Draft Anaesthesia Associates and Physician Associates Order 2024

Karin Smyth Excerpts

Wednesday 17th January 2024 General Committees

[Karin Smyth (Bristol South) (Lab)]

It is a pleasure to serve under your chairmanship, Dame Caroline. I thank the Minister and his officials for meeting me in advance of today’s sitting, and for the courtesy they showed to the Opposition in doing so.

When we are in need of care from the NHS, we are usually at our most vulnerable. We expect to be seen and treated by a professional who is competent in their role and regulated. It is vital that patients know who is undertaking their care, and can be confident in their competence. It is paramount to patient safety that those treating patients in the NHS are regulated. There has clearly been a delay in getting to that point with physician associates and anaesthesia associates, and regulation is long overdue. Those positions play an important role as part of a flexible and diverse workforce, but should never be seen as a replacement for doctors. I am pleased that the Minister has made that clear.

PAs and AAs were first introduced as assistants by the previous Labour Government because they are important in bringing people with different skills into the NHS and providing opportunities for those who do not take the traditional route into clinical roles. They exist in many systems around the world, and we thank them for their service. As part of a multidisciplinary team, they can provide much-needed capacity by supporting doctors and other frontline staff. So important are they that, as we have heard, their numbers are going to be increased as part of the Government’s workforce plan.

However, we must be clear that associates are not a panacea to 14 years of Conservative mismanagement of the NHS. The current crisis on the frontline, the workforce crisis, and record high waiting lists will not be solved by increasing the number of associates. The Government have cut 2,000 GPs, and many people now find it impossible to get an appointment when they need one. The failure to recruit, and particularly to retain, enough fully qualified staff should not be papered over by using alternatives. The Government’s inability to maintain relationships with frontline staff, including both junior doctors and GPs, is exacerbating worries about this legislation. The Government have already shattered morale among the health workforce. Many of us, as MPs, have heard from the people concerned most specifically in the run-up to this legislation. My first question for the Minister is: will he reassure me that the expansion of PAs and AAs will not impinge on medical specialty training expansion and, crucially, opportunities?

A number of concerns have been raised with me and other colleagues about the detail of this order and its implications for safety—concerns that really should have been addressed earlier if the Government had better relationships with key stakeholders. It is important for a Government to listen to and work with patients and professionals, and address their concerns. I ask the Minister to do that today, as this legislation goes through, and throughout the consultation process. That is my second question to the Minister: can he provide assurance that, going forward, all stakeholders will be fully consulted by the GMC on the details of the draft order? Patients need clarity about who is treating them and why. What measures will the Minister take to ensure that patients have that clarity, and improved awareness of who they could be speaking to in a GP surgery or other medical setting?

It is vital that people who are looking to become associates are properly supported and supervised to work within a defined scope in those roles. Addressing the workforce crisis in the NHS, so that staff have the time and, crucially, the capacity to support PAs and AAs, is crucial to ensure that those roles are successful. Can the Minister indicate what support would be available to PAs and AAs, what level of supervision will be suitable, and how the Government will ensure that that is in place, given that we all know how stretched the frontline already is? Has he had discussion with the GMC about defining the scope of PAs and AAs?

It will also be helpful to hear the Minister’s thoughts on how the draft order may impact on career progression in the NHS and help with retention, which we all want. Are there plans to define the core capabilities expected of PAs and AAs? What assurances can the Minster give us that the GMC is the best regulator to undertake that work? That point has been raised with many Members. Will the Minister explain how the order fits in with wider regulation reform, which is to be undertaken over the next year or so? Patient safety is and must always be our No. 1 priority. Can the Minister provide any assurances about the measures in place to review this legislation over the two-year transition period, particularly given the expansion of the role of PAs and AAs in the NHS?

Finally, some have expressed concern about the safeguards around the fitness-to-practice decisions taken by regulators, including decisions to remove or reduce regulatory restrictions on a registrant who has been found to present a possibly serious risk to the public. What assurances can the Minister give on that point? If the legislation is deemed not suitable to improve patient safety, what measures will the Government take to remedy that and keep on top of the situation?

The draft order provides a framework for the regulation of associates. It is vital that all those treating patients in the NHS are regulated and safe, and for that reason we will not oppose the statutory instrument. We support regulation. However, I hope that my concerns and those of others—I know that other right hon. and hon. colleagues wish to speak—will be monitored closely. I look forward to hearing further assurances from the Minister as he works to ensure that the change is successful.

