Future of the NHS

Debate between Liz Twist and Alex Cunningham

Thursday 23rd February 2023 Commons Chamber

[Alex Cunningham]

My hon. Friend and I were in a meeting earlier this week with the regional care board, and it told us that, in the north-east, we actually perform a little bit better on elective care. However, it also told us that the growth we can expect in the north of England is going to be much smaller than elsewhere in the country. Does that concern my hon. Friend as it does me?

[Liz Twist]

That certainly concerns me and, yes, my hon. Friend is absolutely right to say that. Actually, I would say that in the north-east we have really good and positive acute services, which are the ones he is talking about, thanks to the hard work of so many people, but what we lack is the preventive work and the work to avoid people becoming ill in the first place. We have the lower life expectancy and the health inequalities that my hon. Friend the Member for Jarrow talked about, so it is important to our people that we do that.

I was interested to hear the comments of the right hon. Member for West Suffolk on health inequalities. He is right to identify them, but what the Government have done is reduce the amount available to public health to address those issues before they develop. It is great that we have good hospitals and good-quality services, although they are really under pressure, but unless we address those public health issues and fund public health services, we are not going to tackle some of those issues.

The other aspect of that is social care. Once again, the Government have failed to tackle social care, and we know that one of the key things in tackling social care is getting people discharged from hospital, and getting them and supporting them to be independent at home. However, we really need a plan and to think some more about this. It may be a different Department—[Interruption.] No, it is the same Department now—sorry; my mistake—but we need to tackle that issue if we are going to make real progress.

I want to talk a little about mental health services. Many Members will know that I chair the all-party parliamentary group on suicide and self-harm prevention. We see the impact of a whole range of different policies, and the inability to access services. Too many mental health patients are forced to seek mental health treatment through emergency or crisis services. One in 10 ends up in A&E. We need to ensure adequate access to mental health services for both children and adults facing mental health crises.

Smokefree 2030

Debate between Liz Twist and Alex Cunningham

Thursday 3rd November 2022 Commons Chamber

[Liz Twist]

My hon. Friend is speaking powerfully about the experience in the north-east and nationally. He will be aware that, between 2007 and 2019, when the Government led the way in introducing tough new regulations, our smoking rates declined far faster than in the rest of Europe and most of the world, but that has dropped off, so we need to take further action. Is he aware of this recent research into smoking habits? University College London’s smoking toolkit study has surveyed smokers’ behaviour monthly since 2006. After years of steady decline in adult smoking—the proportion went from 24.1% in 2006, as he said, to 14.8% in 2020—smoking rates have stagnated, standing at 14.9% as we reach the end of 2022. Worse still, although the uptake of smoking among young adults declined year on year from 2007, that started rising again after 2019.

[Alex Cunningham]

I am grateful to my hon. Friend; I was not aware of some of the research to which she referred. However, the reduction in smoking has plateaued in recent times, and that is lamentable. I have a big enough heart to say that the Conservative Government have done much over the years to reduce smoking, building on much of what the Labour Government did between 1997 and 2010, but we cannot allow ourselves to stop there. We need to do so much more.

There are often arguments—many of which are put forward by front organisations funded by the tobacco industry—that further smoking regulation would be the “nail in the coffin” for small businesses, but that is not so. As the hon. Member for Harrow East mentioned, a recent survey commissioned by Action on Smoking and Health found that small tobacco retailers in the UK support further measures to reduce the harm of tobacco, including increasing the age of sale from 18 to 21, mandating a licence to sell tobacco and requiring tobacco companies to pay for services to help smokers to quit. John McClurey, a retired local retailer from Newcastle said, “Tobacco is a burden” to small businesses. The Government could help to lift that burden and charge the tobacco companies to do so.

In my last speech on smoking in Westminster Hall, I again stressed the need for a levy on the tobacco companies, but Ministers were reluctant. The new Minister will want to take action in this space. As we all know, cash will be tight and the Budget in two weeks’ time will be difficult, so he can earn himself brownie points by requiring the industry that makes billions in profits while killing our people to pay up instead. It needs to pay, because more than 4,000 people died prematurely from smoking in the north-east alone last year, with 30 times as many suffering disease and disability caused by smoking.

Going hand in hand with the personal suffering caused by smoking is the economic cost to our already disadvantaged communities. In their election manifesto, the Government claimed:

“We are committed to reducing health inequality.”

Why, then, are there such pronounced inequalities? In the north-east, 42% of smoking households are in poverty and tobacco spending accounts for a higher share of gross disposable household income per head than in any other UK region or nation. Please do not give me the argument that if people are poor, they should give up their fags. Smoking is an addiction and they need help to quit. Ending smoking in such communities would not just benefit the health and wellbeing of individuals but inject money into local economies that was previously going up in smoke.

