Tackling Obesity

Peter Dowd Excerpts

Tuesday 27th February 2024 Westminster Hall

[Sarah Dyke (Somerton and Frome) (LD)]

It is a pleasure to serve under your chairship this afternoon, Mr Dowd. I congratulate the right hon. Member for Bexleyheath and Crayford (Sir David Evennett) on securing this important debate. Whenever possible, I like to talk about the accomplishments of my constituents. One constituent of mine made an outstanding contribution to tackling obesity eight years ago, and I am glad that the hon. Member has recognised their efforts, because that constituent is the former Chancellor, who introduced the soft drinks levy in 2016.

That policy has meant a 46% fall in average sugar levels per soft drink product since 2015. Sales have not been affected; actually, they have increased by 14.9% over 4 years. That levy has been a remarkable success. The Medical Research Council estimates that it has prevented about 5,000 cases of obesity in year 6 girls, and 5,500 hospital admissions for children with tooth decay within five years. This is unambiguous and indisputable. Interventionist health policies are the only way to solve our obesity crisis, because the food system in this country is rigged against us.

This is not just a crisis. In Somerset, 34.6% of children leave primary school overweight or obese, but 21.8% of five-year-old children start primary school overweight or obese. In 2021, 60% of adults in Somerset were overweight or obese. We should be one of the healthiest countries in the world—we have an NHS that covers every citizen, a mild climate and a high level of economic development—but we are not. Thirty years of failed Government obesity policies tell us that we must change. A University of Cambridge team analysed 30 years of Government obesity policies in England—14 obesity strategies with 689 individual actions. Eight per cent fulfilled seven criteria identified by researchers as necessary for successful implementation, and 29% did not meet a single criterion.

We have tried blaming the individual, and it has not worked. It is not just remiss; it is wrong. The charity Beat reported that

“strategies harmful to people with eating disorders appear…to be ineffective at reducing obesity.”

By refusing to change the system and telling people that they are to blame, we are killing people who are already vulnerable, and there is a consensus. Polling last September from the Food, Farming and Countryside Commission and More in Common showed that 77% of participants wanted Government to put health standards over cost, and 67% thought that the Government were not doing enough to safeguard children against unhealthy food and drinks. The status quo simply cannot continue. Our farmers are underpaid, undervalued and underused in a food system that does not prioritise healthy local food of high standard. Small and medium UK agrifood businesses cannot compete with cheap, ultra-processed food. Our NHS staff are so overwhelmed in dealing with the results of obesity that they have little time or budget to deal with the causes.

We Liberal Democrats want a robust, thorough obesity and food strategy that meets all seven standards specified by Cambridge. We want junk food advertising restricted on TV and online, as the right hon. Member for Bexleyheath and Crayford has mentioned. We want public sector food procurement strategies that benefit the farmers and local businesses producing the food. We want to extend the “polluter pays” principle that we have for water companies. We want to make junk food giants either change their ways or pay their way.

As a serving Somerset councillor, I know how vital it is to empower local authorities to develop and manage tailored strategies in their areas. We should give local authorities more power over planning to prevent high streets being clogged up with cheap fast food outlets, and to restrict junk food advertising. Let them develop food partnerships with farmers and agrifood businesses. We must have a new, interventionist approach to our food system. All other approaches have failed. It makes economic sense, environmental sense and moral sense. Let us make a better food future.

[Peter Dowd (in the Chair)]

I am going to give Members five minutes each. The Opposition spokespersons will have five, and the Minister will have ten.

--- Later in debate ---

[Amy Callaghan (East Dunbartonshire) (SNP)]

It is a pleasure to serve under your chairship, Mr Dowd. I congratulate the right hon. Member for Bexleyheath and Crayford (Sir David Evennett) on securing this debate. In the context of the ongoing Tory cost of living crisis and an increasingly unhealthy population, it is important that it takes place, so I welcome his bringing it to the Chamber. Huge financial pressure and high food prices are forcing families to eat less healthily, getting cheaper calories from unhealthy foods. There is a clear link between deprivation and obesity, which is why tackling health inequalities and poverty are top priorities for the SNP Scottish Government.

We have heard lots of interesting contributions. The right hon. Member for Bexleyheath and Crayford touched on junk food advertising, and I discussed that exact issue with the University of Glasgow earlier this afternoon. We need to be incredibly mindful of where, what and when we are advertising; otherwise, we will have an often detrimental impact on health inequalities.

The hon. Member for Somerton and Frome (Sarah Dyke) spoke a great deal about child obesity, which I will come on to. I very much agree with her on that point, but I would welcome an intervention from her on how the Liberal Democrat party’s abandonment of free tuition is impacting household budgets, and thus people’s ability to access healthy foods.

It was hugely welcome that the hon. Member for Putney (Fleur Anderson) mentioned the Daily Mile, which originated in Stirling. It was nice to hear a non-Scottish Member cast light on a project that originated in Scotland, so I certainly welcome that comment.

Obesity is a problem that is escalating on a global scale, but sadly the effects are being felt severely in Scotland. According to a survey, 67% of adults are deemed overweight and a third of children are at risk of becoming overweight. That same survey found that obesity was more common in households with lower incomes—a correlation we know and recognise all too well. That is why I and my SNP colleagues are consistently calling on the UK Government to take action to tackle the cost of living crisis, improve universal credit and reverse their policies that deny families crucial support.

The Scottish Government do not have the levers to be able to do those things at the moment. They therefore mitigate the bad political decisions made in this place, reducing family household costs by providing free prescriptions, free school meals, free childcare, free period products, free university education and free bus travel for those under 22 and over 60; freezing council tax; providing the young carer grant, the Scottish child payment, and both adult and child disability payments; and mitigating the bedroom tax, the rape clause, the benefits cap and real-terms cuts to social security.

Earlier today I met Professor Iain McInnes of the University of Glasgow, whose project, “Creating Healthier Places: A Place-Based Approach to Research & Partnership”, factors access to healthy foods into its research on 20-minute neighbourhoods. It is a fascinating project, and I urge the Minister to have a look at it—I think she would be just as impressed as I am.

Through the best start grant and best start foods applications, the Scottish Government have also provided over £180 million to low-income families to help with expenses during their children’s early years. The eligibility for best start foods will be expanding so that a further 20,000 people can access support to buy healthy food. Such steps are essential to ensure that support is there for the least well-off families to be able to make healthy food choices.

In my constituency, new data from Cancer Research has shown that 22.5% of four to five-year-olds are overweight or obese—that is four to five-year-olds who are already increasing their risk of serious illnesses. That is not a choice by those children or their parents, but a symptom of families not having the resources to provide healthy options. It is a symptom of 14 years of austerity. It is a symptom of being tied to this broken Westminster system.

I know that the Minister cares deeply about these issues and will give a compassionate and considerate response. I simply urge her to mirror some of the policies the Scottish Government are taking on tackling health inequalities. That is why in Scotland, all pupils in primaries 1 to 5, all children in additional support needs schools, and eligible pupils in primary 6 through to S6 can benefit from free school meals—the most generous free school meals offer anywhere in these isles, saving families—

[Peter Dowd (in the Chair)]

Order. I call Preet Kaur Gill.

Osteoporosis

Peter Dowd Excerpts

Thursday 26th October 2023 Commons Chamber

[Judith Cummins]

The hon. Lady raises some important points. I agree that screening and prevention are key to tackling osteoporosis, and I congratulate her and Southend on getting their FLS up and running. It will make a real difference to the lives of people in Southend.

[Peter Dowd (Bootle) (Lab)]

My hon. Friend is doing a fantastic job in this policy area. Given only half of NHS trusts have a fracture liaison service, does she agree that it is vital that that 50% figure grows week in, week out, to ensure that everyone gets get that service?

[Judith Cummins]

My hon. Friend makes a valuable intervention. He has been a staunch advocate for those suffering from osteoporosis and has backed the Better Bones campaign, for which I am very grateful. I agree that this issue is all about ensuring equity in access to NHS services, including FLS.

Podiatry Workforce and Patient Care

Peter Dowd Excerpts

Tuesday 20th June 2023 Westminster Hall

[Peter Dowd (in the Chair)]

I will call John McDonnell to move the motion, and I will then call the Minister to respond. As is the convention for 30-minute debates, there will not be an opportunity for the Member in charge to wind up.

[John McDonnell (Hayes and Harlington) (Lab)]

I beg to move,

That this House has considered the podiatry workforce and patient care.

The background to this debate is a meeting I had with a number of local podiatrists representing the Royal College of Podiatry, so let me thank them for the briefing that the royal college has sent me. I want to talk about the development of a workforce strategy for podiatry.

To explain for those who may take an interest in the debate, podiatrists are highly skilled healthcare professionals. They are trained to assess, diagnose, prevent, treat and rehabilitate complications of the foot and lower limbs. They manage foot, ankle and lower-limb musculoskeletal pain, and skin conditions of the legs and feet. They treat infection, and assess and manage lower-limb neurological and circulatory disorders. They are unique in working across conditions and across the life course, rather than on a disease of a specific area.

A podiatrist’s training and expertise extends across population groups to those who have multiple chronic, long-term conditions, which place a high burden on NHS resources. The conditions largely relate to diabetes, arthritis, obesity and cardiovascular disease. In addition to delivering wider public health messages in order to minimise isolation, promote physical activity and support weight-loss strategies and healthy lifestyle choices, podiatrists keep people mobile, in work and active throughout their life. They contribute to the wellbeing of our economy and workforce.

