Covid-19 Update

Liz Twist Excerpts

Thursday 17th December 2020 Commons Chamber

[Matt Hancock]

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.

[Liz Twist (Blaydon) (Lab)]

I start by thanking the people of my constituency and across Gateshead who have worked really hard to get the figure down. Professor Michael Marmot’s covid-19 review, which was published this week, shows that the pandemic has exposed long-standing health inequalities, particularly in the north. Public health teams play a vital part in this pandemic and are core to addressing those longer-term health inequalities. What has the Secretary of State done to ensure that public health teams are properly funded so that they can address those inequities and, as Professor Marmot says, “build back fairer”?

[Matt Hancock]

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.

Ockenden Review

Liz Twist Excerpts

Thursday 10th December 2020 Commons Chamber

[Ms Dorries]

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.

[Liz Twist (Blaydon) (Lab)]

First, our thoughts today must be with all the families who have been affected by this tragedy. The investigation found that an area of concern was having the right staffing levels and the right skills mix. Will the Government look to legislate for safe staffing levels in the NHS and, in particular, midwifery?

[Ms Dorries]

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.

Coronavirus Vaccine

Liz Twist Excerpts

Wednesday 2nd December 2020 Commons Chamber

[Matt Hancock]

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.

[Liz Twist (Blaydon) (Lab)]

Last week we celebrated Carers Rights Day, and today they are not included on the priority list issued by the Joint Committee on Vaccination and Immunisation. They do a huge job in looking after some of our most vulnerable people. Will the Health Secretary look again at that decision?

[Matt Hancock]

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.

Covid-19 Update

Liz Twist Excerpts

Thursday 26th November 2020 Commons Chamber

[Matt Hancock]

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.

[Liz Twist (Blaydon) (Lab)]

May I start by assuring the Secretary of State that directors of public health and local authorities in the LA7 area and the wider north-east are certainly very focused on getting that figure down and have had some success? I would like to make that absolutely clear. The second point I would like to make is that my constituents and others across the north-east will be hugely disappointed to find they are in tier 3, particularly those businesses in hospitality and leisure which are going to be so desperately hit by this. The real point I want to make, however, is about public health. Nothing has shown more than this pandemic that public health should be at the heart of what we do. We know it affects outcomes in covid-19, and we know it affects health inequalities and the rate of transmission. Will the Secretary of State ensure that he impresses that on the Chancellor, and ask him for more funding for public health services, both now and in the future?

[Matt Hancock]

Yes, I agree with every word of what the hon. Lady said.

Covid-19: Acquired Brain Injury

Liz Twist Excerpts

Tuesday 24th November 2020 Westminster Hall

[Liz Twist (Blaydon) (Lab)]

Does my hon. Friend agree that our report, “Time for Change”, which was produced by the APPG with the help of the United Kingdom Acquired Brain Injury Forum, actually demonstrates the importance of neurorehabilitation, both in acute settings and in community-based cases?

[Chris Bryant]

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.

[Liz Twist]

Does my hon. Friend agree that we now need to make sure that those rehabilitation services come to the top of the pile, because this is causing a real problem for too many people in their everyday lives?

[Chris Bryant]

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.

Smokefree England: Covid-19 and PHE Abolition

Liz Twist Excerpts

Thursday 12th November 2020 Commons Chamber

[Liz Twist (Blaydon) (Lab)]

May I start by congratulating my hon. Friend the Member for City of Durham (Mary Kelly Foy) on securing this debate and on her introductory speech? I am going to start in time-honoured speaking fashion by telling you, Minister, what I am going to ask you, and then elucidating on that—

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order.

[Liz Twist]

Sorry. I will start by telling you, Madam Deputy Speaker, what I am going to be asking the Minister and then perhaps expanding on that. First of all, Minister, I will be asking you about the tobacco control plan, which my hon. Friend has already referred to. If we are going to achieve the smokefree by 2030 ambition, that needs to happen quickly, and I will be asking you what you can do—

[Madam Deputy Speaker]

Order. The hon. Lady really must refer to the Minister, because when she says “you”, she is talking to me.

