Winter Preparedness

Peter Swallow Excerpts

Wednesday 18th December 2024 Commons Chamber

[Karin Smyth]

I join the hon. Gentleman in thanking everyone who works in the system. As I said, the NHS is getting £12 billion more this year from this Government than it had from the previous Government in the spring Budget. We are now focused on ensuring that money is used properly.

[Peter Swallow (Bracknell) (Lab)]

Let me take this opportunity to thank healthcare workers in Bracknell Forest, who will be working so hard across the Christmas period to keep patients safe this winter. Does the Minister agree that we must ensure that we have not only the right investment in our health services but the right reforms, so that we can fix the broken NHS and get it back on its feet?

[Karin Smyth]

My hon. Friend is absolutely right. We want to make sure that taxpayers’ money is used efficiently and effectively in the right places for the right treatment at the right time. That is why we are looking at our long-term plan. That is why we want to stabilise the system, so we do not have to keep coming back here year after year with a so-called winter crisis.

Puberty-suppressing Hormones

Peter Swallow Excerpts

Wednesday 11th December 2024 Commons Chamber

[Wes Streeting]

The only thing worse than a Member not knowing the answer to their own question is the Minister not knowing the answer. Happily, in this case, I can say that surgical intervention for trans people does not apply to children and young people.

[Peter Swallow (Bracknell) (Lab)]

I welcome the spirit in which the Health Secretary has made today’s statement and his commitment to improving healthcare for all trans people, but I want to press him a bit on continuity of care. This summer, I had a real struggle working with parents of young trans kids who were supporting their children in their journey and had accessed puberty blockers through overseas prescribers. They had done so after much heartfelt indecision, because they thought they were supporting what was best for their children and, frankly, because better healthcare options were not available to them under the previous Government. I welcome the moves taken to speed up the trial, but can my right hon. Friend assure me that while we wait for that trial to be set up, nobody currently receiving treatment with puberty blockers—however they may have accessed them in the past—will face a discontinuity in their care?

[Wes Streeting]

Any young person in Great Britain and Northern Ireland who had a valid prescription for these medicines in the six months prior to 3 June and 27 August respectively can seek continuation of their prescription from a UK-registered clinician. Guidance has been issued to general practitioners setting out prescribing scenarios. It remains the case that continuation of puberty-supressing hormones can be considered where the GP feels competent to do so, and where confirmation in the form of documentary evidence that treatment had been under way is available. The guidance also makes clear that GPs should consider what further support should be offered, including assessing whether referral to the children and young people’s gender service or, indeed, for mental health support is required.

Tobacco and Vapes Bill

Peter Swallow Excerpts

2nd reading
Tuesday 26th November 2024 Commons Chamber

[Edward Argar (Melton and Syston) (Con)]

I do not always do this, but I express my gratitude to the Secretary of State for the tone he has adopted in this debate and for recognising the strongly and sincerely held views of right hon. and hon. Members on both sides of it. I am also grateful to him for being typically willing to share with the House in support of his points something as personal as what happened to his grandmother. Sadly, it will not surprise him that no one asks me for my ID these days—I will have to take some tips from him on the moisturiser that he uses. [Interruption.] I will ignore the unkind comment that he has just made.

In many ways, this Bill is like the curate’s egg: it is good in parts—indeed, it is good in many parts—and started from a place of good intentions. As the Secretary of State set out, smoking has a huge cost to society and to individuals. We know that smoking is the single biggest entirely preventable cause of ill health, death and disability in this country, and we see in our NHS the impact of smoking every day. It is responsible for around 80,000 deaths in the UK each year and is estimated to cost the NHS and social care more than £3 billion a year, including 75,000 GP appointments every month. As the Secretary of State said, almost every minute someone is admitted to hospital because of smoking. It substantially increases the risk of many major health conditions throughout people’s lives, such as stroke, diabetes, heart disease, stillbirth, cancers, dementia and asthma.

