Cass Review

Lloyd Russell-Moyle Excerpts

Monday 15th April 2024 Commons Chamber

[Victoria Atkins]

This report sets out the evidence, which was not there before. It has taken four long years of very hard work to gather that evidence, and I hope and expect that the health sector will implement these recommendations. I also hope we can have a conversation about our wider public space, and I was very pleased to read the article by my right hon. Friend the Minister for Women and Equalities over the weekend. We have to de-politicise the public space and ensure that this evidence is applied across the board for the health of all our constituents and our country.

[Lloyd Russell-Moyle (Brighton, Kemptown) (Lab/Co-op)]

I welcome any research, and this report moves the debate forward. My reading is that Cass says there is a toxic debate on all sides, and that there are particularly nasty and vicious people on all sides. I have had posters put outside my house with rude words on them, etc, and it has happened on all sides. That is what Cass says—that it is unhelpful.

Cass says there seems to be little evidence that large numbers of people feel either regret or success, that there is poor evidence of effectiveness, and that there needs to be more evidence on the usefulness of social transition. I read it as saying that there needs to be an awful lot more evidence, but Cass is clear that young people should not be denied access to healthcare if they are trans; in fact, they should have more healthcare and more pathways. Will the Minister agree to fund that research? We should not get evidence from just adult services. We need proper longitudinal studies that mean we have an evidence base. Will the Government support a Cass-compliant amendment to my Conversion Practices (Prohibition) Bill that I believe can square this circle?

[Victoria Atkins]

I am sorry, but I think there is a certain amount of disbelief in the Chamber. I cannot be the only one who remembers the debate on the Gender Recognition Reform (Scotland) Bill in January 2023 when the hon. Gentleman not only tried to shout down female Opposition colleagues but felt so exercised that he crossed the Floor of the House to sit next to my hon. Friend the Member for Penistone and Stocksbridge (Miriam Cates). I remember how Conservative Members were genuinely surprised that a Member of Parliament would think it appropriate to behave in that way when debating a subject that we are entitled to, and should feel free to, debate. I am sorry to hear that the hon. Gentleman suffered the abuse that he describes, but setting a good example starts at home. I hope he will never again behave as he did in the Chamber that day, because that is how we sort out the toxicity of this debate.

NHS Dentistry

Lloyd Russell-Moyle Excerpts

Tuesday 9th January 2024 Commons Chamber

[Wes Streeting]

I totally agree, and I do not think we should be complacent about this as a country. The NHS is already becoming a two-tier healthcare system, where those who can afford to go private are paying and the rest are left with an increasingly poor service for poor people. Government Members protest now, but they admit their goals once they leave the Department for Health and Social Care. The Health Secretary’s predecessors may not have said it when they were in her place at the Dispatch Box, but, as soon as they were out the door of the Department, the right hon. Members for West Suffolk (Matt Hancock) and for Bromsgrove (Sir Sajid Javid) said what they really believe: patients should be charged for GP appointments. Well, why stop there with this Conservative philosophy? Why not go further? That is the future for the health service if the Conservative party is given another five years. That is the risk facing patients across the country, and that is the choice facing voters at the next general election: further neglect, mismanagement and decline under the Conservatives or change with Labour and a decade of national renewal.

On NHS dentistry, the need for change could not be clearer. By the Conservative party’s own admission, it does not have a plan—just the vague promise of one coming in the future. All it does have is a record of 14 years of failure. If we stick to the current path, full universal access to NHS dentistry may be gone for good. The Conservatives may be happy to wave goodbye to this vital public service, but that is not the Labour way. With Labour, there is a clear plan, with immediate steps to tackle the crisis and long-term reform to rebuild dentistry. There will be more appointments, more dentists, more support for children and long-term reform to put the service on a sustainable footing, paid for by abolishing the non-dom tax status. That is because Labour believes that people who live and work in Britain should pay their taxes here, too. It does not matter whether they live on Downing Street or any other street: if they make their money here in Britain, they should pay their taxes here, too.

[Lloyd Russell-Moyle (Brighton, Kemptown) (Lab/Co-op)]

My hon. Friend is making an excellent speech. Abby Lane, in my constituency, has contacted over 30 dental practices. Not one is accepting her and her one-year-old child, who desperately needs dental treatment. Is it not the case that we now need to reform the system so that local commissioners can ensure that dental commissioning is happening in local areas where there is need, and not just have this patchwork system where dentists are fleeing because it is not paying well enough?

[Wes Streeting]

I totally agree. The tragedy is that if we look at the system as a whole and think about the pressure the whole system is under, and if we got NHS dentistry right, we would not only be saving patients untold pain, but saving the NHS money. As Lucy Rigby, Labour’s candidate in Northampton North, reported to me, in 2022 tooth decay forced 625 of her local patients to A&E—worse for them and more expensive for the taxpayer.

If Tory Members disagree with charging non-doms their fair share, maybe they could explain in their own contributions why they disagree. I am sure that their constituents would love to hear their defence of the non-doms, and we would be happy to give them space on Labour leaflets to quote their arguments back at them and let the public decide. I would particularly like to know why the Prime Minister is so wedded to this tax break for the wealthiest.

While Tory Members are set to oppose Labour’s rescue motion today, I understand that our plan on supervised toothbrushing for three to five-year-olds has received an endorsement from an unlikely source. On his podcast, former Conservative Chancellor George Osborne said:

“That really is the nanny-state in action.”

Coming from the Chancellor who introduced a sugar tax, I am sure George meant that as a compliment. Of course, Conservative Members may not see it the same way, just as they do not agree with Labour’s proposal to phase out smoking for children. Don’t worry, we have the Prime Minister’s back on that one; it is, after all, our proposal. But I ask those who attack our plan as nanny-state, what is the alternative? If a child cannot see a dentist and their parents will not do the responsible thing and make sure they clean their teeth, then should we just shrug our shoulders and do nothing while children’s teeth rot?

The problem for the small-statists on the Conservative Benches is this. Too many children today are not cleaning their teeth. Their teeth are rotting and they end up having them pulled out in hospital, which is worse for them and more expensive for the taxpayer. Last year, the NHS spent £80 million on tooth extraction. Toothbrushing in schools would cost a fraction of that, yet the Conservatives choose to waste taxpayers’ money, burning through taxpayers’ cash on the altar of ideological dogma and putting children through unnecessary misery, because it fits their confused ideology.

That is the irony of the Conservative party. Tories say that they believe in a small state and low taxes, yet they have left our country with the highest tax burden since the 1950s. The NHS receives £169 billion a year, yet it is going through the biggest crisis in its history. Because they do not understand that prevention is better than cure. Because they have refused to undertake meaningful reform. Because they treat taxpayers’ money with utter carelessness and contempt. And so they have left us with an NHS that gets to people too late, delivering worse care for patients at greater cost to the taxpayer. We are paying more and getting less. That is Tory Britain. No wonder Tory candidates are so worried.

Before this debate, I happened on a letter on Facebook from the hon. Member for Darlington (Peter Gibson) who is, happily, in his place. First he talks about the state of dentistry in his constituency—we obviously agree with him there—and then he says:

“I was shocked to learn at the end of last year that little to no progress has been made by the Health Board in our region who are responsible for commissioning this service to you.”

Let us assume it was in anticipation of Labour’s motion, which he is going to vote against because the Whip has been cracked. He goes on to say:

“I have today written to the Chief Executive following on from the meetings I had last year, and will be raising this issue in today’s dentistry debate in the House of Commons.”

What that is, and what voters will see it for, is just one of what will no doubt be countless examples of Tory MPs and Tory Ministers, after 14 years of their failure and mismanagement, pointing the finger of blame at someone else, hoping that voters in Darlington and elsewhere will blame local NHS managers and local NHS commissioners for 14 years of failure. If it is really the case that his integrated care board is to blame for why people in Darlington cannot get a dentist, why are people struggling in Newcastle-under-Lyme? Why are they struggling in Northampton North? Why are they struggling in Shipley? Why are they struggling in Filton and Bradley Stoke? Why are they struggling in Worthing West, Stroud, Stevenage, Great Yarmouth, Truro and Falmouth, Blackpool South, Stockton South and every other constituency in the country? Stop blaming other people for your Government’s failures.

--- Later in debate ---

[Lloyd Russell-Moyle (Brighton, Kemptown) (Lab/Co-op)]

In my constituency, 11 dentists have updated their data. Seven are not accepting adults and nine are not accepting anyone, but the reality is that if I phoned around, I would find that none of them on that list are accepting people.

The situation is so bad in Sussex that the ICB has taken matters into its own hands, ignoring the NHS portal, which it says does not work, and producing a list every month of dentists that will do drop-ins. For the whole of Sussex, we have two in Hastings—hopefully soon to be Labour, with our fantastic candidate Helena there—two in Hove and one in Brighton Pavilion. There are none in Worthing—Worthing West and East Worthing and Shoreham are hopefully soon to get Labour MPs —or in Crawley, Bexhill and Battle, Lewes, Eastbourne, Mid Sussex or Chichester, all of which are marginal constituencies in the next election. I would have thought the Government would be more on it to ensure that constituencies that they are about to lose have dentists that patients can see, but they are not.

