Rare Autoimmune Rheumatic Diseases

Rupa Huq Excerpts

Tuesday 10th December 2024 Westminster Hall

[Jim Shannon]

As my hon. Friend often does in these debates, he brings forward a reminder of why this debate is important and why we need to raise awareness. It is about giving confidence to people out there who may have these diseases and may think that they are fighting this battle all on their own, but are not. We need to raise awareness among NHS staff. It is impossible to know about every rare disease, but it is good to recognise the symptoms and to be able to point people in the right direction.

Rare autoimmune rheumatic diseases are a range of chronic, currently incurable conditions in which the body’s immune system damages its own tissues, often in multiple organs throughout the body simultaneously. That is a lot of words but, to use a phrase that we would say back home, it means that they come at a person from all sides. They can lead to tissue or organ damage that, in some cases, can be fatal. We cannot ignore the fact that that can be fatal and the importance of responding in a positive fashion.

At present, the outcomes are not good enough for people living with rare autoimmune rheumatic diseases: they wait too long for a diagnosis, have variable access to specialist care and cannot always access help and support when they need it. In any debate that we have about ill health, we often say that early diagnosis is important, but so is having access to specialist care. It is important that NHS workers are able to notice something that may be unusual and not something that they see every day. It is also important that the care, help and support that people need is available when they need it. Preliminary data from the Rare Autoimmune Rheumatic Disease Alliance’s soon-to-be-released 2024 patient survey found that the average time to diagnose from symptom onset was two and a half years—it is that long before anything happens. In those two and a half years, people suffer, worry themselves sick and wonder, “Am I going to get out the other side?” The data shows that 30% of patients waited five years for a diagnosis from symptom onset.

Rare autoimmune rheumatic diseases impact on around 170,000 people in the United Kingdom of Great Britain and Northern Ireland. Hon. Members may not recognise some of the diseases, but they include Behçet's disease, lupus, myositis, scleroderma, Sjögren’s syndrome and vasculitis. They can affect many parts of the body—the joints, the skin, the lungs, the kidneys or the heart—and often require cross-medical expertise. That is just a small number of the things that come the way of 170,000 people across the United Kingdom. Unlike the vast majority of rare diseases, the conditions occur predominantly in adult life and are predominantly non-genetic. That means that people do not need to have a history of them: they can come out of the blue.

The Rare Autoimmune Rheumatic Disease Alliance, a group made up of clinicians and charities, such as Lupus UK, Vasculitis UK, Scleroderma & Raynaud’s UK and Sjögren’s UK, has set out a number of key solutions to improve care for RAIRDs. They include strengthening existing specialised networks and setting out what good care looks like through a rare disease equality standard. It has also stressed that it is vital that rare disease is not forgotten in upcoming policies such as the NHS’s 10-year plan, which I will refer to later. In that plan, it is really important that we—by which I mean the Government and the Minister—can give hope to people who suffer from those diseases, and it is really important that they do not think they are on their own. The evidential base response from the Minister would give them that assurance, and it is important that the progress made to date by the UK rare diseases framework is built on. That is my first question: is the rare diseases framework part of the NHS 10-year plan?

I want to share an example that has been highlighted to me of someone who has felt the personal impact of rare autoimmune rheumatic disease. Zoi lives with a life-threatening RAIRD, granulomatosis with polyangiitis vasculitis. In her words, she is “lucky” because she had a relatively short journey to diagnosis. When she looks at others, she thinks she is lucky. I would like everybody who suffers from these diseases to have the same luck—if luck is the word. I do not believe in luck; my personal opinion is that everything is predestined. I am interested in how we make it better.

The quick diagnosis came only because Zoi’s GP recognised her symptoms and knew to refer her right away. Does every doctor have that knowledge? I hope they have, but they might not have the personal observation of that doctor. The difference was that he had had a friend who had died of the disease, so he knew what to look out for and red-lighted those symptoms.

Despite Zoi’s positive experience of diagnosis, however, her experience of care since has been variable—that is the second stage. Following diagnosis of the disease, the care system works its way out. She has faced long waits for appointments and poor communication between teams responsible for her care. In one instance, she received a letter from a consultant four months after the date of the appointment. Was that the fault of the Royal Mail? I do not know. It was not Zoi’s fault that she did not know about the appointment until it was too late. It meant that she had been taking a medication unnecessarily for months longer than needed.

It is about early diagnosis, treatment going forward and speed and urgency in the process to make it happen. Zoi works for a charity that supports other people living with vasculitis. She describes it as “heartbreaking” that hers is one of the best diagnostic journeys one will hear of. She has been diagnosed and gone through the NHS process to get out the other side and try to be better. As she says, hers is one of the best diagnostic journeys, but how can the rest be improved?

How do we improve care? Speedy diagnosis should not be down to Zoi’s word “luck”. People such as Zoi living with serious rare diseases should be able to access vital care when they need it. That is why I am calling on the Minister to consider the following recommendations advocated by RAIRDA. It is important to be aware of the issues.

The first recommendation is to ensure that rare diseases are a focus of the NHS 10-year plan. I am always pleased to see the Minister in his place. I mean that genuinely, not to give the Minister a big head. He comes with an understanding that we all greatly appreciate— I do and am sure everybody else does. Will there be a focus in the 10-year plan on rare diseases? I am pretty sure the answer will be yes, but we need confirmation of that in Hansard today. We need to reassure our constituents who are struggling with disease and are unsure what the future means for them.

The UK rare diseases framework, introduced just three years ago in 2021, has been a significant step forward in securing equity of treatment for rare diseases. I welcome that, but sometimes the system does not work as well as it should. It is crucial that the Government do not lose sight of the work done to date to drive change for people living with rare conditions. Good work has been done, and I always like to recognise good work. It is important that we give encouragement to those who are working hard, and it is important sometimes to think, when we are ploughing away, what we are getting for it. Many of us—all of us in this room, for instance—appreciate what our NHS does. The good work that has happened for those with rare conditions needs to continue with the same zest, enthusiasm and fervour as it has done in the past.

It is particularly important that the working groups on the NHS 10-year health plan consider how improvements in rare disease care will be championed in that plan. In addition, it is important that the plan considers how the work plan of the UK rare diseases framework will be continued past the framework’s end point in 2026. That is my second ask. I am sure that within the 10-year plan the Government are committed to that continuation, but I need to personally reassure my constituents and we need to reassure the nation. We need to reassure those 170,000 individuals and their families and friends.

