Tobacco and Vapes Bill

Rosie Winterton Excerpts

2nd reading
Tuesday 16th April 2024 Commons Chamber

[Daisy Cooper]

Colleagues across the House have genuine concerns about that point. I know from engagements in my constituency that a number of retailers already suffer attacks when challenging people wishing to buy other age-related products, so I hope the Government will offer reassurances about what they intend to do to tackle that.

As I have said, I will be supporting the measures in this Bill, but coming to that decision was a bit of a journey for me. My first reaction on hearing of the Bill before it was published was indignation, because the measures are just a drop in the ocean in terms of what is needed to tackle cancer. One in two of us will get cancer at some point, yet the Government have missed their targets to provide fast cancer treatment every year since 2015 and have dropped their 10-year cancer plan. What we need is research in rare cancers, outdated cancer scanners updated, cancer nurses and efforts to tackle waiting times. It would perhaps have been better if the measures in this Bill had been a single clause in a much broader Bill. To be honest, I am frustrated that so much energy is going into this Bill, which could be described as low-hanging fruit, rather than into producing a much more ambitious plan to tackle cancer more broadly. We need to see more ambition in this area.

My second reaction was the raising of my liberal hackles. Liberals are not libertarians; we do not object to all bans. Liberals support bans as a last resort, but not as a first lever. The situation here is frustrating, however: it is a bit rich that the Government are bringing this Bill forward when they have simultaneously been slashing public health budgets, including for smoking cessation programmes, since 2015. Even with the new money the Government have put into smoking cessation programmes, the funds still fall far short of 2015 levels. We also know that smoking rates among young people have dropped very quickly; they are now down to 1% and continue to drop.

Liberals do sometimes back bans when a particular product or practice causes excessive harm, and that is why I have decided to back this ban. Fundamentally, I asked myself a simple question: is this going to help reduce the overwhelming harm caused by the significantly dangerous and addictive practice of smoking? The answer is yes, it is. We know that smoking is dangerous and highly addictive. We know that smoking is the UK’s biggest preventable killer, causing around one in four cancer deaths, including 64,000 in England alone. We know that 75,000 GP appointments each month are taken up by smoking-related illness. We know that smoking costs the economy £17 billion a year through smoking-related lost earnings, unemployment and early death. We know that it comes at enormous cost to our NHS, and we know that smoking rates in pregnancy vary hugely, with as many as 20% of pregnant women smoking in some parts of the country, increasing the chance of stillbirth by almost 50%. That is an incredibly stark health inequality.

Some people have suggested it could be contradictory for a liberal to support a ban on tobacco for 15-year-olds and younger while wanting to legalise cannabis, but let me say to them that they are wrong. It is entirely consistent for a liberal to want to make harmful products illegal—harmful products such as nicotine in cigarettes, skunk and products with high THC levels that can cause psychosis—while simultaneously wanting to have a legal regulated market for less harmful products such as vapes for nicotine and cannabis products with low and regulated THC levels.

In conclusion, do I think this measure is the first or best thing that the Government should be doing to tackle cancer? No. Do I think this measure is particularly ambitious? No. But do I think it is a useful step that will help us to tackle the dangerous health impacts of smoking addiction, to improve population health and to take pressure off the NHS? Personally, I do.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I remind colleagues to stick to the guidance of seven minutes, because otherwise I will have to impose a time limit, and it might not be seven minutes, which would be annoying for everybody.

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[Several hon. Members rose—]

[Madam Deputy Speaker (Dame Rosie Winterton)]

I remind colleagues that if they go quite a long way over the guidance, it does mean that others will have less time to speak. The guidance was seven minutes.

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[Several hon. Members rose—]

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. I have nothing against interventions, but I suggest that if colleagues take interventions, they should still stick to the guidelines.

Cass Review

Rosie Winterton Excerpts

Monday 15th April 2024 Commons Chamber

[The Secretary of State for Health and Social Care (Victoria Atkins)]

With your permission, Madam Deputy Speaker, I would like to make a statement on the Cass review of gender identity services for children and young people. May I say how pleased I am that we are joined by parents of children who have been affected by some of the issues raised in this review? I hope all of us will bear the sensitivities of this debate in mind as we discuss it this afternoon.

This review strikes hard and sure at an area of public policy where fashionable cultural values have overtaken evidence, safety and biological reality. This must now stop. As recently as 2009, the NHS’s sole gender identity development service at the Tavistock and Portman NHS Foundation Trust received fewer than 60 referrals for children and young people, and just 15 for adolescent girls. Since then, demand has surged. By 2016, over 1,700 children and young people a year were referred—a 34-fold increase. More than half were teenage girls. In 2022, more than 5,000 children and young people were referred to gender identity clinics, and almost three quarters were female.

This exponential increase in demand is not a coincidence; it has been driven by a number of factors which I will come to later, but at its heart it was driven by a myth. This myth was that for children and young people grappling with adolescence who were questioning their identity, their sexuality or their path in life, the answer to their questions was inevitably to change gender to solve their feelings of unease, discomfort or distress.

That near-uniform prescription was imposed on children and young people with complex needs without full and thoughtful consideration of their wider needs, including, as is set out in the report, conditions such as neurodiversity, experiences such as childhood trauma or mental health conditions, or indeed discovering who it is that they may one day fall in love with. Indeed, the response from some of the people who should have protected them—some of the clinicians in charge of their care at the Tavistock clinic—was almost always to put them on an irreversible path: blocking puberty, then prescribing cross-sex hormones, and on to surgery as an adult. In other words, such professionals were not asking the right questions of themselves or of their patients.

That is why in 2020, with the support of my predecessors, my right hon. Friends the Members for West Suffolk (Matt Hancock) and for Bromsgrove (Sir Sajid Javid), NHS England commissioned Dr Hilary Cass to examine the state of services for children questioning their gender. I would like to start by thanking Dr Cass and her team for undertaking a considered, comprehensive and courageous review into an extremely contentious area of healthcare. Since NHS England commissioned the review in 2020, they have meticulously unpicked what went wrong, what the evidence really shows and how to design a fundamentally different service that better serves the needs of children.

I must also thank those who raised the alarm and contributed to the review over the last four years: the clinicians who spoke up against their peers to blow the whistle about what was happening at the Tavistock clinic, even though it risked their careers; the journalists, academics and activists who listened to their stories and investigated further, even when they were derided as bigots and transphobes; the parents who were just trying their best to support their children, but were so badly let down by a service that vilified them for questioning whether the interventions offered were right for their children; and, of course, the young people themselves who have shared their experiences, including those who have gone through the pain of de-transitioning only to find out that the so-called “reversible” treatments they were offered are not in fact reversible.

The Cass review makes for sober reading. It is extremely thorough, so I will not attempt to cover all its recommendations today, but I genuinely encourage all Members to read the report in full. It should concern every single Member of this House that part of our public space—the NHS—was overtaken by a culture of secrecy and ideology that was allowed to trump evidence and safety. We say enough is enough; our young people deserve better, and we must do whatever it takes to protect them.

Since the publication of Dr Cass’s interim report in 2022, a series of important changes have been made, and I put on record my thanks to NHS England’s chief executive, Amanda Pritchard, and all those at NHS England who have worked hard with Dr Cass to implement them. On 31 March, the Tavistock clinic finally closed, having stopped seeing new patients a year earlier. Two new regional hubs have been opened, in partnership with the country’s most prestigious children’s hospitals, to ensure that children are supported by specialist, multidisciplinary teams. Indeed, another hub will follow in Bristol later this year.

In the past few weeks, NHS England made the landmark decision to end the routine prescription to children of puberty blockers for gender dysphoria. On the day of publication of Dr Cass’s final report, it announced that it is stopping children under 18 from being seen by adult gender services with immediate effect, and an urgent review on clinical policy for cross-sex hormones will now follow without delay. I also welcome NHS England’s plans to bring forward its full review of adult services, including Dr Cass’s recommendation for a follow-through service for young people up to the age of 25.