The ICB says that it cannot find dentists to volunteer—that is what they do. All the ICB can do is beg and plead with dentists to voluntarily take extra patients, because the contracts do not work. Also, many dentists say that they cannot update the online system because other dentists do not update it, so if they do, they are flooded and all their places get taken. So dentists do not update the system properly. When asked why they do not, they also say that the system does not provide enough granularity. They can say whether they accept children and adults—yes or no—but they cannot say whether they take local people or prioritise other requirements.

Dentists prefer to operate a system in which patients have to ring around. That is no good for my constituent Carolynn Bain, who rang around all the lists in Worthing and Eastbourne, and in the end had to go to London for her dental treatment. She was told that dentists do not want to update the system because they are afraid of the effect. When I have asked the CCB—sorry, the ICB; they change the names of these darned things so often that no one can remember—it says that that inhibits the information to constituents. We need a system, like we have for doctors, of proper planning in catchment areas. We need the ICB to be able to say, “This is the population in this area. This is what is needed.” Just like with doctors, patients should be able to choose dentists out of area or dentists they have a connection with, perhaps because they work in an area but do not live there. There needs to be proper planning, and there is none at the moment. That is why Labour’s plans for more urgent appointments and better and more NHS training are welcome.

I hope the Government will also look at dental schools. At the moment there is no dental school in Sussex, Hampshire, Surrey or Kent—none in the south-east. There are London dental schools. That makes a huge difference to the ability to train and recruit dentists, because many will end up staying in the area in which they have trained. I urge the Minister to look at establishing a new dental school in the south-east—we would love to have it in Brighton, but Hastings is also a good option. Our Hastings candidate will be pushing very hard for that. After the closure of the University of Brighton in Hastings, there is a need for a new university or medical school there, and that would be very welcome.

We have heard a lot of pledges from the Government to increase the number of dental hygienists, but this is a huge smokescreen. Under the NHS, patients can only access a dental hygienist if they have been referred by a dentist. If they go private, they can pay to go directly. Actually, we should encourage people to go to directly to dental hygienists once a year, and once a year to a dentist. There is no need for a six-monthly check-up with a dentist if a patient also goes to a hygienist. But at the moment, patients cannot go to a hygienist unless they are referred as a tier 2 form of treatment, so they cannot do it on the initial check-up. That needs to change to make dental hygienists relevant; otherwise, the Government are talking about recruiting into the private sector a load of dental hygienists no NHS patient will be able to see.

The same goes for the list system. It is absolute madness that if a patient has not seen a dentist for six months or a year, they can be thrown off the dentist’s list. That would never happen with a doctor. We need to change the funding model so that dentists are encouraged to keep patients on their list if they have not seen them. They should get a bonus for seeing them, and some reward for preventive treatment. That preventive treatment might not always involve seeing a patient, but may involve educational resources or sending them to a hygienist, with the hygienist reporting that no further action is needed.

All those things could be done. The start of an education and preventive approach should be in our schools. That is why Labour is pledging to take action. That is why this country has been so let down by the Government.

Oral Answers to Questions

Lloyd Russell-Moyle Excerpts

Tuesday 5th December 2023 Commons Chamber

[Madam Deputy Speaker (Dame Eleanor Laing)]

We will have to go a bit faster.

[Lloyd Russell-Moyle (Brighton, Kemptown) (Lab/Co-op)]

11. What steps she is taking to improve access to mental health services.

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

We are improving mental health services, transforming them with an extra £2.3 billion a year. We have already seen some improvements in the delivery of those changes from giving mental health services parity of esteem with physical services.

[Lloyd Russell-Moyle]

The Minister will know, because it covers her constituency as well, that the Sussex Partnership NHS Foundation Trust does vital work in mental health, but there simply is not the resource, and I am afraid that parroting about parity of esteem does not tackle the issues. Wait times are 190 days for children and young people in her constituency and mine. I recently spoke to a mother in Peacehaven whose son is waiting for an attention deficit hyperactivity disorder diagnosis. His performance at school is in rapid decline, but because of the wait times he is not eligible for support in school via any education, health and care plan to start to turn things around. What assurances can the Minister give my constituents, and indeed her constituents, that the wait times for mental health will come down and that resources will be given to these partnerships, rather than just empty words?

[Maria Caulfield]

The hon. Member is absolutely right: we know that in Sussex we have higher rates of mental health illness than in many other parts of the country, with a 15% increase in Sussex A&E attendances. He might not be aware of them, but multiple schemes are available in Sussex. Health in Mind is offering psychological support to those suffering stress and anxiety, which can be self-referred. We have the Sussex mental health crisis line, now open 24/7, which is accessed via the 111 service. We have mental health professionals rolling out the blue light triage service in Sussex, and we have the Brighton and Hove mental health rapid response service, open 24/7, to which anyone can refer themselves urgently. Perhaps if he looks at some of the services provided locally, he will be able to reassure his constituents.

HIV Action Plan Annual Update 2022-23

Lloyd Russell-Moyle Excerpts

Tuesday 18th July 2023 Westminster Hall

[Nicola Richards]

I thank my hon. Friend for his intervention. I know that opt-out testing is already making improvements and that that will benefit his constituents in Blackpool. We have the blueprint for how to do this; we just need to roll it out further.

The numbers do not lie. The annual update revealed that more than 2,000 people have been diagnosed with HIV, hepatitis B and hepatitis C in 12 months alone. It is very likely that without opt-out testing many of these people would not have been diagnosed until a much later stage. That includes diagnoses in parts of London classed as having a “high” rather than a “very high” prevalence of HIV. Let us imagine what can be achieved if we now extend the roll-out to areas of high HIV prevalence, such as in my constituency of West Bromwich East.

The west midlands have several high-prevalence areas outside Sandwell, including Wolverhampton, Coventry and Birmingham. That is why, for World AIDS Day last year, West Midlands Mayor Andy Street joined the calls to fund this scheme in the west midlands. The way to end this virus is to find exactly these people—those who are unaware that they are carrying the disease but who are in fact passing it on to others—so that they can get the care they need and do not increase transmission further.

Opt-out testing in London, Blackpool, Brighton and Manchester has also revealed a quiet but growing crisis by identifying people who have previously been diagnosed with HIV but are not receiving the treatment they need. The UK Health Security Agency estimates the number of people who have fallen out of the HIV care system since 2015 to be an alarming 22,670. The Terrence Higgins Trust, which I take this opportunity to thank for all its excellent work, estimates the number of those who are alive and remain living in the UK as somewhere between 10,650 and 13,006. They are all at risk of becoming seriously ill and further transmitting the virus. In fact, hospitals in London are reporting that this has overtaken undiagnosed HIV as the primary cause of HIV-related hospital admissions.

This is totally preventable. Once someone living with HIV is on effective treatment, they can live a long, healthy life and do not pass on the virus. The annual update shows that more than a third of those found with HIV by opt-out testing were previously lost to care. That is another 473 people who can access treatment, prevent further serious illness and help to stop the spread of HIV. This is an important step forward, but we should not only be finding people when they need emergency care; we should be supporting them to stay in care in the first place. Without finding and providing treatment to those people, we cannot realise our ambition of ending new cases by 2030.

Opt-out testing is helping not only to save lives, but to save money in our health system. The initial investment to set up opt-out testing is dwarfed by the amount saved by providing treatment earlier and preventing serious illness. There is a huge saving to be made, and it is truly making a difference to health outcomes in the places in the country that already have opt-out testing.

[Dame Caroline Dinenage in the Chair]

Furthermore, the Elton John AIDS Foundation has done fantastic work with hospitals in south London on a pilot scheme that can inform a national programme to re-engage people who have been diagnosed with HIV but who are lost to care. Clearly, finding and restarting treatment for those lost to care is an urgent consideration and, at a cost of £3,000 per person, it would be significantly cheaper than providing emergency care if their condition worsened.

[Lloyd Russell-Moyle (Brighton, Kemptown) (Lab/Co-op)]

The hon. Lady highlights an important study from the Elton John AIDS Foundation, which found that, with a low amount of money, people can be returned to care. The problem is that sexual health and HIV services are under strain. That money needs to be ringfenced and provided by the Government so that we can spend now to save later.

[Nicola Richards]

The hon. Gentleman does a lot of work in this area and is a voice to be listened to.

I have shown that the key benefits of extending opt-out testing and further lost-to-care work are threefold: saving lives, saving money and reducing the pressure on the NHS at a time when every effort must be made to reduce waiting lists.

At the time of the World AIDS Day debate last December, I was assured that the Minister would look closely at the outcomes of the trial once 12 months of data was available. I hope that he agrees that the trial has been a success, as the annual report states, and that we should extend the roll-out without delay.