The framework has been an important tool in co-ordinating methods to improve care for rare diseases, and not just in England. I understand that health is a devolved matter, but this is how it works: whatever happens here, health-wise, is the next stage for us back in Northern Ireland, through the Health Minister. I was talking to another Health Minister on the tube coming here, and we were saying how important that co-ordination across all four regions is. It is good to push for that here, and to see it received back home.

The framework has been an important tool in co-ordinating methods to improve care for rare diseases, not just in England but across the United Kingdom of Great Britain and Northern Ireland. The numbers of people suffering in Northern Ireland may seem small numerically, because we are a region of 1.9 million people, but the impact is huge. I am overtly aware that health is a devolved matter, but I am also aware that the standard can and should be UK-wide. The Minister always gives me and those from other parts of this great United Kingdom reassurance on the co-ordination between here and the Northern Ireland Assembly. I know he has met the Health Minister, Mike Nesbitt, and I am sure they will meet again in the foreseeable future.

How do we develop a standard of care? The National Institute for Health and Care Excellence quality standards consist of defined, measurable statements that can be audited to reduce variations in cases throughout the country. A rare disease quality standard would help to incentivise an increased focus on delivering high-quality care and treatment for rare conditions in the NHS, including rare autoimmune rheumatic diseases. That is my third ask: to develop the standard of care we need to have a quality standard, which would help to incentivise all the regions—all the parts of England, Scotland, Wales and Northern Ireland collectively; better together.

Work in this area is already well under way. RAIRDA has been working hard with organisations across the rare disease community to understand what good care looks like for people living with rare disease, and how that should be reflected in quality statements. Has the Minister had the opportunity to talk to the alliance? I am sure he has; I do not doubt that for a second. It would be good to have that liaison to help to bring together the ideas from the alliance and the Government. It is important that the current work to develop quality statements is built on in a timely way, with the swift development of a rare disease quality standard.

On my fourth request, it is clear that we need development in IT capacity in the fight for diagnosis, to ensure that more people can experience a quick diagnosis, like Zoi did. We need to increase funding for research into the diagnostic journey for rare autoimmune rheumatic diseases, to aid the development of diagnostic technology. It is really important that we look towards the next stage on research and development. How do we do that?

To sidestep slightly, today’s paper—I think it was the Express—said that the Government should be doing something to look at dementia as the numbers rise. Although we are talking about rare diseases that will be well down the Government’s to-do list, early diagnosis is important, as is research and development to improve the capacity to find a cure, to lessen the pain and to lengthen the time that people have in this world. Again, any indication of what is happening with research and development would be greatly appreciated.

Investment in research would help to identify blockers to rapid diagnosis, as well as supporting the development of digital tools for faster and more accurate diagnoses. Some months ago my colleague, the hon. and learned Member for North Antrim (Jim Allister), asked the Secretary of State for Health and Social Care a question in the Chamber about the report on the way forward for the NHS. He mentioned the need for digital data tools, and the Secretary of State replied very positively, so I think the Government are looking into this, but it is important that we have the digital tools in place. With better data and more accuracy, we can help to speed up the process and find a better way forward.

Because of their rarity, it is unrealistic to expect every hospital to have clinicians with expert knowledge of rare autoimmune rheumatic diseases. I understand that, as we cannot know everything. Clinicians may have a small portion of knowledge, but this subject requires expert knowledge, so we need another way of doing it. A 2024 survey found that 29% of respondents were not very, or not at all, confident that the specialist healthcare professionals providing their care understood their condition. How do we improve that? I understand that we are in difficult, financially straitened times, and the Government have rightly committed a large sum of money to the NHS and health services—as they should, and I support that entirely—but we need improvement. My fifth ask of the Minister is: how can we do better? If 29% of respondents are not very confident, or not at all confident, we need to address that.

I believe that improvement can be achieved by developing specialised networks for rare autoimmune rheumatic conditions. Such networks would allow health professionals to access the knowledge and expertise of tertiary specialists, while also developing the capability and capacity to provide more care and treatment locally. I feel that would be the answer to my fifth question, and I am interested to hear the Minister’s thoughts.

Networks already exist, with an excellent example being the Eastern Network for Rare Autoimmune Disease, established in 2016. We have a system in place, so let us look at it—not in a judgmental way—to see what it is doing and where improvements can be made. The network was formed to maximise patient access to relevant expertise while keeping their care as close to home as possible. This has been achieved by setting up excellent communication and cascading training to enable much better co-ordination, digital data sharing and contact between specialised centres and local trusts.

The network lead has calculated that the network’s creation has saved the NHS money, so it has to be considered. The network runs at a cost of between £70,000 and £100,000, but it has generated annual savings estimated at between £150,000 and £200,000. That means that for every £1 spent, the NHS has saved £2, over a seven-year period, through a reduction in the use of inappropriate high-cost drugs.

On my sixth ask, networks throughout the country, like ENRAD, are run on the good will of clinicians. That is not sustainable, and it never can be. I respectfully ask the Minister to perhaps look at the ENRAD scheme, which is run on the good will of clinicians and has been very effective in how it responds, to see how such networks can be better helped to expand. If it saves money—if every £1 saves the NHS £2—then the financial equation is clear, and it should be pursued across all of this great United Kingdom of Great Britain and Northern Ireland.

To address this issue, the Government must provide the necessary financial support for networks to be developed and maintained. That funding would enable the creation of vital posts, such as meeting co-ordinators, and allow clinicians to be reimbursed for their time. Again, I feel that would be the right incentive. Good will is good to have, and there is much of it across this great nation, but, at the same time, there may be better ways of doing things. Such support would ensure that benefits for patients, and the NHS’s budget, could be realised throughout the country. With the £25.3 billion committed to the NHS—I think that is the figure, but the Minister will correct me if I am wrong—this is another way to save money in the NHS, and it really should be done.

My last request is about specialist nurses, who can play a crucial role in supporting people living with rare autoimmune rheumatic diseases. The preliminary results from the 2024 survey show that respondents with access to a specialist nurse were more likely to report that they had access to enough information and support about their condition, compared with those who did not have any access to a specialist nurse. But less than three in 10 respondents—some 28%—had accessed information from a specialist nurse, and this varied widely by condition group. Wow: how important is the role of specialist nurses? I would be reassured if the Minister came back to me in respect of the critical role they play, perhaps exclusively. If only 28% of people have access to information from a specialist nurse and it should be more, what can be done to improve that?

