Terminally Ill Adults (End of Life) Bill (Money)
Nusrat Ghani Excerpts(1 day, 14 hours ago)
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The Minister for Care (Stephen Kinnock)
I beg to move,
That, for the purposes of any Act resulting from the Terminally Ill Adults (End of Life) Bill, it is expedient to authorise the payment out of money provided by Parliament of:
(1) any expenditure incurred under or by virtue of the Act by the Secretary of State, and
(2) any increase attributable to the Act in the sums payable under or by virtue of any other Act out of money so provided.
The Government are of the view that the Bill is a matter for Parliament rather than the Government to decide. In order for the Public Bill Committee that is now scrutinising the Bill to consider the clause that would have spending implications, the Government must first table this money resolution. This is purely to allow the Bill to be debated in Committee, and the Government have taken the view that tabling this motion does not act against our commitment to remain neutral. Only the Government can table such motions, so tabling it allows further debate to happen. To assist that debate, the Government will also assess the impacts of the Bill, and we expect to publish the impact assessment before MPs consider the Bill on Report.
Several hon. Members rose—
Madam Deputy Speaker (Ms Nusrat Ghani)
Order. Members should keep their contributions within scope. This is about the financial implications of the Bill if it is passed, so let us keep contributions within scope.
Several hon. Members rose—
Madam Deputy Speaker (Ms Nusrat Ghani)
To ensure that as many colleagues as possible can get in during the time allowed, there will be a speaking limit of four minutes.
Brian Mathew (Melksham and Devizes) (LD)
Let me start by saying that I am in in favour of the motion, so I will vote for it, if it comes to that. However, would the hon. Member for Spen Valley (Kim Leadbeater) and the Minister consider the inclusion of two social workers on the group, made up of two GPs and a High Court judge, that assesses requests for assisted dying?
Madam Deputy Speaker (Ms Nusrat Ghani)
Order. Your contribution has to be within the scope of what we are discussing, which is the financial organisation of the Bill.
Brian Mathew
There would be added expense. Social workers are trained in understanding family dynamics, and need desperately to be involved in these situations.
Liz Saville Roberts
Let us imagine what the public would make of our role in this place if this legislation were to fall at this point.
Madam Deputy Speaker (Ms Nusrat Ghani)
Order. We are going to drop the speech limit to three minutes.
Jim Allister
I would be happy to do so in a moment.
It is quite clear that the measures will impose huge costs on the health and justice budgets. Given the provisions in the Bill, is it impossible for that not to be the consequence, so when the Treasury Minister produces the financial information, will he include current Government expenditure on palliative care and suicide prevention, so that we can look at and balance what we are spending? The Bill invites the Government to move from funding charities to prevent suicide to becoming facilitators and providers of suicide.
Madam Deputy Speaker (Ms Nusrat Ghani)
Order. Mr Allister, we must confine our remarks to the money resolution for the Bill.
Jim Allister
Madam Deputy Speaker, I was seeking to do that by asking the Treasury Minister to give us a comparison. What is this Bill going to cost our health service and justice system? How does that compare with what we are already spending on palliative care and suicide prevention? Those are pertinent questions and we need the answers.
Jim Allister
I agree. We all have our views on the merits of the Bill, but fundamentally we have a duty to our constituents to handle public money properly. In handling that money, we must know how much the Bill will cost. When it comes to that financial statement, it must not be fudged or opaque; it must be absolutely clear and it must—
Jim Shannon (Strangford) (DUP)
On a point of order, Madam Deputy Speaker. The right hon. Member for North West Hampshire (Kit Malthouse) made a comment that I feel impinged upon my integrity. I have spoken to the right hon. Gentleman and he knows what I am referring to. I underlined and highlighted that the Terminally Ill Adults (End of Life) Bill Committee went into private session; some 15 Members, who support the Bill, voted for the private session and nine Members, who oppose the Bill, voted against the private session. The record must be corrected about what the right hon. Gentleman said about the comments I made about that. Facts are facts; they matter to me, as does my integrity.
Madam Deputy Speaker (Ms Nusrat Ghani)
Thank you, Mr Shannon, for letting me know you would be making a point of order. The Chair is not responsible for the content of Member’s speeches, but I remind the House of the advice in Erskine May on the importance of good temper and moderation in parliamentary language.
Kit Malthouse
Further to that point of order, Madam Deputy Speaker. There was no intent in my remarks to undermine the integrity of the hon. Member for Strangford (Jim Shannon). I may have misunderstood his remarks, but he implied that the Committee was adopting some kind of veil of secrecy over our affairs and I was pointing out to him that, in my view, that was a misunderstanding of what we were attempting to do yesterday. I am sorry if the hon. Gentleman was offended, as he knows I hold him in great affection and I had no intention to do so.
Madam Deputy Speaker
Thank you, Mr Malthouse. I can see Mr Shannon nodding, so hopefully your apology has been accepted.
Obesity: Food and Diet
Nusrat Ghani Excerpts(3 days, 14 hours ago)
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Several hon. Members rose—
Madam Deputy Speaker (Ms Nusrat Ghani)
Order. As Members can see from the annunciator, the debate on financial education has been postponed, so the current debate can go on until 10 pm.
Madam Deputy Speaker (Ms Nusrat Ghani)
Order. When the hon. Member for Chelsea and Fulham (Ben Coleman) takes an intervention, he must be seated.
John Glen
The hon. Gentleman is making a thought-provoking observation, but does he acknowledge that in times past, the proportion of income that any individual, from whichever class, spent on food was considerably higher than it is today? If we are to get to the heart of the matter, we have to address the wider challenge of our society’s expectations of how much money we should spend on food. Does he not agree that we are addicted to cheap food?
Several hon. Members rose—
Madam Deputy Speaker (Ms Nusrat Ghani)
Order. To ensure that everybody gets in, I am setting a time limit of eight minutes.
Medicines and Healthcare Products Regulatory Agency
Nusrat Ghani Excerpts(1 week ago)
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Graham Stringer (Blackley and Middleton South) (Lab)
It is a pleasure to follow the right hon. Member for Tatton (Esther McVey). I agree with every word she said. It is late in the day for a Thursday, so I will try not to repeat many of the pieces of evidence and arguments that she proposed, but they are all valuable contributions to this debate.
I will start by talking about the attitude of Members of Parliament and politicians to regulation in general. A long time ago, I had responsibility in the Cabinet Office for dealing with better regulations. I travelled around the country to look at businesses that complained about regulations and see how those regulations could be made better—that was 18 months of my life that I will never get back. I came to a number of conclusions after that. Politicians have a knee-jerk reaction when it comes to regulation. If a child dies, if there is a fire, or if there is another disaster of some sort, there is a cry from both sides of the House for more regulation— not necessarily better regulation and enforcement, but more regulation—when, in many cases, regulations are already there but inspections and enforcement have not taken place.
The other knee-jerk response, which my Government are giving at the moment, is to say, “Regulations are burdensome so we will try to get rid of some of them.” I do not think that either of those responses deals with the issue. We set up regulators—this afternoon we are talking about the MHRA—but, by and large, once they are set up, MPs and Ministers abdicate responsibility and do not consider them until there is a crisis.
When I had that responsibility, I went to see the European Medicines Agency—this was some time before we left the EU. One of the surprising things I found—or maybe it was not so surprising—was that I was the only Minister who had been anywhere near the place. It was the major European agency that this country got after the Maastricht treaty. It had wide-ranging and important powers, to deal both with the market and with regulation, but nobody bothered with it. If there had been a crisis, however, Ministers and shadow Ministers would have been queuing up to go there.
If there is a lesson, particularly in relation to the MHRA, it is that we should look at regulators—be they water, medicine or other regulators—all the time. We cannot as a Government and MPs abdicate our responsibility, because we then come to a crisis, and the electorate say, “Well, what are you doing?” and the answer is, “Not a lot; we have passed that on.” Those water regulators or medical regulators might be, as the right hon. Lady showed, pretty useless. We should be looking at them all the time.
I was a member of the Science and Technology Committee in 2012. Partly because of that experience, and partly because there was a lot of press discussion and debate about metal hips that were squeaking and not working very well when they had been implanted and about breast implants that were falling apart, potentially damaging and poisoning the recipients, we had an inquiry that reported in October of that year. I will read out some of the comments from the witnesses we heard from about the MHRA, because they are being repeated now. They are very similar to what the right hon. Member for Tatton said about the MHRA’s responses—secretive and slow. For instance, there was evidence that there were problems with metal hips for four years before the MHRA took any action whatsoever. Nearly 14 years later, it still has the same problems.