Podiatry is intrinsic to multiple care pathways too, and podiatrists liaise between community, residential, domiciliary, secondary care and primary care settings. They specialise in being flexible and responsive, ensuring focused patient care, irrespective of the clinical setting. Podiatrists are at the forefront of delivering innovation in integrated care. They deliver high-quality and timely care, as well as embracing safe and effective technologies that lead to improved patient outcomes.

The role of podiatrists in managing diabetic foot complications is key. They play a vital role in the prevention and management of diabetic foot complications, which, at the last estimate, cost the NHS in England £1 billion a year. In the three-year period from 2017-18 to 2019-20, there were over 190 minor and major amputations per week in England. Of the people affected, 79% will be confined to one room within a year, with 80% tragically dying within five years. That is a shocking outcome for patients, and it is even worse than the outcomes for the majority of cancers we seek to deal with.

The impact of lower-limb amputations on patients’ quality of life and chances of survival are shocking, so we must do everything we can to prevent diabetic foot complications. We have to act in a timely and targeted manner to ensure that people have the best possible chance of living long and fulfilled lives.

It is estimated that by 2025, 1.2 million people with diabetes in the UK will require regular podiatry appointments if they are to remain ulcer, infection and amputation free.

[John McDonnell]

What I have discovered on my journey of finding out about podiatry, which I knew very little about before I met podiatrists in my constituency, is that of course people need professional care, and that care needs to be properly funded. There are volunteers, but we should not have to rely solely on volunteers; we need professionals leading the way. Podiatrists are skilled and trained in the prevention and management of diabetes-related foot complications. That is why many of us believe that they must be at the heart of the NHS plan to eliminate unnecessary amputations and the consequent avoidable deaths.

As I said, the broader cost of diabetic foot ulcers to the NHS is more than £1 billion per year—the equivalent of just under 1% of the entire NHS budget. Effective and early intervention for diabetic foot complications prior to ulceration could save thousands of lives and millions of pounds each year.

The situation in my area in Hillingdon exemplifies what is happening elsewhere in the country, which the hon. Member for Strangford (Jim Shannon) has mentioned. Hillingdon’s community podiatry service is part of the Central and North West London NHS Foundation Trust. It is suffering from severe workforce issues, which is having a detrimental effect on the people delivering the service and those suffering from foot ulceration, infection and amputation.

The service is currently failing to meet its timescales for seeing patients at high risk of developing a foot ulcer. What should be a team of 13 clinical podiatrists is now just 3.5 full-time equivalents and three support workers. The immediate concern is the pressure that puts on the staff who remain and the impact it has on the patients who need a minimum of weekly wound re-dressings to enable healing and prevent infection and life-changing amputation. The opportunities to prevent life-changing and life-threatening complications are minimised by the shortage of staff.

We also have concerns that support workers are being asked to triage and treat people beyond their scope of practice due to the staff shortage. That is not a criticism of them, but it is the reality. We should be filling the service with professionals who are fully trained to deal with the range of complications that they might come across. The workforce challenge facing podiatry is the real issue.

There is a need for focused recruitment. As I said, it is estimated that by 2025, 1.2 million people with diabetes in the UK will require regular podiatry appointments if they are to remain ulcer and amputation free. In the absence of that, there will be a greater risk of premature disability and death. There are currently just under 10,000 podiatrists registered with the Health and Care Professions Council. That is just one per 5,500 residents in England, and that number is due to decline as a result of demographics.

Following the removal of NHS bursaries for student podiatrists in 2016, the number of undergraduates studying podiatry has declined by 38%. Prior to that, the student bursary was set at £9,000 a year and it covered the cost of tuition for a year. In 2020, in a welcome move, the Government reintroduced student bursaries, but at £5,000. That has caused a slight improvement in recruitment to the profession, but it falls far short of ensuring the future of the podiatry workforce that will be required to deal with the oncoming wave of severe diabetic complications coming out of the pandemic.

Another issue is that the average age of podiatry students on graduation is 32. The majority of students are pursuing a second degree, and the need for a second student loan is having a damaging impact on universities’ ability to recruit undergraduates to train as podiatrists. By leaving it up to the market, we face the prospect of not training the workforce required to meet the needs of an ageing population.

The other issue raised with me is the limited career progression in NHS settings. Of the podiatrists currently qualified in England, approximately 40% work in the national health service. It is projected that many of those podiatrists not heading for retirement are likely to move to work in the private sector in the next five years. The reasons cited for that include lack of career development opportunities; repetitive workloads, with limited skill mix; and high demand and low capacity to meet it, leading to what people consider are unsafe staffing levels and to staff burnout.

Expansion of the podiatric workforce across primary, community and secondary services may address some but not all of those issues. Support for workforce growth is critical, but support for those already qualified to progress to advanced clinical practice and consultancy is also critical to workforce retention and ensuring adequate capability in senior clinical, leadership, education and research roles.

We need policy to ensure closer working across providers and the delivery of a foot health strategy. There is significant opportunity to expand the foot health workforce to include non-registered roles, supported by qualified, expert podiatrists. There is also opportunity to consider alternative workforce models that are inclusive of podiatrists working in private practice or the wider foot health workforce in the third and voluntary sectors, for example. A clear workforce strategy is desperately needed now. It needs to explicitly underpin how the foot health workforce is optimally configured, funded, implemented and trained and what the core outcomes of foot health services must be to meet the needs of our future population.

Currently, there is no workforce strategy, no clear statement of aim, and no standardised set of core outcome measures informed by public health or policy. Clear foot health policy is urgently needed to maximise all the benefits that podiatry can offer across an integrated care system, before the profession becomes—as we predict it will—unsustainable, with staffing levels even more unsafe and avoidable patient harms, amputations and deaths relating to lower-limb disease rising dramatically.

I therefore have three key asks. First, I ask the Government to reinstate the £9,000 bursary for student podiatrists. If podiatrists are to be able to support the millions of people who will require their expertise, the Government must reinstate the full podiatry student bursary of £9,000 a year. That is essential if the workforce is to be secured and expanded for future generations. In the absence of long-term funding confidence, allied health professions such as podiatry are unable to commit substantial and consistent investment towards maximising recruitment and retention, both of which will be crucial in securing the future viability of this vital profession.

My second ask is for national collection of podiatry vacancy rates and inclusion of podiatry in workforce planning. Publishing a national workforce plan that considers future need for allied health professionals such as podiatrists must be a priority for the Government. That plan must take into account current trends in recruitment and retention and, for future needs-based public health, comorbidities and their impact on disease prevalence. A national workforce plan will also act as a crucial evidence base for the allocation of long-term workforce funding.

My third ask is for the guidance on integrated care system membership to be strengthened to include allied health professionals. The absence of national guidance or recommendations regarding which organisations and individuals should be included in integrated care partnerships has resulted in a patchwork of involvement for allied health professionals, including podiatrists, in integrated care decision making. Without their meaningful engagement in those discussions, there is a danger that the invaluable contribution podiatrists can make to the delivery of care might simply be overlooked. Strengthened national guidance on the make-up of integrated care partnerships, to include representation of allied health professionals such as podiatrists, should be developed and implemented at the earliest opportunity.

I conclude by thanking the professionals who work in my constituency, as well as those who work nationally. I recognise the pressures they are under and the valiant way that they cope with them.

[Peter Dowd (in the Chair)]

I remind the Minister that the debate must conclude by 4.41 pm.

Reforms to NHS Dentistry

Peter Dowd Excerpts

Thursday 27th April 2023 Commons Chamber

[Peter Dowd (Bootle) (Lab)]

I thank my hon. Friend the Member for Bradford South (Judith Cummins) and the hon. Member for Waveney (Peter Aldous) for securing this debate, and I thank other hon. and right hon. Member for their persistence in pursuing this matter and ensuring it remains a priority. It is worth repeating that this debate is about the progress on reforming NHS dentistry. The two colleagues I mentioned made the case for this debate:

“Underfunding and the current NHS dental contract are to blame for long-standing problems with burnout, recruitment and retention in NHS dental services. Morale amongst NHS dentists is at an all-time low and we are facing an exodus of dentists from the NHS. Reform of the dysfunctional NHS dental contract is a matter of urgency—a reformed service won’t work if there is no workforce left by the time it’s finally introduced.”

To solve the problem, it is crucial to accept that there actually is a problem, and it is important to recognise the extent of that problem. The first question I want to ask the Minister is whether he accepts that there is a problem with access to NHS dental services.

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

indicated assent.

--- Later in debate ---

[Peter Dowd]

I am pleased that the Minister nods and recognises that. The second is whether he acknowledges the extent of the problem with access to dental services. What progress has actually been made—that is what the debate is about—and has it been significant enough? The Minister accepts that there is a problem, but I am still not convinced, on the evidence we have, that the progress has gone far enough. That is my view. The hon. Member for Hartlepool (Jill Mortimer) talked about the 2006 contract, which we all know needs to be redesigned. The Labour Government recognised, in good faith, as early as 2009 that it had to change. We are now 13 years on, so we have to get to grips with it now. I do not point the finger in that regard, but that is the context for the debate today. Actions speak louder than words. Have there been sufficient actions to resolve the problem that the Minister recognises? I am not convinced there have been.

We had a debate in Westminster Hall on 10 February last year—over 12 months ago—in which I asked Conservative Members to

“press the Minister and ask the Secretary of State and the Prime Minister—their colleagues—to listen to the facts, because, unless Members opposite can get that message across to an indurate Government, things can only get worse.”—[Official Report, 10 February 2022; Vol. 708, c. 473WH.]