Finally, when developing the NHS workforce plans, will the Minister consider what more can be done to recruit more specialist nurses to support people with rare autoimmune rheumatic diseases? We must always consider the fact that although the chances of getting a rare disease may be one in 10,000, the reality is that the patient deserves all the help we can offer, from diagnosis to treatment and support. I ask the Minister—very kindly, sincerely and humbly—to clarify whether that is this Government’s goal. I believe that it is, but it is not about me today; it is about the people we represent in this House, collectively, together, across this great nation. I believe we have an important role to play.

RAIRDA, with all the clinicians and all the charities, has brought together some positive ideas that can help us together. This is not about blame—it is is never, ever about blame; it is about how we do it better. On behalf of my constituents who have contacted me, and others who will speak shortly, and for the shadow Minister and the Minister, we put forward our case and look forward to support from Government.

[Dr Rupa Huq (in the Chair)]

I remind Members that they should bob if they want to be called in the debate.

--- Later in debate ---

[Alison Bennett (Mid Sussex) (LD)]

It is a pleasure to serve under your chairmanship, Dr Huq. I thank the hon. Member for Strangford (Jim Shannon) for bringing forward this debate on a subject that all too often does not get enough attention, but that is important and affects millions of people. I also thank the hon. Member for Bootle (Peter Dowd) for his contribution.

More than 160,000 people in the UK live with rare autoimmune rheumatic diseases. Identifying, treating and caring for those people is complex. Yesterday, my constituent Carrie told me about her experience. She suffers from a number of conditions and has done since she was diagnosed 30 years ago. Interestingly, for someone who has carried those conditions for 30 years, she considers herself fortunate to have been diagnosed with Raynaud’s and lupus at a young age, because it allowed her to start treatment early and receive consistent care. She knows from experience that early diagnosis and treatment makes a real difference, a point that has already been made by hon. Members.

While Carrie believes that she has been lucky and has received good care, she stressed that many people face years of misdiagnosis or dismissal, and poor or almost non-existent care. Those failures only exacerbate their symptoms further down the line. Sadly, one of those less fortunate than Carrie is her own mother, who lives not in Sussex but in Yorkshire, and also has multiple autoimmune conditions. Contrastingly, however, she has always been made to feel like a hypochondriac—not an unusual experience for those seeking help with rare autoimmune rheumatic diseases.

Carrie’s mother was eventually diagnosed after many unnecessary years of suffering. She suffered for longer and to a greater degree simply because no one believed her or was able to diagnose her. Carrie told me that a postcode lottery exists in the quality of care for those with these conditions. It really is down to the specific medics and practitioners who an individual meets as to how well their condition is identified and whether treatment can begin.

Carrie’s Raynaud’s is particularly debilitating in winter. She told me that more awareness of the issues around the conditions and how symptoms can be alleviated is vital. Often, solutions can be as simple as helping with buying things such as thermal gloves or socks.

Another major challenge has been the impact of her autoimmune conditions on her teeth, particularly with the Sjögren’s that she suffers from. Carrie has spent thousands and thousands of pounds on private dental care over the years—the only option as NHS treatment was not available. Despite that money, Carrie now thinks that it is not long until she will have very few teeth left.

Carrie thinks that the current system is disjointed, with her dentist not understanding the issues surrounding her conditions, and her rheumatologist likewise not understanding the impact her conditions have on her dental health. She believes that a more co-ordinated, multidisciplinary approach to treating the conditions would help. It is clear from my conversation with Carrie that we simply must do better on this issue.

We must tackle the postcode lottery, exemplified by Carrie and her mother at opposite ends of the country; build a more joined-up system; and take rare autoimmune rheumatic diseases seriously so that we can start diagnosing earlier and more consistently. While the problems seem daunting, I believe that by collaborating—for example, with organisations such as RAIRDA—we can find solutions to the problems that Carrie told me about.

It is already Liberal Democrat policy to ensure that everyone with long-term health conditions has access to a named GP. We must also do better on dentistry, both generally, by sorting out the NHS contract and ensuring that we have a proper workforce plan for dentistry, and specifically, for people with those rare diseases that have a massive impact on dental health. As well as having access to a named GP, the Liberal Democrats are campaigning for the Medicines and Healthcare products Regulatory Agency to have greater capacity, which would help to speed up the process by which new treatments reach patients—a potential game changer for those suffering with such conditions.

We need change so that we can help the people living with those complex, long-term and debilitating conditions. The diseases may be complex, but I believe the solutions need not be. I am encouraged by the words of hon. Members today, and together, we can effect the change that Carrie, her mother and so many others need and deserve.

[Dr Rupa Huq (in the Chair)]

I call the shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans), to speak for His Majesty’s loyal Opposition.

Ultra-processed Food

Rupa Huq Excerpts

Wednesday 21st June 2023 Westminster Hall

[Suzanne Webb]

It is, hence my sparkling water, which I was rushing out for. In May 2023, the World Health Organisation said it was concerned about the long-term use of aspartame as it increased the risk of type 2 diabetes, heart diseases and mortality, although the UK’s Food Standards Agency has accepted that it is safe.

Much of this food is our everyday pleasure, so I am not advocating that we tell people what to eat and not to eat. I am hugely conscious of the cost of living pressures and the ways that people are trying to make changes and save money. Consumed in isolation and moderation, this food is fine. The problem is when it takes over our lives—and it has.

The key challenge is to get supermarkets to put healthy products on multi-buys, encourage a promotional spend shift to healthier food products and focus on making food more affordable. Promotional deals are easy ways to make profit for the supermarkets, peddling products that, to them, are low cost but high margin, and have no nutritional value. There is no doubt that modern living and work patterns mean that we find it difficult to find time to cook unprocessed foods instead of purchasing ultra-processed foods, as they are quicker to cook, ready to eat and cheaper. I do not think that there is anyone here who has not left Westminster on a Wednesday night and probably just picked up a ready meal because it is the quicker and easiest thing to do.

I am pleased to have read that the Scientific Advisory Committee on Nutrition, which provides recommendations on dietary guidelines, is carrying out a scoping review of the evidence on processed foods and health. It aims to publish its initial assessment in the summer of 2023. TV medic Dr Chris van Tulleken has also been vociferous on ultra-processed foods, and long may that continue. The facts are there. It is a serious crisis when one in three children are obese by the time they leave primary school.