We already have an excellent programme in place, ready to support the expansion of combined blood-borne virus testing. After the Government initially invested £20 million in opt-out A&E testing through the HIV action plan, funding from the hepatitis C programme made it possible to add hep B and hep C to the programme. The success of that has been remarkable, and the hepatitis C elimination programme is already funding opt-out hep C testing in further areas. However, without specific funding for HIV we are missing an opportunity to save even more lives by testing for HIV at the same time.

For example, a pilot programme that took place in the Leeds Teaching Hospitals NHS Trust, where opt-out HIV testing was rolled out alongside hepatitis testing, found 25 people with HIV in just 17 months, along with a combined 297 people with hep B and C. After the end of that pilot, the hospital has been able to secure funding from NHS England to reinstate hepatitis C testing in the emergency department whenever blood is taken. However, it is disappointing that no funding has been provided for HIV testing to go alongside that, especially when the area is one in which there is a high prevalence of HIV. These opportunities to test are currently being wasted.

If we are to expand HIV testing further, it has to be combined with blood-borne virus testing—there is no hierarchy when it comes to the elimination of viruses, and it is important that we make progress against both. We are showing that combining testing is not just better; it is cheaper, more effective and de-stigmatising. I would therefore appreciate it if the Minister could confirm that a national expansion of opt-out hepatitis C testing would include HIV and hep B, as should be the case.

Another way in which we can stop the spread of the virus is by better utilising PrEP, which has been proven to be very effective at preventing the transmission of HIV. As part of the HIV action plan, we committed to an innovation in PrEP delivery to improve access for key groups, including provision in settings outside sexual and reproductive health services. However, we continue to await a date for when that will start, and I strongly urge the Department to outline when that will be as soon as possible.

The Prime Minister recently committed to making other prescription medications, including contraception, available directly from pharmacies. Please can the Government consider doing the same for PrEP, which would make a massive difference to so many? By making it easier to access, we can prevent those most at risk from ever being infected with HIV. PrEP needs to be available to people in GP surgeries, pharmacies and online to truly harness its potential to stop HIV spreading and to end the inequalities in access to the drug. I hope that that is something the Minister can provide an update on when responding to this debate.

[Lloyd Russell-Moyle]

The hon. Lady is dreadfully kind for giving way. I hope she will acknowledge to the Minister that many people end up buying PrEP online, anyway, so there is already a market for it where people access it outside of clinics. The Government are taking a cautious approach, and the people have already marched two miles ahead. The Government should take a more reactive approach, follow where the people are and allow them to buy it over the counter, with advisory blood tests rather than compulsory ones.

[Nicola Richards]

I thank the hon. Member again for his intervention, and I totally agree.

I would also like to raise the plight of those who are living with HIV but who feel unable to access healthcare for a variety of reasons—mainly as a result of the stigma surrounding the virus and concerns over their mental health. Engagement with this group is an important part of the action plan. Can the Minister please use this opportunity today to reassure colleagues that people living with HIV have the opportunity to seek support, and that tailored measures will be introduced to combat the issues I have raised?

Finally, all parts of the health system are responsible for delivering on the action plan. Shortly this will change, with adult HIV services moving from NHS England to integrated care systems in April 2024. As may be evident, the lines of responsibility are somewhat blurred. For that reason, it is key that we clarify as soon as possible the exact lines of authority, so that work can be accelerated to deal with the disparity in HIV support across different areas of the country. Again, I strongly encourage the Minister to provide the House with information on what the Government are doing to deal with this issue.

It is vital that we deliver on the HIV action plan, which gives us a genuine opportunity to be the first nation in the world to end this epidemic, which has both taken and harmed so many lives. By working together and implementing the reforms the action plan sets out, some of which I have mentioned today, we can stop the spread of the virus and, instead of allowing transmission to go undetected, we can stop the virus in its tracks. Many of these measures are non-burdensome but highly effective, so it is vital that we act before it is too late. We have a social responsibility to do all we can now and not to delay the implementation of the plan. I look forward to hearing the Government’s response.

--- Later in debate ---

[Caroline Nokes (Romsey and Southampton North) (Con)]

It is a pleasure to serve under your chairmanship, Dame Caroline. I, too, would like to congratulate my hon. Friend the Member for West Bromwich East (Nicola Richards) on securing the debate and on her comments. She has already said much of what I wanted to say, so that will spare us some time.

I apologise if anyone thinks I am about to drift out of order—I am not—but I want to focus on the women’s health strategy. We know that the HIV action plan has been incredibly effective in increasing the number of men diagnosed with HIV. We have seen a fantastic and sustained fall in HIV incidence for gay, bisexual and other men who have sex with men, but not for women. That is because there seems to be a lack of joined-up thinking when it comes to breaking down some of the stigmas and taboos that still exist for women, and we need to do more to ensure that they are tested.

This is where I drift off into the women’s health strategy, which is a comprehensive and excellent document, and I pay tribute to you, Dame Caroline, for ensuring we saw it get over the line. It clearly states:

“independent reports have shown, too often it is women whom the healthcare system fails to keep safe and fails to listen to.”

The document contains some important and crucial points around tackling taboos and stigma and addressing disparities in outcome that might be affected by age, ethnicity or where the woman is from. It says clearly that those factors should not impact a woman’s ability to access services, but they do.

We know that women are less likely to have access to PrEP and that they are the least likely group to have their need for it identified—only 33% in 2021 had had their need identified. They are also the least likely to continue taking PrEP. The HIV action plan told us about making PrEP available from GPs, and the hon. Member for Brighton, Kemptown (Lloyd Russell-Moyle) commented on making medication more readily available from pharmacies. We have already done that for a range of conditions. Some contraception is readily available from pharmacies. For women, some forms of hormone replacement therapy are available from pharmacies. The morning-after pill is available from pharmacies. What we need to do, to break down the stigma and taboo, is to ensure that PrEP is more accessible from pharmacies. It seems to be a complete no-brainer.

[Lloyd Russell-Moyle]

The right hon. Lady makes some very good points about PrEP. But is this not also about a problem with sexual health and reproductive testing in clinics? In Britain, only one in 10 clinics offers online testing. That means that many people who cannot take time off work, or who cannot get away at the right time, are never able to get tested.

[Caroline Nokes]

The hon. Gentleman makes an important point, and one that I had completely forgotten about but that I wanted to highlight. Online testing and receiving test packets through the post is incredibly discreet, quick, easy and efficient. I know that because even I have availed myself of those services—that will send the Twittersphere into an absolute frenzy. It is a really important point: to be in control of their own health, a person needs to know. Annually, I have an HIV test provided to me—I believe it is Terrence Higgins Trust that does that, because it is a brilliant charity that does fantastic work, not least in providing us with up-to-date information. It also promotes relentlessly the need to make sure that testing kits are readily and easily available through the post and online. It is absolutely critical that we have that. We learned during the pandemic, did we not, the importance of test, test, test?

That moves me on to tests, tests, tests of the opt-out variety. My constituency in Southampton does not benefit from opt-out testing at present. It is classified as having a high prevalence of HIV, with 2.4 adults per every 1,000 living with HIV in the area. We know that opt-out testing finds people living with HIV and brings about an earlier diagnosis in many cases. We all know that earlier treatment is the most effective and that once somebody on treatment has got to the point where their viral load is undetectable, it is untransmissible. Of course, we have to do the maths backwards; we know that if people are not diagnosed and not receiving treatment, they are more likely to be transmitting HIV.

We know that opt-out testing works. We know that it works in Blackpool and London, but we know that in Southampton, more than a third of HIV diagnoses are late, which puts people at much greater risk of ill health and death and increases the problem of onward transmission. We also know that women, black Africans and older people are more likely to be diagnosed late. My plea to the Minister is to ensure that we have an expansion of opt-out testing so that we can identify those people from groups who are less likely to be identified. We know that opt-out testing means that a higher proportion of women and older women are also likely to be identified.

That takes me very neatly back to the women’s health strategy, which puts people into three stages of life. There is the early stage, from puberty up to about 24; the mid-stage of life; and older people, such as me, who have passed their 51st birthday. The important thing about the women’s health strategy is that it is absolutely explicit in saying that sexual health and wellbeing is relevant across all three of those age groups. I make a big plea that we do not forget older people; the hon. Member for Vauxhall (Florence Eshalomi) mentioned a woman of 85 going through opt-out testing. It is absolutely, crucially important. Representing Romsey and Southampton North, it would be remiss of me not to make a quick plea for those living in rural areas, who wait an average of 19 days to get an appointment with a sexual health service. That is far too long to wait.

Much of this comes down to education and information. We know from the women’s health strategy that there is a big emphasis on relationships, sex and health education and that the Department for Education is conducting a review into that at the moment. We must teach boys as well as girls about sexual and reproductive health. The best place to do that is via RSHE, yet a written answer from the Department of Health and Social Care tells me that there has not yet been any contribution to the RSHE review from the Department. That is remiss of the DHSC; it should feed into the review in the same way that every other Government Department that has even a passing interest in the wellbeing of our young people and their ability to respect themselves and each other should. Notwithstanding the fact that I had a very negative answer from the Department, dated earlier this week—it might have been the latter end of last week—will the Minister take back to the Department how crucial that is if we are to hit the target of living HIV-free? Government Departments must work together to ensure that that happens.