I also share Dr Cass’s concerns that clinicians who subscribe to gender ideology will try to use private providers to get around the rules. Let me give a very clear warning: prescribing is a highly regulated activity, and the Care Quality Commission has not licensed any gender clinic to prescribe hormone blockers or cross-sex hormones to people under the age of 16. Any clinic that does may be committing extremely serious regulatory offences for which its licence can be revoked and its clinicians can be struck off. My officials have been in contact with the CQC following the final report to ask that it looks again at the age thresholds in its licensing conditions.

The CQC has also reassured us that it will incorporate Dr Cass’s recommendations into their safe care and treatment standards for all care providers. That means that all new providers will be asked if their practices respect the Cass review, and all existing providers have to meet the same rigorous standards when they are reviewed by the CQC. My officials met the General Medical Council over the weekend, and will do so again in the coming days, to understand how it will ensure that every clinician on its register follows its code of practice and implements the wider findings of the Cass review.

It is morally and medically reprehensible that some online providers not registered in the UK have stated their intention to continue to issue prescriptions to children in this country. I am looking closely at what can be done to curtail any loopholes in prescribing practices, including legislative options. Nothing is off the table, and I will update the House in due course as we progress that work at pace.

Dr Cass also found that there was a lack of robust data on what happened to the 9,000 children who were treated by gender identity services between 2009 and 2020. Many went on to continue their treatment at adult clinics, and the University of York had been due to research the long-term consequences of treatment they received as children, so that we can properly support them through their journey into adulthood. It was expected to provide important insights into the clinic’s work, including how many patients de-transitioned and how many were also diagnosed with a mental health condition or an autism spectrum disorder.

This Government took the unprecedented step of changing the law to make it possible for adult gender clinics to share medical data with the university. All bar one of the adult gender clinics refused to co-operate with this vital research. To quote Dr Cass, that is “unacceptable”, but I would go even further: I think it is deplorable and a dereliction of their professional duty. I am pleased to update the House that following the publication of Dr Cass’s report, I have been informed that all seven clinical leads for the adult gender services now intend to fully participate in this important work.

Dr Cass also concludes that a cultural shift alone “does not adequately explain” the huge growth in young women being referred to gender services. She paints an alarming picture of digitally engaged young women who are frequently exposed to pornography involving violent, coercive, degrading and pain-inducing acts. Is it any wonder than more and more of them are looking for ways to opt out of becoming women? That is deeply troubling and, as Dr Cass makes clear, we have a duty to support those young women with considered, evidence-based care.

Our children deserve healthcare that is compassionate, caring and careful. Their safety and wellbeing must come above any other concern, and anyone who threatens it must be held to account. I will work with NHS England to root out the ideology that has caused so much unnecessary harm, to support those who have already received life-altering treatment, to give the next generation access to holistic care, and to protect our children’s futures. Anything less would be neglecting our duty to the next generation. That will not happen under this Government, and it will not happen under my watch.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I call the shadow Secretary of State.

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[Victoria Atkins]

I thank my hon. Friend, who in her parliamentary career has done so much to shine a light on this sort of behaviour. She has espoused worries, both publicly and privately, about the children and young people at the heart of this matter. Looking to the future, the Tavistock clinic has shut. As I said, it stopped admitting patients a year ago. The new services that are already in place—the two new hubs, with plans to expand further across the country—are about ensuring a multidisciplinary approach to young people, so that, with exactly the experiences Dr Cass sets outs so starkly in her report, children are treated as human beings and patients, not as siloed conditions. One of the main problems that emerged with the Tavistock behaviour and the way it took place is that gender questioning was siloed in a way that no other health or mental health condition was. We want to move back to a place where clinicians are no longer scared of looking after children and young people with these issues, and that they see it as part of their general practice and general work. That is how we are best going to address the very complex needs of many of these children and young people.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I call the SNP spokesperson.

[Kirsten Oswald (East Renfrewshire) (SNP)]

I am grateful for advance sight of the statement.

Nobody’s identity should be up for debate, and nor should it be used as a political football. Dr Cass said in her report:

“Polarisation and stifling of debate do nothing to help the young people caught in the middle of a stormy social discourse, and in the long run will also hamper the research that is essential to finding the best way of supporting them to thrive.”

That polarisation is the last thing needed by young people in accessing care, their families and the NHS staff working hard to care for them. Does the Secretary of State agree that we must all remain respectful at all times when discussing these important issues, and that decisions on this and any other type of treatment should rightly be made by clinicians, not politicians?

Dr Cass explicitly makes the point that her report is not about questioning trans identities or rolling back access to healthcare for young trans people. Indeed, supporting and improving the gender identity healthcare system for all, including children and young people, is what we should be focused on. So can the Secretary of State confirm today whether any additional funding will be made available to ensure that young trans people can access the quality healthcare they need and deserve?

Finally, on conversion practices, the Government Equalities Office said last month in an answer to a written question:

“The Government expects to deliver a draft Bill that takes account of the independent Cass review”.

Can the Secretary of State provide an update on what conversations she has had with Cabinet colleagues on how the Cass review will influence the UK Government’s legislative proposals on banning conversion practices, and when can we expect them to be published?

[Victoria Atkins]

I encourage both the Scottish National party in Scotland and Labour in Wales—health is devolved in those countries, of course—to respond as quickly as possible to the findings of the review. The hon. Lady asks whether it is Barnett-ised. For these purposes, our work to ensure that the clinics meet the needs of our population in England is not additional money. We are re-prioritising within NHS budgets to ensure that the services are spread across the country. I encourage the Scottish nationalists to prioritise the needs of their children and young people in the same way.

I would also gently make the point that, when it comes to the atmosphere of this debate, I do not believe it has been helped by the SNP’s highly controversial Hate Crime and Public Order (Scotland) Act 2021. I note, for example, the behaviour and engagement on Twitter of very high-profile people in Scotland, and the impact that it has had when people have dared to name activists in this arena. I would also ask the Scottish Labour party to explain why it helped the SNP to pass that Act, because to me this seems to be all about the atmosphere.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I call the Chair of the Women and Equalities Committee.

[Caroline Nokes (Romsey and Southampton North) (Con)]

Dr Cass’s observations about violent and degrading pornography are chilling, and we know of the impact that is having not just on young girls but on all our young people. Her recommendations also include significant and specific references to expanded services and follow-through services for 17 to 25-year-olds. What concerns has my right hon. Friend about the capacity for that, and about the possible impact on other areas of healthcare?

We know that the transition from children’s services to adult services can be problematic in the case of a wide range of services, not least for those suffering from body dysmorphia or eating disorders. Might there be any crossover, with young people having access to some sort of interim service before the age of 25, and will more funds be committed so that we do not continue to see what all of us will face in our constituencies: the horror of young people being unable to access child and adolescent mental health services before they turn 18 and become reliant on adult mental health care?

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[Several hon. Members rose—]

[Madam Deputy Speaker]

Order. I am anxious to ensure that everyone gets in, because this is an important statement, but we also need to ensure that the questions are brief so that the Secretary of State can give brief responses. We have a big debate ahead of us on the Safety of Rwanda (Asylum and Immigration) Bill, followed by another debate on the hospice movement, and I am sure that many Members will want to participate in those as well. Perhaps they will bear that in mind when framing their questions.

[Rosie Duffield (Canterbury) (Lab)]

Let me first thank the Secretary of State for her thoughtful and considered statement on the Cass review, and especially for mentioning the journalists, such as my friend Hannah Barnes, who blew the whistle on the Tavistock clinic. As she has said, those who have raised this issue over the last few years, desperately concerned about the safeguarding of vulnerable children and young people—too young to make life-changing decisions—are owed a heartfelt apology for being no-platformed, ghosted, sidelined and disciplined at the behest of a few extreme groups of activists, some within political parties. Does she agree that these academics, politicians, writers, psychologists and actors, along with any other people who have questioned the signing up of their workplaces to Stonewall law, have now been vindicated by Dr Cass’s expert review, and that they should be apologised to?