I asked Dr Heneghan from the Centre for Evidence-Based Medicine at the University of Oxford who had authorised those metal hips. His answer was extraordinary: “Nobody knows. I don’t know—nobody knows.” It was a different regulatory regime then, because we were part of the European Union. Anybody who had the competence—or at least the authority—in any country in the EU could give authorisation, but nobody knew which body had done it, and whether that body was composed of competent people and what evidence they had used to do so.
However, when the MHRA found out, it did nothing for four years. That is disgraceful, and there were all sorts of comments that I can give the House. One was from Dr Stephen O’Connor at the Institute of Physics and Engineering, who said that the MHRA was overly bureaucratic relative to other competent bodies, inefficient, and difficult to deal with. As the right hon. Member for Tatton showed, the MHRA does not answer FOI requests, and it does not tell us what is going on.
The Lancet said about the breast implants, which I will talk about next, that the MHRA was in paralysis and in need of reform. Again, that was a long time ago. It was a different issue with the breast implants, because the MHRA was dealing with a fraudulent product—the products that had been authorised were not the products that were being sold to surgeons to be implanted in women. However, the Committee asked for there to be random and regular testing of the bodies that were responsible for manufacturing those implants. I do not expect the Minister to know at this time, but will she check whether the authorities have done any of those randomised tests on those bodies?
That is the history. The right hon. Member for Tatton has basically analysed what is going on now, but I will just talk about what we learned during the covid period. We learned that many of the NHS’s constituent parts—although not the clinicians—were secretive. Earlier today in the Chamber, we talked about the Government’s response to the first part of the covid inquiry. At the present time, that inquiry is not getting to part of what went wrong during covid, which was the fact that the NHS did not tell us what was going on, and there was also a restriction on political debate. If we are to get the best policies in any crisis, and in the regular turn of events outside crises, we need transparency so that we know how things can be improved and what we can criticise.
The right hon. Lady made the excellent point that keeping things secret encourages people who do not trust vaccines and have odd theories about how societies is controlled not to take the protection from vaccines. We know that no medicine is 100% safe, and there is no point in pretending they are safe, but vaccines have saved many lives over decades—more than decades; over a century—and it is good for society and for individuals that people understand that, and they will be less trusting if we do not tell them what is going on.
As recently as a few minutes ago, I got an email telling me that the UK Health Security Agency is still refusing to release the cost of the bird flu vaccines it has purchased. What possible reason can there be for not saying how much public money has been spent on a good cause? Having vaccines ready for any flu epidemic is a good thing because it saves people’s lives, as we have been discussing. Why should it be kept secret? Could the Minister to respond to that?
Is there any Member in the House who thinks that turning the MHRA, in the right hon. Lady’s phrase, from a watchdog to an enabler is a good idea, or even knows what it means and what is being enabled? I certainly do not know what is being enabled, but one of the things we should remember is that the MHRA and the whole of the health industry are swimming in a sea of pharmaceutical sharks. Pharmaceutical companies produce some extraordinarily wonderful products that keep us safe, but they also produce huge profits, and sometimes they get their products on to the markets by telling lies, or certainly by sins of omission. Everybody knows about the thalidomide case, and how long it took to prove it and to get compensation for the victims.
Almost at random, I have picked two other cases. With Paroxetine—I think that is how to pronounce it—GSK held back information because it did not release the tests that did not show a positive benefit. It also kept back tests that showed that Paroxetine increased the chances of children committing suicide, and it took a lot of investigation to get that—
Madam Deputy Speaker (Ms Nusrat Ghani)
Order. Mr Stringer, I assume you are coming to a conclusion soon.
Graham Stringer
I am. I have one sentence. I am sorry; I did not realise I had speaking for so long.
Lastly, Reboxetine is another example of where the information given out to doctors was inadequate because it did not show the negative tests. I use those two examples basically to show that the MHRA should not be enabling these things. It should be much more vigilant, and it should be asking for powers to demand the right to know all the information that drugs companies have before it says those drugs are as safe as they can be.
Several hon. Members rose—
Madam Deputy Speaker
Order. To enable us to get everyone in, I hope all Members will be mindful of those who are to speak after them.
Sir Christopher Chope (Christchurch) (Con)
I shall try to be brief, Madam Deputy Speaker. I follow the hon. Member for Blackley and Middleton South (Graham Stringer) by referring to a quote from Hayek’s book, “The Road to Serfdom”. I do not claim credit for identifying it myself; it was quoted in the other place by Lord Hannan of Kingsclere on 15 January in the context of the Football Governance Bill. He was talking about the growth of the administrative state, about which the hon. Gentleman was speaking at the beginning of his speech. Hayek said:
“The delegation of particular tasks to separate bodies, while a regular feature, is yet only the first step in the process by which a democracy…relinquishes its powers”.
That is in chapter 5 of “The Road to Serfdom” from 1944, so not much has changed. The MHRA is an example of what happens if we in this House transfer responsibility to unelected and unaccountable organisations.
It so happens that on the Order Paper for tomorrow is my Covid-19 Vaccine Damage Bill, which is sponsored by a former Attorney General. That Bill calls for an independent review of covid-19 vaccine damage. It calls on the Secretary of State to
“appoint a current or former High Court judge to lead an independent review of disablement caused by Covid-19 vaccinations administered in the United Kingdom and the adequacy of the compensation offered to persons so disabled.”
We know that more than 600 people have already been told by the agency responsible at the Department of Health and Social Care that they have suffered disabilities as a result of covid-19 vaccines. A large number of them, where the disability is in excess of 60%, have been awarded wholly derisory payments of £120,000 each.
My Bill goes on:
“The review must consider…the rates and extent of disablement caused by each type of Covid-19 vaccination offered in the United Kingdom”.
Relevant to this debate, the review must also consider
“the effectiveness of Medicines and Healthcare products Regulatory Agency monitoring of such side effects, and National Health Service and Government responses to such monitoring”,
as well as
“the adequacy of compensation offered to persons so disabled”.
There has always been an agreement, basically, that if something goes wrong for people who undertake vaccination voluntarily or are in receipt of other medical products—if they are doing the right thing by the country at large—and they have an adverse reaction, they will be able to look to the Government or the taxpayer to pay them some recompense under the scheme to which I have referred, if causation is established. The trust built by that scheme has been undermined by the long denial of the previous Government—and, to an extent, the current one—that any adverse reactions had been caused by the covid-19 vaccines, other than the most minor disablement. It has also been undermined by the fact that so many people have applied for a review of their cases. Some people—I think more than a thousand—have been waiting more than 18 months for a decision. That shows that this is a low priority for the Government.
I hope that when the Minister responds to the debate, she will be able to explain why the Government will block my Bill again tomorrow. If they were taking this issue seriously, as they should be, they would be open to and supportive of the establishment of an independent review of disablement.
Several hon. Members rose—
Madam Deputy Speaker (Ms Nusrat Ghani)
We are going to have to drop the time limit to four minutes. I call Dr Simon Opher.
Yasmin Qureshi (Bolton South and Walkden) (Lab)
My interest in this matter arises as I chair the APPG on Primodos, and it is a campaign that I and many other MPs have been working on for the past 12 years. On one occasion, after a big debate, the Minister ordered an expert working group to be set up. The MHRA was supposed to examine the evidence. We the campaigners and Members of Parliament thought that all the documents we had would be looked at by the MHRA, but clearly it did not look at them. The MHRA was supposed to engage with the victims and their families, but they were not spoken to or dealt with properly, and there was no thorough examination.
In fact, some of the members of the expert working group, which was set up by the Commission on Human Medicines, had connections with pharmaceutical companies. We wanted the MHRA to look at the documents, which showed very clearly that in the 1970s it was accepted by the then Committee on Safety of Medicines that this drug was causing deformities. However, the chief medical officer at the time colluded with the manufacturer, destroyed the evidence and refused to help.
We have documents that show that the manufacturer knew there was a cover-up, and yet the MHRA refused to look at them. Subsequently, Professor Carl Heneghan from Oxford University looked at the same material the EWG had looked at and came to a completely different conclusion: he said the evidence showed that there was a connection. The EWG was asked to look at whether there was a causal connection, and it changed its recommendation again. The former Prime Minister, Mrs May, was also not convinced by the expert working group. We persuaded her to set up a review chaired by Baroness Cumberlege, who said there was avoidable harm and that the victims should be compensated.
