It is a real pleasure to take part in the debate under your stewardship, Mr Hollobone. I thank the right hon. Member for Kingston and Surbiton (Ed Davey) for enabling us to tease out the issues relating to unpaid carers. I concur with much of what he said.
I am disappointed to see only Labour and Liberal Democrat Back Benchers taking part in the debate. I genuinely would have liked to listen to Tory MPs’ views on the matter, given that it affects so many people in our constituencies. It is worth reiterating a few figures. In 2019-20, around 7% of the UK population were providing unpaid care. That is just under 5 million people, or an average of more than 7,500 people in each constituency, providing unpaid care.
In my own local authority in Sefton, around 5,000 people aged over 65 have dementia. In my constituency alone, that is around 1,700 people. I expect that figure could be higher if we take into account non-diagnosed dementia and people who are below the radar. By 2030, that number is set to rise to almost 6,500 people and over 4,000 of them will have severe dementia, meaning they are most likely to need support and social care. As many as 700,000 informal carers support people with dementia in the UK. They are asking to be helped out—not to be given a free ride. Of course, a significant number of carers themselves will be older and have their own physical and/or mental health issues. The real human impact on the lives of so many people and individuals can be clouded by the figures, but the figures cannot be ignored.
When I use the word “clouded”, it actually brings to mind the Alzheimer's Society report, “The Fog of Support”, which I exhort Members to read. In short, it sets out the challenges faced by both informal and/or unpaid carers, and formal carers. Some of the examples are heartbreaking. One carer says:
“Because I’ve got to be back within a certain time…you’re clockwatching. You can’t relax.”
Another quotation reads:
“He doesn’t want to go and if he goes in for respite he packs his case every night, ready to come home.”
Covid has thrown a cloak over the needs of many, and those two examples are not just reflective of reality; they are reality. For those who have no family and are the only carer, the strain and pressure are intolerable. In the first wave of covid, family and friends spent an additional 92 million hours caring for people with dementia—unpaid care. Since the pandemic began, unpaid carers have provided £135 billion-worth of care. It has been a long 16 months, and many relationships are under strain.
Members will have seen the Alzheimer’s Society briefing for the debate, and I thank it for that information. I am afraid that the Government’s policy on support for carers is in complete disarray. The Commons Library report is, as ever, a measured assessment of the current state of affairs. It says:
“The Government has said that it intends to publish a final evaluation of the Carers Action Plan in 2021…When the Government decided not to proceed with the publication of a Carers Strategy it stated that carers would instead be included in a then expected Green Paper on the reform of adult social care. However, the expected Green Paper had not been published by the time of the 2019 general election and the current Government no longer specifically refers to plans for a Green Paper.”
There is delay after delay, with more delay for good measure in case there was insufficient delay in the first place. A meeting between the Prime Minister, the Chancellor and the former Health Secretary—a so-called “do or die” meeting—was postponed in June. Asked about the postponement on Radio 4, the Business Secretary said he did not know that it was happening, and that it had been called off. If three senior members of the Government cannot even co-ordinate their diaries on one of the most important social issues affecting millions of people, what confidence can we have in their getting to grips with the substantive issue?
The Prime Minister, the Chancellor, the Health Secretary and every single member of the Government and their supporters are letting down not just older people but younger people, children and working-age disabled people. The Disabled Children’s Partnership produced an excellent briefing for the debate. Time does not allow me to go into its findings in any detail, but I hope it will be a salutary and informative read for the Minister. How much more evidence do the Government need to prove that the care system in general is in disarray, as is the informal, or unpaid, care system?
The Prime Minister likes things to be oven ready. He claims to like to get things done. He has promised action on this time after time, so perhaps he could use his isolation in Chequers productively and get to grips with this issue. It is time to deliver. Actions speak louder than words.
It is a pleasure to serve under your chairmanship today, Mr Hollobone, and I thank my right hon. Friend the Member for Kingston and Surbiton (Ed Davey) for securing this massively important debate. I should declare an interest, because I am a carer, and have been for the past 22 years; however, I do not want to talk about that today.
Although I thought I knew everything there was to know about caring as an individual, I was taken by surprise at a clinic I held when I was a Member of the Scottish Parliament. I was at a clinic in Castletown in Caithness, and a gentleman in his early 60s came to see me. He was a bachelor; he was on a very low pension; and he told me how he was looking after his mother, who was bedridden and incontinent. He told me that he was not going to put her in a home; she had looked after him all his life, and he was now going to look after her. He then broke down in the middle of the clinic, which as a new Member of the Scottish Parliament I found rather disturbing, and told me his tale. The national health service had afforded him an allowance of four adult diapers—nappies—for his mother, per day. Each fortnight, or month—whatever the period was—the requisite number of diapers would be delivered to his household. He then told me that what was awful was that, at the flick of an unknown health mandarin’s pen, this allowance had been decreased to three diapers a day. He said that the reason he broke down was, “I’m not in my first youth—I’m not as young as I was. It’s the bed linen. It’s nighties. I can’t cope with this. I can’t cope. I’m desperate.” I gritted my teeth and said that, “If I do nothing else as a Member of the Scottish Parliament, I’ll sort this for you.”
I was so angry the next day that I went to Heather Macmillan, who runs my constituency office, and said, “Take a letter! Words fail me. I cannot believe it.” She said, “Jamie, go for a walk. I’ll write the letter. I’ve got the gist of the problem.” We got it sorted and he got back up to four diapers a day. One little thing had been destroying his life, and that was an unexpected aspect of caring that I had not foreseen—it was a real curveball. I can only tell this anecdote now because the gentleman concerned is no longer with us—I have kept quiet all these years—and the point of it is that there are things that can impinge on caring that can be entirely unexpected. It is not always about money; it is about a clumsy and thoughtless decision that was, I fancy, taken far away from where this man lived in Caithness.
Another point, to echo what other Members have said, is about young carers. In my constituency, we are very fortunate to have an organisation called Tykes Young Carers, based in Golspie, Sutherland. I have waited a long time to go on the record and commend that organisation here in this place. I take my hat off to it. Having met its representatives over the years, I have learned certain things and I am sure that all Members will be familiar with similar examples. A young carer who returns home from school, perhaps to a remote croft in the highlands, might have to look after a single parent who is alcoholic and feed and look after younger siblings. Then, when they go back to school the next day, they get roasted by the teacher for not having done their homework. That is an oversight on the teacher’s part, but the teacher cannot be blamed for not knowing all the facts about that particular family. That, however, is another unintended occurrence for carers. Over 22 years of looking after my better half—as we say in the highlands—I thought I knew it all, but I did not.
My appeal to the Minister is, as the hon. Member for Blaydon (Liz Twist) has just said, for the Government to take an overall look at this situation. Yes, it is about resources, but it is also about having the radar, being truly three-dimensional and working this way and that way to identify all the things that can go wrong with caring—they need not necessarily be related to money—and make a care giver’s life truly miserable. I go back to my fist anecdote: what was the cost of one adult diaper? It was probably a fraction of a penny—it was not so difficult to provide. However, because of the bureaucracy, and because the unknown mandarin’s pen ticked what it did, that gentleman’s life had been destroyed. I often wonder whether I did any good as a Member of the Scottish Parliament; I like to think that, if I did nothing else, at least I sorted that chap’s life out.
I am very happy to meet the right hon. Gentleman to talk about that. It is about the technicalities of data, data sitting in different places, and how we can overcome that so that we have a better and common information source. Yes, I am absolutely happy to meet him.
I will come back to some of the things that we did during the pandemic, because I want to cover the topics that have been raised in the debate. We published guidance specifically for carers to try to support them through the pandemic, including on maintaining their own health and wellbeing. We provided PPE for unpaid carers who live separately from those for whom they care, in line with the clinical advice on when it is appropriate for a carer to use PPE. Crucial to all that was drawing on the experiences and insights of carers, including young carers, during the pandemic. We held a series of roundtable discussions in order to do that. Young carers frequently fly under the radar of services and community networks that would otherwise help them.
We provided extra funding to charities, including £500,000 to the Carers Trust in order to provide support to those who experienced loneliness during the pandemic, and over £150,000 to Carers UK so that it could extend its helpline opening hours in order to provide information and support to unpaid carers. We have supported initiatives for young carers, including providing over £11 million to the Sea, Hear, Respond programme, which ran from June 2020 until March 2021, in order to support more vulnerable children and young people.
We have also worked to give extra support to young carers in education. During the national lockdown, schools and colleges remained open for the children of critical workers and vulnerable children, including young carers. I recognise that if a young carer looks after somebody who is more vulnerable to covid, they will be more worried about going to school, so I am determined to ensure that, as part of our catch-up programme for children, some of the £3 billion education recovery package can be used to support young carers who have missed out on school.
I want to talk about day services, which provide essential respite for carers. It is so important that carers, particularly those who do high-intensity care, have time to see a dentist or doctor, to go shopping or to do something for themselves. Such respite is so important, and the day service or respite care is of great value to the individual who attends it. I was truly disappointed to read Carers UK’s new research report, “Breaks or breakdown”, which was published during Carers Week. It said that
“72% of carers have not had any breaks from their caring”
during the pandemic. However, many respite services and day services have not been fully operational for much of the last 16 months. I want to see the reopening of such services. That is one reason why, as part of the infection control fund, we have given nearly £1.5 billion to social care during the pandemic. One use of that fund has been to support the reopening of day services.
I know we can go further. Just last week, I spoke to local authority leaders and emphasised to them the importance of reopening day services and respite services, and I urged them to take advantage of the support that is on offer. I personally commissioned two surveys of day service provision—one last October and one in spring this year. During that period, that provision has increased; the situation in the recent report was better than last year’s, but it is not yet back to the pre-pandemic level. I will continue to work with adult directors of social services, the Ministry of Housing, Communities and Local Government and local authorities to fully understand the challenges in getting day services back to the level that they were at before.
Of course, there are financial pressures across public services, and more widely across our economy we face an extremely challenging time, but we have given significant extra funding to local authorities to support them through the pandemic. That is why I urge them to prioritise this issue. I emphasise the importance of the carer’s needs assessment that local authorities carry out, because that is such a crucial way of identifying what support a carer may need for themselves and their wellbeing, including the need for respite and taking a break from caring, and then making sure that that happens.
May I, too, commend the Backbench Business Committee for securing this important debate?
My constituent Mrs Jennifer Meakin was pregnant with her third child, Daniel, when she was prescribed Primodos as a pregnancy test. Daniel was born on 14 September 1974, with severe birth defects. He had an occipital swelling containing brain cells and fluid, which had leaked out when the neural tube was developing, and he was categorised as spina bifida. Daniel has undergone five major brain operations. By any standard, he is severely disabled. Equally, by any standard, the challenges experienced by the Meakin family since his birth over 47 years ago have been enormous.
Hormone pregnancy tests first came on to the market in the early 1960s, and approximately 1 million prescriptions were dispensed. As early as 1967, warnings were made available to the Committee on Safety of Drugs that such tests were unreliable, might cause neural tube defects of the sort that afflicted Daniel, and could precipitate an early abortion. However, a 1967 CSD press release reported:
“The consensus of expert opinion is that there is no scientific evidence to support the view that the hormones used in pregnancy tests can cause congenital malformations.”
The IMMDS report comments on that very forthrightly, stating:
“Given the concerns raised, the non-essential nature of HPTs and the provision of risk-free alternative tests…the CSD…should have recommended the withdrawal of the indication for use as a pregnancy test in 1967.”
However, it was not until June 1975 that a general warning was issued by the Committee on Safety of Medicines, the statutory successor to the CSD, about the possible association between hormone pregnancy tests and an increased incidence of congenital abnormalities, with an explicit recommendation that doctors should not prescribe hormonal preparations for pregnancy tests. That was some eight years after concerns about the tests were first raised and eight years after the date when, according to the report, the CSD should have recommended that Primodos should not be used as a pregnancy test—and sadly, of course, it was after Mrs Meakin was prescribed the drug for that purpose.
The report makes two specific recommendations in relation to Primodos, which I strongly endorse: first, the establishment of specialist centres for all families adversely affected by medicines taken in pregnancy, to provide integrated medical and social care in one place; and secondly, an ex gratia scheme, to provide discretionary payments. Families who have been afflicted by this scandal for half a century need all the support that they can get. It is a tribute to their persistence and indefatigability that they have pursued their campaign for so long. The report rightly observes that, although causal association has not yet been established, families such as the Meakins have suffered stress, anxiety, psychological harm and the general toll of fighting for recognition. They have, in short, put up with almost unbearable adversity.
The Government did the right thing recently when they confirmed a commitment to lifetime support for the thalidomide victims. I say to my hon. Friend the Minister that the Government would, similarly, be doing the right thing now if they were to establish a support scheme for the families affected by Primodos. I strongly urge them to do so.
I thank the Backbench Business Committee for allowing this debate in my name and that of the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy).
When the hon. Lady and I met to discuss the progress that may or may not have been made, we felt it was important to hold this debate today because it is one year since the publication of the report. Everybody in this House, and I am sure a lot of people around the country, understands that the past year has created a set of circumstances that was always going to put some aspects on the back burner and not move them forward. So today’s debate is not designed to criticise and have a go at the Government—I have a great deal of respect for the Minister and the Department—but merely to say, “Please don’t forget about this report.” It is one of the most important reports on health matters that has come before this House in many years.
What is important today is that none of us loses sight of the people we are talking about. Hon. and right hon. Members from across the House have already raised issues relating to the people themselves—real stories about real people. The hon. Member for Washington and Sunderland West (Mrs Hodgson) has done enormous amounts of work on this and speaks with passion and from the heart of the effect it had personally on her family and her mother. I can only wish her and her family the best and hope that those matters can be resolved.
This first came to my attention when a constituent came to see me. I know that some hon. and right hon. Members will have heard this story before—in fact, the hon. Member for Washington and Sunderland West touched on it—but it is worth telling again. The constituent was a very, very brave lady. She was in her 40s. She had had a child. She was a physiotherapist for the NHS. She was fit and healthy. She stood in front of me and could not sit down. She was having to bend her body into a position to feel as comfortable as she could. She sweated throughout the entire surgery because she was in crippling agony.
I knew nothing about this subject when my constituent came to see me and explained what had happened. What was even more terrifying was that it was an operation she never needed. She had had her child. She continued to have a full, loving and sexual relationship with her husband. But every now and again she had some urinary leakage, and she was told, “Don’t worry, we’ve got a cure for that. It’s a great cure. We can put some mesh inside you. We’ve done it for years. You’ll be fixed and there’ll be no problem.” She went ahead and had the operation done.
About eight years later, things started to go wrong. The fundamental problem is the time between having the operation and problems becoming apparent. That is why the recommendation of a proper database is so very important. As the hon. Member for Kingston upon Hull West and Hessle said, inserting the mesh is being recorded as a successful operation, but what happens afterwards is not recorded. To be blunt, thalidomide was successful in what it was supposed to do because it stopped morning sickness. Nine months later, the consequences were horrific. We do not class that as a successful drug that was administered. Indeed, we could talk about other drugs today, such as sodium valproate and Primodos, which raise a very important point in relation to this report. However, I am going to focus on the vaginal mesh issues.
One reason why I will focus on vaginal mesh is that my jaw hit the floor at some of the stories that my constituent told me. First, let me get rather graphic, because I think it is important. She described to me how during sexual intercourse, her husband’s penis was sliced. That is not a successful operation in anybody’s book. She then went through several operations, where, to be blunt, she was butchered to the point where she has no sexual stimulation whatever. She was told, “On the bright side, you now have a designer vagina.”
In what circumstances does anybody feel it is appropriate to comment on the perceived attractiveness of somebody’s genitalia, especially when they are suffering the pain and agony that my constituent is going through? I am afraid that that comment alone shows the arrogance of clinicians that we are up against with this issue. It is appalling, and it is one of the reasons why, as I said to the hon. Member for Kingston upon Hull West and Hessle, and indeed to the hon. Member for Washington and Sunderland West, we have to push back against clinicians saying, “We want to stop the suspension of the use of mesh because it works in so many circumstances.” I am sorry, but there is too much information out there about patients simply not being listened to.
It took two and a half years for Baroness Cumberlege to put the report together. The review went around the country. Indeed, the constituent I am speaking about sat and spoke at a table with my noble Friend. She said to me afterwards, “It is fantastic. I was really listened to.” Normally when a Government set up an inquiry, you think, “Yeah, yeah, yeah, they will take some hearings and everything else”, and you get, “You’re my Member of Parliament, can you feed in?”, and so on. She said to me afterwards, “I was really listened to.”
When that report came out, women felt that they had finally been listened to and things were moving forward. I have to say that the Minister, my hon. Friend the Member for Mid Bedfordshire (Ms Dorries), performed brilliantly that day when she stood at the Dispatch Box and first of all issued the apology. My constituent said to me she had nothing but praise for the Minister. I hope the Minister knows that the comments I am making today are in no way directed towards her; they are more directed towards what is going on in the NHS and the clinicians. Obviously the driver of this debate today is making sure, as we come out of this global pandemic and all the strains that have been put on the health service, that we reinvigorate these reports and say that they must, must, must be at the forefront of what happens.
I am afraid there is a pattern forming. One of the things that struck me when we had the debate about vaginal mesh in Westminster Hall, which I believe was around 2017, was when I described what I have just described to the House about my constituent’s sex life. In that debate—it is in Hansard—I used the word “clitoris”. It is incredible how much notice was taken of what I had said because a man used that word. I am afraid there is a blunt truth to this debate: it appears to be that only when men talk about women’s issues do people perk up and listen. It seems to me that there appears to be a huge gender blindness in the NHS to how it approaches the health issues of women.
It simply cannot be right that a woman goes time and time again to a doctor and is just dismissed out of hand. As my right hon. Friend the Member for Maidenhead (Mrs May) clearly outlined in her speech, we hear, “There, there. You will get over it.” I have heard that so many times.
Today’s debate does not include endometriosis—that is a different debate, but many in the House will know that I feel very passionate about it, and the hon. Member for Kingston upon Hull West and Hessle works very hard on it alongside me. To deviate for one minute, if you will allow me, Madam Deputy Speaker, endometriosis is a crippling disease that affects 10% of women in this country, yet there is still an eight to 10-year diagnosis period before anything is done. That again shows the problem. Why are women not being listened to? Why does it take a male Member of Parliament to say these things and get noticed? It is not good enough. The reality is that the recommendations in Baroness Cumberlege’s review need to be implemented.
As I bring my comments to a close, I want to focus on the issue of redress. Redress is not about compensation culture. It is about the fact that my constituent— a healthy and active woman in her 40s who was a physiotherapist and worked for the NHS—as a result of an operation she never asked for, has seen her marriage break down, her career disappear and her life destroyed. The destroying of her life has meant that she can no longer operate as a physiotherapist. She physically cannot do the job. To a certain extent, she has had sick pay and has been looked after, but that is not the point. The point is that the NHS did the operation, said it was all fine and ignored her. She had to take out a loan and go privately to have the mesh removed because of the waiting list. It got to the point where, after she had the operation and was still not getting better, she had further scans that revealed that the mesh had intruded into her bones. Someone commented, “It’s like trying to remove hair from a piece of chewing gum.”