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[Sir William Cash (Stone) (Con)]

Although I would like to believe that many of these problems will be resolved by guidance and by changing the administrative rules, and things of that kind, I fear that the real problem is much deeper. It is about the manner in which, over the last generation, we have introduced legislation that has facilitated these arrangements. I am glad that the Government have passed the Online Safety Act 2023 to deal with the platforms on which a lot of this stuff has been spuriously put out by people with absolutely no moral compass.

I thank the Secretary of State for what she has said this afternoon, and for the robust and extremely effective manner in which she has said it, but please do not believe that this will be resolved just by changes to administrative rules. This is about a moral compass and telling the truth. The legislation, whether it is the Equality Act 2010, human rights law or whatever else it might be, will need to be changed.

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. I want to get everyone in, but we really cannot have mini-speeches. We need questions that the Secretary of State can answer briefly.

[Victoria Atkins]

The brevity of my answer demonstrates my respect for the observations and experience of my hon. Friend the Member for Stone (Sir William Cash). I completely agree with him, and I will enjoy working with him on this.

NHS Dentistry

Rosie Winterton Excerpts

Tuesday 9th January 2024 Commons Chamber

[Debbie Abrahams]

You are the Government, unless you want to call a general election.

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. The hon. Lady knows that she must not refer directly to other Members.

[Victoria Atkins]

I think the hon. Member for Oldham East and Saddleworth (Debbie Abrahams) was raising her voice at me, but it was not me who heckled her. I recognise the passion she brings to her intervention, and I simply made the point that this is an Opposition day debate. The hon. Member for Ilford North understandably set out some of his plans, which is his job, and I was merely questioning him on the detail of those plans. Sadly, he was not able to provide that detail.

The long-term workforce plan is about not just training more staff but delivering value for hard-working taxpayers. Currently, around a third of dentists do not carry out any NHS work. This simply is not fair on the taxpayers who fund their training, which is why, through the long-term workforce plan, we are exploring the introduction of a tie-in period that encourages dentists, after they graduate, to spend a minimum proportion of their time delivering NHS care. We have also made it easier for experienced dentists from around the world to come to the UK to ply their trade, which is apparently something with which Labour Members do not agree.

Last year, we brought forward legislation to give the General Dental Council greater flexibility in administering the overseas registration exam. The Government welcome its decision to triple the capacity of the next three sittings of part one of the ORE, from August last year, and to increase the number of sittings of the second part of the exam from three to four, creating an additional 1,300 places. Ministers will continue to meet the GDC to discuss how we can make these flexibilities as effective as possible, to get more dentists into the NHS workforce delivering care for patients.

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[Several hon. Members rose—]

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. As colleagues will see, this is a very well-subscribed debate, so I am going to impose an immediate time limit of six minutes, which I hope will allow everybody to have roughly the same amount of time. I have been able to tell the first two speakers that I am doing that.

[Gill Furniss (Sheffield, Brightside and Hillsborough) (Lab)]

The crisis in NHS dentistry is plain to see and it is affecting so many of my constituents. I am therefore grateful for this opportunity to shed light on this emergency and to support Labour's plan to rebuild our broken dentistry. People are finding it impossible to find an NHS dentist for themselves and their children, which is leading to serious consequences for public health. It is also exacerbating health inequalities, and creating a divide between those who can afford private dentistry and those who cannot. The proportion of children with dental decay in the most deprived areas is more than two and a half times greater than it is in the least deprived areas, and the gap is widening. That has led to a public health crisis: 169 children each day are undergoing tooth extraction; rotting teeth is, shockingly, the No. 1 cause of hospital admissions among six to 10-year-olds; and one in 10 people have even attempted their own do-it-yourself dentistry, which just does damage and puts even more pressure on the NHS. That reads like a Charles Dickens novel, but it is the harsh reality of 14 years of Conservative government. Nowhere is that more apparent than in my constituency, where not one of the seven dental surgeries that recently provided an update was accepting new adult patients and only one was accepting new child patients.

Although those figures are appalling, they are not surprising. I am regularly contacted by constituents who cannot find an NHS dentist and cannot afford to go private. They ask me, “What am I supposed to do?”. Without radical reform, there is no answer I can give them. We often talk about crumbling dental services, but in my constituency they have already crumbled; the services simply are not there for the people who need them most. One constituent has contacted more than 25 dentists in Sheffield, with each telling her the same thing: they are not accepting new NHS patients at this time. The best she has been offered is to be put on a waiting list, which could last years. She cannot afford to go private, so she and her young child are stuck without any access to a dentist. We have also seen the provision of community dental services grind to a halt. Those services are a vital safety net, providing specialised treatment when other dentists cannot accommodate the needs of disabled people and people with long-term health conditions. That safety net is no longer there for all too many people. Research shows that, nationally, more than 12,000 children were on a waiting list for community dental services at the start of 2023, and they could face waits of up to 80 weeks for tooth extractions. Healthwatch has heard from many people and their carers who cannot access community dentistry, leaving them without treatment.

The basic provision of NHS dentistry has been worn away on this Government’s watch. The warning signs of this crisis have been stark for years, but Ministers have continued to bury their heads in the sand. Funding has been cut in real terms, meaning that dentists are leaving the NHS in droves and areas such as mine have become dental deserts. It is clear that this Government are not willing to provide the radical changes needed to bring NHS dentistry back from the brink. In April last year, Ministers promised a new dental recovery plan; but we are still waiting for it to see the light of day. I urge the Minister to tell us when that will happen and not just say “soon”. Labour has formulated a fully costed plan that will get NHS dentistry back up and running. The best treatment is prevention, which is why Labour will introduce a targeted, supervised toothbrushing scheme for three to five-year-olds, encouraging lifelong good dental hygiene. Labour will also provide an extra 700,000 urgent appointments per year to help the most vulnerable access the services they need and introduce an incentive scheme to bring more dentists to dental deserts. I am proud to say that all of that will be paid for by abolishing the non-dom tax status. Those tangible steps will bring NHS dentistry back to constituencies such as mine, where services have disappeared. Where this Government have failed, Labour will step in and help all our constituents to access the NHS dentistry they need. I will be proud to support Labour’s plan in today's vote, and I urge all colleagues, including Conservative Members, to vote with us.

[Madam Deputy Speaker]

I call the Chair of the Select Committee on Health and Social Care.

Building an NHS Fit for the Future

Rosie Winterton Excerpts

Monday 13th November 2023 Commons Chamber

[Several hon. Members rose—]

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. I was merely glancing at the hon. Member for Southend West (Anna Firth) because I believe that the previous occupant of the Chair encouraged Members to speak for about eight or nine minutes so that we can get everyone in equitably.

[Ian Lavery (Wansbeck) (Lab)]

The issues that we have all been discussing today, and will discuss further, are extremely important, but looking at what is happening globally, they appear extremely trivial. The unbearable terror, suffering and death of innocent civilians in the middle east, in Gaza and Israel, must stop, which is why I have added my name to the call for an immediate ceasefire.

This country is in crisis. Our public services are collapsing, a climate change crisis is upon us, and working-class people are suffering a horrendous cost of living crisis that is draining them of the resources that they and their families need just to lead basic, decent lives. In my constituency of Wansbeck, ordinary families are bearing the brunt of this Government’s utter failure. Child poverty is surging, mutual aid groups and food banks are stretched to the limit, and businesses are suffering because of the lack of available finances. A Government with even an iota of human decency would have presented to the House a legislative plan for the next year that could address those grave crises, but instead they have delivered an agenda that will do absolutely nothing to alleviate the strain that these problems are causing our people. In fact, they are happy to draft statutes to make the crises even worse.