Government PPE Contracts

Lloyd Russell-Moyle Excerpts

Tuesday 6th December 2022 Commons Chamber

[Angela Rayner]

I was not criticising Members from the other place. I am just quoting what a Member from this place, who was a Health Minister at the time, said. I am asking this Minister today if he can give us clarity on what was said, because that is now on the public record. That is all I am asking the Minister for. I have not said that about any person from the other place—that is what a former Minister said in his diaries, so it would be nice if this Minister can give us some light on this whole murky affair.

Let us turn to the numbers because, as they say, the numbers don’t lie. Ten: how many times more likely to get a contract a company was if it was in the VIP lane. One in five: the proportion of emergency contracts handed out by the Government that have been flagged for corruption. Three and a half billion: the value, in pounds, of contracts given to the Tory party’s mates—that we know of. Three billion: the value, in pounds, of contracts awarded that warrant further investigation. None, zilch, zero: the number of times this Government have come clean about this dodgy Medpro scandal. A cover-up, a whitewash, events swept under the carpet—and now they have been dragged kicking and screaming to the House today to give an honest account of their shameful dealings. The public are sick of being ripped off and taken for fools. They want to know the truth.

[Lloyd Russell-Moyle (Brighton, Kemptown) (Lab/Co-op)]

Is it not now clear to the public that the Conservative party believes in one thing only: how much money it can grab from the public purse, give to its cronies and friends, and steal from the pockets of hard-working people in this country?

[Angela Rayner]

My hon. Friend captures the mood of the public. They want answers—they want to know what happened to their money and what happened with these contracts at the time they most needed the Government to act responsibly—so we have tabled today’s motion and will put it to a vote.

Let me be clear. We are not asking the Government to do anything that would undermine any chance of recovering our money or anything that would conflict with any police investigation, but for 10 months they have told us that they are in mediation. What progress has been made? When will they conclude that the mediation has failed and take action? Can they actually get our money back or are they just kicking the can down the road?

Our motion asks Ministers to hand the records over to the Public Accounts Committee—a body that this House relies on to hold them to account for public spending—because the only logical conclusion is that they do indeed have something to hide. The public deserve answers on whether the dodgy lobbying at the heart of this scandal played a part in how vast sums of taxpayers’ cash have been wasted and whether shameful profiteering has been enabled by this Government.

That leads me to my second simple question for the House today: will Conservative Members—the few who are in—now vote for a clean-up or for yet another cover-up? Just last week, the Government led Tory Members in the other place through the Not Content Lobby to block amendment 72 to their Procurement Bill, which would have banned VIP lanes in future procurement decisions. They voted it down. They voted to protect unlawful VIP access instead of protecting taxpayers’ money.

The Prime Minister, fresh from writing off the billions he carelessly lost to covid fraud, is peddling legislation full of loopholes that would give Tory Ministers free rein to do it all over again. The question for the House is whether to act to prevent a repeat. Today, I say to Conservative right hon. and hon. Members: “Learn your lesson. Don’t let this shameful episode be repeated.”

The loss and trauma of the pandemic were immense. Millions of families lost loved ones—some only got to say goodbye via an iPad as mothers, fathers, husbands, wives and friends slipped away—and then we learned that throughout that trauma, companies with WhatsApp links to Ministers were given special VIP access to contracts that have seen billions poured down the drain.

This Government have done untold damage to the public’s faith in politics. The first step in restoring trust is publishing these documents today. The public need answers about how this happened and they need them now, but they also deserve reassurances that it will never, ever be allowed to happen again. Taxpayers’ money must be treated with respect, not handed out in backroom deals to cronies or used as a passport to profiteering.

PPE Medpro is just the tip of the iceberg in this scandal. We now know that companies that got into the VIP lane were 10 times more likely to win a contract. We now know that many did not go through the so-called eight-stage process of due diligence, as Ministers have now admitted, and we now know that this left dozens of experienced British businesses out in the cold—businesses that had the expertise to procure PPE and ventilators precisely and fast; businesses that offered their help in our darkest hour; businesses whose only mistake was to play by the rules.

Not a single one of the companies referred to the VIP lane was referred by a politician of any political party other than the Conservative party. The then Chancellor of the Duchy of Lancaster, the right hon. Member for Surrey Heath (Michael Gove)—the Cabinet member who oversaw the entire emergency procurement programme —reportedly fast-tracked a bid from one of his own personal friends and donors, who went on to win hundreds of millions of pounds of public money. Last week, he said he had simply referred the bid from PPE Medpro to officials; but we also know that he passed it on directly to his ministerial colleague Lord Agnew.

World AIDS Day

Lloyd Russell-Moyle Excerpts

Thursday 1st December 2022 Commons Chamber

[Lloyd Russell-Moyle (Brighton, Kemptown) (Lab/Co-op)]

I beg to move,

That this House has considered World AIDS Day.

I declare an interest as the vice-chair of the all-party parliamentary group on HIV and AIDS and honorary patron of the British HIV Association, and of course as someone who is personally affected by these issues.

I thank the Backbench Business Committee for granting this debate to mark World AIDS Day. Every year, on 1 December, the world commemorates World AIDS Day. People from around the world unite to show support for people living with and affected by HIV, and remember those who lost their lives to AIDS. At 5.30 pm, I, among the community in Brighton, will read out the names of all the people who have died of AIDS in Brighton in the 40 years since the first death, as we do every year. Vigils such as that will be happening up and down the country: in London, in Birmingham, in Manchester, in Oxford, and in other places.

This year’s theme is “equalise”. It is a recognition of the health inequalities that still affect far too many children, men that sleep with men, transgender people, drug users, sex workers and people in prison. Those are the populations most affected by HIV and AIDS in their respective countries; different countries might have different, more focused populations, but those are the groups. Fundamentally, however, the groups that are most at risk are people who are marginalised from healthcare, and that is what we need to equalise—that is what we need to sort out.

This year marks the 40th anniversary of the death of the former Hansard reporter Terry Higgins, who died of an AIDS-related illness on 4 July 1982, and the creation of the now well-known Terrence Higgins Trust. On behalf of the APPG, I thank the Terrence Higgins Trust, not only for the work it has done over the past 40 years but for the work it keeps doing, pushing for us to have no new transmissions of HIV by 2030. That seems a remarkable target, but it is within our reach; it will help the estimated 106,000 people living with HIV in England that we know of. The work of the Terrence Higgins Trust, along with the National AIDS Trust and others, continues to lead the way, and I am delighted that the two organisations are working closer together. I hope that collaboration continues.

Ahead of World AIDS Day in 2018, four years ago now, I spoke in this Chamber about my own diagnosis. I said then that World AIDS Day was

“deeply personal to me, because next year I will be marking an anniversary of my own”.—[Official Report, 29 November 2018; Vol. 650, c. 492.]

Now, of course, it is 14 years since I became HIV-positive. It has been a long journey, from fear to acceptance and to today, where I now play a role of advocacy, knowing that my treatment keeps me healthy and protects any partner that I might have, preventing me from passing on the disease. Since then, further developments have taken place in the fight against HIV/AIDS—many of them positive, but there have been some setbacks, which I wish to talk about in a bit.

We have, of course, a HIV action plan in England, setting clear goals and milestones for achieving our target. Similar plans are set to be launched in Scotland and Wales—we hope they will come quickly. Last year’s HIV action plan for England sets out how we will achieve an 80% reduction in HIV infections by 2025, building to the end of transmissions by 2030. First, that plan will prevent new infections by expanding and improving HIV prevention activities, investing £3.5 million in a national HIV prevention programme up to 2024, and ensure that PrEP—pre-exposure prophylaxis—is expanded to all key groups. Secondly, it will scale up HIV testing in high-risk populations where uptake is low, and ensure that new infections are identified rapidly, including through the expansion of opt-out testing in A&E departments in areas of very high prevalence of HIV. That testing will be backed by £20 million over the next three years.

Thirdly, the plan will ensure that, once diagnosed, people rapidly receive treatment. When I was first diagnosed, you waited until your CD4 count was below 200, which is when you can start to get infections and AIDS can start to be diagnosed. At that time, we did not know whether the drugs would cause continuing side effects; now, as soon as someone is diagnosed, they go on the drugs, because we know that they have very few side effects. Of course, each person has to get the combination that is right for them, because everyone reacts differently, but we have a good array of drugs with which to do that. That means that very quickly—within a matter of months—new people who are diagnosed can be undetectable, and can effectively go about their life without fear or favour. That is a remarkable change in those 14 years.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman, and commend him for his stance and leadership in this House—and, indeed, outside of this House—when it comes to HIV/AIDS and how to live with it, as he does. In Northern Ireland, which he did not refer to, the Public Health Agency has responsibility for this area. Its hope and ambition is to reach the target of eliminating HIV transmission by 2030, and it seems confident that it can do so, because of the PrEP that he has referred to. It is good sometimes to mark and record the things that are going well.

