Oral Answers to Questions

Maria Miller Excerpts

Tuesday 19th April 2022 Commons Chamber

[Mrs Maria Miller (Basingstoke) (Con)]

My hon. Friend the Minister is right to talk about the contracts with dentists, but should she not also look at how dentistry is structured and the regional nature of the contracting? It sits outside our clinical commissioning groups, which reduces co-ordination and accountability in respect of something that is central to our health. Should this not change?

[Maria Caulfield]

My right hon. Friend is right. Health Education England is addressing the overall system of where dentists are training and where the gaps in provision are filled in its “Advancing Dental Care” review. It is also working with commissioners at a local level to develop more opportunities in those places that we term dental deserts, where there is currently a lack of provision.

Health and Care Bill

Maria Miller Excerpts

Consideration of Lords amendments
Wednesday 30th March 2022 Commons Chamber

[Jess Phillips]

I have heard similar framing, with some saying people will take the pills after 10 weeks. If we look at the actual data, we see it shows that the change increased from 25% to 40% the proportion of abortions happening before six weeks. Telemedicine has dramatically reduced the gestational period, making it much less. I am afraid to say that these are not a good faith arguments. They are based not on fact, but on the idea that women will lie. Women are concerned about their health. They are frightened about their health. We do not make decisions about our health in the hope that we will be harmed; we do what is best. We should not be treated like children; we should be treated like adults.

[Mrs Maria Miller (Basingstoke) (Con)]

I thank the hon. Lady for giving way and add my condolences to those of others for her sad loss.

The hon. Lady is right when she says that these issues can be entrenched and people have entrenched points of view. When we have that situation as a House, we look at the facts and at what the experts say. The experts who support Government amendment (a) in lieu of Baroness Sugg’s Lords amendment 92 include the vast majority of professionals: the Royal College of General Practitioners, the Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives, the British Medical Association; and the Academy of Medical Royal Colleges. Does the hon. Lady agree that, when it comes to trying to find a way forward through entrenched views, we should look at the experts, and the experts are giving us a very clear way forward, followed by my hon. Friend the Minister?

[Jess Phillips]

I absolutely agree. It is difficult to be dispassionate. I have never been accused of being dispassionate about anything. I am passionate about what I eat for my breakfast. I am just not a dispassionate sort, but the right hon. Lady is absolutely right that we must look at column A and column B in this instance. Column A is full of experts—medical experts, women’s rights experts, and women themselves—and a huge amount of evidence.

--- Later in debate ---

[Dame Diana Johnson]

I want to address the issue of safeguarding. Let me be clear: creating more barriers to access does not help women; it helps abusers. The End Violence Against Women coalition and other major VAWG organisations reject the claim that telemedical abortions put women at greater risk of coercive abortions. The fact is that coercive pregnancies are far more common than coercive abortions, and since the introduction of telemedical abortions providers have seen a rise—a rise—in safeguarding disclosures, highlighting that the system provides a safe space for women to come forward if they are being coerced. Nurses are highly trained to assess safeguarding issues, and if concerned they will ask the women to come to the clinic for face-to-face assessment.

Finally and crucially, women themselves strongly favour keeping telemedicine for early medical abortion. A clear majority want it to continue.

As a country, we have an opportunity to be seen to be a shining light for women’s reproductive rights around the globe at a time when those rights are being rolled back elsewhere. The weight of the evidence in favour of maintaining this essential women’s healthcare pathway is overwhelming. I ask Members to support the amendment in lieu.

[Mrs Miller]

First, I apologise for being late to the debate, Mr Deputy Speaker. I appreciate your calling me to speak, and I will be brief.

Amendment (a) in lieu of Lords amendment 92 is all about increasing women’s choice, not about taking choice away from anyone. The basis on which the amendment can be judged is the evidence we have gathered, not in a short period of time, but during two years in which 150,000 women have used telemedical abortion care. Judge the amendment against that backdrop; it is done not on a whim or a fancy, but after two years of intensive analysis.

While I might want to agree with those of my right hon. and hon. Friends who are calling for a reasoned debate in the House of Commons on the broader issues of abortion, the truth is that we do not have those debates because the Government talk about changes to abortion provision coming from Back Benchers when that provision is now so out of date in our country that we need the Government to look at it more broadly. I will support the amendment because it is the right thing to do. The amendment is backed by a huge range of organisations and a significant body of evidence, and it requires the Government to look more broadly at abortion—to take this as a responsibility and to stop shoving it back on to the Back Benches.

Continuing telemedical abortions will be supported and regulated in exactly the same way as face-to-face abortion care, and to suggest otherwise is to be factually incorrect. Members really need to think about the evidence showing that online sales of abortion pills from unregulated providers have decreased since telemedical abortion was made legally available. Rather than push people back into an unregulated market, let us keep what we have, which has worked for 150,000 women over the past two years. But please, please, Minister, let us have a reasoned look at abortion more broadly. Stop saying that this is an issue for Back Benchers. It is not.

[Alex Cunningham (Stockton North) (Lab)]

I will speak specifically to Lords amendments 85 to 88 on tobacco control. First, I pay tribute to my hon. Friend the Member for City of Durham (Mary Kelly Foy) who put so much work into tobacco control amendments in Committee but is unable to be here. Like her, I am an officer of the all-party parliamentary group on smoking and health, and I strongly support amendments 85 to 88 on the “polluter pays” levy on tobacco manufacturers. I heard what the Minister said about a levy being complicated and how it might take years to implement, but a way must be found to make big tobacco pay for the crisis that it sustains every day that it remains in business.

Like my hon. Friend the Member for City of Durham, I represent a constituency in north-east England, which is the most deprived region of the country and has high rates of smoking. We have reduced smoking significantly in recent years, but, despite that progress, it is still the leading cause of premature death, killing more than 400 of my constituents a year. In my constituency, smoking costs society more than £62 million, which is money that our community can ill afford. I also worry that nearly 15% of local pregnant women are still smoking at the time of delivery, which is 50% higher than the national average. We all know that smoking in pregnancy significantly increases the risks of miscarriage, stillbirth, sudden infant death syndrome and foetal growth retardation. The levy would raise vitally needed money for investment in deprived areas such as ours in the north-east to break the cycle of addiction, disease and premature death. At current rates of decline, Cancer Research UK has calculated that the smokefree 2030 ambition will not be achieved for our most disadvantaged communities until 2047.

Access to NHS Dentistry

Maria Miller Excerpts

Thursday 10th February 2022 Westminster Hall

[Mrs Maria Miller (Basingstoke) (Con)]

It is a great pleasure to serve under your chairmanship, Mr Efford. I thank my hon. Friend the Member for Waveney (Peter Aldous) for his leadership on the issue. I pay tribute to my everyone at my local dentist for the work that they do—the technicians, the hygienist and the staff in both the private and NHS practices. I particularly pay tribute to them for everything they tried to do during the pandemic, as mentioned by my hon. Friend the Member for North East Bedfordshire (Richard Fuller).

Let us be under no illusion about the importance of dental health. It is not some cosmetic thing. The science shows that the health of our teeth and gums is integral to our overall health. Gum disease is linked to strokes, diabetes and heart disease, so the health of our teeth really matters. The Government spend more than £3 billion a year on NHS dentistry, including around £500 million in my own region of the south-east. Why does it feel, from all the conversations we have had, that that part of our health system is a distant cousin in comparison with the rest of our community health services?

Certainly in my own part of North Hampshire, that came into stark relief during the pandemic, showing the systemic fault line in the dental system and how it is semi-detached from the rest of our local NHS services. Despite being one of the sectors of the NHS that is most experienced with infection control, it was effectively shut completely for almost three months, and for many more months measures were put in place to significantly reduce the number of patients that could be seen. There was almost no way of accessing support, despite the fact that many professionals were very willing to put it in place, including dentists from my own area who contacted me at the time.

There are three systemic issues that the Minister needs to touch on. We need to be clearer about the role of the NHS in providing dentistry. The hon. Member for Bradford South (Judith Cummins) touched on the importance of private and NHS provision, but let us not fudge it. We need a mixed economy in the sector if we are going to go forward. Although I agree with the Father of the House that there should always be an NHS option, we need a system that embraces both private and NHS services and enables them to work together.

The second issue is around NHS contracts, which we have heard a lot about in the debate. There are no incentives in the current contracts for prevention or continuity of care set out by the National Institute for Health and Care Excellence. There is no real requirement to develop a relationship with patients, which would be beneficial for the long term. Surely that has to change. Can the Minister update us on that?

When it comes to scrutiny and accountability, dentistry is simply not the same as the rest of the NHS. I asked my local regional commissioner in the south-east for some data about 10 days ago when the debate was announced. I still do not have any local data on waiting times for appointments. Why? Because it is not collected. That is appalling. We are spending £500 million in my region, but we are not collecting any data on waiting times. Commissioning the service at a distant, regional level not only failed us in the pandemic, but fails us on an ongoing basis. Will my hon. Friend the Minister, who is really diligent in her work, touch on that in her speech?

We have to see a way forward. The people who access NHS dentistry rate it really highly. We welcome the additional funds that the Government have put in place to provide catch-up, but even though my constituency has two of the three Hampshire dentists who provide those extra services, I am still seeing a spike in problems in accessing the extra dental appointments. I do not think we are out of the woods yet with the hangover from the pandemic.