The people I proudly represent in south-east Northumberland know what it is like to be forgotten, to be neglected, and to be offered nothing by this Government. They also know that it is Tory Governments who have caused many of the problems that they face—not just those caused by the past 13 years of disastrous Tory rule, but the legacies of previous Tory Governments as well. It is the Tories who, over the years, have not only destroyed the industrial base that we have needed to produce well-paid jobs, but passed and continue to pass anti-trade union legislation that will deprive working-class people in my area and all over the UK of the means to obtain the decent wages that they deserve.

We are living with the legacy of the anti-trade union laws that began with the Thatcher regime. That legacy is a low-wage economy in which even workers in what should be very well-paid jobs struggle to make ends meet. Those laws have made it harder for unions to organise themselves in workplaces, and have created rules for industrial action that are some of the most restrictive in the world. The legal obstacles to organising a successful strike ballot are immense, and have given the employers an unfair advantage in disputes in which trade union members have rightly asked for a fair wage. It is not surprising that many workers now face falling living standards, and the stressful day-to-day torment of trying to make ends meet.

Where in the King’s Speech was the much-promised employment Bill to protect people in employment? Where was the abolition of zero-hours contracts, and the abolition of fire and rehire in the workplace? The last 13 years have seen wages across many sectors decline in real terms, forcing many of our fellow citizens to take strike action. They have been determined enough to fight these injustices that they have overcome the treacherous anti-strike laws designed to thwart them. The Government have antagonised workers up and down the country, including many who were classified as key workers, who drove the country through the worst pandemic and some of the darkest times in history. Strikes and industrial action continue at the likes of the bus company Go North East, and balloting is taking place even at Oxfam—an organisation that prides itself on looking after the deprived and the poor—which has amassed a fortune, but still not enough to pay the workforce properly. There are pockets of strike action in the civil service and elsewhere in the public sector. I ask again, where is the employment rights Bill that the Government have promised for so long? In the private sector, individuals have seen their wages decline at the same time as company directors and CEOs have seen their remuneration packages grow grotesquely. In the public sector, many of those we value so highly and who showed their dedication to serving us so courageously during the covid pandemic have been forced to take action not only to seek to restore their own wages but to try and redress the crippling staff shortages caused by Tory neglect.

In the NHS, staff shortages have been created by a long-term Tory public sector wage squeeze, which has also made staff retention and recruitment extremely difficult. That has been a major factor in the decline of our public services, especially in the NHS. The NHS is held together by the glue that is the dedication, passion and commitment of the staff, and we should all pay tribute to every single one of them. Where in this King’s Speech was there anything to do with the deterioration of our people’s health, caused as a direct result of the wilful Tory neglect of the NHS? For instance, why was there nothing to improve the cancer waiting lists that are endangering so many lives? In my area, the privately operated Rutherford Centre was being used by the NHS for cancer scanning and treatments. In June 2022, the company that owned it went into liquidation and it remains closed to this day. It remains empty and its treatment rooms are silent through Tory indifference. It is locked up and idle, but it could be helping individuals with cancer.

The King’s Speech could have been used to announce full compensation payments to parents and children who have suffered the loss of loved ones as a consequence of the blood contamination scandal. These people have been promised time and time again that full compensation would be paid. It was undoubtedly the worst tragedy in the history of the NHS, and I fear that many more victims of this tragedy will die before the Government agree to pay full compensation as well as interim repayments to some of the individuals. My constituent Sean Cavens was among those victims. They have all suffered and they have been tret terribly. The King’s Speech could have recognised their suffering and that of so many others, but it did not, because the Tories simply do not care.

This issue cannot continue to be kicked into the long grass. Victims are dying on a daily basis, and the recent reshuffle, only hours ago, means that the Minister in charge of the contaminated blood tragedy has now left their post, leaving the victims at a loss over who will take charge of this absolutely desperate situation. I would love the Minister who is summing up to tell the victims of contaminated blood who will be in charge and, as victims of the NHS failing to comply with the regulations all those years ago, tell them when they will receive fair and right compensation.

The Government have announced in the King’s Speech that they intend to use the powers they created under the Strikes (Minimum Service Levels) Act 2023 to lay down minimum service levels during strikes in the health services, transport services and other sectors. That will force many into work against their will and allow them to be sacked if they refuse. It will be done without negotiating with the unions, in the dictatorial manner that we have come to expect from anti-trade-union fanatics. It will be chaotic, undemocratic in the extreme and probably illegal under international labour law. The Government consistently manifest their disdain for democracy, whether by attacking people’s right to strike or through undermining our freedom to protest, yet they have the nerve to say that they are the true guardians of British values.

Let us not forget that this Tory Government recently revealed that their only constant principle was to encourage greed and help those who have the most already. In a country in which we have the disgrace of families having to rely on food banks to live, the Tories think it is more important to remove the restrictions on bankers’ bonuses than to meaningfully address the needs of the poor and the low-paid. That is in sharp contrast to the values shown by the shadow Deputy Prime Minister, who has pledged that within the first 100 days of a Labour Government, the recent anti-strike measures will be repealed and measures will be created to allow trade unions to organise more freely.

There is lots more, Madam Deputy Speaker, but I see many others waiting to speak. I wanted to hear something in the King’s Speech about the gigafactory in my constituency, which was again neglected; it never received a penny from the Government, from the automotive transformation fund, to progress lots of jobs in my area. That did not happen. Why was it not in the King’s Speech? I represent a mining area. Why was there nothing in the King’s Speech on the surplus that the Government are robbing from the mineworkers’ pension scheme, and why was there nothing on the changing regulations on pneumoconiosis and mesothelioma, when people are dying on a regular basis? The Government are dying, and they have nothing to offer but further chaos and despair. The King’s Speech was evidence of this terrible state of affairs, and we need to strip aside the worst Government in living memory.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I emphasise that we need to think of others and try to stick to the advisory guidance.

Under-age Vaping

Rosie Winterton Excerpts

Wednesday 12th July 2023 Commons Chamber

[Kirsten Oswald]

Will the hon. Gentleman give way?

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. I would gently say that the hon. Lady has made a long contribution, and I do have two other speakers to get in. That is the only problem.

[Jerome Mayhew]

Thank you for that indication, Madam Deputy Speaker.

To wrap up my submissions, I will say that the Government are absolutely right to have put out a call for evidence. That evidence has now been obtained, last month, and the Government should take every second that is needed to assess it and come up with draft proposals, but not a second longer, because this is a very important issue. As a parent, I share the concerns that have been expressed across the House. We need to address this issue—we cannot waste time—but we should do so based on the evidence.

--- Later in debate ---

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

Twenty-nine years ago I handed in my dissertation for my degree. It was focused on tobacco advertising, and the very arguments being made today by the industry were being made back then as to why it was so important that advertising should not be prohibited further. That is why today’s debate should be as much about the business model, driven by the industry, as about the harm from these products to children and young people. I congratulate my hon. Friend the Member for Denton and Reddish (Andrew Gwynne) on bringing this motion before the House, because the timing is so important. Some 30% of children and young people across Yorkshire have already tried vaping and we know, as we move into that summer period, that more and more children will be socialising outside of school time, and those risks will go up, as will the number of adults we see vaping.

I was honoured to sit on the Health and Social Care Committee as we took evidence from the industry, health professionals and an articulate headteacher talking about their experiences. What I have to say back is that over the past 29 years, we have seen an industry that has become far cannier in how it advertises and markets its products than it was in yesteryear. The situation calls on the Government to step up and be far cannier in being able to expediently put in place the full range of measures that we know will have an impact on the number of young people taking up vaping.

We welcome the reduction in the number of children smoking cigarettes, and we have seen that important shift over the decades. We know the measures that have levered that in—increasing the cost has certainly had an effect, and making smoking less accessible and less attractive has had an impact—but what also needs to be learned is that the very mechanisms put in place around cigarettes need to be applied immediately to vaping, too.