Let us take a rain-check a year or so on. Have things stayed the same? Have they got better? Have they got worse? In my view, and that of many others, things have not stayed the same and they have not improved substantially, so it does not take Hercule Poirot to work out that things have deteriorated. I accept, in good faith, that Conservative Members have lobbied the Government, but I am sorry to say that, looking at the situation on the ground in my constituency—and, no doubt, in other Members’ constituencies—their exhortations have fallen on nearly deaf ears, or at least have not been listened to sufficiently.

From Monday gone, there has been an 8.5% increase in NHS patient charges for dentistry in England—during a cost of living crisis. That increase will hit millions of people on modest incomes, including patients in my constituency, and that is those who can actually get to see a dentist. Many statistics have been mentioned today and I could rehearse them, but I will not do so for purposes of brevity. Everybody gets the gist that things are in a grim state.

One statistic I will mention is that dentistry is now the No. 1 issue raised with Healthwatch, with four in five people—79%—who contact it saying they found it difficult to access timely dental care. The British Dental Association has said:

“The Government’s support package for NHS dentistry launched in November consists of marginal changes that will do little to arrest the exodus of dentists from the service or address the crisis in patient access.”

On top of that, we have low morale in the service and dentists quitting in great numbers. I do not think it goes too far to say that we are facing meltdown. The BDA sees an existential threat; I say meltdown—we all get the gist.

Despite the £3 billion dentistry budget, some 10% of the money allocated will be returned, not because of lack of demand but because of dentist shortages. That is the irony. The money is returned, but that must be set in the context of underfunding over many years, on top of which is the poor contract. Retention issues are borne out of burn-out and consequent recruitment issues in NHS dental services. The BDA is right to say that marginal changes will not sort out the problem. I am pleased that the Chair of the Select Committee is on board on that.

First, fundamental reform of the contract is needed. Despite discussions between the BDA and NHS England, the fact remains that unless there is a substantive and substantial change to the contract, matters will continue to deteriorate. Second is the question of resources. It will take up to half a billion pounds annually to restore the funding of NHS dental services to 2010 levels. After a decade of attrition, that is the situation. In real terms, net Government spending on NHS dental services was cut by a quarter between 2010 and 2020. Again, I am not finger-pointing; it is just something that we have to factor in as we try to resolve the problem. Of course, as has been mentioned, the question of prevention has a crucial role to play, as it always does in health services. That, too, must be a priority for the Government.

Having heard what hon. Members, the British Dental Association and the NHS Confederation have said, and what constituents in their droves are telling us, I really hope that the Minister will take action and get to grips with this major problem with provision in this crucial part of the NHS. I started with the issue of progress being made. The question is: can we really say that we have made sufficient progress after three Backbench Business debates? Alas, at this stage, I do not think that we have done.

Cancer Care

Peter Dowd Excerpts

Tuesday 14th March 2023 Westminster Hall

[Peter Dowd (Bootle) (Lab)]

It is a pleasure to be in the Chamber under your stewardship, Mr Paisley. I offer my condolences to the hon. Member for West Bromwich East (Nicola Richards). Cancer is a dreadful disease that needs to be tackled in the most empathetic yet robust way.

There is no question that cancer care is in crisis. We have heard the figures relating to NHS waiting lists generally. Given that 7 million people are waiting for treatment, that equates to about 13,000 people waiting for care in my constituency alone, many of whom will, without doubt, be waiting for cancer-related care. One of my constituents wrote to me—I will not mention her name—exhorting me to come to the debate, because she said that she was deeply concerned about the latest waiting times for cancer treatment. They show that in England, in January, nearly one in two cancer patients missed life-saving treatment targets. That brings us to the crux of the issue: what are we going to do about that? What do the Government intend to do about that? Notwithstanding what they are trying to do, frankly I am not sure that that is sufficiently robust to take us forward.

We are replete with statistics from organisations such as the Royal College of Radiologists, which states that the best way to improve cancer survival rates is by diagnosing and treating patients earlier and more rapidly, as the hon. Lady said, and by ensuring that there are enough radiologists and oncologists to provide cancer care today. That is essential, but there is a shortfall across those areas. Having determined that that is a crucial part of the pathway to diagnosing or treating cancer patients, we find that the shortfall in the number of clinical radiology consultants is 30%, or 1,453 people, and the shortfall in the number of clinical oncology consultants is 17%, or 163 people, which is predicted to rise to 26%, or 317, by 2026. The reality is that the line is going down. Meanwhile, demand is increasing. By 2035, it is estimated that more than half a million people a year will be diagnosed with cancer in the UK, an increase of 40% since 2015. That is why we have to tackle this situation.

As the hon. Lady said, without sufficient investment, chronic workforce shortages will continue to be an issue and will limit the capacity and capability for innovation. I hope that the Government’s long-term workforce plan will move us along. However, it was like dragging a screaming child to get the Government to agree to a long-term plan. We do not know when that will come out—I hope that it will appear pretty soon, but I am not sure. We need that plan as soon as practicable.

For the first time in the history of the NHS, nearly half of all cancer patients fail to receive treatment within two months of an urgent referral. That figure comes from January 2023. It is damning but, more importantly, for the individual patients concerned, the situation is life-threatening. I am not sure that the Government have quite grasped that fact. To do so, they would have to realise the seriousness and challenges they face and I am genuinely not sure that they have grasped the seriousness.

The same is true for bowel cancer. Bowel cancer is the fourth most common cancer in the UK and the second biggest cancer killer. It kills more than 16,500 people a year. A targeted long-term plan for cancer is the best way to improve outcomes for those patients. The Government have to commit, as has been requested, to an ambitious, fully funded, dedicated plan for cancer, which addresses current issues in cancer care and equips services to meet future demand. Yet more organisations are, in effect, asking the Government to pull their finger out.

The organisations that I mentioned are external to Parliament, but Parliament’s Public Accounts Committee also said, in relation to the management of NHS backlogs and waiting times in England:

“Cancer waiting times are at their worst recorded level and NHS England will not meet its first cancer recovery target.”

It stated that, in August 2022,

“there were 2,600 patients who had been waiting more than two years.”

Let me repeat that: 2,600 patients had been waiting more than two years. A record 7 million people, of course, are on the waiting list. The Committee also said that NHS England—and the Government are as guilty on this point—

“made unrealistic assumptions about the first year of recovery, including that there would be low levels of COVID-19…The NHS is still not planning properly for the staffing and other resources it needs to deliver additional diagnostic and treatment capacity.”

I could go on—I will not—but I hope that those points give a flavour of the crisis that the NHS tends to be in, generally, and that particular services are in, whether that is radiology, dentistry or pharmacy. Frankly, the list goes on and on, and that means that our constituents are not getting the care they need.

I hope the Minister has read the documents from all the organisations that I have mentioned, as well as those from a plethora of other health and health service organisations. I hope she has read all the submissions because it seems to me that, to use a hackneyed old phrase, we are getting warm words. No doubt the Minister will tell us what the Government are doing, have been doing, might do and are planning to do. The reality is, however, that the situation is not moving along and, in the meantime, patients are suffering, families are suffering, and patients are dying. Let us not beat about the bush; that is the reality.

I exhort the Minister to look at all the documents and evidence she wants and to consider it as much as she can, but the Government have to accept, realise and recognise that there is a crisis in cancer care for which they—along with all the professionals and organisations in the NHS; I completely accept that—are primarily responsible. They are the ones responsible for the funding and organisation. I hope the Minister bears that in mind during these deliberations.

[Tim Farron (Westmorland and Lonsdale) (LD)]

It is an honour to serve under your guidance today, Mr Paisley, and to follow the hon. Member for Bootle (Peter Dowd), who made some important points, for which I thank him. I express massive congratulations to the hon. Member for West Bromwich East (Nicola Richards) not just on securing an important debate, but on making an excellent speech. I commiserate, console and offer my condolences to her on the loss of her mother. I also lost my mum to cancer. The hon. Lady is a bit younger than I am, so I assume we lost our mums at about the same age.

My mum, Dr Susan Farron—she would like me to mention her title, I am sure—passed away from ovarian cancer 19 years ago. Although we are here to represent our constituents and do what is right, whether we are personally affected or not, there is an element of honouring our mothers in what we seek to do today. I am sure the hon. Lady’s mother would be massively proud of her, not just for what she has done today.

This is a huge issue. It is said that half of us will get cancer at some point in our lives, and 100% will be affected by it in one way or another. We deal at the moment with terrifying waiting times for cancer treatment. They are not quite as awful as they were a month or so ago. The Minister may say that, and we will grab some positives where they exist, but they are still deeply troubling.

In my constituency, in south Cumbria, 27% of people with cancer are not being seen within two months of being diagnosed. Someone who has cancer and has been told they have this dangerous thing within them that is potentially going to kill them then waits for two months for treatment. In north Cumbria, 44% of people diagnosed with cancer are waiting more than two months for their first intervention. What terror does that spark in an individual with cancer and all their loved ones? What frustration does that lead to within the clinical community, who desperately want to care for those people? To add substance to that terror, we know that on average—although there is no average cancer—for every four weeks that treatment is delayed, there is a 10% reduction in life expectancy. That is disastrous and massively worrying for everybody who faces that challenge.

Covid has played a part, with its massive impact on our health service. People perhaps did not come forward with symptoms during the pandemic as soon as they might have done. I have many disagreements with the Government about how they handled the pandemic, but it is important to say that, if they had not locked down, the situation would have been far, far worse. Let us remember that many of the pressures that we face are because we sought to protect the NHS to save lives, and we did just that. However, the waiting times are unacceptable. They are explicable but not excusable.