My constituent cannot work. She will never, ever return to the life that she had. Not to mention the breakdown of her marriage, she will never return to the profession that she trained for. She has a caring attitude. She always points out to me, “Alec, you’re too fat. Your knees are going to collapse. I see it all the time.” In fact, I bumped into her in Wetherby market square about two weeks ago, and she said, “Well, at least you’ve listened and lost a bit of weight, but there is still some way to go.”
My constituent was part of the caring profession. That is who she is, but she cannot work again. That is why redress is important. It is important that we are able to look after the people the NHS damaged. She did not need the operation and was damaged. This is not about compensation culture; it is about looking after such people. As my right hon. Friend the Member for Maidenhead made clear, the NHS is an all-encompassing caring body and society. We cannot just pick out parts of it and say, “That was the care, but now we are going to ignore you.” We either believe in what it was set up for and what it is meant to do or we do not; it is as simple and black and white as that.
I believe that everybody in this House believes that; I certainly know that my hon. Friend the Minister does. I read her comments in the Daily Mail this week about women’s pain being ignored and about the idea that women can just accept a bit of pain—I think it was about the implanting of the contraceptive coil. It is high time that we start to recognise the institutional picture that that paints. The first step, and the reason why I wanted to speak in this debate—I know my hon. Friend the Minister is absolutely dedicated to these causes—is to bring this as high as we can in the public spotlight. We must move as quickly as we can to implement the nine recommendations, because we are destroying people’s lives. We have destroyed people’s lives, and although we will never rectify the situation, we have a responsibility as a society to do everything we can to support the people who have suffered.
As my hon. Friend says, it is essential that we get GP access back to normal. We can all understand why, during this pandemic, GPs have had to do other jobs such as help us to get the vaccines out, and have not been available in the normal way because of social distancing rules and for other reasons, but I think we are gradually starting to see things going back towards normal. The changes announced yesterday will help with that. As the vaccine programme—which will continue for a while, as we have set out—settles down and we get more people dedicated to it, we can release GPs from some of those duties. All that put together will help.
The hon. Lady is absolutely right to draw attention to this issue. One of the worst outcomes of all the restrictions we have necessarily had to have during the pandemic is the significant rise in depression and many other public health problems. We need to start to make tackling that much more of a priority now that we can move past what I hope is the worst of this pandemic. I want to come forward as quickly as I can with a new plan on mental health, to set out what more we can do not only to clear the backlog of cases, as it were—we need to put more effort and resources into that—but to look at what more we can do through investment in both skills and capital.
It is a pleasure to serve under your chairmanship, Sir Gary. We have talked a lot about self-isolation over the past year but less about the impact of being isolated on our mental health. Many children and young people have faced the disruption, hardship and heartbreak of this pandemic largely away from their friends and school support networks.
Last week, I visited a breakfast club at a primary school in Camden, where I had some really uplifting conversations with young children. Most were absolutely delighted to be back in school, around their classmates and teachers once again. We know that the attainment gap has widened substantially during school closures, in part due to the Government’s failure to deliver laptops to disadvantaged children. Many of the children I have spoken to, however, found that their wellbeing and mental health took the biggest hit in lockdown. Most have been able to do classes on Zoom and to get on with their homework remotely, but they said that the wellbeing support which can only be delivered properly by teachers in person is what they have missed out on the most. The teachers I spoke to at the school expressed their frustration that they were not able to do more to help with mental health issues during school closures.
Children with special educational needs and disabilities have suffered particularly badly, with three quarters of parents saying that their disabled child is socially isolated and often unhappy, downhearted or tearful, and that there is a real risk that that could translate into serious long-term mental health issues without better support. That is also something I have picked up in my role as the governor of a primary school in my constituency. Remote learning also stifled the role that teachers often play in spotting problems that are emerging, intervening with assistance or, in serious cases, with referrals to other services.
The number of children and young people receiving support through the NHS for mental health difficulties halved in April and May last year, as did the number of referrals to CAMHS, compared with the previous year. Sadly, the number of current referrals does not make up that shortfall or address the worsening problems caused by the pandemic. That means that many children are still suffering in silence and without the support that they desperately need.
I heard that message loud and clear last summer when I met a group of inspiring children—the meeting was organised by Barnardo’s—who told me about the isolation and other difficulties they had faced as a result of the pandemic. They also spoke about how difficult it can be to access basic mental health assistance and how there is almost no joined-up thinking between different but related support services in some areas of the country. The reality is that young people are far too often unable to access mental health support until it is too late and they have, sadly, started to harm themselves.
It is a source of great sadness and shame that one in six young people in the UK could now have a mental health disorder, up from one in nine in 2017. We must turn that around, which requires a laser-like focus on improving access to mental health support, and giving schools and other bodies the resources to provide direct targeted help and to join up children’s services properly. The children and young people I have spoken to over the past year simply cannot afford to wait for the snail’s pace of change that this Government are overseeing in prioritising and investing in mental health support. We have to act, and we have to act now.
It is a pleasure to serve under your chairmanship, Sir Gary, and I thank the hon. Member for Twickenham (Munira Wilson) for having secured this incredibly important debate. We know that half of mental health illnesses develop before the age of 14, and it is therefore essential that everyone has access to mental health services from an early age. I have spoken many times in this House about the inadequacies of CAMHS provision, including unacceptably long waiting times for referrals and the incredibly high threshold for treatment. However, today, I want to focus my remarks on infant mental health.
Worryingly, reports have demonstrated that there is a baby blind spot in our mental health service when it comes to the very youngest, and while children and young people’s mental health services are aimed at those aged 0 to 19, research has shown that there is inadequate provision for our youngest children. In 2019, 42% of clinical commissioning groups in England reported that their mental health services would not take a referral for a child aged two or under. The Parent-Infant Foundation recently surveyed professionals working in children’s mental health, and found that only 9% of those surveyed believed that sufficient provision was available for infants whose mental health was at risk.
Just like us, babies and toddlers can experience stress, anxiety and trauma. This impacts on their emotional wellbeing and development, but by failing to provide infants with access to mental health support, we enable mental health problems to build up. Given that thousands of babies have been born during lockdown with limited access to health visitors, peer support, playgroups and children’s centres, it is really urgent that we tackle these issues. Early intervention can have long-lasting benefits for mental wellbeing, benefiting not only the infant, but also reducing demands on mental health services in the future if it is tackled early on.
It is clear that we need action to address this blind spot. We need to invest in the provision of infant mental health services. We must also develop a strategy to ensure that there are enough qualified professionals to deliver it, so I urge the Government to address this baby blind spot and ensure that babies are not forgotten in mental health policies, strategies and services.
More widely, I am concerned by reports that find that one in six children now have a probable mental health condition. Demand for support is rising; there was a 35% increase in referrals to children’s mental health services in 2019-20. The Children’s Commissioner has warned that the pandemic will have a profound impact on children’s mental health going forward, putting already struggling mental health services under more pressure.
It is clear that urgent action is needed to support CAMHS. The postcode lottery in service provision has only worsened during the pandemic. There is huge disparity in the length of waiting lists, in the number of children accessing treatment and in the number of children being turned away. It is not acceptable that the availability of support can be based on where someone lives. The ability to access mental health services is so important, and this needs to be addressed.
I am concerned that the current expansion of mental health services is not fast enough to meet increased demand, and the Government must urgently address this. We need full and sustainable funding to support expansion, and we need a plan to address the shortage of specialist staff in the sector. Greater emphasis needs to be put on prevention and early intervention to ease demand, with properly funded mental health support in every single school across the country. After the extremely difficult year that our children, infants and young people have had, we owe it to them to put their mental health at the top of the agenda.
It is a pleasure to serve under your strong and stable chairmanship, Mrs Miller. It is a great privilege to speak in the debate, and I thank the hon. Member for City of Durham (Mary Kelly Foy) for introducing it.
We are debating a vital issue, and the UK can be No. 1 in the world for its approach on reducing smoking and the harm it causes. I commend my hon. Friend the Member for Harrow East (Bob Blackman) for his input into the report and his earlier contribution, and my right hon. Friend the Member for Clwyd West (Mr Jones) for his apposite remarks, which I am sure the Minister took on board. I also commend the Minister herself, and the Government, for their approach. I would say that she is mistress of the brief, as we have had many conversations and interactions through correspondence, and there is no doubt that she gets all the issues to do with smoking cessation devices and the tobacco control plan.
The industry in the UK seems to be aligned with the Government’s objectives on reducing smoking, as Philip Morris, British American Tobacco and many of the other firms recognise that this is the end of the game—it is the end of smoking in the United Kingdom, even if that might not be the case in certain far eastern countries, in Africa or elsewhere. The companies accept their responsibilities, and it would be of no surprise to them—they would not be disappointed about this—that they needed to make contributions to a fund to help to secure the goal of a smoke-free Britain, which should certainly be firmly on the table.
I speak as chair of the Parliamentary Office of Science and Technology and a member of the all-party group on e-cigarettes, and it seems to me that we are in an era in which we must be driven by data and evidence. There can be no doubt that the data is completely one way on vaping devices, electronic nicotine delivery systems and all sorts of other technologies to help smoking cessation. Vaping, using an electronic device or even using snus is so much safer than smoking. Smoke is the killer; tobacco is the killer. I urge the Minister not to do what the European Union has done, or what the World Health Organisation seems to be doing, by mangling the two issues. Tobacco is one thing; smoking cessation devices, which in most cases contain nicotine, are a completely different thing, with a completely different scale of harm and risk.
I recognise that other hon. Members will talk about various recommendations from the all-party group on smoking and health, so let me briefly focus on three. Recommendation 5 says that smokers should be advised annually of their options for quitting. Reminding people that they can choose an alternative to smoking is an important step forward. If we ask any smoker—I was a smoker for a few years, some time ago—“Would you like your children to smoke?” they all say no. It is clear that no one really wants to smoke, no matter what their brain says about dopamine levels. In that scenario, I think it a good idea to remind people annually that there are alternatives. Nicotine patches are not the only alternatives. Those have some efficacy, but, to be frank, very little for the money that is paid for them. People should certainly consider vaping devices.
The second recommendation I draw to hon. Members’ attention to is No. 6, which is support for those with mental health challenges. It also says
“for those living in social housing”,
but I will broaden that slightly to those on lower incomes and in lower-paid jobs, among whom there is a far higher incidence of smoking than in the general population. There is work to be done to focus the efforts in those areas.
Recommendation 11 is also important, because there is still an ambiguity about whether vaping is a smoking cessation device or just another way of inhaling nicotine. It is clear from the evidence that it is a smoking cessation device that works, and it is twice as effective—if not more—at helping smokers to cease smoking as the other available treatments. Let us dig into the pockets of the tobacco companies—they are actually happy for their pockets to be dug into—and use that money to publish the relative health benefits of vaping, e-cigarettes and other alternatives to smoking.
Windsor is a lovely seat, and thankfully we have slightly lower smoking rates than the rest of the country, but we still have perhaps 200 or 300 people a year dying of smoking-related diseases, as well as all sorts of other challenges.
In conclusion, we are first in the world for genomics, for the vaccine roll-out, and for FinTech and financial services. Let us make this another one: let us be the first in the world to implement a tobacco control plan that completely takes on board the wonderful innovation of vaping devices, e-cigarettes and all the other technology, and let us not mangle it together in a tobacco directive.
It is a pleasure to serve under your chairmanship, Mrs Miller, as others have said.
I also follow others in thanking the hon. Member for City of Durham (Mary Kelly Foy) for securing this debate. I also thank Action on Smoking and Health for providing a briefing for it. I am conscious that most of this debate and this documentation relates to England. There are some aspects that apply to Scotland; indeed, I hope they will be replicated in Scotland and I will do my best to encourage some action to be taken, because some actions are cross-border, if not universal. It is from that perspective that I come to this debate.
As others have said, or confessed to, I do not smoke; I never have smoked and I have discouraged my family from so doing. I come from a generation in which youngsters, such as myself, who were quite interested in sport were told by Jim Watt, the boxer, that he could be caught by a right but never with a fag in his hand. I think that Scotland would be a better place if we had had similar efforts on alcohol, but we only concentrated on smoking. That is where we are coming from. We have made progress from the time of my childhood in the ’60s and ’70s, but there is still a considerable distance to travel, especially when we find smoking rooted in the poorest areas, where there are already underlying health vulnerabilities, and indeed in other sections of our society. There is considerable work still to be done.
The question is this: what action is to be taken? It is not a question of what action per se, because action has to be taken; it is more about the extent and calibration of the action that is taken. I say that because I wish to ensure that the social progress that we need to make, and want to make, in tackling smoking and the social ill that it is does not come at a cost to other communities or, indeed, in the form of other aspects that cause harm in our community.
I come from the perspective of having served as Justice Secretary in Scotland for seven and a half years. I established a serious organised crime taskforce. As other speakers have mentioned, there is a link between illegal tobacco and serious organised crime. Not only is there a link between them; it also turns into other harms that plague our communities. In my interlude between Parliaments, I chaired the Scottish Anti-Illicit Trade Group, which sought to bring together all organisations involved in law enforcement and keeping communities safe, at whatever level and in whatever jurisdiction. Indeed, it also brought in business, because a problem shared is a problem halved.
I want simply to highlight that cost loading has limits. That is not to say that there should not be cost loading. It is quite correct that the “polluter pays” aspect should be considered. I certainly argued that as Justice Secretary in the case of alcohol, and that has been taken up. Equally, to what extent do we load it? I am no free market capitalist, but I recognise, as did Adam Smith, that there has to be some regulation and that we have to ensure that there is some control over the market, because we know that in other aspects of society, if we close down supply, we find it simply results in aspects coming around in other ways.
I am not here to make a special plea for big tobacco. I would not seek to do that. They can fight their own battles, but there is an effect on others. As was mentioned by the hon. Member for North Antrim (Ian Paisley), small grocers—people who pay their taxes—are affected. They employ staff, provide for their communities, work on limited margins and yet they lose out. The tragedy we face is that people view illicit tobacco as simply ripping off big tobacco or, even more likely, ripping off the taxman—they have no love for him either—but the reality is that they are harming their communities and those who pay their taxes and work hard. They are harming their families and, indeed, their neighbours who work in and depend on employment in local stores, whether they purchase from a pop-up Facebook page or from a white van man.
Action has to be taken, and I support calls for an improvement in what we do to tackle the illicit trade. Much more could be done at a governmental level on both sides of the border. In terms of today’s debate, I welcome progress and fully support what has been called for here today. I simply emphasise that we have to ensure that we get the calibration right. In seeking to tackle harm within our communities, we must keep it proportionate and at a level that will not be counterproductive, because we do not want to make further progress in tackling tobacco that at the same time results in fuelling organised crime and in other aspects being abused. It is therefore a matter of balance.
Indeed I do. Actually, the levelling-up agenda and our manifesto commitment to ensure five more healthy life years must be driven by achieving the targets we have set ourselves. Smoking has such a direct correlation with other illnesses. My right hon. Friend the Member for Clwyd West mentioned his interest with Cancer Research UK, and we know about the link to cancer, but there is also a link to chronic obstructive pulmonary disease as well as other respiratory challenges and so on. As I say, a disproportionate burden is borne by those disadvantaged families and communities.
I thank the hon. Member for Ealing, Southall (Mr Sharma) for making an interesting point. I assure him that we are focused on the need to make these interventions local. The local directors of public health and PHE drive plans in localities. I would like to think that we have taken, and can take, much learning from the successful local interventions of the past 18 months, such as with the vaccination programme. There are also clever uses of technology, where we have prompted people to take a vaccination. That might be interesting to look at in connection with recommendation 11, to which my hon. Friend the Member for Windsor (Adam Afriyie) alluded—I think it was him—requiring people to be prompted annually. They might look at that particular behaviour in order to modify it.
I could not agree more with the person who said that data saves lives—indeed, it does. The more we understand about the data held across the NHS, the more we can use it effectively to target interventions and to ensure that people get not only the right treatment but the right care, at the right point on their life’s journey.
In the new plan, we will ensure that we have a strong focus to drive down rates across the whole country, ensuring that they are level to where rates are the lowest, because everybody deserves to live in an area where we have targeted smoking rates and are achieving success. For too long, the harms from smoking have hit those areas that already face challenges. One in 10 babies is born to a mother who smokes. It is estimated that one in five new mothers smokes in Kingston upon Hull, compared with one in 50 in west London. It is those disparities that we need to tackle.
We must also close the gap seen among smokers with mental health conditions and smokers in routine and manual occupations. Could we be cleverer? Could we work in workplaces, for example? It is vital we continue to support interventions that make the most difference, helping people to cease smoking and encouraging them to move to less harmful products.
If I have time, I will come on to that—I will try to speed up.
Many Members will be pleased to know that, within the plan, we will recommit to our evidenced approach to e-cigarettes. The products certainly have a role in supporting smokers to quit, and we will ensure that they remain accessible to smokers while protecting non-smokers and young people.
The fight against tobacco is not one we can win alone. It requires a joint effort through the health and care system and working across Government. There are good examples of that, because while NHS England is working to roll out the tobacco dependence treatment and the commitments in the long-term plan—we know there have been some delays—we are putting effort into driving the agenda forward, funding seven early implementer sites across England and establishing services as we speak.
Other Departments, such as HMRC, are tackling illicit tobacco. Her Majesty’s Treasury has taken action to raise tobacco taxation. We have also introduced a ring-fenced grant of £1 million to support an HMRC and trading standards intelligence cell called Operation CeCe. That was operational earlier this year. We are also working with the Department for Environment, Food and Rural Affairs on the suitability of options for littering.
I shall have to come to a close, but I will address the question of my right hon. Friend the Member for Clwyd West about how we are working with the WHO. We are a global leader in tobacco control and were instrumental in the framework convention on tobacco control. We will continue to take our treaty obligations seriously, including the commitment under article 5.3. I was particularly proud that we have been recognised in that work. The recognised commitment to our global prevention work with the WHO is important.
I hope the Chamber is aware that I am determined to protect the population from the harms of tobacco. As we build back better, we must make smoking a thing of the past, to improve the health of the nation and level up society, freeing up the billions of pounds spent on smoking by disadvantaged families and protecting the NHS. Clearly, with investment and with us all pushing in the same direction, we can truly make that target.
I congratulate my hon. Friend the Member for Aberconwy (Robin Millar) and the hon. Member for Airdrie and Shotts (Anum Qaisar-Javed) on their excellent maiden speeches. Whether it takes 17 months or less than seven days to make a maiden speech, we have seen two politicians on both sides of the Chamber who have come to this place to represent their local constituencies and get things done and who are passionate about really making a difference; I am sure that they will both do that in their respective roles.