[Liz Twist]

Sorry, Madam Deputy Speaker. I am getting carried away.

I will be asking the Minister what he will be doing to ensure that vital maternity safety programmes, such as the saving babies’ lives care bundle, can get back on track. I will be asking him what he will do to develop a national strategy for reducing rates of smoking in pregnancy among women from disadvantaged communities, learning the lessons from the areas where the greatest declines have been seen in smoking in pregnancy. I will be asking him how he will ensure that mental health trusts are required to implement National Institute for Health and Care Excellence guidance and that the Care Quality Commission is directed to assess that when it carries out its inspections. Finally, I will be asking him what steps he will take to ensure that smokers with mental health conditions receive evidence-based advice about switching from smoking to vaping.

I want to elaborate a little further on those issues. As a result of comprehensive action at national, regional and local levels, significant progress has been made over the years on bringing down smoking rates in England. The 2019 prevention Green Paper’s commitment to make England smokefree by 2030 was an appropriately ambitious and welcome commitment to continuing this important mission. However, a year on from the end of the Green Paper consultation, we have yet to see the Government’s response or their promised and much-needed further proposals, which would enable us to meet the 2030 ambition.

Despite our national progress, smoking remains the leading cause of preventable illness and death in England. Each year, smoking kills more people than obesity, alcohol, drug misuse, HIV and traffic accidents combined. Smoking is a particular challenge in my constituency of Blaydon, where 17.4% of adults smoke, compared with 15.3% across the north-east and 13.9% nationally. Smoking costs Blaydon £1.8 million every year, largely as a result of NHS treatment costs, lost productivity due to ill health and premature death caused by smoking. For communities such as Blaydon, achieving the smokefree 2030 ambition will be tough, but it remains essential for the health and wellbeing of our community. However, analysis by Cancer Research UK finds that on current trends, disadvantaged communities such as my own will not become smokefree until the mid-2040s. This rate of progress is not acceptable and not affordable for our most deprived communities.

The last tobacco control plan was two years late, as we have heard. It should have been published in 2015, and it was delivered in the summer of 2017 only because of the commitment of the then Health Minister, the hon. Member for Winchester (Steve Brine), who I am pleased to say has just joined us. The tobacco control plan that he introduced included the ambition for a smokefree generation, and now that the Government have committed to deliver this by 2030, the pressure is on. Our current tobacco control plan is set to run out in 2022, leaving an eight-year gap in which, according to Cancer Research UK, the rate of smoking prevalence decline must be 40% faster than our current trajectory if our nation is to meet the 2030 tobacco control plan commensurate with the scale of the ambition to be smokefree by 2030.

I shall turn now to the NHS long-term plan. The successful delivery of the plan is essential to the achievement of the smokefree 2030 ambition. The plan published in January last year sets out welcome commitments to tackle smoking in the NHS. By 2023-24, NHS-funded tobacco dependence treatment will be offered to all hospital in-patients who smoke; all pregnant smokers and their partners, too, if they smoke; and all long-term users of specialist mental health and learning disability services who smoke.

The evidence is clear of the benefits this will bring, both to smokers and to the NHS. Smokers are 36% more likely to be admitted to hospital and smoking is responsible for almost 500,000 admissions each year in England. One hospital patient in four is estimated to smoke. The increased demand that smoking places on NHS treatment capacity translates into an enormous financial burden. Each year, smoking costs the NHS around £2.6 billion, including avoidable secondary care costs estimated at £890 million a year. The cost in the north-east to the NHS is around £132.3 million a year, with smoking in Blaydon alone responsible for around £300,000 of that. Across the north-east, it is estimated that implementing the long-term plan commitments at just 40% coverage, as is aimed for by the end of 2021-22, would deliver net savings of nearly £12 million to the NHS in the north-east.

In the north-east, progress towards implementation of the long-term plan’s commitments on smoking is well under way. Treating tobacco dependency is one of two key priorities for the north-east and north Cumbria integrated care system population health and prevention work stream. To focus efforts across the region, a dedicated north-east Smokefree NHS/Treating Tobacco Dependency Task Force was established in 2017. The taskforce has provided strategic direction, developing regional resources and facilitating partnership working with all stakeholders, including NHS trusts, local authority tobacco commissioners, Public Health England and primary care.

As of April 2020, all NHS trusts in the north-east had achieved smokefree NHS status by implementing updated smokefree NHS policies and pathways to identify and treat smokers from admission, in line with national guidance. Across the north-east, trusts have established good links between hospitals and community stop-smoking services funded by local authorities to ensure treatment started in hospital is continued after patients leave hospital. Trusts are training staff to build capacity. They have also signed the NHS smokefree pledge as a clear and visible way to show commitment to helping smokers to quit and to providing smokefree environments.

Elsewhere, progress has not been so heartening, and it is clear that the funding and focus promised by the long-term plan are much needed. An audit of smoking cessation advice and services in NHS acute hospitals, published earlier this year by the British Thoracic Society, concluded that there is poor adherence to national standards and slow progress in identifying and treating smokers. In fact, in many cases the situation is worse than at the time of the last audit in 2016. One smoker in two is not asked whether they would like help to quit. Only one hospital in three has a hospital-funded smoking cessation practitioner, compared to one in two in 2016. Referral to hospital smoking cessation services is available in only four out of 10 hospitals. In 2016, the figure was more than half.

Progress on the long-term plan’s commitments has also not been immune from the impact of the covid-19 pandemic. Early implementation sites chosen to stress test the new tobacco dependency treatment pathways set out in the long-term plan were due to start in April, but this had to be delayed until last month. With winter approaching, and the risk of co-circulation of covid-19 and seasonal flu looming, there is a real risk that work to deliver the long-term plan’s commitments on smoking could be derailed. If we are to achieve the smokefree 2030 ambition, addressing smoking where contact with smokers is greatest is an opportunity that must not be missed

Let me turn to smoking in pregnancy. The Minister is as concerned as I am about this issue, on which there is too little progress. This needs to be a major focus of the next tobacco control plan. Ensuring that more pregnancies are smokefree not only protects the baby as it grows and reduces the risks of complications such as stillbirth and miscarriage; it also gives children the best start in life. NHS England has included addressing smoking as a key part of the initiative to reduce stillbirth and neonatal deaths through its saving babies’ lives care bundle, which is designed to encourage trusts to implement evidence-based measures to improve the safety of pregnancies. However, as with other aspects of NHS activity, this work has been undermined by the impact of covid-19, with a key aspect—carbon monoxide breath tests for all women—currently suspended. I understand that there are also reports from local authorities’ stop-smoking services that fewer pregnant women are being referred for them for support by maternity services. What will the Minister do to ensure that those vital maternity services get back on track as a matter of urgency?

Despite work in the NHS, progress has not been made anywhere near swiftly enough. There are big variations in the performance of different parts of the country. In a soon-to-be published analysis, Action on Smoking and Health finds that rates of smoking in pregnancy have increased in the past five years in a third of clinical commissioning groups, while declines have been seen in less than half, or 44%. It is therefore hardly surprising that the Government seem so unlikely to achieve their ambition of reducing rates to 6% by 2022. In the north-east, we continue to have some of the highest rates of smoking in pregnancy in the country. These are driven by high levels of disadvantage in the region, but, unlike in some regions where rates have even increased, rates in the north-east have fallen in the past five years, from 17% in 2016 to 15% in 2020. Progress has been driven by the regional tobacco programme in the north-east and by the work of NHS England, Public Health England and local government.

The Minister might be interested to hear that a recent analysis by The Times found that areas of the country that were likely to have seen big drops in rates of smoking in pregnancy were also more likely to have implemented financial incentive schemes to support pregnant women to quit. Evidence on the effectiveness of these schemes has been accumulating for many years; they have been shown to increase quit rates when implemented alongside evidence-based quit support. Such incentive schemes are in place in Greater Manchester and South Tyneside. Madam Deputy Speaker, I can see you looking at the clock, so I shall press on.

[Madam Deputy Speaker (Dame Eleanor Laing)]

For the sake of clarification, there are very few people present and the hon. Lady is making important points, so, just for once, I am not putting her under any time pressure.

[Liz Twist]

As you say, Madam Deputy Speaker, this is an important issue.

I return to my point about developing a national strategy for reducing rates of smoking in pregnancy among women and the disadvantaged communities they come from. What does the Minister plan to do to ensure that those reductions are seen and that there is a continued decline in smoking in pregnancy?

Let me turn to smoking and mental health. The last tobacco control plan for England was widely welcomed for including a specific focus on smoking and mental health. With such high rates of smoking in the community and such little progress in reducing rates, this focus was long overdue. Progress has been made since the plan was published, with mental health trusts being set a target: to implement smokefree settings, in line with NICE guidance on smoking, by 2018.

However, despite that, an ASH survey commissioned by Public Health England to look at trust implementation found the following:

“Staff behaviour often enables smoking, with staff accompanying patients on smoking breaks every day in 57% of trusts.

In 55% of trusts, patients were not always asked if they smoked on admission.

Only 47% of trusts offered the choice”

of stop smoking medications

“in line with NICE best practice”.

The impact of covid-19 is likely to have further hindered the implementation of NICE guidance. The Mental Health and Smoking Partnership, a coalition of leading mental health and physical health charities, has raised concerns that some trusts have been rolling back what smokefree policies they had put in place. There are concerns that the Care Quality Commission is not assessing the implementation of NICE guidance on smoking in a consistent way, with trusts receiving conflicting messages on implementation from different parts of the system. Another question I ask the Minister is whether he will ensure that mental health trusts are required to implement NICE guidance PH48 and that the CQC is directed to address this when it carries out inspections.

Action in mental health in-patient settings is only the tip of the iceberg; most smokers with a mental health condition will never have an in-patient stay. The NHS long-term plan has committed to implement a universal smoking cessation service in mental health settings. A promising area for support in the community, and via primary care, is improving access to psychological therapies services, which were established in 2008 with the ambition of scaling up access to talking therapies. About 1 million people with depression and anxiety access IAPT services each year. It is estimated that about 28% of people with depression and anxiety smoke. Quitting smoking has also been found to improve depression, with the same effect as taking antidepressants, so there is a major opportunity to improve both mental and physical health by integrating smoking cessation support into IAPT services. Research by the University of Bristol is under way to explore the integration of support for smokers with these talking therapies, and the early findings are positive. Individual local services, such as Talkworks in Devon, have also started to explore the potential of integration. However, smaller-scale pilots, although important, miss the big opportunity to reach many thousands each year with additional support.

E-cigarettes are a major opportunity to help more smokers to quit, particularly those with high levels of dependency, common among smokers with a mental health condition. E-cigarettes have been shown to help smokers successfully quit at greater rates than traditional nicotine replacement therapies and to be popular quitting aids. Despite the need among smokers with mental health conditions and the potential for e-cigarettes to save many lives, the attitude towards e-cigarettes within mental health services remains varied. Two excellent examples of good practice in mental health trusts can be found in my region, where the Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust and the Tees, Esk and Wear Valleys NHS Foundation Trust both offer e-cigarettes to their patients as a treatment option, alongside the provision of nicotine replacement therapies. Those trusts have shown not only leadership in treating tobacco dependency and implementing national guidance, but real pragmatism on vaping, which could save the lives of many smokers with mental health problems who may not otherwise be able to quit smoking.

Unfortunately, that pragmatism is not found nationwide, and in many trusts the restrictions placed on vaping are not dissimilar to those placed on smoking. Such inconsistency is also seen in staff attitudes towards e-cigarettes. New unpublished data gathered by ASH found that 46% of mental health nurses and 66% of psychiatrists had received no training on e-cigarettes. As a result, many are uncertain about the role of e-cigarettes in supporting smokers in their care. So I reiterate the last of my questions: what steps will the Minister take to ensure that smokers with mental health conditions receive evidence-based advice about switching to vaping? This is an important issue that requires persistence and detailed attention. I look forward to the Minister’s positive responses to these proposals.

Covid-19 Update

Liz Twist Excerpts

Tuesday 20th October 2020 Commons Chamber

[Matt Hancock]

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.

[Liz Twist (Blaydon) (Lab)]

Earlier, the Prime Minister said that he was still talking to the north-east. May I reiterate that, in the north-east, we believe that we should remain in tier 2 and are working hard to that end? What we do need is financial support for the test and trace work already being carried out effectively locally and financial support for our hospitality, leisure and retail sectors, which are taking the strain of current restrictions. Will the Secretary of State now fund the test and trace work being done so effectively locally, and urge the Chancellor to provide a financial support package for our hospitality, leisure and retail sectors within tier 2 to support our economy and local people?

[Matt Hancock]

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.

Covid-19 Update

Liz Twist Excerpts

Programme motion
Monday 19th October 2020 Commons Chamber

[Matt Hancock]

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.

[Liz Twist (Blaydon) (Lab)]

Earlier this year, at the start of the pandemic, the Government committed to give the NHS whatever resources it needed to deal with coronavirus. The NHS has that money for dealing with covid-19, but it will need more to enable it to catch up on all the conditions that need to be treated now that treatment is taking place. Will the Secretary of State commit to provide the funding and resources needed to carry out those vital treatments?

[Matt Hancock]

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.

Public Health

Liz Twist Excerpts

Wednesday 7th October 2020 Commons Chamber

[Liz Twist (Blaydon) (Lab)]

In the brief time available, I would like to follow my hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell) and make several points. This is tough, and it is difficult for many residents to understand the different shades of restrictions and so on. We should not underestimate the effect on those people who cannot see as many people as they used to see, even in the recent past. It is particularly hard on people with relatives in care homes, who are finding it really difficult not to see members of their family.

The seven local authorities in the north of the north-east, if I can put it that way, took a proactive approach to try to counteract the spread, prevent further infection and keep the rate down, but there were asks when they came to Government with that, as well as proposed restrictions to help us manage and come out of further measures in as healthy an economic state as possible. The first ask was to have a test and trace system locally, run by local authorities. There was a call for a localised track and trace service, because our public health teams, our local NHS and our councils know our area and are best placed to follow through on that action, so it is really important that we follow that. Secondly, those local authorities asked for support for businesses most affected, as we have heard—hospitality, retail, leisure, pubs and restaurants, which have all been affected by the 10 pm curfew and, as other hon. Members have said, by the fear of going out. We need extra measures and funding effectively to manage the situation locally and to make sure that we can come out with viable jobs in place.

On Tuesday, I asked the Secretary of State about local test and trace. In his reply, he said that the Government had given £10 million for local track and trace services, but our councils do not appear to have heard about that. Can the Minister confirm that that £10 million has been made available? It is particularly important in the light of the fiasco of the unreported test results last week that we have a really effective test and trace service, so can the Minister confirm that £10 million is there?

Covid-19 Update

Liz Twist Excerpts

Monday 5th October 2020 Commons Chamber

[Matt Hancock]

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.

[Liz Twist (Blaydon) (Lab)]

The local authorities in the north-east have put forward a proposal to be able to provide a test and trace service regionally. After this latest fiasco, will the Secretary of State now agree to pick up that offer of local testing and tracing and fund the local authorities in the north-east to provide this?

[Matt Hancock]

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.