[Lloyd Russell-Moyle]

It is remarkable. If we achieve that 2030 target in this country, and if we then achieve a roll-out of it globally—that is a lot of ifs—HIV will be the first disease that we have rolled back via treatment and prevention, rather than vaccines. It would be a world leader, and hopefully a pioneer in how we can treat and test other diseases, particularly with mass testing, which I will come on to in a second.

If all that happens, we will meet the 2030 target, but—as we always say—the Government need to do more. To start with, they need to expand opt-out testing. That has been trialled in areas with very high prevalence—that is, Brighton, London, Manchester and Blackpool. Not all of London was originally included in the opt-out testing, but it took the decision to expand that to all hospitals in London, sharing out the money. Remarkably, that has shown that, in non-high prevalence areas, the percentage of people coming back with an HIV-positive test is still significant. The argument, therefore, is to roll that out to all areas.

Over the past 12 months, we have seen real successes in opt-out testing in England. That happens when somebody is already having their blood taken in A&E and the vial is sent off for an additional test. We are testing for HIV and hepatitis B, unless someone opts out. No one is forced to do this, but I understand that very few people opt out.

The pilot’s results have been astonishing. In just three months, 102 people were newly identified, and 70 people were identified as having dropped out of treatment. If someone drops out of treatment, they are a risk not only to themselves, but to the wider community. Those people have been brought back into treatment and that has saved lives. The results are clear: opt-out testing is working.

On a side note, it is also possible to test for syphilis with the same vial. However, it was not possible to expand this to syphilis, because syphilis testing is paid for by local authorities, not by NHS England, and the local authorities were unable to identify where people were from, because hospitals are not coterminous with local authorities and it was too complicated. That seems ridiculous. We need the Government to sit down with local authorities or to provide for that through central funding. If we are taking the vial, we can run it through the same machine. If the only reason stopping us is bureaucratic, I do not see why we cannot do this. We should test people routinely for as many things as we can, if we know that it will help people’s lives. We know that there is a spike in syphilis in certain key populations.

If this vital programme is eventually expanded to all towns and cities with high prevalence, it will be a game- changer. Where London has expanded the programme, it has already been worthwhile financially in areas that do not have very high prevalence. The programme should also be expanded to sexual health clinics to ensure that everyone going to one is tested for HIV. This may be a surprise to many, but that is not always done routinely and it is not an opt-out system. Actually, an HIV test is becoming less, not more common, because more sexual health clinics are moving to online services. Online services have some great advantages, but one downside is that they require people to collect a vial of their blood, which often does not happen, or does not happen effectively, so HIV test rates are lower. We need to ensure that, when people attend a clinic, it is routine and there is an opt-out system. Some clinics do this already, but it is not universal.

I spoke about the HIV prevention drug, PrEP, in 2018. We have a come a long way since the PrEP impact trial. To remind colleagues, PrEP, which is a pill that people take daily, contains two of the three drugs that someone with HIV would have. In fact, I have now been reduced to two because the latest evidence shows that, when someone gets to “undetectable”, the drug load for people who have HIV can be reduced to, effectively, just the PrEP load. The drugs will not be exactly the same as I take for PrEP, but some people can maintain on those as well. So this is also about new interventions that can reduce the costs and the amount of drugs that we are providing.

PrEP prevents HIV and the pill is covered by NHS England, but thousands are still missing out. They are struggling to get PrEP appointments because of under-resourced sexual health services. That is laid bare in the latest report from the National AIDS Trust, the Terrence Higgins Trust, PrEPster, Sophia Forum and One Voice Network. Due to the fragmentation of services in England, the drug PrEP is paid for by NHS England. That is a real milestone for the NHS, and I congratulate the Government on getting that out eventually, after our interventions.

Anyone who is currently sexually active should be tested by sexual health services every three months, and anyone on PrEP should be tested every three months. In theory, therefore, there is no additional resource for sexual health services for someone on PrEP, because the only people on PrEP should be those who are sexually active, or drug-injecting users who should also be tested, and so on—we should not give it to people who do not need it. But our sexual health services in this country rely on balancing the budget through the fact that people do not attend as regularly as they should. Therefore, that limits the places for PrEP appointments and limits the people who can get access to the drug that the NHS is paying for, even though they are entitled to it and should be offered that level of service.

Awareness of PrEP is far too low and it cannot be given out by GPs, pharmacies, community or maternity services. That means that the burden is solely on local government-funded sexual health services. We all know what is happening with local government and probably do not need to go there today—that is a whole other debate.

If we are going to meet our 2030 target, it is vital that everyone who is at risk of acquiring HIV and who wishes to access PrEP can do so as a key tool in completely and effectively preventing new HIV transmissions when it is taken as directed. Over the past two years, the all-party group on HIV and AIDS has published three important reports. We published “Increasing and normalising HIV testing across the UK”—which I just touched on—and “Nothing about us without us”, which addresses the needs of black, Asian and minority ethnic communities in the UK. Those communities are some of the hardest-hit by HIV in this country and are the least likely to have HIV testing done routinely. The roll-out and trial of the saliva HIV testing, which the Terrence Higgins Trust did two years ago and last year, was particularly effective in those communities. It was seen as less invasive, more private, easier to get hold of and possible to do through online and postal services. The Government should consider whether that process should be normalised nationally or provided cheaply and accessibly.

Our other report, “HIV and Quality of Life—What do we mean? How do we achieve it?”, was published today, and my colleagues have been launching that in Brussels with our partners in Europe. Those reports have been made possible only through the evidence provided by the strong HIV sector that we have in the UK. Its continued insights and hard work are appreciated.

The latest data, however, is not quite as positive. There were 2,692 people diagnosed across England in 2021. That is up 0.7%, from 2,673 in 2020. Some might say that is a small amount but, in 2022, there was a fall of 0.2% and, in 2019, there was a fall of 33%. We are clearly plateauing and there is a danger that we are starting to get more diagnoses. That might be positive because we are delving down to the hardest-to-reach areas, but we need more evidence on why that has plateaued and why it is creeping up before we can be sure that that is something to celebrate, rather than to be worried about.

To keep on track, it is vital that we use every lever available to end HIV transmission and to ensure that we do not plateau, as the numbers show. As I said, we can end transmission by 2030 and I strongly believe that the UK will be one of the first countries to do so. We are a world leader. At the beginning of the week, I spoke to our London NHS colleagues, who said that it is the first time in their career that people have been phoning up from around the world to say, “How are you doing the opt-out testing? How are you doing the PrEP roll-out? We want to learn from you.” That is remarkable and we should be deeply proud of that. The head of UNAIDS came to London and Brighton and we showed her the HIV testing vending machines that we have in Brighton. She said, “I thought that I would never learn anything for the developing world from a rich country. I was here as a courtesy visit, but I have seen what you are doing and how we can roll that out to parts of Kenya and Uganda, and community settings around the world, with HIV testing vending machines that run using solar panels”.

[Patrick Grady (Glasgow North) (Ind)]

I congratulate the hon. Member on all his work on the issue. Global leadership is incredibly important. He might be coming on to this point, but does he share the disappointment felt by a lot of people in the sector and the wider international development sector—perhaps even the head of UNAIDS—about the cut in the UK Government’s funding for the Global Fund to Fight AIDS, Tuberculosis and Malaria? That risks exactly the kind of backsliding that the hon. Member warns us about.

[Lloyd Russell-Moyle]

I agree exactly. I will come on to the Global Fund at the very end of my speech, but let me move on now to the picture globally, which I am afraid is totally different.

Back in 2018, I said that

“one young person every day is still diagnosed with HIV and young people continue to suffer some of the worst sexual health outcomes.”—[Official Report, 29 November 2018; Vol. 650, c. 496.]

The situation globally has become bleaker. Last year, an adolescent girl or young woman was newly infected with HIV every two minutes. In the past year alone, 650,000 people have died of AIDS-related illnesses and 1.5 million people became infected with HIV. Only half of children living with HIV have access to life-saving medication. Inequality between children and adults in HIV treatment coverage is increasing rather than narrowing.

Why are people still dying unnecessarily of AIDS? Why are there so many new HIV infections year after year, globally? It is too easy to put the blame on current crises such as covid and war; the reality is that we were already off target before many of those crises hit. The lack of a comprehensive healthcare system, a lack of education and the growing influence of evangelical Christian churches in Africa—often American-backed—have led to an environment that is hostile to an effective HIV response.

Uganda was the first country to host the world AIDS summit—it was a revolutionary leader. The same President is in power now, but has completely rolled things back. When Uganda hosted the world AIDS conference almost 30 years ago, condoms were given to every delegate and given out into community settings. When I went to Uganda only a few years ago to visit aid projects that we were paying for, I sat at the back of a classroom with Stephen Twigg, the then Chair of the Select Committee on International Development. We heard a teacher tell children that they could prevent AIDS if they washed the toilet seat and observed “sex only after marriage”. I am afraid that things have gone backwards because of the influence of some malign groups. It is concerning.