It is a pleasure to speak in today’s debate on the NHS. What our NHS has done over the last year is nothing short of remarkable. In Scotland, England, Wales and Northern Ireland, our NHS staff have risen to the enormous challenge that they faced with this global pandemic, and they have responded in such a magnificent way.
Because time is short, I want to focus on my local area of Moray. Moray is one of two local council areas in Scotland that, sadly, did not see an easing of restrictions in the last week. While the rest of mainland Scotland moved from level 3 to level 2, and the islands thankfully moved to level 1, Moray and Glasgow remained in level 3. I am very optimistic that, at the end of this week, Moray will come out of those restrictions. I would say to anyone watching that, hopefully towards the end of this week, Moray will once again be open for business, and I know that our tourism and hospitality sector is ready to welcome people back to our wonderful area. We are only in such a positive position because of the response from our local NHS staff.
One of the keys to getting our spike in cases down has been more testing, rapid testing and an increase in vaccinations. I went along to the Fiona Elcock vaccination centre in Elgin on Sunday and was amazed by the professionalism of the staff and how they have converted a former Topps Tiles shop into a vaccination centre that is even allowing people without appointments to walk up and get a vaccination. We now have 85% of our population in Moray vaccinated with their first dose in response to the spike in cases, and 20% of those have been vaccinated in the last few weeks. That is down to the hard work of Alison Smart and her team in turning that derelict retail unit into a vaccination centre.
Every single member of NHS staff, the Elgin Rotary Club team who are volunteering and everyone involved in that operation have done an outstanding job. As I walked out, Edith Campbell asked me whether there was any way that I could highlight the great work they were doing, and I thought, “Yes, I can.” So today in the House of Commons, I thank Edith, Alison and everyone at the Fiona Elcock centre for what they are doing to get Moray back on track. That is just one example of how our NHS has gone above and beyond to get us out of this crisis.
Mr Deputy Speaker, with your ceiling of three minutes, I am going to focus on one aspect of one Bill—namely, the proposal to change the approach to the fluoridation of community water supplies. I am a dentist and a member of the British Fluoridation Society. It is therefore with considerable enthusiasm that I support the proposed change of the procedure for introducing fluoridation of domestic water supplies. Our western nation comparators have between 60% and 80% of their domestic water supplies fluoridated. This country has a shameful 10%.
When I first came to this country as an ethnic minority immigrant, I worked in the national health service in a deprived area of London. I was appalled by the general state of my patients’ teeth, particularly by the state of children’s teeth. Trying to maintain children’s dentition was and still is, as a colleague put it, like trying to fill a bath with the plug out. Far and away the biggest reason for referral of children for general anaesthetics to hospitals in England is to remove rotten teeth. In 2019, hospitals throughout England carried out an average of 177 operations a day on children and teenagers, just removing decayed, rotten and abscessed teeth that should not be in that state. The annual cost is more than £40 million.
Tooth decay is essentially highly preventable. Water fluoridation is the single most effective public measure that could be taken to prevent tooth decay. Implementation of fluoridation is in the powers of the local authority, but little progress has been made since that was introduced in 2013. The costs are to local councils and the cost benefits are to the national health service. The process of consultation is lengthy and tedious, and it is enabling a platform for protestors of the same genre of the anti-vaccination people.
On a more practical point, there are considerable difficulties for both the local authorities and the water companies in that their boundaries are rarely, if ever, coterminous. It makes eminent sense for the implementation process for new schemes of fluoridation to be put in the hands of and driven by central Government. In doing so, I hope the Government will curtail the procedures on consultation, as they only permit continuous reception and repetition of scaremongering stories from people who are basically cranks.
The safety, efficiency, cost-effectiveness and benefits of fluoridated water supplies, whether natural—and they are in many parts of the world—or as an additive, have been proven worldwide for what must be approaching 100 years. With this proposed step and Government determination, rather than lagging behind the rest of the world, we could actually lead.
I have just waxed lyrical about the value of Scotland working with the UK Government and of Northern Ireland working with the UK Government, and my hon. Friend almost chastises me for not mentioning Wales. Of course working with Wales is incredibly important—look at the Wockhardt fill-finish plant. The number of people who have been vaccinated in this country with a product that is manufactured in Wales measures in the tens of millions, including me. We should all be very proud of that, and I look forward to working with my new Welsh counterpart, the Minister for Health in Wales, and making sure that we use all capabilities across these islands to get us back on the road to recovery.
It is really clear that we are removing restrictions. I am delighted that we are able to remove restrictions, such as the absolute restrictions on close physical contact, and rely more on people’s personal responsibility. In order to do that, we are providing the best possible advice that we can, such as to hug, but cautiously. Everybody knows what that means: it means outside is better than inside, it means making sure it is in ventilated spaces and it means that those who have had the vaccine, and in particular two vaccines, are safer than those who have not.
It is incumbent on us all to communicate these messages from our scientists and to make sure that people understand them. I am pretty sure that the British public get that. Given how brilliantly people have responded to requests during the pandemic, I am highly confident that this approach will be successful and that people will be cautious, but enjoy the new freedoms that we are thankfully able to give.
I remind hon. Members that there have been some changes to the normal practice, in order to support the new hybrid arrangements. Timings of debates have been amended to allow technical arrangements to be made for the next debate, so there will also be suspensions between each debate. I remind Members participating physically and virtually that they must arrive at the start of the debate in Westminster Hall. Members are expected to remain for the entire debate. I must also remind Members participating virtually that they are visible at all times, both to each other and to us here in the Boothroyd Room. If Members attending virtually have any technical problems, they should email Westminster Hall Clerks. Members should clean their spaces before they use them and before they leave the room. I remind Members that Mr Speaker has stated that masks should be worn in Westminster Hall except, of course, when speaking.
There are no more notes from me but a reminder that we shall move to winding-up speeches at about 5.28, and after the first speech I am afraid I shall have to put in a formal three-minute time limit, because it is a heavily subscribed debate.
It is a pleasure to serve under your chairmanship, Mrs Miller. I am afraid that I have been asked a huge number of questions. The shadow Minister just said he hoped I could answer them, but I am afraid that is not going to be possible. However, I will write to the hon. Member for Blaydon (Liz Twist) and answer her questions in detail. I congratulate her on securing this important debate. I think someone described her as a doughty campaigner, and I pay tribute to her tireless work championing the rare disease community as chair of the all-party parliamentary group on rare, genetic and undiagnosed conditions. I will try to answer a few of the points in the short time that I have and I will write on the rest.
First, I will answer a more general point. Many hon. Members brought up the drug Kuvan, which is indicated to reduce blood phenylalanine levels in patients with phenylketonuria. PKU is an inherited metabolic disorder. NICE published draft guidance on 25 February recommending Kuvan for people with PKU who are under 18. Hon. Members have quite rightly acknowledged that when children and young people reach the age of 18, that is a problematic step.
NICE’s draft guidance is a huge step forward for children who stand to benefit from Kuvan as a treatment, but I understand that it will be disappointing for adults. It is important to stress that this is not the final guidance. NICE will carefully consider all comments received during the recent consultation. The Government encourage the company to continue working with NICE, NHS England and NHS Improvement to ensure that Kuvan is priced affordably, so that more patients may benefit. That is a sort of round-robin answer to a number of the questions that have been asked.
I would like to pick up the first question that the hon. Member for Blaydon asked about the report to be published on the outcomes of the UK strategy for rare diseases. We have published yearly updates on the UK strategy for rare diseases implementation plan. Those updates highlight areas of progress and ongoing action against the commitments described in the strategy. The Department is constantly engaging stakeholders to learn what has worked in the strategy and the implementation plan.
We are constantly engaging and looking for areas of improvement, and we took the learnings into consideration when we developed the UK rare diseases framework. The framework builds on the previous strategy, outlining clear, concise and actionable priorities that were developed in close collaboration with the rare diseases community, including patients themselves.
The shadow Minister asked about screening newborns in the UK. As part of our screening improvement programme, the Department is considering how better to integrate targeted screening of high-risk groups in our population-based screening programmes. The chief medical officers of the UK have established a screening advisory working group to consider the scope and remit of the single screening advisory body proposed by Professor Sir Mike Richard. We have committed to making better use of technology to develop a more personalised screening offer, including important genetic testing, inter-screening and diagnostics. In the 2019 report, “Generation genome and the opportunities for screening programmes”, the UK National Screening Committee concluded that there is “clear potential” for genomics in the testing for many of the conditions currently included in the blood spot test. I think that all of us here today would agree on one fact: screening and medical science are moving forward at a rapid pace.
Only last month, we marked Rare Diseases Day. We have heard many touching stories today from Members, but last month we also heard many touching stories and how rare diseases, including PKU, can have an impact on patients and on their family members. As many Members of this House know, while rare diseases are individually rare, they are collectively common: one in 17 people is affected by rare disease at some point in their lifetime. In the UK, that amounts to more than 3.5 million, which is a significant group of people.
I am sure that the hon. Member for Blaydon would like to respond to the debate, so I will end. We will write to her with detailed responses to her thoughtful and detailed questions. I hope she will be able to share that information with the rest of the people who have spoken.
I would be very happy to ensure that the children of Bite Back 2030 meet the Minister for public health, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), who leads on these matters, and my hon. Friend is right to raise that incredibly important point.
Yes, absolutely, and we will be writing to all those who are shielding to set out the details so that they get a personal copy of those guidelines. What I would say is that the rates of covid now are much lower than when we paused shielding in the past, so this is not just because of the vaccination programme—which of course has benefited many people who are shielding, and we know that the first dose brings huge safety and benefit already—but is also because the rates of covid are so much lower.
I thank the hon. Member for Richmond Park (Sarah Olney) for introducing this debate. I declare an interest as co-chair of the all-party parliamentary group on cerebral palsy
Maternal mental health has been one of the hidden impacts of the pandemic. Being a new mam is a special time for any woman. However, it can also be overwhelming and generally challenging. In normal times, many women receive support from their family and friends, who are there to offer invaluable guidance. However, for the past year, the public health restrictions needed to tackle covid-19 have meant that many women have had to make this journey on their own.
I had my first child, Maria, at 21. The advice from my mam was crucial in spotting the missed stages in her early development, which enabled her cerebral palsy diagnosis to come much sooner than it otherwise would have. I cannot put into words how valuable her support was following such heart-rending news. It was thanks to my family and friends that I felt confident enough to go on and have two more children.
It strikes me that if Maria had been born during this pandemic, the personal support I received from my mam and health visitors would have been much more limited. My heart truly goes out to those who have become mothers during the pandemic. I cannot imagine the impact that isolation is having on their mental health. I worry that sadly some may choose not to extend their families in future.
The pandemic has particularly affected those whose babies have received neonatal care, with more than 90% of parents who responded to a Bliss survey saying that they felt more isolated due to having a baby in neonatal care during the pandemic, and 70% saying that their mental health was negatively impacted as a result of their experience. The situation has not been helped by the fact that Bliss research also found that psychological support for parents experiencing neonatal care was inconsistent at best. Around half the parents said they were not offered mental health support during or after this care.
The impact of negative maternal mental health goes beyond the parent and is not limited to the short term. As we have heard, the first 18 to 24 months of a baby’s life are critical in their development, and the stress and trauma of poor maternal mental health has the potential severely to impact a child’s life chances.
In parts of the north-east, where my constituency is located, existing health inequalities mean that some children begin their lives with inferior life chances to those from less deprived regions. We simply cannot afford to place further obstacles in the way of their development and risk losing a whole generation. As a result of the pandemic, we are facing a potential mental health crisis in Britain and maternal mental health is significant.
It is unreasonable to suggest that, as a society, we could experience a collective trauma on this scale without it impacting on mental health. Inevitably, that will be challenging, especially when the existing foundations of mental health care in the country are already weak. It was therefore incredibly disappointing that health services were absent from the Chancellor’s Budget last week. He could do with learning that the damage to public health from the pandemic will not fix itself.
It seems fitting that the debate is happening in the week in which International Women’s Day falls. Not only have women consistently stepped up to the plate during the pandemic, with little to no reward, but they have shown resilience in coping with one of life’s toughest challenges—becoming a mam. We owe it to the women in our constituencies to have the best mental health support out there, for what is undoubtedly one of the most beautiful yet challenging life experiences they will face.
I lost a few words of the hon. Lady’s question, but I think I know what she was asking about in respect of the Prime Minister’s remarks on 22 February. May I start by saying that her kind words at the start of her contribution are reciprocated? I have known her since I came to this House and I have the highest regard for her as well; so I am grateful for her kind words.
In terms of the specifics the hon. Lady asked about in respect of the Court judgment and the Prime Minister, as I understand it on the date the Prime Minister spoke 100% of the contract awards notices—the details of the contracts are contained within them—were published, and that, I believe, is what my right hon. Friend was referring to.
I am grateful for the hon. Lady’s question. She is right to highlight the amazing work being done in the roll-out of the vaccine by our frontline health and social care workers, and indeed many others, and I join her in paying tribute to them. What is important is that we worked flat out, as did senior officials, to make sure that the NHS and the frontline got what they needed last year: PPE to help keep them safe. I have to say to the hon. Lady that I hear the point she makes, but I make no apology for the efforts made by the Government to get the PPE in the quantities needed to keep our front- line safe.
I suspect I can do no better than to quote the judgment, which stated that in respect of regulation 50 the Government “acted unlawfully”, but my hon. Friend is right to highlight the fact that—again, as the judgment set out—the Secretary of State is almost at complete compliance, which is exactly what the Government are committed to.
Last autumn’s spending review included £1 billion of funding to address backlogs, tackle long waiting lists and support up to 1 million extra checks, scans and additional operations in the NHS. As the NHS recovers, for liver care, as for other areas of treatment, we will look to not only recover backlogs but continue to improve the care provided and help people to live healthier lives to prevent illness in the first place.
Yesterday, the Government published the road map that will put us cautiously but, we hope, irreversibly on the path towards reclaiming our freedoms once more. We are able to take these steps because of the resolve of people across the UK and the extraordinary success in vaccinating more than 17.7 million people—one in every three adults across the UK—and I would like to pay tribute to everyone who has played their part.
The hon. Lady is a long-standing and passionate campaigner for Kuvan, and I pay tribute to the work that she has done. The NICE methods review looks at the question she raises. It is important that we have a clinically-led process for approval of medicines, and I know she agrees with that. The question is ensuring that the details live up to that principle. The methods review will make sure that we take advantage of advances in medical technology, which will, I hope, allow us to bring drugs and treatments to patients of rare diseases who need them more quickly than in the past.
Yes. Across England, we have set the goal of having a vaccination centre within 10 miles of where anybody lives. It is harder in more rural parts, such as my hon. Friend’s constituency, of course. We are absolutely willing to support the Welsh NHS in delivery locally. In fact, the British armed services are involved in support of the roll-out across Wales, as they are in England. I am happy to meet my hon. Friend to discuss what more we can do to ensure that people can get the vaccination as easily and closely as possible in her sparse and very beautiful constituency.
Before Christmas, I visited Gotham Primary School in Rushcliffe to see what the children had been doing in Parliament Week. Like us today, they had discussed rules and presented their ideas. I heard passionate arguments against school uniforms. I learned about the rules in Beech class designed, like the regulations we are debating today, to stop the spread of coronavirus. There were excellent campaigns for a nature reserve and a bug hotel, and a multimedia campaign for more litter bins involving leaflets, posters, speeches and a video. I am thinking of trying to make some new recruits there for my next election campaign.
I left with a strong sense of how happy and engaged the children were at school with their friends and teachers. The headteacher, Janette Allen, and her teaching team had done an amazing job to give children back the normality that lockdown last spring had taken from them. I know that they and schools across Rushcliffe will be working hard to provide remote learning and support to children and their families. I also know that it cannot possibly be the same, so it is with a heavy heart that I support these regulations today. I do not believe we have any other choice given the sky-rocketing rates of infection we are seeing from the new covid variant and the pressure our hospitals are under.
I congratulate the Vaccine Taskforce on the amazing work it has done to develop one of the largest and most diverse vaccination portfolios in the world. Thanks to it, and the incredible Oxford-AstraZeneca team, the vaccine is already being rolled out at pace. I urge the Secretary of State and the Prime Minister to continue to explore every option available, enlisting both civilian and military help, for getting the vaccine out quickly, and to continue to get rid of any bureaucracy like the ridiculous training modules on anti-terrorism for volunteer vaccinators.
I am very proud of the communities in Rushcliffe who have given their all to battling this virus, but it is taking its toll. People are tired and weary. They need clarity on the conditions that must be met for the restrictions to be eased and on how they will be eased as we emerge from lockdown. They also need to see a clear plan of how schools will be opened up again. I urge my right hon. Friends across Government to make this available sooner rather than later, to give people the morale boost they need to get through this final lockdown.
The proposed restrictions are right. There is no greater freedom than the right to life and we are willing to suspend many freedoms to protect especially those who are vulnerable, and those who work night and day in the NHS and our care settings to protect us. They deserve and require us to abide by the regulations and rules—we owe it to them—not least because we can now see the light at the end of the tunnel.
Given that the vaccination programme is beginning, it is all the more urgent that the Government recognise the importance of supporting the economy and everybody within it throughout the coming months. We know that it is not an ill-defined and possibly indefinite period, but that this will be over at some point in the coming months. That is a source of great joy and should focus the Chancellor’s mind on the support that he needs to give those who are missing out. There are many of them: people who have been self-employed for less than two years; directors of very small limited companies, such as taxi drivers; people who have been on maternity leave. They have been excluded from support. It is an outrage that those people have been left to get into deeper and deeper debt because the Government have yet to devise a mechanism for supporting them. They must do so now. We need those people to build our economy back once we are out of this situation. To let them flounder in poverty now is outrageous and unacceptable.
I would also like the Government to pay attention to the needs and the plight of our outdoor education centres, which are in serious danger of closure. Many have already lost more than a third of their workforce in the past few months. There needs to be a Scotland-style direct grant support payment for those centres so that we can keep them going and they can contribute for years to come.
I also want the Government to come up with a specific and properly funded strategy for dealing with the backlog in cancer treatment. We estimate that 60,000 years of life will be lost to cancer due to the coronavirus pandemic, and it could get worse.
The vaccine is the light at the end of the tunnel. It is wonderful and I pay tribute to everyone involved in making that come to be and in administering the vaccines as we speak. However, the Government are making that tunnel a little bit longer than they need to. It is clear that supply of vaccine to places in South Cumbria is not as good as it might be. Places such as Sedbergh and Windermere have not yet got vaccination centres. Those sites need to be approved.
Finally, given that our teachers are teaching the children of key workers, they should also be vaccinated as a priority.
