Preventable Baby Loss

Karin Smyth Excerpts

Wednesday 4th September 2024 Westminster Hall

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairmanship, Mr Dowd, and to speak for the Government in this important and moving debate. I am grateful to the hon. Member for Ashfield (Lee Anderson) for raising this important issue. As my hon. Friend the Member for Washington and Gateshead South (Mrs Hodgson) said, it is the last taboo, and the hon. Member for Clacton (Nigel Farage) articulated well the difficulties that many people have in knowing what to say.

The debate gives me the opportunity to put on the record my deepest sympathies to the bereaved families: thank you for making the decision to come here today. Others might be listening in on the Parliament channel. The decision to attend is brave, and I commend the hon. Member for Ashfield for giving voice to the moving and harrowing stories of Emma and Rob, Bianca Chapman, Amelia Bradley and Hayley Moore, about their babies, Olivia, Imiza and Theo.

We know that preventable baby loss remains a serious issue every time such debates come before the House. Today, we have heard how many people have taken part in previous debates; I have listened in before. What little consolation they must be for parents and wider families who have lost a loved one, but I am always inspired. I hope that the families present today recognise that every Member of Parliament is also a human being, with their own experience and that of their families. The issue touches every family; as the hon. Member for Strangford (Jim Shannon) said, it stays with families for decades. Sharing such experiences is brave of hon. Members, but they have given voice to how important the issue is.

Every baby’s death is tragic, but all the more devastating when parents are told that it could have been prevented. As we have heard, report after report has told us that this remains a serious issue in our health service, and that is backed up by the data. Two years ago, the Office for National Statistics found that almost 2,300 stillbirths were recorded in England and almost 1,700 neonatal deaths, a rate of 2.9 per 1,000 live births.

In 2022, I welcomed the Ockenden review, as many did, but it made for harrowing reading. The Government’s position is that any preventable death is unacceptable. We are committed to ensuring that all baby deaths that can be prevented will be prevented. Donna Ockenden’s review shone a light on maternity staff too exhausted to do their jobs. It showed patterns of poor care, a lack of adequate training for staff, and failure in governance and leadership that led to widespread avoidable harm and death, and to shocking inequalities in maternity provision. Dr Bill Kirkup’s review of East Kent identified similar themes, but also showed that leadership and culture changes were needed. That is why this Government stood on a manifesto commitment to train thousands more midwives and to set an explicit target to close the black and Asian maternal mortality gap.

There are a number of initiatives, some of which we have heard about today, and I will run through some of them. If I do not address some concerns expressed by hon. Members in my update, we will get be in touch with people, including the official Opposition—I commend the hon. Member for Sleaford and North Hykeham (Dr Johnson) on her experience in this area as a clinician as well as a spokesperson.

The NHS put in place a three-year plan to deliver the reviews’ recommendations to make maternity and neonatal care safer, more tailored to every new mother’s needs, and more equitable. That includes the Saving Babies Lives care bundle, which is being rolled out to every trust. That provides maternity units with guidance and interventions to reduce stillbirths, neonatal brain injury, neonatal death and pre-term birth. That will need to be updated regularly, but I will confirm the details to the hon. Lady.

The plan also includes initiatives to reduce inequalities. As we have heard, a serious cause for concern is the higher rate of stillbirths, neonatal deaths and pre-term births among babies from the black and Asian ethnic groups. Babies of black ethnicity are about twice as likely to be stillborn as babies of white ethnicity. That is unacceptable in modern Britain. We will not rest until outcomes are equally good for everyone in this country.

We also know that women living in deprived areas, not least my own constituency, are more likely to suffer adverse outcomes. In 2022, the stillbirth rate per 1,000 births in the 10% most deprived areas in England was 5.0, or 389; in the 10% least deprived areas in England, the stillbirth rate was 3.7 or 155. All local maternity and neonatal systems have equity and equality action plans in place to tackle such inequalities. NHS England is investing £10 million every year to target the 10 most deprived areas of England.

Wider work is also important. NHS Resolution’s maternity incentive scheme is improving maternity safety by rewarding NHS trusts that demonstrate that they are taking concrete steps to improve the quality of care for women, families and newborns. The National Institute for Health and Care Research has commissioned studies into how we can prevent pre-term births and improve care for mothers and babies. This year it launched a £50 million funding call, challenging researchers and policymakers to come up with new ways of tackling maternity inequalities and poor pregnancy outcomes.

There are ongoing initiatives to ensure that lessons are learned from every individual tragic event and to prevent similar events from happening in the future. All hospitals already carry out internal perinatal mortality reviews, which create reports that aim to provide answers for bereaved parents about why their baby died. They also help hospitals to improve care and ensure they try to learn something from every tragedy, wherever it happens.

The maternity and newborn safety investigations programme conducts independent investigations of early neonatal deaths, intrapartum stillbirths and severe brain injury in babies following labour. All trusts are required to tell the programme about these incidents. It will then carry out an independent investigation and make safety recommendations to improve maternity services. Coroners are also required to investigate deaths that are violent, unnatural or of unknown cause, although their remit excludes stillbirths; but that should leave no stone unturned when it comes to uncovering the cause of death, including an inquest where appropriate. Additionally, as of June 2024, I am assured that all NHS trusts have signed up to the national bereavement care pathway, which many hon. Members have raised today.

The existing measures, taken together, are helping to achieve improvements; we have already heard about some of the positives. Since 2010, the neonatal mortality rate has decreased by 25% for babies with at least 24 weeks’ completed gestation, the stillbirth rate in England has decreased by 23%, and the overall rate of brain injuries occurring during or soon after birth fell by 2%. But we know, and have heard so movingly today, that more must be done.

People rightly expect assurances that lessons will be learned and that things that went wrong are not repeated. As hon. Members have pointed out, the sad truth is that we are likely to be debating these issues in the future, when the CQC releases its next report on maternity inspections and when Donna Ockenden completes her investigation into Nottingham. I expect to be speaking with hon. Members again about this issue, and my noble Friend Baroness Merron, Minister for Patient Safety, Women’s Health and Mental Health, will be following that very closely.

Many of the issues identified locally are being repeated across the country, so I am clear that national leadership is needed. The Government will be honest about the challenges facing the health service and are serious about tackling them. I will listen to women and their families and do everything I can as a Minister to help deliver safer and fairer maternity and neonatal services for women and their babies. I really commend hon. Members who have shared their experiences today— particularly new Members; I do not think I would have been able to do that as a new Member of Parliament. My hon. Friend the Member for Washington and Gateshead South spoke very honestly about how long it took for her to do that. That was valuable.

