability of naloxone will be vital to our ability to respond and save lives.
Addiction is not a choice. It is often fuelled by wider issues, such as trauma and housing instability. This is a complex public health issue and must be tackled as such. We must change the narrative on addiction to one that is about preventing drug use, reducing harm and enabling recovery. The changes in the legislation are simple and low risk, but have the potential to save countless lives. On that basis, I commend the draft regulations to the House.
Dr Ben Spencer (Runnymede and Weybridge) (Con)
It is not often that one speaks in this place on changes to the law that will have the direct result of saving lives, but once the draft regulations pass, as I hope they will this evening, we expect them to save many peoples’ lives. Today is a very special occasion. I do not say this to disparage people who work in the public health industry, but at its core, public health is not about flash or pizazz; it is about incremental changes that make a real difference to people’s lives, and have an ongoing, cumulative effect. Naloxone reverses the effects of opiate intoxication or overdose. It stops people from dying of accidental or deliberate overdoses of heroin and other opiate drugs, and opiate medications. It is quite literally a life-saving medication. Accordingly, it is one of the World Health Organisation’s essential medications.
Tomorrow is World Suicide Prevention Day, so I am pleased that we are supporting and debating a motion to expand access to and administration of a vital antidote to opiate poisoning. Suicide is the biggest cause of death in men under the age of 50. The stats vary, but while I was looking for the best and most recent data, I read that around three quarters of suicides each year are by men, and that suicide is the biggest killer of under-35s, impacting people from all walks of life. Many people are affected by such deaths. On World Suicide Prevention Day, we remember all those affected by suicide, and the work that we need to do to reduce suicides through public health measures and mental health service provision and treatment.
The use of highly addictive, lethal opiates, perhaps in combination with other substances, is often responsible for death as a consequence of drug misuse. In 2022, opioids were involved in 73% of drug misuse deaths in England, and 82% in Scotland. The last Government worked very hard to make progress on reversing the upward trend in drug poisoning deaths. Our 10-year, cross-departmental drugs strategy, published in 2022, aimed to prevent nearly 1,000 deaths in England by 2025. The naloxone roll-out has been highly effective in reducing drug misuse deaths by treating the effects of opiate overdoses.
There have been several regulatory changes that have expanded access in the last decade. Under the last Government, the Human Medicines Regulations were approved in 2012 to regulate the supply and use of drugs in the UK. That was followed by further amendments in 2015 and 2019, which focused on expanding access to naloxone for emergency use. The last Government then called on Dame Carol Black to lead an independent review of drugs policy. I thank Dame Carol for her work in this space, and indeed everyone working in this area, and those who contributed to our consultation earlier this year.
One of Dame Carol’s key recommendations was that more individuals supporting drug users be able to access and give out naloxone. I am pleased that she welcomed the proposals to expand access to naloxone earlier this year. When we launched a consultation seeking views on improving naloxone access through named services and professionals, as required by the Medicines and Medical Devices Act 2021, there was strong support. There were over 300 responses, of which a third were from organisations and over 200 from individuals and professionals. More than 80% were supportive of improving access through named services and professionals, and of introducing registration with a naloxone supply co-ordinator.
I am pleased that Ministers have followed the direction of the previous Government in legislating to expand access to naloxone to more healthcare professionals and services, as they want and need it. That will build on work across the UK to reduce the scourge of drug-related deaths caused by opioids. On this legislation, the Government will have the support of His Majesty’s loyal Opposition, and I encourage all colleagues from across the House to give it their backing.
Of course, I have a question for the Minister about training, which is critical. During my psychiatric training at medical school, a key thing instilled into my head about the use of naloxone is that it is a wonderful drug for the first 30 minutes, but then it starts to wear off. It has a short half-life—the time that it takes to leave the body—and then the effects of opiate overdose can start to reoccur, especially when we are talking about long-acting opiates, so although it fixes one problem, another problem is coming down the track. The patient must have adequate treatment quickly so that they do not suffer after effects when naloxone wears off. Can the Minister reassure me that for those involved in the administration of naloxone kits and aftercare—she mentioned families, and broader access for homelessness charities—the training component is as secure as possible, so that everything is done to avoid further drug-related deaths?
