Hospice Funding

Peter Gibson Excerpts

Monday 22nd April 2024 Commons Chamber

[Peter Gibson (Darlington) (Con)]

It is a pleasure to follow the hon. Member for Enfield, Southgate (Bambos Charalambous); it is great to see him in the Chamber after his performance yesterday in the London marathon. I congratulate him on completing it.

It is a pleasure to be called to speak in this long-awaited debate, and I thank and congratulate my hon. Friend the Member for Hastings and Rye (Sally-Ann Hart) for moving the motion. I thank hospices around the country that have engaged with me in my preparation for today’s debate, and I thank the Hospice UK team—Toby, Katie and Olivia in particular—for their ongoing support for me and the all-party parliamentary group on hospice and end of life care, which I co-chair along with Baroness Finlay of Llandaff.

I draw the House’s attention to my entry in the Register of Members’ Financial Interests: I am a trustee of North Yorkshire Hospice Care, which operates both Herriot Hospice Homecare and Saint Michael’s hospice in Harrogate. I have served as a trustee of that hospice for over a decade, and have seen the difficulties that piecemeal commissioning causes for our precious hospices. To my mind, this debate is not simply about asking the Government for more money—we know that there are serious public financial challenges post pandemic—but an opportunity to discuss on the Floor of the House solutions to the challenges that our hospices face. I thank the Backbench Business Committee for allowing us to have this debate. The number of Members who wish to speak in support of their local hospices today is testament to how much each and every one of our communities values its local hospices.

This is a matter of life and death. The hospice movement is there to deliver good deaths; that might seem a strange thing to say, but palliative care delivered in the right environment—be that a hospice, a children’s hospice, or a person’s home through a hospice at home service—is a truly wonderful thing. Those precious final few weeks of a person’s life are imprinted into our memories, and it is right that those who are dying, and those who are loving, supporting and caring for them, do so in an environment where there is proper funding and commissioning, and where we can plan and prepare to provide continuing care.

[Martin Vickers (Cleethorpes) (Con)]

I thank my hon. Friend for his contribution, as well as the Members who made the previous contributions, both of which focused to some extent on palliative and end of life care. Two hospices serve my constituency, St Andrew’s in Grimsby and Lindsey Lodge in Scunthorpe; both provide an excellent end of life environment. Does my hon. Friend agree that if we are to defuse the movement towards encouraging assisted dying, we need to ensure that our hospices provide a service as an alternative?

[Peter Gibson]

I am very grateful to my hon. Friend for his intervention. I have my personal views about assisted dying, and I am sure that in the fullness of time, this House will debate that issue. This debate is not about assisted dying: it is about our hospices, and how we fund and support them. With the greatest of respect to my hon. Friend, conflating the two issues is not helpful.

Even post death, our wonderful hospice movement provides much-needed bereavement care to those who have suffered the loss of a loved one. The Health and Social Care Act 2021 made provision for the very first time for the commissioning of palliative care. That is a landmark. Integrated care boards around the country now have responsibility for commissioning palliative care to meet the needs of the community that they serve, which is a good thing. It ensures that local commissioners, working together with local providers and local representatives, can deliver the palliative care needs of their respective communities.

[Steve Brine (Winchester) (Con)]

This is a timely debate. Tomorrow morning, the Health and Social Care Committee will have a topical session on hospice care. My hon. Friend mentioned “ICBs”, plural. I have Naomi House and Jacksplace hospice in my constituency. Its trouble is that on top of all the rising costs and inflationary pressures that it faces, it is negotiating with six ICBs for the same amount of grant. When my hon. Friend comes to summarise the recommendations of his excellent all-party group, will he recognise that challenge that many hospices face across multiple commissioning bodies?

[Peter Gibson]

I am very grateful to the Chairman of the Select Committee for his intervention, and for his continuing engagement with me on this important topic. He raises a really important issue. As I will come on to say, this is not simply about each ICB meeting its own challenges. We need national and Government attention to resolve the issue.

There is a very mixed patchwork picture across the country. During covid, the Government stepped up to the plate, acted decisively and provided much-needed financial support to the hospice movement. That support not only prevented many hospices from failing and collapsing, but ensured that much-needed palliative care could continue to be delivered around the country. The picture today, however, is one of immense challenges for our hospices. Many have failed to receive increased support under their contracts with ICBs to meet the rising costs of energy and staffing. At the same time, our hospitals face increased pressure for beds. It is a fact that one night in a hospice costs less than a night in a bed in hospital, and while there are reasons why a person may need to remain in hospital, better palliative care can be delivered in the more appropriate surroundings of a hospice.

Just last week, I met the chief executive of Sue Ryder, Heidi Travis, who also serves as a commissioner for Cambridgeshire and Peterborough ICB. It was interesting to learn that work is being undertaken to explore ways in which hospices can do more with the same funding, or in some cases less. However, if we are to explore creative new ways of delivering hospice care, either through hospice-at-home models or virtual wards, full and frank conversations need to be had between hospices and their integrated care boards to truly explore the art of the possible.

In the Tees Valley, I have been pleased to be able to bring together, on multiple occasions, St Teresa’s in Darlington, Alice House in Hartlepool, Butterwick hospice in Stockton, and Teesside hospice in Middlesbrough. They work collectively with all eight Members of Parliament covering the Tees Valley, so that there is a collective voice for the region, and so that we can be a beacon of excellence in the provision of palliative care in the north-east. The uplift in funding for those four hospices under the North East and North Cumbria integrated care board is simply not enough, but the fact that they are working together and meeting the ICB is a sign of improving relations, and there is hope for the future.

I wish to touch on the work of our children’s hospices, which a number of Members have mentioned. They are an integral part of palliative care across the country, and I am grateful for the engagement I have had in recent weeks and months with Together for Short Lives. The NHS children’s hospice grant of £25 million from the Government is gratefully received by the sector. However, that funding should be guaranteed for a minimum of three years to enable those hospices to plan properly and commission services, and the amount should be uprated in line with inflation each year. Furthermore, the money must be ringfenced, so that when it is passed on through regional ICBs, the entirety of the money flows to the frontline—to those children’s hospices. I ask the Minister to address that point in her summing up.

In preparing for today’s debate, I asked for information and evidence from Hospice UK about hospices in each of the four nations of our country. Saint Michael’s, a hospice of which I am a trustee, is the local hospice care charity supporting people affected by terminal illness and bereavement across Harrogate. Each year, the vital care it provides costs almost £6 million to deliver. Of that, just 17% is funded by the Government; that equates to a little over £1 million of its total running costs. That leaves over £5 million to be raised through the generosity of its supporters and community. The rise in inflation has put additional strain on its finances, but has been met with a funding increase of just 1.2% from the ICB.

Shalom House in Pembrokeshire needs to raise around £288,000 to keep running, which is equal to £24,000 per month. It receives only £5,000 per month from its health board, and this amount has been halved in the last five years from £10,000. It has not received an uplift for at least the last four years. It anticipates that funding ending in September 2024, when the new commissioning model in Wales comes into effect. Without a cash injection, it is in danger of closing within the next 12 months, as its reserves are low. While Shalom House is small, the impact on the community, like that of all hospices, is huge.

In Scotland, Ardgowan in Inverclyde is, despite a very generous community, facing a deficit of £100,000. It expects this to rise to £172,000 for the next financial year. In the last 18 months, it has seen utility costs rise by 67% and insurance costs by 10%. It needs increased support.

In Northern Ireland, 65% of the funding for Foyle hospice in Londonderry comes purely from fundraising. It is unable to plan ahead or reconfigure services because of the uncertainty about statutory funding, including the outcome of the recent day hospice review. It has received some non-recurrent funding through the cancer charities relief fund, but may be unable to provide those highly valuable services when that funding runs out in March 2025.

We are a compassionate and wealthy country. We have a national health service that, despite some of its challenges, does incredible things, but so too do our hospices—be they based in buildings or in patients’ homes. Our hospices really must be seen as an integral part of our national health service.

[Martin Docherty-Hughes]

I want to push the hon. Gentleman on the point I made to the hon. Member for Enfield, Southgate, because I have heard this notion of symbiosis with the NHS, but they are two very distinct approaches to care. From my perspective, the palliative care sector is at its best when it is run as a voluntary local body. Would he expand a wee bit more on what he means by that kind of convergence with the NHS? There is a fear among those in the voluntary hospice sector that what they are doing to push palliative care forward could be held back by more physical integration in the NHS.

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. Before the hon. Member continues, I just remind everybody that there is quite a bit of interest in this debate. If we could ensure self-discipline in the length of speeches, that would be very helpful.

[Peter Gibson]

I am very grateful for the intervention, and the hon. Gentleman raises some really important points, which I am not sure I have time to go into in detail. If the Government are going to give the national health service enough money to increase the wages of everybody in the national health service and the integrated care boards are commissioning services from hospices around the country, the very least those hospices should expect is an equal minimum uplift so that they can maintain parity of wages. Our hospices are not seeking to be nationalised. They cherish their independence passionately, and it is because of their independence that they are so integrated into our community, but if we are going to rely on them to provide services, the least we can do as a society is to meet the costs of the services we are expecting them to provide.

Mr Deputy Speaker, mindful of your words, I will bring my remarks to a close in a moment. Philanthropy and charitable giving have been the foundations on which our wonderful hospice movement has been established. To my mind, hospices’ charitable status has enabled them to be flexible and to develop an holistic pattern of palliative care outside the NHS. However, in the 21st century it cannot be acceptable that funding is reliant on pensioners performing skydives and communities baking cakes to fund palliative care.