As the Secretary of State has alluded to in the past, it is often people in more deprived areas who have higher smoking rates, lower healthy life expectancy and higher mortality rates linked to smoking. Some 230,000 households are estimated to live in smoking-induced poverty, and children of smokers are three times as likely to start to smoke, potentially perpetuating the cycle. Over 80% of smokers started before they turned 20—many started as children—yet more than half of current smokers want to quit; as the Secretary of State said, three quarters say that they would never have started smoking if they had the choice again. Let me be clear: reducing smoking, giving people the information and support to quit, and helping to protect children in particular are worthy ambitions.

Among all the doom and gloom, there is some positive news: smoking rates are falling anyway. While around 6 million people in the UK smoke, the number of smokers has been falling for decades. In 2023, just 10.5% of people aged 16 and over smoked, compared with 20.3% in 2010, 20.7% in 2000 and 30% a decade before that in 1990. Likewise, the number of children who smoke is falling. While this trend is welcome, it is understandable that there is a strong desire to see continued action to further drive down the prevalence of smoking and tackle the recent rise in vaping among non-smokers, especially among young people, and to protect future generations.

As was evidenced by the interventions that the Secretary of State kindly took from many hon. Members, I am sure that many of us in the House have been alarmed by the surge in youth vaping, which has doubled in the past five years. Despite it already being illegal to sell nicotine vapes to under-18s, a quarter of children tried vaping in 2023. While nicotine vapes can and do play an important part in helping adults to quit smoking, we are clear that children who do not smoke should not take up vaping. The nicotine content makes those products highly addictive, while the long-term impacts of the colours and flavours being inhaled are highly unlikely to be beneficial. Of course, the full effects may not be known for some years yet.

The uptake in youth vaping has been driven in part by the branding and promotion of products clearly aimed at children, with vapes, packaging, descriptions and marketing all designed to appeal specifically to young people. Grown adults trying to quit smoking are unlikely to see the appeal of cartoon characters on their vapes, but of course, children and young people will. Likewise, the bright colours and fruit flavours are far more likely to appeal to children than to those looking to quit tobacco smoking.

For those reasons, the last Government introduced a Bill that primarily targeted our interventions at young people. It would have restricted who could purchase tobacco products without impacting current adult smokers. It sought to tackle youth vaping by restricting flavours, introducing plain packaging and changing how vapes are displayed in shops so that they do not appeal to children. It would also have prohibited the sale of non-nicotine vapes and vaping alternatives such as nicotine pouches to under-18s, just as it is already illegal to sell nicotine vapes to children. In parallel, it would have introduced new fines for rogue retailers in order to tackle the illegal market, seeking to make sure that the law—such as age restrictions on purchasing vapes—was properly enforced.

That approach was targeted at the next generation of young people and aimed to prevent the take-up of smoking and vaping and break the cycle of nicotine addiction before it had even started. That Bill was not about demonising people who smoke or curtailing current smokers’ rights or entitlements in any way. None the less, it had challenging practical implementation impacts.

I have a lot of respect for the public health Minister, the hon. Member for Gorton and Denton (Andrew Gwynne)—I think that is his new constituency name—and know him well. I hope that when he winds up the debate, he will address some of the points I am about to make. My first point is about the impact on shopkeepers, particularly small shopkeepers, of enforcing and operating within increased restrictions, and the extent to which those restrictions are practically enforceable. In the context of what the Bill sets out to do, how does one avoid the existence of, or an increase in, a black-market economy in vapes or cigarettes?

We introduced our Bill before the general election. Since then, the new Government have introduced a Bill that may have the same name, but is not quite the same Bill that was introduced back in March. The Bill before us today gives the Secretary of State new, or significantly modified, powers under the Health Act 2006. It runs the risk of piling an unknown number of regulations on to retailers through a new licensing scheme, and it creates a whole new registration scheme. The challenge is that right hon. and hon. Members will not be told in detail what those schemes will look like, the specific impact they will have on businesses, or the detailed impact they will have on smoking and vaping rates until after the legislation has been passed. A hefty impact assessment—all 294 pages of it—has been produced. Given that the public health Minister has signed it, I fear he had to read every one of those pages before doing so. However, even with that impact assessment, the detailed impact of the individual regulations that may follow is unclear.