One of the inequalities standing in the way of ending AIDS is access to education, particularly for young girls. Six in seven new HIV infections among adolescents in sub-Saharan Africa occur among girls who are outside formal education. Enabling girls to stay in school until they complete secondary education reduces their vulnerability to HIV by more than 50%. All children, including those who have dropped out because of covid and those who were out of school anyway, should get a complete secondary education, including comprehensive sex education.

[Caroline Nokes (Romsey and Southampton North) (Con)]

The hon. Gentleman makes such an important point. Does he agree that we cannot shy away from talking about sexual and reproductive health in the developing world, because that is the single most effective way to ensure that girls stay in school, stay not pregnant and stay free from diseases that will affect them in future? It is crucial that in our role as providers of international aid we do not step back from programmes that talk about contraception.

[Lloyd Russell-Moyle]

I totally agree. As dark forces around the world try, I am afraid, to withdraw money from programmes that talk in a rational and evidence-based way about sex and reproductive rights, we have a greater responsibility. We must step up, because if we do not, others will not. As the right hon. Lady points out, there are two sides to the coin: providing better sexual health education means that girls stay in school, and staying in school allows them to get better education about their health. Those are both positive things. Both issues need to be tackled together.

Another inequality standing in the way of ending AIDS is the inequality in the realisation of human rights. Some 68 countries still criminalise gay men. As well as contravening the human rights of LGBT+ people, laws that punish same-sex relations help to sustain stigma and discrimination. Such laws are barriers preventing people from seeking and receiving healthcare for fear of being punished or detained. Repealing them worldwide is vital to the task of working against AIDS.

Of the 68 countries that outlaw homosexuality, 36 are Commonwealth countries. The majority of Commonwealth countries are still upholding laws that we imposed and that never originated in the countries themselves. In fact, before British colonialism—British imperialism, I should say—many of those countries had better customs and practices around homosexuality than they do now. These customs and practices are not native to people’s home countries; they were imposed. They should be discarded with the shackles of imperialism, which we all now recognise was wrong. One in four men in Caribbean countries where homosexuality is criminalised have HIV. Globally, 60% of people with HIV live in Commonwealth countries. Collectively, we have a responsibility to tackle that in the Commonwealth. Barriers undermine the right to health: a right that all people should enjoy.

Beyond the human rights implications, the laws criminalising homosexuality also have an impact on public health. LGBT+ people end up not seeking health services for fear of being prosecuted. Those who do seek health services often have to lie about how they were infected. Astronomically high numbers of people with HIV in Russia say that they were infected because they were drug-injecting users; that is widely believed to be partly because of the attitude in Russia that it is better to be a drug-injecting user than an LGBTQ person. Without accurately knowing the source of infections, we cannot accurately run public health programmes to save people. Putting people undercover in the dark, hidden in corners, means that the virus lives on. That is a danger for us all.

In some countries, people living with HIV are at risk of being criminalised even when they take precautions with their sexual partners. That opens them up to blackmail and fraudulent claims from former partners. People with HIV in the UK are not immune to that either, as we have seen in some high-profile cases. We have known for at least 20 years that antiretroviral therapy reduces HIV transmission, and for the past few years we have known that it stops it completely, so there should be no doubt that a person with sustained undetectable levels of HIV in their blood cannot transmit HIV to their sexual partner, and laws should not punish them. However, under Canadian criminal law, for example, people living with HIV can be charged and prosecuted if they do not inform their partner about their HIV-positive status before having sex. The law does not follow the science, and it puts people at risk.

Laws requiring disclosure perpetuate the stigma against HIV-positive people. With the advent of PrEP and with “Undetectable = untransmittable”, the law should now reflect the fact that everyone has a role in protecting themselves against HIV and everyone must step up. The criminalisation of drug-injecting users and sex workers has an equally negative effect on HIV prevention and treatment, as I have outlined, in LGBT communities. In all these areas, a health and human rights-based approach must be taken if we truly want to see the end of HIV.

Beating pandemics is a political challenge. We can end HIV and AIDS by 2030 in this country, but only if we are bold in our actions and our investments. We need courageous leadership. We need people worldwide to insist that their leaders be courageous. That is why last month it was so disappointing not to see courageous leadership from this Government. The UK Government were the only donor to the Global Fund to Fight AIDS, Tuberculosis and Malaria to cut their financial settlement—by £400 million. The fund asked donors to raise their pledges by 30% this year, and almost all the G7 nations—which are suffering economic problems that are, in many respects, similar to ours; as the Government often remind us, this is a global crisis, not a crisis of their own making, although in our view it is a bit of both—increased their amounts. For decades the UK was the leader in the global response to these infections and diseases, but that is no longer the case. When our allies met the fund’s request for a 30% increase, the UK went for a 30% cut from their 2019 pledge.

[Anthony Mangnall (Totnes) (Con)]

I thank the hon. Gentleman—my friend—for making this speech; he is an extraordinary advocate in this area. However, I want to put on record the fact that the UK is the third biggest funder of the Global Fund. We have, to date, contributed just under £4.5 billion.

The hon. Gentleman has said that we are leading the way in respect of our health and our treatment, and that other countries are following. This, too, is a commodity that can be traded and given to other countries. It is not always a question of the value of the money that we give, because we can trade skills, research and development as well. The hon. Gentleman knows where I stand on the development issue, but I think it is worth making that point.

[Lloyd Russell-Moyle]

The hon. Gentleman has been very good on development issues in the past, and I think he is right. He has also touched on the discussion about patents and patent waivers. There is a live discussion about how we can ensure that the poorest countries in the world can gain access to some of the frontline drugs. Long-lasting drugs are one of the latest innovations, with the possibility of either an injection or a set of, effectively, implants—I cannot think of the exact term off the top of my head—which would last for up to a month and a half. That is revolutionary, especially for those who have irregular access to health systems. The problem is that these are the most expensive drugs because of the way our patent system works; but they are also the most useful in the parts of the world that are hardest to reach. In the UK, most people have regular access to medical settings and can receive daily pill medication. The UK has not always been the very best when it comes to seeking patent waivers. We have done it in the case of many HIV drugs, but we should consider doing it more widely. That might be a good compromise, but we will then need to step it up.

The UK’s decision on the 30% cut is, in my view, a disastrous decision, which stems from the Conservatives’ 0.5% cap on international development. Rather than considering that amount to be a floor and saying that it is the bottom of our ambition, the Government have said that it is the top of our ambition. Moreover, as a result of their insistence on including the Homes for Ukraine scheme, whereby we are housing Ukrainian people here in the UK, in that 0.5% cap, money is flowing out of the international development Department. International development—internationally spent money—should be 0.5%; that would enable us to fulfil many of our commitments quite easily. The additional aid and charity that we provide should be celebrated, but it should not be detrimental to others. This cut will result in the preventable deaths of up to 1.5 million people, and risk over 34.5 million new transmissions of HIV, TB and malaria. It will no doubt harm our credibility, and I hope we will reverse it as soon as we can.

We in the APPG have the political will to meet the targets set by UNAIDS and the action plans for Wales, Scotland, England and, I was pleased to hear, Northern Ireland. We will continue to work with and challenge the Government in ensuring that they do the same, because it is time we stepped up and pushed for that final mile. When you are at the end of the race, you do not slow down; you speed up. This is a prize that we can win, so let us not allow it to slip through our hands. In the words of the former Prime Minister Boris Johnson, let us end the “dither and delay”. Let us end HIV/AIDS today.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O'Brien)]

Let me start by congratulating all Members from across the House who have taken part in what has been an incredibly informative and high quality debate. Let me join others in congratulating the hon. Member for Brighton, Kemptown (Lloyd Russell-Moyle), on a speech that mixed huge personal experience and knowledge, years of advocacy and successful campaigning, and a huge number of insights.

I undertake to look at numerous issues raised by the hon. Member, but to pick just a few, he asked about: the bureaucratic barriers stopping syphilis testing from being added to the opt-out testing that we already do for HIV and hepatitis B and C; some of the risks around the shift to online clinics; people on PrEP being tested regularly; and the promising experiment by the Terrence Higgins Trust with saliva testing for HIV. He raised a number of other points, including the important issue about patent waivers. There was a huge amount in his speech to take away and look at.

The same is true of other hon. Members. My right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) made hugely important points about women and girls, and gave some incredibly striking and harrowing statistics. She made important points about the barriers to testing, particularly among minority groups. We can learn from the way that we are tackling that problem in other fields, including in covid vaccination work.

The hon. Member for Strangford (Jim Shannon) gave us insights on what is happening in Northern Ireland, such as the role of the Public Health Agency there and what it is doing on PrEP. He talked about the role of the church in his constituency and the connection between Swaziland and Strangford, which might surprise outsiders. He talked of the work of the Positive Life charity in Northern Ireland, which I commend.