We need more accountability. We need dentistry to be part of our local health system, we need regional commissioning to be a thing of the past and we need a contract that really works. The 2020 NAO report on the subject is really important, demonstrating that in some areas there are significant under-deliveries of contracted dental services, making it even harder for patients to get NHS services that the NHS is actually willing to pay for. Indeed, the NAO report estimated that almost 1,000 practices fell into that category, delivering up to 40% fewer dental units than they should be in some areas. Let us have a contract that means that people get what they need, that prevention is in place, and that there is continuity of care. Others have touched on the need for more dentists. We have significantly fewer dentists per head than Germany and France. I welcome the work that the Government are doing on that but we need more.

The short-term problems created by the pandemic have shown much more significant and fundamental problems in our dental services. Let us use this opportunity to capitalise on that understanding of where the problems lie and get change that will deliver, for the long term, better dental service for everybody in the private and NHS sectors.

--- Later in debate ---

[Mrs Miller]

Will the hon. Gentleman give way?

[Peter Dowd]

In a moment. I am happy to give way, but we were told earlier that we did not have much time.

I do not want to detract from the substance of the debate, but it would be remiss of me not to talk about the crisis in health and social care more generally. Specific recognition from the Government of a crisis in access to dental services would give me a bit more confidence that they have a handle on it. More importantly, it would give me confidence that they are actually going to do something substantive about it. I wait with bated breath.

[Mrs Miller]

Will the hon. Gentleman give way?

[Peter Dowd]

In a moment.

Any denial by the Minister that there is a problem is itself a part of the problem. I really do not want to hear any denials.

[Peter Dowd]

I am pleased that the hon. Gentleman raises that. The bottom line is this: look at the Public Accounts Committee documents. There are more to come out. If the hon. Gentleman wants to have a debate on fraud, I am more than happy to have one. Perhaps he can put in the application and I will come and speak to him about it.

[Mrs Miller]

What would the hon. Gentleman have done differently in 2006 when the current dental contract was put in place? Of course, at that point, he would have been able to influence the Labour Government.

[Peter Dowd]

I will come back to that in a minute. I am an optimist—hope springs eternal, as Alexander Pope said—and I hope the Minister will accept that there is a crisis. Perhaps then we can all move on, in a very collegiate way, as the hon. Member for Thirsk and Malton (Kevin Hollinrake) says, towards finding a solution, which he knows I am more than happy to do.

Public Health

Maria Miller Excerpts

Tuesday 14th December 2021 Commons Chamber

[Mrs Maria Miller (Basingstoke) (Con)]

The health of the nation has united this House over the past 22 months, but what we know about the impact of covid on the health of the nation has now changed, which has led to this debate. We know that the physical impact of covid is only part of the story, that mental health is a significant consideration and that the impact of covid on our hospitals has to be considered alongside the impact of cancelling non-covid treatments, too. Many hon. Members have referred to the impact on children of being schooled at home, and there is the impact on many people of working at home, which is not without its risks.

My right hon. Friend the Secretary of State for Health and Social Care set out very clearly his case for the measures before the House. The new omicron variant is more transmissible than the delta variant and, even if it has the same impact on our health as the delta variant, its high transmissibility means this new variant could have a more significant impact on the number of people who need urgent hospital treatment. Stopping the NHS being overwhelmed has been our objective from the start.

I commend the Government’s focus on ramping up the booster roll-out, which is a vital part of solving the problems we face, but these regulations are designed to take those actions a step further to help keep down transmission levels, which is why I support them. The nature of human activity means we will not have a perfect set of neat decisions. These regulations do what is possible, not what is perfect.

I have a couple of questions for the Minister, particularly on the importance of making sure we protect the education of our children. Will he provide an update to hon. Members next week on the number of hospitalisations, even if the House is not sitting? We cannot eliminate the risk of covid-19, but these time-limited measures will help to reduce the risks faced by our communities. If our NHS is overwhelmed, it will put at risk not only covid patients but anyone who needs emergency care through the winter months. We have to act with caution, which is why I will support these measures in totality. I commend the Government for putting the safety of the people we represent first, and I commend them for taking this approach.

Covid-19 Update

Maria Miller Excerpts

Monday 13th December 2021 Commons Chamber

[Sajid Javid]

It is an important fund, and I will look into that.

[Mrs Maria Miller (Basingstoke) (Con)]

I thank my right hon. Friend for everything that he and his whole team are doing in what are incredibly challenging circumstances. Can I bring him back to the specific issue of access to booster appointments? He said in his statement that the booster roll-out was now a national programme rather than being locally led. Our local GP teams are doing a fantastic job, but will this difference in approach mean that more pharmacies, such as those in Basingstoke, will be able to be part of the booster roll-out in a way that they have not been to date?

Sickle Cell Treatment

Maria Miller Excerpts

Wednesday 8th December 2021 Westminster Hall

[Mrs Maria Miller (in the Chair)]

Before we begin, I remind Members that they are expected to wear face coverings when they are not speaking in the debate, in line with current guidance. I remind Members that they are asked by the House to have lateral flow tests twice a week. Please make sure that you give members of staff and other people lots of space when you are leaving or coming into the room. I expect that there will be a Division at around 3 o’clock, and I am advised that there could be up to four votes. If the Division bell rings, I will remind hon. Members what to do, but people who are speaking at around that time should bear that in mind, so that it does not freak you out—sorry, that is probably not parliamentary language—or catch you unawares.

[Mr Pat McFadden (Wolverhampton South East) (Lab)]

I beg to move,

That this House has considered the treatment of sickle cell.

Thank you for chairing our proceedings, Mrs Miller. I am very pleased to open this debate. I chair the sickle cell and thalassaemia all-party parliamentary group, which works for a better understanding of sickle cell and better treatment for those living with the condition. I am enormously grateful to all hon. Members who have supported the APPG’s work, including our late colleague Sir David Amess, who was one of our officers. I am also grateful to the Sickle Cell Society, which provides the secretariat function for the APPG. I also thank Parliament’s digital engagement unit, and the hundreds of individuals from around the country who have emailed me in advance of today’s debate.

The focus of our debate is the APPG’s recent report, “No one’s listening”, which has a number of findings and recommendations in relation to the care of people with sickle cell. The trigger for our report was the tragic and avoidable death of Evan Nathan Smith in North Middlesex University Hospital in 2019. The coroner’s report into Evan’s death, published in April of this year, found that he would not have died if medical staff had recognised his symptoms and treated him sooner. The report pointed to a

“lack of understanding of sickle cell disease in the medical and nursing staff looking after Mr Smith”

and

“a failure to appreciate the significance of those symptoms by those looking after Mr Smith at the time.”

Evan Smith was just 21 years old; he had his whole life in front of him. His death is not the only one in which a lack of understanding of sickle cell and mistakes in treatment have been contributory causes.

--- Later in debate ---

[Mr McFadden]

I very much agree with my hon. Friend. Indeed, the next finding that I was going to cite is a lack of research and innovation in treatment. There has only been one new drug approved in the UK for sickle cell treatment in decades and it was approved just before our report was published.

For each of the findings, we made recommendations: about training; about compliance with clinical guidelines; about reviews of sickle cell treatment in secondary care; about communications change; very importantly, about a stronger voice for patients in all of this; and in many other areas, too.

Underlying all those individual findings and recommendations are some key overarching themes. First of all, the experiences that I have described have contributed to a damaging loss of trust among sickle cell patients in the system that is there to help them. Some patients told us that they avoided going to hospital at all costs, no matter how serious their crisis, because they found the whole experience so exhausting and debilitating, or, as one woman put it,

“to avoid the mental strain of another battle...when she does not have the energy to advocate for herself”.

It cannot be right that people who need help have so little trust that they do not seek that help from the very system of care that is supposed to be there for them.

Secondly, there is the unavoidable question of race. Sickle cell is a condition that predominantly, but not exclusively, affects black people. Many patients told us of being treated with suspicion when they sought treatment, being regarded as troublesome by staff, being thought of as drug-seekers, and encountering negative and sometimes even hostile attitudes.

The principle of racial equality in healthcare is fundamental. No one is seeking to put one group of people above another, but we want to see equality in healthcare treatment and right now with sickle cell we do not have that. That situation is completely unacceptable and, following this report, it must be addressed.

Thirdly, the findings that we cite in our report are not new; these things have been happening for a long, long time. They have been raised time and again, and the fact that this situation is continuing has led to a great deal of anger and frustration among those living with sickle cell and their families.

Yet, even though all of those things are true, this might—just might—be a moment of opportunity. Why do I say that? Soon after the Secretary of State for Health and Social Care was appointed, he spoke about the “disease of disparity” and about how the covid pandemic had exposed a number of long-standing health inequalities, including racial ones. I welcome the Secretary of State’s commitment to address these inequalities and his warm welcome for our report on the day it was published. Perhaps this is a moment when we are more aware of health inequalities than we would have been before the pandemic; maybe this period can be a turning point for change.

There is no need for this to be a partisan issue. No one is pretending that the findings in our report only began in recent years or under one Government. These things have been there for a long time. However, perhaps the experience of the pandemic will give us a new-found resolve; maybe it will mean that this time people listen.

From the Secretary of State and the Department to the NHS in every part of the United Kingdom, we want this report to mark a moment of change in the treatment of sickle cell. We want to ensure that the issues raised in the report are addressed once and for all, and that training is improved so that staff throughout the system understand, and have a knowledge of, the condition. We want to ensure that care plans and pain relief protocols are adhered to by both the generalist and the specialist parts of the system. We want to step up research and innovation in treatment and restore trust among sickle cell patients. Most of all, we want to ensure that there is equal health treatment for everyone, regardless of the colour of their skin. That is not too much to ask for, but we do not have it at present.

Today I appeal to the Minister, the Secretary of State, my own Front-Bench team and the other parties represented here to become our allies in this and to work with us. Please do not let this be a missed opportunity. Let us collectively resolve that we will not have me, or another chair of the APPG, standing here in a few years’ time making exactly the same points as I am making today. Let us make sure that this time people do listen, that we act on these long-standing failures in the care of people with sickle cell and that we improve healthcare for people with this condition once and for all.

[Mrs Maria Miller (in the Chair)]

I remind hon. Members that if they want to speak in the debate, they should indicate it by rising in the normal way. I intend to call the Front-Bench spokespeople and the Minister just over 30 minutes before the end of the debate, whenever that falls—I will clarify that if there is a vote. I will not put in a time limit; if everybody is respectful of each other’s time, everybody should be able to speak.

--- Later in debate ---

[Jim Shannon (Strangford) (DUP)]

Thank you, Mrs Miller, for giving me the opportunity to speak on this issue. I am my party’s health spokesperson and it is always a pleasure to speak on any health issue.

I was talking to a colleague about Stephen Pound, the former Member for Ealing North, who told me about this disease. He and I had a good, friendly relationship. I went to an all-party group event on sickle cell, and through Stephen’s introduction I perhaps gained some small knowledge of the disease. I want to speak today on behalf of those people who have sickle cell. We do not have it in Northern Ireland; thank the Lord we do not have it in Northern Ireland—[Interruption.]

[Mrs Maria Miller (in the Chair)]

Order.

[Jim Shannon]

I was just getting started.

[Mrs Maria Miller (in the Chair)]

There is a Division in the House. I am going to suspend the sitting for 15 minutes, and for 10 minutes for each subsequent vote, but may I encourage Members to return to this Chamber as soon as possible so that we can resume the debate and ensure that as many Members as possible can participate? Thank you.

--- Later in debate ---

On resuming—

[Mrs Maria Miller (in the Chair)]

Order. If the next break is 15 minutes long, and we have just one break, we should complete this debate at around 5 o’clock. Can Members bear that in mind?

[Jim Shannon]

I will not repeat what I have already said; I will not take more than four or five minutes, and then I will give other Members a chance to speak. I was referring to Stephen Pound, the former Member for Ealing North, who introduced me to sickle cell and understanding that process. This happened around the time that the daughter of one of my staff members had taken ill—she lives over here. I am not smarter than anyone else when it comes to health issues, but I just happened to say to my staff member, “I hope she hasn’t got that sickle cell.” From what I understand, she could not have had it. However, she did have primary biliary cholangitis; this is a lifetime health issue—a forever illness. It was just because at that time, I had been made aware of sickle cell, and I wondered if there was any connection.

Sickle cell can affect anyone, although it is more common in people from African and Caribbean backgrounds. The National Institute for Health and Care Excellence estimates that there are currently 12,500 to 15,000 people with sickle cell disease in England, while data from NHS Digital shows that there were almost 25,000 hospital admissions in England in 2020-21 where the primary diagnosis was sickle cell disorders. It is very clear that there is a significant issue when it comes to sickle cell. I commend the right hon. Member for Wolverhampton South East (Mr McFadden) for introducing the debate and raising awareness of the condition—I should have done so at the beginning; apologies for not doing so—and I support all the other speakers who are here today.

A stem cell or bone marrow transplant is currently the only cure for sickle cell disease. Neither are commonly undertaken in sickle cell patients. The US National Heart, Lung and Blood Institute notes that a

“well- matched donor is needed for a patient to have the best chance for a successful transplant”.

In the introduction to sickle cell given to me by Stephen Pound, that was one of the things that we looked at in relation to transplant issues. However, most patients who have sickle cell disease are either too old for transplants, since the risks associated with transplants become greater as a person gets older—and the older someone gets, the less they may want to receive one—or they do not have a relative who is a good enough genetic match to be a donor.

There are many issues that need to be resolved. After reading the APPG on sickle cell and thalassaemia report into the quality of care received by sickle cell patients, “No One’s Listening”, my heart went out to those people who quite simply feel abandoned—many people do. How do we improve that? The Minister and I are good friends, and I know that, when asked for help with this issue, she will come back with a response that the right hon. Member for Wolverhampton South East, and others, will be happy with.

The key findings of the report are a true indictment of the current state of play for sickle cell sufferers. Evidence of substandard care for sickle cell patients, either in a general ward or attending an accident and emergency department, including a widespread lack of adherence to national care standards, is unacceptable, as is the fact that there is clearly a low awareness of sickle cell among health care professionals. There are examples of inadequate training and insufficient investment in sickle cell care. In the Minister’s response, can she give some indication of how that can be improved, so that awareness can be raised and sickness levels addressed?

Many sickle cell sufferers feel that they are not getting answers. That is not a criticism of Government, but if we indicate that there is a problem, as we are doing through this debate, and there is a way of curing that problem, let us do that. There is a clear breakdown that must addressed, not simply clinically, with treatments being made widely available, but further with the training of medical staff and teams to understand this disease and its other medical contraindications.

Those are the issues that we are looking to the Minister to address. I support the right hon. Member for Wolverhampton South East and his attempt to highlight this plight, as he and other speakers have done so well—that will continue in the following contributions. They have not simply highlighted the problem, but pushed the Government and the Minister for action to begin the steps to rectify our current approach.

--- Later in debate ---

[Janet Daby (Lewisham East) (Lab)]

There have been some really powerful contributions to this debate, especially from my hon. Friend the Member for Vauxhall (Florence Eshalomi). I appreciate everything that she has shared, including the turmoil and difficulty that was endured when she had to care for her mother. I want to acknowledge that, and show her my appreciation and thank her for her contribution.

I also congratulate my right hon. Friend the Member for Wolverhampton South East (Mr McFadden) on securing this important debate. He knows only too well the need to speak about the experience of children, young people and adults who have sickle cell disease and where they experience health inequalities. People with sickle cell disease desperately need us to raise their profile in this place, and I am so pleased that we are able to do so this afternoon. My right hon. Friend and I have worked hard on this issue together through the sickle cell and thalassaemia APPG.

It is truly shameful that the history of treatment of sickle cell in this country is a story of ignorance and neglect. That disease causes unimaginable suffering, most often to people of African and Caribbean descent, a group of people who already experience medical discrimination. I have frequently spoken out in this place about health inequalities, with specific reference to the impact of sickle cell in diverse communities, and the correspondingly poor investment into care and research. I have heard first-hand stories of the suffering of patients, both their physical pain and the psychological trauma of not being able to afford their medication or their condition not being understood as a student, in the workplace or, indeed, in hospitals. I have heard from people who feel worried about disclosing their illness—about their voices not being heard and their pain not being believed. A young man has told me that he is afraid to attend an A&E department in case he is not believed and treated correctly when he is in a crisis, and that is not the first time that I have heard this. Going into hospital should be about alleviating fears and worries. A hospital should be a place of safety, but that is not the general experience among some people who suffer from sickle cell.

When a doctor or nurse does know how to treat someone with sickle cell, that patient feels confident, but too often, that is not the case. Our nation has already heard about the case of Evan Nathan Smith—[Interruption.]

[Mrs Maria Miller (in the Chair)]

Order. The sitting is suspended for 15 minutes.

--- Later in debate ---

On resuming—

[Mrs Maria Miller (in the Chair)]

Everyone is back now, so I will recommence the debate. Just so that everybody can plan their day, I can confirm that we will end the debate at 4.56 pm. I will call the Front Benchers at 4.24 pm.

[Janet Daby]

Thank you, Mrs Miller. Our nation should know of the case of Evan Nathan Smith, but there were also the deaths of two army recruits during military training. If they had been treated appropriately—all of them—their deaths could have been avoided. One of the young men was aged 21; the other was 31. They were undiagnosed with sickle cell. A coroner warned that their deaths could be repeated without urgent Government intervention. The recent inquiry by the APPG found that the majority of sickle cell patients surveyed had received inadequate healthcare support, adding to their physical discomfort and distress. Our NHS is underfunded, and it needs the resources to train staff to have specialist understanding of sickle cell.

The Government have decided not to fund the research that is so desperately needed and they need to say why that is. Will the Minister give young and old sickle cell sufferers hope for their future by ensuring that training on sickle cell is included in the teaching of medical, nursing and midwifery degrees at all universities and colleges? A further area that needs to be addressed urgently is how to respond to a sickle cell crisis. That information is needed, and these professionals need to know what to do.

A sickle cell crisis is when sufferers experience a severe attack. Their blood cells stick together, and it causes unimaginable pain across their whole body. Sadly, too often medical professionals do not recognise the signs of a crisis. Stigma and stereotyping have a part to play in this, and racial discrimination must come to an end. If necessary pain relief is not given, the condition can worsen and go on to affect internal organs, which causes other medical conditions. At its worse, it leads to death. That can be prevented if the Government have the will to make the necessary changes.

NICE guidelines state that the first dose of pain relief should be administered no longer than 30 minutes after a sickle cell crisis starts. Can the Minister tell me why that target is so often missed? Why does the Care Quality Commission not recommend it as an official guideline? What do the Government intend to do to address this?

The APPG report made several recommendations, including guidance for specific NHS trusts to improve their performance. It requested commitments to raise awareness of sickle cell in the medical community, from paramedics to A&E doctors and senior consultants. Professionals from across the public sector also need to be educated in what sickle cell involves, from nursery nurses to teachers and employers. Children, young people and adults with sickle cell need to be understood.

We should investigate whether we can test every baby for this disease. We know that around 300 babies are born with sickle cell each year. If they have not done so already, I ask that the Minister and her team urgently read the APPG report supported by research from the Sickle Cell Society and take heed of the guidance to change practices. Sickle cell patients like Shubby Osoba are describing sickle cell care as a lottery. On some days, in some hospitals, sufferers get the help they need. On other days, in other hospitals, they do not. That is just not good enough.

Over two years ago I asked the then Health Secretary, the right hon. Member for West Suffolk (Matt Hancock) if he would remove the current charge for prescriptions for sickle cell medicines. Some patients are on five different medications a day. For a lifelong illness, that is a heavy financial cost. The right hon. Member for West Suffolk promised to look into this, but all this time later nothing has changed. Will the Minister take forward this measure and relieve patients of yet another burden on their lives?

I also bring it to the Minister’s attention that it is more cost-effective for the public purse to prevent hospitalisation by adding this lifelong disease to the list for free medication than to treat people with this disease in hospital. I am sure Members would agree that prevention is better than cure. In this case, preventing a crisis by free medicine is much cheaper than being in hospital. I impress upon the Minister the need to have a conversation with the Chancellor concerning this issue. So much more needs to be done. On behalf of those with sickle cell and their families, I ask the Minister to respond appropriately to the serious concerns that have been raised by myself and other Members across this Chamber.

[Mrs Maria Miller (in the Chair)]

I remind hon. Members that we need to go to the Front-Bench speeches at 4.24 pm.

--- Later in debate ---

[Liz Kendall (Leicester West) (Lab)]

It is a pleasure to serve under your chairmanship, Mrs Miller. Like everyone, I congratulate the right hon. Member for Wolverhampton South East (Mr McFadden) on securing this debate on an extremely important issue. I pay tribute to the members, officers and staff of the APPG on sickle cell and thalassaemia. The report “No One’s Listening” is one of the most powerful, serious and substantial reports I have read in a long time in this place and while working in the health and care field. The detail, analysis and recommendations it provides are really important and cannot be ignored.

As we heard from right hon. and hon. Members, the report was carried out in response to the absolutely tragic case of Evan Nathan Smith, who died in the most utterly appalling circumstances with his whole life ahead of him. It is crystal clear from the coroner’s inquest that he would not have died had it not been for the failures in his care: the failure to get the pain relief he desperately needed, the failure to give him a timely blood transfusion and the utter lack of understanding about sickle cell Opposition the part of the staff looking after him, in an area where they should have known because of the local population.

Most importantly, the report highlights far more fundamental issues, which my right hon. Friend the Member for Wolverhampton South East picked out in his comments. First, this is not an isolated incident, as my hon. Friends the Members for Vauxhall (Florence Eshalomi) and for Streatham (Bell Ribeiro-Addy) so powerfully and personally described. There is a pattern of years of substandard care in this crucial area. Patients understandably lose trust in the system. Secondly, there is the issue of race—the racial inequalities in the standard of care being provided and the stereotyping and discriminatory attitudes towards black people that have contributed to that. Of course, those two things are inextricably linked—

[Mrs Maria Miller (in the Chair)]

Order. Could I encourage the hon. Lady to project her voice this way?

[Liz Kendall]

I apologise. I should be speaking to people rather than into a void.

Unless we understand those two fundamental issues, we will never get the change we need. I want to use my time not to repeat what others have said but to talk about how we get real and lasting change, thinking about some of my own experience of working in health and care for 20 to 25 years. There is a lot in the report that is excellent. Much of it is coming from the top down, and there are important recommendations that should be followed, but the real change that we need to see is to give patients and their families far more say, control and involvement in the system, because that is how we will get lasting change.

Five key areas need to be addressed. The first is tackling the appalling variations in care that the report highlights. The really important issue, which my hon. Friend the Member for Vauxhall picked up, is that as our country becomes more diverse—something we should celebrate—this issue will not just affect London. That point was made in evidence to the APPG by Global Blood Therapeutics, which clearly said that the geography of sickle cell is starting to change, with patients increasingly moving outside London. In understanding that, we have to ensure that variations in care are ended in all parts of the country.

One of the most important recommendations in the report is that all NHS trusts should share findings of their internal reviews into incidents involving serious sickle cell care failings with the National Haemoglobinopathy Panel so that learnings can be communicated across the country. It is within the remit of the Minister and the Department to ensure that that happens, so I hope she will set out what she intends to do and what discussions she has had with NHS England about making it happen.

The second key recommendation around variations is that the CQC should make compliance with NICE clinical guidelines on the delivery of pain relief within 30 minutes for sickle cell patients an essential criterion that it uses when assessing NHS trusts. As far as I can see, the CQC has not responded to the report. I wonder what discussions the Minister has had with the CQC about that, because it is crucial.

The third issue around variation, which the right hon. Member for Tunbridge Wells (Greg Clark) touched on, is that we now have integrated care systems across the country. Every time there is an NHS reorganisation, and there have been many over the last two decades—I have been involved in some myself—we lose institutional memory about these issues and findings. What discussions has the Minister had with colleagues in the NHS about how we ensure that, when people have made changes or are trying to make a difference, that is reflected in the new ICSs as they get up and running across the country?

The second key issue is around communication and the lack of joined-up care. There are so many parts of the NHS where those conversations do not happen, and it is patients who are left telling people what they need. Will the Minister set out what she will do to try to ensure that NHS trusts improve communication within their own hospitals and follow the particular recommendation that all haematology teams are informed whenever a sickle cell patient comes into A&E or on to a general ward? I will pursue that with University Hospitals of Leicester in my constituency as a result of the report to ensure that it happens.

Thirdly, improved awareness of the condition and training are critical. That has the power to make one of the biggest differences. Staff are not purposely not understanding it; they need to be trained in it. The report sets out recommendations about universities having proper training, and says that the Nursing and Midwifery Council and the General Medical Council should urgently review their approach to training on sickle cell conditions. Again, I do not think that the NMC or the GMC have responded, although I may be mistaken, but unless people are properly trained how will they make a difference in the future?

The fourth issue is that of race, racism and discrimination within the NHS. I know from my own diverse constituency and the work that I have done with Leicester Against Racism that there is much that can be done to improve understanding of the different issues facing black, Asian and minority ethnic communities in the NHS, to improve access to and outcomes of care, to understand the implicit and explicit discriminatory attitudes that may be present in the NHS and, crucially, to have better representation of BAME communities in senior NHS leadership positions.

During today’s debate people have talked about their own experiences, understanding the issues and showing that Parliament can act on the issues that matter to our communities because of our diverse representation. That is what we need in the NHS. I hope the Minister will be able to say what NHS England is doing about those issues.

Last but by no means least, the NHS always changes its structures and organisations, and people move around, so it is often difficult to embed change in the system. In my experience, the only way to do that is to give patients and their families far more voice, and I include training in that.

Imagine if my hon. Friend the Member for Vauxhall—if she was not extremely busy representing her constituents—was involved in the training of health professionals and told her story so that people could hear what had happened to her. It would be a powerful driver of change if the people who use services could be part of the training and the way the system is regulated. That is how we will get real change in the system and I hope the Minister will set that out.

In conclusion, the report provides an opportunity to make substantial and lasting change. I hope the Minister will set out the Government’s response when she stands to speak.

Health and Care Bill

Maria Miller Excerpts

Report stage
Tuesday 23rd November 2021 Commons Chamber

[Emma Hardy]

I will be brief, speaking to new clause 32 in my name. It is an amendment based on the proposed Charlie’s law. I thank my dear friend and colleague, my hon. Friend the Member for Enfield, Southgate (Bambos Charalambous), who has been working on the issue with the Charlie Gard Foundation and the tireless campaigning of Charlie’s parents.

I will be as brief as I can be. In short, my new clause seeks to do five things: first, to require the Secretary of State to put in place measures to improve early access to mediation services in hospitals where conflict is in prospect; secondly, to provide for access to appropriate clinical ethics committees, so that both doctors and parents are supported in making difficult decisions by impartial ethical experts; thirdly, to provide the means necessary to obtain second medical opinions swiftly and to ensure that, when requested, parents receive access to their child’s full medical data, so that the second opinions are fully informed; fourthly, to provide access to legal aid to ensure that families are not forced to employ costly legal representation or to rely on outside interest groups to fund representation in court; and, finally, to create a new legal test of whether an alternative credible medical treatment would cause a child a disproportionate risk or significant harm in deciding whether a parent is able to seek that treatment for their child.

In essence, the provisions set out in the new clause would mitigate conflicts at the earliest stage, ensure that the voices and opinions of parents are listened to, save hundreds and thousands of pounds for parents, doctors and the NHS in protracted legal battles, and ensure that a critically ill child is given the best care and support available at a crucial time in that child’s life. No parent wants to spend time in court or in battle against the NHS when their child is critically ill. There must be a better way to resolve conflict. I hope that the Minister looks seriously at my new clause 32 and at ways to incorporate it into future legislation.

[Mrs Maria Miller (Basingstoke) (Con)]

I speak to new clause 50, tabled in my name and that of the right hon. Member for Kingston upon Hull North (Dame Diana Johnson).

We badly need a wake-up call, because at the moment we are allowing the criminal law as currently drafted to drive a fundamental wedge between Northern Ireland and Great Britain, treating women in Northern Ireland in a completely different way from women in England and Wales when it comes to abortion. Two years ago, the Government changed the law governing abortion in Northern Ireland after a vote in this place, removing criminal sanctions on abortions in Northern Ireland, while leaving women in England and indeed Wales facing the possibility of the harshest criminal sanctions for abortion in the world, under laws passed more than 50 years before any women was even able to vote for the people representing them in this place.

New clause 50 would change that. It would decriminalise abortion and ensure that women in England and Wales are treated in the same way as women in Northern Ireland when it comes to abortion. Our values and our rights are what unite our four nations. To treat women differently in those nations weakens those ties. That needs to be rectified. The new clause does just that, and it would change nothing about abortion services, access to abortion or the time limits on abortion.

The women most likely to be affected and governed by the criminal law are some of the most vulnerable in our society: victims of domestic abuse, of honour-based violence and of rape, and those who are too poor or marginalised to travel to a clinic to seek help. If a desperate woman attempts to end her pregnancy, do we really want her to not seek medical help for fear of arrest and prosecution? New clause 50 simply removes women from being subject to the criminal law for seeking an abortion, and it is fully supported by the medical experts, the Royal College of Obstetricians and Gynaecologists and the Royal College of General Practitioners.

--- Later in debate ---

[Jim Shannon]

It is a pleasure to be able to make some comments on Third Reading. The Secretary of State and the Minister will know my position on these matters. I should like to commend the hon. Member for Congleton (Fiona Bruce) and my hon. Friend the Member for Upper Bann (Carla Lockhart) for their dedication to these issues. Their passion in this House is matched by many in my constituency who, despite the fact that their view is constantly disregarded, still urge me in their hundreds—I received hundreds of emails yesterday and hundreds today—to do what I can to speak for life. That is what I do here today. I care about the life of the woman and I care about the life of the unborn child. I am starting from the position that both lives matter, and it is one on which I stand firm.

In this House, there is a large number of MPs who are opposed to abortion on demand and who have an opinion on that. They include those who represent Northern Ireland and other parts of the UK in this House. I want to reiterate my position on the last vote that took place in Northern Ireland. An opinion poll found that 60% of constituents were opposed to abortion on demand. I am sure that I am far from being alone in recognising the double standards that our medical guidelines currently endorse, fighting for a life at 22 weeks in one case and ending it at 22 weeks in another case.

There are those who advocate that choice comes above viability, but that view is not replicated even by the many who support abortion in principle. It is a pity that clause 31 and clauses 51 and 52 were not brought to the House today. We expressed our concern some time ago that this House making the decision for Northern Ireland over and above the views of its elected representatives, its constituents and a majority of people across Northern Ireland would have an impact on the abortion rules in this House. We would have had an example of that today if new clause 50 had been approved, which it was not. It would have removed vital safeguards for women and girls seeking abortions up to 28 weeks of pregnancy, such as the requirement for two doctors, or even any medical professional, to be involved. The law change that was agreed in this House for Northern Ireland could have the shocking impact of placing at risk women and girls in abusive situations. It could legalise abortions that women and girls would carry out on themselves up to 28 weeks of pregnancy, for any reason.

[Mrs Miller]

Will the hon. Gentleman give way?

[Jim Shannon]

I have almost finished my speech.

The Health and Care Bill is an opportunity to improve health and wellbeing, and it should not be usurped to remove essential safeguards such as contact with a medical professional, counselling and referral to appropriate care pathways. This House must be mindful, whatever decisions it takes here, that those decisions will have an impact on Northern Ireland. We in Northern Ireland are very concerned, and there is great disappointment at where we are.

Question put, That the Bill be now read the Third time.

Health and Care Bill

Maria Miller Excerpts

Report stage
Monday 22nd November 2021 Commons Chamber

[Daisy Cooper (St Albans) (LD)]

I would like to start by talking about social care. The Liberal Democrats have long called for reform to properly integrate health and social care services, but this Bill does not do that. As others have mentioned, it seeks to reorganise parts of the NHS, but it pays lip service only to social care. That is why the Lib Dems think that the Bill should be put on hold until the proper social care reforms are brought forward.

As others have mentioned, it has been months since the Prime Minister announced his plan to fix social care. It is unforgivable that this new clause was sneaked out during the sleaze row last week, in a move that changed the goalposts. The Minister would do well to listen to the unease among his Back Benchers as well as among Opposition Members.

Struggling families now face being hammered by a double whammy of unfair tax rises and the prospect of losing their homes to fund care costs. The right hon. Member for West Suffolk (Matt Hancock) is no longer in his place, but I noted that he selectively quoted Andrew Dilnot. He did not quote Andrew Dilnot’s comments on new clause 49. Andrew Dilnot said that that proposal was not welcome. He said that he was very disappointed and that this represented “a big change” that

“finds savings exclusively from the less well-off”.

That is two promises from this Tory Government now broken.

There is also no mention in this Bill of the millions of people who are unpaid carers in the UK, even though we know that carers are twice as likely to experience ill health as a result of caring. That is why I have tabled new clause 63 for debate tomorrow. It is supported by Carers UK and it calls for the NHS to ensure that the health and wellbeing of unpaid carers is taken into account when decisions are made concerning the health and care of the person for whom they care. I hope the Government will support it. I know it is grouped for debate tomorrow, but I reference it now to highlight again the fact that the Bill does not present a comprehensive plan to reform social care.

The Bill also represents a massive and unnecessary power grab by the Secretary of State. It is simply wrong for the Government to have the power to abolish arm’s length bodies and approve or reject the chairs of integrated care systems. The public have been rightly outraged at political meddling in covid contracts, and the Government should learn their lesson. We should all be seeking to protect the independence of the NHS.

Vacancies in the NHS and social care are utterly staggering. We know the numbers: 100,000 vacancies in the NHS and more than 120,000 in social care; and 1.5 million people missing out on the care they need. We simply cannot go on like this, with the Government setting their own sporadic targets and constantly missing them. NHS waiting lists are at a record high. Ambulance services received a record number of calls in October. Major A&Es treated more than 1.4 million people in October—the third highest monthly figure on record.

The Bill will do nothing to get those waiting lists down, nothing to recruit the workforce we need, nothing to help people get seen faster and nothing for the millions of unpaid carers. The Government should delay the Bill for a few months and look properly at reforming social care, rather than doing a half-baked job now. But I do not think they will, and that is why the Lib Dems will vote against it.

[Mrs Maria Miller (Basingstoke) (Con)]

I listened carefully to my hon. Friend the Minister for Health earlier as he introduced new clause 49 because the funding of social care has been a huge concern for too many years. The people we represent deserve far more certainty about how their old age will be funded if they require social care.

We have a pension system and a system to support disabled people, but the funding of social care is a real uncertainty. I pay tribute to the Minister for bringing forward these costed proposals to provide some certainty for the future for more people. He is to be commended for being clear that no one will lose out under the proposals and that the majority will be better off because of the issues that we have already gone through—particularly because the means-test threshold is being significantly raised. He can say that with some force because of the more than £5 billion extra being put forward by the Government to fund social care in a sustainable way for the future.

However, there is still clearly some concern, as the Minister can hear from the debate. As my hon. Friend the Member for Gosport (Caroline Dinenage) said, no solution will be perfect, so I was particularly pleased to hear of the Minister’s plans to publish an impact assessment, which will clearly set out the impact of these measures across the board. That is important.

Finally, I want to speak in support of my amendment 102. We all know that the quality of support that we give victims of domestic and sexual abuse is a marker for the health of our society, and it is not just a matter for the NHS. However, the NHS plays a vital part in that support. Amendment 102 requires the joint forward plan for integrated care boards and their partners to properly set out the steps they propose to take to address the needs of victims of domestic abuse—whether domestic violence or sexual abuse, and whether it involves children or adults.

Amendment 102 does not limit the plan to addressing only the victims of domestic abuse; many other types of abuse are equally devastating, and it is permissive enough to allow innovation and improved ways of working to be developed in guidance. I hope that it can be used as a basis for guidance to integrated care boards as part of their general powers.

Amendment 102 is just part of the greater whole. The Police, Crime, Sentencing and Courts Bill in particular will require action across Government, but the amendment will help to ensure that every part of the state is pulling in the same direction when it comes to issues of domestic and sexual abuse. My amendment is similar to new clause 33, which my hon. Friend the Member for Newton Abbot (Anne Marie Morris) outlined earlier, but my amendment is more permissive and less prescriptive, so I hope the Government will find it acceptable.

[Edward Argar]

I am grateful to my right hon. Friend for the case she is making. I should also put on the record my gratitude for the work that my hon. Friend the Member for Newton Abbot (Anne Marie Morris) has done in this policy space and for her proposal. Her Majesty’s Government are happy to accept my right hon. Friend’s amendment 102 on support for victims of domestic abuse.

[Mrs Miller]

I thank the Minister for his acceptance of my amendment. Many people in all parts of the House will see it as a continuation of this Government’s commitment to tackling the issues of domestic abuse and sexual abuse. I thank him for such a positive acceptance.

[Bell Ribeiro-Addy (Streatham) (Lab)]

I rise to speak against the Bill overall but in favour of new clauses 56 and 57, tabled in my name, and those amendments and new clauses tabled by any Member who has sought to change the pernicious outcomes of the Bill.

Our NHS is really one of the best things about this country, but the Bill is the biggest threat to it yet. It rolls out the red carpet for private companies, ramps up the Government’s long-standing attempts to privatise the NHS, and makes easier what we have witnessed over the past 18 months: the awarding of contract after contract without a competitive process, and the rewarding of failing companies with new contracts again and again.

The Bill will be the destruction of our NHS as we know it, and will widen the inequalities that the pandemic has exacerbated. We now have more than 5.7 million people on NHS waiting lists. Of course, that is not solely because of the pandemic—far from it. After the Government won the 2010 election, around 500,000 to 750,000 people were on NHS waiting lists, and the number rose every year before the pandemic, so the waiting lists are the long-term effect of the Conservative policies of underfunding and privatisation.

Waiting lists have now doubled, and our NHS is in danger of toppling over. All the while, health inequality is rising. That is why, with the support of the Health Foundation, I tabled new clause 57, which would compel the NHS to set out data-collection guidelines on health inequalities. We know that health inequalities exist and have seen them play out with the worst consequences, from postcode lotteries to racial disparities, and it is time that we accepted that, collected the proper data—it is a farce that we do not already do so—and set out to make real change.

Since 2010, improvements in life expectancy in England have slowed more than in any other country in Europe, and the gap between rich and poor in respect of the number of years people can expect to live in good health has widened even further. During the pandemic, that was shown by the higher death rates among people who live in more deprived areas and among certain populations, most notably disabled people and people from black, Asian and minority ethnic communities. Among people younger than 65, the covid-19 mortality rate was almost four times higher for the 10% living in the most-deprived areas than for those living in the least-deprived areas. This is nothing new; the Marmot reviews have covered that many times.

Earlier this year, the King’s Fund found for the NHS Race and Health Observatory that any success we have in tackling health inequalities is always drowned out by other strains, such as waiting times and other clinical priorities. Put quite simply, we cannot tackle inequalities because this Government have never put equality at the front and centre of their policy making. That makes their so-called levelling-up agenda meaningless.

The Bill will enshrine in law the new so-called triple aim to promote various different factors, but the Government are so short-sighted that they have declined to incorporate health inequalities into the triple aim. What a complete missed opportunity that is—or a clear indication that the Government really could not care less. Before anybody says any different, and that the NHS has other means of doing that, we need to look at the state of the outcomes, because what is happening is clearly not working.

The Government continuously and repeatedly fail to accept examples of institutional discrimination, let alone meet their duties under equalities law. We recently heard about how the issues in respect of oximeters and dark skin will have contributed to worse outcomes. The Secretary of State for Health and Social Care has called for a review of gender and race bias in medical equipment; quite frankly, that is groundbreaking—all we seem to do is have reviews. We would already have these types of policies had we just heeded past Government reviews and looked at the equality impact assessments. There is no excuse for the Government to keep ignoring the requirement that is already set out in law for them to meet their equalities duties to people right across this country.

Hospital Building Programme

Maria Miller Excerpts

Wednesday 3rd November 2021 Westminster Hall

[Mrs Maria Miller (Basingstoke) (Con)]

It is a pleasure to see you in the Chair today, Mr Sharma. I congratulate my hon. Friend the Member for Crewe and Nantwich (Dr Mullan) on securing the debate. He is absolutely right to say that our hospitals are the centre of our communities. That is absolutely the case in my constituency of Basingstoke. Of course, care is provided by our doctors, our nurses and all the staff involved in running the hospital, but it is also one of my largest local employers. I congratulate the Minister, who I am pleased to see still in his place, on all the work he is doing to ensure that the Government’s commitments to build 40 new hospitals by 2030, the other eight previously committed to and upgrades to more than 70 hospitals, are being progressed as fast as they can be.

My hospital is a similar age to that of my hon. Friend the Member for Crewe and Nantwich. Like his, Basingstoke and North Hampshire Hospital was built to last 30 years, back in the 1970s. The backlog of maintenance reflects the fact that it should have been replaced many years ago. Hampshire Hospitals NHS Foundation Trust, an excellent trust that serves my community, was already well advanced with plans for a new hospital when the Government also identified that the current hospital needed replacing and included it in the renewal programme.

Basingstoke hospital has served our community extremely well since the 1970s, but the buildings are reaching the end of their useful life, for many of the reasons that Members have gone through. Those buildings were not built to last any longer. Furthermore, estimates show that the population that is served by the Hampshire Hospitals NHS Foundation Trust will increase by around 23% between 2018 and 2050. Unlike many areas of the country, Basingstoke has continued to build houses not just for the last two decades but for the last four decades. We have grown extraordinarily as a town over that time, served by the same hospital. Our population is therefore rapidly ageing, with all the implications that brings for our health services. Our over-75s population in Hampshire will have increased by a shocking 35% between 2017 and 2024. I should not be surprised about that, given the level of house building.

So many of the people who moved to Basingstoke when it rapidly expanded in the 1960s and 1970s are reaching an age where they are much more reliant on the health services available. The Government need to make sure that they follow through not only on more recent commitments to building houses, particularly in the south-east, but on the commitments that date back many decades, when people were encouraged from London out to places such as Basingstoke. That is an ageing population, and the Government need to ensure that the right facilities are in place for that much bigger population.

I am fortunate in Basingstoke that all the organisations involved in planning for the new hospital are working together in exemplary fashion, through an organisation that has been formed called Hampshire Together, which is all about modernising our hospitals and health services. That organisation firmly welcomed the Prime Minister’s announcements in October that all NHS trusts that receive seed funding to develop a business case for a new hospital project as part of phase 2 of the health infrastructure plan 2 programme, including Hampshire Hospitals NHS Foundation Trust, will be fully funded to deliver those by 2030.

The trust was especially pleased to note that Hampshire Together had been earmarked for inclusion in first group of HIP2 projects due for completion. The trust’s plans are well-developed with a preferred site, which the Minister already knows a little about, at junction 7 on the M3, which has been identified by the ambulance services as the best location to save more lives, providing acute care for hundreds of thousands of people living in the rapidly expanding communities in north and mid Hampshire. The planning authorities of Basingstoke and Deane Borough Council and Hampshire County Council are working actively and positively together, and Hampshire hospitals have been working to put together their business case and have forwarded their cases to the Department. They are very much looking forward to putting those cases out to public consultation as soon as possible.

Because our house building has been so rapid in Basingstoke throughout the 50 years that our hospital has been in existence, there is a need for a new hospital now. We would value a commitment from the Minister on the timelines and the next round of seed funding, so that we can continue to develop the business case and will be able to start building from 2025. I also renew my offer for the Minister to visit Basingstoke to see the site that we have already earmarked for the construction of the hospital. It is a greenfield site, so that residents’ enjoyment of the hospital facilities will not be disrupted during the building process.

--- Later in debate ---

[Edward Argar]

I omitted to mention two things to the shadow Minister: the spending review and backlog maintenance—he always avails himself of the opportunity to gently raise that issue. We have seen a confirmation of the money already in place for the new hospital programme, but we have also seen further moneys announced for capital in the spending review—new money—for example, just over £5 billion for community diagnostic centres, surgical hubs and the IT infrastructure around that. We have therefore seen a reconfirmation of money, plus new money in the capital space.

I turn now to maintenance, which the shadow Minister rightly always highlights. He will know—he occasionally quotes it at me at the Dispatch Box—that backlog maintenance across the entire estate is around £9 billion-worth. That is pretty constant from the previous financial year; it has not particularly increased. It may have gone up by a tiny fraction, but it has remained broadly constant.

[Mrs Miller]

rose—

[Mike Amesbury]

rose—

[Edward Argar]

Let me just finish this point before I take interventions from my right hon. Friend the Member for Basingstoke and then the hon. Member for Weaver Vale.

Our investment in new hospitals will also significantly reduce the backlog maintenance, because it will take out of the total a number of hospitals, some of which have been mentioned, that are being propped up day after day, with money being spent just to patch up and mend.

[Mrs Miller]

I thank the Minister for agreeing to come to our new preferred site in Basingstoke—we will be grateful for that—and for his comment about backlog maintenance. I think Basingstoke is in the top three in the country for backlog maintenance.

May I press the Minister on the timelines of the next round of seed funding to develop business cases and to be able to start building our new hospital in 2025? Clarity on some of these timelines is essential not only for our communities but for the people developing the plans, because they need to know what will happen next and have clarity on that.

[Edward Argar]

I am grateful to my right hon. Friend, and I entirely understand her call for clarity. Each case is being looked at on an individual basis, in the allocation of the £3.7 billion. The senior responsible officer of the new hospitals programme, Natalie Forrest, is in regular discussion with each trust, but business cases, more funding to develop business cases, and movement from outline business cases to final business cases are done on a case-by-case basis by trusts. It is not the case that every one must submit them by a fixed time.

[Mrs Miller]

rose—

[Edward Argar]

Let me take the hon. Member for Weaver Vale first, because I promised him that I would give way. I also want to leave a few minutes at the end for my hon. Friend the Member for Crewe and Nantwich to wind up.

--- Later in debate ---

[Edward Argar]

I suspect that the Department will have heard my right hon. Friend’s point.

[Mrs Miller]

Will the Minister give way?

[Edward Argar]

Very briefly, because I want to leave some time for my hon. Friend the Member for Crewe and Nantwich.

[Mrs Miller]

This is really important. What the Minister has just said is that no part of the process should be held up because certain projects might be ahead of others. Therefore, the public consultation that stands ready to go live in Basingstoke should not be delayed for any reason other than hopefully getting ministerial approval.

[Edward Argar]

I take the point, and I think I understand where my right hon. Friend is coming from on this. I said that business cases will be considered on their own merits, but of course there has to be phasing of different trusts at different times and different phases of this programme, because of the profiling of that funding. Only £3.7 billion has been committed so far, with more to come in further spending reviews, so if every trust came forward and said, “We are ready”—as my right hon. Friend knows, many will do so, although I suspect she would say that her trust is genuinely ready compared with some others—we could not commit to every one of those, because we have to look at the financial profiling that the Treasury has given us about when that money becomes available. That is the point. I hope she will forgive me if I did not understand what she was getting at in the first instance, but I hope that is of some help.

I will conclude, in order to leave my hon. Friend the Member for Crewe and Nantwich a little time to wind up. As a Government, we are proud that we have committed to arguably the largest and most ambitious new hospital building programme in decades, with initial moneys of £3.7 billion put in place to get that programme going. Eight of those new hospitals are in construction and one is completed, and we look forward to delivering on that commitment in full by 2030.

Tobacco Control Plan

Maria Miller Excerpts

Thursday 10th June 2021 Westminster Hall

[Mrs Maria Miller (in the Chair)]

I remind Members that there have been some changes to normal practice in order to support the new hybrid arrangements, and timings of debates have been amended to allow technical arrangements to be made for the following debate. There will also be a suspension between each debate.

I remind Members participating virtually and physically that they must arrive at the start of the debate in Westminster Hall, and Members are expected to remain for the entire debate. I also remind Members participating virtually that they are visible at all times, both to each other and to us in the Boothroyd Room. If Members attending virtually have any technical problems, could they contact the Westminster Hall Clerks? Members attending physically should clean their spaces before they use them, and when they leave the room.

I also remind Members that Mr Speaker has stated that masks should be worn, except, of course, when speaking. Members attending physically who are in the later stage of the call list can use the seats at the back of the Gallery, but I think we are okay on space today.

[Mary Kelly Foy (City of Durham) (Lab)]

I beg to move,

That this House has considered recommendations for the forthcoming Tobacco Control Plan.

It is a pleasure to serve under your chairmanship, Mrs Miller. In December, the Minister confirmed to Parliament that the Government will publish a new tobacco control plan this year, setting out measures to deliver the smoke-free 2030 ambition in the 2019 prevention Green Paper. I welcome this announcement: as a former chair of the Gateshead tobacco control alliance, this issue is close to my heart. In my own area of County Durham, adult smoking prevalence is 17%, compared with 13.9% nationally, and rising to 27% among people in routine and manual occupations. Some 16.8% of mothers smoke during pregnancy, compared with 10.4% in England, and smoking in County Durham has an annual cost to society of approximately £122 million.

The Secretary of State himself stated that the “extremely challenging ambition” of a smoke-free 2030 will not be delivered by business as usual. The new report from the all-party parliamentary group on smoking and health sets out the evidence-based recommendations needed to achieve that ambition. Smoking is responsible for half the difference in life expectancy between rich and poor, and the impact is passed down through generations, with those who grow up in smoking households far more likely to become smokers. With 1,500 people dying from smoking-related diseases every week, and less than a decade to go to achieve a smoke-free 2030, there is no time to waste.

However, this will not happen without investment. That is why the key recommendation of the APPG’s report is for a smoke-free 2030 fund, requiring the tobacco industry to pay for tobacco control. This is the “polluters pay” approach that the Government committed to considering in the 2019 prevention Green Paper. As such, can the Minister assure me that the proposals put forward by the APPG on smoking and health will be considered as part of the forthcoming control plan? In particular, will the Government deliver on their commitment to consider a US-style “polluter pays” approach to fund the tobacco control measures needed to deliver a smoke-free 2030?

More investment is needed, because the huge gap in smoking prevalence between those in routine and manual occupations and those in other occupations is stubbornly persistent. Ending smoking would lift around 450,000 households out of poverty, including more than 250,000 million children and 140,000 pensioners, concentrated in the most disadvantaged parts of the country. That would not only benefit the health and wellbeing of individuals but inject money into local economies, which would show just how serious the Government are about the levelling-up agenda.

Smoking is linked to almost every indicator of disadvantage, and those indicators overlap different communities. Smokers in routine and manual occupations or who are unemployed are also more likely to live in social housing and to be diagnosed with mental health conditions. The Government have been unsuccessful so far in reducing the inequality gap in smoking and need to redouble their efforts to achieve a smoke-free 2030 for all. There is a clear need for a national strategy that targets investment and enhanced support at disadvantaged smokers.

Unfortunately, smokers from deprived communities with higher smoking rates tend to be more heavily addicted than those from more affluent areas. Analysis of Government data shows that in 2019 nearly half of England’s smokers were in routine and manual occupations or were long-term unemployed. They are just as motivated to quit as other smokers, but it is harder to succeed when smoking is more commonplace and cheap, illicit tobacco is widely available.

Regional tobacco control programmes have been effective in tackling these disparities, as shown by the example of Fresh in the north-east, which is the longest-running—indeed, the only surviving—regional office of tobacco control. When Fresh was founded in 2005, smoking prevalence in the north-east was over 20% higher than the national average for England, and the disparity was growing. Since then, the north-east has seen the greatest decline in smoking prevalence of any region: smoking prevalence in the north-east is now only 10% higher than the England average. However, the regional work done in the north-east and elsewhere has been limited by cuts to the public health grant for local authorities since 2015-16. This led to the closure of the regional offices in the north-west and the south-west, and funding in the north-east has been significantly reduced. New funding streams are needed.

Smokers can successfully quit only if they are motivated to make an attempt to quit. Sustained mass multimedia behaviour change campaigns are the most impactful and cost-effective way to provide that motivation. The US Government’s “Tips From Former Smokers” campaign was funded by tobacco manufacturers through the USA’s user-free scheme, which raises $711 million annually from the tobacco industry. The Food and Drug Administration campaign led to over half a million sustained quits in three years, and it was associated with healthcare cost savings of $11,400 per lifetime quit.

Such campaigns have an immediate impact and can be targeted with precision at disadvantaged smokers, yet investment in behaviour change campaigns has fallen year on year in England. This has coincided with a significant decline in the number of adult smokers who have tried to quit. In 2008, 40% of adult smokers in England had tried to quit within the previous year; by 2018, that had fallen to just 30%. Over the same period, funding for mass media campaigns fell by over £20 million.

Behaviour change campaigns need to be targeted at key groups and communities to reduce socioeconomic inequalities. The effectiveness of national campaigns can be significantly enhanced when they are supplemented by targeted regional campaigns. Regional funding for stop-smoking behaviour change campaigns in the north and midlands would support the levelling up of some of the more deprived regions of England. These are the regions with the highest rates of smoking, combined with the lowest gross disposable household income. Supporting smokers in these regions to quit will prevent people’s hard-earned incomes from going up in smoke, lifting thousands of households out of poverty and providing a boost to local economies.

Modelling by University College London for the all-party parliamentary group on smoking and health estimates that a sustained national behaviour change campaign aimed at deprived smokers, combined with regional campaigns in the north and midlands, would result in an additional 1 million quit attempts, 179,000 successful quit attempts and 45,000 more ex-smokers in C2/DE occupations in England by 2030. The investment required is estimated to be about £28 million a year, which the tobacco manufacturers could easily afford to pay from their £900 million profits in the UK—and more than three quarters of the public want the tobacco manufacturers to pay for those measures. Does the Minister agree that targeted investment to tackle high rates of smoking among our most deprived communities is vital to delivering the Government’s levelling-up agenda?

Sadly, illicit tobacco is more accessible to children, and as it is cheaper than legally sold tobacco it reduces the incentive for adult smokers to quit. In 2018-19, the total tax revenue lost because of illicit tobacco was estimated by Her Majesty’s Revenue and Customs to be £1.9 billion. The illicit trade is heavily concentrated in the more deprived communities, contributing to higher smoking rates. Addressing that disparity requires tackling both the supply and demand for illicit tobacco in communities where it is endemic.

In the north-east, there have been dedicated multi-stranded programmes of work in place since 2007 to reduce the supply and demand as part of a broader activity to reduce smoking prevalence and improve the population’s health. Such programmes drive a strategic approach to tackling illicit tobacco at local, regional and national level. One programme was described as follows:

“an exemplar of partnership working…and…deserves to be widely disseminated”—

a recommendation supported by the National Audit Office. Unfortunately, that has not yet been possible owing to lack of funding, and the funding in the regions where it does exist is under threat because of cuts to public health budgets. Fresh and the Greater Manchester health and social care partnership have estimated that it would cost approximately £5 million annually to roll it out across England.

As the Minister said at the launch of our report, we need to get HMRC to do more to tackle illicit tobacco. Just £5 million for a highly effective regional programme is peanuts and would return far more in lost revenue than it costs. Will the Minister commit to discussing with HMRC how funding can be found for the illicit tobacco partnership to extend cover to all the regions of England to reduce the use of illicit tobacco, which is endemic in poorer communities in every part of England?

We are delighted that the Minister was able to attend the launch of the report by the APPG. I know how passionate she is about the issue. I look forward to hearing her response to our report and recommendations. I am confident that if the Government can embrace our recommendations in the forthcoming tobacco control plan, we will be well on the way to a smoke-free England by 2030.

[Mrs Maria Miller (in the Chair)]

Before I call the next speaker, I should say that I shall be moving to Front-Bench contributions at 2.35 pm. I suggest an informal five-minute time limit to enable all colleagues to make their contributions. I call Bob Blackman.

--- Later in debate ---

[Alex Norris (Nottingham North) (Lab/Co-op)]

It is a pleasure to serve under you in the Chair, Mrs Miller. I say a big thank you to my hon. Friend the Member for City of Durham (Mary Kelly Foy) and the hon. Member for Harrow East (Bob Blackman) for their doughty leadership on this issue, for their work in the APPG on smoking and health and for securing this debate, which has been a particularly good one. The points that my hon. Friend made about regional disadvantage and the way in which that links to every indicator of social deprivation and then to smoking were really good ones. It was very interesting and pleasing to hear about the work that has been done in the north-east about closing the gap. That, to me, served as an endorsement of regional approaches and, beyond that, sub-regional approaches, which I think we have lost in recent years and which I hope, through this plan, we can rebuild.

On the regional theme, my hon Friend was joined by a fine array of north-east MPs, who surround me here— I did feel rather out of place. My hon. Friend the Member for North Tyneside (Mary Glindon) made a really strong and compelling case for alternatives such as e-cigarettes and vaping. The thing I took away from that was how unequivocal it was. There is a real danger of being squeamish and equivocal about these new models, and I do not think that serves anyone. That is a theme that I will come to shortly.

That theme was shared by the right hon. Member for Clwyd West (Mr Jones). I agreed with the points he made about the new regulatory framework and the regulations. The review gives us a real chance to look at these things, so I hope we will hear some more from the Minister on that. Similarly, the hon. Member for Windsor (Adam Afriyie) talked about data and evidence. We have a common goal: we want fewer people to smoke and die. It behoves us, therefore, to follow the data and evidence about how to do that and not to be squeamish when they point one way.

My hon. Friend the Member for Blaydon (Liz Twist) made very poignant points about baby loss and smoking during pregnancy. She and other hon. Members will have heard some of the reasons why women smoke in pregnancy, which include perceptions about having a smaller baby and family traditions of doing so. The reasons are complicated and various, so we need ground-level, peer-led services to tackle that. Much of the content of the Leadsom review will help us in that space, so I hope to hear a commitment to that from the Minister.

My hon. Friend the Member for Jarrow (Kate Osborne) talked about regional inequalities and made a point about having services nearer to people. I will return to that shortly. My hon. Friend the Member for Ealing, Southall (Mr Sharma) also talked about inequalities—this time around ethnicity. We should not lose that in this debate. He also talked about localised approaches by service leaders who know their communities and have effective ways to reach different people. I think that is the whole battle here.

The hon. Member for Harrow East spoke with characteristic plainness, but we needed a bit of that. The 2030 target is a stretching one. At the current rate, we are seven years behind, but in the poorest communities it is 14. That means that we need big ideas. The document that he co-authored through the APPG has big ideas, and I will touch on a couple shortly.

I agree with the points that the hon. Member for North Antrim (Ian Paisley) made about organised crime. Again, that can form part of a tobacco control plan. I think there is complete political consensus about that. I do not agree that increasing the cost has not been an effective way of reducing smoking. Over two decades, it absolutely has. I also do not agree that tobacco control plans over the past couple of decades have not had an impact. Clearly, they have, and I will touch on that shortly.

For me, smoking is the ultimate equalities issue. It accounts for half the difference in premature death between the best and the worst off, so if levelling up is to be the theme of this Parliament, post covid, it seems that smoking is a very good place to start. I have similar statistics to those of my colleagues. In Nottingham, where I live, smoking rates are well above the national average: 20.9% of our community smokes, compared with an England average of 13.9%; and 16.5% of pregnant women are smokers when their baby is born, compared with 10% nationally. The cost to us is about £75 million every year through health and care needs, lost productivity and premature death, so tackling this is a really big prize for a community such as mine.

We should be confident that we are building on a platform of two decades of good progress on smoking cessation. Under Labour and Conservative Governments, we have implemented a comprehensive approach to tobacco control, including banning smoking in public places and cars, point-of-sale display bans and standardised packaging. All that has contributed to driving down smoking rates and discouraging young people from starting. We are here in a spirit of cross-party co-operation, and we are in lockstep in support of the goal of being smoke free by 2030.

I very much welcome the APPG’s report, which sets out the bold steps that we ought to take if we are to achieve this extremely challenging ambition. Among other things—this is always a very good place to start—it highlights the strong public support for that ambition: three quarters of the public are in favour, and that includes majority support for key recommendations from voters of all political parties. There is a clear mandate for action. I want to take the opportunity to thank Action on Smoking and Health, both for its work as the secretariat to the APPG and for the support it has given me in developing policy.

In this debate and the one we had a few months ago, colleagues have given the Minister plenty of content for the new control plan—in fact, probably a whole control plan and a bit more—but I want to offer a few points myself. First, the focus must now be on inequalities. Yes, this is a national goal and effort, but to make the most progress, we need locally led, community-sensitive smoking cessation services. The evidence for those is very strong indeed. It is a source of sadness that the Government have lopped away at the public health grant to the point that it has reduced by more than 40% since 2013, and those cuts have of course fallen disproportionately on poorer communities. If we are wondering why progress is stubborn in those areas, that is a significant reason, so I hope to hear a commitment from the Minister today to restore funds lost, with a particular focus on need. The report helpfully suggests an industry fund to cover the cost. Frankly, we should never have disinvested in the first place—cutting smoking cessation services is the falsest of false economies—but if the Government come up with an alternative along those lines, we will of course be supportive.

I want briefly to mention raising the age of sale to 21. We know that the best way to reduce smoking is never to start and we know that young people who start smoking generally tend to regret doing so. Seventy per cent. of adult smokers in England want to quit and an even bigger proportion—three quarters—regret ever having started, which makes an interesting point about raising the age of sale to 21. One of the things that surprised me in the report was the level of public support for that proposal—I did not think it would be as popular as it is—so the recommendation of at least a public consultation is a sound one. I would be interested to hear the Minister’s views on that, because it would be a very interesting public debate to have.

Turning to e-cigarettes, vaping and similar, this must be a feature of the tobacco control plan. I hope that the Minister and the Government more generally, via their role in the World Health Organisation, can push harder for stronger and clearer messages, based on the data and evidence, at the WHO level. I looked at the WHO website yesterday, and while I fancy myself as quite a smart guy—I might hide it well sometimes—I could not fathom what it was trying to tell me. It was incredible. That sort of equivocation makes it really hard for people thinking about alternatives to know whether they are supposed to go ahead or not.

I always rely on the Public Health England position in 2018 that these products represent a 95% reduction in harm, which seems a pretty good place to start. The APPG report says that in 2017 they helped 50,000 people to stop smoking and that concerns around children’s starting have not materialised. The 2017 tobacco control plan included a promise that:

“The Medicines and Healthcare products Regulatory Agency...will ensure that the route to medicinal regulation for e-cigarette products is fit for purpose so that a range of safe and effective products can potentially be made available for NHS prescription.”

This has not happened; it now must happen, and I hope it is a main feature of the new plan. The Government should also seek to regulate this market through the regulations review, to ensure that it promotes quality, safety and protection of young people.

Finally, the 2030 target is a vital and unifying goal, but we cannot wait until 31 December 2030 to look at the stats and see whether we have made it. We know it is a stretching target and we know we are currently not on course, hence the need for a new plan as soon as possible, but that plan has to have interim goals so that we know whether we are making enough progress. Again, the APPG report made some very good suggestions on that.

The report also makes strong recommendations on the data we do not currently have, which is a particular challenge in the case of people living with mental health conditions, who we know have disproportionately high rates of smoking. Data is collected in primary care on smoking status and mental health, but not routinely analysed. Smoking status data can also be collected through the mental health services dataset, but this is not done routinely. As a result, our data for folks with serious mental illness and others in secondary mental health services is not good. Reliable data is an important part of being sure that we are making the progress that we want to in this area, so I hope we will hear a commitment from the Minister on interim targets and better data.

To conclude, if we want a big public policy win—and goodness, this is about as big as they come—whether it is early intervention we are into or reducing inequalities, this is a major chance to make a step change. We need a plan, we need a good plan, and we very much look forward to playing our role in that process.

[Mrs Maria Miller (in the Chair)]

May I remind everyone that only Members physically present can intervene on the Minister?