I want to see the private sector lead by example, with manufacturers stepping up, taking responsibility and stopping packaging and promotional techniques that lure customers towards ultra-processed food with no nutritional value. We need to address the potential loopholes and displacement from marketing regulation of food that is higher in fat, sugar and salt when selling the dream of a 100% beef burger when, in fact, it is not. Regulators need to focus more on how the processing of food impacts our health outcomes. Will the Minister consider introducing the important advertising watershed sooner rather than later? We cannot afford to delay. The obesity figures speak for themselves; the cost to the NHS speaks for itself. Also on my wish list is considering introducing a reduction target to keep focused on ensuring that ultra-processed food consumption levels in the UK are at a healthier level.

I am deeply concerned about the impact that such food is having on health outcomes and the impact on the NHS. We need to continue the debate, as the simple fact is that 64% of adults in England and 40% of 10 to 11-year-olds are either obese or overweight. That is staggering. To me, we are not far off from the time for urgent intervention like we had in the cigarette industry. An article was written on Monday, independent of my securing this debate, in which I read someone saying very similar things. The obesity crisis is truly shocking and cannot be ignored. The role of ultra-processed foods in that is significant, as is the role of the food supply chain. The food supply chain needs to step up and play its part in the fight against obesity before the Government need to intervene and start to tackle the ultra-processed foods like they did with tobacco— to basically get in there. The Government will have to intervene at some point if the industry do not get a grip.

[Dr Rupa Huq (in the Chair)]

I will start to call the Front Benchers at 5.33 pm, with five minutes for the SNP and Labour, because it is only a 60-minute debate. If we do speeches within five-and-a-half minutes, everyone will get in.

New Hospital Programme and Imperial College Healthcare NHS Trust

Rupa Huq Excerpts

Tuesday 13th June 2023 Westminster Hall

[Andy Slaughter (Hammersmith) (Lab)]

I beg to move,

That this House has considered the New Hospital Programme and Imperial College Healthcare NHS Trust.

It is a pleasure to see you in the Chair this afternoon, Sir Mark. I understand that our proceedings may be interrupted for some time, but let us make a start. I am delighted to see my west London colleagues here—my hon. Friends the Members for Westminster North (Ms Buck), for Ealing Central and Acton (Dr Huq) and for Brentford and Isleworth (Ruth Cadbury)—and indeed the hon. Member for Cities of London and Westminster (Nickie Aiken), my hon. Friend the Member for Reading East (Matt Rodda), and, of course, the hon. Member for Strangford (Jim Shannon), without whom no debate would be complete, perhaps to remind us that although this is to some extent a local or regional issue, it has much wider implications.

To be clear, this debate is about one thing specifically: the defunding and removal from the 2030 new hospital programme of three major hospitals—Charing Cross, Hammersmith, and St Mary’s—all of which form part of the Imperial College Healthcare NHS Trust. They are teaching hospitals, major emergency and trauma hospitals, research hospitals, academic hospitals, tertiary hospitals—hospitals with a huge national and international reputation—but they are also local hospitals for my constituents and those of many other Members.

In the Secretary of State’s statement on the new hospital programme on 25 May, seven of the schemes that had previously been in the 40 hospitals scheme were removed from that programme with respect to completion by 2030—we must be careful in our words here. I need to deconstruct what has happened since that time, because there has been some misleading presentation of the facts. In order to clarify this, I sent some rather key questions to the Minister in advance of this debate.

Essentially, looking at the statement that was made, the Secretary of State said, in respect of those seven schemes:

“The work will start on those schemes over the next two years, but they will be part of a rolling programme where not all work will be completed by 2030.”—[Official Report, 25 May 2023; Vol. 733, c. 479.]

That is the key change, as far as we are concerned, in relation to that statement.

The questions that still sadly remain unanswered are these: what works will be done at each of the three hospitals before 2030? How much will the budget be for that, and will it come out of the £20 billion new hospitals by 2030 programme? What is the total budget for the rebuild schemes at each of the three hospitals? Is this secured funding, and when will it be allocated? By what date or dates will the works for each hospital be completed?

I have put together what I think are the answers—I have done my sleuthing—but I really need to hear it from the Minister’s own mouth, this afternoon if possible, or in a follow up if he needs to use that. I might also add a sort of meta-question to that: when will I receive a response to the email that I and my hon. Friend the Member for Westminster North sent to the Secretary of State on 28 May, which raised those same issues?

I understand that there is confusion associated with the new hospital programme—as would be true of any scheme that came in under the aegis of the former Member for Uxbridge and South Ruislip—about whether those were new hospitals or not. Almost a year ago, I asked the then Prime Minister about the new hospitals—the “new” hospital at Hammersmith that opened in 1902, and the “new” hospital at Charing Cross that opened in 1818—but I will not focus on that point today. This is about the funding and the timetabling of the scheme; frankly, the Minister can call them whatever he likes.

There have been a number of schemes moving in and out. At one stage there were going to be 48 new hospitals. I think 128 bids came in for the extra eight places and five were successful. We are told there is £20 billion, which sounds like a lot of money—it is a lot of money—but it is not the £32 billion to £35 billion that the Health Service Journal says would be needed to complete all the schemes that have at one time been put forward for the new hospital programme. Those are legitimate grievances, but I do not have time to deal with them all today. I have time only to deal with the one matter that I have already raised.

I need to give a little bit of background. As I have indicated, the hospitals have a long and illustrious history, going back more than two centuries in the case of Charing Cross. In 2012, an Orwellian programme called Shaping a Healthier Future, which had been the product of two years’ secret work by the consultants McKinsey, said that several A&Es should close, including the one at Hammersmith, and that Charing Cross should be demolished and replaced by primary care and treatment services on the site. It was the biggest closure programme in the history of the NHS.

Sadly, we did lose the A&E at Hammersmith in 2014, but after a herculean battle fought over seven years by community groups, such as Save Our Hospitals, and by Labour local authorities, particularly that in Hammersmith, that battle was won and Charing Cross had a reprieve and would go on being a major hospital. That happened in 2019.

It was rumoured that the money that would have been gained by selling most of the land at Charing Cross might have gone into the St Mary’s scheme, which, by common consent, is the hospital that most needs emergency work. But although the bill for essential repairs on the three hospitals is about £350 million—far and away the biggest repair bill of any hospitals in the country—if we want to make those hospitals fit for the 21st century, the actual cost, which I believe is accepted by Department of Health and Social Care officials, will be about 10 times that, between £3 billion and £4 billion. If that seems an unspecific figure—my hon. Friend the Member for Westminster North will say more about this—it is because it depends to some extent on what receipts can be received from land value and moneys at Charing Cross. It is a significant sum of money, but it is to make those essential and world-class hospitals fit for purpose for decades going forward, not just to patch them up.