If we look at some of the measures introduced over the past 20 years, we have seen the billboards taken down along with newspaper and magazine advertising, the removal of tobacco from promotions, its removal from sport, its access taken away in shops, the shutters put down, vending machines taken away and these products being put out of use. There were also important public health measures to move away from indoor smoking and, as my hon. Friend the Member for Stockton North (Alex Cunningham) has just said, smoking in cars where there are children. We also had that important intervention on plain packaging, which we know Israel and Finland have already introduced for e-cigarettes. There is therefore no reason for a delay here.

The industry is using every reason it can consider as to why it needs to continue using advertising. I cross-examined the industry at the Select Committee. To summarise some of the exchange, we were discussing why Blackburn Rovers had those products on the shirts of the heroes of that town. The industry was saying, “It’s really important that we distract people from tobacco products on to our products, because that is our public health measure.” I challenged back and said, “Why don’t you have public health messaging on those shirts instead?” Of course, they argued that that would not work, because they wanted to draw in the next generation of people to use their products. That is what the industry has always been about: it is about generating profit for its shareholders. When it did that with tobacco-based products, ultimately its customers died. That was not the best business model it could induce. With vaping, the industry wants to make sure it has a continuous stream of addicts, and we need to understand that business model to introduce the public health measures needed around harm reduction.

If we look at the figures, we see that a YouGov survey showed that of the 3.6 million adults who are vaping, 2 million are ex-smokers who have now returned to using a nicotine-based product, 1.4 million are current smokers and 200,000 have never smoked and are vaping. Another survey showed that of the people who were vaping, only 47% were also smokers, and 53% were not. We can deduce from that that the reach of these measures and the availability of vaping products means they are being used far beyond the purposes that Public Health England intended and that Javed Khan put in his report to reduce people’s use of tobacco-based products. As a result, we are seeing more people drawn into an addictive habit, addicted to nicotine and able to use it more regularly and with far more availability. They are therefore taking on higher quantities of this drug, and we are seeing the consequences of that.

The call for taking all the same measures currently in place for cigarettes is therefore vital. ASH and others recommend putting an excise tax of £5 on the product, and we will need to adjust the cost of cigarettes in line with that to ensure that they remain less attractive. We need to ensure that we have investment in the trading standards workforce to address the illicit trade we see in counterfeit products, with the dangers they cause. On branding, it is very clear that plain packaging is required. We must remove the cartoons, the sweet names, the colours and the flavours that are currently being propagated. We must also ensure that promotion is not possible in any sphere. Ultimately, we need to ensure that these products are used only for harm reduction and take that really important whole approach to public health as opposed to looking at one product or another.

We have got to question why young people are taking up the use of nicotine. Yes, there is peer pressure—of course, we understand that, and that is really important. We heard about how children discuss the different flavours and try them out, using the product more and more as a result. Yes, there is the power of advertising—why else would companies advertise but to attract custom? But why is it that young people need a dependency on a drug? We need to get to the heart of that question through a wider public health approach. I am very disappointed that the Government have pulled away from some of their public health strategies, including the health disparities White Paper and bringing forward a more holistic approach to public health. Ultimately, we have got to protect young people from becoming the addicts of the future. That is the role of this Parliament

[Madam Deputy Speaker (Dame Rosie Winterton)]

I call the shadow Minister.

National Carers Week

Rosie Winterton Excerpts

Thursday 8th June 2023 Commons Chamber

[Dame Caroline Dinenage]

I reiterate my thanks to the Backbench Business Committee for allowing us to have this debate today. I thank both the Minister and the Front-Bench spokesman, the hon. Member for Leicester West (Liz Kendall), for showing that they both understand and care about this issue. I also thank all the Members who have taken part: the hon. Members for Worsley and Eccles South (Barbara Keeley), for North East Fife (Wendy Chamberlain), for Ceredigion (Ben Lake) and for Motherwell and Wishaw (Marion Fellows), the right hon. Member for Hayes and Harlington (John McDonnell), and my hon. Friend the Member for Cities of London and Westminster (Nickie Aiken).

Many Members shared their own personal experiences; I kicked off by talking about mine, when my mum cared for my grandmother who lived with dementia. I think it is only now that I am probably at a similar age to my mum in that caring role that I fully understand what she was going through and the toll that it would have taken on her own wellbeing. I put on record today—because I have never had the opportunity to do so—my thanks to her, and to the 7,000 carers in my constituency of Gosport and the millions across the UK. They deserve our thanks.

In many cases, what those carers do is so invisible. I know that they do not do it for thanks—they do it because they love the people who they care for—but that does not mean that we should take it for granted. It means that we need to recognise them and value them, and to put our money where our mouth is when we do that. It means that we need to provide them with support, funding and respite, and with everything they need to continue doing their role, because it is thankless and hard. I know that they probably would not have it any other way, but that does not mean that it should be done for free. The final thing I will say to the Minister today is that we need a national carers strategy to bring together all that good work, and to demonstrate to carers that we do care.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I know that the young people from Balby Central Primary Academy will have enjoyed the contributions made about carers, particularly young carers.

Question put and agreed to.

Resolved,

That this House has considered National Carers Week and respite for carers.

Mental Health Treatment and Support

Rosie Winterton Excerpts

Wednesday 7th June 2023 Commons Chamber

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

As we have heard today, England is in the midst of a mental health crisis, and that is certainly true in the north-east. I join my hon. Friends the Members for Middlesbrough (Andy McDonald) and for Darlington (Peter Gibson) in calling for an independent inquiry into the Tees, Esk and Wear Valley NHS Trust. The testimonies I have heard have shocked me. I know that I can speak only in broad terms, but they include serious cases of improper care and misdiagnosis, and of putting people on waiting lists despite their feeling suicidal.

The Care Quality Commission reports that we have seen raise concerns about risk assessments, communications and record keeping, and a lack of observation. There have also been concerns raised about the lack of beds for children, as well as poor staffing levels, high staff turnover and a lack of neurodiversity training. Horrifically, young people have even taken their lives while in the care of the trust. We owe it to them, and all those who have been harmed, to investigate what is going on within the trust. Will the Minister commit to an independent, judge-led inquiry into the trust? She can either respond to me now or I can wait for her response in her closing speech. One thing is clear: this cannot go on.

I want to highlight the crisis in children’s mental health. In my region, children spent over 1,000 hours in A&E because they were in a mental health crisis. There are over 30,000 children on waiting lists. Across England, one in six children aged five to 16 are likely to have a mental health issue. Children’s happiness and sense of wellbeing continues to decline. With mental health trusts raising the threshold of how ill under-18s must be, we have seen a quarter of a million children being denied help for their mental health. Poor mental health compounds. Left untreated, it can spiral out of control, as we have heard many times today. No one should be in a mental health crisis, let alone children. The Government must invest in children’s mental health today—no more delays and no more referrals. The Minister must allow children the happiness that they deserve.

[Madam Deputy Speaker (Dame Rosie Winterton)]

Before I call the shadow Minister, I must say that I am very disappointed that seven Opposition Members who spoke in the debate are not back in the Chamber for the wind-ups, as well as about three Government Members. I must emphasise again that it is really important for people to get back to hear what the shadow Minister has to say, as well as the Minister. I hope that message will be conveyed back to those Members who are not here. I will say it again in the hope that they are back by the time the shadow Minister has finished his speech.

--- Later in debate ---

[Andrew Gwynne]

I will not give way. We have heard enough from the right hon. Lady, supporting her “Through the Looking-Glass” amendment which bears no relation to the reality.