I want to focus my remarks on radiotherapy. I chair the all-party parliamentary group on radiotherapy. One reason for doing that is that I recognise that radiotherapy is one of an important range of tools that can be used to treat, and often cure, that terrible disease of cancer. Across the world, in countries with similar levels of GDP to ours, such as other European countries, Australia and New Zealand, there is an average international target that 53% of patients living with cancer should receive radiotherapy. In the UK, the proportion is 27%. One reason is the lack of investment from Governments of all colours represented in this room. I will point the finger at this Government for not taking the action they need to now, but I could point the finger inwards at the coalition Government and the Labour Government. We have collectively neglected this situation, I am afraid.

Only 27% of people with cancer who should or could receive radiotherapy are getting it. For a clue as to why that is the case, let us look at Australia, where the five-year survival rates for lung cancer are a third better than those in the UK. Australia spends around 10% or 11% of its cancer budget on radiotherapy; in the UK, we spend just 5%.

[Peter Dowd]

I am pleased that the hon. Gentleman raised that. Radiotherapy UK provided some figures indicating that

“by the end of 2024 there will be 74 out of date machines in the NHS,”

and that

“by 2025 it will be 90.”

Does he agree that that is a pretty grim statistic?

[Tim Farron]

It is, and in a moment, I will come on to how we might tackle that. It is a real problem, and not all of it is down to money—some of it is down to where and how the money is spent.

The all-party parliamentary group on radiotherapy has been working with the charity Radiotherapy UK, which the hon. Gentleman rightly referred to. We have been delighted with the coverage that we have received recently through the Daily Express, which has run a campaign alongside us calling for a £1 billion boost in radiotherapy. The Minister can read all about it not just in the Express, but in the manifesto put together by the all-party group, which details that.

To put it bluntly, in the run-up to the Budget this week, we know that the Chancellor has something like £30 billion more to spend than he thought because of underspend on energy support and an increase in tax revenues, not least because of people spending more money on goods due to inflation, and therefore spending more VAT. The Government therefore have that windfall to play with. I am asking for one thirtieth of that to be spent on radiotherapy, so that we can save thousands and thousands of lives.

What would we spend that money on? We would spend it on new kit. Not all of that would need to be new money; it could just be money that is spent more wisely. As the hon. Member for Bootle alluded to, part of the problem is that we have ancient kit. He mentioned the 74 machines—linear accelerators—that will be out of date by the end of next year. Why do we have so many out-of-date linear accelerators and other bits of radiotherapy kit? It is largely because the funding for those machines is feast and famine, and because it is devolved to 42 different specialist commissioners, when we actually need a central, national, well-funded rolling programme to replace and update linear accelerators. It is not rocket science—though it is science—and the Government could do that without spending an absolute fortune.

I want to ask the Minister again about the issue regarding tariffs. Many of our cancer centres are using second-division kit, to put it crudely. The tariff for using a second-division piece of kit means that centres can be paid for the 30 fractions a person might need to deal with their cancer, whereas with a first-division piece of kit, it might take only four, five or six trips to treat someone. Centres are paid per fraction, so there are perverse incentives whereby trusts are more likely to be rewarded if they use poorer kit more often than better kit less often. That has been fixed in part, but not for every cancer, not for every machine and not for every unit. That needs to be dealt with, and again, it could be done freely.

We talked about the workforce. The radiotherapy workforce is really small—about 6,400 individuals. There are 30% fewer entrants coming into the sector than there are places available, which has an impact on the morale of the people already working there. We are losing people as a consequence. Retention is becoming a problem because recruitment is such a problem. People feel under such weight. With such a small workforce, it would not involve an awful lot of effort to significantly increase that. We need to invest in training to bring clinical oncologists and clinical radiologists into the profession, and also to alleviate the pressure that staff are under now by supporting new admin staff up-front, which could be done very quickly, to allow people currently in the profession to be able to concentrate more on their frontline duties, rather than on admin.

I will make a final remark regarding radiotherapy, which is about access. Among the reasons why only 27% of people with cancer are getting radiotherapy in England—as opposed to the 53% who really should—is that many people, particularly in my community, are just too far away from the treatment. In our communities, the majority of patients using our nearest radiotherapy centre are making two or three-hour round trips every single day. The national radiotherapy advisory group says that it is bad practice for people to have to travel more than 45 minutes for treatment—never mind three-hour round trips every day for 30 days. As a consequence, some people do not get referred for treatment at all, or may even make the choice themselves not to finish that treatment. There is no doubt that that is having an impact on survival rates.

We have built a strong case, in our community, for a radiotherapy satellite unit from the Rosemere unit in Preston—our nearest unit—to be deployed at the Westmorland General Hospital in Kendal. A solid clinical and business case was put for that, and I would be grateful if the Minister might agree to meet with me, even for just 15 minutes, to review that and consider the extent to which the Department might be able get behind it and other satellite units around the country that could cut waiting times and save lives.

There are no silver bullets to many problems that we face in this place, but this is quite close to being one. For a relatively small amount of money, the UK Government could do something that would save lives, and do so quickly. I encourage them to do so.

--- Later in debate ---

[The Minister for Social Care (Helen Whately)]

It is a pleasure, Mr Paisley, to serve under your chairmanship.

I thank my hon. Friend the Member for West Bromwich East (Nicola Richards) for securing this debate on cancer care. According to Cancer Research UK, one in two people—half of us—will develop cancer at some point in their lives. There are around 290,000 new cancer diagnoses a year, or nearly 800 every day.

When we cite statistics such as these—as is the case with NHS waiting lists, for instance, across the board—I always remember that every one of the figures is about a human being. Whether it is a parent, a child or a grandparent, they are someone’s loved one. And every one of them will be worried, or even scared, about their diagnosis; their lives are disrupted and they may be living in pain.

My hon. Friend brought that to life in her speech from her own personal experience. May I express my very sincere condolences to her for the loss of her mother? Such a loss is so sad, especially as it came too soon; I believe that her mother was only in her 50s when she died last year. My thoughts are also with her staff member Bradley, who she mentioned, whose mother would have been 58 today. Also, the hon. Member for Westmorland and Lonsdale (Tim Farron) mentioned his mother, who very sadly died of cancer. So this is a moment to think about mothers, perhaps particularly with mother’s day coming up. My best friend in childhood lost her mother to cancer when we were in our teens, and I clearly remember how that was for her. And there are so many other people who have lost loved ones to cancer, too often before their time. That is why diagnosis and treatment of cancer is so important to so many of us.

My hon. Friend rightly spoke about the importance of early diagnosis and prompt treatment. They are important for everybody. However, she particularly talked about areas with higher rates of cancer and the above-average levels of cancer in her own area. As she said, health disparities are part of the problem and they must be tackled, too.

Clearly, and rightly, my hon. Friend keeps a close eye on the performance in her area. I see my job as a Minister to look across the whole country and to help our healthcare system to tackle variation in performance, and indeed to level up where there are inequalities, because everybody should have access to early diagnosis of cancer and effective treatment for it.

Right now, I have three priorities for cancer: one is to recover from the pandemic and reduce the pandemic backlog; the second is to improve early diagnosis and treatment, using the tools and technologies that we have; and the third is for there to be investment in research and innovation, and for those innovations to be developed to make a difference to people’s lives and to the diagnosis and treatment of cancer. We know that technologies such as genomics and artificial intelligence, for instance, have the potential to truly transform our ability to diagnose and treat cancer effectively as a society.

[Peter Dowd]

Yesterday, I received an email from Sarah Taylor on behalf of the #CatchUpWithCancer and Radiotherapy4Life campaign. Among other things, she indicated that in May 2022 over half the heads of radiotherapy departments wrote to the Health Secretary and warned that

“radiotherapy is at crisis point”.

However, to our knowledge, so far they have not had a reply from the Department. Will the Minister try to chase that up if I provide her with further information?

[Helen Whately]

I will come on to talk about radiotherapy, but I can say to the hon. Gentleman here and now that I will indeed look into what has happened to the response to that letter.

However, I will start by talking about the waiting times, recovery from the pandemic and reduction of the pandemic backlog. Our elective recovery plan included the ambitious target to return the number of people waiting for more than 62 days for an urgent cancer referral back to pre-pandemic levels by this month. Since the publication of that recovery plan, the NHS has seen enormously high demand for cancer checks. More than 2.8 million people were seen in the 12 months to January 2023—up by 19% compared with the same period before the pandemic. The return in demand, with people coming forward for cancer checks, is very positive after the falls we saw in the pandemic.

When giving evidence to the Health and Social Care Committee last week, Dame Cally Palmer, NHS England’s national cancer director, said that

“we are not going to meet the pre-pandemic target by the end of March, simply because of those record levels of demand.”

That is already in the public domain. However, I assure hon. Members that we are working closely with NHS England to reduce the time people are waiting to receive a diagnosis, or an all-clear, and to start treatment, and we are making progress on that. The latest published figures show that the 62-day cancer backlog for the week ending 26 February stood at just over 22,000, which is a fall of 35% since its peak in the pandemic. However, that is 22,000 people too many who have had to wait 62 days, and many of them will have had to deal with the anxiety of waiting for a diagnosis or an all-clear, which is why we are working so hard on this issue with NHS England.

As I said, it is good that more people have come forward for cancer checks but, in response, we must increase our capacity to diagnose and treat cancer. That is one reason why we have been investing in community diagnostic centres, and we have more than 93 centres open and operational. That is why the NHS is rolling out what we call fit tests to speed up diagnosis for people who may have, for instance, bowel cancer. That is why the NHS is rolling out teledermatology to speed up diagnosis for people who may have skin cancer, and speeding up access to MRI scans for people who might have prostate cancer. Those are the three types of cancer with the most people waiting for a diagnosis or an all-clear or, if they have a diagnosis, to start treatment, and I am determined to reduce those waits.