It was always going to be difficult, and it was disappointing that the hospitals were in cohort 4 and would just squeak in by 2030—that is when the work would be completed. We would have a newly built hospital at St Mary’s and refurbished hospitals at Charing Cross and Hammersmith over that time. That is why it was so disappointing when they were moved out of that without any further future date being given.

What is at stake here? Because there has been so much information, I do not want to use my own words, but the words of the trust itself. In preparation for this debate today, it said:

“the main funding for our schemes has been pushed back beyond the original commitment of 2030 as other schemes have been added to the programme and prioritised. We had two schemes in the original list of 40 hospitals to be built by 2030: a complete rebuild of St Mary’s Hospital in Paddington; and extensive refurbishment and some new build at both Charing Cross Hospital and Hammersmith Hospital”—

confusingly, the Department of Health classifies the two hospitals of Hammersmith and Charing Cross as one scheme, but it certainly affects the two hospitals. The trust goes on:

“It is clearly very disappointing that we will not now be funded to complete these schemes before 2030.”

It also states that

“some funding to progress to final business case approval and to support enabling work”

should be provided, and

“we are awaiting a response in terms of a decision and a funding allocation.”

It then talks about the business plans that it is going to put forward. In rather more emotive but absolutely accurate language, it says:

“If we waited until 2030 to start building works at St Mary’s it would become impossible to patch up our oldest facilities, many of which house key clinical services. As the provider of London’s busiest major trauma centre and host of the NHS’s largest biomedical research centre, that would be hugely damaging for the health and healthcare of hundreds of thousands of people”.

That is the statement from the chief executive officer at Imperial, Professor Tim Orchard, and those words should resonate with the Minister.

[Dr Rupa Huq (Ealing Central and Acton) (Lab)]

I am aware that the Division bell will probably start ringing as soon as I stand up, but I am familiar with that quote from Tim Orchard. My hon. Friend is making a really powerful speech. I am familiar with all these hospitals, as are all my constituents. I was born at Queen Charlotte’s, my little sister was born at Hammersmith, and both my parents were under Charing Cross. I went to the Western Eye Hospital last year when I had shingles, and I have an auntie who has retired but was a consultant professor at St Mary’s.

Does my hon. Friend agree that it is really sad that, in the 75th year of the NHS, we are talking about crumbling estates and all these issues? The backlogs at these hospitals existed long before covid. The Government like to throw up that smokescreen and say, “It’s covid’s fault.” I have just written to Tim Orchard because a constituent told me that there is only one temporary scanner at Hammersmith at the moment. Is that not scandalous? Does my hon. Friend agree that, to paraphrase the Sex Pistols, who were formed on the Wormholt estate, which borders both our constituencies, this is the great NHS scandal?

[Andy Slaughter]

I thank my hon. Friend for that contribution, and I entirely endorse what she said.

I want to deal briefly with the misinformation—I accept that it was wholly unintentional—in the Secretary of State’s statement, or rather in his responses to questions following his statement, because it is important. A ministerial correction was made following a point of order that I made arising out of that. In response to my hon. Friend the Member for Westminster North, the Health Secretary said:

“We recognise the importance of the Imperial bid; that is why we are starting to build the temporary ward capacity at Charing Cross and the first phase of work is under way on the cardiac elective recovery hub, to bring cardiac work on to the Hammersmith site.”—[Official Report, 25 May 2023; Vol. 733, c. 485.]

There are 47 words in that statement, and four errors had to be corrected in the ministerial correction. That may be an all-time record; I do not know. Some are more important than others. There are bids, not one bid. We are not starting to build; we will start to build at some time in the unspecified future. There is no cardiac elective recovery hub; there is a cardiac catheter lab. The idea that we are just moving cardiac services to the Hammersmith Hospital site would be a surprise, given that St Mary’s is a world-leading cardiac hospital at the moment.

I accept that mistakes happen, but there were other errors in that statement. It implied that works are under way, whereas it is common consent now that they have not yet started. The cardiac work is nothing to do with the new hospital programme; it is part of the ordinary work, as is the refurbishment of wards. The temporary ward at Charing Cross will be necessary, but not until the main funding for the floor-by-floor hospital renewal refurbishment is ready to go. Some greater clarity would be helpful on those very contentious matters.

My first question is: what are the enabling works? What does that mean? We have heard several definitions. The trust says:

“We do not yet know when we will be able to start work.”

There has been mention of surveys. Of course there will have to be surveys before the works, which are estimated to cost several billion pounds, start. We are hoping to get a significant sum of money for the business case—perhaps as much as £200 million. This is about rebuilding the three main hospitals.

An energy centre is mentioned. There will need to be a new energy centre, partly because we have major supply issues in west London, and the existing energy supply would not supply modern, state-of-the-art hospitals. All that is true, but what is not true is that this is somehow the beginnings of the major works of the scheme. That is a fig leaf to cover the fact that the major works have been postponed beyond 2030. The fact is that they are not in the 2030 programme or the current spending review. I ask the Minister again: when will the work be done and what funds have been assigned? Yes, there has been preparatory enabling work, but does that come out of the £20 billion? What is the Government’s commitment to the major work of rebuilding those hospitals? There has been some work, with £20 million spent on preparing plans so far, but we are in limbo at the moment. We are suffering repeatedly from misinformation.

I understand that this is a highly contentious political area. The chairman of the Conservative party will, if the Boundary Commission proposals go through, be the MP who covers Charing Cross Hospital. That is no excuse for putting forward matters that are simply misleading to my constituents and many other people. That does us a great disservice. We all want to see these hospitals thrive, in the interests of patients, staff, management, the trust and the hospitals themselves.

Therefore, I will end my comments, because I want to give others an opportunity to contribute. What I need from the Minister today is clarity and honesty about what is happening. We will live with the consequences of that, and we will continue to campaign as we have done for our wonderful hospitals and local NHS. The Government do a disservice if they are not straightforward and clear in the message they send out.

Eye Health: National Strategy

Rupa Huq Excerpts

Wednesday 17th May 2023 Westminster Hall

[Dr Rupa Huq (Ealing Central and Acton) (Lab)]

It is a pleasure to serve under your chairmanship, Mrs Harris. I congratulate my hon. Friend the Member for Battersea (Marsha De Cordova) on a stunning speech and securing a debate on such an important subject.