[Several hon. Members rose —]

New Dementia Treatments

Karin Smyth Excerpts

Thursday 11th January 2024 Westminster Hall

[Karin Smyth (Bristol South) (Lab)]

It is a pleasure to serve under your chairship this afternoon, Mr Sharma. I thank the Backbench Business Committee for granting this debate. I pay tribute to work of the right hon. Member for Ashford (Damian Green) and my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams). They are formidable chairs of their respective APPGs on adult social care and on dementia. I know that the Minister has great respect for them, as we all do; they do fantastic work. Sharing the experiences of supporting family members was very apparent in this debate, and my hon. Friend’s image of holding her mother and feeling the ravages of the disease was incredibly well put. We have heard very moving statements this afternoon.

We are holding this debate at a crucial time for our country. We are a world leader—sometimes we overuse that term—in life sciences research that offers people living with dementia the prospect of new treatments as a lifeline. Finding a cure is where we all want to get to. The new treatments provide real hope and opportunity, but how do we get there? We have touched on that. New treatments and research help, but the workforce is where we will make a big difference. That is why we have committed to recovering clinical trial activity in the UK and delivering on the NHS long-term workforce plan.

We want to make sure it is easier to conduct lifesaving research in the UK for conditions such as dementia by implementing a more efficient set-up process so that people can sign up to participate in trials more easily, but that has to be supported by ensuring our NHS has the staff it needs to enable more clinical trials. Without the workforce to deliver new treatments, those living with dementia and their families will continue to face delays and we will not be able to access the benefits of early diagnosis. That is why I am pleased that the Government have finally accepted the need for a long-term workforce plan in the NHS.

As my hon. Friend the Member for Oldham East and Saddleworth said, it is disappointing that the Government shelved the plans for a dedicated dementia strategy. England remains the only nation without a specific dementia plan. That is very short-term thinking, and it would be interesting to hear from the Minister about that. In 2022, I said:

“We cannot give confidence to people suffering with dementia and their carers without a much clearer plan that is in place very quickly.”—[Official Report, 14 June 2022; Vol. 716, c. 141.]

That remains the case today.

Although we currently have no treatments to slow or cure dementia, as we have heard, there is hope on the horizon after the recent breakthroughs with drugs that target the underlying causes of Alzheimer’s disease, which are a hugely welcome step towards combating it. We need to ensure that our health service is ready and able to deliver the new treatments and technologies when they become available. The treatments, if approved, will depend on early diagnosis, which can be determined only by a PET scan or a CSF test. As the right hon. Member for Ashford said, the health service was not set up in 1948 to cope with dementia and similar diseases, so we need a 21st century service that can. It would be helpful to hear what plans the Minister has to ensure that the NHS is ready to deliver the new treatments. Has she had any discussions with NHS England about delivery ahead of the potential MHRA decision this year on the drugs currently under consideration?

There are too many people living with undiagnosed dementia. Part of the problem is the lack of scanning capacity for accurate diagnosis of dementia sub-types. We have one of the lowest per capita ratios of diagnostic scanners in the OECD, behind Russia, Slovakia and Chile. What steps are the Government taking to increase that diagnostic infrastructure? We have put forward a clear and costed plan to double the number of scanners, and, as with many of our other policies, the Minister is welcome to borrow it.

In a response to a written question last month, the Minister restated the commitment to double funding for dementia research, but I would welcome an update on whether that is on track for delivery this year. Further research continues to be vital to ensure that people living with dementia receive an early and accurate diagnosis. We have heard today about emerging techniques and new technologies, but we have to be able to access them.

It is estimated that more than 1 million people aged 25 to 49 are out of work due to caring responsibilities, so we need to alleviate the challenges and economic strain as a result of those caring for people living with dementia. It is not good for them, their families or, indeed, our economy. New treatments bring hope, but to benefit from them, we need a Government with the competence and foresight to seize the opportunity. Transforming dementia diagnosis and care is vital to improve the lives of those living with dementia and those who care for them. The bulk of the cost of dementia falls not on the NHS, but on unpaid carers and the care system, as hon. Members have said so eloquently today.