The Minister will know that, at the current rate of decline, poorer communities risk being left behind as we move towards the hoped-for smokefree 2030. It will not happen in the communities to which I have referred without robust action. Most of the quitting has been done by people from better-off communities, and the benefits have largely accrued to those communities. In 2019, fewer than one in 10 professional and managerial workers smoked—well on the way to the smoke-free target of less than 5%—compared with nearly one in four workers in routine and manual occupations.

Half the difference in life expectancy between rich and poor is due to smoking, which means that the scope for reducing health inequalities related to social position is limited, unless the many smokers in lower social positions can succeed in stopping smoking. Smoking is linked to almost every indicator of disadvantage. Those overlap different communities, so smokers in routine and manual occupations, or who are unemployed, are also more likely to be living in social housing and to be diagnosed with mental health conditions.

There is a clear need for a new tobacco control plan that targets investment and enhanced support at disadvantaged smokers, wherever they are. As long as smoking remains the norm in some communities, not only will it be harder for smokers to quit, but smoking will continue to be transmitted from one generation to the next. The evidence shows that most people who smoke started as children. Prevention is key, so what will the Government do to reduce the appeal of cigarettes?

[Liz Twist]

Does my hon. Friend agree that raising the age of sale, as the APPG proposes, would reduce youth uptake? According to the UCL modelling that I spoke about, it would reduce smoking among 18 to 20-year-olds by a third. It would narrow the inequalities in uptake: as my hon. Friend has powerfully explained, children from more disadvantaged backgrounds are more likely to take up smoking.

[Alex Cunningham]

I have no doubt that everything my hon. Friend says is totally on the money. We can take action, and it need not cost the Government a fortune either. My hon. Friend raises the issue of age. Some parts of the UK have a Check 25 policy—would it not be wonderful if we could introduce such a check on the sales of cigarettes? It might help to put an end to smoking among younger people.

High smoking rates among people with mental health conditions are a leading cause of premature death and disease. Smoking accounts for two thirds of the reduction in life expectancy for people with a serious mental illness. The smoking rate among people with serious mental illnesses is more than three times that of the general population. The rate among people with depression and anxiety is just under twice that of the general population, but they account for 1.6 million smokers. There is now good evidence that smoking exacerbates levels of poor mental health, whereas stopping smoking contributes to improvements in mental health. Tobacco remains the biggest cause of cancer and death in the UK, so Cancer Research would like to see the ambition to make England smoke free by 2030 implemented. I ask the Minister whether we can expect to see that ambition realised.

I would like to say a little about “The Alternative Smoke-Free 2030 Plan” published by the Institute of Economic Affairs, which the hon. Member for Harrow East has also received. After the disastrous free-market policies promoted by the IEA and adopted by the last Prime Minister and Chancellor, I find it hard to believe that any current Minister would give any credence to the IEA’s recommendations on anything. However, the hon. Member makes an important point: as a party to the World Health Organisation framework convention on tobacco control, the Government and all public authorities are required to protect

“their public health policies…from commercial and other vested interests of the tobacco industry”.

If the Minister is in any doubt about the role played by the IEA, he should take note of the leaked documents that show that during the passage of the tobacco products directive, Philip Morris International described the IEA as a “media messenger” on its behalf, able to assist in “policy outreach” to “pro-actively relay our positions”, while British American Tobacco described it as a “vehicle for delivery” of its UK reputation initiatives. I would like the Minister to restate for the record, on the Floor of the House, the Government’s commitment to complying with paragraph 3 of article 5 of the convention and to preventing tobacco industry-funded organisations from influencing tobacco control policy.

The arguments for bringing tobacco regulation forward are multifaceted and can no longer be ignored. As a member of the APPG, I look forward to working with a new Minister who can do the maths to realise the cash value of a tobacco control plan, especially if we make the polluters pay, and—better still—who can help us to ensure that we have healthier people in all our communities.

Judicial Review and Courts Bill (Sixth sitting)

Debate between Liz Twist and Alex Cunningham

Committee stage
Tuesday 9th November 2021 Public Bill Committees

[Liz Twist (Blaydon) (Lab)]

rose—

[Alex Cunningham]

rose—

[James Cartlidge]

Hang on, there were simultaneous interventions. I will give way to the hon. Member for Blaydon.

Working People’s Finances: Government Policy

Debate between Liz Twist and Alex Cunningham

Tuesday 21st September 2021 Commons Chamber

[Liz Twist]

I absolutely agree about the need for additional council housing.