Throughout all those years, the Government of the day did not want to communicate with us, and they have not been dealing with this issue properly. They have always relied on the expert working group’s report, which has held the victims back and held us back from pursuing a possible legal claim. We say to the Government now that the EWG report needs to be relooked at, and Professor Carl Heneghan’s study of it should also be looked at. Scientific evidence has been produced using an experiment on zebrafish which shows that there is a link with this drug, and we have sent this to the Commission on Human Medicines for the Department to look at.
We must remember that this drug is 40 times the strength of the morning after pill. Women were given this pill and told it had no effect other than to see whether they were pregnant, and it then caused this damage. I ask the Minister today, with the new Government now in place, to please relook at this; the report by the EWG, which was set up by the MHRA, has been discredited, so please stop listening to it.
Alison Bennett
In the interests of time, I will not.
Brexit caused significant confusion for companies looking to sell products from Great Britain to Northern Ireland. It has also slowed down the time in which novel medicines and treatments can be approved for use, as pharmaceutical companies have understandably prioritised obtaining a single approval, allowing access to 27 markets via the EMA.
Meanwhile, strict affordability models imposed by the National Institute for Health and Care Excellence mean that companies face a further hurdle before their products can reach patients. Again, that diminishes the attractiveness of the UK market post Brexit. To help address this issue, the MHRA introduced the international recognition procedure a year ago to streamline the authorisation process by incorporating assessments from trusted regulatory partners worldwide, including the EMA. However, that relies on those partners having already approved the products, so UK patients will inevitably still have access to medicines later than people in other countries, including EU member states. When I met representatives of Roche Diagnostics, based in Burgess Hill in my constituency, they told me about the industry’s serious concerns that the additional GB-specific conformity checks required could be prohibitively expensive and lead to significant delays.
As things stand, the forecast is looking gloomy. My Liberal Democrat colleagues and I are committed to addressing these issues head-on, and to helping the MHRA become world leading. First, we are pushing to expand the MHRA’s capacity by halving the time for treatments to reach patients suffering from illnesses such as cancer. Secondly, we encourage the Government to fully implement the recommendations of the Cumberlege review, including on compensation, corrective surgery and psychological support for those who were failed and who suffered from faulty devices and drugs. Thirdly—this is vital—the Government should actively seek a comprehensive mutual recognition agreement with the EMA to promote faster access to new and novel medicines and medical devices. That would reduce red tape, cost and friction, providing hope for those who need access to these lifesaving and life-enhancing medicines and devices.
Hospice and Palliative Care
Nusrat Ghani Excerpts(1 week, 3 days ago)
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Several hon. Members rose—
Madam Deputy Speaker (Ms Nusrat Ghani)
Order. I will now be imposing a hard stop at four minutes, and that may reduce even further. I call Sorcha Eastwood.
Several hon. Members rose—
Madam Deputy Speaker (Ms Nusrat Ghani)
Order. We have 60 minutes left, and 19 Members still wish to speak, so I will have to drop the time limit to three minutes.
Vikki Slade
I completely agree, but what is really ridiculous is that, according to the Department of Health and Social Care, over 10 million hospital days followed an emergency admission in the last year of life, and 10% of people who died of cancer had three or more emergency admissions in the last three months of their life. The anticipatory care model can prevent some of those admissions and reduce the trauma. Further to my letter, sent in November, I urge the Minister to meet me and Clare Gallie to talk about a transformative approach.
I was deeply concerned when Marie Curie emailed me to say that Dorset integrated care board will stop commissioning specialist end of life care from March. The rationale is that personal care commissioning will go via council frameworks, but they do not require expertise in the provision of end of life care. I urge the Minister to insist that the specialists are listened to in the framework and to ensure that Lewis-Manning and Marie Curie are heard. Those organisations are looking to make redundancies and close services at a time when hospital beds are at a premium—
Brian Mathew (Melksham and Devizes) (LD)
I thank my hon. Friend the Member for Wimbledon (Mr Kohler) for bringing forward this important debate, and all hon. Members for speaking with such compassion.
Although the £100 million for hospice capital projects is to be welcomed, it is cash that is most needed. Julia’s House, a children’s hospice in my constituency that has already been mentioned, will find itself out of pocket by £242,000 per year because of the rise in national insurance. Dorothy House hospice, which is also in my constituency, will lose even more. That is a lot of sponsored walks and parachute jumps—perhaps too many—if the hospices are to avoid cutting their services. I urge the Minister to think again, and to provide the funds that our hospices need.
Jess Brown-Fuller (Chichester) (LD)
I thank my hon. Friend the Member for Wimbledon (Mr Kohler) for securing today’s important debate, and all hon. Members for approaching the conversation with the compassion and thoughtfulness that this topic deserves.
Examples shared across the House show that hospices are a vital part of our healthcare system. They provide outstanding care for patients approaching the end of their lives, offering dignity, comfort and support to families, and they are often driven by hundreds of volunteers, alongside the paid staff. Hospices will play a key role in meeting this Government’s objective to move care from hospitals to the community. This debate is very timely, given that the front pages of the newspapers are reporting today that half a million people were left languishing on trolleys in A&E and in corridors in 2024 because there were not enough beds to admit them.
Hospices, such as the extraordinary St Wilfrid’s in my constituency of Chichester, are the cornerstone of community care. I was blown away during my recent visit to St Wilfrid’s, and I am not ashamed to admit that I was brought to tears by the accounts of the family members, patients and staff I met that day. I applaud the hon. Member for Stoke-on-Trent South (Dr Gardner) for her show of emotion, because it is an emotive topic. St Wilfrid’s provides comfort and compassion to patients and their families during life’s most challenging moments—both directly in the calm and idyllic surroundings of the hospice and out in the community, providing palliative care for 300 people in the comfort of their own homes. It is St Wilfrid’s belief that everybody should be afforded a good death, and it strives to ensure that there is beauty in every day for patients and their loved ones, yet its service is being crippled by rising costs and a lack of sufficient Government support.
Hospices are in the process of setting their upcoming budgets, and many are having to make difficult long-term decisions to cut palliative care because they lack a long-term solution to address the growing financial strain. As the hon. Member for North Herefordshire (Ellie Chowns) mentioned, it is all well and good being able to say you have a lovely car park when you do not have any nurses to park in it. Only 17% of the overall cost of St Wilfrid’s hospice is currently covered by NHS grant funding—well below the minimum requirement across the country.
One of the biggest components of hospice costs is the salary of their expert clinical and other staff. Hospices are trying to match NHS salary increases to ensure that staff can afford to stay with them, and to remain competitive. In addition, they are now burdened with paying increased national insurance contributions, whereas direct NHS providers are exempt. For St Wilfrid’s, the rise in national insurance contributions will cost an additional £210,000, which is a significant financial burden. Although we Liberal Democrats and hospices alike welcomed the capital investment announcement in December 2024, that funding does not address the challenges of day-to-day spend, so there is still a vast gulf between rising expenses and available income. As the hon. Member for Birmingham Erdington (Paulette Hamilton) said, the funding must be the start, not the end.
Hospice UK has warned that around 300 hospice in-patient beds—14% of the total—are currently closed or out of use due to a lack of funding and chronic staff shortages, meaning that fewer patients are able to access the end of life care that they need at one of the most vulnerable times in their lives.
My hon. Friend the Member for Twickenham (Munira Wilson) mentioned the Marie Curie report, as did other Members across the House, which stated that one in four people who need hospice care cannot currently get it. The term “bed blocking” is not one I am particularly comfortable with, but if adequate palliative care is unavailable in the community or in a hospice, those people will remain stuck in hospital, and those hospitals cannot provide the expert care that a hospice can. Our hospices are ready and willing to take on those patients, but they need the support of this Government to do so.
As my hon. Friend the Member for Wimbledon (Mr Kohler), who brought forward this debate, said, people do not want to die in hospital. They want to die at home or in a specialised setting such as a hospice. That is why the Liberal Democrats are calling for hospices to be exempted from the rise in national insurance contributions. This targeted measure would provide immediate relief for a sector that is struggling under the weight of rising costs, and prevent further reductions in capacity or even closures.