For example, clause 136 amends the Health Act 2006 to give the Secretary of State the power to extend smokefree places to some outdoor spaces. Of course, adults should be mindful and thoughtful about where they smoke or vape to be considerate to those around them, especially in areas with children or vulnerable young people, but the Bill risks giving the Secretary of State expanded powers to expand smokefree areas with minimal oversight. I acknowledge that the affirmative resolution procedure will be used, but as we in this House know, a statutory instrument and the procedures that accompany it are not as rigorous in their scrutiny as primary legislation.

Unlike previous laws, which banned smoking in confined areas such as pubs and bars, the Secretary of State is talking about bans in open spaces where the risks of second-hand smoking may be more limited. Page 64 of the delegated powers memorandum states:

“Under Section 4 of the 2006 Act, the Secretary of State could make regulations to designate additional places as smoke-free provided that they were of the opinion that there was a significant risk persons present in such a place would be exposed to significant quantities of smoke without a smoke-free designation…Section 5 of the 2006 Act gave the Secretary of State powers to make regulations for vehicles to be smoke-free.”

It goes on to say:

“Clause 136 amends the existing power in section 4 of the 2006 Act by omitting the risk condition.”

I would be grateful if the public health Minister could explain in his winding-up speech—I suspect he will be able to do so—why that condition is being removed. It was there for a reason: to give a sense of proportionality to anything that was done and to ensure that a particular bar had to be met, given the impact. Its removal effectively gives the Secretary of State much greater discretion to do as he wishes at a future date. I note that the Secretary of State has said today that he changed his mind on banning smoking in pub gardens or outside hospitality venues. I know him well, and he is an honourable man, so I take him at his word on that, but there is nothing in this proposed legislation to prevent a future Secretary of State from coming back, consulting and expanding beyond the areas where he proposes to restrict smoking to other venues and settings at a future date. Under clause 136, that could be done without the crucial risk criteria being applied. I would be grateful if the Minister could address that point, because it is hugely important. Members are being asked to decide now whether they support expanding smokefree places to an unknown list of outdoor spaces in the future, so it genuinely raises significant challenges and concerns if that gateway is not in place.

[Peter Swallow (Bracknell) (Lab)]

I am listening very carefully to what the right hon. Gentleman has to say. Some 13% of adults in Bracknell smoke, but we know that more than half of smokers would like to give up, so what I and my constituents are listening for is a commitment that his party will back concrete measures to end the public health epidemic of smoking once and for all—or are they just going to wrap up their objections in sophistry?

[Edward Argar]

I am grateful to the hon. Gentleman for most of what he just said. I will address precisely his point in a few paragraphs, but I say to him that my party brought forward legislation in March, which was debated in April, that did not have the mission-creep that I fear the Secretary of State is demonstrating with clause 136 and various other measures in this proposed legislation.

I must also challenge the Government on how they anticipate this measure being enforced. Will members of the public be encouraged to call the police if they see a parent smoking in a prohibited place? If there are no children in a park or playground, will it still be prohibited?

Concerns are also raised by the new licensing and registration schemes. While it is right that we had planned to expand the existing notification scheme to include non-nicotine vapes and nicotine products involved in the supply chain, this Bill goes a number of steps further. The Secretary of State will be able to create a new licensing regime for retailers for tobacco, vaping and nicotine products. Over 70% of convenience stores selling vapes and tobacco products are independent shops. How will they fare and how will they be assisted with the layers of added bureaucracy and cost that will be associated with the Bill? Do local authorities, which are already under pressure, have the capacity and additional funding allocated to administer such a licensing scheme in their areas?