Much work has been done, and much work must be done by our ICBs and the Government to map the demands and needs for palliative care across the country. We must end this postcode-based patchwork of provision. It really is time that the Government established a rapid taskforce to collaborate with the entire hospice movement and our integrated care boards to ensure that we as a nation have the best provision in palliative care, and that everybody can have a good and peaceful death.

--- Later in debate ---

[Selaine Saxby (North Devon) (Con)]

I want to take advantage of tonight’s debate to raise the specific issue of the North Devon hospice and its hospice to home service. When I last met its excellent chief executive, Stephen Roberts, last October, he flagged to me that the hospice was no longer in a position to continue its non-commissioned service after the end of this financial year. At the time, he wrote to the then Secretary of State, my right hon. Friend the Member for North East Cambridgeshire (Steve Barclay), detailing those concerns. I instantly phoned my hospital trust, because North Devon is home to the smallest hospital on the UK mainland and it already suffers with discharge issues and an overstretched A&E service.

In February when I met Dr Sarah Wollaston, the chair of the Devon integrated care board, I asked about the service and was assured that it was all fine and the money was being found. When this debate was announced —many thanks to my hon. Friends the Members for Hastings and Rye (Sally-Ann Hart) and for Darlington (Peter Gibson) for securing it—I contacted Stephen Roberts at the end of the recess and said that I would like to check that this was all okay. He told me that my email was timely because everything was not okay, despite having had endless meetings with the integrated care board. He asked me to share with the House tonight some of the email that he sent back to the integrated care board following a phone call with its new chief executive, in which he said:

“Thank you for your time yesterday. I thought it would be prudent to summarise in an email where we have got to as there is nothing on paper or email that corresponds to the discussions we had around your offer of £95k. As a summary as to where we stand today: North Devon Hospice’s Hospice to Home Service is dedicated to support palliative patients who are at the ‘end of life’ stage through: increasing care at home, reducing unplanned/avoidable hospital admissions, and expediting hospital discharges.”

He goes on to detail the 15 staff who deliver that vital service, which costs just £495,000 and which the North Devon Hospice charitable funds have covered for the last decade. He said:

“North Devon Hospice asked for funding support of £157,540 which represents the same level of commissioning support as our bedded unit and community nursing team receive. Devon ICB have stated that they are willing to provide £95k as a one off”

before the next commissioning review period. But he said that the hospice had to state in return:

“due to our year on year million-pound deficit, having funded the service for 10 years and propped up the cost of this service through cost management elsewhere in the organisation we are no longer able to support the service which is at its minimum establishment to be able to operate.”

The hospice has been advising the ICB of this for three years.

[Peter Gibson]

My hon. Friend illustrates one of the biggest single challenges for hospice at home. Hospice at home relies on transport, which in an urban community can be delivered at a relatively small cost, but in a deeply rural constituency like hers, those costs need to be addressed and met in order to deliver that care. Does she agree that the funding models need to address the cost of transport and travel in rural constituencies delivering a hospice at home service?

[Selaine Saxby]

I could not agree with my hon. Friend more. There are many elements of healthcare, but the rurality of constituencies like mine is not fully reflected in the funding settlements.

My hospice requested that the ICB find the additional £65,000 to get it through to the end of the year. The chief executive took this back to the board to see whether we could get that seven months of cover through. However, it has now been through a full board meeting and consultation, and this is where my email came in. He finished his email to the ICB by saying:

“I sincerely hope that the good faith you have asked of us extends to Devon ICB’s good faith in finding the extra £65k.”

The email that he sent to me at the end of the recess says that he met the ICB chief executive,

“and he asked for 8 more weeks to see if he can do something, no promises made. My Board met last night where we agreed to wait for his response before making any decisions on the service. Therefore, any pressure you can apply would be greatly appreciated. The headline is: ‘Has it really come to the point where we have to beg for £62k to stop 32 people dying in an Emergency Room?’”

That was four weeks ago, and the hospice has still heard nothing. Our ICB is also in special measures. I beg the Minister to intervene and see if we can help our much-loved hospice, as well as tackle the ever-growing issues we have with our integrated care board back home in Devon. The hospice to home service is hugely valued by families and ensures that their loved ones can spend their final days at home, not in hospital. It also helps by taking the pressure off North Devon’s much loved, very small hospital. As it says across the shops back home in North Devon for our hospice, “Your life is a story, and the ending matters.” I very much hope that there is a way to secure the future of this hospice to home service to ensure that we have many other happy endings.

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[Jim Shannon]

That is good to remember. I will mention the volunteers.

The hon. Member for Walsall North (Eddie Hughes) is no longer here, but he mentioned a sponsored walk and encouraged the right hon. Member for Hayes and Harlington (John McDonnell) to be involved. Like the right hon. Gentleman, I could not run a marathon, and I probably could not walk it, but he and I could probably dander it—that is the third category. We are danderers. I could do 26 miles, but it would be at my own pace. I am sure everyone else would be on their way home whenever he and I crossed the line—that is a story for another day.

We cannot pay hospice workers enough, but we have a responsibility to ensure that there is enough money to pay them. I do not feel we are currently doing enough, as other Members have said very clearly. The consensus is that we all want to see them paid better, and we want to see the care continue.

Northern Ireland Hospice provides specialist palliative care for more than 4,000 infants, children and adults in Northern Ireland with life-limiting conditions. The charity, which includes the only children’s hospice in Northern Ireland, says that it faces a number of challenges,

“not least of which is the ever-growing cost of this service. Government funds approximately 30% of service costs”.

The hon. Member for Darlington (Peter Gibson) spoke about Foyle hospice, which has to find 65% of its service costs. Well, every other hospice in Northern Ireland has to find 70%, relying on the

“goodwill and generosity of voluntary donations and other fundraising activities.”

[Peter Gibson]

One thing that has not yet been brought out in any of the speeches is the fact that a significant amount of the money that goes to our hospices through their fundraising and charitable fundraising comes in the form of legacy giving. That in itself, because of the size of estates and the value of properties, creates a postcode lottery. Is that part of the problem? Could we use this debate to highlight legacy giving to hospices?

[Jim Shannon]

I understand the issue that the hon. Gentleman highlights, and I will speak about donations.

The people of Northern Ireland are generous to a fault. Understanding Society data suggests that Londoners donate the most, with an annual average of £346 per donor. That is due to a handful of large donors, which I understand is the issue. People from Northern Ireland donate £344 a year to charities in all sectors, not just hospice care, and last week’s figures show that Northern Ireland donates more than anywhere else in the United Kingdom of Great Britain and Northern Ireland. Scotland, at £282 a year, and the south-east, at £270 a year, are the next highest donors. I am proud that we in Northern Ireland are givers, but this has allowed what is tantamount to an abdication of responsibility by those whose duty it is to see this care carried out.

We all support the Marie Curie coffee mornings. They are bun fests, which is not good for a diabetic. People make their donation and drink their tea or coffee. That is what it is about. It is not about what people get out of it; it is about what they give. To me, the Macmillan coffee mornings and Northern Ireland Hospice events should be about providing additional help, not providing the foundation of their funding. We and the Government must step up.

People do not have great disposable incomes, so the coffee mornings intended to raise money for a nurse raise less than half the amount needed to pay for a nurse’s pay increase. We can no longer rely on public generosity to make the difference, and I therefore believe that we must step up and see hospice care not as a charitable extra but as an integral part of the NHS. That is what it needs to be, otherwise we have failed.

I am ever mindful of the seven-minute time limit, Madam Deputy Speaker. If we cannot supply children’s hospice places with specialised staff, we are failing, and we cannot afford to accept failure. The Minister is a good lady, and she believes in hospices. I know she will respond positively, but I want to ascertain how we can do better for palliative care hospices, not in the next budget round but starting here and now. There is a consensus on wanting it to happen, and I believe the Minister and the Government should ensure that it does.

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[James Sunderland]

I commend all the staff in the Saint Francis hospice in Havering on what they do. It sounds remarkable. We have heard so many stories this evening of hospices and palliative care providers right across the country.

The message is clear: we need more funding. We must establish better funding models. We cannot rely so much on charities and donations. We must make sure that funding is provided up front. This is a life-and-death issue. Hospices take pressure off the NHS. The facilities at Thames hospice are state of the art; we can sweat the asset an awful lot more. Perhaps the underused capacity of hospices could sometimes be hired back to the NHS.

[Peter Gibson]

I want to make one final point in this final Back-Bencher contribution to the debate. Many people have called for multi-year funding settlements. That is not to make life easy for the hospices; it is just more sensible, so that they can plan into the future—sign leases, buy equipment, and train, recruit and retain staff. The request for multi-year funding settlements will allow them to put plans in place to provide the care that is needed.

[James Sunderland]

I thank my hon. Friend and I agree completely. Nobody can plan in a vacuum, so this is about more money, earlier money and the ability to plan so we know where the delta is.

I will conclude now. Madam Deputy Speaker, thank you for the opportunity to speak this evening. We need more money, Minister, and I know you will give it to us.

--- Later in debate ---

[The Minister for Social Care (Helen Whately)]

I thank my hon. Friends the Members for Hastings and Rye (Sally-Ann Hart) and for Darlington (Peter Gibson) for securing this debate. The number of speeches this evening reflects the strength of feeling, and the support, for hospices across the country. As the Minister with oversight of end of life care, I share the passion of many hon. Members for hospices and for what they do, caring for people towards and at the end of life, providing respite for carers and supporting families both before and after the death of a loved one. Many hon. Members have rightly praised the work of the hospices that serve their constituents and made special mention of the extraordinary work of hospices for children and young people. I also thank the hospices for all they do, and for all they are doing right now, as their staff work around the clock.