We must think long term. Hospices need a sustainable funding model that guarantees they can continue their vital work of providing care for patients, supporting families and easing the pressure on the NHS. Hospices must also be a part of the conversation in the Government’s upcoming 10-year plan for the NHS, and that must include sustainable hospice funding reform. Examples from across the House today showed a shared recognition of the importance of hospice care. Now we need the Government to match that recognition with action for the patients, for the families and for a health service that depends on hospices.
Health and Adult Social Care Reform
Nusrat Ghani Excerpts(2 weeks, 3 days ago)
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Wes Streeting
I am grateful for that thoughtful question. Let me say two things to the right hon. Gentleman. The first relates to the wider fiscal pressures on the Chancellor. I find it difficult enough to manage the different choices and trade-offs to be made between different parts of health and social care and the competing challenges that I hear from Members in all parts of the House, so I am always thankful that I am not the Chancellor of the Exchequer, who has to balance demands from the NHS alongside the demands of education, a rising welfare bill, rising child poverty and the threats to our nation. These are enormous challenges, which is why I am determined to ensure that every penny that goes into the health service is well spent.
My second responsibility, in addition to ensuring that patients are treated at the right time, in the right place and in the right way, is ensuring that we have a sustainable healthcare system in which there is reduced demand. That means doing more on the prevention side, so that we can keep people out of hospital and not needing to knock on the door of their GP surgery, so that they do not achieve the frequent flier status in the NHS that so many people do achieve—the one frequent flier status to which they do not aspire. We can deal with this only through both health service reform and public health reform, and I want very much to build cross-party consensus on the latter.
Nesil Caliskan (Barking) (Lab)
Just before Christmas, I met care workers in my constituency, who told me about the day-to-day work that they do supporting the most vulnerable people in our community. Does the Secretary of State agree that just as access to GPs helps to relieve pressure on hospitals and A&E departments, an adequate number of adult social care workers will help to relieve the pressure on our GP services, which also have to deal with huge demand?
Several hon. Members rose—
Madam Deputy Speaker (Ms Nusrat Ghani)
I am sorry that we could not get everybody in. I tried to go as fast as I could. The names of those who did not get in have been noted.
Winter Preparedness
Nusrat Ghani Excerpts(1 month ago)
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The Minister for Secondary Care (Karin Smyth)
With permission, Madam Deputy Speaker, I would like to make a statement on winter preparedness. Before I begin, I want to say a very special thank you to all the staff who will be keeping our NHS going over the Christmas holidays and into the new year. When I was a manager in the NHS, I worked on winter planning, so, if I may, I will say an additional thank you to all the people who are often unseen: the managers and admin staff who also keep the system going. I know how hard it is for people to work in the system with the challenges that winter can bring through increased demand and higher rates of infection.
There are things that we cannot predict. Storms Bert and Darragh have added pressure, and we might have a cold snap. I know that many people like a winter cold snap of snow and ice, but it is not something that the NHS ever wants to see. The NHS has excellent people who have done this before and, unlike last year, thanks to the new Government, many of them will not be on strike. While we cannot control the weather, we can plan, prepare and pull together, so today I want to update colleagues with the current picture before moving on to the things that we are doing.
NHS England and the UK Health Security Agency will publish the latest statistics tomorrow morning as usual, but we do know that levels of seasonal illness are high. The most recent figures show that last week there was a 350% increase in flu cases compared with the same week last year, but that is comparable to levels we saw two years ago. Norovirus cases are high, but covid rates are low, and although rates of RSV—respiratory syncytial virus—have been high, we expect them to start coming down over the next few weeks.
I want to make it clear that the current rates for both bed occupancy and ambulance delays are unacceptably high. I will shortly come to measures about how we are dealing with that capacity.
I will not rehearse the Darzi investigation and his findings, except on one thing. I remind the House that he found “a perpetual bed crisis”, particularly during peak periods like winter cold snaps. That means that every winter our staff have been wasting precious time solving process problems, ringing round wards to find beds and desperately trying to hold the system together. We can see that in the figures.
On an average evening in 2009, a patient would have been 39th in the queue when they arrived at a typical accident and emergency department. In 2024, they are 100th. The four-hour A&E standard has not been met for nearly a decade and ambulance response times have not been consistently achieved since their introduction in 2017. In November, the average ambulance response time stood at 42 minutes, which is more than double the NHS constitutional standard. A third of the 2.3 million people who attended A&E last month waited more than four hours, and one in 10 of those people—more than 150,000—waited for more than 12 hours.
Those life and death delays are the result of deep structural issues in the NHS that cannot be fixed overnight. But this winter, NHS staff will be on the frontline, not the picket line, because we took a different approach on how to work with staff and the unions. To resolve the resident doctors’ dispute, we spoke to them on day one, we met them in week one, and by week four we had negotiated a deal to end their strikes. That is why, for the first time in three years, the Government are fully focused on winter and not on planning for strikes.
This is what we are doing. First, the NHS is managing extra demand by strengthening same-day emergency care and offering more falls services for older people, with upgraded 24-hour live data centres. Secondly, we are continuing to support systems that are struggling with direct intervention through the NHS urgent and emergency care tiering programme.
Thirdly, the Secretary of State is chairing weekly meetings with me and senior leaders to ensure that we are managing pressures across the entire system. Last week, he specially convened with trusts and told them to prioritise patient safety by focusing on key metrics, including improving emergency ambulance response times, addressing handover delays and tackling the longest waits in A&E. We have made it crystal clear that we do not want trusts to prioritise patients who can be seen and discharged more quickly over those with the greatest clinical need, because this Government will always prioritise people, not performance. This morning, the NHS published a letter outlining how it is prioritising patient safety.
Fourthly, I am taking steps to ensure that we get a clear picture of what is happening on the ground. I recently visited Newham hospital’s A&E, Bristol Southmead hospital and the head offices of NHS England to see the aforementioned operational control centre, where it receives data in real time and responds to problems as they emerge. Fifthly, we launched a national communication campaign in the autumn to encourage people across the country to take their winter vaccines, with a particular focus on people who are less likely to come forward.
That last point is essential, because the best and easiest way to keep people out of hospital this Christmas is to encourage them to come forward and get vaccinated. Last year, people who received a covid vaccine were half as likely to be admitted to hospital than those who did not. So far, we have delivered over 17 million flu jabs and 9.5 million covid jabs, and we have introduced the first ever public vaccination campaign for RSV, with over a million and counting vaccinations delivered to protect young babies and the elderly. In total, we have delivered nearly 28 million vaccinations for this winter, and I thank every person who has come forward to protect themselves and the vulnerable.
Now, I would like to speak directly to anyone who has not yet been vaccinated. No one wants to be separated from their family and stuck in hospital this Christmas, and there is a real risk that people may inadvertently take flu home to loved ones this year. Please protect yourself, your family and the NHS, and book that appointment today, because tomorrow is the last day you can book a vaccine through the NHS app or website, although after tomorrow there will be local solutions.
While we tackle winter pressures in the short term, we are fixing the foundations of our NHS with long-term reform. Two weeks ago, the Prime Minister spoke to the nation about our plan for change, and set out our ambitions for the health service over this Parliament. We will get a grip on waiting lists and return to 92% of patients waiting no longer than 18 weeks from referral to treatment by the end of this Parliament. We are also taking action on social care, introducing the largest increase in the carer’s allowance weekly earnings limit since 1976. We will ensure that carer’s allowance meets its objectives, while reviewing unpaid carer’s leave and looking at the benefits of introducing paid carer’s leave.
We will publish an improved better care fund framework, using £9 billion of funding to provide better, more integrated health and social care for patients and people who draw on care. We are helping disabled people on low incomes adapt their homes through the disabled facilities grant. The Employment Rights Bill is already in Committee, laying the foundations for the first ever pay agreement for care workers as a first step towards building consensus on the long-term reform needed to create a national care service. By the end of our first year in government, we will deliver an extra 2 million operations, scans and appointments through innovation, investment in additional capacity and productivity gains.
We are sharing the best of the NHS with the rest of the NHS, with our Further Faster teams. These are teams of experts that are supporting 20 trusts with long waits to tackle waiting lists and increase productivity. They have been deployed to five trusts so far, and we are already seeing improvements—for example, in theatres. For this financial year, the Government have committed £12 billion more in everyday spending on health and social care than was planned by the last Government in the spring Budget.