Again, my fear is that we are unable to make a fully informed decision about the impact because the regulations will be set out only after the Bill has passed. The impact assessment states:

“A more restrictive licensing scheme would be expected to have a greater impact on public health and a greater economic impact on businesses.”

However, we simply do not know if that is what the Secretary of State has in mind or what the regulations will look like. Likewise, there is no detail on the impacts of a new registration scheme for all tobacco, vaping, nicotine and herbal products, as well as tobacco-related devices.

In the few months that the Government have been in office, they have sadly shown that they are not particularly a friend of business and have broken a number of their pre- election promises. Although I have confidence in the Secretary of State as an individual and as a right hon. Member of this House, I ask him to forgive the cynicism of those on the Opposition Benches over any attempted reassurances from the Government that they will take businesses’ concerns into account as they consult on their plans.

To the point made by the hon. Member for Bracknell (Peter Swallow), if a Division is called, in line with the precedent set last time this will be a free vote; each Conservative Member may vote as they choose. The Bill, as I have said, comes from a good intention to keep the population healthy, to ease costs for the NHS and to prevent children from taking up addictive habits that may follow them for the rest of their lives. I support those objectives, but I call on the Minister for public health, when he winds up, to give the reassurances I seek and roll back the additional measures that have been put in place, over and above what we were proposing.

It is important that information is available so that people can make informed decisions and that support is available for those who choose to stop smoking. Adult individuals are best placed to make decisions about their own lives, but we recognise that the same is not true for children. I look forward to the responses from the Minister for public health, which I hope will be constructive. I welcome the Secretary of State’s offer to be collaborative and constructive in his approach to the legislation.

Income Tax (Charge)

Peter Swallow Excerpts

Tuesday 5th November 2024 Commons Chamber

[Helen Morgan]

Fair funding for rural authorities, and indeed all local authorities, is something I have talked about many times in this House, and I absolutely agree with the hon. Gentleman on that.

We saw £600 million allocated to social care in the Budget and an increase in the national living wage, both of which are obviously welcome, but the huge pressure on private providers as a result of the national insurance contributions increase will be really problematic, unless councils are funded to pay those additional costs. It is not clear that the funding announced in the Budget will even touch the sides of the crisis in local government funding or in social care. We all know that this is a thorny problem, and that funding social care is extremely expensive and difficult; that is why cross-party talks are so urgent. I urge the Secretary of State to instigate those as soon as possible, so that we can work towards a permanent fix for social care. Liberal Democrats believe that free personal care on the Scotland model would be the best way of achieving that, and the Institute for Public Policy Research says that we could save £3.3 billion by 2031 by implementing that model. That would be a good investment, because it would save taxpayer money and it would keep people in their homes—where they want to be—with dignity.

The debate today covers other public services, and I want to touch on a couple; education is an important one, and we welcome the investment in it, but I want to talk a bit about SEND budgets and local authorities. Schools are under enormous pressure to provide SEND measures for the children they look after, and local authorities are under huge pressure to provide transport and specialist places. The £1 billion for local government will be insufficient to deal with social care, the SEND crisis and SEND transport. As the hon. Member for South Shropshire (Stuart Anderson) mentioned, Shropshire council is spending about 80% of its budget on social care, so without adequate measures for social care, it seems unlikely that this Budget will address all the problems that local authorities need to deal with.

We are therefore concerned about the decision to put VAT on private school fees. Schools such as Oswestry school in my constituency take a relatively large number of pupils who have failed to thrive in a larger setting. They have special educational needs but no education, health and care plan, and they might even have refused school altogether. There is a risk that those children, whose parents are saving hard to put them into that alternative place, will end up back in the state sector, where their needs are not met. They might refuse to go to school, and the school would struggle to cope with those additional children. The capital expenditure is welcome, and I hope that the demountable buildings at the Corbet school in Baschurch will benefit from that announcement, but I urge the Government to reconsider some of those measures.