It may not be for me to say as Government Minister, but I commend the work that my hon. Friend the Member for Washington and Gateshead South and other colleagues across parties have done in the APPG on baby loss. They have raised these issues and worked with Government Ministers, which is really important as parliamentarians. I hope that is reassuring to families here today. That work will hopefully be continued by parliamentarians across the House. Perhaps that will be an outcome of the issue being raised today, so early in this Parliament.

We need to listen to these women and their babies. We need to make sure that we have the midwives and other staff necessary to keep women and their babies safe. Before I finish, I should say that if I have missed anything, hon. Members should please get in touch. I say to my hon. Friend the Member for Sheffield Hallam (Olivia Blake) that we welcome the Tommy’s miscarriage pilot, and my ministerial colleague will be looking closely at those recommendations.

As a new Government, we want to end sticking-plaster politics; that means real and lasting change in the health service. That will take time, but we will build a better future for women in this country. That includes by making sure that all baby deaths that can be prevented will be prevented.

Healthcare Provision: East of England

Karin Smyth Excerpts

Tuesday 3rd September 2024 Westminster Hall

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairmanship, Sir Christopher. I will try not to be too evasive, and to be pleasant.

On his latter point, the hon. Member for Runnymede and Weybridge (Dr Spencer) might want to look at some of the speeches I made during the passage of the Health and Care Act 2022; accountability is writ large through them, although we may disagree about the form it takes. The previous Government had an opportunity to resolve some of these issues, and they did not take it. They destroyed accountability and, indeed, the foundations of the health service with the disastrous Lansley Act—the Health and Social Care Act 2012—which propelled me into coming to this place.

It is a pleasure to be here for the first Westminster Hall debate, and I thank my hon. Friend the Member for Norwich South (Clive Lewis) for securing it. I told my officials that it would be busy. Some of the people in this Chamber and some of those who have left are already my most frequent correspondents because of the state of the NHS in the east of England and more broadly. Getting the NHS back on its feet will be an enormous challenge, but we have the skill, motivation and commitment of our NHS staff. This Government will be unwavering in our support for them, and we will do what is needed to get the NHS back on its feet. We have committed to a 10-year plan because that is what it will take. We will deliver an NHS fit for the future. That is what we promised the British people at the election; that is what we were elected to do.

[Jerome Mayhew]

The Minister says she will deliver an NHS plan for the next 10 years. Does that include a full rebuild of the Queen Elizabeth hospital and the James Paget?

[Karin Smyth]

I will come on to those hospitals. As hon. Members will appreciate, we are in the early days of this, so “We will come back to people” may do a bit of lifting—I apologise for that.

We want to be clear and honest with Members of Parliament and the British people. We want to move the health service from treatment to prevention, which hon. Members have raised; from hospital to home, which is very important in the east of England, which has rural issues; and from analogue to digital. As a first step, my right hon. Friend the Secretary of State asked Lord Darzi to give us a raw and frank assessment of the state of the NHS, and these debates and the work that hon. Members are doing will inform that. This autumn, we will also launch an extensive engagement exercise with the public, staff and stakeholders to inform the plan.

I have at least eight questions from my hon. Friend the Member for Norwich South and a number of others. I will do my best to get through them in the next eight minutes, but I will of course respond to people if they want to come back to me on anything I do not pick up.

My hon. Friend talked particularly about prevention, and touched on climate change, dentistry and mental health, which are clearly important to many people. Prevention is a key part of the Government’s health mission and our mission across all Departments. We want to support people to stay healthier for longer. My hon. Friend said that we want the security of good health; the NHS was set up to provide that so that people can lead fulfilling lives. That promotes greater independence and shortens the time people spend in ill health. We have not touched on that much, but that is a critical target for this Government.

The NHS health check aims to prevent heart disease, stroke, diabetes, kidney disease and some cases of dementia among adults between 40 and 74 years of age. Thanks to the hard work of NHS staff, the programme engages more than 1 million people and prevents about 400 heart attacks or strokes, but take-up of the health check is low—hon. Members could perhaps encourage their constituents to take part. We want to improve access to the service and develop a new digital health check that people can use at home. We have now launched the next phase to develop the service, and I am pleased that Norfolk county council has been selected as one of the three pilot sites that are due to start in 2025.

Hon. Members are right that access to dentists is a pressing issue facing patients. We all knew that before the election campaign, and that is why that is a core part of our commitment to the British public. Only 40% of adults have seen an NHS dentist in the past two years. My hon. Friends the Members for Luton North (Sarah Owen) and for Lowestoft (Jess Asato), in particular, highlighted what we all see when we visit primary schools to look at young people’s oral health. Hon. Members have read our manifesto and know what our plans are. To be clear, the Secretary of State and the Minister for Care, my hon. Friend the Member for Aberafan Maesteg (Stephen Kinnock), met the British Dental Association immediately on taking office and are meeting it regularly to resolve the issues with the contract. We will provide 700,000 more urgent dental appointments and recruit new dentists to areas that need them most. We will rebuild dentistry for the longer term by reforming the contract.

I cannot go into too much detail on the proposal from the UEA. It is a place close to my heart, as it is where I went, almost exactly 40 years ago, to university. It is where I fell in love and got married, but sadly I had to leave the east of England. That is a fantastic hospital. I know it is supported by the local ICB, and I understand that individual Members are seeking to meet with the Minister for Care. I hope we will be able to update Members on that shortly.

My hon. Friend the Member for Norwich South talked about the dire state of the mental health service and the Norfolk and Suffolk NHS foundation trust. To update Members—although most will know—the trust has been in the recovery support programme since July 2021, after the CQC’s inspection report of “requires improvement”. To address quality and safety, the trust has implemented and completed a range of actions from that inspection report. In July it published the “Learning from Deaths” report, which was commissioned by the chief executive to review every death that occurred from April 2019 to October 2023. To improve the culture, the trust has launched Listening into Action, a trust-wide programme to improve how staff work together and listen to each other. In April, NHS England formally agreed a revised timeline for the trust to exit the recovery support programme at the end of 2024, and transition planning for post-exit has commenced. Obviously, we will be paying attention to that very closely, and I know hon. Members will also do so.

In response to the concerns about hospital buildings, we are all in no doubt about the inheritance that we have received from the last Government, particularly on capital, and about the state of our hospital estate. Each trust with a hospital with RAAC issues has invested significant levels of NHS capital to mitigate any safety risk. The safety of our patients must always come first. It is clear that the last Government’s promise to deliver 40 new hospitals by 2030 was not achievable, and it did not have the funding required to deliver it. That is why we are reviewing the programme to put it on a sustainable footing, which means a realistic timetable for delivery and clarity of funding. We will be honest with the British people and transparent about what we can deliver, and we will update the House and hon. Members on the programme’s next steps as soon as we can.