When I meet charities and clinicians, the one message I consistently hear is how important early diagnosis is for improving patient outcomes and care, and that was something my hon. Friend the Member for West Bromwich East referred to. She talked about the ambition in our long-term plan to be diagnosing 75% of cancers at stages 1 or 2 by 2028. As part of achieving that, we are extending targeted lung health checks, with more than double the number of community lung truck sites. The targeted lung health checks programme had diagnosed 1,625 lung cancers by the end of December 2022, with 76% of those diagnosed at an earlier stage.

To help people get a cancer diagnosis or an all-clear more quickly, since November GPs have been able to directly order diagnostic tests such as CT scans, ultrasounds or brain MRIs for patients with concerning symptoms who fall outside the National Institute for Health and Care Excellence’s guideline threshold for urgent referral. Alongside that, community pharmacists in pilot areas are helping to spot signs of cancer in people who might not have noticed symptoms or realised their significance, and we continue to see non-specific symptom pathways rolled out. As of December 2022, more than 100 are live across the 21 cancer alliances.

To encourage people to contact their GP if they notice, or are worried about, symptoms that could be cancer, NHS England has run the “Help Us, Help You” campaign, which seeks to address the barriers deterring patients from accessing the NHS if they are concerned they might have cancer. In March and June 2022, we saw a 1,600% increase in the number of visits to the NHS website’s cancer symptoms landing page, so the campaign had a huge impact on the number of people looking to see whether they might have cancer symptoms. NHS England is in the process of planning “Help Us, Help You” activity for 2023-24, to make sure we continue the momentum and continue to encourage people to come forward if they have worrying symptoms of something that might be cancer.

However, we all know that diagnosis is just the first step on a patient’s journey, so we are also taking steps to improve cancer outcomes by rolling out innovative new treatments, such as the potentially life-saving drug pembrolizumab for one of the most aggressive forms of breast cancer, and mobocertinib to treat a specific form of lung cancer. The National Institute for Health and Care Excellence has made positive recommendations in all 18 of its appraisals of breast cancer medicines since March 2018, and those medicines are now available to NHS patients. NICE is also able to make recommendations to the cancer drugs fund, which has benefited more than 88,000 patients, with 102 medicines receiving funding for treating 241 different cancers.

My hon. Friend the Member for West Bromwich East mentioned radiotherapy equipment, as did the hon. Members for Westmorland and Lonsdale and for Bootle (Peter Dowd). Since 2016, more than £160 million has been invested in radiotherapy equipment so that every radiotherapy provider has access to modern, cutting-edge radiotherapy equipment. That investment enabled the replacement or upgrade of around 100 radiotherapy treatment machines and in some cases the roll-out of new techniques, such as stereotactic ablative radiotherapy. On top of that, £260 million has been invested in establishing two services to deliver proton beam therapy in London and Manchester.

On the workforce, from 2016 to 2021, the number of therapeutic radiotherapy staff grew by more than 17%, and the number of clinical oncologists by more than 24%. From 2021, there has also been an uplift in the number of entry-level places available, with 108 in clinical oncology, up from an average of around 60 per year in previous years.

I want to pick up on the claim that only 27% of cancer patients are treated with radiotherapy. That claim is outdated and incorrect, as it includes radiotherapy only as part of a patient’s primary treatment for cancer and does not capture a substantial proportion of patients who receive radiotherapy as a subsequent treatment. Also, I am told that the data is from 2013-14, so that is also out of date. NHS England has assured me—I have looked into this—that those who need radiotherapy treatment can access it.

NHS Workforce

Peter Dowd Excerpts

Tuesday 6th December 2022 Commons Chamber

[Wes Streeting]

I wholeheartedly agree. I seemed to hear from the Health Secretary this afternoon a one-size-fits-all approach from the Government, as though every hospital’s needs will be the same and we can import a standardised model for every hospital site. I would be happy to be proven wrong, and I would be even happier if the Secretary of State got the ball rolling on some plans that are already agreed, and on which trusts have spent a significant amount of time and taxpayers’ money. I would be even more delighted if we got some of those hospitals open, but I would wager that when we get to the end of the Government’s life, we will not have seen anything like 40 new hospitals delivered or even in the pipeline.

[Peter Dowd (Bootle) (Lab)]

My hon. Friend is making a compelling case. I think I know where we could get some of the money from for training places, and perhaps he will agree. We forgo about £3.2 billion in revenue from non-doms every year. There are 68,000 non-doms, there or thereabouts, which works out at about £44,000 a non-dom. Does he think that he could do much with that?

[Wes Streeting]

My hon. Friend has led me neatly towards setting out Labour’s plans, which rely on people who come to this country and make Britain their home actually paying their taxes here. That is the right and fair thing to do, and I think people across the country would agree that we need nurses more than we need non-doms.

NHS Staffing Levels

Peter Dowd Excerpts

Tuesday 22nd November 2022 Westminster Hall

[Peter Dowd (Bootle) (Lab)]

It is a pleasure to speak under your stewardship, Mr Hollobone. I thank my hon. Friend the Member for Wirral West (Margaret Greenwood) for initiating the debate.

Where do I begin on this subject? It is difficult to know because Members have brought forward a plethora of information, but I will start with the House of Commons Library briefing, which is always a good source of information, and its research is based on independent sources. It says that the Health and Social Care Committee has said:

“The National Health Service and the social care sector are facing the greatest workforce crisis in their history.”

The NHS, which is the best part of 80 years old, is facing the worst crisis in its history, with a vacancy rate of 9.7%, which is 132,139 members of staff.

There is significant shortfall in staff across the piece. The hon. Member for Westmorland and Lonsdale (Tim Farron) talked about vacancies in pharmacy, dentistry, radiology, podiatry, ambulance staff, back-office staff—as those people who are at the heart of the service and keep it going are disparagingly called—cleaners and porters. Everybody says the whole NHS is under huge stress.

[Rachael Maskell]

I want to highlight the neuroradiology profession and the reality that staff shortages have an impact on clinical outcomes. Hardly any of our NHS trusts have neuroradiologists, but they could save 9,000 lives lost to strokes by being able to advance new techniques. Does my hon. Friend agree that it is important to look at the clinical outcomes that health professionals could bring?

[Peter Dowd]

My hon. Friend is right: it is crucial that we do that. A whole range of issues are beginning to affect staffing. For example, there is a £9 billion maintenance backlog in the NHS. Patients are being treated in hospitals that are not, in certain situations, fit for purpose and, importantly, staff have to work in those environments. In many cases, radiology equipment is not up to date, so staff and patients are either working or being treated in an environment in which the conditions and the equipment are not good. That goes to the heart of the staffing crisis as well.

There are lots of suggestions about how the Government could get to grips with the situation. Community Pharmacy England has plans to “resolve the funding squeeze”, which seems pretty straightforward, to

“tackle regulatory and other burdens”

that are affecting staffing, to

“help pharmacies to expand their role in primary care”

and to

“commission a Pharmacy First service”.

All those things go to the heart of enabling staff to feel wanted and that they are working in an environment where they are treated properly.

Of course, we then get people leaving in droves because of pay. I looked at some of the figures in relation to the pay restraint that we have had for the past few years: since the Government came to power in 2010, for all intents and purposes there has been either no pay increase or an increase of 1% here and 2% there.

[Clive Lewis (Norwich South) (Lab)]

I thank my hon. Friend for making such an excellent speech. Will he comment on the fact that at the University of East Anglia medical school we saw a fifth of new nurses, or training nurses, drop out of the course after the Government cut the nursing bursary? With the low pay, crisis of staffing and pressure that is going on, we expect those nurses to work in the NHS as they are training and rack up debt at the same time. If we are going to get the numbers back up, we must surely reintroduce the bursary.

[Peter Dowd]

Yes, we must. When these professionals come into the NHS and work their socks off, for all the hours that God sends, they do not even get a decent pay rise. They have had to pay to do the job, then they pay to do the job again because we are not giving them enough money. My hon. Friend is absolutely right. The amount of funding the NHS gets falls well short of our international competitors in terms of revenue and current and capital expenditure. We spend about £3,055 per person on health; in our competitor countries, which are similar economies with similarly sized populations—such as France and Germany—the figure is £3,600. That difference, of the best part of £600 per person, is absolutely significant. We are falling further behind as the years go by.

The Government say, “Well, this year we have accepted the independent NHS pay review body’s recommendation.” I suspect that this is the first time in many years that they have accepted, championed and blown the bugle for it. Let us look at the detail and analyse it. The terms of reference include

“the need to recruit, retain and motivate suitably able and qualified staff”.

That is not happening, is it? That is nowhere to be seen. They also mention

“regional/local variations in labour markets and their effects on the recruitment and retention of staff”.

That is not working either, is it?

The terms of reference mention:

“The funds available to the Health Departments, as set out in the Government’s Departmental Expenditure Limits”.

In effect, the Government tell the pay review body what it can do, because of the amount the Department has, and then, when the body agrees with what the Government say, they say it has been an independent assessment. It is not as simple as that.

Here is another one: “the Government’s inflation target” is a factor. We all know where that is—whose fault is that? It is not the Government’s fault; it is the Bank of England’s fault.