Yes on both counts. We looked at Leicestershire in great detail and I wish that we could have taken the county and the city out of tier 3. Unfortunately the data did not support that conclusion. I am grateful to everybody across Leicestershire, because I know that this has been a long, hard slog with measures in place for a long time.
We are absolutely determined to build back better. That needs to involve tackling long-term underlying health inequalities. A huge programme of work will be needed to do that, after the pandemic has demonstrated those inequalities.
People in Gateshead have done a great job of getting the case rate down. Like other areas, it is still in tier 3—we are not quite there yet. I know that my team and the hon. Lady’s local director of public health have been talking about getting Gateshead and the rest of the north-east into tier 2 when we can. I hope that we can do that, but for now, let us be cautious and keep this under control.
I thank my hon. Friend, who, again, is a predecessor in my Department—a former Health Minister. He is absolutely right to talk about strong leadership. Strong leadership has been established across the system. In the context of maternity services, which is what we are talking about, we have the maternity safety champions who are being led by Dr Matthew Jolly, the national clinical director of maternity and women’s health, and Professor Jacqueline Dunkley-Bent OBE, the chief midwifery officer for England. There are lead clinicians who are leading clinically.
In terms of the management of the Shrewsbury and Telford trust, there have been eight chief executives in 10 years. That is not good. Good practice does not come from a revolving door of chief executives and board members who constantly rotate, because there is no continuation of learning, no loyalty, and no commitment to good outcomes at the hospital. We have to change this revolving door of boards and chief executives. The chief executive who is there now has our confidence, and we are assured that she will put in place the recommendations of the report, but my hon. Friend is right: it is crucial that we work on this revolving door of managers and those who are not clinically led, because that is part of the problem. He is right to identify that, and I want to reassure him that it is something we are aware of.
It is probably in the Secretary of State’s domain to make that kind of statement at the Dispatch Box, so I cannot give the hon. Lady that reassurance myself, but we are delighted about the huge number of new nurses and doctors that we have in training. Recruitment of our workforce in the NHS is going well, and I hope that that will be the ultimate goal.
Yes, my hon. Friend is absolutely right. Just as when students go home for Christmas, we are able to use the massive testing capacity that we have built up to ensure that they do so safely, so we propose to use testing to allow students to return safely. It is rather like the previous answer I just gave about being able to use testing instead of isolation in schools. I say gently to the hon. Member for Chesterfield (Mr Perkins) who, as he sat down, muttered about this: it is far better to work together, and it is only because of the massive testing capacity that has been built up through the actions of this Government that this is possible. We have the biggest testing capacity in Europe and we can use it for keeping people safe in schools and for allowing people to go safely to and from universities. This is exactly the sort of empowerment that we now have as a result of the huge testing programme that we have built.
I am very happy to ensure that the JCVI takes all the appropriate considerations into account. However, it is not my decision to look at again. My decision is that we should follow the clinical advice. I think we should respect the JCVI, which is hugely expert in the clinical advice it gives.
We carefully considered this issue, consulted on it and discussed it widely. Christmas is a national holiday, as well as being very much a Christian celebration. That is reflected, for instance, in the fact that we have two days of bank holidays. We consulted members of different faiths around precisely the question that my hon. Friend rightly raises, and there was a strong degree of support for having something special in place for Christmas for everybody, even though we have not been able to put that in place for Hanukkah or for other celebrations of other faiths.
I beg to move,
That this House has considered acquired brain injury and covid-19.
It is a great delight to serve under your chairmanship, Ms Eagle, as I have never done so before, as far as I can remember. Some have greatness thrust upon them and I have always waited for this moment.
As hon. Members will know, the issue of how brain injury is treated and dealt with in society has been close to my heart for some considerable time. My hon. Friend the Member for Blaydon (Liz Twist) and I have been running the all-party parliamentary group for acquired brain injury for the past few years. It is frustrating that we have not been able to hold as many meetings this year as we would like to, but I am determined that we are going to move forward on this.
Most hon. Members will have had moments when they have visited a Headway group, a local hospital, a local trauma centre, or perhaps one of the day care centres run by their local authority, and met individuals who have had traumatic brain injuries—perhaps people who have suffered carbon monoxide poisoning, or who have had a stroke, or any one of the many different ways in which the brain can be injured. They will know of the great joy that many families feel that somebody’s life has been saved, and of the great sadness that their quality of life is not what they would want it to be.
I praise the Government for setting up the major trauma centres, because in the last few years, despite lots of controversy locally in many parts of the country, those centres have undoubtedly saved many lives. Probably in the region of 800 to 900 lives are saved every year because of those centres. However, many of those people come out with brain injuries, and the pain for the individual and the family surrounding them can be phenomenal.
I want to say up front to the Minister the things that I want out of this, just to be absolutely clear. I want a national neurorehabilitation strategy, because there is not one at the moment—there are lots of bits and pieces of strategies, but no national neurorehabilitation strategy. I want a national neurorehabilitation lead—a single person who is in charge. I have heard rumours that somebody might have been put in charge, but I am not sure, so I hope the Minister will be able to respond to that.
I want a mandatory system, not a casually achieved system, for commissioning neurorehabilitation, particularly within the community. It is far too patchy up and down the country, and I am not even referring to the differences between England, Wales, Scotland and Northern Ireland; even within England, it is far too patchy and insecure. I have a real fear that, after covid, we will not reinstate all the neurorehabilitation services that we had before covid came to these shores. I have a real fear of that, so I want a guarantee from the Government that all those services and more will be reinstated, and that all the posts that have been furloughed, suspended or not appointed throughout this year will be kept and will be restored.
My hon. Friend is absolutely right, and I pay tribute to her for the work that she has done on this issue in lots of different debates, particularly on the relationship between neurorehabilitation and education. It is about the individual in the acute setting, perhaps after a traumatic brain injury in a car crash or something like that, and then it is about that person being given enough neurorehabilitation so that they do not need an enormous care package when they go out into the community, but it is also making sure that there is enough ongoing neurorehabilitation in the community so that they do not fall back on requiring even more of a care package—not because I want to deny care packages, but because I want people to live independently and have the freedom that we would all want for every individual.
I will add two other things that I really want. I am sorry that I am sounding like a popular beat combo from a previous generation—my husband will be proud of me. Neurorehab should be one of the 12 specialities protected during covid. I have made a similar argument about cancer, and cancer has quite rightly had lots of coverage in the country. I hope that very soon we will see the cancer recovery plan, which we have been awaiting for some time, but we also need one for neurorehabilitation. I will come to some of the reasons for that.
The final thing that I really want is a coherent, consistent and tidy arrangement of community neurorehabilitation across the whole country, so that whether someone is in Wells, in Winchester or in the middle of Manchester, they and their family or loved ones have the same right to access ongoing community rehabilitation. Otherwise, it just seems terribly unfair. One of the things that so many families have said to me time and again is that they feel as if they are pushed from pillar to post. They hear a story of somebody getting rehabilitation sorted in one part of the country, and then they find that it is simply not available in their part.
I therefore reiterate that I really want a single coherent approach towards brain injury, and not just in neurorehabilitation—although, as I said earlier, we also need a national neurorehabilitation strategy. We also have to bring together all the different elements. I have spoken to the Minister for the Cabinet Office, the right hon. Member for Surrey Heath (Michael Gove), about the need to bring together all the different departmental Ministers into a single committee to look at the interaction between the work of the Department for Work and Pensions, the Ministry of Defence—it deals with many veterans who have had brain injuries during active service—the Departments for Education and for Health and Social Care, the Treasury, the Ministry of Housing, Communities and Local Government, because it looks at the provision in local communities, and, for that matter, the Department for Digital, Culture, Media and Sport. One of the most depressing and upsetting things this year has been hearing the family of Bobby Charlton say that they reckon that the dementia from which he suffers is a result of his experience playing football, and particularly heading the ball. I am not an England supporter, being a Welshman, but how depressing is it that so many of the players in the 1966 team have subsequently been found to have had dementia, depression and anxiety, which were almost certainly related to their playing of football? We put these people on a pedestal, but we are not prepared to protect them. I am still extremely critical of the way the Football Association has behaved around this.
The problem this year, in particular, is that during the first lockdown, a lot of people with brain injuries were discharged early. I understand why it happened, because hospitals had to make beds available for people with covid, but lots of units were closed in the east of England and in the midlands, which are the two areas that have done the most research into this. Between 50% and 100% of the beds that are normally allocated for neurorehabilitation were closed down and simply not available, and people were very swiftly discharged into their community.
The Chartered Society of Physiotherapy has found that 80% of NHS services in this field have not yet resumed—80%. The number of people acquiring brain injuries during this time, in all the different ways that I have mentioned, has not slowed down; if anything, it has sped up. We have always said in our all-party parliamentary group that brain injury is a hidden epidemic. The person standing in front of us in a queue may be slurring their words and we might think that they are doing so because they have been drinking, but it may be because they have a brain injury. Of course, it is not written on their forehead. Lots of the problems associated with brain injury are not visible, so it is all the more important that we dig down into these issues.
The waiting list for community neurorehabilitation is now four to six months. That is a phenomenal length of time for families to be providing care, particularly when covid means that they sometimes cannot even visit the person concerned. There are major comorbidity questions as well. Patients have been discharged into adult social care with no neurorehabilitation at all. We now know that covid itself is causing neurocognitive problems for many people—not just people with long covid, but those with other symptoms as well. I guess that as covid develops and we get more understanding of the disease—and, incidentally, as we are able to treat more people and keep them alive—it is likely that there will be more, not fewer, people who need neurorehabilitation.
Absolutely. This is one of the difficulties in this field. We have worked with the United Kingdom Acquired Brain Injury Forum, and Chloe Hayward is wonderful. Headway is also a wonderful organisation, although like many charities in this field, it is having a really difficult time this year. Despite that, the truth is that because there are many different routes to a brain injury, it does not always acquire the same currency as cancer or other medical conditions, and yet it affects at least 1.4 million people in the United Kingdom. That is one of the things we need to tackle.
Specialist early supported discharge and community neurorehabilitation teams were redeployed in large numbers during the first lockdown earlier this year, and many were furloughed. In some cases, they have still not been brought back, and in lots of parts of the country there simply are no services available in this situation. What happens is that the person with the acute condition—the acute set of problems—is not treated but sent out of hospital, because the bed is needed in this second lockdown. That person is sent directly into adult social care, with a phenomenally expensive care package. I am not against the expensive care package—that is what we have to provide—but the point is that neurorehabilitation would be far more cost-effective; there would be far better outcomes for the individual patient; and it would be far more sensible for Government if we could get the system sorted out. In the second lockdown—who knows whether we are having a third lockdown, or a tier situation, or whatever it is?—the truth is that lots of neuro patients are being discharged early. That is just a fact, and I think that it will give us a long problem, not only for the individuals and their families but in lots of local authorities and community services.
What am I talking about here? What is the real issue? I will end in a moment, Ms Eagle. As I have said, brain injury comes in many forms. Young brains are often particularly affected. Kids under the age of five from poorer families are four times more likely to have a significant brain injury—as are teenage kids from poorer backgrounds—than those from wealthier backgrounds. There is a knock-on implication for the Ministry of Justice, and so on. Sometimes it is the executive function that is affected, so people may find it difficult to inhibit some of their immediate instincts. Sometimes it is memory that does not work, or it may be language or elements of personality. For some people, the issue is phenomenal fatigue—not just the kind of thing where someone had a big night out the night before and cannot really be bothered to come into a Westminster Hall debate, but a real fatigue that brings people to the point of absolute despair and an inability to feel like living. For many children in particular, sometimes nine or 12 months after the event, there is neurocognitive stall—basically, the brain seems to go on strike and refuse to work as anybody would want it to.
The thing is that neurorehabilitation works. I do not mean just any old rehabilitation; I mean neurorehabilitation, which uses specialist staff who deal with these issues all the time and know about how the brain and the mind work together and how people can be rehabilitated. That works when it is there from the beginning, when it is available consistently for a sustained period and when the connections between acute and community services are absolutely clear. When it works at its best, it is such a joy, because we see kids who were completely dependent on their parents, and on a whole team of people from social services, suddenly able to smile again and able to discover their own freedom and ability to get on with their lives independently of others. We see older people who are able to regain many of the physical and mental skills that they had before, and to regain some of their personality. That is such a beautiful and rewarding thing to behold, and it is why I hope that the Minister will be able to give me everything that I want.
I beg to move,
That this House welcomes the Government’s ambition for England to be smokefree by 2030; notes the increasing disparities in smoking rates between the richest and poorest in society; further notes the effect of the covid-19 outbreak and the opportunities and risks provided by the reorganisation of public health on the UK’s ability to achieve this ambition; and calls on the Government to set out the further steps it plans to take to deliver a smokefree England by 2030.
I thank the Backbench Business Committee for granting this debate. I am also grateful to every Member who has given up their time to speak, especially the hon. Member for Strangford (Jim Shannon), who I believe has already had two questions and a speech today—and I suspect that he still has an Adjournment debate ahead of him.
This debate is on an issue that is close to my heart. I must declare an interest as a former chair of the Gateshead tobacco control alliance. As the prevention Green Paper acknowledged, achieving the smokefree 2030 ambition will be challenging, especially in deprived communities where smoking rates are higher. On current progress, Cancer Research UK estimates that these communities will not reach the 5% ambition until the mid-2040s. This is simply not acceptable. Indeed, in County Durham, adult smoking prevalence is 17% compared with 13.9% nationally. This rises to 27% among people in routine and manual occupations. On top of that, 16.8% of mothers smoked during pregnancy compared with 10.4% in England.
Smokers in the north-east lose around £600 million because of unemployment and reduced income due to smoking. For working smokers, weekly earnings are on average 6.8% lower than for non-smokers, equivalent to £1,424 less per smoker annually—and this, of course, was prior to covid-19, which is disproportionately harming the health of local economies of already disadvantaged areas. Helping smokers to quit will benefit not just their health and wellbeing but their incomes, helping to level up disadvantaged communities. Smoking is also responsible for half the difference in life expectancy between the rich and the poor. For every person who dies from smoking, another 30 are suffering from serious smoking-related diseases. Disturbingly, every week in England, almost 2,000 children take up smoking, two thirds of whom will go on to become regular smokers.
With 1,500 people dying from smoking-related diseases every week, there is no time to waste. The tobacco control plan published in 2017 was for five years, which comes to an end in 2022. It has already been overtaken by events and is no longer fit for purpose in the light of the ambition for England to be smokefree by 2030, the decision to abolish Public Health England, and the Government’s manifesto commitments to increase healthy life expectancy by five years by 2035 while narrowing inequalities. If a new tobacco control plan is to be put in place in a timely manner, it needs to be in development now. The Minister may remember that the last plan was published two years after its predecessor ran out of time. We need bold announcements from the Government on tough new measures, along the lines set out in the “Roadmap to a smokefree 2030”, which has been endorsed by the all-party group on smoking and health, if we are to achieve a smokefree 2030. Will the Minister confirm whether the Government are developing a new tobacco control plan, and if not consider doing so urgently? Will he further commit to publishing a new tobacco control plan in 2021, setting out concrete measures for delivering on the smokefree 2030 ambition?
Britain is a world leader in tobacco control, having driven down smoking rates by 60% since the start of this century. However, the Government’s decision to abolish Public Health England without a clear plan for the future risks undermining this hard-won progress. The success in tobacco control has been driven by combining national population level interventions with comprehensive actions at regional and local levels.
The national function is currently provided by a combination of the Department of Health and Social Care and Public Health England; what is crucial is not where the function sits, but that it has protected funding and continues to exist. Furthermore, while inequalities in smoking rates remain, where regional tobacco control programmes have been in place there has been a significantly higher rate of decline. Regional programmes, such as those led by Fresh in the north-east, provide an effective bridge between national and local activity and between local authorities and the NHS. The Government must publish a clear plan setting out the future of Public Health England’s health improvement and wider functions; that is crucial if we are to achieve the Government’s interlocking pledges not just to achieve a smokefree 2030, but to increase disability-free life years, reduce inequalities, improve mental health and reduce obesity and alcohol harm.
The covid-19 pandemic makes action to reduce smoking prevalence all the more urgent. Chronic diseases such as cardiovascular disease, respiratory diseases and diabetes account for about 89% of all deaths in the UK and are also linked to higher rates of mortality from covid-19. A robust and sustainable approach to health improvement is vital if we are to tackle the leading causes of chronic diseases, namely smoking, obesity and alcohol and drug abuse.
However, the impact of smoking is not limited to the UK. It is estimated that at least 8 million deaths around the world every year are linked to tobacco, more than for AIDS, tuberculosis and malaria combined. Over 80% of the more than 1 billion smokers in the world live in low and middle-income countries. In addition to the human cost, the impact on already overstretched health care systems puts a heavy economic burden on those countries, adding to the difficulties LMICs face in recovering from the global pandemic.
That is why we can all be proud that the UK, as a global leader in tobacco control, is providing funding via Official Development Assistance to support implementation of the framework convention on tobacco control in low and middle-income countries. The funding was £15 million over five years for the World Health Organisation’s FCTC 2030 project to support low and middle-income countries to implement tobacco control measures. The FCTC 2030 project has been very well regarded; however, funding is due to come to an end. Extending this funding will accelerate progress in ending the global tobacco epidemic, support FCTC 2030 beneficiary countries to recover from covid-19 domestically, and as the UK leaves the EU maintain our position and as a global leader on tobacco control.
This is a matter of development funding so it requires broader support than just from the Department of Health and Social Care, but the Minister’s support for the proposal would greatly facilitate the likelihood of success. Will the Minister therefore commit to supporting extending the UK’s funding for the FCTC 2030 project beyond 2021?
Aside from our international commitments, it is important that there is a focus within the UK at regional and local authority level. Smokers from deprived communities with higher smoking rates tend to be more heavily addicted than those from more affluent communities. Deprived smokers are just as motivated to quit as other smokers, but it is harder to succeed when people are more addicted, when smoking is more commonplace and when cheap, illicit tobacco is widely available.
Regional tobacco control programmes have been effective in tackling these disparities, as shown most clearly by the example of Fresh in the north-east, which is the longest-running and only surviving regional office for tobacco control. When Fresh was founded in 2005, smoking prevalence in the north-east was much higher than the average for England, at 29% compared with 24%, and the disparity was growing. Since then, the north-east has seen the greatest decline in smoking prevalence of any region, and smoking prevalence is now only a little higher than the England average. Smoking rates have also fallen faster among routine and manual workers in the north-east compared with in England as a whole. As a result, although the differential between routine and manual and professional workers declined in the north-east between 2012 and 2017, it has increased in England as a whole. The success and value of Fresh’s work is clear, and I commend it for its vital work in the region.
After the public health grant to local authorities was cut in 2015-16, the funding provided by local authorities for regional offices in the north-west and south-west was cut completely. Even in the north-east, funding has been significantly reduced. New funding streams are therefore needed. In addition, there are stop smoking services that act as a highly effective and cost-effective way of supporting smokers to quit. However, there is a stark inequity in the local authority offer to smokers across England. In some areas, stop smoking services have been scaled down or decommissioned altogether, whereas elsewhere local authorities have sustained or developed their services.