Visual impairment is, in many ways, illustrative of so many of the problems that the wider NHS faces, but it is often underacknowledged and goes unnoticed. The Minister responded to my Adjournment debate on Monday, when I went through a lot of documents from our local ICB and council on the NHS. I was scouring them for mention of eye disease, but it did not seem to be anywhere in them—it tends to fall off the radar.

My hon. Friend gave some powerful statistics. There are 2 million people living in this country with sight loss today, and it is expected to be 2.7 million people by 2030 and 4 million by 2050. There are 600,000 people with age-related macular degeneration. Every six minutes someone is told they are going blind, and every day 250 people start to lose their sight in the UK. Some of these problems are intrinsic to our health service, such as the lack of joined-up-ness that she talked about between primary and secondary care, the fact that services are a postcode lottery and the pre-existing backlogs that were worsened by covid.

With 11 million out-patient appointments a year, ophthalmology is the biggest out-patient speciality in the NHS, yet it is forgotten and is often a Cinderella service. Locally, diabetic eye disease, glaucoma and age-related macular degeneration are all big issues. In Ealing, type 2 diabetes is 3.5 times more prevalent among black, Asian and minority ethnic populations than the wider population. The level of diabetes is very high in our borough, at 8.4%, and it is even higher next door in Harrow, at 9.5%—nearly one in 10 people. Diabetic eye disease is a consequence of that, and it is sight-threatening, as my hon. Friend said.

The odd thing is that primary level optometry is private practice. Specsavers is the biggest provider in the country—it sent us all a briefing for the debate—and there is Boots. In Ealing, there are also great local independents such as Eyes on the Common and Hynes Optometrists. But there seems to be a mismatch with the eye hospitals. I was lucky enough to go to Central Middlesex Hospital recently and be shown around its eye department. I also went to the A&E at Western Eye Hospital last year when I had shingles, which was interesting to see. It was a very long wait of half a day on the weekend. They were very good, but I am sure we could join all these things up better, because there seems to be a disconnect for things such as referrals.

That is why I support and am a signatory to my hon. Friend’s private Member’s Bill, the National Eye Health Strategy Bill. Having a national eye strategy is crucial to reversing a situation that has seen eye care become a Cinderella service. It was a step forward when the first ever national clinical director for eye care, Louisa Wickham, was appointed last year, but unlike with other big issues—for example, I talked on Monday about mental health, dementia and cardiovascular issues—there is no national plan for eye care. It is hit and miss, as my hon. Friend says, and the lockdowns have exacerbated all the waiting lists.

I want to flag the work of my constituent, Judith Potts. For seven years, she has been a one-man band with her charity Esme’s Umbrella, looking at the unusual—actually, it is more prevalent than we think—Charles Bonnet syndrome. The disease affects people who are losing their sight, and they see vivid hallucinations of often quite specific images—they can be swirly patterns and shapes, and they can also be gargoyles, world war one soldiers or boys in sailor suits. When that was described to me, I had never heard anything like it. We have had two receptions just across from this Chamber, in the Jubilee Room, for Esme’s Umbrella, which is now becoming constituted as a proper charity.

It was Judith’s mother, Esme, who suffered from Charles Bonnet syndrome. Judith has managed to persuade the World Health Organisation to recognise it as a condition in the ICD-11—the eleventh edition of the “International Classification of Diseases”—but there is no training for it at medical school and it is seen as a side effect of sight loss. It is estimated that the number of people who suffer from the condition is in six figures—some estimates say there could be a million sufferers in this country—yet people do not even know what to google because it is so unheard of. There are no pathways, no magic pill that can make it disappear and most people have never heard of it. More research is needed to cure the condition and to help people cope with it. There is a job to be done.

“Coronation Street” has played a big role, with the actor Richard Hawley, who was at our last reception in the autumn—I think my hon. Friend the Member for Battersea was there as well—playing the character Johnny Connor, who is a sufferer. That has done something to put the condition on the map, but I appeal to the Minister to recognise Charles Bonnet syndrome as part of a comprehensive eye strategy. Proper research needs to be funded. The trustees of the Esme’s Umbrella charity, as it has now been constituted, are highly respected people from Great Ormond Street, Moorfields and the Francis Crick Institute. They are all top consultants, but as the condition is not a recognised thing, they have to do the research on the side. That is not satisfactory. We need to persuade people, take them with us and fund the proper research.

In March, the Health Service Journal reported on a survey carried out by the Royal College of Ophthalmologists, which found that independent providers—my hon. Friend referred to this too—are having a negative effect on patient care. I mentioned this on Monday, so I hope Members will forgive me if they have a sense of déjà vu. Patient choice sounds good and we have backlogs that need clearing, but the independent sector creams off all the stuff aimed at cutting the cataract waiting list, which is low-risk, routine work—and I have to say that those patients are usually from majority white populations—when it could do out-patient appointments or follow-ups too. The NHS is left with serious and costly cases of high complexity, in which patients—typically BAME ones, I have to say—are at risk of going blind.

The Royal College of Ophthalmologists found significant staff shortages in NHS ophthalmology capacity. That is set to worsen in coming years unless immediate action is taken. Seventy-six per cent.—over two thirds of NHS eye units in the UK—do not even have the consultants to meet current demand and 80% have become more reliant on non-medical or allied professionals in the past 12 months. The capacity is missing. The equation has gone all wrong. Twenty-five per cent. of consultants plan to leave the ophthalmology workforce in the next five years. That includes those planning to retire, but we also have a mismatch, with doctors being trained in hospitals where the easy cataract stuff is gone. They are meant to get their teeth into that first and then do the complex stuff; it has all gone the wrong way.

As well as the training issue, there is an issue with the sustainability of the NHS. Tackling the backlogs is a priority, but so is sustainability and training in our health service. Dr Evelyn Mensah, an inspirational woman at Central Middlesex Hospital, argues that the status quo is leading to the destabilisation of hospital services. The inequity that has flowed means that the foundational principle of the NHS at its launch in 1948—the whole point that it is free at the point of need—has gone wrong. In other words, if patients have the easy stuff, they will be dealt with, but if they have the sight-threatening, dangerous stuff, they languish.

Dr Mensah says that the direction of travel towards the private sector, instead of

“resourcing and supporting the NHS is undermining our comprehensive free service and will exacerbate inequality.”