Beyond that, I thank everyone who gives palliative and end of life care, as part of hospice teams but also working in the NHS. How you die, how your loved ones die or how you live towards the end of your life, matters. As the hon. Member for Birmingham, Erdington (Mrs Hamilton) said so eloquently earlier this evening, and as all of us here this evening know, that is why palliative and end of life care matters. It matters when that care is provided by the NHS, as it is for the majority of people, and when it is provided by hospices. I emphasise that point, because there is sometimes a misunderstanding, which I have heard a few times this evening. The fact is that most palliative and end of life care is provided by the NHS, whether in hospitals, by primary care or through community trusts. Alongside and in addition to that, hospices do the wonderful work that they do. Recognising the importance of palliative and end of life care, we specified in the Health and Care Act 2022 that integrated care boards must commission these services to meet the needs of their populations.

Some hon. Members have argued this evening for hospice funding to be centralised, taken away from integrated care boards and, I assume, allocated by either NHS England or the Department of Health and Social Care. While I understand their motivation in making that call, I do not agree. We purposefully set up ICBs to understand the healthcare needs of our local communities, to plan and commission services to meet those needs and, in so doing, to reduce health disparities. Our communities and their needs, and the services they already have in place, are different, and rarely is a one-size-fits-all decision made in Westminster the right answer. I stand by a more localised approach, in which there is, of course, variation.

Another source of variation is historical. The hospice movement has grown organically, and the location of hospices has not been planned to meet demographic need, for instance. There are, therefore, inequalities in access to hospice services, especially for those living in rural and more deprived areas. This variation in access to hospice care has to be taken into account by ICBs in the decisions they must make to ensure that people have access to end of life care, whether or not they live in an area served by a hospice.

[Peter Gibson]

My hon. Friend makes an important point about the organic way in which our hospices have developed and emerged. Does she agree that our ICBs have the opportunity to use our hospices to address those shortfalls in certain communities by directing funding specifically to them to meet needs that have not previously been met?

Will the Minister further clarify one small point? She has made a clear distinction between NHS-provided care and hospice care, but there are many cases around the country where the NHS is funding, in full or in part, specific services from hospices. How would she distinguish between them? Is it NHS care or hospice care if it has been fully commissioned and fully funded by the NHS?

[Helen Whately]

I will pick up on a few of those points.

On the NHS providing palliative and end of life care, I have heard a misunderstanding in some speeches, both this evening and on other occasions, that all end of life and palliative care is provided by hospices. It is more mixed. Integrated care boards do, indeed, commission hospices to provide care, but hospices also provide care independently, and NHS services do so, too. These teams also work together collaboratively. That diversity is a strength.

In seeking to address inequalities, ICBs can look to hospices to do more in underserved areas, for instance. At other times it may be more appropriate for them to look to NHS services. It will vary by area, which is one reason why these decisions should be localised, rather than made by somebody sitting in my place saying, “This is how it should be done across the whole country.”

Although I do not agree with centralising hospice funding, I am working on the transparency and accountability of ICBs to their communities and hon. Members, as representatives. That is why I have regular meetings with NHS England leads on palliative and end of life care, and it is why I am pleased to have secured NHS England’s commitment to including palliative and end of life care in the topics discussed at its regular performance meetings with ICBs. It is also why I am pushing NHS England and ICBs to improve the data they collect on the access to and quality of palliative and end of life care.

NHS England has developed a palliative and end of life care data dashboard to help ICBs understand the needs of their populations and then address and track inequalities in access to end of life care. This is progress, but I want the transparency to go further so that we all have the data we need to assure ourselves that our ICBs are commissioning the care that our constituents need.

I have heard the calls for more funding for hospices and the stories of some fantastic fundraising efforts, from the “star trek” night walk and the “Santa sprint” to the magnificent marathon runners who have joined us in the Chamber tonight fresh from yesterday’s London marathon. I congratulate those who ran, and particularly those who did so on behalf of hospices, which is timely for this debate.

That said, I disagree with the hon. Member who said that people running a marathon for hospices is “sad”—it is not; it is a wonderful thing. It is a sign of the tremendous support that hospices have in our communities and that people are willing to choose to fund hospices, not just when the taxman comes along; they are choosing to have a hospice providing services to people in their area. It is a good thing because that fundraising gives hospices an independent funding stream, the freedom that goes with that to serve their communities as they see fit, and the strong ties with their communities and with all those people who fundraise for their hospices.

NHS Dentistry: Recovery and Reform

Peter Gibson Excerpts

Wednesday 7th February 2024 Commons Chamber

[Victoria Atkins]

I must admit that I did not know quite where that question was going, but I think the hon. Gentleman is urging me to speak to dentists. I am delighted to reassure him that my ministerial officials and I do of course speak to dentists. In fact, only today I was at a practice in the heart of Westminster, speaking to a dental manager who welcomes this plan. I will veer away and resist the temptation to comment on Rip Van Winkle.

[Peter Gibson (Darlington) (Con)]

I welcome this dental recovery plan, which will help to deliver dentistry in Darlington. Can my right hon. Friend the Secretary of State provide me with advice on what more I can do to get my integrated care board to get on with the commissioning at Firthmoor community centre, which lost its dentistry practice 10 months ago? In looking to expand the number of dental training places, I urge the Secretary of State to look at Teesside University, which has ambitions to build on its existing dental technology provision and train the Tees Valley dentists of tomorrow.

[Victoria Atkins]

Thanks to the work of my hon. Friend and others, Tees Valley is a powerhouse of growth industries, as exemplified by the Chancellor in his Budget and autumn statements recently. I will take away my hon. Friend’s words of advice about his university. On the point about encouraging ICBs to take part in this work, as this plan is a joint document with NHS England, the expectation will be on ICBs to deliver the plan, because they exist to look after our constituents. This plan is one of the ways we will be able to secure that help.

Illegal Vapes

Peter Gibson Excerpts

Tuesday 16th January 2024 Westminster Hall

[Peter Gibson (Darlington) (Con)]

I beg to move,

That this House has considered the matter of the use and sale of illegal vapes.

It is a pleasure to serve under your chairmanship, Sir Mark, and I am pleased to have secured this debate, in order to highlight my concerns about the use and sale of illegal vapes.

As a country, we should be pleased with the progress that we have made in reducing smoking, with smoking rates falling to their lowest since records began; now, only 12.9% of the population smoke. In some part, this progress is down to the wide array of nicotine replacement products: patches, pouches, gum, and of course, in more recent years, vapes.

However, despite vapes being an effective alternative for adults to use in order to quit smoking, we must be concerned about the risks they pose to children and non-smokers. Vapes are not risk-free. Nicotine is a highly addictive substance, whatever means are used to absorb it, and there remain unanswered questions about the longer-term use of vaping. As Professor Chris Whitty, the Chief Medical Officer, has said:

“If you smoke, vaping is much safer; if you don’t smoke, don’t vape.”

I have concerns about vaping that I wish to raise with the Minister in this debate. They are threefold: first, the availability of vaping products to children; secondly, the sale and supply of illegal vaping products to children and adults; and thirdly, the organised crime and exploitation that lie behind the illegal products.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Gentleman for securing this debate. Many people see vaping as an alternative to smoking and it probably is, but that does not mean that it is, in some cases, any less destructive. Indeed, it has become an overnight epidemic, with vape shops popping up, including in Newtownards, the main town in my constituency. My concern has always been about the regulation of these pop-up shops; they come here and they disappear, only to pop up somewhere else.

Does the hon. Gentleman share that concern and agree that there must be a licence to sell vapes, which should be vigorously checked by the local council to ensure that laws are being adhered to, so that the things he has expressed concern about regarding children gaining access to vapes cannot happen?

[Peter Gibson]

It would not be a Westminster Hall debate without an intervention from the hon. Gentleman. He anticipates two of the points that I am about to come on to in my speech—first, the popping up of these shops; and secondly, the need for licensing. So, I thank him for his intervention.

Legally supplied cigarettes have reached a price that puts them beyond the reach of children’s pocket money. That has been brought about by a raft of measures, including a ban on smaller packets, a ban on advertising, plain packaging, concealed displays and raising the legal age to buy cigarettes to 18. However, we have seen a worrying trend of children taking up the habit of vaping; the latest figures show that some 20% of children have tried vaping.

Those children have taken up the use of a product that is designed to help people to quit smoking, but—this is the important point—they themselves have never smoked. We know that the flavours, packaging and design of vapes are attractive to children, and that vapes are on very visible display in shops, in contrast to the cigarettes that they are designed to replace.

As with the sale of cigarettes, the sale of nicotine-related products is restricted to people over 18, but that restriction is clearly not working. To my mind, many of the measures that we introduced to curtail smoking need to be considered again in addressing this problem.

I have met the parents of children who are addicted to vaping. It is not uncommon to see children vaping in the street and the whole disposable vape industry is visibly responsible for the increase of litter on our streets, which local authorities face huge difficulties in dealing with and which increases the risk of fire in general waste collections.