An Action on Smoking and Health and Cancer Research UK report published in January looked at the state of local stop smoking support and found that among the local authorities that still had a budget for stop smoking services, 35% had cut that budget between 2018-19 and 2019-20. That was the fifth successive year in which more than a third of local authorities had cut their stop smoking service budgets. Financial pressures caused by the cuts to public health funding and the wider pressures on local government finances are the major reason for that. The public health grant, which funds local authority tobacco control, has been cut by around a fifth in real terms since 2015-16, falling from £4 billion in ’15-16 to £3.2 billion now.
Analysis by the King’s Fund in 2018 found that wider tobacco control and stop smoking services were among the biggest losers in planned budget cuts and that these cuts have been accompanied by a 38% decline in the number of smokers setting quit dates at stop smoking services since 2015. Among pregnant women, the number setting quit dates has fallen by a fifth. This is one of the many failures of austerity, so will the Minister confirm that the Government will reverse the cuts made to local public health budgets to ensure that local authorities can play their part in delivering a smokefree 2030?
We must also recognise the value of social marketing campaigns, which have immediate impact, can be targeted with precision at disadvantaged smokers and can be highly cost-effective if carried out at a regional and national level. Such campaigns play a particularly important role in motivating smokers to try to quit. In 2016, Fresh worked with Smoke Free Yorkshire and the Humber to implement a hard-hitting quit smoking campaign aimed at raising smokers’ awareness of the links between smoking and 16 types of cancer and to trigger quit attempts, reaching millions of people. It is now thought to have been among the most successful quit campaigns to have ever been run in England in terms of awareness, attitudes and actions taken, with around 10% of people who saw it making a quit attempt—that is around 72,000 smokers. However, this regional activity is threatened by local authority budget cuts, which led to the decommissioning of the regional offices in the north-west and south-west. A smokefree 2030 fund imposed on the tobacco industry, as proposed in the Green Paper consultation, would provide vital funding for national and regional anti-smoking mass media campaigns.
Another important regional issue is the impact of illicit tobacco, which is concentrated in poorer communities. Cheap and illicit tobacco provides easier access to tobacco for children and reduces the incentive for adults to quit. In 2009, Fresh, along with colleagues in the north-west and Yorkshire and the Humber, established the North of England Tackling Illicit Tobacco for Better Health programme, originally with pump priming from a Department of Health grant. The aim was to increase the health of the population by reducing smoking prevalence; reducing the availability of illicit tobacco, therefore keeping real tobacco prices high; developing infrastructure to aid information sharing, identification of illicit markets and enforcement action; reducing the demand for illicit tobacco through campaigns raising awareness of the issue; engaging with relevant health and community workers; and finally, regularly monitoring smokers’ attitudes and behaviour to measure the effectiveness of the programme.
Between 2009 and 2019, the illicit market share declined by a third in the north-east from 15% to 10%, and enforcement was enhanced. That compares with the national market share of illicit tobacco in 2018-19 and of manufactured cigarettes, with a share of 34% for hand-rolled tobacco. Elements of the original north of England programme have been sustained by Fresh in the north-east, including insight-led demand reduction programmes. Fresh now leads the national Illicit Tobacco Partnership, supported by ASH and other partners. However, the 2013 National Audit Office recommendation that this approach be rolled out nationally has not yet been adopted, while essential regional activity to tackle illicit tobacco and reduce smoking among children and young people has been put at risk by cuts to public health grants since 2015-16. Does the Minister agree that regional activity to get illicit tobacco off our streets should be sustainably funded?
Finally, I would like to raise the regulation review. While we await the Government’s response to the prevention Green Paper consultation, I hope the Minister can tell us what has happened to the Government’s response to the consultation on the Nicotine Inhaling Products (Age of Sale and Proxy Purchasing) Regulations 2015, which closed in September last year. A response to that consultation was due last December, and almost a year on, there has been no word from the Government about when it will be published. The Government are also required to review the Tobacco and Related Products Regulations 2016 and the Standardised Packaging of Tobacco Products Regulations 2015 by May 2021. They should set out the timetable for the consultation process for both sets of regulations as soon as possible. We are therefore awaiting the Government’s response to two consultations and the launch of two more, which need to be reported by the end of the financial year. Can the Minister confirm when the Government will deliver on all four of those?
I recognise that I have posed a lot of questions, and I thank the Minister and the House for their time. However, those are questions that need to be asked and answered if we are to achieve the smokefree 2030 ambition that is shared right across the House.
It is a pleasure to follow the hon. Member for Blaydon (Liz Twist), who I have been questioned by many times. Thinking about today’s debate, I remember in early summer 2017, when I was standing down there at the Dispatch Box answering Health questions, being pressed by my then shadow, the lovely lady the hon. Member for Washington and Sunderland West (Mrs Hodgson), on when I was going to publish the long-awaited tobacco control plan, which, as the hon. Member for Blaydon reminds us, was due to be out in December 2015. Rather to the surprise of my shadow that day and my officials sitting in the box, I said that it would be out “before the summer recess” and, true to my word, it was.
That was an early lesson for me in how to focus minds in the civil service, because I have never seen them move so fast, but more importantly, it set out some of the key ambitions for us to hit by 2022. The prevention Green Paper a few years later then set the course for England to be smokefree by 2030. I stand by the ambitions, both in the plan and in the Green Paper, 100%, and I believe with all my heart that they are completely achievable, but we will have to get our skates on, as has been said by the first two speakers, the hon. Members for City of Durham (Mary Kelly Foy) and for Blaydon. We will have to be very bold and make the most of one of the rare opportunities afforded to us by the covid pandemic.
I want to make just a few points today. On public health reorganisation, I have previously raised my concerns in the House about the future of Public Health England’s work to tackle issues such as smoking, obesity, inequality and air quality after the new National Institute for Health Protection comes online. I have no issue with the desire to take the health protection functions out and create the new institute based on the German model—it makes a lot of sense, and I have said so to the Health Secretary in public and in private. My concern is about the health prevention parts of Public Health England. On 1 September, I asked the Secretary of State whether he was considering bringing Public Health England’s expertise and significant experience in this area back into the Department. When I was travelling abroad representing the Government and I needed briefing on these issues, I always knew that there would be somebody who knew infinitely more than me inside Public Health England. I do not want to see that wasted.
I note that the Department has now established a programme of work to pick through this. The snappily titled population health improvement stakeholder advisory group has been formed and there are some notable names on there, such as Seema Kennedy, who was my successor as Public Health Minister; Professor Helen Stokes-Lampard, formerly of the Royal College of General Practitioners and now chair of the Academy of Medical Royal Colleges; Professor John Newton from Public Health England; Dr Jenny Harries, whom many of the public will be familiar with as deputy chief medical officer; and Professor Paul Cosford, emeritus medical director of Public Health England and a truly excellent official—one of the best I ever worked with. There are some good people on there.
On balance, I would restate my call for the Department to recover these functions, and I refer the Minister to a pretty comprehensive piece of work published just this week by Policy Exchange, examining how a new deal for public health can build a healthier nation. It calls for the creation of a new institute for health improvement housed in the Department of Health and Social Care, reporting directly to Ministers and the chief medical officer, for a new funded national mission to improve the health of the nation. There is a lot of sense in that, and I recommend the report to the Minister.
Let me dwell for a moment on the word “funded”. I do not think—the record will show that I was always lukewarm at best on this idea—that the Government should proceed with the idea of ending the ring fence of the public health grant. I think it would be a mistake. That should be kept. It should be measured much more tightly and, if anything, I think it should be increased to help our directors of public health to do what works towards smokefree 2030. I am not making unfunded spending commitments. The prevention Green Paper, which I helped to draft and still think is a very credible piece of work, talks about the principle of making the polluter—that is, the tobacco firms—pay, as has been done in France and in the United States, and we should progress that to create a smokefree 2030 fund. I would be grateful if the Minister could reassure me that the Government are at least considering this option and what it might look like in practice.
The Government’s ambition for what we call “smokefree” is for a smoking prevalence in England of 5% or less in the next 10 years, but, as we have heard, significant action is clearly needed if we are to achieve this. The rate in Winchester, which I represent, may be 8.3%, but the national average is 14.1%, so there is a way to go. Smoking remains the biggest single cause of preventable death in our country today, and it is a leading cause of health inequalities. The issue is also one of inequality. About one in four people in routine and manual occupations smoke—about two and a half times more than people in managerial and professional occupations—and this gap has widened significantly since 2012, according to the Office for National Statistics. The inequalities are also geographic, as we have heard.
As a Conservative Member, I see becoming smokefree as a vital step towards delivering our manifesto pledges on extending healthy life years by five by 2035, reducing inequalities across the board, and, as the Prime Minister calls it, levelling up every part of our country. However, as the Green Paper concluded, this is an extremely challenging ambition for any Government. The all-party group on smoking and health has recommended a new tobacco control plan focusing on delivering the 2030 ambition, and that is an eminently sensible suggestion. Given how long it takes to get a tobacco control plan, even when making promises at the Dispatch Box, has the Minister commissioned officials to start work on renewing the TCP to set a course for the smokefree ambition? I think that Ministers will be doing that, with smoking prevalence going in the right direction, albeit not fast enough to meet our agreed ambition, but also off the back of the opportunity afforded to us by the by the pandemic.
The University College London smoking toolkit indicates that the pandemic has been a driver of quitting among smokers across all social groups, with the highest rate of people stopping smoking seen in the past 30 years. That is the good news. However, we cannot be complacent. Although it is true that many people have quit, there are signs that some have relapsed into smoking. In particular, there are worrying signs among the 18 to 24-year-old group that smoking rates may be increasing again and have certainly stopped declining.
Turning to the alternatives, the UK has long been a leader in traditional tobacco control measures such as the use of taxation, as we hear at Budget time; the smoking ban, which was a great credit to the Blair Government; plain packaging; readily available smoking cessation services; and numerous tobacco harm reduction policies using less harmful alternatives to smoking. I was often criticised in office both for promoting e-cigarettes too much and for not promoting them enough as an alternative. That suggested to me that I may have had the balance about right, but I will go further. Data from the ONS tells us that over half of smokers in this country want to quit and that, on average, smokers try some 30 times or more before giving up successfully. Of those who are successful, only 2% quit through stop smoking services, and over 40% use an e-cigarette. However, while many have quit using vaping, the fact remains—we cannot deny this—that nearly half of smokers in Britain have tried vaping but did not stick with it. On top of that, the figures now show that the number of vapers is falling, while some 1.3 million vapers have not fully made the switch and still continue to smoke at the same time.
Since the early 2000s, tobacco policy in the UK has been driven by the European Union through the tobacco products directive. That is about to change. May I therefore ask the Minister to speculate, as I know Ministers love to do, on what opportunities Brexit brings to advance our leading role as a tobacco harm reduction advocate? We may be leaving the political structures of the European Union, but I sincerely hope that we are not leaving our leadership role in this area when many countries around the world look to see what the UK does.
Our prevention Green Paper pledged—as, indeed, did I when in office—to
“run a call for independent evidence to assess further how effective heated tobacco products are, or are not, in helping people quit smoking and reducing health harms from smoking.”
The Government said that the call for evidence would be announced in summer 2020. Of course, we all understand why that has slipped, but I wonder if we might get a reaffirmation today, because recent word, including a parliamentary written answer on 21 September to my hon. Friend the Member for Broxbourne (Sir Charles Walker), who I know wanted to speak today, said that the Government would merely
“consider looking at this at a later date”.
It is imperative that the Government recommit to holding that call for independent evidence as soon as possible, so that the effectiveness of heated tobacco products can be assessed and smokers can have confidence that they are switching to a less harmful alternative.
I say that because there is growing evidence that adult smokers’ misperception of the risks surrounding vaping may be preventing them from transitioning to less harmful alternatives. Last month the excellent UK charity Action on Smoking and Health, otherwise known as ASH, which campaigns against smoking and is run by Deborah Arnott, published survey data showing that vaping in the UK had stagnated as a percentage of the total smoking population, after year-on-year growth. The charity blamed what it called
“unfounded concerns about the relative safety of e-cigarettes”
as a likely cause.
Given that public health authorities in the UK actively support and champion vaping as an alternative to smoking, that statistic shows how damaging inaccurate media coverage can be. To maximise the public health benefits of e-cigarettes, I think regulations should be risk-proportionate and reflect the scientific evidence base on the relative harms of cigarette alternatives and their potential for harm reduction. For example, when this Parliament’s Select Committee on Science and Technology, chaired so ably by my right hon. Friend the Member for Tunbridge Wells (Greg Clark), reviewed the scientific evidence on e-cigarettes, it recommended that the Government should move to a
“risk-proportionate regulatory environment; where regulations, advertising rules and tax/duties reflect the evidence on the relative harms”
of vape products compared with combustible cigarettes.
The UK Government have invested a lot of resources to understand the science behind these products, which I think has informed the pragmatic and progressive approach that successive Governments have taken to vaping regulation over many years. The results have been impressive, suggesting that it would be a strong regulatory model for other countries to consider. Given competing public health priorities, of course I appreciate that it is not as simple as it sounds, but I believe we should dedicate sufficient time and resource to understanding the science around vape products and their potential to improve public health. That is why I would like us to recommit to what it says in the Green Paper that I partly wrote.
Will the Government consider increasing the age of sale from 16 to 21? That could be a useful tool in the toolbox. ASH has suggested that the Government should consult on that as a means of reducing youth uptake. The call has been backed by more than 70 organisations, including Cancer Research UK, the British Heart Foundation and the Royal College of Physicians. I think it is well worth considering.
In conclusion, we should keep the ambition. We have never been short on the ambition, across the last Government, the coalition Government and this Government. We should tighten and update the plan, to bring it in line with the ambition in the Green Paper. We should stick to what we know works and be honest enough to say what does not. We should fund the directors of public health on what does work, and I have given a suggestion as to where I think that can happen. There is a lot riding on getting this right. A lot of people’s lives depend on us getting this right, and we need to do so for their benefit and for that of the next generation, so that another generation of young people is not weaned on to the damaging lifestyle that smoking can lead to. I have given a few ideas and look forward to hearing the Minister’s response at the end of the debate.
I agree, of course, with what Professor Jonathan Van-Tam said. He is a very fine scientist and a brilliant man. Right now, no one is looking for political differences for politics’ sake. What people are looking for is for people to come together to make the right decisions in the national interest or the local interest, and to take these decisions as locally as possible to make sure that we support people as much as possible: take action where it is necessary, but make sure that we do not take action where it is not necessary.
We are working very closely with the local leadership in the north-east and with colleagues. It was very good to see the hon. Lady on a Zoom call recently to discuss this. It is important that we take the action if it is necessary, but there are early signs that the number of cases in the north-east is starting to flatten. In the first instance, that is happening among younger people, and I am still worried about the number of cases among the over-60s, who, of course, are the people who are most likely to end up in hospital or worse. So we will keep a very close eye on the situation, but we have no imminent plans to make a change. If the clinical advice were to change and we needed to move urgently, then, of course, we would seek to do that with the support of the local area.
My right hon. Friend makes an important point and, in a way, highlights that it is not just the case rate that matters; it is also the rate of change of the case rate, the over-60s case rate and the impact on hospitals. In the case of London, cases are over 100 per 100,000, which is a worrying level, but I really hope that the measures, and the people of London and all those who work here, can bring the case rate down so we can get out of it as fast as possible. Team London is, in fact, working on a proposed strategy for coming out of level 2, but the first thing that everybody in London has to do is follow the rules to get the rate of increase down, because it is only then that we can even start to consider the next steps.
We have put in the extra resource that the hon. Lady mentions, which is important. Not only has the extra resource gone in, but we are hiring people to do the work and building the buildings in which it can be done. She raises an important point about the need to recover the backlog. I am really glad that in areas such as cancer and many others, the backlog is being worked through, but there is still more work to do.
In the time available to me, it is hard to convey just how frustrating and frightening the current situation is. We are living through an international health crisis, but it is now translating into local crises too, especially in the north of England. Cases in Newcastle remain at an alarming level of 240 per 100,000 people.
It is frustrating that there is a clear contradiction in the Government’s approach that makes the task of controlling the rise much more challenging. While the Health Secretary focuses on suppressing the virus through local lockdowns, the Chancellor’s blanket approach of winding down financial support measures across the country makes it much more difficult for people to protect themselves and others from the virus, undermining the very purpose of these lockdowns. We already know that the mortality rates from coronavirus in the most deprived parts of England are more than twice as high as those in the least deprived areas. Pre-crisis economic and social conditions have left certain parts of the country particularly vulnerable to covid-19, which has in turn brought on local lockdowns, just as the Government are withdrawing financial support. It is not a sustainable approach for the months ahead.
Let us look at the hospitality sector as just one example. The reality of local lockdowns and restrictions on households mixing means that countless jobs in pubs, cafés and restaurants will become unviable—to use the Chancellor’s words—when the furlough scheme comes to an end this month. The Chancellor says that the replacement for the job retention scheme—the job support scheme—will support jobs that are viable in the long term. Clearly, the pandemic will impact on future working and consumption patterns, but are we really to believe—this is the implied logic—that Geordies will be less interested in going out for food and drink than people in other parts of the country in the long term? As we are seeing a high degree of local variation in covid cases and in the public health response, we need properly funded, localised economic responses too. If we fail to provide sufficient support in the areas most vulnerable to covid-19 we risk exacerbating further the country’s stark economic inequalities.
I have a few questions. When are we going to see the financial support for which LA7 leaders in the north-east have asked? Only one in eight workers are eligible for the new self-isolation payment. How are others going to be able to afford to self-isolate without it? The Government knew, when the virus first hit this year, that their public health strategy had to be backed up with an economic support package. The money was there to ensure that people could afford to do what it took to get the virus under control, to stay home wherever possible, and isolate where necessary. That support needs to be given again. We are not all in this together, but we will be if the Government do not step up soon.
I thank colleagues for the contributions that have been made today, which I have listened to very carefully. There have been some extremely heartfelt speeches on all sides of the House that clearly reflect the enormously difficult time we face right now in this country for all our constituencies and all our constituents. They are facing restrictions and things that affect their day-to-day life—their livelihoods, the businesses they may run or work in, or, for instance, visiting relatives in care homes; we want to do everything we can to make sure that can be done safely.
But this does all reflect that we are truly facing a global pandemic and, as I said yesterday, for those who were in the Chamber for the debate yesterday, the greatest crisis or the greatest challenge that our country has faced since the second world war. That means that, however we want things to be, at the moment there is no way they will be as we want them to be. I am sure hon. Members on all sides of the House recognise that everybody, whatever role they are in, is doing their very best to make things as least bad as they possibly can be.