The terms of reference mention:

“The principle of equal pay for work of equal value in the NHS”—

which was referred to earlier and is not happening. They talk about:

“The overall strategy that the NHS should place patients at the heart of all it does”—

but it is far from putting them at the heart of the service. In conclusion, staff need a pay rise and better working conditions; the only way they will get that is with a Labour Government in two years’ time.

--- Later in debate ---

[Feryal Clark (Enfield North) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. I pay tribute to my hon. Friend the Member for Wirral West (Margaret Greenwood) for securing this important debate, and praise all the Members who have spoken this afternoon for their brilliant contributions.

The NHS is a cornerstone of communities up and down our country. It is the biggest employer in Europe and one of the biggest in the world, supporting the livelihoods of millions of British families. A publicly funded healthcare service that is free at the point of need is a lifeline for so many, and the people of this country are overwhelmingly proud of it. The pride and respect we have for the NHS means that it will always have people to stand up and defend it when things are going wrong.

However, the reality is that patients are finding it impossible to get a GP appointment due to chronic shortages of doctors, as we heard from my hon. Friend the Member for Birmingham, Erdington (Mrs Hamilton). Stroke and heart attack victims are waiting an hour for an ambulance, and over 400,000 patients have been waiting more than a year for an operation. We have gone from an NHS that treated people well and on time to not just a winter crisis, but a year-round crisis, and an NHS that is understaffed and unable to deliver timely care.

The NHS is facing the greatest workforce crisis in its history. Right now, there are 132,000 vacancies across the NHS, and 165,000 in social care. We are short of 40,000 nurses, and we are losing midwives faster than we can recruit them. We are short of 12,000 hospital doctors, yet this summer, medical school places were cut by 30%, turning away thousands of straight-A students from training to become doctors when we need them more than ever. As we have heard again and again this afternoon, the consistent failure to train and retain the nurses and doctors our NHS needs has left staff overworked, overstretched and struggling to cope.

[Peter Dowd]

The Royal College of Physicians produced a short, medium and long-term plan for the NHS, specifically in relation to staffing. I was shocked to read that the measures to increase satisfaction and retention of current staff—getting the basics right—included access to hot food and drink, and rest facilities, at all hours of the day. The Royal College of Physicians putting that into a document shows how poor the situation is. Would my hon. Friend agree that the Government have to listen to that?

[Feryal Clark]

I wholehearted agree with my hon. Friend. With nurses already doing an average of £2,000 a year in overtime to make up shortages, the Government cannot rely on good will to get us through this crisis. They cannot afford to play politics and refuse to get around the negotiating table to avoid strike action.

It would be far too simplistic to suggest that pay is the sole cause of this crisis, as we have heard in this debate. Members who have spoken with NHS staff in their communities will know that the problems run far deeper than that. In this debate we have heard how staff are demoralised, burnt out and undervalued, and are working in poor conditions. Staff members are working harder than ever, but are unable to deliver the level of service they want for patients.

When I speak to NHS staff in my constituency of Enfield North, their passion and dedication is in no doubt whatsoever. One of the clear themes that came through in a local healthcare survey run over the summer was an appreciation in our community for the efforts of NHS staff. On a recent visit to Chase Farm urgent care centre, I saw at first hand the pride that staff had for the work they did, and their desire to deliver the best for patients, despite chronic shortages of staff and the most trying of circumstances. They are going above and beyond the call of duty.

We cannot keep relying on the good will of staff. We need to see their attitude matched by action from the Government. Staff need to know that they will not be hung out to dry and that help is there for them. What reassurance can the Minister give to staff, at places such as Chase Farm, that their cries for help will be heard? If the Minister believes that what we heard from the Chancellor is sufficient, then he is very much mistaken. I am pleased that, after long calls from the Back Benchers, the Chancellor has dragged his party into agreeing to an independent assessment of our NHS workforce needs, but does the Minister really expect that assessment to say that the NHS has the people it needs to deliver a safe standard of care for patients?

Talking will not cut it for NHS staff. We need a plan of action. I was pleased to hear from my hon. Friends the Members for Bradford West (Naz Shah) and for Barnsley East (Stephanie Peacock), who set out Labour’s plan so well. Labour’s plan will deliver the biggest expansion of medical school places in history, doubling the number to give the NHS the doctors it needs to get patients seen on time. It will also include an extra 10,000 nursing and midwifery places, helping to close the gap caused by the loss of 800 midwives in the NHS since the last election. Labour would double the number of district nurses qualifying each year and train 5,000 more health visitors. That would be funded by abolishing non-dom status, a move that brings in double the £1.6 billion investment that our NHS workforce needs. The Chancellor has described our plan as something that

“I very much hope the government adopts on the basis that smart governments always nick the best ideas of their opponents.”

Given that statement, I look forward the Minister bringing the plan forward as the Government’s own, sooner rather than later.

We know that getting more staff into the system will not, on its own, solve the problem. Our NHS has brilliant staff working in it already, and we must do more to give them the confidence to stay. The Government are simply not doing enough, and unless we improve retention, extra recruitment will not deliver the numbers we need. As we have heard, staff are leaving faster than we are recruiting. The scale of the crisis means that we cannot simply wait things out and hope it blows over. We need a plan and some action from the Government now. I look forward to the Minister telling us how they will deliver that.

Kettering General Hospital Redevelopment

Peter Dowd Excerpts

Wednesday 26th October 2022 Westminster Hall

[Peter Dowd (in the Chair)]

Order. Can people kindly leave the Chamber, please? I will call Philip Hollobone to move the motion, and then the Minister to respond.

[Mr Philip Hollobone (Kettering) (Con)]

I beg to move,

That this House has considered redevelopment of Kettering General Hospital.

It is a genuine pleasure to see you in the Chair, Mr Dowd. I thank Mr Speaker for granting me this debate, and I welcome the Minister to his place. The redevelopment of Kettering General Hospital is the No. 1 local priority for all residents in Kettering and across north Northamptonshire because our hospital is a much-loved local institution. It has been in the town of Kettering since the year of Queen Victoria’s diamond jubilee, in 1897. That was a great year for Kettering because of the establishment of not only the hospital but the much-loved local newspaper, the Northamptonshire Evening Telegraph. Here we are, 125 years on, with an extremely exciting programme of investment going into the hospital. It is such an important issue that this is now my ninth debate on Kettering General Hospital and my sixth since September 2019. We really want this redevelopment programme to succeed.

I want to start by acknowledging the Government’s commitment to the hospital, because they have pledged a massive amount of money, totalling £563 million. That includes the write-off in 2020 of £167 million of trust debt; an award of £46 million, initially to develop an on-site urgent care hub; and the main investment of £350 million—which was always going to be for 2025 to 2030—under health infrastructure plan 2 funding, for the major redevelopment of the hospital. I welcome that very much indeed. However, pledges of investment are one thing; actually delivering the cash is another. That is why this is now the sixth debate since September 2019. I see it as my role to constantly prod the Government to ensure that the investment is forthcoming.

We need that investment because Kettering and north Northamptonshire are among the fastest-growing places in the country. The hospital serves the population of Northamptonshire and south Leicestershire, which has already grown by double the national average over recent years. The latest Office for National Statistics data estimates above-average percentage population growth of up to 40% over the next 30 years in all three components of population change—net within-UK migration, net international migration and net births and deaths. Corby also has the country’s highest birth rate. The hospital expects a 21% increase in the number—

NHS Dentistry

Peter Dowd Excerpts

Thursday 20th October 2022 Commons Chamber

[Judith Cummins (Bradford South) (Lab)]

I thank the Backbench Business Committee for granting this important debate and I thank my co-sponsor, or co-conspirator, the hon. Member for Waveney (Peter Aldous).

If you might indulge me this once, Madam Deputy Speaker, I did, in preparing for this debate, look up my past remarks on this issue; a sort of compendium of forecasting doom for NHS dentistry that, as it turns out, is entirely accurate. As we have heard, Members from across the House and across the country are raising concerns on behalf of constituents who are simply unable to access an NHS dentist. The current system remains unfit for purpose. Recent BBC research found that in the south-west, the north-west and Yorkshire and the Humber, just 2% of dental practices were taking on NHS patients.

[Peter Dowd (Bootle) (Lab)]

Is my hon. Friend aware that not a single dental practice in either the current former Prime Minister’s constituency or the Health Secretary’s constituency is accepting new NHS patients? Should it not spur on the Government that the former Prime Minister’s constituents and the current Health Secretary’s constituents cannot get access to NHS dentistry?

[Judith Cummins]

I am indeed aware of that fact, as my hon. Friend the Member for Bolton South East (Yasmin Qureshi) raised it with me yesterday. Sadly, she cannot be here today to make that very point, so I thank my hon. Friend for doing so.

In Bradford, 98% of dentists are closed to NHS patients, forcing people to go either to accident and emergency or to go private, whether they can afford to or not, often taking out a payment plan because they do not have the luxury of an NHS dentist available to them. In Bradford, 16% of three-year-olds and over a third of five-year-olds are now suffering with visible signs of tooth decay. In Yorkshire and the Humber, over 2,700 children under 10 had teeth extracted in hospital between 2020 and 2021. In fact, children born in Bradford are eight times more likely to be admitted to hospital with dental decay before their sixth birthday than if they were born in the former Prime Minister’s region. The truth is that NHS dentistry in its current form is just not working anywhere for anyone.