We are giving our capital-starved NHS the funding it so badly lacked over the past decade, setting aside at least £1.5 billion next year, which will create additional capacity, including new surgical hubs and diagnostic scanners, and new beds across the estate. That will enable 30,000 additional procedures and over a million diagnostic tests as they come online. That is the difference that a Government of service make. We have also been clear that investment must come with reform. Lord Darzi has given us the diagnosis, and the cure can be found in shifting the NHS from treatment to prevention, hospital to home, and analogue to digital.
Harold Wilson once called himself an optimist who carries a raincoat. As someone who has worked in our NHS at this critical time, I am fully aware of the challenges we face and the effort required. I am making sure that we have a firm hold on problems in the short term, while we do the work of fixing the foundations of our NHS with long-term reform. Over the past 14 years, we have limped from one crisis to the next, improvising and making do with sticking plasters. It cannot go on. It is bad for patient care and it is totally demoralising for staff.
We are building a health service that is fit for the future, ready to face every winter with confidence, and we will publish our 10-year plan for health in the spring. Anyone who thinks that we cannot do it should remember: we have fixed the NHS before, and we will fix it again. The public rightly expect us to put an end to the annual winter crisis, and that is what we will deliver. I commend this statement to the House.
Karin Smyth
My hon. Friend’s comments reinforce how much pressure, we understand, is front facing. A&E is demonstrative of the overall pressure in the system, not just at discharge but, as she rightly says, in primary care. We took action in the summer to improve primary care, increasing the number of GPs available in the system. It is absolutely critical that primary care community services are integral to winter planning at a local level. That is what we expect from every single system. We will continue to monitor that over the winter period and into the spring. If those services are not involved in planning for any particular systems, enabling them to monitor the surge and flow of people, we very much want to understand how that is working.
Helen Morgan (North Shropshire) (LD)
I express my thanks and those of my Lib Dem colleagues to everyone working over the Christmas period to keep people healthy and safe. Preparedness for winter is absolutely critical for our health and care system, and a quick look at what happened last year shows us why. Ambulances across England collectively spent a total of 112 years waiting outside hospitals to hand patients over, and a quarter of a million people waited more than 12 hours to be seen. Every winter we are warned of a winter crisis. Under the Conservatives, crisis became the norm not just in winter but all year round.
This year is very concerning so far. A&Es have overflowed through spring, summer and autumn. At my local hospital trust, Shrewsbury and Telford, one in three ambulances have had to wait more than an hour to hand over patients, while patients with devastating cancer diagnoses have had to wait months for crucial scan results. Across England, more than 7 million people are on waiting lists. Meanwhile, I am afraid, we have not heard enough from the Government on fixing one of the root causes of this crisis, which is our broken social care system.
The scale of the crisis is demonstrated by the challenges facing ambulance services across the country at the moment. October—before the winter—was the third worst month ever for handover delays at West Midlands ambulance service, which covers my constituency. The equivalent of 130 ambulance crews are out of action, waiting every single day. Now these overstretched ambulance services are formally changing their advice to reflect the pressure they are under. At times of peak demand, even category 2 patients—those suffering a heart attack or a stroke—will be asked to make their own way to a hospital. People in North Shropshire have long had to put up with some of the worst ambulance waits in the country, and they have come to harm as a result. It may no longer be the case that they can rely on an ambulance arriving.
Action is urgently needed to prevent more preventable deaths this winter. I am sure the Minister shares my alarm that ambulances may not be reaching people facing life-threatening situations. If she does, will she commit today to the Government tackling the handover delays paralysing the ambulance service by accepting Liberal Democrat proposals to make a £1.5 billion fund to provide more staffed beds, and by agreeing to urgent cross-party talks to fix the crisis in social care?
Karin Smyth
I think I have addressed the Government’s plans on social care. The hon. Lady makes an excellent point on ambulance delays, which we know to be a problem, and particularly so in the west midlands. That is one of the things I have asked the system to look at particularly, so that the Government and hon. Members can better understand the particular problems in their particular systems. We know that ambulance and handover delays are a particular problem in some systems. We are making sure that clinical and managerial leads from NHS England are visiting those systems and that they are understanding in depth the process issues in some places, where they may not be adopting the best practice that can be learned from others.
We need to roll out best practice across the country. When the Secretary of State and I visited the operational centre of the London ambulance service, we sat in on some hear-and-treat calls; in dealing with people in mental health crises, in particular, some places are doing that better than others. Those are the sorts of examples we want to learn from. I absolutely hear what the hon. Lady says about the unacceptable delays in particular parts of the country. That is very much on our priority list.
Jen Craft (Thurrock) (Lab)
Last week, I visited Basildon hospital, which is relied on by my constituents and people across Essex. Staff in the emergency department told me that they were operating under intense pressure all year round, and that it is indeed winter all year for them. That is due to a lack of beds, the terrible condition of parts of the estate and inadequate primary care services, meaning that people turn up at the ED when they should be somewhere more appropriate. What steps is the Minister taking to turn the page on 14 years of decline, and to ensure that Basildon and hospitals across the country have the resources and structures they need to better manage seasonal and year-round pressure?
Karin Smyth
My hon. Friend has already been a fantastic advocate for her local NHS services. Like the hon. Member for North Shropshire (Helen Morgan), my hon. Friend is absolutely right to highlight the acute pressures all year round. We did not always have winter crises under the last Labour Government. It was tough; I worked during some of that time, and it did happen, but getting used to such levels of bed occupancy and pressure in the system all year round is a direct legacy of the Conservatives and what they did to the NHS, particularly with the Lansley reforms, and their refusal to take a grip of it. This matter of a summer crisis going into a winter crisis is a real problem. That is why we are committed to these short-term measures to stabilise and support the system over the winter. However, as I said in my statement, we will also look at medium and longer-term reform so that we do not have to revisit this scenario year on year.
Layla Moran (Oxford West and Abingdon) (LD)
Last Friday, I visited Sherwood Pharmacy in Abingdon. Ben, who owns it, told me that local pharmacies stand ready to help. In fact, they are more than keen to help, but there are two things that he needs from the Government. First, there needs to be a real push for GPs to refer people to pharmacies, in particular for vaccinations, so that we are not collecting patients in one already overstretched part of the system and they can do what they do best. Secondly, there needs to be a general plea to the public that they can go to their pharmacies for those things. I note that in her statement the Minister did not mention pharmacies once. Let us be honest, this question is not going to do it either. How do we ensure that the message—“Go to your pharmacy and get vaccinated, you can do it faster there”—gets out there this winter?
Karin Smyth
I thank the Chair of the Select Committee for her point. She is right that I did not mention pharmacies, which was an omission on my part. We are running an advertising campaign, “Think Pharmacy First”, to ensure people use pharmacies. She is absolutely right that they stand ready. I will visit mine over the next few days to make sure I am vaccinated. Their support, working with primary care, is critical. Again, in some places relationships are working well and pharmacies support people in the community—that is apparent in the statistics. We are absolutely committed to ensuring that that works better, as part of our long-term reforms.
Karin Smyth
Again, my hon. Friend is already representing the people of his constituency so well by getting to the heart of what is happening on the ground, learning it for himself and bringing such examples to the House. He is absolutely right that there are such examples across the country, working differently in different systems, which are challenging other systems to look at that practice. That is why we say we want to bring the best of the NHS to the rest of the NHS. That is exactly what we mean. I am confident in the work happening centrally at NHS England. It is learning from such examples and wants to go around the country to ensure that we spread those sorts of ideas to other places. We are looking at them all very closely.
Andrew George (St Ives) (LD)
In the far west of Cornwall, in a medical emergency we cannot look for additional support from the north, west or south, because it is sea. The urgent treatment centre at Penzance hospital was closed two and a half years ago, under the Conservatives, adding pressure to the only emergency department for the next 100 miles, which is in Truro, and the out-of-hours doctor service has no doctors. The Minister mentioned in her statement that the NHS urgent and emergency care tiering programme is able to help. Will she use her influence to reopen the urgent treatment centre so that we can have a 24/7 emergency service in the far west of Cornwall?
Several hon. Members rose—
Madam Deputy Speaker
Order. The questions seem to be getting longer and longer, as do the responses. Let us try to keep the questions on point, and no doubt the answers will be the same.