My hon. Friend the Member for West Bromwich East (Nicola Richards) spoke powerfully about her constituents’ experiences of stigma. She made the important point that, as a high prevalence area, it should be considered for the expansion of opt-out testing. A similar point was made by the hon. Member for Slough (Mr Dhesi) and my hon. Friend the Member for Heywood and Middleton (Chris Clarkson). I join my hon. Friend in commending the work of Middleton Health Centre.

The hon. Member for Coatbridge, Chryston and Bellshill (Steven Bonnar) talked about some important lessons that we can learn. We are keen to learn across the UK about the rollout of PrEP in Scotland. On the roll-out of our world-leading vaccination campaign against mpox—one of many issues raised by the hon. Member for Denton and Reddish (Andrew Gwynne) in his speech—we are talking to that relatively small number of clinics that have had to deliver the huge majority of the campaign about its impact financially and on their day-to-day work.

World AIDS Day is an invitation to underline our commitment to tackling HIV, to show our support for people living with HIV and to remember those we have lost to AIDS. I am proud of how far we have come: from the stigma and the sidelining of the past, which a number of Members have mentioned, to where we are today thanks to collaborative efforts and the commitment of the Government, together with HIV patients, their friends and family, campaigners, medics, researchers and the health and care system at all levels.

Today, when diagnosed early and with access to antiretroviral therapy, most people living with HIV in England can expect a near-normal life expectancy. People diagnosed with HIV can expect to receive world-class, free and open-access HIV care. That has been a result of our collective and collaborative partnerships. However, despite successes, HIV has not gone away. There is still more that we should do. That is why last year, this Government published their commitment to end new HIV transmissions in England by 2030 through the HIV action plan. That plan is the cornerstone of our approach in England to drive forward progress and achieve our bold ambitions.

We have come far in the first year since its publication. The UK met the UNAIDS 95-95-95 targets for the first time in 2020: 95% of HIV-positive individuals were diagnosed; 99% of those diagnosed were receiving treatment; and 97% of those receiving treatment were being virally suppressed. I am pleased that the number of people being newly diagnosed with HIV in England continues to fall. The latest data on HIV diagnoses shows that 2,955 people were diagnosed with HIV in England in 2021—a 33% decline compared with 2019, when the Government first made their commitment to end all new HIV transmissions in England by 2030. We are conscious of the need to avoid flatlining or slowing the pace in any way. We are still understanding the impact of the covid pandemic and the things that happened during that period, but there has been progress.

Those successes have been underpinned by clear national leadership and strengthened partnership working. I am grateful to Professor Kevin Fenton, the Government’s chief adviser on HIV, who has been chairing the HIV action plan implementation steering group, involving the key partners in the delivery of the HIV action plan, including local government, the NHS, and our voluntary and community sector. The steering group has met quarterly throughout the year to monitor progress on our commitments and ensure that appropriate action was taken to keep us moving forward with our objectives. Within the remit of the group, they have established specific task and finish groups focusing on key priority areas for action, such as improving equity and access to HIV drug prevention—PrEP—and addressing workforce challenges, among others.

We are also thankful for the work of the UK Health Security Agency, which excels as a world-class leader running high-quality data collection and surveillance systems to help us to better understand and address the challenges on HIV. Those have enabled us to truly understand developments, emerging issues and where we can have the greatest impact with our prevention efforts, and add to our growing repertoire of world-leading British innovation, systems and technology.

Of course, none of this could have been possible without the brilliant efforts of our local government, NHS and voluntary and community sector partners to deliver the highest-quality healthcare tailored to the needs of their local populations. We know through their work that different areas face different challenges, and we remain committed to helping level up outcomes for the whole population across the country.

A key priority, therefore, of the Government’s approach is to ensure that all under-served populations benefit equally from improvements in HIV outcomes. A range of important suggestions have been made in this debate about how to go further. The approach includes scaling up our prevention efforts and increasing access to PrEP. We have already invested £33 million to roll out PrEP access across sexual health services over the past two years. PrEP is now being commissioned as a routine service through the public health grant.

In delivering against these commitments, UKHSA has now developed and published a monitoring and evaluation framework to support local authorities, sexual health services and other key stakeholders to inform continuous service development in PrEP commissioning and delivery, using the existing available data. I am sure many of the people involved in delivery of those services will have followed this debate with great interest and noted some of the challenges posed by different hon. Members.

[Lloyd Russell-Moyle]

One of the problems is that the Department does not collate data on the average wait times for sexual health clinics or the availability of stocks for PrEP appointments in those clinics. Without that data, we rely on voluntary organisations to make freedom of information requests and report periodically. Having a baseline set from the Department would make a big difference and help us to understand areas that are struggling to roll out PrEP versus areas that maybe are not. Is that something the Minister could take back to the Department? I understand why in the past we have been nervous about publishing data on sexual health issues, but now is the time when we can be a bit more open about that and maybe publish that data, or collate it if that is not already done, so we can start to target our actions.

[Neil O'Brien]

That is certainly something I will take away and look at. As the hon. Gentleman points out, there are a number of challenges in doing that and in unpicking the activities of sexual health services on different diseases, and he has already alluded to some of the risks. However, I will certainly undertake to go away and look at that important point.

We know there is still more to do to improve PrEP access for key groups and we are in the process of developing a plan for provision of PrEP in settings beyond sexual and reproductive health services, to help us to reach those who are underrepresented—something a number of hon. Members have called for. Our efforts are also focused on scaling and improving testing levels in targeted, high-risk populations, including in black African communities, to be able to reach those 4,500 individuals who we believe are living with HIV but unaware of their status.

As part of implementation of the action plan, NHS England is investing £20 million over the next three years to expand opt-out HIV testing in A&E departments in the local authority areas across the country with the highest prevalence of HIV and across the whole of London. As a number of hon. Members have pointed out, it is a proven effective way to identify new HIV cases, as it promotes testing on admission to hospital of anyone who has not previously been diagnosed with HIV, therefore rapidly helping to identify the virus. Some 33 A&E departments are now live, delivering that important initiative.

We also took the opportunity to link the initiative to the hepatitis C elimination programme, backed by a further £6.85 million, to provide hepatitis B and C testing as well. As several hon. Members alluded to, NHSE published its report on the first 100 days yesterday, describing the progress, challenges, results and learning from the first period of this initiative.

Those very early findings show the benefits of the approach: more than 200,000 HIV tests were conducted over just the first 100 days of opt-out testing across London, Manchester, Salford, Blackpool and Brighton, which meant that more than 600 people were identified with a previously unknown blood-borne virus. Of those, 128 people were newly identified as living with HIV and an additional 65 people living with HIV who were previously diagnosed but were not under the care of an HIV clinic were also identified.

This approach is important to ensure everyone living with HIV can access testing and rapid linkage to treatment and care, allowing them to live a long and healthy life. Moreover, 325 people were newly identified with hepatitis B and 153 people were newly identified with chronic hepatitis C virus; a further 50 were found who had disengaged from care for both diseases and seven people were identified who had previously cleared the hepatitis C virus.

We will be considering the initial evidence from the first year of testing alongside the data on progress towards our ambitions to decide how and whether we further expand this programme. We are in the very early days of evidence on this, but I must say that evidence is extremely encouraging. I hear what hon. Members across the House are calling for, given the success of that programme in its first 100 days, but we need further evidence as it develops.

We redoubled our efforts to increase HIV testing throughout the country during National HIV Testing Week, which took place in February this year. Results are promising: 30% of the almost 25,000 users who ordered an HIV and syphilis self-sampling kit during the campaign had never tested before, and a majority of the campaign’s target audiences reported having taken some kind of preventative action as a result of the campaign.

We know there is still more we need to do to achieve our ambitions. The HIV action plan monitoring and evaluation framework developed by UKHSA, published today, will explore in detail the inequalities and gaps in HIV prevention, testing and care and other indicators of the progress required to achieve our shared ambitions and will help inform our progress. Our actions continue to be closely monitored by the HIV action plan implementation steering group, which includes key delivery partners such as local government, the NHS and the voluntary and community sector, to ensure we remain on track to meet the 2025 and 2030 objectives. The Secretary of State will report annually to Parliament on progress towards our objectives.

World Aids Day gives us the chance to reflect on progress and challenges, being accountable for what we have done over the past year and where we need to continue improving. But, most importantly, it gives us the possibility of coming together to restate our collective commitment to continue working together to end new HIV transmissions in England by 2030 and to finish the race.

[Lloyd Russell-Moyle]

I thank everyone who has spoken today: the right hon. Member for Romsey and Southampton North (Caroline Nokes), the hon. Members for Strangford (Jim Shannon), for West Bromwich East (Nicola Richards) and for Heywood and Middleton (Chris Clarkson), and the Front-Bench speakers. All the speeches and interventions have been very good.