The reality is that we are fighting this truly invisible, deadly enemy that is spreading through our communities—and we know, sadly, killing as it goes—and we must suppress it, but do so with this incredibly difficult balance. Colleagues have talked about the impact on businesses and the local economy in their constituencies. We must do so while doing our utmost to protect the economy and, of course, keep kids in school and support those in university and other forms of education. As has been said, if the pandemic spreads faster and further, that in its own right also has impacts on the economy—not just the restrictions, but the impact of the pandemic itself and more people getting covid.
As the Government have responded over the weeks that have passed, we have been constantly learning, listening, adapting—learning from those overseas, as well as from the data that we have built up ourselves—and working closely with those in local areas, because the only way we will win against this virus is, indeed, by working together, fighting together and defeating it together.
I now come to some of the comments from honourable colleagues. One thing that came up several times is: why are we seeing different action in different areas? What I will say is that numerous factors are looked at—the incidence rate, the positivity rate, hospitalisations, intensive care units and, of course, taking into account local views. That absolutely has been taken into account in the regulations that we are debating today. As for the impact—in fact, one colleague asked: are they still necessary?—some areas have come out of some restrictions and seen easements. We do know that it takes time for there to be an impact, but we need to continue to take the steps that are necessary because, as we know, the real exit from this is for us to see rates come down.
We are clearly working flat out for a vaccine, and we are continuing to build up the capacity of our test and trace system. I want to pick up one particular concern that there might have been some problem in that there was not the right data because of the technical problem last week. What I will say is that actually the data on which these decisions were made, or the data that did not feed through was too recent to affect these decisions, but it will feed into future decisions—very much so. What I will say, and ask colleagues to remember, is that we have built up the capacity of our testing system from testing 2,000 people a day to being able to test well over 200,000 people a day, which is not to be sniffed at, and working up to 500,000 day by the end this month.
Members have asked about local test and trace. Absolutely, the systems work together. The national system does work with local tracers and is working with local teams, although what I will say to those who want their local public health to be running the whole thing is that I am hearing from local public health teams that they are really maxed out with a huge number of responsibilities at the moment. We should continue to work together, because the local and national complement each other.
There are no easy answers. Some colleagues have said that they want restrictions that are easier to live with. Restrictions on our social contact will be hard to live with. I would like to say a huge thank you to all our constituents across the country who are playing their part in following these restrictions, as we must do ourselves. I commend these regulations to the House.
Question put and agreed to.
That the Health Protection (Coronavirus, Restrictions) (North of England and North East and North West of England etc.) (Amendment) Regulations 2020 (S.I., 2020, No. 1074), dated 1 October 2020, a copy of which was laid before this House on 2 October, be approved.
We are doing a huge amount of work to trial these next-generation tests at the same time as expanding the current testing capability. For instance, if we have to have a test, would it not be easier if we just needed some of our saliva rather than to having to put the swab all the way up our nose and down the back of our throat? These sorts of improvements in technology are in the pipeline and we are working incredibly hard to bring them to bear as soon as possible.
Yes. We put an extra £10 million into the local authorities in the north-east to support contact tracing and we are also stitching together the data feeds between the national system and each of the individual local authorities in the north-east. We will keep working hard on that project. I will keep listening to the needs of the local authorities in the north-east and across the rest of the country.
My hon. Friend makes an important point. He represents the oldest constituency in the country, so this is an important matter for him and his constituents. This comes back to the central point that it is critical to get the right balance between the measures we take nationally and those we take locally, according to local rates of infection.
Of course I am working to exactly that end. If somebody has the symptoms of coronavirus, they should self-isolate even if they cannot get a test. I understand how frustrating that is, and I am working as hard as I can to try to get those turnaround times as fast as possible.
Yes, absolutely. As I mentioned in my statement, I want to see the A&E in Chorley reopen as soon as is safely possible. My hon. Friend is right that we have put in a huge amount of support, and we all want to see it reopening. I look forward to the day—I hope soon—when we can announce that that has happened.
Yes, I will happily work with the hon. Lady on that question. It is a challenge, because of the problem of intergenerational transmission of the virus—I am sure she understands that side of it—so it is an important balance that we need to strike.
If people have symptoms of coronavirus, they should self-isolate and get a test. We have heard examples—of course we have—of people having challenges getting tests. I am very glad, though, that in two of the cases that my hon. Friend outlined, home tests have been sent. In the third case, there was clearly a technical problem, given that the barcode is emailed to people who supply their email address. People with covid symptoms need to self-isolate and then, if somebody gets a positive test result, their households also have to self-isolate. These policies are absolutely critical to the control of the virus.
Yes, absolutely. The hon. Lady is right to raise this. We are putting more support into mental health services, but there is a challenge, especially with people who were not able to access mental health services during the lockdown and therefore their condition got worse and more acute. This is an area that I am working on closely. I have had meetings with the Royal College of Psychiatrists throughout the crisis. I would also like to correct or amend a response I gave in a previous exchange, about which the hon. Lady has written to me, when I said that the number of suicides had fallen. The fact is that the number of suicides reported has fallen, but there are concerns about how many were able to be reported because of delays with coroners. I just want to put on record my correction to that fact, in acknowledgement of the problems in reporting. I reported on the figures as fact, but we should report that those figures are the reported facts.
Very soon. As the UK Secretary of State, I urge all people in Scotland to download the app. I know that the Scottish Government’s app is technically excellent and I strongly endorse it, as I will strongly endorse people in England to download the English app, people in Wales to download the Welsh app and people in Northern Ireland to download the Northern Ireland app to support the whole of the UK to do everything we all can to tackle this problem.
I am happy for that to stand on the record.
Yes. I want to protect all the residents of Ilkley from the disease. As we have got the number of new infections right down to between 5,000 and 6,000 each day, according to the ONS—a long way below where it was at the peak—and as the number of deaths has fallen, I want to keep that down. Where there is evidence of a specific cluster or flare-up, we will take local action that will help to protect the residents of Ilkley, elsewhere in Yorkshire and throughout the country, so that we can then safely release other lockdown measures while keeping the community safe.
I will say three things in response to my right hon. Friend’s questions. On special schools, one of the carve-outs in the closure of schools was keeping open schools for those who are vulnerable, including those with special educational needs. The Bill includes a power to enable us to move from that position, but we do not propose to exercise it unless absolutely necessary. The position therefore is that if someone wishes to send their child to a special school, that is fine. It was one of the specific carve-outs. In the same way, if a key worker needs to send their child to school and cannot look after them at home, schools are available.
My right hon. Friend asked about care. I want to make it clear that for people who are volunteering in response to covid-19 and those who are caring, even if their responsibilities are unpaid or informal, they are okay to do that and should do that. They should stay more than 2 metres away from others wherever possible, but that has to be a practical instruction, because of course we need to care for people. As I said in the statement, travel allows for caring, and I want to make it clear that volunteering in the response to covid-19 is a legitimate reason to travel. For example, the increasing numbers of volunteers in the NHS are important. Although it is not paid work, it is work in the national effort to respond to covid-19.
My third point is that the Patient Safety, Suicide Prevention and Mental Health Minister is sitting next to me and close to me, because she has recovered and all the evidence shows that people cannot catch covid-19 twice, at least not in quick succession. I welcome her back to her place.
It is a real pleasure to serve under your chairmanship, Mr Paisley, and to debate this matter with the hon. Member for Congleton (Fiona Bruce). I am always inspired by her compassion and her devotion to doing all she can to make her constituency and the nation a better place to live. That always encourages me and encourages all of us.
I am also pleased to stand with the hon. Lady on many things; I do not think there is anything that she and I disagree on—not that I am aware of anyway. We are kindred spirits across political parties. We may have different opinions on the politics, but not on the constitutional issues and certainly not on what we want for society.
I am a great believer in all things in moderation. Since becoming a type 2 diabetic I have realised that the key to my continued health lies in my ability to eat in moderation. It took me many years to realise that. The issue with alcohol is that many people struggle for moderation, just as I used to struggle with sweet food—two bottles of Coca-Cola with a Chinese takeaway from Davy Lee’s in Newtownards, five nights a week. In addition to that, there was the stress issue. I was probably Davy Lee’s best customer. Now I have a meal from there once in three months, at most, and it is “no Coke here”. I have no sweet drinks whatsoever.
The issue of alcohol-related harm is not ring-fenced for people with alcoholism, or any specific age group. It is a UK-wide problem across classes, genders and race, and we need a better way to address it. We look to the Minister for a helpful response. I concur with the comments of those who have spoken—and probably those who will speak after me—in that we need to address the issue not only in England but in Scotland, Wales and Northern Ireland, from where I have got my statistics and information.
Across the United Kingdom, 80 people a day die because of alcohol, and that statistic has to change. In Northern Ireland there were more than 11,000 hospital admissions due to alcohol in 2016-17. Across the UK 33 people a day are diagnosed with an alcohol-related cancer. There is a high cost to those numbers, and it is not only medical and physical; it is emotional and affects families. Healthcare costs associated with alcohol in Northern Ireland are estimated at £122 million, and alcohol is strongly linked to health inequalities there. We can see that it is, in our offices and advice centres. The rate of alcohol-specific deaths is more than three times higher in Northern Ireland’s most deprived areas than in its least deprived areas. I see that in my office every day, as I am sure you do, Mr Paisley. I see families who are broken by alcohol, by verbal and physical exchanges, by the effect on children, by abuse, marriage break-up, despair and sadness.
Shockingly, alcohol is involved in 40% of violent crime in Northern Ireland. I understand that the relationship between alcohol and domestic violence is complex, but research finds that between 25% and 50% of perpetrators of domestic abuse have been drinking at the time of the assault. The figure is as high as 73% in some studies. I concur with what my hon. Friend the Member for East Londonderry (Mr Campbell) said in reference to the coronavirus and the steps that the Government have taken. I welcome what the Government have done and urge everyone everywhere to focus on the directions and rules laid down by the Prime Minister and the Government. As my hon. Friend said, if there is no sport or social interaction during the coronavirus outbreak, people will be at home—perhaps for 24 hours a day, if they are struck down with the virus. There is potential for all sorts of problems and, let us be honest, people will probably go to the off-licence—or someone will go for them—and buy drink in. They will consume alcohol at home. I am not a prophet, nor the son of a prophet, but I can see great potential for issues to arise from that.
It is for that reason that I support the calls by the Alcohol Health Alliance UK for minimum pricing. In its words:
“The cheaper alcohol is, the more people drink, and the more harm is caused. One of the reasons why alcohol harm has been rising is because alcohol has become much more affordable over the last few decades. It is possible to buy a bottle of…cider, containing the same amount of alcohol as 19 shots of vodka, for as little as £3.70.”
That is someone’s high for under a fiver. The alliance states:
“The most effective policy to tackle such cheap high-strength drinks is minimum unit pricing (MUP). By setting a floor price linked to the amount of alcohol in a product, MUP targets the cheapest drinks which are linked to the most harm, while having minimal impact on moderate drinkers or on pub and restaurant prices.
MUP was introduced in Scotland in 2018 and in Wales in March 2020. The early evidence from Scotland is very encouraging”.
I often look to Scotland for the direction it is taking on health issues. Particularly in this case it has shown what the rest of us can do. The alliance says that
“off-trade alcohol sales fell by 3.6% in the year following MUP; in England and Wales, they rose by 3.2% over the same time. The minister of health in the Republic of Ireland has recently written to the Northern Irish executive regarding implementing MUP on both sides of the border”.
I fully support that, and I urge the Northern Assembly to take that action and to do it as soon as possible.
It is essential that Northern Ireland, the part of the United Kingdom with the second highest rate of alcohol-specific deaths, is not left behind. I want to see minimum unit pricing in Northern Ireland. For the protection of health in my country, I stand by these calls, Mr Paisley, as I know you will, too, and I urge the Minister to consider how we can help to minimise alcohol harm without adversely affecting our hospitality sector, which is vital. If people drink in moderation, that is okay, but we are talking about those people who do not do it in moderation. That is why this debate is so important.
I look forward to hearing the Minister’s response and I thank the hon. Member for Congleton again for bringing this matter forward. Her desire to help to make homes and communities stronger and happier by reducing the harm caused by alcohol is something that is close to my heart, close to my chest and close to the person that I am.
I am pleased to be participating in this debate. I begin by paying tribute to the hon. Member for Congleton (Fiona Bruce) for giving us a very thoughtful and comprehensive opening to the debate. I begin also by saying that people have mentioned the effect of being isolated at home because of the coronavirus and that it is worth bearing in mind, as we go through this crisis, that drinking alcohol lowers the body’s immunity.
We have heard a lot today about the damage of alcohol over-consumption. The cost to our families, our communities and ourselves is almost incalculable. It cannot be counted in pounds and pence, although very often we are forced to do that, for practical reasons. Alcohol abuse leads people to lose their homes, families and jobs. There is a cost in hospital admissions, perhaps on numerous occasions, and people may even end up encountering the criminal justice system. Victims of alcohol abuse become economically inactive. They often become absent parents. The damage to mental health and physical and emotional wellbeing is profound.
I remember standing in this Chamber a couple of years ago to speak on alcohol abuse. A number of us involved in that debate were willing to admit that we came from homes with an alcoholic parent. My father was by all accounts an alcoholic, although I never knew him, as he died when I was 15 months old—he was very much helped on his way by alcohol. The damage to my family was not insignificant. My husband’s father was also an alcoholic and died because of the demon drink. These stories are not unusual; in fact, they are far too common. Almost every person we meet has a family member or knows someone who is an alcoholic. That is very sad, but it is a fact of life. However, that does not mean that we cannot turn things around. It does not mean there are not measures that we can take and, in Scotland’s case, have already taken to combat this problem. There is no silver bullet, but much can be done to mitigate the harmful grip that alcohol has on our communities. In the round, a number of measures can be taken.
In Scotland, 686 hospital admissions and 22 deaths every week are due to alcohol. In 2018, the figure for alcohol-specific deaths was 1,136. In 2018-19, there were 35,685 alcohol-related hospital admissions in general acute hospitals. Worryingly, hospital admissions are still more than four times higher than the level seen in the 1980s. Clearly, in Scotland, we could not simply shrug our shoulders and tolerate that. We tried to turn the situation around. I am pleased that the SNP Government chose to use the powers at their disposal to tackle the level of alcohol harm suffered by our communities, at great cost to those communities, on every single measure.
The hon. Member for Congleton pointed out the need for England to have a revised or updated alcohol strategy, and she is correct to say so, as the current one is out of date. Indeed, the Scottish Government updated their own alcohol strategy in 2018.
I could stand here today and talk about the fact that the Scottish Government have invested almost £800 million to tackle alcohol harm and drug use since 2008 and will allocate a further £95 million next year to reduce the harms caused by alcohol and drugs. I could mention—indeed, I have already alluded to—the Scottish Government’s alcohol framework setting out 20 actions that build on existing measures to change Scotland’s relationship with alcohol. I could even mention the legislation introduced by the Scottish Government to ban irresponsible alcohol promotions, such as the multi-buy discounts in supermarkets.
I am grateful for the constructive tone in which the hon. Gentleman asked the questions. This is an example of the House working well, because he and I have sometimes had cross words across this Chamber, but he has asked these two questions quite rightly. The advice given on 111 has to be dependent on the circumstances presented to the clinician giving that advice on the other end of the phone. It is really important that I do not fetter their discretion, but if he comes to me with details of the individual case and wants me to double-check that his constituent got the right advice, I am happy to do so.
On the second point, the deputy chief medical officer had a discussion with the Prime Minister today that was videoed and put on Facebook, and in that she was clear on this question about masks. There is not an advantage in wearing a mask if you are healthy—that is the advice from the medics here—but there is an advantage in respect of keeping others safe if someone who is ill wears a mask. There are also examples of when medical staff will need to wear the right type of mask to keep them safe. But the general advice is: don’t wear a mask unless you are advised to by PHE; or if you are ill, it is perfectly reasonable to wear a mask to stop infecting others—that is an act of generosity.
Absolutely. I agree very much with the hon. Lady about the importance of sign language and the signing of this session. I thank the House authorities for arranging it.
Yes, new guidance on care homes will be put out this week. If the hon. Lady passes on the details of her individual case to the Minister for Care, I am sure that my hon. Friend will be happy to look at it.
It is great to see two Ministers on the Front Bench. For me, health inequalities are closely linked to the health of my local NHS trust, so I make no apologies for talking about Isle of Wight healthcare in relation to health inequalities. I do so within the framework of the unavoidably small hospitals programme, which is potentially a very interesting move by this Government. I discussed it with the Minister for Health, my hon. Friend the Member for Charnwood (Edward Argar) and the Secretary of State last week. The background is as follows: 12 national hospitals qualify as unavoidably small, and the economics of those hospitals has an impact on healthcare, especially in a place such as the Isle of Wight, which has a 100% remoteness factor, because we are separated by the sea. The diseconomies of scale over a wide range of health issues affect the ability to deliver healthcare to the same standard as on the mainland. That is part of the wider issue I am looking at when seeking an Isle of Wight deal. We reckon that the additional costs of providing healthcare on the Island to the same standard as on the mainland is about £12 million. I will not go further into the details, because of a shortage of time, but I have talked to the Secretary of State and the Minister for Health about that.
What do I intend to do about this? I am going to try to secure debates on the USH programme, in the hope that the 20 or so Members concerned, mostly Conservatives but with one Opposition Member, will join in supporting me, so that we can ensure that Ministers understand the additional pressures on these hospitals.
I will also make the case to Sir Simon Stevens for looking at increased revenue for unavoidably small hospitals, especially on the Island, which has a 100% remoteness factor. We will, though, continue to drive efficiency on the Island. Our chief executive Maggie Oldham and the leadership team are looking at doing that by linking up with Portsmouth district general hospital and with Solent NHS mental health trust, and by doing other good things so that we use public money as efficiently as possible.
I would very much like recognition from the Government that there is an additional cost for unavoidably small hospitals because of diseconomies of scale. That should translate into something in terms of revenue. In addition, when it comes to helping Islanders to get patient treatment on the mainland, there are additional costs for patient travel. I will leave it there.
Health inequality is explicitly linked to the wider inequality caused by 10 years of austerity policies. Labour’s record shows that health inequality and child poverty—they are very much linked—are not inevitable and that Governments can address them effectively, but this Government have had a decade to do that and have simply not done enough. Huge health inequalities exist in my constituency. I shall concentrate on healthy food, housing and air pollution.
Roehampton includes areas that are among the 20% most deprived areas in England, and the 10% most deprived with respect to income and housing. Health levels in Roehampton are consistently lower than those in the wider London Borough of Wandsworth. Average life expectancy is 7.4 years less for men and 5.5 years less for women in Roehampton than in Thamesfield ward at the other end of my constituency. Men in the Alton and Putney Vale area of Roehampton spend up to 6.6 years fewer in good health than the Wandsworth average and women up to 4.9 years fewer. It is a scandal.