Lizzi Collinge (Morecambe and Lunesdale) (Lab)
When I started working in public health, winter pressures were just that: seasonal flu and extra hip fractures. Under the Conservatives, winters started getting longer and longer. How will our 10-year plan ensure that seasonal pressures actually become seasonal and manageable again?
Tobacco and Vapes Bill
Nusrat Ghani ExcerptsTuesday 26th November 2024
(1 month, 4 weeks ago)
Commons ChamberRead Full debate Tobacco and Vapes Bill 2024-26 View all Tobacco and Vapes Bill 2024-26 Debates Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Mr Lee Dillon (Newbury) (LD)
I was a smoker for 15 years, I have vaped for 12 years and I have three children under 12, who I hope will follow neither habit. I support the ambition to create a smokefree society. The harm to individuals is clear, as smoking causes 80,000 deaths per year, and the cost to the country is just as clear, with smoking costing the economy nearly £22 billion a year.
However, I have concerns about the ability of retailers to enforce the age escalator proposals. Will the Minister look at increasing the age at which people can buy tobacco by a year every year, rather than linking it to when a child is born? That would mean that people of the same age would have the same right, rather than two people being 37, for example, and one not being able to purchase tobacco because of exactly when they were born during the year.
My biggest concern about the Bill is the inclusion of vapes, alongside tobacco. Vaping is the fastest growing smoking-cessation method, and evidence has found that it is twice as effective as other tools used to stop smoking. I took part in the statutory instrument debate on 13 November and I support the ban on disposable vapes that that regulation enacted. The regulation will reduce the number of children vaping, the amount of dangerous fake vapes and the impact on the environment.
However, the Bill could go too far on vaping. The all-party parliamentary group on responsible vaping has provided a useful briefing. I believe the House will pass the Bill’s Second Reading later today, so I ask hon. Members to look at the briefing before we get to Committee. Part 5, clause 92 of the Bill has the ability to undo the Government’s ambition of a smokefree country, by potentially banning flavours under a future statutory instrument. A study of more than 20,000 vapers showed that those who start with flavoured vapes or move from tobacco to flavoured vapes are more likely to quit smoking.
That was my experience too. I first purchased a refillable vape in France, which came with a tobacco flavour and a cherry flavour. I went back to the gîte with my friends where we were on holiday. I knew what tobacco tasted like—I had my cigarettes in my pocket—so I tried the cherry flavour and enjoyed it so much that I never opened the tobacco-flavoured vape pot. I took the cigarettes I had in my pocket back home to England. They were on my bedside table for six months, after which I screwed the packet up and threw it away. I have not had a cigarette since.
I honestly feel that the provisions in the Bill for Ministers to be able to ban flavours for adults goes too far. For the record, I vape something called blueberry sour raspberry. It is not aimed at children—I buy it from a specialist vape shop where customers have to be over 18. I have the bottle in my pocket and it has no bright colours or fancy graphics on it. That is my preference as an adult to vape and it stops me wanting to pick up a cigarette again. If the Bill passes its Second Reading this evening, clause 92 should require that vape flavours are regulated with a balance between the impact on adults who would otherwise be smoking and the potential for youth uptake. Hon. Members should remember that disposable vapes have already been banned by the statutory instrument passed a couple of weeks ago.
Finally, before Ministers use the affirmative resolution procedure on any of the Bill’s parts or clauses, I urge them to undertake a comprehensive, evidence-based approach to vaping regulations. I will not vote against the Bill at this stage, but I hope the Government are open to practical amendments in Committee that support the ambition to have a smokefree generation without penalising those who already rely on vapes to lead a healthier lifestyle.
Madam Deputy Speaker
We have three remaining contributions from Back-Bench Members. This is fair notice for colleagues who have contributed to the debate to make their way to the Chamber for wind ups. I call Kirith Entwistle.
Phil Brickell
I thank the right hon. Member for his contribution. I will take assurance from the Minister on that when he winds up.
I place on record my enthusiasm for the separate ban on single-use vapes from June 2025, which the hon. Member for Newbury (Mr Dillon) mentioned. As other Members have noted, not only are they particularly cheap and therefore accessible to young adults, but they are an inefficient use of critical resources, difficult to recycle and frequently littered around the countryside.
By introducing these world-leading reforms, we can create a smokefree generation and break the cycle of addiction and disadvantage. I am proud that it is a Labour Government who are delivering this legislation.
National Insurance Contributions: Healthcare
Nusrat Ghani Excerpts(2 months, 1 week ago)
Commons ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Karin Smyth
The hon. Gentleman may or may not think that this is political knockabout, but I was very clear in my opening statement that we understand the pressures that the sector is under. We understand the mess that we inherited, and we are fixing it. We are working with social care, GPs, providers and hospices that are affected by any changes in the Budget, and we will continue to talk to them in the usual way. We are committed to doing this faster than the last Government did it. Under the last Government, planning guidance and commitments to the NHS were always running late—they were always playing catch-up. We are committed to making sure that the sector is much more sustainable, so that it can do the important job we are asking it to do.
Jim Shannon (Strangford) (DUP)
Thank you, Madam Deputy Speaker. As Members know, I am the last person —when I am called, the debate is almost over.
Will the Minister confirm whether consideration has been given to the fact that the rise in national insurance contributions will not affect the NHS as a whole, as the block grant for us in Northern Ireland will cover it? However, GP practices in my constituency of Strangford will suffer, and unlike high street businesses or manufacturing, they cannot increase prices to cover that impending rise, leaving practices with no option other than to reduce hours in order to stay solvent. Does the Minister agree that this is the last thing already overstretched GP practices need, and will she commit to take this issue back to the Treasury for reconsideration as it relates to healthcare businesses such as GPs, dentists and pharmacies?
Income Tax (Charge)
Nusrat Ghani Excerpts(2 months, 2 weeks ago)
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Warinder Juss (Wolverhampton West) (Lab)
The Chancellor’s Budget last week finally ended the Conservative party’s austerity. It is a Budget that fixes the foundations to deliver real change, by fixing the NHS, cutting hospital waiting lists, reforming public services and rebuilding our country.
As the Chancellor said, this Budget is about “investment, investment, investment”. This Labour Government are investing over £25.5 billion over two years in the NHS. That will cut waiting times, so that patients do not have to wait longer than 18 weeks from referral to consultant-led treatment; provide 40,000 extra appointments; put in place new surgical hubs and diagnostic scanners, building capacity for more than 30,000 additional procedures and over 1.25 million diagnostic tests; and provide new radiotherapy machines to improve cancer treatment.
We are investing in NHS technology and digital, to run essential services and to drive NHS productivity improvements, freeing up staff time. We are providing a dedicated capital fund to deliver upgrades to GP surgeries, boosting productivity and enabling the delivery of more appointments.
We are investing £26 million to open new mental health crisis centres. At last, we have a Government who are committed to tackling the root causes of mental health problems and to supporting people to remain in work and to return to work.
We are supporting social care through at least £600 million of new grant funding to be able to increase local Government spending, alongside an £86 million increase to the disabled facilities grant to support more adaptations to homes for those with social care needs, thereby reducing hospitalisations and prolonging independence.
This Government are cutting down barriers to opportunity for all by increasing the core schools budget by £2.3 billion, supporting the recruitment of 6,500 teachers in key subjects and tackling retention issues, to prepare our children for life, work and the future.
We are providing a £1 billion increase to improve SEND provision and to improve outcomes and an additional £300 million for further education to ensure that young people are learning and developing the skills they need to succeed in the modern labour market, which will help the City of Wolverhampton college in my constituency. We are increasing investment in children’s social care reform, and it is great to see a real-terms funding increase for local government spending.
We are taking all of these decisions, while also taking tough decisions on spending and welfare, eliminating fraud and error in the welfare system—
Peter Swallow (Bracknell) (Lab)
I start by declaring that my brother and his wife are both NHS doctors, and I am incredibly proud of them.
The Budget begins the work to undo a decade of recklessness and neglect by the Conservatives, who left our NHS uncared for, our schools crumbling and carers unsupported. It will fix the foundations of our economy, build the growth we need to invest in public services and end 14 years of Tory austerity. With this Budget, my right hon. Friend the Chancellor has put forward a bold, tough vision to deliver on our manifesto promise of change—£25.7 billion over two years for the NHS to slash waiting times, with an extra 40,000 elective appointments a week, and £2 billion committed to technology to begin a serious transformation towards digital healthcare.