Gareth Snell (Stoke-on-Trent Central) (Lab/Co-op)
On a point of order, Madam Deputy Speaker. Last Thursday, during questions to the Leader of the House on the statement of business, I asked a question about BTecs in relation to colleges. Although it is registered in the Register of Members’ Financial Interests that I am a governor of two colleges, I failed to draw the House’s attention to that fact before asking my question. The two colleges that I am a governor of are affected by the answer, so I take this opportunity to place that on the record, and offer my unreserved apology to the House accordingly.
Madam Deputy Speaker (Judith Cummins)
I thank the hon. Member for his point of order and his clarification. I am sure the record will stand amended and corrected.
Business of the House (Today)
Ordered,
That at today’s sitting the Speaker shall put the Questions necessary to dispose of proceedings on the Motion in the name of Lucy Powell relating to the Modernisation Committee not later than one hour after the commencement of proceedings on the Motion for this Order; such Questions shall include the Questions on any Amendments selected by the Speaker which may then be moved; proceedings on that Motion may continue, though opposed, after the moment of interruption; and Standing Order No. 41A (Deferred divisions) shall not apply.—(Lucy Powell.)
Pharmacy Provision: Hampton
Judith Cummins Excerpts(4 months, 3 weeks ago)
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Munira Wilson
I thank my hon. Friend for his intervention, and I congratulate him on his excellent maiden speech. I completely agree with him. We want doctors to use community pharmacy more to alleviate the pressure on other parts of the health service, but frankly, if the pharmacies are not there, the remaining ones will be overwhelmed. I talked to local GPs in the Hampton area following these closures, and they were desperate to see more provision. They thought about trying to set up their own community pharmacy provision, but they just could not make the numbers add up because of the funding shortfall.
The Company Chemists’ Association estimates an average funding shortfall of £67,000 per pharmacy. That is based on an analysis of data published by the Department of Health and Social Care in a written parliamentary answer at the beginning of last year. Many pharmacists are left out of pocket, as they are reimbursed less for a number of medications than the price they pay, and there are stories of some using credit cards and overdrafts to purchase medication.
These funding pressures are coupled with major workforce challenges. When I met Boots following the news that it is closing two branches in Hampton, it cited a lack of pharmacists as a major reason for closing some 300 pharmacies across the UK, although commercial pressures were clearly the main driver. Layered on top of these issues are regular medicine supply shortages, which add more work and create more stress for already overstretched pharmacists. Community Pharmacy England reported last year that 92% of pharmacies were having to manage supply issues daily.
It is a perfect storm for community pharmacy at a time when we need preventive healthcare and self-care more than ever. The potential of community pharmacies to improve patient health and reduce the pressure on NHS hospitals and GPs is immense, yet they are closing in their hundreds every year. We should be relying on pharmacies even more to keep the nation healthy. The previous Conservative Government’s announcement of the Pharmacy First initiative was very welcome in its ambition, but if pharmacies are not even funded for the basics right now, with big gaps in provision opening up all over the country, it is hard to see how Pharmacy First’s ambitions will be achieved.
The Liberal Democrats would like to see the Government building on the Pharmacy First principle and giving pharmacists more prescribing rights and public health responsibilities. As in so many areas of public health, the “invest to save” argument is compelling, and I look forward to hearing the Minister’s comments on what the new Labour Government will do on funding to enable community pharmacy to not just survive, but thrive and grow as an essential part of our primary care infrastructure.
Having addressed the causes of these closures, I will spend some time exploring the processes involved in local communities being informed of pharmacy closures, and their input, or lack thereof, in them, as well as discussing the complete lack of transparency or accountability in relation to applications for new pharmacy licences. For starters, only those organisations designated as “interested parties” in the regulations are informed of new applications, and only their feedback has to be taken into account. Anyone else who is interested, such as me as a local MP, needs to make a freedom of information request, unless someone in the local health community passes on the information. My views, and the views of other people in the community, can be ignored.