In one area of Roehampton, people feel like they are living in a food desert. These are urban areas where it is difficult to buy affordable, good-quality fresh food. That is a poor phenomenon across the country.
Cuts to transport and just having one small supermarket in an area are really big issues. That is a matter of town planning which could be addressed by the future high streets fund. Furthermore, more funding for councils could be used to help establish fresh food shops. Community organisations could also be used.
Linked to this is the high level of overcrowding in Roehampton. The biggest reason for people coming to my surgeries since I was elected is mould. Children growing up in homes with damp and mould are prone to asthma, and are often not able to go to school. Poor housing also means less physical activity, loss of sleep and missing school, and those problems are exacerbated in temporary accommodation where, often, there is no fridge, no cooker and no space to prepare food. I call for a public health review of our temporary accommodation.
Finally, air quality is not just a public health issue, but a social justice issue. Poorer families are less likely to have a car, but also more likely to live on the most polluted streets. To tackle this, we need a legally binding commitment to meet the World Health Organisation guideline levels for fine particulate matter; a strengthened Office for Environmental Protection; and targets and funding for councils to have a modal shift towards cycling and walking. These are public health issues. Residents of Putney, Roehampton and Southfields face health inequalities, and the Government need to start listening and take action.
I welcome this Bill. It is crucial that we have an effective regulatory system in this country, so we should enable the Government to amend existing regulations post Brexit. We could be a little more ambitious, however. Government time is precious, and I doubt we will have many occasions to discuss medicines and medical devices, which I suspect is why many of my colleagues have raised things that are not covered in the current legislation.
In a world in which medicines and medical devices are changing fast, the Government need to take greater powers to meet those changes and take advantage of them post Brexit. They need to be able not just to amend but to create regulations. My real concern is that the parameters of these new powers are drafted in such a way that they give power to the Government only to amend existing regulations—four sets of them. The Bill does not give the Government the power to do more, which is a missed opportunity.
Although I am conscious of the need to consider this at a European level, medicines and medical devices are, for most of us, a global issue. This Bill should not just be about ensuring we can cope after leaving Europe; it should be about the opportunity that can be created in the new global world we are entering.
A lot has been said, and rightly so, about the challenge of medical devices, which is a fast-growing area in which Britain is a leader, but it involves a huge variety of small and medium-sized enterprises, and innovation within devices is happening at a faster rate than within medicines. That is what we need to address, and I do not feel we achieve it with this Bill.
This legislation will not help with the challenges of breast implants, vaginal mesh and spinal implants that crumble, because the registry that is to be created is within the constraints and confines of existing registries that, by and large, collect information about devices. They do not collect information about the journey of those devices through the patient experience, from implant through to removal and replacement, including where the device may be defective. That information, properly recorded, would enable us not only to recall devices that we knew were faulty, but to go to patients in whom we knew a device had been implanted to expedite dealing with a medical emergency.
More importantly, medicine is about innovation and creativity. Unless we have a mechanism to evaluate the progress of medical devices implanted in individuals, how can we know which ones work and which ones do not? If a patient does not re-present, and if there is nothing added to the record, we will never know. Such a registry is mission critical.
The Government should be brave and consider a new clause to create such a registry, and they need to consider how we can consolidate the existing registries. There are many national, European and international registries for particular disease areas, and a lot of thought has been given to what best practice and the ideal registry look like. The International Medical Device Regulators Forum set out in 2016 exactly what it thought that should look like, and it seems to me that the Government would be well advised to consider that. It suggests collecting information not just about the device but about the journey through and in the patient. It seems to me that only through a change to the Bill will we achieve what we want to achieve.
Things probably go beyond that. Indeed, some of my hon. Friends have explained the complexity of understanding what a “device” is—does it include lip fillers, artificial intelligence and so on? The list of new innovations grows and will, to be honest, grow beyond current human imagination and we need a regulatory system that enables us to take advantage of that and regulate appropriately and quickly. We therefore need the capacity to change the definition of a device, and right now we do not have that because we are effectively adopting the definitions in the rules we adopted from Europe. We are giving ourselves the ability to fiddle, but not to change them fundamentally, and that is actually quite important.
We need to create an international search database so that we can deliver on some of the challenges of urgent harm, which we can prevent and deal with once a defective device is identified, and so that we can create something that gives us the opportunity to be world leaders in not only medical devices but medicines. It seems to me that that is the opportunity. Why do we constrain ourselves to being a follower? Why do we always talk about keeping up with Europe? Why not be the leaders? The National Institute for Health and Care Excellence was always set out as the global standard that everybody looked to—as absolutely what we wanted in every country. Why not have exactly the right system, whatever the NICE or the Medicines and Healthcare Products Regulatory Agency of the future looks like? Why not set the standard that others then follow?
In the earlier part of the Bill, where it covers the regulation of medicine as opposed to medical devices, there are some changes that look to the future—that is certainly the case for the changes regarding medical trials. However, it seems to me that that is a missed opportunity not only to consider the sort of regulatory system we might want in the future, but—even though we have NICE, the MHRA and notified bodies for the lower levels of medical devices, which provide CE marks— to look at this all over again. As has been said, some things that seem to be harmless and very simple, and seem simply to merit a CE mark, can become very dangerous in how they are ultimately used by a practitioner. We might need to look at all this again, but the power to do that simply is not in the Bill.
There is also nothing in the medicines section, as far as I can see, about increasing the speed of access to new developments and new medicines. That has always been a mantra of this Government, but I cannot see any provision for it. If we had control to look at the MHRA and NICE, we could do that, but as the Minister well knows the reality is that she has no power. The power to deal with the regulatory system and the regulations set by the MHRA and NICE is in the gift of NHS England. Following the Lansley reforms, that power is not now in the gift of the Government and it seems to me that the Government, who have this proactive agenda, should be taking the initiative so that they can be more direct in ensuring that we have the regulatory system we need. At the moment, all we have is the ability to limit the money that is available.
For example, the Government have talked about an innovative medicines fund, but I see nothing in the Bill to provide for that. I understand that the idea is that it can be just an extension of the cancer drugs fund, but, I ask the Minister, is that actually right? There should be different criteria—there will be different tests and different needs. Simply extending the cancer drugs fund will muddy the water and not deliver what we are really looking for, which is something that looks specifically at innovative medicines, which need clearly defining and properly clarifying. If we are to cover both groups, we need to increase the pot, but there is no suggestion of doing so.
There is a lot still to be done. Earlier, one of my colleagues made the good point that if we are to be a global leader rather than just a follower, we ought perhaps to look at how our marketing authorisations could be adopted and accepted in other countries, effectively saving costs and getting medicines to market faster. The UK would therefore be seen as the place to come for one’s marketing authorisation, rather than Europe, despite the size differential, because we would be the market leader in the mechanism to develop that.
For me, the Government have made a good start, but there is much to do. I look forward very much to the Minister’s closing remarks and, more importantly, to her confirmation that the Government have an ambitious vision and will be working hard during the following stages of the Bill’s consideration, of which I would very much like to be part, to consider changes that will deliver opportunities that the as drafted Bill does not offer. That said, it is a good start and something we can build on.
I totally agree with the hon. Lady about the concerns and, we hope, the opportunity to ensure that any pack of sodium valproate that is dispensed carries the information. Does she share my concerns at the talk of having digital information, as many people are digitally excluded? Having actively to seek information about a drug is perhaps an additional barrier. We should be making this easier, simplifying the leaflets that are in with drugs, perhaps by having more infographics, to allow people with poor English or limited understanding to recognise what they should be doing around their medication.
I must start by declaring an interest: before arriving in this place, I spent some nine years working in the pharmaceutical industry for two European companies, and I continue to hold a small number of shares granted to me by Novartis Pharmaceuticals Ltd.
Although I and my party support this legislation, clearly it is important that the UK should have the ability to regulate human medicines, veterinary medicines and medical devices following the end of the transition period. It will not surprise Members to hear me say that we believe it is extremely regrettable that we are even in this position in the first place. Clearly, in terms of ensuring that British patients have safe and swift access to medicines and medical devices, and ensuring our life sciences industry continues to remain competitive, our interests would have been best served by staying in the EU. That is why we will continue to fight tooth and nail against a hard Tory Brexit, despite the reckless and threatening approach to negotiations being taken by this Government. A hard, no-deal Brexit at the end of this year could spell catastrophe for British patients and the life sciences industry.
My main concern is that the provisions of this Bill could allow for significant regulatory divergence for medicines and medical devices from the rest of the EU. The medical research community and manufacturers are united in their call for the UK to remain as close as possible to the EU, preferably through negotiating associate membership of the European Medicines Agency. Any divergence from European regulation should take account of three principles: patient safety; early access for British patients to the latest innovations; and the competitiveness of the UK life sciences sector. In using the powers of this Bill to seek any divergence from the European regulatory framework, the No. 1 consideration should always be protecting patient safety. Any bid to make a UK stand-alone regulatory system more competitive than Europe must not seek to undercut the EU in safety standards, be that in terms of clinical trial regulation or the hurdles a new medicine, vaccine or device must clear to secure marketing authorisation or accreditation in the UK.
I would also take this opportunity to urge Ministers to consider, as they enter into negotiations with the EU, the critical and indeed life-saving importance of remaining part of the EMA’s pharmacovigilance network. By collecting and sharing real-time data on approved medicines, the EMA is able to identify trends and quickly take actions to inform patients and health professionals about safety concerns. By remaining part of a network across 28 countries rather than just the UK on its own, our network would have far wider coverage, with a far greater number of patients using a drug, thus increasing the likelihood of the data collected being more accurate, and concerns being picked up at an earlier stage. Related to that point, I wish to highlight the shocking and wanton disregard for public health and safety that we have heard from the Government about wanting to withdraw from the EU’s early warning system on pandemics, given the serious global challenge we face on coronavirus. Even the Government’s former Minister Baroness Blackwood has been saying in the media today that that is not the way forward to ensure that we protect patient safety. We all know that disease knows no borders, so it is ridiculous and isolationist, as the hon. Member for Central Ayrshire (Dr Whitford) has said, to withdraw from that system.
The second principle to consider when using the powers within this Bill to diverge from European regulation is ensuring that British patients continue to have swift and early access to the latest innovations. I welcome the Government’s intention to use these provisions to ensure that NHS hospitals are able to manufacture and trial the most innovative new personalised and short-life medicines. The UK should be at the cutting edge of supporting those pioneering new treatments to be made available to British patients. However, we must not forget that the vast majority of medicines, and indeed devices, coming through the pipeline are not in that category. Any significant divergence from the EU regulatory framework will inevitably lead to delays in new technologies being made available to British patients.
As has been mentioned, the maths is obvious: the EMA covers 25% of global medicines sales, whereas the UK on its own makes up only 3%. Companies are likely to submit applications for new drugs to the EMA before the MHRA, meaning that UK patients risk having slower access to the latest medicines—we see this with Switzerland, Canada and Australia already. How will the Government ensure that the MHRA’s processes remain among the fastest in the world, while maintaining patient safety? The hon. Member for Newton Abbot (Anne Marie Morris) implores us to be a leader in that regard, not a follower, but it makes no commercial sense for us to be outside the European regulatory framework. I know that from my personal experience of working on the dreaded Brexit taskforce when I was in industry. My European regulatory colleagues were not in the slightest bit interested in helping me and British colleagues define, and then represent to Government, what a competitive new divergent system might look like. Understandably, commercially their priority was and remains the 445 million inhabitants of the other EU27, as opposed to the 66 million or so in the lone ranger that is the UK. That point is not lost on Cancer Research UK, which has specifically called for clause 2(1) in part 1 of the Bill to be used to facilitate UK recognition of and participation in the EMA’s medicines licensing processes.
One of the earliest ways that patients gain access to the latest innovations is through clinical trials. The Bill could be used to amend the regulations that govern clinical trials in the UK. It is worth noting that the number of trials conducted in the UK has fallen since 2016, with the UK falling behind the USA, Germany, Canada and Spain for phase 3 commercial clinical trials. Although there is an opportunity to make the UK more attractive for clinical trials, any such opportunity must not come at the cost of patient safety, and high standards should be maintained. Any stimulation of the clinical trial environment must include continued UK-EU collaboration on trials, which is critical for trials involving medicines for rare diseases or children, in respect of which the population in any one country is not sufficiently large for a trial. Furthermore, the EU’s clinical trials regulation, which is due to be implemented in 2022, should accelerate trial setup times, improve safety reporting and facilitate collaborative research, because of the digital infrastructure that underpins it. The UK played a pivotal role in developing the CTR and our patients would benefit greatly from it being implemented here.
My third point is closely connected to my previous point: any divergence from European regulation should take account of the competitiveness of the life sciences sector, which successive Governments have often described as a “jewel in the crown” of UK plc. Our remaining an early launch market by keeping in step with EMA is key to our continuing to attract high levels of foreign direct investment into the UK from pharmaceutical companies. Any additional burden on applying for marketing authorisation for medicines, or a separate system for the accreditation of medical devices in the UK, away from the CE marking scheme, will make the industries less competitive. Also key to competitiveness is the securing of frictionless and tariff-free trade as part of the negotiations with the EU. That is critical given the integrated and complex cross-border supply chains in the manufacture of medicines and medical devices.
To summarise, the Bill is necessary in view of the UK’s unfortunate decision to leave the EU. However, I urge caution on Ministers in respect of how the powers in the Bill are used. British patients must be kept safe, they must be able to access the latest medicines and technologies at the earliest opportunity, and we must not undermine the thriving life sciences industry in the UK. The Government’s quest to make the UK a Singapore-style regulation-light country must not see us undercutting safety standards in a bid to improve our competitiveness. As the Government seek to negotiate a trade deal with the EU, the way to safely ensure that British patients can access the medicines and technologies that they need, and the way to keep attracting industry investment into the UK, is by remaining as close as possible to the European regulatory regime.
Thank you very much, Mr Deputy Speaker.
Devon is a wonderful place for people to come and retire, and as a consequence we have many older people. According to Age UK, we have 39,853 individuals over 65 who have unmet social care needs, and in my own constituency the figure is 3,614. We know that there is a problem. It is not just in my constituency, and it is not just in Devon. I think that there is already a strong chord of agreement in the House that this is no longer about talking, but about action.
Those listening will expect us to act for them. They will not expect us to get involved in political wrangles. We have already had political wrangles over Brexit, and look where that got us: three years of inactivity. This Government have a majority, and with that comes a responsibility to finally resolve this social care problem. We have to find a solution. No more reports. No more royal commissions. We have had Sutherland, Wanless and Dilnot, and no Government who commissioned any of those reports have accepted all their recommendations. What would be the point of another one? The Care Act 2014 was a great start, but part two has not been implemented. Frankly, I do not think it ever will be. The reason? It is not affordable. Certainly, how we would afford it has not been thought through.
What is the barrier to all this? Why do Governments of every colour fail to deliver? First, there is a reluctance to ’fess up and actually admit how much this is going to cost. Secondly, there is disagreement across the House as to exactly how that cost can be met. We have already seen examples of that in the contributions today. Even if we could agree, there are other things that need to be sorted out, as my hon. Friend the Member for Thurrock (Jackie Doyle-Price) mentioned. We need to agree as a nation on the standard of care that should be delivered. We are not there yet. Even LaingBuisson, which has set many of the standards, has not done that.
We need to accept personal responsibility to maintain and improve our own health. We do not yet do that. We need to reduce our own care needs, or at the very least delay them. We need to consider developing community resilience. Families are often widespread, and we need to take responsibility for our neighbours and plan together for our wellbeing. We need to drive forward a wellness and wellbeing agenda, which is much more a public health agenda. Too much time is spent on illness, and not on wellness. We need to change our mindset with regard to old age, and I would certainly recommend reading “Extra Time: 10 lessons for an ageing world” by Camilla Cavendish. Being old does not necessarily mean that we are past it and falling off our perch.
What is the roadmap to change? For me, first, we need to define what “good” looks like to the recipient. Secondly, we need to decide what resources we need to provide that. Thirdly, we must develop a proper training and recruitment plan, and motivate our staff. Fourthly, we need to evaluate the adequacy of the existing infrastructure for care delivery. Do we have the right model? No, I do not think so. The earlier references to housing were well made in that regard. Fifthly, we need to look at integrating not just health and care but the whole IT strategy and housing strategy. There is much more work to be done on that. Sixthly, we must bite the bullet and decide which of the nine funding models—because there are nine—suggested in the various reviews we are going to use. There will be a degree of mix and match, but we have to make a decision.
So, that is for the long term. In the short term, we need a fix, and it is not just about money. We need to ask the Care Quality Commission to set the minimum funding levels that we will expect local government to pay for the care of any client, and central Government should be obligated to pay for that. We must make local authorities accountable for both the quality and quantity of care provided. They are not at the moment, and we know that there is a bit of a postcode lottery. We must make the NHS and local authorities equally and jointly accountable for the health and care delivered in the home and in care settings. That is not the case now. I do not ever want to hear a clinical commissioning group telling me, when it is talking about closing one of my local community care hospitals when we have no nursing care in the area, that it is not the CCG’s problem but the problem of the local authority. That is not acceptable, and it is not responsible.
We also need to put in place a full review of nursing care outside NHS provider institutions, and provide ring-fenced capital funding to deal with it. We need to stop the practice of putting people who should be receiving nursing care into residential care homes. That is not responsible; it is not right for the care home or for the client. We must stop caring for dementia patients in hospitals. That is completely wrong. It is not right for their care and not right for them in the long term. We need to create the right provision.
I am afraid that we also need to increase general taxation and report annually as to how that money, which should be ring-fenced, is being spent. I believe that those who are working should carry on paying national insurance contributions even past retirement. I take the point about the older generation who have retired contributing, and that needs to be taken into account. We should raise the level of personal funds that an individual may keep before they contribute. I think it should be raised to £100,000, and we need to cost that. We need to include more people with lesser care needs in the state-funded system, and, as has been discussed, we need to develop a funding model with the private care sector and the insurance sector that combines personal and state contributions to care costs, looking at compulsory savings and risk-sharing mechanisms.
We have made a promise to the British people, and we must keep it. Now is the time for action. No more talk, no more reports and no more commissions. This is the time for this Government, who have a majority, to deliver.
My hon. Friend mentioned the very personal nature of the care provided by prepared carers, but young carers also do this. They allocate medicines, and they even take their parents to the toilet or wash them. Does she agree that so much more needs to be done to recognise the role of young carers and to give them even greater support?
I support the Government’s amendment, particularly the line about seeking cross-party consensus. Opposition day debates may not be the ideal time to seek consensus across the Chamber, but consensus will be vital in the long term.
Governments of all stripes have tiptoed around this problem for 20 years because no credible solution is painless for everyone. It is expensive, emotive and, for those of us who have seen the current system close up through our family, often very painful, but there have clearly not been enough of us to make solving the problems less painful than allowing them to drift on with regular injections of emergency funding, which are of course welcome, but they are a sticking plaster.