The Local Government Association is deeply concerned about what to do with the almost 200 million disposable vapes that are thrown away every year in our country, and we should all be concerned about their environmental impact. However, my primary concern is the use and sale of illegal vapes, which do not always comply with our legislation and often have much higher concentrations of nicotine. They are sold with much higher capacities than their legal equivalents. It is estimated that a staggering one out of every three vapes sold in the UK is illicit. They are being sold with no care whatever for the user.

In the north-east, we have seen tragic cases of young children hospitalised as a result of using high-strength illegal vapes. The sale of these products is often concentrated in pop-up mini-markets, which are easily identifiable and distinguishable from reliable and traditional corner shops. Once upon a time criminality hid away, but these operators hide in plain sight. These shops appear quite rapidly, with blocked out windows, vivid lighting and a sparse supply of genuine goods on the shelf and are often, although not always, also selling illegal tobacco products.

I want to put on the record my thanks to Phoebe Abruzzese from The Northern Echo in Darlington for her campaigning journalism on this issue, and I am pleased to be working with her to highlight this problem.

[Gareth Johnson (Dartford) (Con)]

I am grateful to my hon. Friend for securing this debate. He is right to want to see a clampdown on illegal vapes. They are very different from those produced by responsible manufacturers, which help adults quit smoking and thereby save lives. Does he agree that we should continue to encourage adult smokers to vape, and that we should not throw the baby out with the bathwater over this? The responsible attitude is to allow people to use legal vapes while clamping down on the illicit ones that we see too many of.

[Peter Gibson]

I am grateful to my hon. Friend for that intervention; he raises a really important point. It is right that we encourage people to stop smoking and that smokers have an array of products available to help them, but those products must be legal. They must be supplied legally and made available in the right way.

Trading standards in Darlington, which is doing a tremendous job led by Shaun Trevor, has had much success over the past 18 months in targeting these traders. Products with a value of over £300,000 have been seized from some 23 retailers. Among those products were almost 20,000 packets of illegal cigarettes. Their sale would have resulted in a massive loss of revenue to the Exchequer—something that I am sure the Chancellor would be interested to learn about.

Last week, I went to visit a number of my local independent corner shops. They report that their tobacco sales have fallen off a cliff. In one instance, a trader of some 40 years reported that his tobacco sales had fallen from more than £7,000 a week to just £2,000. One the one hand, we can celebrate that as it will partly be the result of some people giving up smoking, but we know that the real underlying cause is that the trade has shifted to illegal sales in newly popped-up competition, which is robbing trade from our legitimate traders. Together with the footfall that tobacco sales bring to those shops and the massive loss in revenue, one retailer I visited estimates that his store is collecting nearly £200,000 less duty and VAT because of the sale of illegal tobacco. That is just one shop in one town. Imagine the scale of that lost revenue to the country as a whole.

I have shared my concerns about children vaping and about the availability of illegal products, but for me the most important aspect of this debate is the organised crime that sits behind the illegal supply and sale of these products. I know at first hand of the collaborative work going on between my local council and police in the sharing of intelligence, and I know that they are acutely aware of the damage caused to our community and the local economy. We have evidence locally that the funding for these shops is rooted in organised crime and money laundering. We know that, besides being supplied with illegal tobacco and vapes, children are being used as mules to fetch and carry the illegal products, which are stored off site rather than on the shop premises, or to act as agents by selling the vapes to their friends in the school playground. The most shocking local case was of a young person being groomed for sex with the enticement of illegal vapes. We should be wide awake to the risks in our community to young people who are exposed to exploitation in this way.

I will conclude by putting to the Minister some suggestions of things that can be done that I believe can help tackle these issues. We need to see a nationwide awareness campaign on illegal vapes for both adults and children. We need to see much-increased awareness in our schools of the safeguarding risks to young people posed by the sale and supply of these products. I would like to see all vape products in plain packaging and out of sight, just like tobacco. We need to fully explore a robust licensing system for both vapes and tobacco. We need greater collaboration on intelligence between our very small trading standards departments and police forces across the country. We need on-the-spot fines, set at punitive rates, to tackle the sale of these illegal vapes and tobaccos, and we need to see swifter premises closure orders.

I am sure that all Members are as concerned as I am about the issues that I have shared, and I have no doubt that more worrying stories will be shared throughout this debate. I look forward to the Minister’s response and to a plan that sees us clamp down on this danger.

--- Later in debate ---

[Kirsten Oswald]

No, I do not accept the hon. Gentleman’s proposition at all. That is absolutely wrong-headed. We can see in front of our eyes that these products are so attractive to young people that they are hooking them in—[Interruption.] The hon. Gentleman is mumbling from his chair. If I can finish my speech, I will set out for him that these products are hooking young people in and getting them addicted, and some of these young people then go on to start smoking. That is far from the situation he laid out, and we should take a very serious attitude to these products.

I have spoken about the harms caused by legal vapes to the planet, whether it is plastic, overuse of precious metals or fires. We have heard today about the impact that these substances have on the young people who ingest them, which should be of significant concern to us. Vaping is popular among young people. Since 2021, there has been a more than sevenfold increase in the number of 11 to 17-year-olds vaping and using disposable vapes rather than reusable ones. These devices are colourful and attractive, with snazzy names and fruity flavours. Vaping has risen so rapidly among children that one in five are now using disposable vapes.

We are not speaking about a smoking cessation mechanism. We are speaking about something that health professionals increasingly warn about. They are increasingly worried about a generation of young people who are hooked on nicotine. As the Royal College of Paediatrics and Child Health has said:

“Youth vaping is fast becoming an epidemic”.

Despite all that, and despite the fact that the public would be concerned to know all these things, we have this stream of illicit, and other, vapes on our streets. We know that local shops are the most likely source for young people to come by them, and we have heard quite a lot about that today. There is also the online space, which is a source of significant concern to me. Unregulated and untested products are coming via the online space, and we have no idea what harms will be caused to the young people consuming them.

I met a business owner from my area last week, and she talked me through her concerns about illegal medical products—obviously not proper medical products. She showed me how she was targeted by online accounts pushing these goods to her. She is a responsible professional and she resisted, but let us be clear that there are many and complex routes by which these illicit vapes arrive here, just as there are for illicit medical products. All those routes need to be closed down, and they need to be closed down now. Whatever the disposable vape, it causes harm.

We know that there are significant kinds of harm being caused with the flavours and the colours. We have heard from the hon. Member for Hastings and Rye (Sally-Ann Hart) about the worries that Action on Smoking and Health spoke about. We are hearing more and more about vape use being glamourised online, and when people under the legal age cannot purchase vapes legally, they are purchasing them illegally or purchasing illegal ones.

The public health messaging on this issue is not as clear as it should be. The hon. Member for Dartford (Gareth Johnson) tried to tell me that vapes would be a perfectly reasonable way to expect adults to support themselves in smoking cessation, but that is not right and that should not be what the public health messaging tells us. We heard from the hon. Member for Darlington that vapes are a gateway to other, sometimes very serious, concerns and to riskier behaviour, such as smoking and substance abuse. He eloquently outlined the even greater and more significant harms that can be caused.

These things are arriving in huge numbers. I am grateful to the Advertising Standards Authority, which met with me after the most recent vape-related debate I spoke in. It is doing significant work trying to uphold the ban on advertising in various places, including on social media, of nicotine-containing cigarettes that are not licensed as medicines. None the less, Members may have seen adverts that would cause them to think that was not the case, and that is part of this torrent and this pushing of vapes, which needs our urgent attention.

Indeed, vapes need attention across the world. Let us be clear that the scale of the problem and the potential harms to young people and the planet should cause us deep worry. I read a really interesting piece by Chris Kirkham from Reuters last month about the owners of Elf Bar, which is a company with roots in China. Elf Bar products are very popular here, and the company is now, according to Reuters, flooding the US with illegal vapes—ones not covered by Food and Drug Administration regulations.

[Peter Gibson]

Will the hon. Lady give way?

[Kirsten Oswald]

I am going to make progress, but if I have time, I would be happy to let the hon. Gentleman come in later.

Elf Bar is simply ignoring those regulations to get its products to market. In the UK, it is taking a different approach and complying with regulations so that it can—one presumes—sell the maximum number of its products. That means that we need different regulations that will stop the surge in young people vaping. Of course, if we banned all disposable vapes, it would be far easier to identify the illicit ones, because all vapes would be illicit. It is far better that we close down the distributors and that we do so in a wholehearted way.

I have spoken before about my own concerns about sports advertising of vapes. I spoke about Blackburn Rovers, and a 15-year-old footballer, who came on as a substitute in their FA cup win recently, made history as their youngest ever player. However, his shirt did not have the club sponsor, Totally Wicked, on it. Blackburn Rovers said that, as the legal vaping age in the UK is 18, under-18s cannot wear that logo—but they can still see it, because it is displayed on everyone else’s strip. We would not want tobacco companies advertising on sports strips. We would not want whisky, beer or cider companies on sports strips. None of those things should be acceptable to us, and advertising for vapes should not be acceptable to us either. If we are serious about dealing with the harms that young people experience because of vaping, we should expect sports clubs to take that seriously too. The claims by both Blackburn Rovers and Totally Wicked at the time that vaping had a positive and proven role in supporting the reduction of smoking are simply not credible when we think of the young people who are interested in football.

I will bring my remarks to a conclusion. I noticed recently that some vaping companies are actually going out and looking for sportspeople to sponsor. I think that is hugely dangerous and hugely unwelcome. I ask the Minister to give us some of her thoughts on that matter in her response.