As we have heard today, people who require mental health support, no matter where they live—except in the right hon. Lady’s part of England—will be confronted by a system that is buckling under the pressure of 13 years of Tory mismanagement, neglect and incompetence. The right hon. Lady shakes her head, but the figures speak for themselves. Last year, patients suffering with mental health issues waited more than 5.4 million hours in accident and emergency departments. There are 400,000 children currently waiting for mental health treatment, and 1.2 million people are waiting for community mental health care, with some patients being forced to travel more than 300 miles because there are no beds in their local area. My hon. Friend the Member for Hemsworth spoke powerfully about that. The Resolution Foundation has found that, of the 185,000 young people who are unable to work, nearly two thirds cite mental ill health as the reason. Suicide is now the leading cause of death in adults under 34, with about 18 people losing their lives every single day. As the cost of living crisis has worsened, we have also seen a knock-on effect on addiction and rehabilitation. Drug-related deaths are at a record high, and last year there were 9,641 deaths in the UK from alcohol misuse, a 27% increase on the year before.

Make no mistake: the emergency in mental health has become a public health crisis, and we need to see action. Our motion calls on the Government to adopt Labour’s plan to recruit 8,500 mental health staff to expand access to treatment, to provide specialist mental health support in every school, and to establish open-access mental health hubs for children and young people. That would be paid for by the closing of tax loopholes, because politics is about priorities, and Labour’s priority is to ensure that those who need mental health support have access to it in all parts of the country. Our priority is to build a Britain where patients start receiving appropriate treatment within a month of referral. I hope that those on the Government Benches will demonstrate that they share these priorities by voting for Labour’s motion today.

Staffing is just one part of the equation. Like any public health issue, addressing mental health requires a holistic approach that recognises its complex nature. That is why Labour has committed to a whole-Government plan to improve outcomes for people with mental health needs and to address the social determinants that drive mental ill health for many people. Our mental health can be influenced by a multitude of different things. Secure jobs, fair pay and good housing are all building blocks for a healthy life, physically and mentally, and unless we improve people’s lives in the round, positive change will remain out of reach.

It is for this reason that the next Labour Government will focus as much on prevention as we do on treatment. We will pioneer a transformative cross-departmental agenda with a mission delivery board at the heart of the Government ensuring that all Departments work to improve the wider determinants of health. We will boost capacity in mental and public health teams so that people can get the support they need before presenting at A&E or turning to substance abuse. We will also encourage the integrated care systems to identify opportunities to join up services within the community. Our aim will be for more patients to have one point of contact for appointments with a range of professionals and services. This neighbourhood team will include the family doctor, carers, health visitors, social prescribers and mental health specialists.

Our vision is to turn the national health service into a neighbourhood health service with the patient right at the heart of it. The benefits of this kind of work will travel far beyond improving the lives of individuals suffering from mental ill health. For instance, in my own region of the north-west of England there were over 140,000 calls to 999 from people in a mental health crisis last year, and in my own constituency local people spent over 6,500 hours waiting in A&E for mental health treatment. If we were to help people before they reached these crisis points, we would drastically reduce pressure on the wider health system and thereby improve patient outcomes right across the board.

The same is true of wider economic productivity. As we have heard in the debate, the Mental Health Foundation and the London School of Economics have estimated that poor mental health costs the British economy £117 billion a year. That is a phenomenal amount of money and a huge loss to our country’s economic power. Improving mental health outcomes is therefore not just a moral imperative—although it is certainly that—but a practical one, and one that is essential if we want the United Kingdom to prosper, as I hope and believe we all do. That is what we come to this House for. We want to leave our country in a better shape for our children than it has been for ourselves.

That brings me again to the motion. All Members of the House have the opportunity today to support a fully funded plan to improve mental health treatment. Those on the Government Benches can choose to put party politics first, but that will not change the fact that this Government have failed people on mental health. No matter what amendments they put before us, that does not change people’s real, lived experiences or the experiences of Members on both sides of the House who deal with the impact of mental ill health in their constituency casework. The system is crumbling and more of the same will just not cut it, so I am enormously proud to be supporting Labour’s motion today and I would strongly urge Members on both sides of the House to back it. It is time to give those suffering from mental ill health the treatment and support they deserve, and I commend our motion to the House.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I reiterate for those who were not here that it is incredibly important that people get back in good time to hear the Opposition wind-up as well as the Government wind-up—that includes Ministers. I would expect anybody who was not here at the beginning of the Opposition wind-up, some of whom are still not here, to write to Mr Speaker to apologise. I take it that people will do that.

--- Later in debate ---

[Yvette Cooper (Normanton, Pontefract and Castleford) (Lab)]

On a point of order, Madam Deputy Speaker, on Monday, the Home Secretary gave inaccurate information to Parliament when she said that

“the asylum initial decision backlog is down by 17,000”.—[Official Report, 5 June 2023; Vol. 733, c. 557.]

The asylum initial decision backlog is clearly defined by the Home Office. It is the total backlog of initial decisions before and after June of last year, and Home Office figures show that it has gone up from 132,000 to 137,000 for main applicants since the beginning of December. It has gone up from 160,000 to 172,000 for all applicants in the first quarter of this year. On either measure, that backlog is up, and not down.

I raised this matter as a point of order on Monday, and the Home Secretary refused to correct the record then. I have written to the Home Secretary this morning, but have still heard nothing back. The ministerial code requires

“that Ministers give accurate and truthful information to Parliament, correcting any inadvertent error at the earliest opportunity.”

I know that the Home Secretary has a history of breaching the ministerial code but, Madam Deputy Speaker, would you agree that facts matter and that it is not acceptable for Ministers to fail to correct the record if they have given inaccurate information to Parliament? Have you heard from the Home Secretary about her intention to come and correct the record?

[Madam Deputy Speaker (Dame Rosie Winterton)]

I thank the right hon. Lady for her point of order. As has been said before, and I think this was said when she raised the point of order yesterday, it is obviously not for the Chair to adjudicate in cases of differing interpretations of statistics. That said, if a Minister has made a mistake in the House, I would of course expect them to correct it. The right hon. Lady has put her perspective on the record. Ministers will have heard it, and I am sure the Home Secretary will reflect on whether a correction is required in this case. I see that the Whip, the hon. Member for Beaconsfield (Joy Morrissey), is writing this down and it will be fed back, and I am sure Ministers will do the same. I thank the right hon. Lady, and I think we will leave it at that.

Recovering Access to Primary Care

Rosie Winterton Excerpts

Tuesday 9th May 2023 Commons Chamber

[The Secretary of State for Health and Social Care (Steve Barclay)]

With permission, I would like to make a statement on the primary care recovery plan. For most of us, general practice is our front door to the NHS. In the last six months, over half the UK population has used GP services, and GPs in England carry out around 1 million appointments every single day. They are doing more than ever. General practice is delivering 10% more appointments a month than before the pandemic—the equivalent of the average GP surgery seeing about 20 additional patients every working day. There are more staff than ever, with numbers up by a quarter since 2019, and we are on track to deliver our manifesto target, with an additional 25,000 staff already recruited into primary care. We are investing more than ever, too, with the most recent figures showing that funding was around a fifth higher than five years before, even once inflation is taken into account.

But we know that there is a great deal still to do. Covid-19 presented many challenges across the health service, leaving us with large numbers of people on NHS waiting lists, which need to be tackled. In general practice, patient contacts with GPs have increased between 20% and 40% since before the pandemic. As well as recovering from the pandemic, we face longer-term challenges, too. Since 2010, the number of people in England aged 70 and above has increased by a third, and this group attends five times more GP appointments than young people. Not only that, but advances in technology and treatments mean that people understandably expect more from primary care systems.

Today I can announce our primary care recovery plan, and I pay tribute to the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien), for his work on this plan. I have deposited copies of the plan in the Libraries of both Houses. Our plan will enable us to better recover from the pandemic, to cut NHS waiting lists and to make the most of the opportunities ahead by focusing on three key areas: first, tackling the 8 am rush by giving GPs new digital tools; secondly, freeing up GP appointments by funding pharmacists to do more, with a “pharmacy first” approach; and thirdly, providing more GPs’ staff and more appointments. NHS England and my Department have committed to make over £1.2 billion of funding available to support the plan, in addition to the significant real-terms increases in spending on general practice in recent years. Taken together, our plan will make it easier for people to get the help they need.