On transport, it was disappointing to see the bus fare cap increased, although in Shropshire it will not make any difference, because it is almost impossible to catch a bus anywhere. We would really like to see some of the detail behind the public transport plans announced by the Chancellor, particularly the bus service improvement plan that Shropshire council has put forward, and railway schemes such as the Oswestry to Berwyn line.

Finally—it may be stretching it to call this a point about public services—I believe that farmers provide an essential public service in feeding us, looking after the countryside and protecting the rural environment, and it is disappointing to see that there is confusion between the Department for Environment, Food and Rural Affairs and the Treasury about how many farms will be affected. My sense from talking to local farmers in Shropshire is that the DEFRA numbers are more accurate.

[Peter Swallow (Bracknell) (Lab)]

Does the hon. Lady not see that by opposing every measure in the Budget to raise money while supporting every measure to spend more money on our vital public services, she is creating a bigger problem than the one we inherited from the last Government?

[Helen Morgan]

I thank the hon. Gentleman for his intervention. The point that we are trying to make is that some of the Budget measures will cost extra money. If we look at the detail on the national insurance contributions hike, for example, we see that changes in behaviour and exemptions for the NHS will reduce the amount of money raised to about £10 billion. We have absolutely put forward alternative measures to raise £10 billion. Whether by reversing the Tories’ cuts to the banking taxes or by putting taxes on online media giants, we would find alternative ways to raise those funds. The point about private school fees is the same. If we overburden the state sector with children who have special educational needs, difficulties and disabilities, those children will not have their needs met, and that will cost us more in the future. This is all about making sensible choices to save taxpayer money in the future and, most importantly, delivering public services to the people who need them most, whether they are trying to access NHS care or whether they need help to get through their school career in order to thrive and achieve their potential.

--- Later in debate ---

[Peter Swallow (Bracknell) (Lab)]

I start by declaring that my brother and his wife are both NHS doctors, and I am incredibly proud of them.

The Budget begins the work to undo a decade of recklessness and neglect by the Conservatives, who left our NHS uncared for, our schools crumbling and carers unsupported. It will fix the foundations of our economy, build the growth we need to invest in public services and end 14 years of Tory austerity. With this Budget, my right hon. Friend the Chancellor has put forward a bold, tough vision to deliver on our manifesto promise of change—£25.7 billion over two years for the NHS to slash waiting times, with an extra 40,000 elective appointments a week, and £2 billion committed to technology to begin a serious transformation towards digital healthcare.

Labour Members understand the need to fund our NHS properly, but we also understand that after 14 years of neglect, the NHS is badly in need of reform. We cannot cure 14 years of sickness in one Budget, but with this investment, we are finally taking the medicine we need.

I warmly welcome the £1 billion investment the Chancellor is making to address the crisis in special educational needs—a first step in fixing a broken system. During the Conservative leadership contest, the new Leader of the Opposition endorsed the view that getting an autism diagnosis brings

“economic advantages and protections”

and

“better treatment or equipment”.

That is a far cry from the experience of parents and children with SEND in my constituency. The Leader of the Opposition would do well to listen to the former Conservative Education Secretary, who described the SEND system under her party as “lose, lose, lose”. The Government’s commitment to increase SEND funding by £1 billion is a step towards addressing the crisis. It must be only the beginning of tackling this huge long-term problem. Ultimately, the system needs root and branch reform, but the money will start to make real, concrete differences and to break down the barriers to opportunity for many young people in Bracknell and across the country.

I will briefly mention the fantastic commitment to set up a £44 million investment to trial a new kinship carer’s allowance—again, that is a real contribution to solving a problem that has long been neglected.

This is a Budget that invests in our NHS, in education, and in families and working people. If the Opposition choose to oppose it, they need to be honest with their constituents and the British people about what that means. Opposing the Budget means less money for our NHS, less money for our struggling SEND system, and no additional support for the kinship carers who have felt invisible for too long. The Government have chosen to fix the foundations—

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. I call Dr Peter Prinsley.