--- Later in debate ---

[Peter Gibson]

I am delighted to have led the debate this afternoon and to have heard from the Minister. I was pleased to hear all the contributions from Members across the Chamber, and it is clear that there is cross-party and political-free concern about the issue of our children’s welfare. I am particularly pleased that my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson) is here, given that she is a consultant paediatrician and has campaigned long and hard on this issue. I was particularly interested in her idea about bringing in some excise duties as a way to stop illegal vapes.

I am delighted to have heard from the Minister. She stole the words that I had written down—I was going to say that she was on the warpath. She is clearly—

NHS Dentistry

Peter Gibson Excerpts

Tuesday 9th January 2024 Commons Chamber

[Wes Streeting]

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

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

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

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

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

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

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

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

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

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

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

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

[Peter Gibson (Darlington) (Con)]

I am very grateful to the hon. Gentleman for giving way and I appreciate that he gave me notice that he was going to mention my constituency. What he failed to do in his contribution was read out the letter in full. He has also not anticipated the full content of my speech, which highlights all the work I have been doing in my constituency to tackle the failure by the ICB to deliver the missing contract.

[Wes Streeting]

I could quote the full letter, but it does not help the hon. Gentleman. He misses the fundamental point. This is not just a failure in Darlington. This is not just a problem in the north-east of England. It is the south-west of England, it is the south-east of England, it is the west midlands, it is the east midlands, it is the north-west, it is Cumbria—it is right across the country. In fact, even in London, my city, which has the best NHS dentistry provision in the country—so much for levelling up—dentistry is still in a poor condition. That is why people in Darlington are looking to Labour and, I hope, Lola McEvoy, to take responsibility, show some leadership, back good Labour policies and rescue NHS dentistry in Darlington. The general election cannot come soon enough.

The choice is clear. Under the Tories, NHS dentistry is dying a slow death. The only chance for survival is change with Labour. Labour’s plan will deliver: 700,000 more dental appointments a year for those most in need; new dentists recruited to dental deserts where there is not a single dentist taking on new patients; toothbrushing in primary school for three to five year-olds to promote good health and prevent demand on the NHS; and reform of the dental contract after 14 years of failure, so that once again every patient who needs a dentist can get one. Politics is about choices. Labour chooses to rescue NHS dentistry, not give the wealthiest a tax break. Labour’s plan is fully costed, fully funded, and will make a real difference to people across the country. The Tories have left our country toothless. Labour will give our country its smile back and give its NHS back, too.

--- Later in debate ---

[Peter Gibson (Darlington) (Con)]

I wish to put on the record at the outset my thanks to my hon. Friend the Member for Harborough (Neil O’Brien) for his work on dentistry. I also thank the Under-Secretary of State for Health and Social Care, my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom), for her early engagement with colleagues on this topic just days into her new role.

My constituency office has received enquiries from almost 200 residents who have been unable to access NHS dentistry services, despite the fact that there are many dentists in our town. The current NHS contract for dentistry stems from Labour’s reforms of 2006, and has increasingly shown itself to be lacking. The regime of payments based on units of dental activity has been unfair to dentists from the start, and, due to insufficient commissioning in areas of greatest need, it has been unfair to patients too.

Last year, a practice based at Firthmoor community centre in Darlington handed back its NHS contract as it was unable to be economically viable while being paid a mere £23.50 for a UDA. After struggling to recruit a new dentist, the owner of the practice, who also operates in other parts of the north-east and is paid almost £40 for a UDA in leafy parts of Newcastle, took the very sad but entirely understandable decision to close their Darlington branch. No business can recruit and employ staff when the money coming in does not cover the operating costs, never mind make a profit. NHS England, which did the commissioning prior to April 2023, offered to increase the UDA rate to nearly £30, but frankly, that was too little, too late.

When the North East and North Cumbria integrated care board took over responsibility for dentistry in April last year, I was filled with fresh hope that a resolution for the situation in Darlington would be found. I was assured that emergency provision would be expanded and additional commissioning would be provided at a higher UDA to further expand provision in Darlington. Imagine my dismay and disappointment when, in late November, I learned that little, if anything, had been done—literally nothing. There then followed numerous meetings, conversations and communications as I became increasingly angry that I had effectively been misled and my constituents were still being under-provided for. I am grateful to the hon. Member for Ilford North (Wes Streeting) for kindly highlighting my work on this topic as a constituency MP, in contrast to his time prior to his current role, when he mentioned dentistry not once.

Our ICBs do not even have to have a dentist on their boards. It has become clear to me that only by our lobbying, pushing and raising this in the media will our ICBs actually turn their attention away from their own internal bureaucracy and focus on the job of providing the services that they have an obligation to commission. I welcome that the Government will bring forward a dental recovery plan, which really cannot come soon enough. In the meantime, I urge the Minister to give our ICBs a boot up the backside and get them to pull their finger out. When things are as bad as they are, their underspend on dentistry is utterly shocking.

While I am on my feet, I have a few suggestions for the Minister. I have shared them directly with her before, but it would be good to get them on the record. We need more dental training. Will she consider the addition of a dental school to Teesside University, alongside its excellent dental technician training facilities? I welcome that we will oblige our new dentists, whose training comes at massive public cost, to spend a period of time providing public services before they go fully private. Dentists should be required to publish their fees and charges for NHS, private and insurance-backed work, so that patients can make clear and informed choices. We also need to see greater provision of mobile dentists visiting schools, particularly in areas of higher deprivation.

We need to see much more progress on this issue. We need to go further and faster, and I am quite sure that my right hon. Friend the Minister is the right person to do just that.

--- Later in debate ---

[Peter Gibson]

The hon. Lady and I share the same integrated care board. If this is to do with austerity, why has she not engaged with our local ICB to ask it about the underspend and the provision in her constituency?

[Mary Kelly Foy]

I do speak to the ICB whenever I need to and it has told me, as I am about to say, that our welfare state, of which the NHS is a part, has been hollowed out. The system is wrong. Austerity has caused these problems: it is not the pandemic; it happened many years before then.

Supporters of austerity often say they do not want to burden future generations with debt, but austerity and preventive healthcare are incompatible; we cannot have both. The healthcare problems this Government have caused our constituents—issues that could have been prevented with funding and investment—will now be more expensive to resolve down the line. Conservative Members have saddled future generations with poorer health, poorer opportunities and ultimately a poorer country, and it is time for them to go.

--- Later in debate ---

[Ashley Dalton (West Lancashire) (Lab)]

I am grateful for the opportunity to speak in this debate, because inability to gain access to an NHS dentist is an issue plaguing my constituents.

In 2024 Tory Britain, the opening of additional NHS dentistry practices is national news, with reports of people queuing on high streets just for the chance to be seen by a dentist. This is a Britain where a call to an NHS dentist to inquire about registering as a new patient is met with laughter down the phone. That is not hyperbole or hearsay: it is what I heard when I tried to register my 88-year-old mother and myself with a new NHS dentist. My dad does not need one: he had his teeth taken out for his 21st birthday, because—my hon. Friend the Member for Wallasey (Dame Angela Eagle) made this point—it was cheaper and easier. It is shocking that we seem to be back in that situation today. In 2024, it is easier to get your hands on Taylor Swift tickets than to get an NHS dental appointment.

For the benefit of the hon. Member for North Devon (Selaine Saxby), who is no longer in her place, my constituency is a rural one, and it is a beauty. However, for many of my constituents, living in a rural constituency makes accessing vital services nothing short of stress-inducing. The presence of the new Labour Members, my hon. Friends the Members for Selby and Ainsty (Keir Mather) and for Mid Bedfordshire (Alistair Strathern), would point to the idea that people in rural communities do believe that Labour has got a grip on what rural communities need; and our colleagues the candidate in Hexham, Joe Morris, and the candidate in Carlisle, Julie Minns, are also telling me that their local people, and hopefully future constituents, believe that Labour has a grip on what is needed in rural communities.

When services are not available in Burscough, in my constituency, it is not as simple as phoning the next practice down the road, or the one just over from that. It means travelling to Skelmersdale, to Southport, to Liverpool. One of my constituents has contacted every practice in our constituency and beyond, from Ormskirk to Blackpool, and is unable to register anywhere as an NHS patient—and Blackpool is 50 miles away, a four-hour round trip by public transport. Another parent in my constituency has been unable to register either of their children, both of whom have additional needs, with an NHS practice.

Another recent arrival to Skem cannot register any of his family members as an NHS patient. I took up his case with the ICB—I am sure that the hon. Member for Darlington (Peter Gibson), who is still in his place, would approve. The ICB told me the shocking truth that Government funding of NHS dentistry is only sufficient to enable around 50% of the population to access routine dental care. So where is the funding for the other half? What are the other 50% of our constituents meant to do?

[Peter Gibson]

The hon. Lady is obviously in a different ICB area from mine and I am not privy to the detail in respect of her ICB’s underspend, but it would be wonderful to know whether her ICB does in fact have an underspend.

[Ashley Dalton]

I thank the hon. Gentleman for leading up conveniently to my next point. The issue is that the ICB is actually bringing back more money than ever before from our dentists, and the local NHS dentist in Burscough is telling me that that is because they cannot recruit dentists or hygienists or other dental professionals in order to meet their target. They would love to do it; they cannot. The hon. Member for Darlington also talked about choice, but it is no choice when the only choice is private or nowt—and that is what my constituents are looking at.

If only the problem stopped at dentistry. The inability to access a dentist and regular check-ups leads to people having to visit their GP for knock-on health issues, or they are in so much pain that they are forced to end up at an already stretched A&E. Under this Government, the state of NHS dentistry services has ended up as dismal. A member of the public who contacted Healthwatch Lancashire recently, reported that they were in so much pain that they were feeling suicidal.