The rise in national insurance will disproportionately affect younger people and those on low incomes. It is absolutely right that we need more money for the NHS and social care after years and years of cuts, but it cannot be right that it is the lowest-paid earners who pay for it. The Government’s plan will not end the crisis in social care or help to fix the backlog in the NHS.

[Alex Cunningham]

The hon. Member for Aberdeen North (Kirsty Blackman) talked about the Conservatives not really understanding the plight of people living on universal credit. Does my hon. Friend agree with me that it might be a good idea for some of them to spend a month living on the income of a person on universal credit? Not just that, however. Let us load them with a debt of £10,000 and say that they have to pay off some of that debt out of their income as well, and maybe they might understand a little bit more.

[Liz Twist]

I would not like to load anyone with debt, frankly, but I do wish that people would understand what it is like to live on universal credit, and not just for a week or a month, with no recourse to a cash pot in the bank on which they can draw if they run out of money. Many of us will not understand that, but it came home to me very clearly when I became a councillor and an MP just how much on the breadline some people are, with no access to credit cards or other finance. It is a really difficult life for people.

I was talking about social care. As I said, the Government’s plan will not end the crisis in social care or help to fix the backlog in the NHS. It will take money from those already struggling financially, without fixing the problems. What my constituents want to know, when we talk about social care, is what services they will be able to access. We have talked about money and the need to address that, and we have talked about caps. What we have not talked about is what the Government’s social care plan means for those of my constituents who actually receive social care, with people coming in to look after them. Will they receive a better service? Will the staff, many of whom will be caught by the universal credit cap, see decent pay and conditions, and recognition for the really important work they do? We are missing a huge piece of the jigsaw and the Government need to address that. Labour has said that there are many other ways to raise the money, including taxing the incomes of landlords, and of those who buy and sell large quantities of financial assets, stocks and shares. Labour has been clear that we want those with the broadest shoulders to carry the burden.

I want to talk a little bit about the excluded, because so many of my constituents during the pandemic, including the self-employed, have found themselves facing real problems. They were excluded from any schemes that the Government brought forward and in many cases they were excluded from universal credit because of money that they might have put away for tax, or small amounts of money. Lots of single people running dance schools or hairdressers or working from home have found it hard to get through. It is really important that we recognise the pandemic’s impact on them. I know from Zoom calls with my constituents—people who own beauty salons, people who were creative—how much they have been affected. They really have suffered.

Lastly, I pay tribute to Gateshead food bank, Gateshead Council and the many other local organisations that have picked up a lot of the slack. They are doing a great job, but for goodness’ sake, it should not be necessary in this day and age.

Social Care

Debate between Liz Twist and Alex Cunningham

Tuesday 25th February 2020 Commons Chamber

[Liz Twist (Blaydon) (Lab)]

As I was preparing for this debate, I looked at last year’s debate and, as other hon. Members have said, it was like we have not moved on at all. We are repeating the same arguments, and nothing has really changed. What has changed, however, is that we are seeing increased demand for social care, whether domiciliary or residential, but local authorities’ ability to deliver that support is decreasing because of financial pressures.

Demand is continuing to rise. Age UK says that 1.5 million people aged 65 or over have an unmet social care need and believes that that could rise to 2.1 million by 2030 if the current approach continues. Last year, over half of the 1.32 million new requests for social care resulted in no services being provided. In my constituency, Age UK tells me that 3,012 older people have unmet care needs, and that 2,517 older people are providing the care that family members require. Of course, we must also recognise that thousands of unpaid care workers are providing support to people in their homes, and we must never forget that. I salute them for carrying out that essential work.

I will reiterate some of the points covered in the previous debate, because they remain central to this debate on social care. We need more money. We do not need the drip feed of a 2% increase in council tax, which in constituencies with a low council tax base, such as mine, will not produce anything near the money we need, compounding inequality and injustice. We need a substantial increase, and Age UK estimates that an increase of £8 billion is required over the next two years to stabilise the current system while we look at what will be provided in the future.

We need to look at the market for social care providers. The market is fragmented at the moment in both residential and domiciliary care, and most authorities have seen providers fail in both areas, meaning that they need to step in as an emergency measure to ensure that people get the help they need. We cannot continue with a market based substantially on price competition, because local authorities are forced to look for the lowest bids. We need quality services that deliver the things that people require and deserve. I would like to see more directly provided social care services, because that gives us control.