She asks for additional funding to support independent recovery as, right now, private providers cherry-pick the low-risk cataract work and people are in danger of going blind if they are not seen in time. These are very uncomfortable procedures on the delicate eyeball, which is susceptible to discomfort and infection. We need to save sight, as well as the low-risk stuff. As a business case, the status quo is not good value for the taxpayer; we need to do both.

The College of Optometrists argues for more mixed-mode referrals. There are record numbers in the surgical backlog, but there are also out-patient delays with glaucoma reviews, medical retina reviews and all the follow-up stuff. Diseases such as glaucoma are silent, so it is easy to put them off forever and ever, but people’s sight is threatened; we cannot postpone these things.

We need to spread the load. The whole point of ICBs is that they are meant to provide integrated care, so let us share the load, with proper guidance. In an ideal world, the work would be universal, standardised and consistent. There would be data sharing and all the systems would be joined up at the touch of a button. We could deliver eye care in a modern way, working together and contributing to the system.

Joy Hynes from Hynes Optometrists on Northfield Avenue told me:

“I would like to understand why the urgency for controlling our increasing numbers of myopic patients is not being taken seriously. The Government has no strategy for prevention of this myopic epidemic. Myopia sadly often leads to blindness and that in itself is a problem with scant resource. Understanding the gravity of this situation we have for years been successfully running a specialist clinic for myopia management. This should not be the domain of the well off but should be available to every myopic child.”

In conclusion, we cannot rewind the clock to February 2020 overnight, but let us hope that the jolt of covid is a wake-up call to connect all the different bits of community eye care, optometry and hospitals. Let us go for diversity and inclusion in the workplace, as well as equality of outcomes, so we can join up the different systems and institute a national eye health strategy. I am so proud of my hon. Friend the Member for Battersea and her Bill. Clearing the backlog is only part of the picture. Let us go for a systemic approach with a national strategy, so that sight can be saved.

--- Later in debate ---

[Neil O'Brien]

Until there is a date, there is no date, but it will be fairly soon.

[Dr Huq]

The Minister says he is open to the idea of more research. Charles Bonnet syndrome is recognised by the NHS, but it is seen as a side-effect of sight loss. Will he commit to some proper research on that?

Just to correct the record, I agree that it should be all hands on deck to clear the backlogs. I was not saying that it is either/or; it is about joining forces on cataracts.

[Neil O'Brien]

Very good. As a first step towards the research that the hon. Lady calls for, I commit to doing my own research on the syndrome that she describes, which sounds incredibly disturbing for those who suffer from it.

I hope that the range of work that I have outlined reassures hon. Members that we acknowledge and take seriously the hugely important challenges faced by eye care services. We are working at pace on these issues, and we will be doing more. I thank all hon. Members who have taken part in the debate for raising these important issues.

Health Inequalities: North-west London

Rupa Huq Excerpts

Monday 15th May 2023 Commons Chamber

[Dr Rupa Huq (Ealing Central and Acton) (Lab)]

As Public Health England said in 2017:

“Everyone should have the same opportunity to lead a healthy life, no matter where they live or who they are.”

In reality, someone’s socioeconomic and environmental circumstances will determine that. Health inequalities are about not just clinical disease, but wellbeing and a complex cycle of interacting factors. Income, education, housing, environment, experience of discrimination and “sharp-elbowedness” are all unevenly distributed among the population and the playing field is far from level.

The Government have been widely condemned by the British Medical Association, numerous pressure groups, royal colleges and professors for their U-turn on their 2021 commitment to publish a White Paper on health disparities. The ex-deputy director of health inequalities at the Department of Health, David Buck, is now at the King’s Fund. He called it

“the latest example of repeated political failure to tackle the widening inequalities that leave thousands of people suffering and dying earlier than they need to.”

In talking about north-west London, I am referring to the health administration definition of that area. That comprises suburban Ealing, Brent, Hillingdon, Harrow and Hounslow, and the more inner-city areas of Kensington and Chelsea, and Hammersmith and Fulham. At first sight, they look to be an affluent chunk of both the capital and the country, with a population of 2 million-plus. On closer inspection, however, the eight boroughs covered by the integrated care board contain huge discrepancies, both within and between, in life expectancy, ethnicity, income and multiple determinants behind headline health issues. Big ones locally include diabetes, cardiovascular, maternity and mental health services—all factors identified by the integrated care board’s decent “addressing inequalities” strategy last year.

So what’s class got to do with it, as Tina Turner might have said? Well, the answer is a lot. Average income in Ealing Broadway is £49,100, which is above the national average. However, if you get off Crossrail five minutes later at Southall, it drops to below £30,000. That is £20,000 down in a couple of tube stops. A man in Chiswick will, on average, live for over 82 years. That is 5.8 years longer than in neighbouring south Acton. One is in W4 and the other is in W3. And if anyone has a serious mental health condition, we have to subtract 15 to 20 years from those totals.

Demographically, north-west London has a young population. There are worryingly long waits for child and adolescent mental health services appointments. Every parent knows how children were affected by lockdowns, whether mentally, in lost learning or socialisation. The population is young, but it is ageing. In the ICB, 13.1% of people are over 65. That is forecast to climb, putting a strain on council budgets for adult social care and dementia services. My own late mother, who is looking down somewhere from above, was a dementia sufferer, so I know all too well about that condition. If we add to all those factors Brexit, the cost of living crisis, the aftershocks of long covid and the long waiting lists that have grown since, our cradle-to-grave health service locally is under pressure like never before. Medical staff at the sharp end are in danger of burnout and stress. What I want to say to the Minister is that political intervention can help to solve that and address all those problems.

North-west London is ethnically diverse and that is seen in the disproportionality. For example, 164,435 people in north-west London live with diabetes. Forty-three per cent. of those registered are Asian British, 24% are the population at large. Ditto heart disease: 30% of registered patients are Asian British, 24% are the general population. In the eight boroughs, 18,000-plus people have serious mental health problems. The black British community represent over twice the number of registered mental health patients: 17%, compared with the wider population, at 8%. On cancer, which saw off my late father, who is looking down from somewhere, the white community make up 61% of cancer patients, but 42% of the whole population and prevalence is strongly linked to age.

Poorer finances lead to stress, which, in turn, can lead to the take-up of unhealthy behaviours, such as smoking, and a drop in the take-up of healthy leisure activities. It is a vicious cycle, with happiness and loneliness also in the mix. So what can be done? I have a series of lessons for the Minister. They are things that are fixable, and would be easy wins for the Government and for the country.