To describe the bureaucratic process that sits around new applications as byzantine would be generous. I hope the Minister, Madam Deputy Speaker and other hon. Members will bear with me while I try to explain what happened in Hampton. We are part of the South West London Integrated Care Board, but NHS England has delegated the pharmacy market entry function for the whole of London to the North East London ICB, which is on completely the opposite side of the city. Officials have no local knowledge of our area, no understanding of local transport links and no relationships with the local health system.
Let me start with the closures. The Minister will be aware of the statutory three-month notice period for pharmacy closures; last August, Boots would have had to give NHS England three months’ notice of its intentions in Hampton. That information was not passed by NHSE to the Richmond health and wellbeing board. I find that utterly staggering. The first that local councillors, the local health community in the area and I as the MP knew about the planned closures was when Boots placed signs in its windows to inform customers, and concerned constituents started to contact me about the likely impact of the closures.
At the end of August 2023, while this was going on and we were all in the dark, the local health and wellbeing board published a pharmaceutical needs assessment, but it was inaccurate and failed to identify an imminent future gap in need in the Hampton North area because it had not been notified of the closures. The Tangley Park Boots subsequently closed in late October. The Priory Road Boots, which was directly opposite a busy GP surgery, closed in early November.
In November, an application was received for a new independent pharmacy licence on the Tangley Park Boots site. Once again, the local health and wellbeing board was not notified of the application—this time, for two whole months. During this period of complete silence, the health and wellbeing board issued a supplementary statement to the local pharmaceutical needs assessment, which identified the gap in Hampton. However, because the application for a new pharmacy was made in November, and it referred to the original needs assessment that was made before the supplementary statement was published, it was rejected, even though the application itself identified the gap, which was officially made clear in the supplementary statement subsequently published in December. Not only that, but it took the North East London ICB a full eight months to issue the rejection; tht happened earlier this month, even though the decision used evidence received in December to justify the rejection.
Madam Deputy Speaker, if you and other hon. Members are still managing to follow this sorry story, I hope you will agree that this decision is utterly perverse. It is also utterly unreasonable that timely applications to open pharmacies in response to multiple closures should be inherently prevented in this way. The delays in sharing information with the local health and wellbeing board and the delays in decision making are unforgivable. During the lengthy delay, the local authority received a planning application to change the Tangley Park pharmacy site into a fast food outlet. Thankfully, that was rejected earlier this month after representations from the public health team and councillors, but I am sure the public health Minister will agree that it would be unfortunate, to put it mildly, if a pharmacy were replaced with a fast food outlet.
One local official told me yesterday that the systems architecture is too complicated, and that there is a need for clearer responsibilities and accountability. Amen to that, I say. Healthwatch Richmond has demanded answers from the North East London ICB, but it has received a frankly woeful response that does not address the substantive question of why the application was so badly handled. The response passes the buck and blames regulations. To be clear, Healthwatch and I are not qualified to comment on the merits of an application; what we are doing is challenging the unfathomable process.
I say to the Minister that the huge funding challenges facing community pharmacy are pressing. I appreciate that they may be extremely difficult for him to address, given that the Chancellor has an iron fist as far as any additional public spending is concerned, but the Minister must wage a campaign to improve the funding situation. It makes financial sense. We will not grow the economy without improving the nation’s health. In that campaign, he will have cross-party support from Members on the Opposition Benches.
Revisiting the regulations and how NHS England is implementing them will cost next to nothing. There should be proper consultation with and involvement from the local community on closure notices, and changes in the process for new licences could ensure that we can quickly plug pharmacy gaps when they open up in areas such as Hampton. Crucially, those powers need to be delegated to the local ICB, with full involvement from the local health and wellbeing board. They know their communities and their geography best—trust them.
Finally, if the Minister could step in on the specific issues in my constituency—the application that has been rejected and is going NHS Resolution on appeal—simply to ensure a common-sense approach, the residents of Hampton North and I would be very grateful. We desperately need a new pharmacy for our community. I look forward to his response.