How did we get to this position? The answer is threefold: a contract not fit for purpose, dramatic underfunding and an exodus out of the NHS workforce. During my time in this place, Minister after Minister after Minister has stood here accepting that fundamental reform of the contract is needed. And yet we are still waiting. After years of delay, the Government announced in July some small contract changes, but unfortunately those quick wins completely failed on the fundamentals. NHS dentists in my constituency tell me that the financial uplifts are minor to the point of insignificance. The Government are conducting a polish and a clean when what is needed is root canal treatment. Will the Minister tell us exactly why the Government have not delivered the long-awaited full-scale contract reforms? Is it still their intention to conduct those reforms? If so, when can we expect them? If not, why not?

It is important to put on the record that the issue here is not a shortage of dentists. The number of registered dentists is at a record high. We have the dentists, but they are working in private practice. Until the Government fix the problems with the contract, which sees highly qualified and experienced dentists squeezed out of the system, they are simply pouring water into a bucket with a giant hole at the bottom of it.

My next point is on funding cuts. We saw funding to NHS dentistry fall by around a third in real terms over the last decade and that was before the cost of living crisis. In January, the Government announced a £50 million catch-up fund for dentistry, funded from clawback, that gave practices three months to offer urgent care appointments to deal with the pandemic backlog. I warned the Government at the time that their strategy was flawed and that the funding to tackle the covid backlog would prove to be unusable and the system unworkable. ITV recently revealed that approximately £14 million of the promised £50 million was actually spent. That is just 28% of the funding allocated, which delivered only 18% of the 350,000 appointments it was meant to. In Yorkshire and the Humber, my region, only 16% of the allocated funding was actually spent. The shortfall was clawed back by the Government once again and not reinvested back into dentistry in my region. That is less than a third of the money spent, not because it is not needed, but because the Government set up a system that was unworkable.

We need targeted funding to address an acute problem in areas of high need. The successful Bradford project that I developed with former Ministers back in 2017 really worked. It was a transformative project that meant we got 4,200 extra NHS dental appointments for people who had not had a dentist appointment for over two years. In the long term, however, we need fundamental change, and a comprehensive reform of the contract to push prevention is absolutely critical to that reform. Good oral health must not be restricted by either postcode or wealth. Going to A&E cannot be an alternative to NHS dentistry.

Although I welcome the Minister to his new role and, indeed, welcome the Secretary of State’s new emphasis on dentistry in her ABCD of priorities, whoever the Secretary of State is, in whatever Government, they should learn the lessons of targeting and invest in NHS dentistry, as prevention really is better than the cure. We simply cannot go on like this. The public are fed up to the back teeth with inaction and excuses.

--- Later in debate ---

[Peter Dowd (Bootle) (Lab)]

Where are we to begin with this? We have been here before, time after time. I thank my hon. Friend the Member for Bradford South (Judith Cummins) and the hon. Member for Waveney (Peter Aldous) for bringing us this debate. We have discussed this many times and we had a debate in Westminster Hall in the summer, but nothing has really moved on. Nothing at all seems to have changed.

I want to read out part of a letter I received from a constituent, and this is typical of the problem we are facing. I have received even worse horror stories, to the extent that one local dentist told me that they may close in the next few weeks. That is typical and symptomatic of this bigger problem. My constituent said:

“I wanted to take the time to get in touch with you over my experience of getting on the books for an NHS dentist. I have had no luck and have had to have private dental visits. I have luckily not had to have any treatment as I would not be able to afford it. I have reached out to a few dental practices in the area…to be told that they are only taking on children on the NHS.”

That is typical of the experience of everyone in this Chamber. I exhort Conservative Members to stop dealing with this in the abstract, as though it is only affecting individual Members of Parliament; it is a collective issue, and it needs a thorough review and a thorough push by the Government. It is not in the abstract. The hon. Member for Salisbury (John Glen) referred to covid. I completely accept that covid had an impact on the provision of dental services—it hothoused an already challenging situation—but dental services in all our constituencies were under huge pressure before covid. Let us not pretend that covid was the be all and end all of the dental health problem.

[Sir John Hayes (South Holland and The Deepings) (Con)]

I agree with the hon. Gentleman that there are systemic problems, part of which goes back to the contracts agreed with dentists donkey’s years ago, under the Labour Government—the same applies in respect of GPs. That genesis of the problem was there, but we then face the problem of training too few dentists, which I think we do, and the problems in particular parts of the country, including, Lincolnshire, which is among the worst affected. My constituents cannot get an NHS dentist and they need to have one. That particularly applies to young people and children. He is absolutely right on this.

--- Later in debate ---

[Peter Dowd]

I am grateful to the right hon. Gentleman, who reinforces the point that I am trying to make. We are being contacted by constituents, as I have just set out. We are being contacted by Bupa—I suspect that Members will have had a briefing. We have had a briefing from the British Dental Association. We have had contact directly from dentists. They are all saying exactly the same thing and the Government have to listen. Not only do they have to listen—it is dead easy to do that—but they have to act. The Government have to put their hand in their pocket. So let us stop pretending that £50 million just before the summer is going to do anything in any significant or substantive way to resolve this problem—it is not.

The hon. Member for Bath (Wera Hobhouse) referred to an existential threat, and there is one—dentists are telling us that, as is the BDA. In practical terms our constituents are saying that to us, because their experience shows that there is an existential threat. The contract is a discredited one and it needs to be put right; it puts targets ahead of patient care. But this is also down to the fact that, whether we like it or not, and whether the Government like it or not, cuts in dentistry have not had any parallel to any other cuts in healthcare. We are talking about cuts of more than 25% between 2010 and 2020. That factors in and it creeps up on us year after year until we get to the situation where access to dentistry is the No. 1 issue raised with Healthwatch.

[Wera Hobhouse]

I was pleased to hear that the mother of the hon. Member for Salisbury (John Glen) has had excellent NHS dental care in Bath, and of course dentists are excellent practitioners and professionals. The thing is that his mother will have been a long-term NHS patient and the problem is that dentists do not take on new NHS patients, because the dental contract completely disincentivises them to do so.

[Peter Dowd]

That is a point well made. Another factor is that there are deep inequalities in access to dentistry. In my constituency, it is difficult to get to see an NHS dentist for love or money. I am not blaming the dentists; they are doing a fantastic job in the circumstances. They are going over and above their duty. I put on the record my thanks—as I am sure we all would—to my dentist practice, which I have been with for over 45 years. Dentists are doing a fantastic job, but they have both their hands tied behind their back at the moment. That has to change.

Some 91% of people, including 80% of children, are not able to access a dentist, and 75% of dentists are reducing their NHS engagement. The new contract announced before the summer did not really do anything and there was no new money with it. There is a significant gap—potentially as much as £750 million—in the resources that dentists need.

Another aspect is dentists’ morale, with 87% having experienced stress, burnout or depression in the last 12 months. That is a dreadful situation to put a committed profession in. We have a scenario in our country in which dentists who trained for seven or eight years—possibly more—and practised for many years are now getting to the stage where the majority are stressed, burned out or depressed. That is dreadful. According to one study, half of them are considering changing career. Some of them are seeking early retirement or going fully private. They are getting stressed out because they just cannot move the dial. They are waiting for the Government to move it, but the Government are not moving it.

Children in my constituency are three times more likely to have their teeth extracted in a hospital because they do not have access to a dentist. My right hon. Friend the Member for Knowsley (Sir George Howarth) and the hon. Member for Bath referred to oral cancer. That is identified very early on—and who does the identification? Surprise: it is often the dentist. We need substantive support from the Government, not tinkering around with the contract. We need them to provide adequate funding.

Dentists must not be an afterthought. They are a vital component of the health of the nation. We must build on the historical commitment to prevention; that is key—as the saying goes, prevention is better than cure. Dentists have had enough; they are under pressure. My constituents have had enough; they are under pressure. The Government have to do something about it.

In the debate before the summer, I referred, in relation to the lack of substantive action by the Government, to a rejigging of what Ian Fleming said about crisis: if once is happenstance and twice is coincidence, three times is friendly fire and four times is enemy action. We are now in a situation where the Government are perceived as the enemy because of their lack of action.

[Rachael Maskell (York Central) (Lab/Co-op)]

I apologise that I was not able to be here for the whole debate; I have been in a Bill Committee. In York, people have to wait six years to see a dentist. Of course that is completely unacceptable, but my real concern is that, with the transition of dental services into integrated care systems, ICSs will not have the powers—the levers—to make the difference on training, funding and the contract and, ultimately, dentistry will be pushed into a tug of war between ICSs and the Government.

[Peter Dowd]

I am glad that my hon. Friend raised that matter because it is something that I was going to raise. The health service, because of the reorganisation, is in an element of flux. It is feeling under a bit of pressure. Potentially, people are having to reapply for jobs in the broader sense in the NHS because of the reorganisation. That is a fact. I am not sure whether we should be having a reorganisation of the NHS in the post-covid environment, but that is a different argument for a different day. The broader dissonance in the system now multiplies the problems that we are having in dental practices, because they are getting pushed further away, which is why practices need representation on these boards. I am glad that my hon. Friend highlighted that point.

As I said in the debate before the summer, we do not want any more excuses from the Government. We do not want any more prevarication, any more procrastination, any more pretext or any more self-exoneration. I hope the Government and the Minister, whom I welcome to his place, really get the sense of the frustration and, in certain situations, anger in the Chamber today. They really must pull their finger out—if not people’s teeth.

Community Pharmacies

Peter Dowd Excerpts

Tuesday 21st June 2022 Westminster Hall

[Peter Dowd (Bootle) (Lab)]

I beg to move,

That this House has considered the future of community pharmacies.