The public know that they cannot trust the Tories with NHS dentistry, and the alternative with Labour is clear. Prevention is by far the most effective way to improve patient outcomes across the NHS, and there is no better way to prevent than to educate. We have heard that a Labour Government will introduce supervised toothbrushing in schools for three to five-year-olds, giving children the best chance to avoid tooth decay altogether; 700,000 more urgent appointments for the most serious treatments such as fillings and root canals; and will incentivise dentists to work in areas where they are needed most. That is music to the ears of residents in rural areas such as mine. Even better than that, it is all paid for, by ensuring that the people who make Britain their home pay their taxes here, abolishing the non-dom tax status once and for all.

Toothache is nothing compared with the hurt of another five years of this Government’s inaction on dentistry. It is time they called a general election to make way for a Government with a plan to fix our nation’s teeth.

Oral Answers to Questions

Peter Gibson Excerpts

Tuesday 5th December 2023 Commons Chamber

[Victoria Atkins]

We have in fact made progress by delivering record numbers of urgent cancer checks, and levels of first treatments following an urgent cancer referral have been consistently above pre-pandemic levels, with activity in September standing at 108% of pre-pandemic levels on a per working day basis.

[Peter Gibson (Darlington) (Con)]

T6. Some six months ago, the dentist based at Firthmoor community centre, serving 8,000 of my constituents, handed back its contract to the integrated care board. I was shocked last week to learn that the ICB has still not commenced the tender process to replace that provision. What advice can the Minister give me to ensure that our ICB is doing what it needs to do?

[The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)]

My hon. Friend has already raised this issue with me several times in the almost two weeks I have been in this post, so he is doing a great job, and he is right to raise it. Tendering exercises for NHS dentistry are bound by current procurement law, but I am happy to meet him to discuss how much faster we can go to get this sorted out.

Hospice Services: South Devon

Peter Gibson Excerpts

Wednesday 29th November 2023 Westminster Hall

[Kevin Foster]

I always welcome an intervention from my hon. Friend, who is absolutely right that we are seeing leading work. He will be unsurprised to hear that later in my speech I will refer to some of that and invite the Minister to see for herself what is being done.

Hospice services provide vital support to those with life-limiting conditions, but they do face challenges themselves. In terms of their income, a Hospice UK survey in March 2023 revealed that 96% of hospices were budgeting for a deficit. While some of this confirms planning based on the likelihood of receiving bequests from wills, which for obvious reasons cannot be specifically predicted, it reflects the way hospices must continually look for support to maintain their services. There is also strong regional variation in the percentage of statutory funding; to be clear, this is a balance between NHS funding, contract funding and the fundraising income they receive. The variation in the percentage of support provided through statutory funding is significant: for example, in London this accounts for an average of 43% of funding, whereas in the south-west it accounts for just 24%—the lowest overall percentage rate, which it shares with south central and Wales.

The range of statutory funding percentages for individual hospices is worth noting, with 23 getting over 50%, while 85 get less than 32% of their funds from statutory sources. I accept that fundraising abilities vary depending on the community and the type of services, as well as the type of services being contracted, but these figures are very stark in their difference.

[Peter Gibson (Darlington) (Con)]

I congratulate my hon. Friend on securing this important debate. As the co-chair of the all-party parliamentary group on hospice and end of life care, the opportunity to highlight the wonderful work that our hospices do is really incredible; we should all take the opportunity to do that.

My hon. Friend mentioned the challenges about funding from statutory sources. I wonder whether he agrees with me that, now that we have the statutory obligation to commission palliative care in the Health and Social Care Act 2012, our integrated care boards need to step up to the plate and properly commission these services universally across the country, ending the postcode lottery.

[Kevin Foster]

I thank my hon. Friend for his intervention and for the work that he does as the chair of the APPG. I could not have put it better myself; he is absolutely right that there can be postcode lottery. Also, the variations are quite significant; I accept that some areas may have different types of services and some may have a greater ability to fundraise, but we should certainly seek a level of consistency across the country, to ensure that people have access to that service when they need it.

Building an NHS Fit for the Future

Peter Gibson Excerpts

Monday 13th November 2023 Commons Chamber

[Peter Gibson (Darlington) (Con)]

I congratulate my hon. Friend the Member for Uxbridge and South Ruislip (Steve Tuckwell) on his excellent maiden speech.

Let me begin by paying tribute to His Majesty on his first Gracious Speech. As he reflected in that speech, we were all reminded of the selflessness of his mother, Her late Majesty, which he continues to exemplify. It was fantastic to hear the wonderful speeches of the proposer and the seconder of the motion on the Loyal Address, my right hon. Friend the Member for Scarborough and Whitby (Sir Robert Goodwill) and my hon. Friend the Member for Stroud (Siobhan Baillie). They are both fellow Yorkshire folk and both great friends. My right hon. Friend the Member for Scarborough and Whitby has regaled friends and colleagues alike for many years with his jokes. It was wonderful to hear his entire repertoire in just one sitting. He told us that his first parliamentary contest was, just like mine, in Redcar, where I lived as a child and went to school. It was also where my mum served as an NHS community midwife, so I saw at first hand the incredible work of the NHS from a very early age. Fast forward to the present day, I have the privilege of representing the town, and the hospital where my mum undertook her nursing training. That was some years before I was even born, but still I regularly meet constituents who worked alongside mum in the 1960s.

I welcome the Government’s focus on building an NHS fit for the future. As I visit dentists, doctors and Darlington Memorial Hospital and I speak to constituents at my surgeries, it is clear that despite this Government’s strong record of investment, with record funding, record doctors and record nurses, much more needs to be done. Tees, Esk and Wear Valleys is our local mental health trust. It has some immense challenges to deliver the mental health care that my constituents need. My surgery regularly features people with heartbreaking stories, where the support they need has not been there. That is why I welcome more funding to deliver mental health support.

I regularly see families in my surgery affected by the tragedy of suicide. Those terrible stories of pain and suffering are incredibly difficult to hear. That is why the Government have my full backing in their suicide prevention strategy. However, I think they should bring forward long discussed mental health legislation, just as I believe that we need progress on banning conversion practices. I join my hon. Friend the Member for Thurrock (Jackie Doyle-Price) in her comments on the terminology used. Abuse is abuse, not therapy.

I also welcome the £8 billion commitment for NHS and adult social care. As a solicitor before being elected to this place, I found that the biggest single concern of those planning for later life was how their care would be covered. Our elderly should have confidence in the care and support they need in later life. I welcome the steps being taken to deliver that.

On hospices, I am privileged to follow in the steps of Jack Dromey as co-chair of the all-party parliamentary group for hospice and end of life care. I refer the House to my entry in the Register of Members’ Financial Interests, as a hospice trustee. The Government rightly supported our hospices incredibly well during covid. However, with patchwork commissioning from our ICBs, and despite clear direction in the Health and Social Care Act 2012 to commission palliative care, many hospices are vulnerable to closure or reduction in services, putting increased pressure on our NHS. It need not be like that, with ringfenced funding in ICB budgets for palliative care.

Darlington is still not getting sufficient dentistry. Ministers say that is down to the ICBs; the ICBs say it is down to the dentists; and the dentists cannot make the contracts work. Even when additional funding is found, as it has been recently following the closure of one practice, we still cannot get the dentists we need. Is it time to insist that every dentist trained here spends a number of years providing NHS services before they move to exclusively private work? I welcome the expansion in dental skills and urge Ministers to go further to accelerate growth in numbers.

Tackling the challenges of tobacco, illegal tobacco sales, disposable vape sales, the child grooming that flows with that and the organised crime that lies behind that, is of deep concern to parents in my constituency. I welcome the measures to clamp down on tobacco use and disposable vapes, and I would welcome the licensing of sales of legal tobacco as a further way of cracking down on that.

[Jim Shannon]

Respiratory health is very important. Across the United Kingdom, one of many issues is chronic obstructive pulmonary disease. The hon. Gentleman is well aware of that, for he has spoken before about it. We have the worst figures in all of Europe except for Denmark. Some 33% of COPD patients are readmitted within 28 days of discharge, even though readmission has been found to be strongly related to post-discharge mentality. Does the hon. Gentleman agree that for that 33%, the NICE system in place for COPD needs to be reviewed, and a better service needs to be delivered?

[Peter Gibson]

I concur with the hon. Gentleman’s calls for further work on that. It is deeply concerning to see children using disposable vapes and suffering severe traumas that result in hospitalisation. More must be done to clamp down on the illegal sale of those products.

I am pleased that the Government are focused on building an NHS fit for the future. Finally, can we please see more dentists in Darlington?

Oral Answers to Questions

Peter Gibson Excerpts

Tuesday 17th October 2023 Commons Chamber

[Peter Gibson (Darlington) (Con)]

7. What recent assessment he has made of the effectiveness of emergency department opt-out testing for HIV.

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

Provisional NHS data shows that opt-out testing has found around 700 cases of HIV during its first year. In total, it has found more than 2,000 cases of blood-borne diseases, including hepatitis B and C.

[Peter Gibson]

I welcome the Minister’s news on those figures. He will have seen the impact of opt-out testing—detecting more people, treating them earlier and saving the NHS money. However, if we are to meet our 2030 target on no new infections, we cannot delay a further roll-out of opt-out testing. Will he commit the resources needed to expand it in time for World AIDS Day on 1 December?