The plan builds on lots of other important work. Last year, we launched the elective recovery plan, which is making big strides to reduce the backlog brought by covid-19. We eliminated nearly all waits over two years by last July, and 18-month waits have now decreased by over 90% since their peak in September 2021. By contrast, in the NHS in Labour-run Wales, people are twice as likely to be waiting for treatment than in England. They still have over 41,000 people waiting over two years and nearly 80,000 waiting over 18 months. In addition, this January, I came before the House to launch our urgent and emergency care plan, which is focused on how to better manage pressures in emergency departments, with funding to support discharge to improve patient flow in hospitals. Today’s plan is the next important piece of work.

Turning to the detail of the plan, our first aim is to tackle the 8 am rush. We will do that by providing GPs with new and better technology, moving us from an analogue approach to ways of working in the digital age. An average-sized GP practice will get around 100 calls in the first hour of a Monday morning. No team of receptionists, no matter how hard-working, can handle such demand. About half of GPs are still on old analogue phones, meaning that when things get busy, people get engaged tones. We are changing that by investing in modern phone systems for all GPs, including features such as call-back options, and by improving the digital front door for even more patients. In the GP practices that have already adopted those systems, there has been a 30% improvement in patient feedback on their ability to access the appointments they need. That also reflects the fact that online requests can help find the right person within the practice, such as being directed to a pharmacist for a medicine prescription review or to a physio for back pain.

In doing that, we will make the most of the 25,000 more staff we now have in primary care. Today’s plans fund practices without this technology to adopt it, while also providing them with staff cover to help them manage a smooth transition to the technology. Indeed, many small GP practices in particular find it hardest to fund new technology, or to manage the disruption that comes with transitioning to new ways of working, so we are funding locum cover alongside the tech itself. Notwithstanding that, people will always be able to walk in or ring if they prefer; if someone wants to ring up and see someone face to face, these investments will make that easier, too.

We also want to make sure that patients know on the same day that they make contact how their request is going to be handled. Clinically urgent issues will be assessed on the same day, or the next day if raised in the afternoon. If the issue is not urgent, an appointment will be scheduled within two weeks, but crucially, people will not be asked to call back the following day. Instead, they will get their appointment booked on the same day or be signposted to other services.

The second area of the plan is Pharmacy First. As well as giving GPs new technology, I know that we need to take pressure off GPs where possible by making better use of the skills of all clinicians working in primary care. We saw the incredible role that pharmacists played during the pandemic—their capacity to innovate and deliver for the communities that they served, freeing up GP appointments in doing so—so the second part of our plan is to introduce a new NHS service, Pharmacy First, on which we are already consulting with the Pharmaceutical Services Negotiating Committee.

Some 80% of people live within a 20-minute walk of a pharmacy, so making it easier for pharmacists to take referrals can have a huge impact. Referrals might be from GPs, NHS 111 or, from next week, urgent and emergency care settings. Community pharmacies already take referrals for a range of minor conditions, such as diarrhoea, vomiting and conjunctivitis, but with our Pharmacy First approach we can go further still. We will invest up to £645 million over the next two years so that pharmacists can supply prescription-only medicines for common conditions, such as ear pain, urinary tract infections and sore throats, without requiring a prescription from a GP.

One of the most significant shifts we are making is on oral contraception. Pharmacists can already manage the supply of contraception prescribed elsewhere; from later this year, they will also be able to start women on courses of oral contraception. This is another way in which, in light of our women’s health strategy, we aim to reduce the barriers to women accessing contraception. Pharmacists will also be able to do more blood pressure checks, which is one of the most important risk factors for cardiovascular disease. Not only will those kinds of steps make it easier for people to get the care they need, we expect them to release up to 10 million appointments a year by 2024-25.

The third part of our plan is about providing more staff and more appointments. We are making huge investments in our primary care workforce, and are on track to meet the manifesto commitment of 26,000 more primary care staff by next March, meaning that we have more pharmacists, physios and paramedics delivering appointments in primary care than ever before. In 2021, we hit our target of 4,000 people accepting GP training places, and our upcoming NHS workforce plan will set out how we will further expand GP training. We are also helping to retain senior GPs by reforming pension rules, lifting 9,000 GPs out of annual tax changes. These are the pension reforms that the British Medical Association welcomed, describing them as “significant” and “decisive” changes and citing them as “transformative for the NHS”.

As well as freeing up more staff time, our plan cuts bureaucracy, too, so that GPs spend less time on paperwork and more time caring for patients. We will remove unnecessary targets, improve communication between GPs and hospitals, and reduce the amount of non-GP work that GPs are being asked to do. For example, patients are often discharged from hospital without fit notes, meaning that they then have to go to their GP to get one. By the end of this year, NHS secondary care services, which understand those patient conditions better, will be able to issue fit notes, and we have streamlined the number of targets on primary care networks from 36 down to just five. Taken together, this work will free up around £37,000 a practice.

Today’s primary care recovery plan funds and empowers our GPs and pharmacists to do more, so that we can prevent ill health, keep cutting NHS waiting lists and improve that vital front door to the NHS for many millions of people. I commend this statement to the House.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I call the shadow Secretary of State for Health and Social Care.

--- Later in debate ---

[Steve Barclay]

The hon. Member started with the message to the public, and the message to the public can be seen by what key figures in the sector say about this recovery plan. Let me just share that with the House. The Pharmaceutical Services Negotiating Committee says that the plan is

“the most significant investment in community pharmacy in well over a decade”.

The Boots chief executive says that this is

“great news that they’ll be able use their clinical expertise more widely”.

The Company Chemists Association says that it is a

“real vote of confidence for the future profession”.

The message to the public from the industries in this sector is clear that this is a well thought through plan which will have a beneficial impact for patients. I will give one final quote: the chair of the Royal Pharmaceutical Society says that this plan will be

“a real game-changer for patients”,

and that is what our focus has been.

The hon. Member raised the issue of our delivery against the 18 months target. It is very generous of him to give me the opportunity to share once again with the House the contrast with Wales, but perhaps he missed it first time around. We have reduced the wait for 18 months by over 90%, yet Wales still has vastly more—over 80,000 waiting there—and that is from a much smaller population. Wales still has over 40,000 waiting more than two years, a target that we virtually eliminated as long ago as last summer. Those who want to see what a Labour Government would mean for the NHS can see it with the performance against the two-year waiting list and the 18-month waiting list in Wales, so it is very generous of him to give me the opportunity to share that once again with the House.

The hon. Member talks about what the recovery plan is for. Clearly, the pandemic has placed huge pressure on primary care, and we can see that just from the increased volumes of appointments that primary care faces. Again, I touched in my opening remarks on the fact that GPs and primary care are seeing more than 10% more appointments than before the pandemic—1 million appointments a day. It is clear why we need to invest in new forms of working, online booking technology and cutting bureaucracy: it is so that GPs can focus on the aspects of their role that apply purely to GPs and we can better use the 25,000 additional roles that are being recruited into primary care.

The hon. Gentleman talked about his direct referral policy. We actually announced our policy guidance in December, a month before his announcement, so it is something of a stretch to say that we are following his approach. He again kindly raised the issue of mental health, which gives me the opportunity to remind the House of the increased funding that this Government are making in mental health. That was a key priority when my right hon. Friend the Member for Maidenhead (Mrs May) was Prime Minister and a cornerstone of the long-term plan, with an extra £2.3 billion going into mental health. But we did not stop there. At the Budget, the Chancellor further prioritised mental health—for example, mental health digital apps were a cornerstone of the measures for economically inactive people. We are recruiting an additional 25,000 roles into primary care in recognition that specialists are needed, whether physios, pharmacists, paramedics or specialists in mental health support.