First, if we pay people fairly, we will have a contented workforce. That includes those in health and social care who we somehow expect to be superhuman. We have seen junior doctors, paramedics and, for the first time ever, nurses out on strike, when, not that long ago, all of them were hailed as heroes. It was a common sight to see those rainbow drawings with, “Thank you NHS”, pasted up around our streets. We have clapped for carers, but the poorly paid adult care sector, which covers private companies through to council provision, is non-unionised and too disorganised, with too many zero-hour contracts for its workers to be able even to withdraw their labour.

I emailed the title of this debate, “Health Inequalities: North-west London”, to a few people, including a very respected retired consultant at Ealing Hospital. His answer was, “I never needed to supplement my NHS income with private work in my day, but I understand that a lot of the younger generation do”. Again, that shows how this question can be interpreted differently by different people. It should not have to be that NHS employees have to bump up their wages through other means.

Secondly, councils should be sufficiently resourced. Ealing has developed a great healthy lives strategy, and even a racial equality commission following what happened to George Floyd, thanks to Councillors Josh Blacker and Aysha Raza. However, £6 out of every £10 that the borough had in 2010 has gone in local government cuts. It is facing a rising population and is expected to do more and more with less and less, because public health has been added to its brief. That means that corners are cut. Some boroughs, for example, have stopped smoking cessation services. Although smoking in the population has declined, it is still the biggest avoidable risky lifestyle factor everywhere.

The third lesson is to stop reaching for facile “solutionism” and the target culture, which can have perverse outcomes: for example, if one vows to reduce waiting lists and then there is no treatment available at the other end. There is the unintended consequence of patient choice at the eye department at Central Middlesex Hospital. I visited there and was told that private providers cream off some of the easy cataract work—the typical patients are majority-white elderly patients. They are opting to do so because they can, leaving the NHS with unaffordably big bills, plus all the complex procedures—the patients are commonly BAME people—for things such as glaucoma and diabetic eye disease. So the NHS is left with all the difficult stuff. It also means that junior doctors training in hospital are not able to start on the easy stuff. The profile of their training is getting skewed, which needs to be addressed. It is an unintended consequence. We should be under no illusions that backlogs were present before covid.

The fourth lesson is to go out to communities and housing estates. Both Ealing and Camden have an HIV bus and a diabetes bus that go into the estates. That is better than expecting those hard-to-reach populations to come to the hospitals.

The fifth lesson is to listen to the person at the frontline, not just the man from the Ministry. London has a GP crisis, which needs addressing. That should be done by consulting the GPs rather than by imposing solutions in the face of their rising workload and shrunken workforce. One local practice in Ealing had architect costings and planning permission to renovate their premises to bring it up to scratch to accommodate the rise in their patient numbers—from 3,000 to 9000 in a decade. However, under current regulation, although the practice is at capacity, it is not allowed to refuse anyone and NHS Estates says it cannot pay the rent. One partner there said:

“Frankly, there is no estates strategy, we’re just being asked to ‘suck it up’ at full capacity until reaching breaking point… In the meantime, our landlord could serve us notice at any time, putting nearly 10k patients at risk.”

Point six is to look at the profile of disease and trials and recognise that the woman in the white coat can know better than the man in the grey suit. Dr Christiana Dinah, NHS consultant ophthalmologist of those aforementioned vision-threatening conditions in Ealing, Brent and Harrow, conducts award-winning research, but she has a problem in that the BAME population are under-represented in the clinical trials. If only the white well come forward, that gives an incomplete picture, and it jeopardises the chances of the results being applicable and the treatments effective in all the target populations. There is work that could be done there.

We have seen local services withdrawn, including maternity, paediatrics, stroke and mental health beds gone from Ealing. I am familiar with the bureaucrat’s argument that people do not need a facility at the end of their street if there is a much bigger and better one slightly further away, but even if we accept that, let us remember that when facilities get “consolidated”—that is the language—it is no good if there is no public transport to get there, and conduct mandatory mapping.

My penultimate message is to stop blaming individuals, as Government messaging sometimes tends to sound as though it is doing. We are the most obese nation in western Europe, and Sir Simon Stevens once said that obesity threatens to bankrupt the NHS, yet the official rhetoric presupposes that that is a choice. If someone is time and cash-poor, feeding multiple mouths and working multiple jobs, the ultra-processed, high fat, sugar and salt, unhealthy choice tends to be the most convenient and the cheapest. We could look at incentivising buying organic and fresh food, so that the healthy choice becomes the easy choice, and we could do so by taxing and pricing, as we have seen with the sugar tax and, historically, the decline in smoking due to the tax regime.

Lastly, we could recognise the joined-up nature of policy intervention. A mixed-ability comprehensive school that I was at the other day, which not long ago was in the “requires improvement” category, noticed such a glut of obesity among pupils post lockdown that it now provides a free breakfast for all, a free Chromebook for all and voluntary basketball at 7.30 am. The take-up on all three has been enormous. It is expensive, the head said, but it is worth it: the school is out of special measures and even has record successful Oxbridge acceptances. Sadiq Khan’s free school meals for all primary pupils from next year is another visionary and bold scheme. It sounds a bit Oliver Twist, but I say, “More please, Minister!”, so that we can do it nationally.

In short, I would say, “Be unafraid—be very unafraid—of intervention.” Health inequalities arise from overlapping factors, from commercial to cultural, but also from politics and policy. Covid-19 illustrated how disadvantaged communities experienced proportionally higher morbidity and mortality, but before coronavirus hit, who would ever have thought that the Government would foot the nation’s wage bill while we were all locked up for months on end, or preside over the biggest ever mass vaccination programme? We can do things when we put our mind to it, and the pandemic was meant to be a reset moment, was it not?

In this country, we are mostly all—to paraphrase Bruce Springsteen—born in the NHS, but divergence starts at birth. It is a scary sign of rampant inflation that baby milk is now theft-alarmed in supermarkets. Professor Michael Marmot recently stated in the i newspaper that a proper start in life is so fundamental that the powdered formula should be free on prescription for those forced to shoplift it. It is an idea; I do not think it has been taken up by any political party, but it is a thinking-outside-the-box solution.

Another issue we could address, at the other end of the life cycle, is loneliness, which stereotypically, but not exclusively, affects the elderly, and is said to be as bad for health as smoking 15 cigarettes a day. Let us think of ways around it. