Tobacco and Vapes Bill (First sitting)

Lisa Cameron Excerpts

Committee stage
Tuesday 30th April 2024 Public Bill Committees

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I am an NHS consultant paediatrician, and a member of the Royal College of Paediatrics and Child Health.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (Con)]

I am a practising psychologist, and I also chair the all-party parliamentary health group.

[Mary Glindon (North Tyneside) (Lab)]

Sir George, do we have to declare our memberships of any groups? I am a member of the all-party parliamentary group for responsible vaping.

[The Chair]

Well, whether it was required or not, you have now done it.

[Dr Cameron]

I am, too.

[The Chair]

We will now hear oral evidence from Michelle Mitchell, the chief executive of Cancer Research UK, Deborah Arnott, the chief executive of Action on Smoking and Health, and Sheila Duffy, the chief executive of ASH Scotland. To begin with, I will call on Michelle Mitchell.

Michelle Mitchell: First, thank you for your openness and transparency, Sir George. It is also important to declare whether anybody giving evidence has associations with the tobacco industry; I have none. The principle of accountability and transparency is also important for the people who are giving evidence.

Smoking is the biggest cause of death, ill health and disability. It is the biggest cause of cancer in the UK. It has a huge impact on preventable deaths, the economy, productivity and of course families and loved ones. Cancer Research UK supports the legislation to create the first ever smoke-free generation and to stop young people developing addictions, risk, ill health and, of course, cancer. We believe that the rights and entitlements of current smokers are reasonably unaffected. We urge you through your considerations in Parliament to pass the legislation, as does the public, 73% of whom support the legislation.

--- Later in debate ---

[Preet Kaur Gill]

Q I want to ask about the information that is given to parents, especially if their children have never smoked but have taken up vaping. We know that a generation of children is becoming addicted to nicotine because products that have been classified as 0% nicotine do actually contain it. One of the parents that I spoke to asked, “Well, how many puffs are there in one vape? If my child has two or three of those in a day, what does that actually mean?” It is about the information on that sort of risk, and how we share that information with parents who are trying to address this issue with their children. Is there anything you want to say about that, and is there any research being done to look at that?

Dr Griffiths: I would observe that there is so much variation between products and how people are consuming them. I think it is quite difficult to give advice in a standard way, and that it is part of it being an emergent product and market. As we have discussed, there is no doubt that, with nicotine being so deeply addictive, it is an incredible worry that a child has a single puff on a vape, given the potency of nicotine and where we know it leads people, having seen that over generations with smoking.

I should perhaps take a moment to emphasise that we also really support the £70 million investment being allocated to public health campaigning and cessation services, as well as enforcement. You are right that we need to be really clear with the messaging of the Bill to encourage support from parents and others around children in particular. We really applaud the decision to put resourcing behind this as well. We know that effective public campaigning can be an incredibly powerful tool. We were really proud to run the “Give Up Before You Clog Up” fatty cigarette campaign way back 20 years ago, and we know even that campaign led to 14,000 smokers seeking to quit. We know public campaigning works, and it was a great thought to allocate that resource as part of this work—it will be needed.

Sarah Sleet: The variation in nicotine levels and the method of delivery, which affects the uptake of the nicotine, is undoubtedly very concerning in vapes. I am a mother of three adult children who all vape, and I am very concerned about how often they are doing that and what impact that is having. We must also remember that, from what we know at the moment, it would appear that smoking is far and away the most damaging activity, compared with vaping. There is a little bit of concern that we overemphasise the harms of vaping to the extent that people say, “Well, I might as well smoke then. I’ll do that instead.” We need to be very careful about how we have this conversation.

[Dr Cameron]

Q I want to follow up on something that both of you alluded to earlier in the evidence you have given. Is there any research beginning to form that suggests that, while vaping can be helpful for cessation, it might also be a gateway to smoking itself for young people?

Dr Griffiths: That is an interesting question, and I can see the clear linkage you have described, but I am not able to provide any evidence. I am very happy to go back and provide that as a follow-up.

Sarah Sleet: I am not aware of any evidence around that either.

Dr Griffiths: It is a great question.

[The Chair]

I call Dr Caroline Johnson, and this will be the final question.

--- Later in debate ---

[Kirsten Oswald]

Q I wonder if you can develop some of the points you have made, which have been very useful. I am hearing anecdotally about issues in schools where the addiction of children to these vapes is itself causing a problem, because the children are unable to sit in the classroom and have to go out to vape, with whatever excuse is made, so that they then feel able to come back to the classroom, such is the level of their addiction to these products. If I may go beyond that slightly, what are your views on the way these things are promoted—for instance, on our particular concern about vape companies advertising on sports strips and in sports stadiums, and the impact on the same young people who are so addicted?

Matthew Shanks: I completely agree. The way in which vapes are marketed—the colours, flavours and so on—and the places where they are marketed suggest to people that they are safe. The fact that they are put forward as a “safe” alternative to cigarettes, the fact that parents use them and the fact that there are lots of colourful vape shops open in high streets: all those aspects promote the idea that vaping is okay.

At the same time, getting into a child’s mindset—we have all been there, as children—we like to break the rules and feel like we are pushing at boundaries. We know that it is not okay, but it is made okay. I would suggest that more children engage in vaping than in cigarette smoking, because they are not sure what the harmful effects are. That is the danger in it. I do think it leads on, because the younger children vape, but by the time they are 16 or 17, vaping might not be cool any more, so they go on to cigarettes or other things.

Anecdotally, we have heard of schools down in the south-west where people are putting cannabis into the vapes, so the addiction grows from that point of view as well. It leads to children coming out of lessons agitated. If I did not have three coffees in the morning, my agitation would be quite high. If children are not getting nicotine, as well as going through all the other things they are going through, they really do present as confrontational to staff, which makes it difficult to deal with them in classrooms and engage them in their learning. At the same time, to repeat a point I made earlier, you have parents at home who are saying, “Well, it’s okay to do.” I absolutely concur about the way it is marketed and so on.

Patrick Roach: To add to that, because those are important points: vape producers and manufacturers, and indeed those supplying vapes, are advertising freely in ways that make their products increasingly attractive to children and young people, with the way vapes are advertised and the marketing descriptors used for them. All the evidence we have, and certainly what our members tell us—our survey was of 4,000 teachers, so this is not anecdotal; it has an impact right across the system— suggests that the way those products are marketed and described deliberately seeks to entice young people to make use of them.

We believe that this is a strong Bill that very clearly sets out the societal expectations in this space, but as with any legislation, there is always scope for loopholes. If there are areas in the Bill where there is potential to further strengthen the legislation, I think the enticing way products are described, before an individual understands what they are getting themselves into, is something that needs to be considered and addressed.

From our point of view, it is about advertising, but it is also about access to these products. With the best will in the world, and no matter how they are advertised, if the products are easily available at the point of sale it makes things incredibly difficult. I remember that when I was bringing up my own children I worried about going to the supermarket with them, because they would be surrounded by candy and sweet products at the checkouts. You could not navigate your way through the checkouts. Thankfully, things have moved on: that has changed, and many parents are benefiting from those changes.

Young people are very much interacting with many of these products at the point of sale. They are in the shops that are in the vicinity of or on the route to and from school. They are being marketed in places that young people will frequent, whether that be a local café, the hairdressers or the barbers. They are in places where young people will be. They are also immediately available. The more we can do to stop the immediacy of marketing of these products and that easy availability, no matter how they are described, the better.

[Dr Cameron]

Q I have been hearing from parents and schools in my constituency that they are very concerned that children are going out at lunchtime and spending their lunch money on vapes, so they are not having anything nutritious during the day. Is there any evidence that indicates that there might be a pattern developing in that respect that will have an impact on children’s physical health and wellbeing?

Matthew Shanks: Absolutely: children will find any which way they can to do what they want to do. At the moment, while this is not illegal, they will gather more people to follow the crowd and go out. In my experience, the majority of children want to do as they are instructed—probably about 85%, anecdotally, over the years—but they will follow the herd. At the moment, there is a greater herd growing because of all the things we have talked about, with the marketing and colour of vapes. I can absolutely see children going out at lunchtime and spending their money on that, instead of on food. There is peer pressure to do that as well—it is taking more people with them. As Patrick said, you can see these products in the barbers, in the shops and so on.

Patrick Roach: To add to that, there are also bullying behaviours that manifest themselves. Whether a pupil is making the choice to go out at lunchtime to acquire vapes or is feeling coerced to do so, there is an issue either way. The availability of those products in the proximity of schools needs to be considered. That is a point that we would make.

Increasingly, schools have introduced systems to seek to ensure that children are being fed at lunch times, for example. We should not lose sight of that, but in some instances these products—particularly disposable vapes —are cheap as chips. I know that that is an issue of concern to the Government, and it is of concern to us and our members.

It is really important that we look at how we can ban the sale of disposable vapes entirely, because frankly no one knows what is in them, and they are incredibly cheap to acquire. Even if your parent can see what you had on Tuesday lunchtime because it comes up on their phone, how will they know if you have spent 10 minutes popping out to the local shop to acquire some vapes, particularly if they are of the disposable variety? More can be done not only to limit appeal, but to reduce the availability and accessibility of those products to young people. The more that can be done on that, the better.

[The Chair]

Four more people want to get in—actually, it has just gone up to five—and we have about 12 or 13 minutes left. It is unlikely that I will be able to get everybody in, but if Members put their questions as briefly as possible and witnesses respond as concisely as possible, I will try.

--- Later in debate ---

[The Chair]

I will attempt one final question from Dr Lisa Cameron. I simply make the point that the briefer the question, the more possibility there is that she will get an answer.

[Dr Cameron]

Q Thank you; I will be very brief. Do you think it is fair to describe older adults as having made a choice, when perhaps it was not an informed choice, given the misinformation and lack of evidence at the time that they made the choice to start smoking?

Paul Farmer: I think a lot of people made a choice without having the information in front of them. I suppose my parting thought to this Committee is that the consequences of failing to intervene in previous generations are now seen by the older people of today. If this legislation is implemented, the first generation of people will not reach 65 until 2074, but I can tell you that that generation of 65-year-olds will look back and recognise the contribution that the Government have made to changing and impacting on their long-term health in the same way that this generation looks back on the contribution of other Governments in other health initiatives.

[The Chair]

I thank the witness for his answers to the questions from Members, which were really helpful. They gave us not only the perspective of those who his organisation represents, but the intergenerational nature of their role in the world. That brings us to the end of this morning’s sitting. The Committee will meet again at 2 pm here in the Boothroyd room to continue taking oral evidence.

Ordered, That further consideration be now adjourned. —(Aaron Bell.)

Tobacco and Vapes Bill (Second sitting)

Lisa Cameron Excerpts

Committee stage
Tuesday 30th April 2024 Public Bill Committees

[Mary Glindon (North Tyneside) (Lab)]

Q It is always great to see you and your enthusiasm shows through. We are very grateful for what you do in the north-east with Fresh and Balance. Does there need to be some kind of balance—no pun intended—between education and enforcement in order to make this a successful campaign, and to make the Bill as successful as we all want it to be?

Ailsa Rutter: We have a really good track record over the last two decades of collaboration and cross-party working, with fantastic support from civil society, the NHS and local authorities. The previous legislation has gone through really well, overall, because we have worked together to build up public awareness and support. It is really important that we have adequate resourcing for our important professional groups, such as trading standards.

For me, it is about the communication, the vision and the narrative that we can set. Undoubtedly, if we can get this through, it will not just stop a whole new generation starting; we also know that it will trigger many people to think, “You know what? I am going to give it another go. I am going to try to quit.” We know that it can take people many attempts to quit for good. That is why it is really good that this is being backed up by additional investment in the important stop-smoking support systems and in our NHS trusts.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (Con)]

Q We heard this morning that some individuals and families had misinformation about vaping. We were given the example that, where the flavour is grapefruit or another fruity flavour, people might think that it is actually beneficial for children to be using vapes. Should we tackle those types of flavours and do more in terms of education, to make sure that families are aware that just because something has a fruity flavour, that does not necessarily mean that it is good for their health?

Ailsa Rutter: I note the aspects of the Bill that deal with flavours. We absolutely think that more should be done on the descriptors. We wholeheartedly agree that some of the description is completely inappropriate. However, flavours play a really important role. For example, in our mental health trust, it is the fruit flavours that have got addicted smokers to stop. I genuinely have not heard that come up in the north-east—parents thinking that it is somehow healthy for a young person if it has a fruit flavour. What is wrong, though, is when it is in a packet called “Unicorn bubbly shake” or whatever, with a cartoon image on it. Those are things that we should look at addressing.

On vaping by young people in the north east, I want to make the point that we need to be careful about the data. Sometimes people say that all young people are vaping, but the evidence does not stack up. All of our local authorities do health behaviour questionnaires and, across the board, around 10% occasionally vape. I am not at all saying that we should be happy with that, but the risk of a public narrative that all young people are vaping is that we inadvertently promote it as a norm. Schools North East—

[The Chair]

Order. I am sorry, but we have hit 2.50 pm. Caroline, I am sorry to you, too. We are not allowed to go over the time limit. Ailsa, thank you so much for your evidence; it has been absolutely first-class. We wish you well with all the important work.

Examination of Witness

Adrian Simpson gave evidence.

--- Later in debate ---

[Mary Glindon]

Q I was just searching for a quote, which I think I cited in a debate last year, about a survey that had been commissioned about buying vapes. Out of the 28 vapes that were bought, 25 were illicit vapes. I presume that those are from places that are not responsible retailers—they clearly are irresponsible if they sell those. Are there a lot of retailers that do not subscribe to your organisation where this sort of thing could be occurring? If that is the case, how can we encourage them to become responsible retailers and join the consortium? What should be done? Do you try to reach out to retailers that you know are perhaps not the best and that you would like to see engage with your organisation to help to prevent this kind of illicit sale?

Adrian Simpson: Exactly. Our membership is predominantly the household-name retailers—the large retailers; the ones that certainly would not be selling illicit vapes. We have comprehensive supply chains, and our members put a lot of effort into making sure that their supply chains are operating with integrity, so that illicit products cannot enter them. I have not seen that report, but my feeling would be that the sellers mentioned in it are highly unlikely to be members of a reputable trade organisation. They might be ones that would not be looking for the same standards that our members would operate to.

[Dr Cameron]

Q Do any of your members worry that they might get into some bother if they think that someone looks a bit older than they are, and they do not ask them for identification? I am just wondering what sort of training would be beneficial, because you mentioned that you were looking to put in place training prior to this going through.

Adrian Simpson: A lot of the training done by our members has been put together with the help of trading standards’ services, so there is a lot in there about the law, but also about what perhaps is termed the soft skills—how to deal with the aggression, and with violence as well. Of course, this is a high-profile issue, and it is one of the top priorities at the British Retail Consortium as well.

We know that, with new rules, new regulations and new opportunities to challenge consumers, there will always be some resistance from consumers. We will certainly make sure that all our colleagues working in our members’ stores are given all the support they need to deal with any potential aggression or any bother, and our members will comply with whatever the law says. They will not let someone who should not buy a product buy it just because they are worried, or something like that. They will follow whatever the in-store procedures are and the training from the work with trading standards.

[Dr Cameron]

Q But it is probably more difficult to tell whether someone is 35, 40 or 45 than whether someone is an older adult, going on a bus, or whether someone is a teenager rather than someone in their mid-20s. I am just wondering how that could work, in a sense, in terms of the training.

Adrian Simpson: I agree—that is difficult. It takes me back to discussions around Challenge 25, which we have mentioned. It started out as Challenge 21, and the age was raised because it was very difficult to tell the difference between a 21-year-old and an 18-year-old. Technology is evolving in this area. There are new things. We know that members are using new forms of technology to help with that. They rely on things like Government-issued ID. There are various ways of challenging someone. It comes down to things like the training and how the consumer is around the till. Are they acting nervous or like they are up to something? It is then down to the retailer to use the training that they have been given to check the ID and use their own in-store procedures, as well to try to operate responsibly.

[Kirsten Oswald]

Q To follow on from that dialogue, it strikes me that a degree of social change will be needed, because it will have to become normal for you to go into a shop and provide whatever kind of ID. It seems to me unlikely that that will be a conversation that will centre on whether you look this age or a year older. Has that led you to any conversations with people who deal with things like bus passes or the voter ID that is required? Is the communication of that to the public—a different angle from the communication to the retail staff—something that you are working on?

Adrian Simpson: Yes, we do work closely with trading standards, who are very good at doing the education side. It is not just about educating our members, but educating the public and bringing about a cultural change where it is almost expected that you will be asked for ID. If you have been in any large retailer recently, you have probably seen the badges they wear that say, “It’s our job to ask for your age”, for example. Certainly, among our member businesses, it very much is the culture to go for the Challenge 25. Although these regulations with the rolling age will have challenges, I am sure our members are well placed to overcome them.

--- Later in debate ---

[Bob Blackman]

Thank you.

[Dr Cameron]

Q This question is for John. You stated in the response to the Bill that enforcing the new age restriction will present its own challenges. What challenges do you foresee? Will the sector be penalised if it cannot tell the difference between a 35-year-old and a 40-year-old? How do you manage those intricacies?

John Herriman: I will let Kate answer on this one as well. There was a really good, comprehensive answer earlier from one of the people giving evidence: if this is the right thing to do, the right idea, it is something we will have to get used to doing. I think that is probably the principle that we would apply within the world of trading standards as well. We just have to get used to the new legislation and what it asks us to do, and then make sure that sellers are following that legislation. Probably the problem will be more at the business end rather than at our end, and this is where there is a really important role for business education and the likes of the British Retail Consortium, the Association of Convenience Stores and other organisations.

We must get the balance right: this is about the enforcement activity and the right level of legislation, but we also have to make sure there is an onus of responsibility and accountability on businesses themselves to solve part of the problem. I do not think it is right to put all of the problem on enforcement, for example. Therefore I would definitely be looking towards businesses to make sure that they are embracing this and making sure that they are doing the right business education and training along the way. Have you anything else to say on that, Kate?

Kate Pike: Absolutely. The other point, obviously, is about resources, which John has already highlighted. We are in discussions, but we do need to make it clear that trading standards needs more resources to enable it to deliver the enforcement in this Bill.

[The Chair]

I think we have received that message very loud and very clear.

Kate Pike: Good.

John Herriman: Did I mention that? [Laughter.]

Oral Answers to Questions

Lisa Cameron Excerpts

Tuesday 23rd April 2024 Commons Chamber

[Victoria Atkins]

These reforms are being brought forward because of a simply unsustainable rise in the number of people being given fit notes so that they cannot re-enter the world of work. We want to support people into work, not only because we believe that it is the best way to help them to recover, but because it helps us to fund the NHS. It is funded by people who work and pay their taxes. Again, I draw the hon. Lady’s attention to matters a little closer to home; sadly, Scotland’s record on health is very difficult to read and it includes the worst level of drug deaths in Europe. I encourage her to concentrate on how the SNP is running health services in its local area.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (Con)]

T3. I refer the House to my entry in the Register of Members’ Financial Interests. The British Psychological Society has commended the benefit of Government support for staff mental health and wellbeing hubs and is keen to see that support continue. Will the Minister therefore give an update on the support being provided and the progress being made on the vital issue of staff mental health and wellbeing?

[The Minister for Health and Secondary Care (Andrew Stephenson)]

That is an important point. We know how vital it is to support everyone who is working so hard in our NHS to support patients. NHS England is reviewing mental health services for all staff who need them, to ensure that they can access the support they need. It is working collaboratively with regions and integrated care systems to agree the best approach to doing that.

Oral Answers to Questions

Lisa Cameron Excerpts

Tuesday 23rd January 2024 Commons Chamber

[Maria Caulfield]

I have news for the hon. Gentleman, because we have a plan and it is working. Our investment of £143 million into crisis support is showing early evidence of reducing admissions—admissions are 8% lower. With the crisis telephone services, which are available 24/7, we have admissions down 12%. More importantly, detentions under the Mental Health Act are 15% lower. We have a plan, and it is working.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (Con)]

15. What recent progress her Department has made on reducing the number of people with a learning disability in in-patient units.

[The Secretary of State for Health and Social Care (Victoria Atkins)]

We have made progress against our target to reduce learning disability and autism in-patient numbers in England by 50% since 2015. For people with a learning disability without an autism diagnosis, there has been a 58% net reduction; for people with a learning disability who are autistic, the net reduction is 35%.

[Dr Cameron]

I thank the Secretary of State for that comprehensive answer. As chair of the all-party parliamentary group for disability, I have been hearing from organisations such as Mencap that remain concerned that people with learning difficulties are disproportionately detained for five to 10 years and for over 10 years. Will she reassure those organisations that the “Building the right support” action plan will continue to progress the great work that is being done?

[Victoria Atkins]

I thank my hon. Friend for her interest and, of course, her many years working as a clinical psychologist. She brings that experience to the Chamber. National commissioning guidance to integrated care boards was published in November. It sets out that a mental health in-patient stay for a person with a learning disability

“should be for the minimum time possible, for assessment and/or treatment which can only be provided in hospital”.

In overseeing implementation of the action plan going forwards, the “Building the right support” delivery board will maintain focus on quality of care and on reducing long stays.

Oral Answers to Questions

Lisa Cameron Excerpts

Tuesday 6th June 2023 Commons Chamber

[Steve Barclay]

Clearly, an increase in population in a specific area will have an impact on the health needs there. I recognise the concern that my right hon. Friend raises, and I will ask the Minister for Primary Care and Public Health to follow up with him on this important point. While the NHS is well equipped to deal with short-term pressures, this issue highlights the importance of the Prime Minister’s commitment to stop the boats and the Government’s overall strategy on illegal migration.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

T5. As chair of the all-party parliamentary health group, I have been hearing so much about the importance of artificial intelligence innovation in mental health, and I was pleased to launch the AVATAR2 clinical trials in three universities across the UK. Will the Secretary of State commend this progress being made in digital innovation? It deserves scrutiny, but can make much progress.

[Steve Barclay]

I very much welcome it. I am delighted to hear that constructive approach to AI from the hon. Lady. The importance of AI is why we have been funding more than 80 AI lab schemes with more than £130 million. AI has huge potential to help patients. We are seeing that, for example, in stroke patients getting care much quicker. She is right that there are also some regulatory and other issues that we need to address, but we should not miss the opportunities of AI, and she is right to highlight them.

Food Labelling and Allergies

Lisa Cameron Excerpts

Monday 15th May 2023 Westminster Hall

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

It is a pleasure to serve under your chairmanship, Sir Graham. I congratulate the hon. Member for Don Valley (Nick Fletcher), who opened the debate on behalf of the Petitions Committee. It is an extremely important and very poignant debate for many here today and for people across the United Kingdom who have been affected by allergies and inadequate labelling and service provision, which have led to the tragic deaths that have been relayed by Members today. I thank the families for the work that they have done and will continue to do in this space until the allergy tsar is appointed—a proposal that has been supported by everybody who has spoken so far.

The hon. Member set the scene perfectly. He asked for the allergy tsar to be appointed to address the important issues that have been raised, and he highlighted why it is so vital that menus are explicit. The point was also made that although people can have a discussion about their health-related issues at the dinner table, it is perhaps something that not everybody feels comfortable doing. That is exactly why it is so important that menus are explicit and that the issue is taken forward with prominence.

The hon. Member spoke about the numbers of people affected and why it is so important that we have accurate data, which includes not only those who have been impacted, but the near miss cases. Only with accurate data can we understand the scale of the issue and the prevention measures that are needed. He highlighted some of the difficulties for the trade in implementing the changes needed, but, my goodness, when young people’s lives are at stake, it is vital that those changes are made and that we work together with industry to ensure that they happen.

I also thank the hon. Member for Dagenham and Rainham (Jon Cruddas), who highlighted that this is a corporate responsibility across Government and that we have been waiting for 20 years, which is far too long, with far too many lives lost in the interim. We must make sure that the strategy comes together, that the tsar is appointed and that Government implement the policies that are so desperately needed.

The hon. Member for Winchester (Steve Brine) said that Owen’s law has already progressed in the Republic of Ireland. That is very important because it shows that despite the difficulties outlined at the start, this can be done and progress can be made. This proposal therefore has to be implemented pragmatically. The hon. Member for Chesham and Amersham (Sarah Green) described her constituent’s near miss case very eloquently, saying that that is why it is so important that we have a standardised approach.

The hon. Member for South East Cornwall (Mrs Murray) spoke eloquently on behalf of her constituents, as she continually does in this House. She raised the case of Owen and spoke of the support she has given to the family. She has also ensured that constituents’ concerns are heard at the highest level. She called it an absolute priority, and asked the Government for changes to be made in law.

There were some very good interventions from the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier), who is no longer in her place, particularly about the Food Standards Agency having been too slow to react. The hon. Member for Hammersmith (Andy Slaughter) spoke at length, reinforcing the need for the tsar to be put in place. His point that the clinical outcomes have not improved was so important: whatever has been done so far has perhaps made progress, but it is just not enough and is not making a difference clinically. He underlined the point that the current position is therefore inadequate. Finally, the hon. Member for Sheffield, Brightside and Hillsborough (Gill Furniss) said—this sums up the debate—that common-sense changes are needed, that we must work together and that no one has disagreed.

I would like to reinforce the asks that have been made of the Minister. I also think that much more testing should be available for allergies. I remember being tested, and the nurse saying to me, “Do you have any allergies, Lisa?” I said no, and I was so shocked when my arm started coming up with lots of little red spots and I was told that indeed I had quite a few allergies. We need to make sure that everybody can have that diagnosis and testing so that there are not accidental cases in which people may not even be aware that they have allergies.

As has been said, training for staff in the hospitality sector and others is so vital in this case. The other thing that I am very interested in is the digital, technological advancements that we are making. I would like to hear from the Minister—he can write to me if he does not have this information today; that would be perfect—about the blockchain digital technology that I have heard can be applied to food labelling and distribution. That technological advancement might help us to move forward in this case. Finally, I echo everybody’s words and call on the Minister to please appoint an allergy tsar, because we will be saving very many people’s lives.

--- Later in debate ---

[Neil O’Brien]

To reiterate what I said at the start of my remarks, I am mentioning some of the issues that we have to solve, not presenting them as insuperable obstacles to doing what a lot of people are calling for.

Another challenge that we have to grapple with, and are grappling with, is how to avoid some smaller businesses taking away a lot of choices for people with allergies by simply labelling too many items as containing allergens. Such businesses may have small kitchens that work with lots of different products and multiple allergens. We cannot take away lots of choices for people with allergies; we want them to have the freedom of choice that everyone expects to enjoy, but to have safety at the same time.

[Dr Cameron]

The Minister is making some good points, but on his last point, even if some outlets are being over-cautious, surely it is more sensible to be over-cautious than to put people’s lives at risk.

[Neil O’Brien]

That is a perfectly reasonable point. Of course, safety has to come first; I am merely laying out some of the challenges that we are grappling with as we think about Owen’s law and how we go further.

Even as we work on these issues and think about how we go further in providing information, we are getting on with improving training and knowledge for people in the food industry. Since September 2020, 380,000 people have signed up for allergy training through the FSA, which is a huge improvement in the provision of information and the correct treatment of people with severe allergies. Over the past 22 years, the FSA has invested about £22 million into researching these issues. Its scientific and social research, which improves the understanding of the views of those who are affected, of food businesses and of other key stakeholders, underpins our approach. To underline what I said a few moments ago, although I am not making an announcement today, nothing is off the table. We continue to look at and work on these issues at pace.

Let me turn to some other issues that have been raised in the debate. We have heard the calls for an allergy tsar, a form of leadership to advocate on behalf of those with serious allergies and their families. We already have parts of that leadership role in place, although, to address the point made by the hon. Member for Hammersmith (Andy Slaughter), that responsibility is not squarely on one individual’s shoulders. We will look closely at the proposal and at how we get to a more joined-up approach. The hon. Member asked directly whether I would meet with expert groups and those representing families who have been affected. The answer is yes, absolutely. I am extremely keen to meet and learn from those who have done lots of work on the subject.

It is worth setting out a bit about how the current NHS England operation works and what it is doing, although I recognise that that operation is not what those who are campaigning for a single joined-up tsar are asking for. In NHS England, there is a clinical reference group chaired by the national specialty adviser, Dr Claire Bethune. The group provides clinical advice and leadership on specialised immunology and allergy services. Its members include clinicians, commissioners, public health experts and patient and public voice members to try to capture the insights of those who are most affected by the issues. The members use their combined knowledge and expertise to advise NHS England on the optimal arrangements for the commissioning of specialised services. That advice includes the development of national standards in the form of service specifications and policies. As hon. Members know, those are tremendously important in defining what NHS services must be available.

The CRG is in the process of commencing a review of the current service specification for specialised allergy services. The output of that review will be an updated specification that makes reference to up-to-date guidance and takes account of the very latest evidence to clearly define the standards of care for commissioned specialised services, including transition into adult services.

The CRG is just one tool that we have at our disposal to address the multifaceted challenges that people with allergies face. Officials across Government are working with the National Allergy Strategy Group to consider how we can work more effectively together through things like an expert advisory group for allergy. The arguments that I have heard today will strike a chord with many people listening across the country. I am certain that it is right that we continue the conversation about how to work in a more joined-up way in future.

On ensuring that we have the right mix of staff to support people with allergies, in recent years there has been a 100% fill rate for doctors going into the two most relevant training pathways, allergy and immunology. NHS England will continue to identify priorities for investment in this space, in line with the expressed service priorities of the NHS across all medical specialties and the wider workforce. That work will be complemented by the forthcoming long-term workforce plan that we have commissioned NHS England to develop for the next 15 years, which we have committed to publishing shortly. It will include projections for the number of doctors, nurses and other professionals that will be needed in five, 10 and 15 years’ time, taking full account of improvements in productivity and the need for particular specialisms and skilled people to deal with things like immunology and allergy.

Most people with an allergy can be cared for in primary care settings, with services planned and commissioned by their local ICB. Specialised allergy services, however, are also provided for patients with the most severe allergic conditions, or those who have common allergic conditions for which conventional management has failed or for whom specialised treatments are required. In the current financial year, 2023-24, those services are jointly commissioned by NHS England specialised commissioning integrated care boards, in line with the published service specification.

All patients have access to those specialised services. Specialised services are required to be compliant with the service specification, including the need to have physicians, dieticians and nurses who are specially trained in allergy or have had long specialist expertise in the practice of allergy management and have up-to-date, continuing professional experience. All that work is serving to improve the lives of millions of people who have been affected to a greater or lesser degree by allergy.

There is clearly much more that remains to be done. The Government and those who have personal experience and great expertise working together will be central to driving forward continuing improvements, building on the work that has already been done and the changes that have been made. In future, we want to work closely with those who are most affected to improve the care and service provision for those who have serious allergies, so that they can live full, meaningful and safe lives.

Oral Answers

Lisa Cameron Excerpts

Tuesday 25th April 2023 Commons Chamber

[The Minister for Social Care (Helen Whately)]

My hon. Friend makes a really important point. I can say to her here and now that functional neurological disorder was previously regarded through a diagnosis of exclusion. It now has a rule-in diagnosis with available treatments, which is a major step forward in destigmatising the disorder. I am very happy to meet her to discuss this further.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

T5. As chair of the all-party parliamentary health group, I have heard from UK patients who struggle to access GP appointments from chain GP practices. Many of those practices have very low ratios of GPs to patients, including, in one case, only two GPs registered for 30,000 patients. Will the Department meet the APPG to address these grave concerns?

[Neil O’Brien]

We have increased real-terms spending on general practice by over a fifth since 2016, and as a result there are now 10% more appointments happening every month. We are grateful to GPs for that. We have more doctors and clinicians, but we want to keep going, and I am happy to discuss this with anyone who has useful ideas to keep us powering forward.

NHS Staffing Levels

Lisa Cameron Excerpts

Tuesday 22nd November 2022 Westminster Hall

[Margaret Greenwood (Wirral West) (Lab)]

I beg to move,

That this House has considered NHS staffing levels.

It is a pleasure to serve under your chairmanship this afternoon, Mr Hollobone. I pay tribute to all the nurses, doctors and other medical professionals—indeed, everybody who works in the NHS—for the work they do to look after patients and keep us all safe.

I have been overwhelmed by the number of organisations that have shown interest in this debate and have shared details of how the NHS staffing crisis is impacting on the people they represent. They are too numerous to mention here, but they include the Royal College of Nursing, the Royal College of General Practitioners, Versus Arthritis, Cancer Research UK, Unite the union, Parkinson’s UK, the Royal College of Midwives and many others. It is clear that there is insufficient capacity in the NHS in England to meet the needs of patients.

The NHS staffing crisis is a direct result of the failure of Conservative Governments to plan and deliver the workforce that we need. The crisis is not just about the impact of the pandemic; it predates that. In June this year, there were more than 132,000 vacancies in the NHS in England, which is up from around 98,000 the previous year and from around 105,000 in March. When we look specifically at registered nursing staff, as of June there were over 46,000 vacancies. Alarmingly, that is almost 8,000 more than in March. For medical staff, there were over 10,500 vacancies in June, which is around 2,500 more than in March.

By way of comparison, in December 2019 there were around 38,000 nursing vacancies and more than 8,800 medical staff vacancies. What was already an extremely serious situation before the pandemic has become worse. Staffing shortages create stress for NHS workers, and delays and deteriorating quality and safety for patients. As well as vacancies, waiting times for treatment and emergency services have continued to soar. Last month, of the nearly 1.4 million people who visited major A&E departments, more than 550,000 waited more than four hours from arrival to admission, transfer or discharge. That is 45.2% of attendees, which is way short of the target of 95% to be seen in four hours. In December 2019, 31.4% waited for more than four hours. Again, an already serious situation before covid has got worse.

As of last month, a total of 7.1 million people in England were waiting to start routine hospital treatment. More than 400,000 people had been waiting more than 52 weeks, and more than 2,000 longer than two years. Behind those statistics are huge numbers of people waiting in pain and anxiety. Cancer Research UK points out that, in September of this year, only 60.5% of patients started treatment within 62 days of an urgent referral, against a target of 85%. That means that, in September alone, around 6,000 people waited for more than 62 days for their cancer treatment to start. Even before the pandemic, cancer patients were waiting too long for diagnosis and treatment. The 62-day target has not been met since 2015.

On the Conservatives’ watch, millions of patients are being deprived of the timely treatment that they desperately need. Because of the unacceptable delays, some are paying for expensive private healthcare, and many are distressed to do so, because they believe in a publicly owned, universal, comprehensive national health service. They have been failed by Conservative Governments.

The staffing crisis is having a devastating impact on retention. Last month, the Health Service Journal reported that a record number of NHS workers voluntarily resigned from their jobs during the first quarter of this financial year. Almost 35,000 resigned voluntarily, which is up from around 28,000 during the same period in 2021 and around 19,000 in 2020. The most common reason for leaving during quarter 1 of 2021-22 was work-life balance, which almost 7,000 NHS workers cited as their reason for leaving.

A few months ago, I met with members of the Royal College of Nursing. They told me about the incredible amount of pressure that they are under because of staff shortages. They also told me of nurses suffering financial hardship. Some are going to food banks, some are unable to afford to drive to work, and some are leaving the profession to work in chain stores for better pay. However, it is not just about pay. The nurses told me that they often simply do not have enough colleagues to work alongside them. That is extremely stressful for them, and dangerous and deeply unfair for patients.

I turn now to industrial action. NHS staff care deeply about their patients, but they can also see that the NHS is at breaking point. Earlier this month, the Royal College of Nursing voted to take strike action in its fight for fair pay and safe staffing. That is unprecedented and has not been done lightly. The RCN has been clear: its members have voted for fair pay for nursing, safe patient care and to protect patients.

Numerous other organisations, representing thousands of workers, are also balloting for industrial action, including Unite the Union, Unison, the Royal College of Midwives and the GMB union. The Conservative Government’s failure to address the NHS staffing crisis is putting those working in the service under immense pressure and, in some instances, putting patients at risk. It is notable that, in a poll of 6,000 adults, carried out on behalf of Unite, 73% of respondents supported NHS and careworkers receiving pay rises that keep up with the cost of living. The Government should take note.

We cannot discuss the NHS staffing crisis without highlighting the Conservatives’ privatisation agenda, because it does impact on people working in the service. The Health and Care Act 2022 split the NHS in England into 42 statutory integrated care systems, each comprising an integrated care board and integrated care partnership.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

I thank the hon. Lady for making such a poignant and important speech, and for securing this debate, because we are all grappling with the issue. Does she agree that the staff in the NHS do their very best, but the future planning of the workforce is also an issue? We do not have enough staff for the future workforce plan. That is particularly the case in mental health and learning disabilities. I read that 215 young people took their lives in 2021, the highest figure since records began. Is that a concern to her, because I think it is for most of us in the House? I am sure that, in the excellent speech is making, she will want to highlight that.

World Menopause Day

Lisa Cameron Excerpts

Thursday 27th October 2022 Westminster Hall

[Carolyn Harris (Swansea East) (Lab)]

I beg to move,

That this House has considered World Menopause Day.

It is a pleasure to serve under your chairmanship, Mr Hollobone. I thank the Backbench Business Committee for granting time for this important debate. I am delighted to co-sponsor it with the right hon. Member for Romsey and Southampton North (Caroline Nokes), who shares my passion and determination to improve access to support and treatment for those experiencing symptoms of the menopause.

Anyone in or around Parliament last week might have noticed a buzz of activity. The reason, obviously, was that last Tuesday was World Menopause Day. It was an honour to welcome a group of women who have been instrumental in campaigning for change, from grassroots campaigners to clinicians and celebrities who are using their platform to amplify the message. The day ended with a rally in Old Palace Yard, almost 12 months on from our last Westminster menopause rally. Last year, I stood among jubilant women in Parliament Square. We were celebrating the fact that the Government had listened and committed to dramatically reducing the cost of NHS prescriptions for hormone replacement therapy in England, which would bring them somewhere near the free prescriptions in Wales, Scotland and Northern Ireland. They also committed to setting up a taskforce to look at other barriers women face.

This year, many of the same women were back again. They were as determined as they were last year. They were loud—possibly a little louder than last year. But they were a little less jubilant, a little more sceptical and far less confident in the Government’s commitment to the promises that they made in October 2021. However, they have not given up.

At the rally, Menopause Mandate launched a wonderful book, “It’s Beyond a Joke”, a collection of real lived experience stories from women. Some are graphic, some are funny, but some will break your heart. Every one is an honest account of a woman’s personal menopause journey, and every one is different, because no two women experience the same menopause. There are stories of misdiagnosis, insufficient workplace support and HRT shortages. There are stories from women who are struggling to afford the cost of the menopause, and from women who are hitting brick wall after brick wall when they try to access support. Thankfully, there are stories from women who faced some dreadful experiences but came out the other side—stronger, happier and ready to be their wonderful selves all over again.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

I thank the hon. Lady for bringing this vital debate to Parliament. Her speech is a wonderful contribution on what so many people have gone through. Does she agree that menopause is not just a physical condition or response in the body, but something with a mental health and wellbeing impact? People need access to specialist services and clinicians, so that their psychosocial needs can be met in a holistic way.

Procurement of Evusheld

Lisa Cameron Excerpts

Wednesday 12th October 2022 Westminster Hall

[Daisy Cooper]

I am grateful for that question. In fact, Evusheld is now so effective that not only has it been rolled out in 33 countries, but a number of countries, including Japan, Italy, Spain and Israel, have actually put in repeat orders for Evusheld, and the Centers for Disease Control and Prevention in the US has even launched a public drive to increase uptake. In private discussions, both the Minister and his predecessor have indicated to me in meetings that there was some evidence that countries had bought the drug but were not using it.

Let us be clear: the failure of any Government to identify clinically vulnerable patients and distribute the medication to them has nothing to do with the effectiveness of that particular drug. Before we throw stones in glass houses, we should remember that of immunocompromised patients in England who caught covid and were referred for treatment, only 17% actually got it. That failure to distribute is more to do with the fracturing of our health systems; it is not about the effectiveness of this drug.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

I thank the hon. Lady for bringing forward this vital debate on behalf of the many constituents who have contacted me and in my capacity as chair of the all-party parliamentary health group. Does she agree that when people feel they are being left to rot, it is not only their physical health that is impacted; their mental wellbeing is crippled in the stage of recovery where they need the most support possible?

[Daisy Cooper]

The hon. Member is absolutely right. Many people are clinically vulnerable because they have a health condition, and their physical health is getting worse, as it would when someone is stuck at home for two and a half years, but the mental health impact is also incredibly profound. We know that many of our constituents have experienced suicidal thoughts.

I turn now to the advice of the RAPID C-19 oversight group, which has been mentioned. The Government refused to share this advice for some time, and many of us were asking for it. I was pleased to see that this advice was finally published last Thursday on 6 October. I was pretty shocked for two reasons. First, the report actually says that the group looked at real-world data and the impact on people and that data was very strong. Then it looked at the data in a non-clinical setting and decided not to roll it out. That seems absurd to me.

There is a second problem with the evidence that was published last week. It lists the evidence that the group reviewed, and it leaves out one very critical scientific study by the Francis Crick Institute—a study that I believe the Government commissioned themselves. That study was commissioned to look at the effectiveness of a different drug: sotrovimab. That report concluded that sotrovimab was effective, and the Government are using that report to justify why they continue to use sotrovimab. However, the report also concluded that Evusheld was even more effective. So why not buy Evusheld too? Perhaps the Minister can enlighten us.

On the same day the Government published this RAPID group report, The Lancet—the world’s highest-impact general medical journal—carried an article by 19 experts calling on the World Health Organisation to update its guidance on Evusheld, based on the study the Government commissioned. In the article, those experts say that Evusheld should be used for not only preventative, prophylactic use, but treatment. The UK Government are really trailing behind. Can the Minister tell us why the RAPID study ignores this vital piece of research, which they must have known about?

Many of the people we are talking about have already had five or six vaccine jabs, even though they will mount very little, if any, response. The Government say it is important that these people get those vaccines, because they say some response is better than none. Why does that same test not apply to Evusheld? Why is it being singled out and held to an impossible standard?

Let us look at what the Government are proposing, instead of following the science. Ministers have referred Evusheld to NICE for further clinical and cost-effective assessment; apparently, we might hear back in April 2023. That is another delay—another six months of isolation—even though every other covid treatment and vaccine was urgently procured before being appraised. I ask again, why is the Government’s treatment of Evusheld so inconsistent?