It is a pleasure to see you in the Chair this afternoon, Sir Gary. As a member of the all-party parliamentary group on pharmacy, I am pleased to introduce the debate and glad to see so much support from Members who obviously, like me, recognise the huge value that our pharmacies bring to the NHS, patients and the public generally. I hope everyone here agrees that England’s 11,200 pharmacies play a crucial role in providing important healthcare, life-saving medicines and an increasingly wide range of clinical services to their local communities. Not only that, but as the most accessible providers of healthcare, pharmacies are key to reducing health inequalities: 89% of the population are less than a 20-minute walk from their nearest pharmacy, increasing to 99.8% in the most deprived areas, such as mine. It is fair to say that pharmacies understand their communities to a significant extent—sometimes more than the traditional health services—and as such are ideally placed to engage with the most marginalised and vulnerable groups in our communities.

The wider public appreciate the easy accessibility of pharmacies, which by their very nature are located at the heart of every community throughout the country. Throughout the pandemic, not only did community pharmacies remain open and continue to offer their full range of services, but they played a huge role in the vaccination programme, delivering an astonishing 24 million jabs. They also distributed some 27.6 million covid lateral flow tests and initiated a pandemic delivery service that ensured that 6 million vulnerable patients could access their medicine.

I think I am correct in saying that all Members present today would like to put on record their thanks and express their appreciation for all pharmacists, pharmacy dispensers, pharmacy technicians, medicines counter assistants, delivery drivers and administrative teams, who worked so hard during that difficult time to maintain the public’s access to the pharmaceutical services that they relied on. We, and the whole country, owe them a debt of gratitude. But we must also recognise that it is not just about thanking staff; it is also about recognising that the conditions they work in are crucial to the maintenance of a good service, whether a member of staff works in a larger or a smaller pharmacy provider.

[Sir John Hayes (South Holland and The Deepings) (Con)]

I congratulate the hon. Gentleman on securing the debate. The point he is making appears to be twofold: first, as well as responding to need, pharmacies can have a role in preventive medicine; and secondly, we now need to shout louder about that. Pharmacies did a heroic job during the pandemic and they continue to do so, but I am not sure that everyone knows as much as he clearly does about what we can do with and at a community pharmacy, and this debate serves the purpose of telling them.

[Peter Dowd]

The right hon. Gentleman makes a really valid point, and I will talk about some of that later. We have to recognise that, despite pharmacists trying to help people, they sometimes got dreadful abuse. We have to help them and protect them from abuse. That is part of addressing their working conditions. Vacancies in the sector are not caused simply by a shortage of pharmacists. It is also about which part of the space pharmacists work in. In other words, if I were a pharmacist, I would ask, “Do I like the conditions, pay and terms of my work?” If the answer is no, people move on.

Pharmacies are not just a shop; they are a healthcare setting and should be treated as such. They are a crucial part of the NHS ecosystem. I suspect that that is why a pharmacist needs to be on site all the time—this is not just a shop operating within a transactional context. Aside from covid, pharmacies are doing an incredible amount of work for their local communities every single day. In the most recent flu season, in 2021, pharmacies mobilised to deliver the biggest flu vaccination campaign on record, administering 4.85 million doses—over 2 million doses more than in the previous flu season, representing a 75% year-on-year increase.

The recently commissioned NHS blood pressure check service has already meant that 100,000 people have had their blood pressure checked in a pharmacy. Anecdotally, pharmacy representatives say they are already hearing that these checks have picked up cases of extremely high blood pressure in patients, who have then been referred on for treatment. This is a very highly valued healthcare intervention, which will save the NHS money in the long run, because it is cheaper to prevent disease than it is to treat it. More than that, however, I am convinced that these interventions will save lives.

Those two services on their own demonstrate pharmacy at its best. PwC estimates that the sector contributes around £3 billion in net value to society as a whole, and it works every day to improve the health and wellbeing of our local communities and our constituents. That is surely why we have the NHS in the first place.

What is the current financial health of the sector? It is no exaggeration to say that the community pharmacy network is under huge strain and that pharmacy staff and businesses are coming under increasing and, indeed, unsustainable pressure. Pharmacy funding is currently flat, with the total available funding envelope fixed at £2.592 billion. In practice, the Pharmaceutical Services Negotiating Committee reports that this means that real-terms funding is decreasing year on year, as inflationary pressures, rising business costs and increasing workload are not taken into account in that funding deal. Despite all that, many pharmacies have remained open, albeit under extremely difficult economic conditions.

However, the PSNC says that some businesses are reaching the limits of what is possible in terms of remaining viable, and that is already having an impact on patients. A recent survey on pharmacy pressures, conducted by the PSNC, found that 90% of pharmacy businesses are now unable to spend as much time with patients as they did before. Perhaps more worryingly, 92% of respondents said that patients were beginning to be negatively affected by the current pressures on their pharmacy. Despite pharmacies being a significant part of the NHS family—on average, at least 90% of their income comes from the NHS—pharmacy funding has not received the annual funding growth of 3.4% per annum that the rest of the NHS has been afforded.

Those in the sector feel that it is time to put things right. Indeed, the PSNC recently submitted a funding bid to the Department, making the case for extraordinary economic circumstances to be taken into account. When the Minister responds to the debate, I hope she will update Members on whether a funding increase will be granted to the sector.

The PSNC also estimates that the sector has had to make efficiency savings of between 37% and 50% in order to manage the funding squeeze and to keep providing the services it is contracted to deliver, but how much more pressure should we expect it to operate under? Do we want a bare-bones network that delivers only the very basics for patients, or do we want a vibrant, innovative sector that is constantly looking to the future to find new ways of working and providing a personalised and consistently high-quality service for patients, and that is fully integrated with other areas of healthcare and able to be consistently relied on in the future, as millions of people relied on it during the pandemic? Members can certainly guess what my preference is.

One thing is for certain: maintaining the status quo is not an option. So what does the future of community pharmacy look like? I would like to see pharmacies evolve into the go-to healthcare settings for help with minor ailments. There is no need for otherwise healthy patients with minor conditions to continue to see their GP. The truth is that they can get the same expert advice from their local pharmacist, who can exercise their clinical judgment and sometimes even prescribe medicines or offer an over-the-counter treatment at half the cost to the NHS. Indeed, the PSNC estimates that if this policy was rolled out nationwide, the NHS could save a staggering £640 million.

What is more, there would perhaps be no need for people to queue in a waiting room or to visit multiple locations. Pharmacies could be a single go-to place for diagnosing, advising on and supplying medicines for the treatment of minor ailments. As we all know from when we go abroad, that system works in Europe and much of the developed world, so why not here? It would be potentially game-changing for the future of pharmacy and more widely for primary care. I hope the Minister will comment on what plans, if any, the Government have to commission a service of that nature.

Aside from minor ailments, pharmacies are well placed to deliver much of the prevention agenda set out in the NHS long-term plan. They could and should be at the forefront of promoting and supporting self-care. Future services could include a national emergency contraception service, or even the treatment of minor injuries. Pharmacies could also offer help and support to manage long-term conditions. For instance, they could offer a whole host of valuable services for supporting patients with asthma, such as an inhaler technique service or annual asthma reviews. Community pharmacies could do even more than they already do to review patients’ medication and ensure that it is being taken appropriately. That is all extremely important, from a patient perspective.

For the population that is otherwise healthy, pharmacies could play an increased role in promoting health and wellbeing, and in preventing and reducing further healthcare demand in the first place. After all, healthy people do not often visit hospitals or GPs, but they probably pass by pharmacies on the high street regularly. I certainly do. Pharmacies could conduct NHS health checks with enhanced patient follow-up, and they could use personalised wellbeing plans to help people to make healthy lifestyle choices. Pharmacies could also replicate their success with the flu and covid vaccination programmes by expanding into the provision of others such as the shingles and pneumococcal vaccine and NHS travel vaccinations.

When it comes to what pharmacies can do to improve patient outcomes, the possibilities are endless. I know at first hand that, given the capacity and a good working environment, pharmacists and their teams are ready and willing to take on and promote all those new services, but that has to be put into the context of wider deliverability. Let me use one example. Amanda Pritchard, the NHS chief executive, recently announced funding for high street pharmacies to identify signs of early cancer, and for subsequent referrals and follow-up by clinical radiologists. That is a good initiative. Nonetheless, as Anne Brontë wrote,

“there is always a ‘but’ in this imperfect world”.

Workforce and equipment issues are obstacles to a successful roll-out, given that the radiology system is already under pressure. What about an audit and a replacement programme for our increasingly outdated and, in some cases, obsolete imaging equipment? There are no plans to tackle the annual 7% increase in complex imaging demand and no plan to meet the workforce demand, with a 30% shortfall in clinical consultant radiologists. That figure is going up, and there are backlog issues.

The only question is whether the Government will now enable the community pharmacy sector to fulfil its potential by supporting the range of possible services, and by providing it with appropriate support and funding. I sincerely hope that the answer will be yes.

[Several hon. Members rose—]

--- Later in debate ---

[Peter Dowd]

I thank the right hon. Member for South Holland and The Deepings (Sir John Hayes), my hon. Friends the Members for Coventry North West (Taiwo Owatemi) and for Denton and Reddish (Andrew Gwynne), and the hon. Members for Southend West (Anna Firth), for Strangford (Jim Shannon) and for Coatbridge, Chryston and Bellshill (Steven Bonnar).

I think we have reached a degree of consensus. I hope we can move forward with that consensus and that if we revisit this issue in six or 12 months, we will have made significant progress. I also thank the Minister for certain of the reassurances she gave. When we come back, let us review this and see how it is moving on, because that is our job, and I know that the Minister recognises that.