To have a long-term solution, we need all parties to agree, as they have on pensions—another long-term, expensive, complex issue on which we do reasonably well as a country. Even in these divided political times, people of good will can work together across parties.
We have heard a lot about the overall problems of staffing levels, wages and the capacity of the system to cope, all of which I agree on. The vast majority of people agree that we need to spend more. At the same time, they insist that they should not pay any extra tax themselves. We need a serious conversation about this. It is easy to present solutions for those who do not accept there is a bill.
We know that social care, especially for the elderly, is often too opaque for those trying to understand it, with no apparent logic in the conditions that receive free NHS treatment and those that do not. It is also apparently unfair in not rewarding a lifetime of prudence. Those who have saved feel that their savings will simply disappear, while those who have not saved receive the same level of care, often in adjoining beds.
Less well known is the fact that funding social care out of council tax means local authorities are too often reluctant to allow new care homes to be built. An ageing population means that already more than two fifths of council spending goes on social care. That figure will only increase over the years, so councils are understandably fearful that all their other services will be swamped by the rising demands of the social care system. That is not sustainable in the long term.
Of course, all the various failures in the social care system put unnecessary extra pressure on the NHS. Indeed, the long-term plan, with all its generous funding for the NHS, depends on an assumption that we develop a social care system that keeps people out of hospital longer and discharges them faster in a smooth and timely fashion. At the moment, both halves of that assumption are questionable, as others, such as my hon. Friend the Member for Thurrock (Jackie Doyle-Price), have said. We need to solve the social care problem to solve the NHS problem as well.
A new system needs five objectives. Interestingly, I listened to the speech from the hon. Member for Leicester West (Liz Kendall) and my list does not differ hugely from hers, which suggests that a cross-party consensus is possible. First, a new system needs to provide enough money to cope with the increasing, ageing population. Secondly, it needs to be fair across generations, meaning that today’s working taxpayers are not asked to pay both for their own care in decades to come and the care of the generation above them. Thirdly, it needs to be fair between individuals by ensuring that no one has to sell their own home for care and ending the dementia lottery in which one condition is treated on the NHS and another is not. Fourthly, it needs to lead to an increase in the supply of care beds and retirement housing. Fifthly, in an ideal world it should establish a long-term cross-party consensus.
We need to look to the pension system as a model, because it has achieved many of our aims. In recent years, the state pension has been increased significantly, but at the same time most people save additionally throughout their working years to provide comfort and security in old age. Auto-enrolment has been a great cross-party success story. Similarly, just as the basic state pension has been improved, we should offer a better universal care entitlement, with a better level of care for both home care and residential care. Needs would be assessed locally, but crucially the money would come from central Government rather than local government.
We also need to encourage people to save themselves through a care supplement—a new form of insurance designed specifically to fund more expensive care costs in old age. The analogy is with the private pension system, allowing people to buy insurance at a level that they can afford to provide peace of mind. It would not be compulsory so could not be stigmatised as a death tax or dementia tax.
The ideas I have outlined would take the burden of social care funding away from local councils and, even more importantly, offer certainty and security to the increasing numbers who will need social care in old age. No one would have to sell their house and see their whole inheritance disappear; everyone would have the chance of receiving better care; and fewer people would be left unnecessarily in hospital beds as they wait for social care to be available. None of this is easy and it will take political courage, but it is absolutely necessary if we are to provide peace of mind and security to frail, elderly people and working-age people who need care. They all deserve it.
The hon. Gentleman makes an incredibly important point. General practice, where 90% of all NHS appointments take place, needs to reach every part of this country, including his beautiful constituency, which is, as he says, very sparse. Of course we need to ensure that the practices there are sustainable, and again this is an area in which technology can be of particular help. There is great enthusiasm for using technology so that the travelling times of patients and sometimes of GPs can be reduced.
The Government have enshrined in legislation through the Care Act 2014 a council’s statutory duty to meet eligible needs for adult social care. We have given councils access to up to £1.5 billion more dedicated funding for social care in 2020-21 to help them to meet this requirement.
As I have explained, the Care Act sets out the requirement that entitles individuals to a care needs assessment and sets a minimum national threshold at which care should be delivered. We have backed councils up by giving them access to £1.5 billion in additional funding in the next financial year. In the hon. Member’s constituency, that will equate to an additional £5.1 million from the new social care grant. This is something that the Government take very seriously.
I will rattle through as fast as I can, Mr Deputy Speaker, but I also want to take as many interventions as I can, if that is okay. [Interruption.] No, okay, no interventions. That is an unusual request from the House, if I may say so. [Laughter.]
Putting social care on a sustainable footing, where everybody is treated with dignity and respect, is one of the biggest challenges we face as a society. The Prime Minister has said that we will bring forward a plan for social care this year. These are complex questions and the point my hon. Friend raises is very important.
The draft legislation on the long-term plan Bill aims to help us to: speed up the delivery of the long-term plan; reduce bureaucracy; and help to harness the potential of genomics and other new technologies. I hope the House will support it.
The third piece of proposed legislation is the medicines and medical devices Bill. We are at an important moment in the life sciences. This country can and will be at the forefront as the NHS gets access to new medicines and new treatments earlier, so patients can benefit from scientific breakthroughs sooner.
Thank you, Madam Deputy Speaker. Politics has become something of a dirty word in recent years, but during the election campaign, thousands of activists from all parties throughout the country went out in the cold, the dark and the rain because they truly believe that their political viewpoint can make people’s lives better. Across the House we may disagree, often vigorously, on how to do that, but I truly believe that public service is why we are all here.
A true example of that public service was my predecessor, Sir Michael Fallon. I know Sir Michael was a friend to many in this place. He served my constituents in Sevenoaks and Swanley for 22 years, and those in Darlington before that. He served as a Minister under four Prime Ministers, first under Margaret Thatcher as schools Minister, a role he also played under John Major. He was responsible for setting up school league tables and Ofsted—huge leaps forward for the accountability and performance of schools in this country. Sir Michael also served under David Cameron and my right hon. Friend the Member for Maidenhead (Mrs May). Despite his unofficial title as Minister for the “Today” programme, he was in fact a Minister in the Department for Business, Innovation and Skills and in the Department of Energy and Climate Change. He was latterly Secretary of State for Defence—a role that he both excelled at and relished, although I must say, as the person responsible for running the No. 10 grid at the time, it is possible that he did not always manage to run his announcements past No. 10.
Sir Michael was, above all, a strong voice for Sevenoaks and Swanley constituents, an example I am determined to follow. Sevenoaks is a wonderful constituency, with a vibrant community and excellent schools, and it is over 90% green belt—something we must maintain. It is an honour to represent the constituency that houses Chartwell—Winston Churchill’s former home—as well as Chevening, the Foreign Secretary’s residence. I am very much looking forward to an invitation to visit.
Although the constituency is known for both its greenery and transporting much of its population to work in London, there is significant entrepreneurship, with 7,000 businesses in Sevenoaks. We are also developing some fantastic expertise in wine and beer. Squerryes, Westerham Brewery and the Mount Vineyard are creating world-class produce and deserve to become international brands.
I also pay tribute to my brilliant local district council, led by Peter Fleming, who has won numerous awards for his stewardship, and at a time of great fiscal strain made Sevenoaks District Council financially independent. Equally, Roger Gough, the talented leader of Kent County Council, has done so much to deliver the excellent standard of schools throughout the constituency.
I should move on to the health service, which is the main topic of debate today. All of us here will have stories of how the NHS has helped us, and we have heard some incredibly moving ones from my hon. Friends today. My now thriving one-year-old twins were born six weeks early and needed help to breathe and to eat when they were born. I owe the neonatal teams in our NHS everything and I will be forever grateful.
I worked on maternity care and choice policy when I was a special adviser, and it is something that I will continue to speak up for in this place. We must, and I know that we will, ensure better care for women in maternity, ensure that pain relief is freely and readily available, give women a full choice of options on how and where they want to give birth, continue to improve outcomes for multiple births and deliver on our brilliant promise to extend maternity leave for mothers of premature babies.
It has been striking this week that the focus of maiden speeches has been on the importance of social mobility and education. In speeches by my hon. Friends the Members for Wantage (David Johnston), for Eastleigh (Paul Holmes), for East Surrey (Claire Coutinho) and for Stoke-on-Trent North (Jonathan Gullis), among others, it is truly heartening to witness the breadth of expertise, diversity and interest that our intake takes in these issues. I will add my own name to the list of those speaking out on this topic.
I went to a comprehensive and was the first in my family to go to university. My grandfather on one side was a milkman and, on the other, a doorman at The Sun. My grandmother was one of the smartest people I have met. She got a scholarship to a good school, but was not allowed to go as they could not afford the uniform. The thing that changed the fortunes of my family was the great education that my mum and dad received. That is why I am incredibly proud of the Conservative party’s legacy in delivering higher school standards, not just by putting money in with that reform, but by being fearless in demanding better for our children, calling out the soft bigotry of low expectations that my right hon. Friend the Member for Surrey Heath (Michael Gove) so rightly addressed and that my right hon. Friend the Member for South Staffordshire (Gavin Williamson) is continuing to work on.
The levelling up in funding that we have promised is the key next step, but equally important, as with all public services, will be the inspection regime making sure that this leads to higher standards being delivered. The true test of our system is whether we can improve the outcomes for those who need it the most. There are more than 2,000 children in care in Kent. We have taken huge steps forward in addressing their complex needs and improving their educational attainment, but we must do more, and I know that this is a Government who will do so.
I thank the House for listening. Politics done well is making people’s lives better and I am delighted to be part of this one nation Conservative Government, who I am certain will give so much to my constituency and to the country.
It is always a pleasure to follow the hon. Member for Blaydon (Liz Twist). As somebody who is in the early weeks of their seventh Parliament, I can say that I have therefore sat through many waves of maiden speeches over the years. The quality of the speeches that we have heard not just today—we have just heard from my hon. Friend the Member for Sevenoaks (Laura Trott) and from several Members from the Labour Benches—but throughout this debate over the past few days has been breathtakingly high. As somebody who has been round the block a few times, I can say that that is not only very welcome, but slightly alarming.
What I want to do is concentrate specifically on the social care element of today’s debate. It is a hugely important part of the wider health agenda and also obviously vital in its own right. I welcome a number of elements in the Government’s approach. The first is the recognition of the urgency of the need to solve the issue of social care, which has been left on the backburner for far too long. The second is the desire to work on a cross-party basis. I appreciate that that is going to be challenging for the Opposition Front Benchers over the next three months, because they will have other things on their mind, but for the past 18 months I have been working from the Back Benches with both Labour and Lib Dem Members. Although none of them are here at the moment, there are Lib Dem Members who are interested in this issue. I think that that cross-party approach is the best one. The third element is the Government’s recognition that the system today is incredibly fragile and needs extra money to tide it over. I am glad that the Government are helping local authorities with £1 billion in the coming year, but although it may be the world’s most expensive sticking plaster, it is still a sticking plaster, and we all know that we need a much more wholesale approach.
Many aspects of the problem need solving. There is the question of where the workforce are going to come from. Home adaptations will be needed so that more people can live in their own homes for longer. We will need the provision of extra places in care homes, where a shortage is developing. There are also problems when it comes to dementia patients. I think the Alzheimer’s Society has sent many Members a briefing for this debate, and everything it says is very sensible, but beneath all these questions is the issue of money. Where is the extra money going to come from? If there were a simple solution, a Government would have adopted it a long time ago.
I warn Ministers against reaching for the simplest and easiest solution, because the easy solution is to say, “We’ll make it free and we’ll fund it out of general taxation.” That is easy and seductive, because many people think social care is free anyway, but that would be wrong and unfair. It would be wrong not just because of the public spending implications, but for intergenerational fairness. If we fund the solution from the taxation paid by working-age people, we would be telling 20, 30 or 40-somethings not only that we are going to tax them to pay for their own social care if they need it in the future, which would be fair enough, but that we are also taxing them to pay for the social care of their parents’ generation, which would not be fair. That would be particularly unfair in this country, where there is a preponderance of wealth among the baby boomer generation. So much of the wealth in this country is tied up in housing, and that generation are far more likely to own their own homes than their children’s generation.
Madam Deputy Speaker, it is a pleasure to see you back in the Chair in your new role as Deputy Speaker and Chairman of Ways and Means.
I congratulate the hon. Member for Bristol South (Karin Smyth) on securing this debate. I know this is an important subject for her, as she has raised it on many occasions, but she is right that capital—the buildings our NHS operates out of—is actually an important subject for all of us. While it is a shame that there are not many Members in the Chamber, I hope that quality makes up for a lack of quantity. That is certainly the case with her speech, but it is a pleasure to see the hon. Member for Blaydon (Liz Twist)—who, if I recall correctly, held a debate on this subject almost a year ago—here as well.
The hon. Member for Bristol South was perhaps being unduly modest in her opening remarks about her knowledge of this subject and expertise in this area. While it is always a pleasure to see her speak about it, I always watch with a certain degree of trepidation, because she does know her subject extremely well. My knowledge of VAT and tax rules is rather more limited. Although I spent a period of time as a member of a primary care trust board many years ago, I suspect that my knowledge base will not be as deep as hers. However, I will endeavour to respond to all the points she has made. I recognise that the article she wrote that was published this morning on PoliticsHome highlights a number of these issues as well.
I will start by addressing the capital investment programme that the Government have set out and the impact of VAT on that, and then move on to the hon. Lady’s points about wholly owned subsidiaries and some of her subsequent points. In respect of the VAT position with the new health infrastructure plan hospitals—the new 40 hospitals we will be building—under the tax code VAT will be payable by hospital trusts involved in construction, reflecting that these are new builds and we would expect the appropriate HMRC regulations to be adhered to. However, as the hon. Lady touched on in setting out the background to the VAT rules, VAT chargeable on supplies of goods and services in the UK is collected by HMRC on behalf of the Government, so all moneys received in that way are reinvested in public services.
In addition, the funding provided for the 40 new hospital build projects and other capital schemes includes provision for the VAT charged by the suppliers involved in the developments. There may also be scope for an element of VAT reclaim on aspects of those projects, which will be determined and calculated on a case-by-case basis and in line with VAT regulations and rules. The overall funding allocation for the HIP has been built up by overall cost estimates of the schemes, inclusive of VAT. However, the final amount of VAT payable will be determined once the individual schemes have been fully scoped and costed. Current VAT rules will apply, and VAT recovery will be assessed for each scheme in line with the rules set out in section 41 of the Value Added Tax Act 1994 and the Treasury’s “Contracting Out Direction”. In broad terms, we have made allowance for VAT within the estimated costs of those schemes.
As the hon. Lady noted, it was outlined in the spring statement of 2019 that longer-term plans are currently being considered by Her Majesty’s Treasury to review the section 41 VAT rules, to potentially either allow for full VAT reclaim for NHS bodies on all their purchases of goods and services or remove VAT reclaims entirely from them. The VAT review or policy paper will publish a call for evidence in due course. While I know she would like me to give an exact date, I hope she will forgive me for not making announcements that are possibly more appropriate for Treasury Ministers to make. I will ensure that her request to know that date is conveyed to the Financial Secretary to the Treasury, and I hope that he will be able to respond to her swiftly with further information. In the context of the forthcoming call for evidence, I encourage her and others to contribute. She has a lot of knowledge and expertise in this area, and I suspect that in encouraging her to contribute I am pushing at an open door, because she will certainly do that. I know that the Financial Secretary will be pleased to hear from her.
The hon. Lady focused in both her article and speech on wholly owned subsidiaries, as did the hon. Member for Blaydon in her debate a year ago. While there can be VAT advantages of forming wholly owned subsidiary companies, we are clear that they cannot and should not be set up for the purposes of VAT avoidance, and we wrote to all provider trusts in September 2017 to remind them of their clear tax responsibilities. I may provoke the hon. Member for Bristol South, given her plea earlier, by saying that the origins of this position date back to 2004, subsequently consolidated in the National Health Service Act 2006, but she is right to highlight the changes in the 2012 Act. The position has evolved under Governments of both parties, but she is right to look at the future rather than where we have come from.
We expect all NHS providers to follow the guidance when considering any new arrangements or different ways of going down the wholly owned subsidiary route. There can be advantages in that route, as my predecessor, who is now the Brexit Secretary, set out, for employees in terms of flexibility and choice. There can also be commercial advantages for the NHS bodies setting them up, including things such as enabling providers to employ staff on more flexible and, in some cases, more generous terms and conditions—I emphasise the words “in some”; I see the hon. Member for Blaydon watching me carefully—as well as providing more efficient services in some cases to other trusts, being able to attract staff from the local employment market and giving greater flexibility to the operation of that organisation.
I thought I was going to provoke the hon. Lady to intervene, but it is none the less a pleasure that she has done so. She does highlight disparities, but I would say that it is wrong to suggest—even taking out wholly owned subsidiary companies within the NHS more broadly—that there is an exact commonality of terms and conditions, pension arrangements and so on; there are differences already.
What I will commit to do—I was going to mention this at the end, but I will say it now—is that I am very happy to meet both the hon. Lady and the hon. Member for Bristol South to discuss this more broadly in the context of Department of Health and Social Care responsibilities in the NHS, as well as the point the hon. Lady made about self-employed GPs and independent GPs. I am very happy to have that meeting with them. We may have to revert to the Treasury at some time on technical points, but I am very happy to have that meeting. I am very conscious that, in the two minutes or so I have left, there is a limit to how much I will be able to say, but I am happy to pick up other points in that subsequent meeting.
The hon. Lady is right about buildings. It is right that we are building 40 new hospitals and that we are investing capital in our NHS infrastructure, but she is also right to say that, yes, we shape those buildings, but in talking about place-based approaches, they shape us too and they shape our communities, so it is absolutely right that we get this right. On place-based commissioning, I was a cabinet member on Westminster City Council for many years—in the dim and distant past, when I had more hair and it was not grey—and I sat on the PCT at the same time, and where it works for local circumstances, there are clearly opportunities there as well. However, I do think that autonomy remains important, because while consistency and clarity are vital, so too is enabling local autonomy to address local needs and specific local circumstances, and I think we need to be a little bit careful about that.
I will conclude—with about a minute to go before you stop me, Madam Deputy Speaker—by saying I am sorry that we do not have more time for this debate, because it is an important debate. I am sorry there are not more Members here because it is something that would benefit all Members to be involved in. I look forward to any future such debates. I congratulate the hon. Lady on bringing this forward. She is right to highlight this issue, and I hope she will take an active part in putting forward her views to the Treasury review and call for evidence when that comes forward. As I say, I very much look forward to continuing this discussion—if not on the Floor of the House, in a meeting subsequently—and I hope and believe that we will be debating this at some point across the Floor of the House in the near future.
Question put and agreed to.