The hon. Gentleman spoke about other aspects of primary care such as dentistry. We have said frequently that we have a recovery plan for dentistry that we will announce shortly, so that should not be news. On funding, it is slightly bizarre that, although this plan announces more than £1 billion of new funding for primary care, investment in tech, new ways of working, additional staff and empowering our pharmacists, who bring great clinical expertise that we can better harness, the hon. Gentleman, rather than welcoming that, went back to the hackneyed non-dom funding. We have heard that so much before and it has been spent so many times. We have set out ways of best using the skills of our GPs and of the additional roles, where we are delivering on our manifesto with an extra 25,000 already recruited. Above all, we have set out ways of best using our pharmacists, who are a huge resource that we can better use. That is why we are targeting more than £600 million additional funding into pharmacists, which will allow people to better access the care they need in a timely fashion.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I call the Chair of the Health and Social Care Committee.

[Steve Brine (Winchester) (Con)]

I welcome the plan, which I note the Government have released at the first possible moment after the local election purdah period. Members of the Health and Social Care Committee and I will study it carefully, and I know the primary care Minister has already agreed to come before us so that we can give it a good going over. My question is about timing. How quickly can investment in the 8 am scramble part of the policy make a difference to those practices that do not have it? The Secretary of State said that they were already negotiating with the Pharmaceutical Services Negotiating Committee, so how quickly can that very welcome new investment get to the frontline of community pharmacy?

Junior Doctors’ Strikes

Rosie Winterton Excerpts

Thursday 30th March 2023 Commons Chamber

[Steve Barclay]

The urgent question was on the junior doctors—[Interruption.] I am sure I will quote—[Interruption.] There is a rare point of agreement between us. The hon. Gentleman is chuntering, but let me go through the list of things that he did raise pertaining to the junior doctors’ dispute. He said that the Government should get the junior doctors committee in for talks; we have done so—his third question made reference to the fact that we have. We have had the junior doctors in for discussions—[Interruptions.] I will run through the questions.

The hon. Gentleman questions whether there are preconditions attached to those discussions. I have checked the minutes of the meeting and there was a list of conditions —a pay restoration of 35%, and a range of other factors that were put on the table— that were preconditions that the Government had to commit to. The point is that he has said in the media that he does not support those preconditions. He says that 35% is unaffordable, so what is his position? One minute he says that he supports the junior doctors and that they should not go on strike, yet the next minute he says that he does not actually support the precondition that the junior doctors have said is the requirement for them to enter into discussion.

The reality is that the Government have taken a constructive and meaningful approach to trade union negotiations. That is why we have reached agreement with the “Agenda for Change” trade unions. It is why the Royal College of Nursing, Unison, the GMB and the Royal College of Midwives are all recommending the agreement that has been reached, covering more than 1 million staff across the NHS, to their members. The junior doctors have set a precondition on those talks which the hon. Gentleman does not agree—[Interruption.] That is a precondition. He does not seem to understand the terms the junior doctors—[Interruption.] He asked the question, he is getting the answer and the fact that it points to the contradiction in his own position is one that he seems to be having trouble with. Conservative Members are used to contradictions from those on the Opposition Front Bench. He supports the use of the independent sector, whereas his deputy does not. He wants to nationalise the GP estate, but his shadow Chancellor does not. The Opposition are full of contradictions. The reality is that there is a position in terms of the—[Interruption.] The right hon. Member for Islington South and Finsbury (Emily Thornberry) chunters again. There is a position in terms of precondition. The shadow Secretary of State asked me to confirm at the Dispatch Box whether it was a precondition of the junior doctors. Ahead of the urgent question, I checked the minutes—[Interruption.]

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. We cannot have this constant chuntering.

[Steve Barclay]

The Opposition do not seem to like their question being answered. The shadow Secretary of State asked me to confirm the position, for the avoidance of doubt, at the Dispatch Box. That is exactly what I am doing. I have checked the minutes. I have spoken this morning with officials to confirm, before I made the statement to the House, that it was a precondition of the talks. We were told, in terms of the pay erosion of 26.1%, that that needed to be restored at 35%, alongside other things. The reality is that he does not support that. He is facing both ways, wanting to support the junior doctors, but not actually willing to support the pay that they are demanding.

Future of the NHS

Rosie Winterton Excerpts

Thursday 23rd February 2023 Commons Chamber

[Margaret Greenwood]

The right hon. Member is being generous. I completely disagree with him about charging people for missing appointments. I remind him that 7 million adults in this country are functionally illiterate and huge numbers of people have dementia, so if a letter comes through the door, they may not understand it. Does he not agree that it would be much better to put resources into understanding why people do not come to appointments?

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. The right hon. Gentleman has been generous in taking interventions, but I am conscious that there are quite a lot of speakers, and if everybody takes nearly half an hour, we will not get everybody in.

[Matt Hancock]

I apologise; I have tried to be generous in taking interventions. It has been a positive and good-natured debate, which is valuable. I entirely recognise the point made by the hon. Member for Wirral West (Margaret Greenwood), and it has to be done sensitively, but the point made by my hon. Friend the Member for The Cotswolds (Sir Geoffrey Clifton-Brown) about the sheer quantity of missed appointments is a problem that must be resolved.

My final point is that too often, the NHS is a national hospital service that fixes people after they get ill—that happens in this country far more than elsewhere. The effective prevention of ill health is central to ensure that the NHS can continue to thrive in decades to come. The gap across the country is huge and it needs to be addressed. For example, the gap between the life expectancy of 74 years for a man in Blackpool and 81 years for a man in Buckinghamshire is far too high. About half that gap, however, can be put down to the difference in smoking rates—it is not about the NHS service in Blackpool at all, which is excellent.

We have to support people to prevent ill health in the first place; hitherto, the NHS has not put nearly enough effort and attention into that. I hope that the Minister will confirm the importance of prevention. I know that the Select Committee is about to launch an inquiry into prevention policy. I was delighted to set up the National Academy for Social Prescribing when I was the Secretary of State to try to drive the agenda further, but there is clearly much more to do.

The NHS is our national treasure. For those of us who care deeply about a service that is free when people need it, where the nation collectively comes together to look after those who are ill, it has deep moral force and is efficient and effective. If people care about its future, however, we need to reform it and ensure that we bring it into the modern age—only then can that promise to the nation continue to be fulfilled for the rest of our lives.

--- Later in debate ---

[Rob Roberts]

It has—although if Opposition Members want to argue with the King’s Fund, that is fine. But if NHS funding was okay under Labour and has increased in real terms since then, how is it not okay now? I agree that it is not okay now, but that is because of all the reasons I have already mentioned: we are keeping people alive longer, and sicker, there are more of them, and it is more expensive to diagnose and treat them. They are not political issues.

To draw my remarks to a conclusion, I am not familiar with the machinations of how to go about these things, but it seems perfectly reasonable to have, finally, some kind of royal commission—some kind of massive public engagement exercise—on the future of health services in the United Kingdom. We must tackle it head-on. We must not be afraid to go wherever that debate takes us in search of better outcomes for people. I just wish we would keep in mind that we are here for people. We are here to serve them and give them the best outcomes we possibly can, not to get caught up in form and process, or dogma and ideology. We are trying to make people better. We have to do whatever we can to get to the root causes of the issue, because as my former NHS and now private sector nurse partner tells me all the time—I quote—“You could fix so much if you’d just stop politics getting in the bloody way.”

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. I call Paulette Hamilton.

--- Later in debate ---

[Rob Roberts]

On a point of order, Madam Deputy Speaker. I apologise to the House for interrupting the debate. At the end of my speech, I may have used a little bit of intemperate language, which was not necessarily in best keeping with the traditions of the House. I apologise to you, Madam Deputy Speaker, and to the House.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I thank the hon. Gentleman for his apology. As he said, it is important that we use moderation in our language.