We must now develop a workforce strategy for social care. We have talked about that a lot in relation to the NHS plan and the future workforce strategy, but we need to look at it here, too. The social care workforce is predominantly female. They provide the most personal and intimate care to the people we love, and we must recognise the value of their work. They need proper pay. They need professional registration, which people working in the sector are considering. They need improved training and development if we are to recruit and retain the staff we need. We must put an end to carers travelling in their own time, to zero-hours contracts, and to 15-minute visits, which all of us would agree are completely outrageous.

[Alex Cunningham]

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?

[Liz Twist]

I certainly agree that we must recognise the work of young carers, who do a tremendous job. We place huge pressure on them, and we thank them for their work. We must look after them, too.

We need a workforce strategy, and there is much more I could say. Others have already touched on the high cost of care for those with dementia, as opposed to a physical illness, and we need to do something in both the short term and the long term. We need a long-term, thought-through plan for providing social care to all those who need it.

We need a plan for social care that supports people when they need it and that cares for people when they need it. It should not just look after them mechanically; it should care for them. The Prime Minister said during the election that he has a plan. Well, let us see it and debate it, because we all know this action is long overdue.

Industrial Strategy: North-East of England

Debate between Liz Twist and Alex Cunningham

Wednesday 5th June 2019 Westminster Hall

[Liz Twist (Blaydon) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Betts. I thank my hon. Friend the Member for North Tyneside (Mary Glindon) for securing this important debate. It is really apposite that we are having this debate now, as later this month the North East LEP will publish its evidence base, which will contribute to developing our north-east industrial strategy.

As hon. Members have said, we have some difficulties in the north-east. Like others, I am hugely proud of our communities, businesses and places in the north-east. They have real strength, real history and real power, and I want to see us build on that. We need to recognise the issues we face, if we are to have any chance of addressing those difficulties. In my constituency, we have both industrial and retail sites, which I will come to later. We have the Metrocentre, which is still the largest indoor shopping centre in the UK. We also have the long-established Team Valley trading estate, which houses over 700 businesses. Not all of it is in my constituency of Blaydon—some of it is in the Gateshead constituency—but a significant part is. It is really important that we keep our links with the people trading on the estate; they are an important part of our local economy.

As I have said, we need to recognise the issues that we face, if we are to address them. We need to ensure that the north-east can grow and develop its economy, creating more and better jobs. Sadly, unemployment in the region is still 5.4%, compared with 3.8% across the UK, and many of the jobs that have been created are part time and low paid and do not represent the best jobs that we could have for our communities. That is where the industrial strategy is important. It must reflect our current strengths and also grow new sectors. We have heard about the digital sector, and there is also a growing video game sector in Gateshead that we need to develop. Any industrial strategy must consider those new sectors and present new opportunities.

I want to touch on a few of the things that should go into the strategy. The first is infrastructure, which hon. Members have mentioned. Connectivity is a real issue in the north, especially in the north-east. It needs to be addressed if we are to have a positive industrial future. We know that Transport for the North, which covers the whole of the north rather than just the north-east, has submitted a request for industrial funding under the “Rail for the north” strategy. That is a £39 billion development proposal. Many of us in the north-east want to see much more of that rail development in the region, and we will continue to argue for that. We certainly must address that infrastructure issue, and the others that hon. Members have mentioned, if we are to have a positive future industrial strategy.

The issue of European funding was mentioned by my hon. Friend the Member for Sedgefield (Phil Wilson) and others. As we have heard, the north-east is the only region that is a net exporter. We have heard that it will be hit hard by Brexit, especially a no-deal Brexit—there would be an estimated 16% fall in GDP growth. It is important to ensure that we have the right conditions and the right deal for the north-east if we are to avoid real problems.

Hon. Members have already referred to the shared prosperity fund. The north-east currently benefits from EU structural investment funds that are designed to address regional imbalances, receiving £437 million between 2014 and 2020. It is vital that businesses know the size and the terms of the shared prosperity fund as soon as possible. It has been kicked down the road in the years since the initial announcement was made. It is absolutely vital that our businesses know what is coming so they can plan accordingly.

Let me touch on education and skills. As we have heard, the north-east has some excellent universities and further education colleges, including Gateshead College—the outstanding and high-performing college—yet employers still struggle to find workers with the right skills, so we need action to close the skills gap and identify our future skills needs. We must address that in the strategy, and local input—the local power to have a say on skills—is really important when we do that.

The retail sector provides nearly a quarter of the jobs in my constituency. We know that the retail sector, high streets and shopping malls are going through a tough time, so we need a retail strategy. That is one of the weaknesses of the Government’s national industrial strategy. We need a greater emphasis on retail, because it is such a significant part of our economy. We need a proper strategy to deal with the problems on the high street. The Government need look no further than the excellent report on the future of the high street that the Housing, Communities and Local Government Committee produced earlier this year. We must also address the wider problems in retail and issues relating to pay, skills and retail sector workers’ personal development and training, so that they are able to develop, enhance their skills, improve the services they provide and add value to the sector.

[Alex Cunningham]

I congratulate the Select Committee on its excellent report. It visited my constituency to see Stockton high street. Will my hon. Friend join me in congratulating the local authority, which is bringing international athletics to the area? International athletes will be running down the widest high street in England, bringing people into our town centre and boosting our local businesses.

[Liz Twist]

I am very happy to congratulate Stockton on those innovations—while of course mentioning that Gateshead, which is not to be outdone, has a strong record in international athletics.

The north-east has a rich and proud industrial history, but we need support. Positive steps must be taken to put in place infrastructure. We must recognise and address the particular issues that we face in the north-east.

School Funding

Debate between Liz Twist and Alex Cunningham

Monday 4th March 2019 Westminster Hall

[Liz Twist]

I will repeat the point a third time that the petitioners have been clear with me that their concern is that all schools are properly funded, wherever they are, so I will not enter into those discussions.

[Alex Cunningham (Stockton North) (Lab)]

My hon. Friend will share my concern about children in areas of high deprivation. They are already well behind the curve in terms of development; they were disadvantaged the day they were born. The education system can actually drag them out of poverty, but does she agree that this Government policy ensures that they are left in poverty?

[Liz Twist]

Yes, clearly the lack of resources in schools and the loss of jobs mean that attention cannot be given to important issues, which is a real detriment to the people affected.

The second part of my speech is about what these figures mean for our schools: for the staff, the governors, the parents, but most of all, for the pupils in each and every school. I am sure that other Members will indulge me if I talk about the schools in my constituency; I have no doubt that many of them will wish to share experiences from their own schools.

Last Friday, I visited Portobello Primary School in Birtley. During my visit, the headteacher and governors of this great community school told me about their concerns about funding pressures. In the last year, they have lost four valuable members of staff to redundancy: a higher level teaching assistant with 20 years’ experience in early years education; an experienced teacher who led on the arts curriculum; a highly skilled teaching assistant who was trained in supporting children with medical and educational needs; and a dedicated school counsellor, who supported young children with their mental health.

NHS Wholly Owned Subsidiary Companies

Debate between Liz Twist and Alex Cunningham

Tuesday 6th March 2018 Westminster Hall

[Liz Twist]

I most certainly do agree, not just for pensions but also for terms and conditions.

What is the problem with these companies? First, it is that they come at a price, which for the most part is met by the staff who work for them. Secondly, the VAT saved by trusts with these companies is not new money coming into the NHS—the money that trusts save will be lost elsewhere in public services. Already, the Department of Health and Social Care has reminded trusts by letter that they should not engage in any activities that may be construed as tax avoidance, and the loophole could be closed in the future. Thirdly, the establishment of wholly owned subsidiaries leaves the services open to privatisation in the future, continuing the fragmentation of our NHS.

[Alex Cunningham (Stockton North) (Lab)]

The North Tees and Hartlepool NHS trust set up a limited liability partnership last week. Even according to its own published material, it provides no guarantee of job protection beyond a few months and will create a situation with different employees on very different terms and conditions. Is this not all about Government cuts? Does my hon. Friend not agree that we could see even more staff transferred into this sort of arrangement in order to meet the Government’s cuts agenda?

[Liz Twist]

I most certainly do agree. I think this is the start of a very worrying process, not just for facilities management stuff but potentially for other staff.

--- Later in debate ---

[Liz Twist]

I very much agree. It is a very dangerous precedent that does not respect the rights of those staff.

[Alex Cunningham]

Further to that point, is my hon. Friend aware that the question and answer document produced by the North Tees and Hartlepool NHS Foundation Trust says that NHS staff transferred into the new company can expect a pay rise this year, but nothing is guaranteed in the future? They are already seeing their future conditions eroded, unless the new company awards them the pay rise they will get under the current system.

[Liz Twist]

That is absolutely correct, and I have raised with my local trust the potential move away from NHS pay rises.

The main way trusts can make savings is by employing the new staff on worse terms and conditions, which means lower pay rates, less holiday, inferior sickness schemes and no access to the NHS pension scheme. As colleagues said, even transferred staff may be moved on to the worse terms and conditions over time. Trusts are doing that to the lowest-paid workers, who are essential to keeping our hospitals going.