Labour Members understand the need to fund our NHS properly, but we also understand that after 14 years of neglect, the NHS is badly in need of reform. We cannot cure 14 years of sickness in one Budget, but with this investment, we are finally taking the medicine we need.
I warmly welcome the £1 billion investment the Chancellor is making to address the crisis in special educational needs—a first step in fixing a broken system. During the Conservative leadership contest, the new Leader of the Opposition endorsed the view that getting an autism diagnosis brings
“economic advantages and protections”
and
“better treatment or equipment”.
That is a far cry from the experience of parents and children with SEND in my constituency. The Leader of the Opposition would do well to listen to the former Conservative Education Secretary, who described the SEND system under her party as “lose, lose, lose”. The Government’s commitment to increase SEND funding by £1 billion is a step towards addressing the crisis. It must be only the beginning of tackling this huge long-term problem. Ultimately, the system needs root and branch reform, but the money will start to make real, concrete differences and to break down the barriers to opportunity for many young people in Bracknell and across the country.
I will briefly mention the fantastic commitment to set up a £44 million investment to trial a new kinship carer’s allowance—again, that is a real contribution to solving a problem that has long been neglected.
This is a Budget that invests in our NHS, in education, and in families and working people. If the Opposition choose to oppose it, they need to be honest with their constituents and the British people about what that means. Opposing the Budget means less money for our NHS, less money for our struggling SEND system, and no additional support for the kinship carers who have felt invisible for too long. The Government have chosen to fix the foundations—
Clive Jones
On a point of order, Madam Deputy Speaker. I must apologise to the House for not making a declaration at the beginning of my speech. I am a governor of the Royal Berkshire hospital, and I have a family member who has shares in a health company. I apologise for not mentioning it at the beginning of my speech.
Madam Deputy Speaker (Ms Nusrat Ghani)
I thank the hon. Member for advance notice of his point of order. It is most definitely relevant to the debate, and his transparency is noted.
Ms Polly Billington (East Thanet) (Lab)
Even those of us who are new to this place know to expect more communication from our constituents about what is wrong than what is right, so it is notable that I received emails of thanks and congratulations from constituents last week, after the Chancellor delivered her historic Budget. Stability is highly prized by people after so much chaos, and investment, especially in our NHS, is something that people have been crying out for.
However, we must be honest with ourselves about the state of our NHS in east Kent and in coastal communities like mine. East Thanet has been overlooked for far too long. The service has had to endure the chaos and incompetence of the past 14 years, and has not been as resilient as other places to the onslaught. The director of public health in north-east Lincolnshire, Stephen Pintus, has described people living in coastal communities as “old before their time”. We need to reform the way we deliver NHS services in coastal communities. Investment on its own will not be enough. We need to redesign our health service to answer the questions: what care do people need, where do they need it and how do they need it delivered?
My constituents have been suffering with poor NHS services for far too long. East Kent hospitals university NHS foundation trust, which runs the Queen Elizabeth the Queen Mother hospital in Margate, is ranked the third worst in England for its 12-hour waits for emergency services. Its maternity services have been deemed inadequate. When staff were asked, “If a friend or relative needed treatment, would I be happy with their care?”, only 45% of staff said yes. I have people emailing me about their urgent care and essential appointments being delayed by waiting lists. People in dire need of mental healthcare are being told to wait for months to get the help they desperately need. There is denial of continuous care due to costs and a lack of staffing—and, shockingly, poor communication and record keeping resulted in a cancer patient being misdiagnosed.
In a 2021 report by Chris Whitty entitled “Health in Coastal Communities”, he highlighted the problems faced by constituencies such as mine, and found that they had some of the worst health outcomes in England, with low life expectancy and high rates of major diseases. One of the major reasons for that is simply lack of access to healthcare services—both a lack of NHS services in coastal communities and a lack of transport options.
Whatever the reasons for the challenges in coastal communities, we need to see reform. The extra funding the Chancellor announced last week is crucial to bringing down waiting lists and stopping the chaos of 14 years of Tory mismanagement. The British people delivered us a mandate to fix the NHS. If done well, this reform will be transformative for the country, especially in coastal communities like East Thanet.
Madam Deputy Speaker (Ms Nusrat Ghani)
I am about to call the final Back-Bench Member. No doubt a lot of colleagues who have contributed will be making their way back to the Chamber for the Front-Bench speeches. I call Matt Turmaine.
Matt Turmaine (Watford) (Lab)
Thank you very much, Madam Deputy Speaker.
Prior to being elected to this place I worked in health and social care, so it has been interesting to hear some of the pronouncements from the mouths of Opposition Members, which in many instances are, frankly, farcical.
In my constituency, the legacy of 14 years of failed Conservative government is plain to see: people unable to get GP appointments; a lack of NHS dentists for residents to sign up with; poor mental health support for young people and adults; and, of course, the undelivered promise of a new hospital in Watford, cancelled under the coalition and not delivered by the Conservatives over subsequent years. The previous Government’s track record is one of decline. In 2010, average waiting times were 18 weeks and satisfaction levels in the NHS were at their absolute highest. What a contrast to 2024, with the NHS on its knees.
The Chancellor of the Exchequer announced in the Budget an additional £22.6 billion to support the NHS. That will help to deliver more appointments for my constituents in Watford, and it will bring progress towards once again having to wait no more than 18 weeks from referral to treatment. As has been said, we have done it before and we will do it again.
I also welcome the Chancellor’s £1.4 billion to help rebuild schools. She mentioned Watford in her Budget speech, noting that schools in my constituency will benefit from RAAC being dealt with. Mentioning RAAC also brings us to the new hospital programme. I know my right hon. Friend the Chief Secretary to the Treasury will be listening when I say loud and clear that Watford is desperate for a new hospital. That has been the case for many years. The trust’s plan is ready to go, go, go, but I recognise that the Chancellor has achieved the seemingly impossible by managing to start the new hospital programme and moving forward with addressing the hospitals affected by RAAC. We hope the rest will follow soon.
I campaigned in good faith in the general election for a new hospital and to honour the commitment made by the previous Government, but as we heard from the Chancellor in the summer, there was no money there. The Chancellor has worked wonders with this Budget. She has dealt with the financial black hole, she has got the country back on its feet and she has put it on the road to recovery. It is an excellent Budget for the people of Watford; it is an excellent Budget for the country. I wholeheartedly support it.
Madam Deputy Speaker (Ms Nusrat Ghani)
We have been able to get in over 80 contributions, so thank you very much to everybody for abiding by the time limit. I now call the shadow Minister.
Alex Burghart (Brentwood and Ongar) (Con)
Thank you very much, Madam Deputy Speaker. It is a great pleasure to play a part in bringing today’s interesting debate to a close.
I take this opportunity to welcome the Chief Secretary to the Treasury to his post—I know he has been in post for a few months, but we have not had the chance to get to know each other. I must say I have been very impressed him. He is a fluent speaker. He is good on detail. That is not sarcasm—I was once warned by Hansard that sarcasm did not come across well in the written record—but I know what it is to be sent out to defend the indefensible. I can see that he is developing a fine skill and that he is some way on his way to mastering it. I just gently say to your man starting out in his Front Bench career in government not to get too good at it, because you will find your party will give you ample opportunities to defend the indefensible in the years ahead.
Madam Deputy Speaker
Order. Shadow Minister, I do not think you are speaking to me when you say “you”. You are obviously speaking to the Minister.
Alex Burghart
It has been a long day, Madam Deputy Speaker. I hope you will forgive me.
But enough of such pleasantries. This is a bad Budget. It is as bad as bad can be. At its heart is a decision to tax businesses hard—very hard—and through them to tax workers until the pips scream. It is a Budget that sees the total effective tax rate on low-earning roles increase to its highest level since 2010, hitting working people hard, as the Chief Secretary to the Treasury admitted on Sky television on Friday. We know that taxing business is a bad idea. As my right hon. Friend the Member for Tatton (Esther McVey) said earlier, businesses and working people are the dynamo of the economy. If we denude and degrade them, there is nothing for public services to feed on.