My hon. Friend the Member for Norwich South touched on climate change. This is a really big issue for the east of England. I will not have time to go into some of the issues but personally, and, as far as this Government are concerned, the impact of climate change on health and the provision of the health service is a serious issue, with surges in demand for services during periods of extreme weather and heat-related disruption to utilities, such as power outages. We are cognisant of those, and I do think it is an important issue for the health service. The NHS is doing well to become on target to reach net zero by 2040, and all trusts have targets. That is something we will watch closely.

I will give some rapid fire responses. We are not going to look at changing structures. We want to work with the system that we have inherited. It has to work, it has to bring people together, and it has to bring services into neighbourhoods. We have talked about the contract as well. We are keen to work together with local services in the ICB structure. We all know in our own areas that geographies are never quite perfect, but we do not want another reorganisation. We think that detracts from what we need to get on with.

The matter of productivity raised by the hon. Member for Broadland and Fakenham (Jerome Mayhew) is an issue—the concern about what we measure and how we measure it, and making sure that every taxpayer’s pound is used well within the NHS. Part of the issue is the breaking of the foundations of the system. Locally, that has meant it is very difficult for the service to deliver. That is why we are looking at this on a 10-year basis. The foundations need fixing.

Let me finish by once again thanking colleagues for bringing their own insights into heath and care in the east of England. Many new Members have come here from all parties. These are important debates, and it is important for Ministers such as myself to hear directly from Members’ constituents. Many of the issues are symptomatic of an NHS that is broken. That is why we are ending the sticking plaster politics. As the Prime Minister said a week ago, that is worth doing. It will be harder, and it takes more time. We are not going to give deadlines that we cannot meet. I hope that after just about two months in this role, I given answers today that show that we understand the scale of the issues that we face, and that this Government are committed to tackling them. If I have missed anything in particular, I will of course, correspond with hon. Members.

Oral Answers to Questions

Karin Smyth Excerpts

Tuesday 23rd July 2024 Commons Chamber

[Bill Esterson (Sefton Central) (Lab)]

3. Whether his Department plans to provide capital funding for a new health centre at Maghull in Sefton Central constituency.

[The Minister for Secondary Care (Karin Smyth)]

I congratulate my hon. Friend on his re-election. He will know that capital allocations are a matter for the integrated care boards. We are committed to introducing neighbourhood care centres to bring together vital care services, and I look forward to working with him on Labour’s mission to improve the front door to the local NHS.

[Bill Esterson]

I congratulate my right hon. and hon. Friends on their appointments. The predecessors of my right hon. Friend the Health Secretary—there have been quite a few over the past few years—all agreed with me that a health centre in Maghull in my constituency was a priority for the health service, but as my hon. Friend has just said, the allocation of capital by integrated care boards has meant that the priority has been acute hospitals, sometimes at the expense of community facilities. Will my hon. Friend meet me to discuss the importance of investment in health centres such as the one in Maghull, which make such a difference to reducing waiting times in the NHS and improving patient outcomes?

[Karin Smyth]

My hon. Friend is first out of the blocks on this issue, and has shown his commitment to improving primary care for his constituents. I am sure the local ICB has listened very carefully to his question, because we know that the existing primary care estate is under a great deal of pressure. That is why building a neighbourhood health service remains at the forefront of our mission to rebuild the NHS, and I would be pleased to meet him to discuss that topic.

[Adam Jogee (Newcastle-under-Lyme) (Lab)]

4. If he will hold discussions with the Secretary of State for Environment, Food and Rural Affairs on the potential effects of toxic air from landfill sites on people’s health in Newcastle-under-Lyme constituency.

--- Later in debate ---

[Uma Kumaran (Stratford and Bow) (Lab)]

7. What assessment his Department has made of the effectiveness of NHS urgent and emergency care services.

[The Minister for Secondary Care (Karin Smyth)]

I congratulate my hon. Friend on her election, and I also pass on my best wishes to her and her husband, who I know recently suffered a stroke. We hope he makes a speedy recovery. We recognise the great work of NHS staff for them, and indeed for all our constituents every day, but we do know that the NHS is broken. The latest data confirms the terrible state in which the Conservatives left urgent and emergency care services, with one in four patients waiting longer than four hours in A&E. That is why Professor Lord Darzi will lead an investigation into NHS performance, and the findings will inform our 10-year reform of the NHS.

[Uma Kumaran]

I thank the Minister for her kind words today, and I also thank my right hon. Friend the Health Secretary for his wishes on the day. Mr Speaker, may I also take this opportunity to thank you and your staff for the care and kindness you showed me?

Residents in my constituency of Stratford and Bow are served by Barts health NHS trust, which includes Newham University, Royal London and Whipps Cross hospitals. In May, their A&E departments had the second highest volume of any trust in England and the highest in London. Overcrowding and capacity constraints mean that the staff at those hospitals are having to treat some patients in corridors rather than on wards. This is the broken NHS that we have inherited from the Conservatives. Will the Minister ask her Department to look at capacity issues at those hospitals and at how community pharmacy prescribing services may be used to alleviate some of the pressures?

[Karin Smyth]

My hon. Friend makes an excellent point highlighting the challenges particularly around hospital capacity, something well-known on the Front Bench with my right hon. Friend the Health Secretary representing a nearby area. This type of patient experience is unacceptable, but it sadly became normal under the last Government of 14 years. My hon. Friend makes an excellent point about pharmacies: they will have a central role in our future system, and I would of course be happy to undertake a visit with her.

[Priti Patel (Witham) (Con)]

I welcome the new Front-Bench Members to their new portfolios and responsibilities. Essex has actually seen some improvements in emergency care services over the past 14 years, particularly in our ambulance trust, and that should be commended. One way in which pressure on emergency services can be reduced is by having community facilities in our towns and across our districts. Will the Minister commit to meeting me and working with my right hon. Friend the Member for Maldon (Sir John Whittingdale) on looking at ways in which we can safeguard community services at St Peter’s hospital in Maldon, which our communities absolutely need?

[Karin Smyth]

I thank the right hon. Lady because she again makes for us the excellent point about what has happened in the last 14 years under her Government: these situations have been allowed to get so much worse both in Essex and across the country. She should also welcome our mission to rebuild the broken front door to the NHS and have more neighbourhood services based in communities, bringing those services together where patients are; that is absolutely what we all want and I am very happy to discuss this with her.

[Shaun Davies (Telford) (Lab)]

For 14 years the community in Telford and I have worked hard to safeguard our A&E, but the last Conservative Government made Telford the largest town without a fully functioning A&E. Will the Health team meet me and other Shropshire MPs to discuss this discredited and disgraceful decision?

[Karin Smyth]

I welcome my hon. Friend to his place. He knows what we all know, and what we know the entire country knows because we spent the past six weeks campaigning: it is the same story across the country. That is why we are committed to restoring standards and why we will fix this broken NHS, and of course I am happy to meet with him.

[Andrew George (St Ives) (LD)]

A decision by the Conservatives two years ago means that the urgent treatment centre at the West Cornwall hospital in Penzance is now closed at night, and that has put pressure on the only emergency department in Cornwall—a long peninsula—at Treliske, where routinely 20 ambulances are parked outside creating a new metallic ward at the front of the hospital. That situation has had a detrimental impact, of course including avoidable deaths. Will the Minister meet me and colleagues and the local NHS to discuss this issue, to see how we can restore our emergency services?

[Karin Smyth]

Again, across the country we see the damage done over the last 14 years, and the hon. Gentleman is absolutely right to highlight that the situation in one part of the system knocks on to other parts. That is why we want a 10-year plan to look at this, an immediate look with Lord Darzi, and, critically, to understand which community and primary care services can be supported to support the rest of the system. I am very happy to meet with colleagues across Cornwall, where we now have many Labour MPs.

[George Freeman (Mid Norfolk) (Con)]

8. If he will make an assessment of the potential merits of requiring newly-qualified dentists to work for the NHS for a set period of time.

--- Later in debate ---

[Bell Ribeiro-Addy (Clapham and Brixton Hill) (Lab)]

11. If he will take steps to help increase the number of accommodation units available for parents whose babies have been admitted to neonatal care units.

[The Minister for Secondary Care (Karin Smyth)]

I congratulate my hon. Friend on her re-election and thank her for raising this important issue. It is not right that three out of four parents are not able to stay with their critically ill baby overnight at such an important point in that new relationship. NHS England recently concluded a review of neonatal estates. It is in the early stages of analysing the findings, which will be used to inform the next steps. We are all determined to support parents to be involved in every aspect of their baby’s care.

[Bell Ribeiro-Addy]

I congratulate my right hon. and hon. Friends on their re-elections and on taking their places. Recent research from the charity Bliss showed that when a baby receives neonatal care, their parents are routinely expected to leave them in hospital overnight for weeks or even months at a time. Its research found that for every 10 babies who need to stay overnight in neonatal care, there is only one room available for a parent to stay with them. How will the Minister ensure that the existing guidance about facilities for families is followed, and how will she ensure that trusts can access the resources they need to stop the separation of babies and their parents?

[Karin Smyth]

My hon. Friend is absolutely right that the separation of babies and their parents at that time is not acceptable, and about the shocking state of the estate, as we have just heard. We will look at the findings of the NHS review very quickly, and I will be happy to get back to her on those specific points.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for her answer. This issue is clearly not just about accommodation; it is also about providing physical and emotional help for mothers who have been through traumatic circumstances, emotionally and physically. What will be done along those lines to ensure that mothers and babies have all the help they need?

[Karin Smyth]

The hon. Gentleman makes a really important point about mental health support in that critical period. We will absolutely make sure that is looked at.

[Sean Woodcock (Banbury) (Lab)]

12. Whether he plans to hold discussions with NHS staff and patients on his plans for reforming NHS health and social care services.

--- Later in debate ---

[The Minister for Secondary Care (Karin Smyth)]

My hon. Friend makes an excellent point about the stress that people face when waiting, and we have talked about the disaster of the past 14 years. People with potentially deteriorating conditions are waiting, and we absolutely need to address this issue as part of our work to reduce waiting lists.

[Blake Stephenson (Mid Bedfordshire) (Con)]

T6. The Government have announced ambitious house building targets but, as far as I could tell, the Labour party manifesto was silent on the GP estate upgrades. Does the Secretary of State agree that the Conservative policy of rebuilding or refurbishing 250 GP surgeries in England is a sensible policy to implement?

[Tom Rutland (East Worthing and Shoreham) (Lab)]

T3. Last week, Worthing hospital came close to having to consider downgrading its maternity services due to a shortage of specialist neonatal nurses and midwives. Will the Minister please update the House on the Government’s plans to build an NHS that is fit for the future, including by addressing staffing shortages?

[Karin Smyth]

I welcome my hon. Friend to the House. He makes an incredibly important point about this very stressful time, particularly for women, in his area. We will listen to women and deliver evidence-based improvements to make maternity and neonatal services safer and more equitable for women and their babies, and we have committed to delivering the long-term workforce plan.

[Victoria Collins (Harpenden and Berkhamsted) (LD)]

T7. In one month alone at the West Hertfordshire teaching hospitals trust, we lost 843 days because of the social care backlog. The burden of that cost is often taken up by families and individuals, which impacts not only on them, but on the rest of our NHS healthcare. I welcome the talk about working together across parties, but would the Secretary of State also consider introducing greater support for unpaid carers, including paid carers leave and a statutory guarantee of regular respite breaks?

Health Services: Rural Areas

Karin Smyth Excerpts

Wednesday 17th July 2024 Commons Chamber

[The Minister of State, Department of Health and Social Care (Karin Smyth)]

It is a privilege to be the first Minister of this new Labour Government to respond to an Adjournment debate. I am grateful to the hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone) for raising this important matter and, indeed, for his kind words.

I hope we can begin this Parliament as we mean to go on, by being candid about the formidable challenges that the NHS faces. As my right hon. Friend the Secretary of State said on his first day in the job, the NHS is broken, and it will be the task of this Government to build a new NHS for the future. That means the NHS in our rural and coastal areas no less than the NHS in our towns and cities. I agree with the hon. Member for Strangford (Jim Shannon) on that point.

Facing these hard truths does not take away from the heroic efforts of the people working in health and care, who have done their utmost in incredibly difficult circumstances. We all owe them, on behalf of our constituents, a debt of unending gratitude.

Instead, we want to focus our attention on what needs to be done, including early action to improve access to primary care, dentistry and dental health services in particular. We await the conclusions of a thorough investigation undertaken by the distinguished surgeon Lord Darzi to properly understand the scale of the problem. The Government will then begin work on an ambitious programme of action—a 10-year plan to put the NHS back on its feet. It is a privilege to be part of a Labour Government who are committed to fixing the NHS and making it fit for the future.

As the hon. Member for Caithness, Sutherland and Easter Ross said, the Department’s responsibility stretches only to the NHS in England. Healthcare is devolved in Scotland, Wales and Northern Ireland, and it will continue to be so.

I congratulate the hon. Gentleman on being first out of the traps to secure this debate on behalf of his constituents. As a committed advocate for his constituents in one of the most rural parts of Scotland, he has a deep understanding of matters affecting rural communities, as we have heard this evening. He also has a deep understanding of care, about which I have often heard him speak in this Chamber. It is good to see him back again doing just that.

I cannot speak in detail about the NHS in Scotland, of course, but I can speak about many of the common issues affecting access to care that are relevant to rural constituencies in England, Scotland, Northern Ireland and Wales. I know how rural the hon. Gentleman’s constituency is, and I know the particular challenges that creates in accessing GPs, dentists and emergency care, and in accessing women’s health and maternity services—an issue he has been passionately raising for so long. Maternity services are a problem across the United Kingdom, but I accept the examples he outlined.

Few places in England are as remote as the hon. Gentleman’s constituency, but I am very aware of similar issues affecting more rural areas near my Bristol South constituency. We have heard from the hon. Members for Glastonbury and Somerton (Sarah Dyke) and for St Ives (Andrew George) about morale and the difficulties we face in the south-west.

I hope that, in the years ahead, we can share and learn from one another across all of our borders. In many rural areas, the challenge of improving access to services is compounded by travel times and by the recruitment and retention of staff. We must recognise the importance of designing services that reflect an area’s particular circumstances, which is a growing challenge. As the chief medical officer has pointed out in his reports, people are moving out of towns and cities to coastal, semi-rural and rural areas as they age. At the time that people are most likely to need care, they are increasingly living in the places where it is most difficult to provide that care.

In England, integrated care systems will have a key role to play in designing services that meet the needs of local people. To do this, they will need to work with clinicians and local communities at place or neighbourhood level. We know that excellent primary care is an essential foundation for improving access, tackling the root causes of poor health and tackling problems early so that people remain in better health for longer, and hopefully do not need to access secondary and tertiary care at the same level. That is why Labour has pledged, as part of our health mission, to train thousands more GPs and bring back the family doctor, and that applies to all the nations.

We are also doing more to use the transformative power of technology. There is enormous potential in ideas such as virtual wards, which allow care to be delivered in people’s own homes. Such models of care can have disproportionate benefit in areas where rurality is a barrier to care.

Equally, we are committed to seeing the NHS app reach its full potential under the new Government. We understand that some people will need support to use that technology and we are aware of the challenges of rural broadband, but we are committed to making the benefits accessible to all.

[Andrew George]

The Minister has committed the new Labour Government to address those issues, but will she specifically address the matter of the two coroners’ reports into avoidable excess deaths as a result of very long waits for emergency services in Cornwall? They were never addressed by the previous Conservative Government. The reports were about not just the hours spent waiting—sometimes elderly, frail people were on the floors for 10 or more hours—but the fact that sometimes 20 or more ambulances greeted patients when they arrived at the emergency department. Two coroners’ reports were sent to the then Secretary of State, but there was never an adequate response. I very much hope the new Labour Government will review the failings of the previous Government and address those very serious concerns, which affect many other rural areas.

[Karin Smyth]

I am aware of the issues facing the south-west and, when in Opposition, I spoke in the local media about some of the ambulance challenges. I am not aware of those reports, but if the hon. Gentleman writes to me with the details, I will happily look into the issue and get back to him.

We also recognise the additional cost of providing services in rural areas, for example in travel and staff time. That is why the funding formula used by NHS England to allocate funds to integrated care boards includes an element to better reflect needs in some rural, coastal and remote areas.

The NHS faces significant challenges. It needs fundamental reform. The Prime Minister is personally committed to resetting the UK Government’s relationship with devolved Governments in Scotland, Wales and Northern Ireland. I echo the Prime Minister’s words today about our commitment to rural constituencies across the entire country and I hope we can work with hon. Members from across the House, including the hon. Member for Caithness, Sutherland and Easter Ross.

[Jim Shannon]

I welcome the Minister’s clear commitment to England, Scotland, Wales and Northern Ireland—and particularly to Northern Ireland. Let me declare an interest: I am a member of the Ulster Farmers Union. I know that the Ulster Farmers Union back home, in conjunction with the NFU here, has been trying to work with the health service and with all those with responsibility in this area on the issue of suicides. Farmers mostly work on their own and suffer from anxiety and depression. They face pressures from finance and pressures from the bureaucracy that exists in farming. I know the Minister is compassionate and understanding—I mean that honestly. When it comes to addressing that issue, does she think that it must be done in conjunction with the farmers unions? Trying to work together to make things better must be a step in the right direction.

[Karin Smyth]

As ever, the hon. Gentleman makes a valid point. I shall certainly ask my colleagues in the Department for Environment, Food and Rural Affairs about that. His point is extremely well made. I know his constituency in Northern Ireland very well. Let me say that we are very committed to working with hon. Members across the House to share ideas. The hon. Member for Caithness, Sutherland and Easter Ross has put forward more ideas about how that can happen. I do not promise to implement all of those things, but I will certainly look at them. We want to work very closely across all jurisdictions so that we can make progress for all our constituents to improve the health outcomes across the four nations of the United Kingdom.

Question put and agreed to.

Access to Migraine Treatment

Karin Smyth Excerpts

Wednesday 20th March 2024 Westminster Hall

[Karin Smyth (Bristol South) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Mundell. I thank the hon. Member for Bishop Auckland (Dehenna Davison) for opening the debate and sharing her personal experience of how the condition has affected her, which was very powerful for others to hear. We have heard some fantastic contributions today. We know that one in seven people in the UK are living with migraine, and that women are disproportionately affected. I agree with the Chair of the Women and Equalities Committee, the right hon. Member for Romsey and Southampton North (Caroline Nokes), that this needs to be addressed. Women are under-represented in research and development more generally and we need to understand why—beyond reproductive issues—in the women’s health strategy.

Migraine attacks can be hugely debilitating. They can last between four and 72 hours or even longer, often causing pain, vomiting and dizziness. We have heard from the right hon. Member for Romsey and Southampton North about the impact on children, and very movingly from the right hon. Member for South Staffordshire (Sir Gavin Williamson) about the all-consuming impact on family life. They affect every part of life, including social life, education and employment, yet they are often misunderstood and under-diagnosed.

Migraines affect people’s ability to access full employment, with 29% of those who suffer reporting that they have had to move from full time to part-time work, and a further 25% having left a job altogether. People listening to this debate who might think they are in control of their careers—maybe even at the Dispatch Box—will find it very powerful to understand that they are not alone. This adds to the number of people who are economically inactive because of long-term sickness, which has risen to more than 2.5 million—an increase of more than 400,000 since the start of the pandemic. That has a huge impact on our economy and on individuals’ health, wellbeing and ability to support themselves and their families.

I am deeply concerned that the measures laid out by the Government to tackle the leading health-related causes of economic inactivity are not ambitious enough. I join the former Chief Whip, the right hon. Member for South Staffordshire, in exhorting the Government to take greater action and governance. The Access to Work scheme faces huge backlog, so we want to hear from the Minister today what the Government can do to support those suffering from debilitating migraines and help them access work.

Furthermore, support from employers is vital to everyone living with chronic migraines. We have heard a debate about whether this should be considered a disability, but even those who are identified as disabled and are working for Disability Confident employers do not report much better experiences than those working for employers that are not members of that scheme. We need more action from the Government to ensure that disabled people and those with long-term conditions such as chronic migraine can access the support they need at work.

As with too many medical conditions, waiting lists are long. Once someone is diagnosed, it can take up to 29 weeks for them to access a neurologist or headache specialist. Fourteen years of Government mismanagement have left our NHS unable to deliver a full and comprehensive range of health services, which is impacting on care and treatment for migraines.

That is why Labour will build an NHS fit for the future, providing it with the staff, technology, resources and reform that it needs to improve patient care, cutting waiting lists and ensuring timely diagnosis and treatment for the millions of people affected by migraine by getting the NHS working around the clock. That will give staff the opportunity to earn more for working weekends and evening shifts. Getting local hospitals working together will mean that the NHS can deliver the extra 2 million operations, scans and operations a year that are needed. What measures will the Minister take to tackle those waiting lists, particularly the services around neurology?

We have heard today how new treatments can give hope to those suffering from migraines. CGRP antibody medicines have been approved by NICE to prevent migraine in adults. However, as we have heard, only 52% of sufferers are offered them; people have to take a long route before becoming eligible. NICE last updated its guidance in this area in 2021. I would be interested to hear whether the Minister is having further discussions with NICE about ensuring wider access to migraine treatments.

Migraine is a condition that can be isolating and debilitating. We know that pressures on mental health services are acute, but with 78% of respondents to the Migraine Trust’s survey saying that migraine impacts their mental health and 65% reporting that they have experienced anxiety as a result of migraine, it is vital that we consider the mental health impacts of living with migraine.

I am keen to see Labour’s proposals for a whole-Government strategy to improve mental health outcomes and make early interventions becoming a reality for people. That is why the next Labour Government would implement an ambitious plan to cut waiting lists by recruiting over 8,500 additional mental health staff, providing access to mental health support in every school and delivering an open-access mental health hub for children and young people in every community. That would help to redress the current situation in which young people and children do not have sufficient understanding of the debilitating effects of this illness.

Finally, further research into migraine is really important, because we still do not fully understand what causes it; the SNP spokesman spoke very eloquently about the need for research into its causes. We would support our research community with a new regulatory innovation office, which would make Britain the best place in the world to innovate by speeding up decisions and providing clear direction based on a modern industrial strategy. The new office would help to improve outcomes for those living with migraine, tackling the NHS backlog by accelerating the approval for clinical trials, the number of which has fallen off a cliff under this Government, and delivering better access for patients to the latest treatments.

Those living with migraine should be able to access care when and where they need it, and the next Labour Government will ensure that we have the staff and resources needed to improve waiting lists and the right research environment, which would improve access to new treatments.

Children’s Cancer Care: South-East

Karin Smyth Excerpts

Wednesday 13th March 2024 Westminster Hall

[Karin Smyth (Bristol South) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Christopher—it has been severely tested this afternoon, but you have done remarkably well in getting us all to the end of this important debate, particularly for local people, on the issue of children’s cancer. I commend the hon. Member for Twickenham (Munira Wilson) on securing it. The hon. Members for Carshalton and Wallington (Elliot Colburn), for Richmond Park (Sarah Olney) and for Mole Valley (Sir Paul Beresford), my hon. Friend the Member for Mitcham and Morden (Dame Siobhain McDonagh) and the right hon. Member for Kingston and Surbiton (Ed Davey) all spoke on behalf of their constituents with the diligence that we would expect.

Receiving a cancer diagnosis is always distressing and deeply worrying for anyone; for a child and their family it can be particularly devastating. Watching a child go through that is a difficulty that most parents, fortunately, do not have to face, but my thoughts are with the many who do, who are being talked about today—particularly those who have lost a child to cancer. I pay tribute to the many families campaigning for good cancer care for children and young people.

Every year, 4,000 children and young people are diagnosed with cancer in the UK; sadly, it is still the biggest killer by disease of children and young people in our country. As we have heard this afternoon, the needs of children and young people with cancer are very different from those of adults. They can face real challenges in cancer care. It is crucial that they get the right treatment and family support. Often that treatment takes place in dedicated specialist treatment centres far from home: children can travel on average 350 miles to get their cancer treatment.

According to research by Young Lives vs Cancer, distressed and vulnerable children often travel across the country to receive care. As we have heard, the location of the centres is important for local people seeking the best care for their children. My city, Bristol, is home to the paediatric haematology/oncology programme, which serves the whole south-west region, working with shared care centres from Gloucestershire to Cornwall to ensure that children receive care as close to home as possible.

What should that care look like? We know that children receive the best care with early diagnosis and access to treatment from well-supported and trained staff, based on the latest research. Sadly, under this Conservative Government swathes of targets have not been met, and children are left waiting for a diagnosis when every second is vital. Those missed targets include the faster diagnosis standard, with three in every 10 patients waiting longer than 28 days for a diagnosis or to have cancer ruled out in 2022-23. Waiting lists have risen to a record high, with over 400,000 children awaiting consultant-led treatment. Prolonged waits have a detrimental impact not only on children’s health, but on their education and overall wellbeing. Although I welcome the children and young people cancer taskforce announced last month, without a properly functioning wider health system, children with cancer will continue to be vulnerable to those missed targets and delays in care.

The root of the crisis is the failure to provide the NHS with the staff it needs to treat patients on time. Indeed, the Royal College of Radiologists, which represents specialist paediatric radiologists, has said that after years of underinvestment, the workforce is stretched, causing backlogs and delay. That is why Labour is committed to providing the staff, the modern technology and the reform that are crucially needed to bring down those waits to safe levels. We will provide 2 million more appointments a year for planned surgery, diagnostics and out-patient care, and double the number of CT and MRI scanners, speeding up diagnosis and access to treatment for children.

We know and we have heard in the debate how important it is for people, and particularly for their families, to be confident that they will receive the right care in the right place. The guidelines produced by NHS England are very clear about the processes to be followed and the clinical case to be made for major service change. Indeed, that was much discussed in the Bill Committee for the Health and Care Act 2022, on which I sat. I look forward to hearing from the Minister—I will give her plenty of time—about any assurances that she can give to local people on the decision, and to the Members of Parliament who have spoken today on both the process and the substance of decision making in the NHS.

[Sir Christopher Chope (in the Chair)]

Minister, over to you.

Oral Answers to Questions

Karin Smyth Excerpts

Tuesday 5th March 2024 Commons Chamber

[Karin Smyth (Bristol South) (Lab)]

Despite watering down the targets for ambulance response times and the A&E four-hour wait, the Government still cannot meet them. We have heard from Members across the House this morning how patients are waiting longer. The new targets say that there will be further improvements in 2024-25, and the Minister has said that again this morning. Can she let us in on what exactly they will be?

[Helen Whately]

I am not going to pre-empt the publication of targets for the coming year, but, as I have said, we will continue to learn lessons from the progress that we have made this year, including on ambulance response times, which are down by over a third. Anyway, I will take no lessons from Labour, because we know the state of the NHS in Wales.

Heart and Circulatory Diseases: Premature Deaths

Karin Smyth Excerpts

Thursday 22nd February 2024 Commons Chamber

[Karin Smyth (Bristol South) (Lab)]

I thank the Backbench Business Committee for granting the debate and pay tribute to the hon. Member for Watford (Dean Russell) for securing it. I think we all agree that he made an excellent and heartfelt speech not just about his own experience, but about the effect on his family and his team. He thanked the British Heart Foundation, and I agree that the resources of such organisations are well received at such times, which can often be very lonely. We wish him and his family the best of health going forward.

My right hon. Friend the Member for Alyn and Deeside (Mark Tami), who is no longer in his place, spoke about his experience as a family member of a young person who has suffered a heart condition, and the SNP spokesperson, the hon. Member for East Dunbartonshire (Amy Callaghan), highlighted her own experience. Cardio- vascular disease affects not only us, but our families too.

As has been said, every week in 2022 an average of 750 people died prematurely of cardiovascular disease, including heart attacks and strokes. Every premature death is of course a tragedy, and our thoughts are with all affected families. NHS England has reported that cardiovascular disease is responsible for one in four premature deaths in the UK. As we have heard, the rate of premature deaths has risen for the past three years consecutively—that is something that we all wish to understand. Many of my constituents, and people across the country, are worried about the state of heart and circulatory disease services. Despite the best efforts of staff, there is a significant backlog in treatment, the number of people on waiting lists for cardiology services is rising, with a huge 189% increase in the past 10 years.

According to the Institute for Public Policy Research, waiting times for cardiology treatment have risen even more sharply than for elective waiting lists as a whole. That is deeply concerning, because long waits mean poorer outcomes for patients, often with devastating results. An estimated 7.6 million in the UK are currently living with heart or circulatory disease. It is vital that every one of those people receives effective and timely diagnosis, referral and treatment, yet under this Government the NHS has lurched from crisis to crisis, and far too many patients are not receiving that timely care.

Labour has an ambitious 10-year plan of reform and modernisation to speed up treatment, with 2 million more appointments a year. We want to return to the constitutional waiting-time targets within a Parliament. As our mission sets out, it is vital to restore the NHS as a world-leading health system—something that we have lost under this Government. The Government have promised to eradicate waits of over a year for elective care by 2025. It would be good if the Minister indicated whether they are on track to do just that.

Labour has a mission to reduce deaths from heart attacks and strokes by a quarter within 10 years, so that fewer lives are lost to the biggest killers. Under our “Fit for the Future” fund, we would double the number of scanners—speeding up heart and circulatory disease diagnosis—and ensure that patients receive the timely treatment that is so vital for managing those conditions. We would also incentivise continuity of care in general practice, which would improve care in our communities for people living with heart and circulatory disease. It would be helpful if the Minister explained why, in the past 14 years of Conservative Government, we have seen such paltry ambition on cardiovascular care and a decline in cardiovascular health. The Minister is probably going to talk about the major conditions strategy, which was announced 13 years into the Conservative party’s time in power, but when can we expect the full strategy to be published, and will it explore the reasons for the backward trend in cardiovascular disease that we are currently seeing? I agree with other hon. Members: we all need to understand the reasons for that.

One of the most concerning aspects of cardiovascular disease in this country is that many of its drivers are higher in areas of greater deprivation and, as we have heard, for black and minority ethnic groups. That is exacerbating health inequalities; we have heard from the SNP spokesman, the hon. Member for East Dunbartonshire, and from the hon. Member for Strangford (Jim Shannon) about the levels in their communities. In 2022, those in the most deprived 10% of the population in England were more than twice as likely to die prematurely from circulatory diseases than those in the least deprived 10% of the population, something I see very much in my own constituency of Bristol South. That is utterly unacceptable across the United Kingdom in the 21st century, particularly given that cardiovascular disease is largely preventable.

Tackling the issues that impact cardiovascular health, from obesity to high blood pressure or smoking, is vital —not only to tackle CVD, but to improve population health overall. That is why we have to tackle social inequalities that influence health and focus more on prevention, improving capacity in local public health teams that do so much vital work to improve the health of their communities. Innovation will also be vital to centre prevention in our health service, and I would welcome an update from the Minister about the NHS digital health check trial in Cornwall. Given that results from that trial will inform the roll-out this spring, can the Minister indicate any challenges apparent in the trial? When can we expect the results to be published?

As we have heard, prevention starts long before the age of 40, when that health check takes place. That is why Labour will introduce a child health action plan that will put prevention at the top of the agenda, ensuring that the next generation can live healthier lives. There are also widespread concerns that the restructuring of the Office for Health Improvement and Disparities could have a detrimental impact on health inequalities. It would be good to hear a reassurance from the Minister about how those concerns about health inequalities will be prioritised in the event of changes to that body.

Finally, research is crucial to preventing further premature deaths. That is why Labour’s regulatory innovation office would make Britain the best place in the world to innovate by speeding up decisions and providing a clear direction based on our modern industrial strategy, alongside a plan to make it easier for more patients to participate in clinical trials. That will deliver better treatment to patients. We owe that to all those families who have lost a loved one to premature death, as well as those who—we are pleased to see—are surviving and living well with this disease. We must improve outcomes; I look forward to hearing the Minister’s comments on the major conditions strategy, but that strategy must be delivered in tandem with a plan to provide the NHS with the staff, technology and resources it needs to bring down waiting lists and improve patient care. I am pleased that a future Labour Government has a plan to do just that.

Oral Answers to Questions

Karin Smyth Excerpts

Tuesday 23rd January 2024 Commons Chamber

[Mr Speaker]

I call the shadow Minister.

[Karin Smyth (Bristol South) (Lab)]

The Secretary of State has said that preparation for winter started last January, but 54% of A&E departments were still rated inadequate or needing improvement in December, exacerbating the winter crisis. What will she do differently this year to ensure that we do not have another winter crisis in 2024-25?

[Victoria Atkins]

Again, the plan that we laid out last year is having a real impact at local level on the services being deployed through our accident and emergency services. We have seen discharge rates improving, for example. We appreciate that there can be local differences, but the importance that we put on maintaining that flow through hospitals is critical to ensuring that the waiting lists and waiting times that the hon. Lady describes are reduced. However, I gently remind the Labour party that it has been running the NHS in Wales for some time now, and it is a great shame that the good people of Wales—[Interruption.] The good people of Wales are waiting longer for their treatment—[Interruption.] They are almost twice as likely—

COP10: WHO Framework Convention on Tobacco Control

Karin Smyth Excerpts

Thursday 18th January 2024 Westminster Hall

[Karin Smyth (Bristol South) (Lab)]

It is a pleasure to serve under your chairmanship this afternoon, Mr Vickers. I understand that this is the third debate this week about tobacco and vaping, so the subject is getting a good airing. I confess that I was not expecting to have a debate about sovereignty and taking back control this Thursday when talking about smoking, but one always has to be prepared to be taken back, as the Minister says. Like colleagues, I thank the hon. Member for Northampton South (Andrew Lewer) for securing this debate, and I thank the right hon. Member for Clwyd West (Mr Jones), my hon. Friend the Member for Ealing, Southall (Mr Sharma) and the hon. Member for Christchurch (Sir Christopher Chope) for their contributions and the work they do in this area.

As we have heard, the convention on tobacco control was adopted in 2003 and came into force in 2005. It has since become one of the most rapidly and widely embraced treaties in UN history. It was developed in response to the globalisation of the tobacco epidemic, and a quick glance at the statistics tells us why. Tobacco kills up to half its long-term users. It is responsible globally for an estimated 8 million deaths per year, 1.2 million of which are of non-smokers exposed to second-hand smoke, yet the global market is still worth more than £800 billion a year. Tobacco remains the largest cause of health inequalities, accounting for as much as half the difference in amenable mortality between the most and least deprived communities in the country.

My hon. Friend the Member for Ealing, Southall highlighted the work that he has done, particularly on reducing smoking among minority and ethnic communities. In my constituency, the tobacco industry has historically employed many thousands of people and there is a long legacy of tobacco, which can be seen in the higher rates of chronic obstructive pulmonary disease and other smoking-related conditions in Bristol South. Tobacco costs the taxpayer tens of billions every year, putting increased pressure on the NHS and care system, as well as contributing to the productivity crisis through lost earnings, unemployment and, sadly, early deaths.

That is why the Labour party is committed to building a smoke-free future. It is why we have said that we will support the Government’s measures to raise the legal smoking age by a year every year, so that a 14-year-old today will never legally be able to buy a pack of cigarettes. It is also why we would make sure that all hospital trusts integrate opt-out smoking interventions into routine care, so that every interaction with the NHS encourages quitting. Unlike the hon. Member for Linlithgow and East Falkirk (Martyn Day), I am a former smoker who did have to quit. I pay tribute to the people who do it: it is a very hard thing to do.

This is a global issue, which is why we have to tackle it globally. We have seen the tactics of the tobacco industry over many years. Hugely profitable multinational companies will use their muscle in individual states—we have seen in Uruguay, Vietnam and elsewhere how they will behave —so working together seems to be the way forward. The establishment of the WHO framework two decades ago is an important milestone in tackling a public health hazard. It encourages parties to implement common-sense policies that have strong public support, such as protecting public health policies from commercial and vested interests; protecting people from secondary smoke; and bans on advertising and on so on. Those have been developed over many decades.

As we have heard, the next conference of the parties will be the 10th since the convention entered into force and will take place in Panama. Agenda items up for discussion will be articles 9 and 10 of the convention, on the regulation of the contents and disclosure of tobacco products, which is addressed by the UK’s Tobacco and Related Products Regulations 2016. We all seem very keen to send the Minister to Panama—the right hon. Member for Clwyd West suggested a boat, which would take her some length of time—so we are all interested in whether she is going, and, more specifically, how she will be instructing the UK delegation to approach these really important discussions.

Does the Minister have any plans to bring other nicotine products, such as nicotine pouches, into the regulatory process as part of the Government's forthcoming legislation? Many colleagues will have received letters from constituents about e-cigarettes and vaping, which will be discussed at COP10. We hear what they are saying. E-cigarettes are an important tool for stopping smoking. Evidence indicates that they are less harmful than cigarettes, and that their use shows a positive association with quitting smoking, as we have heard so eloquently from colleagues today—something we would support. Particularly in this month, January, many smokers are grappling with their new year's resolutions, and we fully support them in that journey however we can. We must acknowledge, however, that vaping is not risk free, particularly for people who have never smoked, and that there is a lack of evidence on the long-term health impacts.

As we have said many times in this House, we are particularly concerned about the rise in youth vaping. In just the past two years, the number of children aged 11 to 17 who vape regularly has more than trebled. Over 140,000 more children have taken up vaping since the Government voted down Labour’s proposed measures in 2021 to crack down on companies that brand and advertise vapes to appeal to kids. We want tougher regulation of those products and for a strong message to be sent to those companies trying to make a profit at the expense of our children’s health. I hope that Ministers, via their role in the WHO, will push harder for stronger and clearer messages, based on the latest data and evidence, and seek to regulate this market in a way that promotes quality and safety and, crucially, that protects young people.

Will the Minister use the forthcoming tobacco and vapes Bill to close loopholes that allow nicotine-free vapes to be sold to under-18s, and free samples of even addictive nicotine products to be given to children? Is she considering strengthening the powers of the regulator, the Medicines and Healthcare products Regulatory Agency, to deal with the number of illegal vaping products circulating on the UK market today? She is welcome to our policy—will she back our proposal to ban companies from branding and advertising vaping products in a way that is appealing to children?

Just as the last Labour Government led the way on tobacco control, so will the next, with a road map to a smoke-free Britain. We want to make sure that hospital trusts integrate opt-out smoking cessation interventions into routine care, making every clinical consultation count. We will legislate to require tobacco companies to include information in tobacco products that dispels the myth that smoking reduces stress and anxiety, and tackle the rapid rise in youth vaping, on which the Government have failed to act so far. To tackle health inequalities and rescue the NHS from 14 years of decline, we need bold measures to tackle smoking and improve public health.

[Mr David Jones]

Could the hon. Lady say what measures she proposes to put in place to tackle the issue of youth vaping?

[Karin Smyth]

I am sure the right hon. Gentleman took great notice of the Labour party conference, where we announced a ban on targeting, and advertising and marketing to, young people. We think that where there is a will, there is a way. The ban on smoking, which I remember very well from when I was part of an NHS trust, was an incredibly difficult thing to do and enforce. But when the Government make clear that the targeting of young people is completely unacceptable, the market will react. We want to work with companies to make sure that happens. That is our plan for doing that and for getting the NHS back on its feet and making it fit for the future.