I am pleased that the Minister talked about the continued roll-out of opt-out testing. My feeling is that when results come back that are so good, there is sometimes an argument to start making moves now. I am not saying it should be rolled out tomorrow in all those hospitals, but we know that the lead-in time takes a number of months to make sure clinicians and others are co-ordinated. Messages from the Department now, saying, “We will be rolling this out next year when the final results come back, unless something happens,” would enable a smooth roll-out. Some of those things we can go a bit further on, but I am pleased that he mentioned them.

I am also pleased that the Minister will work to ensure better outreach for PrEP in community settings. Those community settings should not just be for hard-to-reach groups, but they, especially pharmacists and doctors, will be particularly helpful for those groups. I am delighted about that.

I will finish by thanking my local organisations, because it is always nice to mention them: the Lawson Unit, which continues to support my care and the care of everyone with HIV in Brighton; Peer Action; the Martin Fisher Foundation, named after one of the HIV consultants who passed away in Brighton and works on stigma; the two anti-stigma buses, with “Undetectable = Untransmittable” stats plastered on the outside, which drive around Brighton and to Tunbridge Wells and back again every day so that even the rural areas of Sussex get to see our messages; Fast-Track Cities, which the Minister mentioned; Lunch Positive; the Sussex Beacon, one of only two residential care centres for people with HIV and AIDS in Britain; MindOut; the Terrence Higgins Trust and, of course, Frontline AIDS, one of the leading global HIV development organisations, based in Brighton and Hove. All those organisations will be there at the memorial at 6 o’clock tonight, and I am sure that many of our community will be too. Thank you again to everyone.

Question put and agreed to.

Resolved,

That this House has considered World AIDS Day.

Urgent and Emergency Care

Lloyd Russell-Moyle Excerpts

Monday 5th September 2022 Commons Chamber

[Steve Barclay]

On the hon. Gentleman’s second point, I will ensure that that particular letter to the Department is highlighted following this statement. On his first point, as I said in my statement, I agree that the greater risk is the unmet need if an ambulance does not arrive, rather than a patient who is in hospital. That is why Professor Stephen Powis and chief nurse Ruth May wrote to the system when there was pressure during the heatwave, flagging that as a specific issue. We have been working with trust leaders, including leading figures such as Anthony Marsh, on pre-cohorting and post-cohorting, capacity in emergency departments, and where risk sits in the system. I recognise the hon. Gentleman’s point.

[Lloyd Russell-Moyle (Brighton, Kemptown) (Lab/Co-op)]

This is about a lack of planning. I could say the same about the monkeypox response, because we still do not have the vaccines; they are now being watered down to half strength, because we have run out, they have not been delivered and we still have 100,000 to order. The ambulance situation is also about a lack of planning. My grandmother was admitted to the Royal Cornwall over the summer via A&E. The person before her waited 24 hours in an ambulance to be discharged. The person behind had been in a car crash, but the ambulance did not turn up for five hours and they had to make their own way to the hospital with a damaged lung. In Brighton, the Royal Sussex’s A&E has been given a very poor Care Quality Commission report. All of these cases are because of the lack of move on beds in social care. In Brighton, a senior care worker can receive less than £10 per hour to work. People get more working in shops on the high street. This needs to be addressed urgently. Is it not time for a national pay, and terms and conditions, for care workers? It would cost the Department nothing, but would stop the loss of many of our workforce.

[Steve Barclay]

Far from there being a lack of planning, the very essence of integration between social care and the NHS through the ICSs is that we recognise the importance of both aspects working much more closely together. That is why we are bringing forward initiatives such as the federated data platform.

Monkeypox is outside the scope of today’s statement, but I know the issue is of particular interest to the hon. Gentleman. He will know that, fortunately, we have not yet had any fatal cases in the UK and the rate of infection has been falling. We purchased the maximum number of vaccines that we could; I wrote to the relevant charities with the details. Although smaller doses are being delivered compared with the initial 50,000, we still have doses in the system. We expect a further 20,000 very shortly and a further 80,000 later this month. We have procured doses, we are getting them out and it is fortuitous that cases are falling, but we are obviously keeping the situation under close watch.

Access to GP Services and NHS Dentistry

Lloyd Russell-Moyle Excerpts

Tuesday 21st June 2022 Commons Chamber

[Madam Deputy Speaker]

Order. I can hear what Members are saying, and it is just not right. It is simply rude when we are supposed to be listening to the Minister.

[Lloyd Russell-Moyle (Brighton, Kemptown) (Lab/Co-op)]

And I think she could do better.

[Madam Deputy Speaker]

Order. You are not saying anything while you are sitting down—nothing! I call the Minister.

Children’s Mental Health

Lloyd Russell-Moyle Excerpts

Tuesday 8th February 2022 Commons Chamber

[Lloyd Russell-Moyle (Brighton, Kemptown) (Lab/Co-op)]

Mental health is at a crisis, but those on the other side of the House who stand up and say that it is because of covid, I am afraid, have their head in the sand, and those on the other side who say that it is because of family break-ups are looking in the wrong direction, because actually the problem is not covid.

The 369 people, most of them young people, who committed suicide between 2016 and 2020 in my NHS trust did not do it because of family break-ups or because of covid. I actually find it repulsive that those on the other side suggest that. They did it because of a failure of the last 10 years, with a destruction of youth work, a destruction of Sure Start and a destruction of counsellors in schools. Those on the other side praise themselves that they are reintroducing counsellors in schools, but let us be clear that it is a reintroduction, because under Labour last time we had those things that stopped the crisis of young people committing suicide in such large numbers. Of course it was not perfect—nothing is—but it was a hell of a lot better than what we have now, and to suggest otherwise is sickening.

I have constituents affected—hundreds of them—but I will mention three now. One who was diagnosed with autism in year 6 had to wait until year 8 at school before he got any support. That contributed to a mental health breakdown, and there was no psychiatrist in the local CAMHS to support him—a three-year wait and still no needed support. I have a constituent whose son is 13 and has been out of education for two years because of suicidal tendencies—a four-year wait for a proper assessment, including 16 months with no education, health and care plan put in place. Then, at the last moment, he was told he has another wait of 24 months, despite his parents having to take time off work in order to look after him around the clock. The son of another constituent was diagnosed in early 2019, and the first assessment was only in December 2020—three and a half years later he is still waiting for the final assessment and support.

The testimony I have had from an NHS nurse in a neighbouring trust says that there are 3,500 children waiting for an initial assessment, they have no CAMHS beds available, and routinely they have 10-plus children stuck in A&E. This is not covid or family breakdowns; this is a lack of funding and Government failure.

Public Health

Lloyd Russell-Moyle Excerpts

Tuesday 14th December 2021 Commons Chamber

[Wes Streeting]

I wholeheartedly agree with my hon. Friend. Indeed, one of our primary reasons for supporting the measures for consideration today is that we on the Labour Benches support business, and we want to support it through a particularly difficult time, when normally trading would be at its busiest.

The goal in the end must of course be to learn to live with the virus. That means effective vaccination, antiviral treatments, and public health measures that have minimal impacts on our lives, our jobs and our businesses. So let me take each of the measures in turn and explain why Labour supports them, and no doubt take interventions.

First, on mask wearing, no one enjoys wearing a mask—I certainly do not, but it is nothing compared with the costs that more draconian restrictions have on our lives, livelihoods and liberties. Masks are simply a price worth paying for our freedom to go out and live our lives during this pandemic. They are proven to be effective, and not only that, but in times of rising infections, when people are feeling increasingly cautious, it is vital to our economy that people feel safe boarding a busy bus or entering a crowded theatre. In our view, the Government should never have got rid of the requirement to wear masks in those settings, but we know why they did. We have counted, in recent weeks, hon. Members on the Government Benches not wearing masks. I am glad to see that compliance has risen somewhat considerably. We know that the Prime Minister no longer has the authority to lead his own party, but I am grateful that Members on the Government Benches have at least listened to their Health Secretary.

Turning to the vaccine pass, and testing to enter nightclubs and large events, I welcome the fact that the Government have listened to representations from Labour and responded. The Labour party has argued consistently against vaccine passports and insisted on people having the option of showing a negative test. Further, we argued that such passes should not be required for access to essential services. On both counts the Government have listened and amended the proposals, and we can support the measure before us today. It is not a vaccine passport. It is, in effect, a default requirement to show a negative test to enter venues where the virus is most likely to spread, with an opt-out available to those with an NHS covid pass.

[Lloyd Russell-Moyle (Brighton, Kemptown) (Lab/Co-op)]

My hon. Friend makes a very good point on that. Is not the reality that if we did not introduce these measures there would be a danger that our night-time economy—pubs, venues and other events—would have to shut completely? So this pass is actually a pass for freedom to allow us to continue to enjoy activities that otherwise would be shut down, and the libertarians opposite should be welcoming it, not bemoaning it.

[Wes Streeting]

I wholeheartedly agree with my hon. Friend. Let me be clear: we in the Labour party support this approach because we support British business. This is about giving people the confidence to go out and about despite the presence of omicron.