But we discover, as this Budget unravels, that it is not just businesses that are being taxed. It is GPs, it is care homes, it is hospices—as the hon. Member for Poole (Neil Duncan-Jordan) pointed out—and it is dentists, charities, childcare, higher education and school support staff. I understand that Labour Members will want to support big tax rises in the Budget, but before they vote on them, I ask them to consider whether they want to vote for tax rises on those services. In response to an intervention from my hon. Friend the Member for Hinckley and Bosworth (Dr Evans), who is sitting behind me, the Health Secretary said that he would listen to GPs, but either the money from the national insurance contributions is in the Budget, or it is not. Either it is in the envelope, or it is not. Has the thinking been done on this? At present, it would seem that all those services are in limbo. Yesterday, during Education questions, the Education Secretary was asked by both the shadow Secretary of State, my right hon. Friend the Member for Sevenoaks (Laura Trott), and the shadow Minister, my hon. Friend the Member for Harborough, Oadby and Wigston (Neil O’Brien), whether school support staff would be affected. She could not answer.
These are serious questions, and the Government must know the answers. His Majesty’s Treasury must have the data, and it must publish that data. So let me first ask the Chief Secretary if he will publish figures showing who will be hit by his national insurance contribution tax rises, what the costs will be to the services concerned, and whether they will receive compensation. As I said, the Treasury must have the data, and if the Chief Secretary does not have it at his fingertips, I ask him to put it in the Library of the House of Commons as soon as possible. We all want better public services; the question is, do we think we can get them if the services that I have mentioned are being taxed? As the Chief Secretary said on television the other day, without reform more generally, money will just follow money out of the door.
We are told that Labour has a plan for improving the NHS. We know that, because the Prime Minister told us in a speech on 11 September that in the spring he would have a plan. That plan, he said, would contain a transition to a digital NHS, moving more care from hospitals to communities, and focusing efforts on prevention over sickness. Who could argue with those sensible measures? It was good to read in the Red Book at a time of the Budget that His Majesty’s Government intend to:
“Invest more than £2 billion in NHS technology and digital to run essential services and drive NHS productivity improvements”,
which
“will deliver 2% productivity next year.”
That is very sensible, but it gives rise to a strange sense of déjà vu—and then one remembers that in the spring Budget this year the then Chancellor, my right hon. Friend the Member for Godalming and Ash (Jeremy Hunt), announced £3.4 billion in additional funding for the NHS to deliver 2% annual increases in productivity through new technology and digital across the health service in England.
So part 1 of Labour’s three-point plan is not new at all. It is a Conservative initiative, already accounted for by a Conservative Chancellor. Let us proceed to part 2, moving more care to communities. On that, the Red Book says absolutely nothing. As for part 3, prevention, there is a small increase in tobacco duty and a vaping products duty. Not content with taxing us into growth, the Chancellor intends to tax us into health—but it is all right, because apparently the Prime Minister has a plan to have a plan in the spring.
I will tell you a funny story about the spring, Madam Deputy Speaker. When I was first working as a parliamentary researcher, there was some long-forgotten report that the Department for Children, Schools and Families was producing. We asked when it would be published, and we were told, “In the spring.” We asked, “When does spring end?” The Department told us, “When summer begins.” In that tale is an insight into the way in which Labour Governments think. It is tomorrow and tomorrow and tomorrow, and never does reform come.
That is the plan for the NHS. It is relatively well developed, next to the non-existent plan for welfare reform. My right hon. Friend the Member for Central Devon (Mel Stride), who is now the shadow Chancellor, started that work, but silence has now descended. More workers are needed to grow the economy—the OBR was quite clear on that. The Chancellor has chosen tax over employment, which will not deliver growth.
The Government’s plan has been to tax, to spend, to think a bit, to set up a website, to get told to serve waffles for every meal, and to think a bit more. Then they will see whether any money is left, they will discover that there is not, and they will need to increase taxes again. What is becoming painfully apparent is that Labour wasted its time in opposition. It had 14 years to come up with a plan for the NHS, but it did not, and now it is scrabbling to find one. By the time we see the Prime Minister’s fabled plan, more than 10% of this Parliament will have passed, and very little will have been done that was not already being done before.
The Prime Minister said there would be no extra money without reform, but that is precisely what he has given the country. That is the price of political complacency. It is the price of thinking that governing is easy. It is the price of believing your own hype, and of failing to be honest with yourselves.
Some people said that the Labour party was trying to pull the wool over people’s eyes, and I was one of them. I thought that behind the great ambiguities of the Labour manifesto there would be a game plan, but game plan has come there none. We have £140 billion of extra borrowing, and £10 billion more in higher debt repayments. Mortgage payments are up, and there is austerity for employers and workers. A loveless landslide has become a loveless tax rise for the British people, and they will not wear it.
NHS Dentistry: Rural Areas
Nusrat Ghani Excerpts(2 months, 2 weeks ago)
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Madam Deputy Speaker (Ms Nusrat Ghani)
Let me give the hon. Lady a moment to gather her thoughts before she resumes her speech. It is best not to refer to a Member by their first name. She has a solid 30 minutes—although the Minister has to respond within those 30 minutes—so she can take her time.
Sarah Gibson
Thank you, Madam Deputy Speaker.
I remind the House that the Conservative Government had the last decade to reform the dental contract but failed to do so. I therefore implore the new Government to act now with two simple actions. First, they should introduce a timeline for reforming the NHS dental contracts system. The Secretary of State for Health and Social Care said that that was their intention, but I feel that there is an element of urgency about this—especially for rural areas—that has not been addressed. Secondly, I would like it to be a mandatory requirement for ICBs to appoint dentists to their boards. There is a strong feeling among dentists that ICB boards of directors do not understand the issues they face.
Tim Roca (Macclesfield) (Lab)
I share the astonishment of other Members that not a single Conservative Member is here, in a debate on NHS dentistry in rural areas. I am a bit old-fashioned and I want a functioning Opposition. It is sad that they are not here to take part in this debate. When I contacted surgeries in Macclesfield to find out the state of play, 15 said that they do not accept NHS patients at all. That is the legacy that the Conservatives have left us. Can the Minister confirm that the Government will move urgently and quickly on NHS dentistry reform?
Madam Deputy Speaker (Ms Nusrat Ghani)
Order. Interventions should be short, and the Minister must respond to the Member whose debate it is.
Stephen Kinnock
We are working at pace, and I will say more about that shortly. I share my hon. Friend’s reflections on the complete absence of the Conservatives. They made a complete mess of our public services, called an election and ran for the hills.
On 4 July, we inherited a broken NHS dentistry system. It is a national scandal that tooth decay is the leading cause of hospital admission for five to nine-year-olds in our country. It is truly shameful and nothing short of Dickensian. In the area served by the NHS Bath and North East Somerset, Swindon and Wiltshire integrated care board, which includes the constituency of the hon. Member for Chippenham, 33% of adults were seen by an NHS dentist in the 24 months up to March 2024. That compares to a 40% average across England. In 2023-24, there were 44 dentists per 100,000 of the population there, whereas the national average was 50.
When we look at the problem in the round, it is not so much that we do not have enough dentists, but that not enough of them are doing NHS work, and they are not in the parts of the country that need them most. That challenge is compounded by the fact that some areas of the country are experiencing recruitment and retention issues, including many rural areas, where the challenges in accessing NHS dentistry are exacerbated. That of course includes Chippenham, where Hathaway dental practice has recently had a request granted to reduce its NHS activity, as the hon. Lady pointed out. I understand, thanks to a freedom of information request by the British Dental Association, that the practice had a £4.2 million underspend on its NHS contract. That is precisely the problem that hon. Members have pointed out. There is a quantum of funding, but the way in which it is structured makes private sector dentistry far more attractive than NHS dentistry. That is the root cause of the problem; we are alive to that issue.
Overall, it is clear that we have a mountain to climb. It is a daunting challenge, but we are not daunted, and we are working at pace. The golden hello scheme, for example, will see up to 240 dentists receive payment of £20,000 to work for three years in one of the areas that needs them the most. Integrated care boards have already begun to advertise posts, as we have accelerated that process. In the ICB area of the hon. Member for Chippenham, there have been seven expressions of interest, five of which have been approved. Providers can now include incentive payments when they advertise vacant positions.
Alongside that, we will deliver a rescue plan that gets NHS dentistry back on its feet. That will start with providing 700,000 additional urgent appointments as rapidly as possible, as set out in our manifesto. Strengthening the workforce is key to our ambitions, but for years the NHS has faced chronic workforce shortages, so we have to be honest about the fact that bringing in the staff we need will take time.