[Neil O’Brien]

I pay tribute to my hon. Friend for all his work on this important issue. We will assess all the evidence and reply before the end of the year. Opt-out testing is not the only thing we are doing to drive down HIV transmission. We have had a 40% rise in the number of people getting pre-exposure prophylaxis, and we have increased the number of people testing, with 20,000 free testing kits handed out this year. We are doing everything we can to meet that visionary goal to stop HIV transmission in this country.

HIV Action Plan Annual Update 2022-23

Peter Gibson Excerpts

Tuesday 18th July 2023 Westminster Hall

[Peter Gibson (Darlington) (Con)]

It is a privilege to serve under your chairmanship, Dame Caroline. I congratulate my hon. Friend the Member for West Bromwich East (Nicola Richards) on leading this important and timely debate. As I remarked in Prime Minister’s questions in February, that month marked the 22nd anniversary of the death of a good friend of mine from AIDS-related complications. I am absolutely certain that had he been tested earlier and more regularly, he would have been given the right treatment and would still be alive today. It is because of people like him that this issue is so important to me.

I am entirely supportive of the Government’s commitment made in 2019 to end all new HIV transmissions in England by 2030. Although we have made some progress, we cannot be complacent. We should rightly celebrate the successes in improving HIV treatment, prevention, management and care. However, without testing we cannot treat, and without PrEP we cannot prevent further infection. It is great that HIV-positive people now experience a similar life expectancy to people without HIV, but we still have a lot of work to do. Although new HIV diagnoses have continued to fall, late diagnoses remain stubbornly high in England, and progress across the UK is not equitable.

There are three key areas where we need to seek more action: access to PrEP, more HIV testing and care for people living with HIV. As we have heard, access to PrEP remains limited. The HIV action plan included a commitment to develop a plan for PrEP access beyond sexual health services. However, more than a year on from that commitment, it is still not possible to access PrEP at a pharmacy or a GP surgery. May I ask the Minister why that is, and whether he will look urgently at this point? This is an easy win in our fight against HIV.

The HIV action plan included a £20 million investment in opt-out testing in emergency departments in areas classed as very high prevalence. As a result of additional hepatitis C funding, the whole of London was included and the programme became a combined one to tackle bloodborne viruses. The annual report includes the first year of data, and the results have been quite remarkable across London, Manchester, Blackpool and Brighton, as other speakers have highlighted. The figures demonstrate the huge success that opt-out testing has had in rooting out cases of bloodborne viruses—not just HIV, but hepatitis C and B.

In February, as a result of campaigning from many colleagues here and stakeholders across the country, the Public Health Minister committed to consider the case for expanding opt-out testing to all areas with a high HIV prevalence. Will he tell us the outcome of that review? When will opt-out testing be rolled out to high prevalence areas? People do not live their whole lives in fixed locations. Simply because someone now lives in an area that is not high prevalence does not mean that they did not once do so or have not visited such areas in the past.

Opt-out is a win-win: it is good for public health and the public purse. It is essential that we meet our target of ending all new HIV transmissions in England by 2030. We have made progress, but I fear that without renewed impetus, greater access to PrEP and an expansion of opt-out testing, we will miss the mark. Our internationally significant position on HIV is in no small part due to the zeal of giants in the field, such as Lord Fowler, and the efforts of the Terrence Higgins Trust. I ask the Minister to rekindle that zeal and energy, and ensure we take up this mantle and race towards a day when we have no new infections. It can be done.

--- Later in debate ---

[Neil O'Brien]

I am happy to look into that. We provided extra funding

in respect of mpox, but I will look into the issues the hon. Gentleman raised.

This debate is an opportunity to restate our joint commitment to tackling HIV and to reflect on the progress we have made since 2019, when the Government first announced our ambition to end new HIV transmissions, new AIDS diagnoses and new HIV-related deaths in England by 2030. As all Members know, 30 years ago AIDS was a fatal illness; today, when they are diagnosed early and have access to antiretrovirals, the majority of people with HIV in England can expect a near-normal life expectancy. People who are diagnosed with HIV can expect to receive HIV care that is world class, free and

open access.

We have come a long way. Despite the unprecedented and challenging backdrop of the covid pandemic, England has seen a 33% fall in new HIV diagnoses since 2019, and fewer than 4,500 people live with undiagnosed HIV. The vast majority of those diagnosed are on high-quality treatment and are now unable to pass on the virus—still not enough people know that. Our successes have been possible only through clear national leadership and strengthened partnership working.

I am incredibly grateful to Professor Kevin Fenton, the Government’s chief adviser on HIV, who chairs the HIV action plan implementation steering group, which has representation from the key partners involved in the delivery of the HIV action plan, including local government, the UK Health Security Agency, the NHS, professional bodies and our voluntary and community sector. The group has met quarterly throughout the year to monitor progress on our commitments and ensure that appropriate action is taken to help us to move forward on our objectives.

Within the steering group’s remit, we have established a community advisory group, comprising representatives from a wide range of community and voluntary groups, from which we have a lot to learn, and four task and finish groups to support PrEP access and equity, workforce, HIV control strategies in low-prevalence areas, and retention and engagement in HIV care. The groups provide vital, comprehensive and timely advice and help us to remain on track to meet our 2030 goal.

Many areas of the country have replicated the national action regionally by providing leadership and oversight of the work that is under way within local systems. For example, we have seen the development of regional HIV action plans in areas such as the south-west, multi-agency working groups in the midlands, and stocktakes of testing activity and action via sexual health networks in the south-east, the north-east and Yorkshire.

[Peter Gibson]

I am interested to hear the stories the Minister is telling about regional action plans; do they include opt-out testing?

Under-age Vaping

Peter Gibson Excerpts

Wednesday 12th July 2023 Commons Chamber

[Peter Gibson (Darlington) (Con)]

I welcome this debate on a hugely important issue that gives rise to related concerns. Recent research shows that 24% of children have used a vape and 11% of secondary school pupils would describe themselves as regular vape users. The data that has been disclosed in today’s article in The Northern Echo reveals that nearly 100,000 children in the north-east have tried vaping. Those figures should be of great concern to all of us.

First, I commend my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson) for the amazing work she has done on this issue. She is my longest friend in politics and I wholeheartedly support her ten-minute rule Bill to prohibit the sale of disposable e-cigarettes. She is right in seeking to end the problems caused by these products. If they were simply used to wean smokers off cigarettes, they would be doing their job, but we know from the debate that they are doing far more harm than that. One key point that she has raised is that although vaping manufacturers often insist that their products are intended for adults only, they design their products with descriptions, colourings and flavourings that, as we have heard, appeal to a far more impressionable audience.

One of my biggest concerns is that we simply do not know the long-term effects of vaping, as e-cigarettes are very new. Let us not forget that there once was a time when cigarettes were considered safe. We know that e-cigarettes or vapes contain carcinogens, cytotoxins and genotoxins. A recent freedom of information request found that vaping-related hospital admissions almost doubled last year, with 32 of those cases involving children. The simple fact is that we do not know how bad the problem is.

I know that children’s vaping is a serious concern in my constituency, where parents are increasingly worried that children are being targeted by brands, with social pressures resulting in more children becoming addicted. At the beginning of this year, Darlington Borough Council began a crackdown on the trade of illegal tobacco and vape products. It began under the previous Conservative administration in Darlington and I hope that its work will continue under the new Labour and Liberal Democrat administration. As a result of that crackdown, a huge amount of counterfeit tobacco and fake vape products were seized, and numerous premises have either been closed down or are under further investigation. Sadly, this is like a case of whack-a-mole: one trader is stopped and another two replace them. Whether we are talking about underage sales or child exploitation, using vapes as a reward, or using children as couriers, we should be acutely aware of the risk to young people in our community from those who would engage in such criminal activity. There is a concern that criminals have now latched on to this market of illicit products to undercut legitimate goods, with a network of organised criminals operating in the background to feed the vaping issue.

I wish to highlight to the House the issue raised by my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) about the location of vaping products in Southampton. In conversation with me, my hon. Friend the Member for Bosworth (Dr Evans) highlighted concerns raised in his community about the siting of vapes in a supermarket. He launched a campaign in his constituency to have those relocated. He tells me that it was well met by the supermarket, so there is perhaps a lesson for us all to raise that issue in our respective local community supermarkets.

Local trading standards teams, such as those in Darlington, rely on local information and intelligence to tackle the issue of purchases of illegal and fake products. I urge everybody to encourage those in their communities to report such issues to trading standards departments.

We must stop children from vaping. My hon. Friend the Member for Sleaford and North Hykeham’s proposal to ban disposable electronic cigarettes is excellent, and I hope that her Bill is successful.

[Dr Hudson]

My hon. Friend is making a powerful speech articulating the risks of vapes in terms of the public health of our young people and the environmental concerns with their disposal, but we are also seeing increasing issues with animals. When I was out walking my young dog, Poppy, the other day, she went into the undergrowth and came out with a bright pink, melon-flavoured disposable vape. She was just about to crunch it and swallow it, when I took it out of her mouth. I shudder to think what would have happened if she had crunched and swallowed it, because it was a foreign body, containing a battery and toxic compounds. Does my hon. Friend agree with me that we just do not know the risks to people, the environment and animals?

[Peter Gibson]

As an expert on animals, my hon. Friend will be acutely aware of the risks to animals of ingesting a battery. We know there are concerns about the disposal of vaping products. He leads me to recall the campaign led by my hon. Friend the Member for Stoke-on-Trent Central (Jo Gideon) on button batteries; this debate highlights similar issues.