After 14 years, Mr Sharma, you would expect me to say that the Conservative party is not capable of making the NHS fit for the 21st century, let alone making the most of the new opportunities that our life science sector present for people. We want to make the NHS fit for the future, so that we are able to benefit from the exciting new treatments being developed and that all those with dementia and their families can be confident that they will receive the support they deserve.

Oral Answers to Questions

Karin Smyth Excerpts

Tuesday 17th October 2023 Commons Chamber

[Mr Speaker]

I call the shadow Minister.

[Karin Smyth (Bristol South) (Lab)]

Not only are the hospital buildings crumbling after 13 years of neglect, creating huge capacity challenges; it seems that those still standing do not have enough beds. As we heard from The Times this morning, the number of

“hospital beds…has fallen by almost 3,000 since ministers promised 5,000 before winter”.

It feels pretty much like winter to me. Is that just another broken promise?

[Steve Barclay]

First, we have got more than £1 billion of investment in an additional 5,000 permanent beds going into the NHS estate as part of our urgent and emergency care recovery programme. More widely, the Government are committed to the biggest ever investment in the NHS estate, backed with more than £20 billion—the biggest of any Government. Of course, we will not take lectures from Labour, which bequeathed the NHS the consequence of expensive private finance initiative deals that many trusts are still paying for to this day.

Fibrodysplasia Ossificans Progressiva

Karin Smyth Excerpts

Thursday 7th September 2023 Commons Chamber

[Karin Smyth (Bristol South) (Lab)]

It is a pleasure to be here this afternoon. I thank the Backbench Business Committee for granting the debate and pay tribute to the right hon. Member for Hemel Hempstead (Sir Mike Penning), who secured it and who has tirelessly campaigned on this issue with his constituents and the charity FOP Friends, who I understand have joined us today in the Public Gallery. I pay tribute to the families’ tenacity and bravery in raising the profile of this rare condition, and in continuing to do so. I also thank my hon. Friend the Member for Blaydon (Liz Twist), the hon. Member for Strangford (Jim Shannon) and the hon. Member for Inverclyde (Ronnie Cowan) for being here this afternoon.

One of the great privileges of our role here is learning from the experience—sometimes the very difficult and harrowing experience—of our constituents, and learning from them about subjects that we might not ordinarily have come across. I have certainly learnt a great deal from preparing for the debate, and also this afternoon. I am grateful to the right hon. Member for Hemel Hempstead for helping me to understand the impact of this condition, which he has done so eloquently and powerfully today on their behalf. I know that he worked with my office and other offices to ensure that all of us were well informed.

As we have heard, this is an ultra-rare condition, affecting only one person in 1 million, and there is currently no cure. However, we also know that what action can be taken is effective, both in diagnosis—which is crucial—and in care, and that people can some people can enjoy have good general health and reach old age, which I have been told is now over 60. It is my birthday this week, so that is quite close. I do not think it is old age, but they can certainly live for quite some time.

Early diagnosis is vital to managing the progression of FOP, and the average age of diagnosis, as I understand it, is around eight years old—as we have heard, the early signs include under-turned big toes—but greater awareness would mean earlier diagnosis for children with FOP. Families who understand that something is not quite right would be comforted to have that diagnosis. As we know, young children are not particularly careful or robust and, although we understand the dangers of immunisations into muscle, it would be a positive step forward for FOP.

Fifty-two per cent of people with FOP initially receive an incorrect diagnosis, creating more delays in care, with swellings due to flare-ups often being misdiagnosed as cancer or other diseases, which leads to unnecessary and potentially harmful procedures.

[Sir Mike Penning]

There have been limb amputations, and the damage that does to the muscle means it almost invariably turns into bone. Surgeons do not amputate a limb for the sake of it, and with the best will in the world, amputation is often more damaging and does not help the patient; if anything, it makes it worse.

[Karin Smyth]

I thank the right hon. Gentleman for his clarification about that, which adds to the trauma that people are living with.

A genetic test can confirm the diagnosis, and we expect to hear whether the Minister has made any assessment about including the test in the national genomic test directory for rare and inherited diseases. Given the commitment in the rare diseases action plan, it would be helpful if the Minister outlined what discussions he has had on new-born screening for FOP and the inclusion of digital education resources relating to FOP. As we have heard, there are only three knowledgeable clinicians in the UK. Access to information and guidance on FOP would make a huge difference for all those living with this condition.

Accepting that the Minister and I are the B team, and scientists would have been preferable, it is important that there is good care to help people with the condition who may be immobilised at a fairly young age. Care for FOP and other rare diseases is specialist and complex, and it reaches across the health and social care systems. I am sure I speak for him when I say that we are both very pleased to talk about the impact on the wider health service. We know that we are very short of care staff more generally, which is not helpful for people who need care or their families. Those living with this condition are vulnerable to some of the wider issues in the care service.

More generally, it would be helpful if the Government could outline more support in the workforce plan, including in social care. Without an increase in the number of care workers, those living with rare diseases such as FOP will struggle to get the care they need. That is why we think it should happen, and it would be helpful to hear what steps the Government are taking to support the care workforce for people living with this condition.

We have heard that research is the greatest hope for those living with this condition, and the right hon. Member for Hemel Hempstead has argued passionately, as have others, for the need to continue funding the STOPFOP trial. The amount of money raised by FOP Friends and the progress that has been made are an incredible achievement. We know that research into FOP will have benefits and implications for more common illnesses, such as osteoporosis, childhood brain cancer and heart disease.

Obviously, we are all pleased to hear that, after a very difficult and uncertain two years of frankly unnecessary negotiations—which have halted or delayed collaboration and research—we will now be involved in the Horizon programme, which will be crucial to making progress in this area. A key commitment in the rare diseases action plan is to improve the Be Part of Research platform to make it easier for people living with rare diseases to participate in research, should they choose to do so. Again, it would be helpful to hear from the Minister what the Government are doing to support those who wish to take part in the trial.

As we have heard, FOP can be devastating. The families want to live in good health and live their best life with their loved ones. I give my heartfelt commendation to those living with this condition and their families. I am pleased that people have come here today and I am sure that that visit to Downing Street was a really positive. The fact that we are debating this issue today is a testament to their hard work and commitment.

Oral Answers to Questions

Karin Smyth Excerpts

Tuesday 11th July 2023 Commons Chamber

[Mr Speaker]

I call the shadow Minister.

[Karin Smyth (Bristol South) (Lab)]

People across the country rely on local, accessible pharmacies, but whether it is high street closures or supply problems leading to the absurd situation where women are phoning or visiting multiple pharmacies for a prescribed dose of hormone replacement therapy and other drugs, the Government are again letting people down. They have repeatedly announced plans to expand the role of community pharmacies, but have failed to update legislation that could possibly help. They keep collapsing the business in this place, so we have time to sort it. Why will they not do so?

[Neil O’Brien]

I have given a flavour of the four different reforms we are making. To give the wider picture, there are more pharmacies in England than there were in 2010, there are 24,000 more pharmacists in England than there were in 2010 and we are putting in £645 million to provide a bunch of services that were not there when Labour was in office. We are very happy to take lessons from the pharmacy sector, but not from the Labour party.

Bladder and Bowel Continence Care

Karin Smyth Excerpts

Thursday 29th June 2023 Westminster Hall

[Karin Smyth (Bristol South) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Graham. I commend the hon. Member for South West Bedfordshire (Andrew Selous) on this comprehensive and moving debate. He gave voice not just to a particular individual but to many people, and that is one of the highlights of being in this place. I also commend the hon. Members for Don Valley (Nick Fletcher) and for Strangford (Jim Shannon) for being here and for their work on Boys Need Bins and men’s health. It is unusual that I am the only woman in this debate. I am happy to be in this company because the hon. Member for South West Bedfordshire is right that there is a taboo and we all need to work together to reduce the stigma.

It is estimated that 14 million people in the UK have some degree of urinary incontinence, while at least 6.5 million people experience bowel control difficulties. Those numbers are staggering. Although it affects twice as many women as men, one in 25 men over the age of 40 also experience urinary incontinence. Gynaecology waiting lists have faced the biggest increase of all medical specialities, with more than half a million women in the UK on gynaecology waiting lists last year. That is something I recently discussed with Dr Ranee Thakar and Kate Lancaster at the Royal College of Obstetricians and Gynaecologists.

We have known about the need for education and prevention for many years. It is something I worked on in the health service in the late 1980s, but we still have not seen the results, and people are living with poor continence all the time. It is different for everyone, but we have heard about some of the significant impacts that incontinence can have on quality of life and mental health, as well as through a reduction in physical and social activity. We should remember that in most cases the problem can be either prevented, cured or managed so that it does not interfere with daily life, but to do that the right support must be available so that we can all live our lives with dignity.

There are excellent innovations and surgical products for stoma wearers, and I pay tribute to the health staff, from specialist nurses to pelvic floor physios, who go over and above to support those with continence issues and to help people to adjust to life-changing surgery. Too often people with continence issues face unnecessary hurdles, and we have heard some today—whether that is a lack of public toilets, lack of awareness or, indeed, the normalisation of continued incontinence following childbirth. Those impacts cannot be underestimated, and I know from my constituents how a lack of amenities can cause isolation, while a lack of awareness around care can lead to people living with these problems for far longer than they should have to. There are also financial pressures on the NHS as a result of poor continence care, from costs associated with hospitalisation or catheterisation to high workload pressures and increased laundry costs. That means the cost to the NHS of incontinence-related care is more than £5 billion every year.

Many people are admitted to hospital with urinary tract infections, often caused by catheter-associated urinary tract infections. That increases A&E attendance and costly unplanned admissions. Improving catheter care in the community would significantly ease the burden and reduce A&E attendance and hospital admissions. That is one reason why the Labour party will shift more care out of hospitals into the community, so that the NHS becomes more of a neighbourhood service.

In Bristol, we are fortunate to have highly recognised work in this area. The CONfidence app, which has already been mentioned, is led by Dr Nikki Cotterill in association with the University of the West of England and Bristol Health Partners. I commend that work to the Minister. It aims to address inequalities for patients with pelvic floor disorders and improve services for the future, as well to provide vital care and support to people who are suffering in silence.

Another project conducted by Bristol Health Partners and the West of England Academic Health Science Network highlighted six opportunities, which I think are worth listing. We need to help people by improving perception; communication; the environment; health services; recognition and support, particularly for mental health issues and anxiety; and participation in society.

The hon. Member for South West Bedfordshire addressed the issue of race inequalities, which we are looking at in Bristol. We have a project to explore the barriers faced by women with incontinence in the Somali community, which I hope all of us across the country can learn from. Not everyone everywhere has the same experience, so it is important that we share. However, everyone facing these problems deserves access to high-quality information and suitable treatment in an NHS that is supported and fit for the future. You would expect me to say this, Sir Graham, but 13 years of Conservative Government have not helped the health service. Waiting lists and preventive care in the community are at breaking point.

People who support those living with incontinence need quality training to ensure the right bowel and bladder care regime for each patient. That is particularly important for those with mobility issues who rely on carers either at home or in a community setting. Nurses are currently required to learn specialist continence care on the job, because of the removal of NHS training courses over the last few years. That adds additional pressure to already overworked nursing and caring staff, putting patients’ quality of life and their health at risk. We are still waiting for the workforce plan, although we hear that it is imminent. I agree with the hon. Member for South West Bedfordshire that those living with incontinence would welcome an update from the Minister on whether the Government will introduce NHS training courses on stoma and continence care for nursing and care professionals.

This is not just an individual health matter, but a public health matter. It would be helpful if the Minister could explain what discussions he is having with integrated care boards throughout the country about tackling incontinence as a prevention issue, knowing, as we have heard, that it affects one in five people across the country. From the examples we have heard, it is clear that specialist treatment and support, including mental health support, is vital. How are the Government ensuring that those who need that support receive it, and particularly those in harder-to-reach communities?

Much has been promised in the women’s health strategy, but we are still awaiting action on things from tackling gynaecology waiting lists to appointing a deputy women’s health ambassador. We have heard good promises but we need to see the findings. Also, any disruption to the flow of medical devices into the UK would have a devastating impact on those who rely on them, and urology projects are no exception. Can the Minister give any assurances to the industry in respect of the sustainability of production and regulatory alignment post Brexit?

Finally, can the Minister provide any information on updating the guidance regarding the disposal of sanitary dressings in the building regulations and in approved document M? I understand that that work has been ongoing since 2020, but it would address many of the issues that have been raised today. If he cannot provide an update now, will he do so in writing? I think the hon. Member for South West Bedfordshire would appreciate that too.

Draft Healthcare (International Arrangements) (EU Exit) Regulations 2023

Karin Smyth Excerpts

Wednesday 28th June 2023 General Committees

[Karin Smyth (Bristol South) (Lab)]

The regulations are vital to implement international healthcare agreements following our exit from the European Union. Reciprocal healthcare agreements support our constituents to access healthcare in the listed countries. Those faced with the stress and worry of a healthcare emergency abroad will rightly expect suitable agreements to be in place where possible. That is particularly true of people with a disability, who are older or who perhaps live with a chronic condition. The Opposition will therefore support the statutory instrument.

It is important to note, however, that the regulations confer further powers on the Secretary of State. It would be helpful if the Minister outlined further details about the Government’s plan for other international healthcare co-operation outside the European economic area and Switzerland, and perhaps gave an idea of what that might look like. From our understanding, payments can be made only if both the following conditions are met: the healthcare treatment is in a country with which we have an international healthcare agreement; and the Secretary of State considers exceptional circumstances to justify the payment.

I appreciate that the public consultation on this matter has recently closed, but will the Minister say what would constitute exceptional circumstances and how the policy framework might work? An early indication of the results of the consultation would be most welcome. Otherwise, we are happy to support the regulations this morning.

New Hospital Programme and Imperial College Healthcare NHS Trust

Karin Smyth Excerpts

Tuesday 13th June 2023 Westminster Hall

[Karin Smyth (Bristol South) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Mark. It is good to see the Minister; the day after we were last opposite one another, he decided he would not continue after the next general election. I hope we have a good exchange today, and I wish him well.

I am pleased to be in the debate. I declare an interest in that I was born in the Chiswick branch of the old Hammersmith Hospital. The groundworks at Ealing were dug by my father and thousands of Irish labourers from across west London, and I used to visit that hospital as a child. My brother was born in Hillingdon. These places matter to local people.

We are here to discuss something called the new hospital programme, but what we quickly learned was that it was not new, they were not hospitals and there certainly were not 40 of them. It is an absolutely sorry saga, and as we have heard it is a hammer blow for people in west London. It is also a saga that is recognised across the country. Members should not just take my word for it; according to the National Audit Office, the NHS estate does not meet the demands of a modern health service. The growth in backlog maintenance risks harm to patients, and the need for capital is being consistently underestimated. Billions of pounds in capital have been diverted to cover inadequate revenue funding, and yet some capital cannot be used for technical reasons, so there are underspends. Assets are sold to fund day-to-day activities.

In July 2020, the Public Accounts Committee recommended a capital strategy and guidance, including expectations on how backlog maintenance costs will be addressed alongside other priorities. In October 2021, the NHS Confederation stated that NHS leaders had concerns about safety standards because they cannot sufficiently maintain their estate, enable positive digital innovations and reduce the elective backlog without further worsening health inequalities. It described a disjointed and opaque allocation system and unresolved issues about how integrated care systems will allocate and prioritise capital spend.

There is more. In September 2022, the King’s Fund reported that levels of capital investment had changed dramatically over the past 15 years—and don’t we know it! The transfer of NHS funds from capital budgets to support day-to-day spending and relieve the pressures in the NHS has come at a huge cost. NHS buildings and equipment have fallen into increasing disrepair and patients have experienced safety incidents.

The Government’s own review, chaired by Patricia Hewitt, recommended that there should be a cross-Government review of the entire NHS capital regime, with a view to implementing recommendations from 2024. Section 5.43 of the report makes suggestions that a review should consider. My first question to the Minister is, will the Government conduct a review in the light of the Hewitt recommendations? The Opposition would like that update.

NHS estates and capital are a subject that has always interested me in my time as a Member of Parliament. My first involvement as an NHS administrator working on NHS estates was in the late 1980s, when I was a junior planner in Enfield working on the final stages of Chase Farm Hospital, liaising with architects and clinicians and producing updates for the planning director. Later, in the noughties, I was part of the Bristol health service plan to reconfigure acute services and develop the primary and community estate as a non-executive. Yet, my real interest in capital, and part of my motivation in becoming an MP, was the disaster of the Tories’ Health and Social Care Act 2012. Nowhere is the destruction caused by that legislation more apparent than in the management of estates and capital planning, which was not even an afterthought. We cannot provide quality healthcare in leaky, dangerous and collapsing buildings.

Local taxpayers deserve to know how their money is being spent, and another key point made by Patricia Hewitt was about accountability. The MPs here today can get no clarity from their local NHS, and that is frankly outrageous. They have come here today from west London, and from across parties, to try to get some answers as to why the promises made to them have been reneged on. They also want some clarity and, as my hon. Friend the Member for Reading East (Matt Rodda) said, some certainty about the capital programme. It is entirely opaque why some schemes go ahead while others languish somewhere in a possible queue—I am not even sure there is a queue. Indeed, my second question is, can we see that queue? Can we understand the criteria for assessing what is in and what is out, and the timings?

There have been questions about enabling works. We need much more detail on what is in the system now, the original bids and the assessment of the capability to deliver. Who is designing? Who is project-managing? Who is freeing up the clinical time and paying for it to lead and advise on what is needed? Who is tackling safety and the sustainability of these future public buildings so they can meet the challenge of climate change? Because of the damage of the last decade, such skills are in short supply across the public and private sectors.

In case the Minister is not across this and does not have the detail from his civil servants, I will end with a little advice. From my 30 years in and around NHS capital schemes, I know they are complex and require a huge range of knowledge and skill throughout a long process that sometimes lasts for decades. We cannot land modular buildings in major towns and cities, with buildings surrounding them that are hundreds of years old. These are complex facilities that need to augment local services; they are not Amazon warehouses. Decanting clinical facilities and patients is not a matter of unplugging a few computers and moving desks into a portakabin.

Crucially, as the people of Hammersmith and Paddington, Hillingdon, and Uxbridge and South Ruislip certainly know, this is a Government of vague but still broken promises. They could not run a bath; they could not deliver a pizza. They are totally incapable of running this hospital programme. I hope the NHS is not waiting for them to deliver a 75th birthday card, because it will never arrive. They need to go.

Obesity and Fatty Liver Disease

Karin Smyth Excerpts

Thursday 8th June 2023 Westminster Hall

[Karin Smyth (Bristol South) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Hollobone, and to respond on behalf of the Opposition health and social care team. As the hon. Member for Linlithgow and East Falkirk (Martyn Day) said, it has been a very well-informed debate. I thank my hon. Friend the Member for Caerphilly (Wayne David) for the exceptional work that he and the other members of the APPG on liver disease and liver cancer are doing to raise awareness of this vital issue.

As has been demonstrated, rising obesity poses a profound threat to public health. We have heard today—from Strangford to Erewash, and from Southall to Linlithgow—that this is an issue across the United Kingdom. Before we hear from the Minister, I want to say how impressed I am with how everyone has tackled their own health and wellbeing through exercise, and I will certainly try to do better the next time I come to one of these debates.

As we have heard, obesity can impact on cardiovascular disease, as well as a variety of other conditions, not least non-alcoholic fatty liver disease. The British Liver Trust estimates that deaths as a result of liver disease have doubled in the last 20 years—that is a sobering statistic—with mortality rates are four times higher in the most deprived areas, as we have heard. Childhood obesity is also rising at the fastest rate on record, with 39% of obese children estimated to be suffering from non-alcoholic fatty liver disease. Not only is obesity rising and costing lives, but it is also causing people to live less prosperous and enjoyable lives and harming our economic productivity, as my hon. Friend the Member for Caerphilly said.

The case for action could not be clearer. If we want to lead happier, healthier lives, while also reducing pressure on our NHS and turbocharging our economy, we must get serious about addressing the obesity crisis. That can be done only by placing prevention at the heart of our work.

Despite our best efforts, individuals cannot tackle obesity alone. Too often, we have a narrative of personal responsibility, but it fails because it promotes harmful, outdated ideas about our bodies, and that is particularly true for women. We need a step change in how we tackle obesity as a society.

I am proud that Labour’s recently launched health mission set out a blueprint for shifting the focus of Government Departments, the NHS, and wider public services to prevention. Most relevantly to today’s debate, we want to give every child a healthy start in life, with a children’s health plan.

I pay tribute to the hon. Member for Erewash (Maggie Throup) for her work as a public health Minister—she knows of what she speaks. We would want to implement that long-overdue 9 pm watershed for junk food advertising on television and to ban paid advertising of less healthy foods on online media. That would come alongside establishing fully funded breakfast clubs in every school and a balanced and broad national curriculum with a wide range of compulsory physical activities.

That is the start of our vision for Government. For far too long, public health problems such as obesity have been viewed as falling exclusively under the purview of the Department of Health and Social Care but, as we have heard, the causes of obesity are multifaceted. It is about what we eat, but also about our access to green spaces, our genetics, the money in our pocket, our access to community care, and so much more. If we want to tackle obesity and, by extension, this disease, every cog in the Government machine must recognise its responsibilities.

For that reason, Labour has committed to embedding health in all policies through the creation of a cross-departmental mission delivery board. That would bring together all Departments with an influence over the social determinants of health and act as an accountable body akin to the Climate Change Committee. That is the kind of bold, ambitious thinking that will define the next Labour Government.

I am aware that those suffering, or at risk, from NAFLD want action from the Government now. With that in mind, I would like the Minister to address some questions. First, in relation to obesity and prevention more generally, the Government recently launched their consultation for the major conditions strategy, singling out six major groups of health conditions but, unfortunately, there is no mention of obesity in the consultation documents, although cases of several of the diseases mentioned are rising in part because of obesity. It would therefore be helpful if the Minister set out what role preventive obesity policy will play in those major disease conditions. Similarly, concerns have been raised that there was no mention of liver disease in the strategy. Will he therefore set out how he plans to address increases in liver disease, and specifically NAFLD?

I also want to press the Minister on health inequalities. The British Liver Trust describes liver disease as, effectively, a barometer for underlying health inequalities. It points out that the main risk factors—obesity, alcohol misuse and viral hepatitis—are most prevalent in marginalised communities, and we heard some shocking statistics from my hon. Friend the Member for Ealing, Southall (Mr Sharma). That goes back to the point made earlier about the wider determinants of health. Unless the Government implement a coherent strategy for health inequalities, we will never be in a position to drive down liver disease.

The Minister will remember that in 2019 the Government pledged to extend healthy life expectancy by five years by 2035 and reduce the gap in healthy life expectancy by 2030. The clock is ticking. Not only is the target on track to be missed, but things are actually getting worse—inequalities in life expectancy are widening. Given that the Government binned their health disparities White Paper, will the Minister provide an update on how he plans to reverse the health inequalities that have widened on this Government’s watch?

We know that liver disease is largely asymptomatic in its early stages and that diagnosis is essential in providing effective treatment. As we have heard, one in four people diagnosed with alcohol-related liver disease in hospital die within 60 days, and there is evidence of huge geographical variation in the pathways for early diagnosis. Given that grim picture, what assessment has the Minister made of current diagnostic provision for liver disease, and how will he improve that picture so that, no matter where someone lives, they can receive a timely diagnosis?

In conclusion, our current trajectory must not be allowed to continue. Unless we address obesity and rising fatty liver disease, more lives will sadly be lost, and our health service will come under existential pressure. Labour stands ready and waiting to address this crisis, but we cannot afford to wait. The Government must get to work now. We look forward to hearing from the Minister.

Oral Answers to Questions

Karin Smyth Excerpts

Tuesday 6th June 2023 Commons Chamber

[Karin Smyth (Bristol South) (Lab)]

From Sittingbourne via Bristol and Oldham, people are fed up with not being able to speak with a GP when they need to. GPs are warning that rising demand and increased costs may lead to workforce cuts or even closures. They are fed up with the bamboozling of numbers—more of which we have heard this morning—whether on GPs, full-time trainees, locums and now appointments. Whatever the metric, can the Secretary of State or the Minister tell us how many more GPs or GP appointments they think are necessary for people to access the care that they need?

[Neil O’Brien]

We committed in our manifesto to increasing the number and availability of appointments by 50 million. We are well on our way to meeting that target, as I have mentioned—we had 10% more appointments in the year to April than in the year before the pandemic. That is the result of the additional staffing that we are putting in: the extra 29,000 other clinicians and the nearly 2,000 more doctors in general practice. We have made that investment, but the reason why GPs are doing more appointments is not just that we have provided a fifth more funding since 2017 up to 2021; it is also that GP teams are working incredibly hard, and I pay tribute to them for all they are doing.