I believe that the time has come for us to consider licensing the retail sale of tobacco products as a means of tackling those traders engaged in the sale of illegal, fake and contraband tobacco and nicotine products. We know such sales fuel organised crime gangs, so licensing is another way of cutting off that money supply.

Finally, I ask the Government to consider a cross-departmental strategy, across the Department of Health and Social Care, the Home Office, Ministry of Justice and the Department for Education, and working with local authorities, to ensure that we have the right legislation in place to tackle these challenges, including the correct disposal and recycling of all the paraphernalia.

--- Later in debate ---

[Alex Cunningham (Stockton North) (Lab)]

I draw attention to my role as a vice-chair of the all-party parliamentary group on smoking and health.

Perhaps I could start my speech with a quiz, although I do not really want any answers because that would in effect name killer cigarettes. No. 1: which brand is promoted here?

“Give your throat a vacation…Smoke a fresh cigarette”.

That brand was promoted with a picture of an ear, nose and throat specialist holding what was described as a “germ-proof” pack of cigarettes as he had tested the brand’s ability to filter the

“peppery dust…that makes you cough.”

No. 2: Cigares De Joy makes the claim that these cigarettes benefit those suffering from

“asthma, cough, bronchitis, hay-fever, influenza & shortness of breath”.

No. 3, and I will name this one for context: Eve, the cigarette for the “feminine woman”, packaged in a box with a floral design, with ads claiming:

“Flowers on the outside. Flavor on the inside.”

I remember the former Member for Broxtowe, Anna Soubry, speaking of the sophisticated, long, slimline menthol cigarettes that were a passion in her days.

There are hundreds, if not thousands, of other adverts promoting cigarettes that we can see online today. Yes, there is cigarette advertising selling the health benefits or the glamorous, sophisticated femininity of a killer product that we all know would never be allowed to be manufactured if someone came up with the idea today. The laws, over the years, have put those ads into the past, but the tobacco companies have always been very clever in their marketing. Let us be in no doubt but that, for generations, they have always had their eye on the next generation of smokers, with children very much in their sights. Now we have e-cigarettes, many of them manufactured by the same tobacco companies, which are becoming increasingly popular with children and young people. When I drive past local secondary schools, it is common to see young people—it appears more girls than boys—sucking away on one of these devices. The advertising of them is a real throwback to those days I have described, when cigarettes were sold as healthy, sophisticated products that everybody should use.

Yesterday, at Health and Social Care questions, I asked the Secretary of State why he has not acted to stop the new range of advertisements for e-cigarettes featuring gummy bears and Skittles, with bright colours and cartoon characters on packaging and labelling, by adopting Labour’s amendment—that of my hon. Friend the Member for City of Durham (Mary Kelly Foy)—to the Health and Care Bill to ban such advertising. He answered that

“we have already taken action. We took measures in April, and the Prime Minister announced further measures in May. We are keen to follow the evidence. That is why we have had a call for evidence. The ministerial team are looking extremely closely at this, and we will take further action to clamp down on something that we all recognise is a risk to children, which is why we are acting on it.”—[Official Report, 11 July 2023; Vol. 736, c. 156.]

But he is not acting on advertising. He could put a stop to it now. I take issue with people who say that this is not a political issue, because Ministers have taken what I can only describe as a political choice to do nothing in this space. The Minister asked my hon. Friend the Member for Denton and Reddish (Andrew Gwynne) for specific things that need to be done. Well, an advertising ban is very specific.

[Peter Gibson]

Will the hon. Gentleman give way?

[Alex Cunningham]

No, I will not.

Yes, something may change in the future, but we need action now. I think the Immigration Minister would probably agree with us—he had the cartoon characters in a detention centre painted over because they were too welcoming and attractive. I will not condone that callous approach to children by the Immigration Minister, but I am sure he would agree that such attractive things should be removed from vape advertising and packs.

I well remember my original ten-minute rule Bill and other Back-Bench Bills to outlaw smoking in cars with children present. Ministers refused to back the measure, even though 600,000 children every day had to share their driver’s smoke. Three years later, the Health Minister, the then MP for Battersea, proposed her own amendment. To be fair, she did acknowledge my work and that of organisations such as the British Lung Foundation, Action on Smoking and Health, and Fresh. The Minister said then that the Government were following the evidence, but there had been years of it, and we do not need any more evidence for the Secretary of State to follow in relation to the advertising of e-cigarettes. It is already plain to see.

[Peter Gibson]

The hon. Gentleman is making an impassioned speech, which includes a great deal of discussion about advertising. Would he care to comment on the advertising for vapes on London buses?

[Alex Cunningham]

That is an interesting question. I would not personally want to see the advertising of vapes on London buses, particularly if they appeal to children.

It has been plain that manufacturers are directly targeting young people. I do not know whether gummy bears and Skittles are akin to the claimed glamour and sophistication of cigarettes, but the advertising is promoting a product with the kind of modern images that appeal to youngsters. We must not forget that e-cigarettes have their place, but that is as an adult quitting aid, not a child’s toy or sweet substitute.

In my area, North Tees and Hartlepool NHS Foundation Trust now includes vapes as part of its adult in-patient tobacco dependency treatment service. Vapes are offered as part of a wider toolkit of treatments available to those who smoke on admission to hospital, alongside nicotine replacement therapy and specialist behavioural support. Patients are provided with support to remain smoke-free during their hospital admission, and following discharge home. Reducing exposure to second-hand smoke has been a priority of mine for many years, and led to that ban on smoking in cars with children present in 2015.

We have known for a long time that breathing in tobacco smoke concentrated in enclosed places is harmful, and at its worst deadly, particularly when children are involved. For parents and carers addicted to nicotine, replacing cigarettes with vapes can substantially reduce the risks to their children. However, promoting vapes to adults as a quitting aid should not go hand in hand with the dreadful marketing of vapes to children. Requiring standardised packaging for vapes is essential, and the Government can be reassured that that has strong public and political support. Indeed, it may not be a political issue, because Members across the House support it. The overwhelming majority of the public would like us to go further and ban all advertising and promotion in shops, which is currently unregulated.

When I walk into shops in my local constituency—I am sure I am not alone in this—e-cigarettes are promoted everywhere. As others have said, vapes are thrust in children’s faces in all kinds of shops, at the till or by the sweets, which is totally unacceptable. When the Government respond to the consultation on youth vaping in the autumn, I urge them to commit to bringing forward legislation to ban not just the child-friendly branding of vapes, but their in-store promotion. As my hon. Friend the Member for Denton and Reddish said, we must not forget the issue of smoking itself, which is still the leading cause of premature death and inequalities in healthy life expectancy across society. Smoking does not just damage people’s health; it undermines our nation’s productivity, costing more than £20 billion a year to our public finances for health, social care and social security.

I know that the Minister is committed to achieving the Government’s smoke-free 2030 ambition, and I welcomed the measures announced earlier this year to support smokers to quit with free vapes, and to provide additional support to help pregnant smokers quit. However, those were only a tiny proportion of the measures recommended by the independent review that the Government commissioned from Javed Khan, to provide advice on how to achieve the smoke-free ambition. Indeed, the funding was only a quarter of that called for by Javed Khan, and the commitment was for only two years. Meanwhile, big tobacco continues to make extreme profits by selling highly addictive, lethal products. A levy on the industry is popular, feasible, and supported by voters of all political persuasions, as well as by the majority of tobacco retailers. The manufacturers have the money, and they should be made to pay to end the epidemic.

In a debate in the House on 20 June on the smoke-free 2030 ambition, the hon. Member for Harrow East (Bob Blackman) asked the Minister to explain how, when and where the Government will find the additional funding needed to deliver that ambition without a commitment to a levy on tobacco manufacturers. He received no answer, so I hope the Minister will answer that question today. Finally, I ask again: will the Minister bring forward the necessary legislation to end the child-targeted advertising of e-cigarettes? Ministers know that is the right thing to do.

--- Later in debate ---

[Peter Gibson]

I am very grateful to the hon. Lady for giving way. She has taken a number of interventions from colleagues. The motion refers to children. The shadow Minister commented that there is no proposal, under a Labour Government, to change the age of 18 for purchasing tobacco. By process of elimination, does the word “children” in the motion refer to anyone under the age of 18? Will she clarify that point?

[Helen Hayes]

I am sure Members across the House do not need much help from me to identify the definition of a child in law as being a person under the age of 18. I will simply move on from there.

What I will say about the motion is that it sets out measures over which I think there can be no disagreement. There can be no disagreement about advertising targeted at children. Measures to deal with packaging that appeals to children could be introduced right now and would have a direct impact on the very alarming numbers of children and young people who are vaping. This has been a very consensual debate, which has acknowledged and set out some of the complexities around the issue, as well as some areas where the Government should be looking at additional regulations and the wider regulatory framework around vaping. I do not think there is disagreement on that either. What we are setting out today is immediate action that is long, long overdue. Frankly, we struggle to see why the Government have been dragging their heels, refusing to act and not accepting these measures.

As I said, Labour is calling on the Government to ban vapes from being branded and advertised to appeal to children, and to work with local councils and the NHS to help ensure that e-cigarettes are used as an aid to stop smoking, rather than as a new form of smoking and addiction. It is inexplicable that the Government are resistant to those entirely proportionate and evidence-based proposals. If they will not act to protect children and young people, the next Labour Government certainly will.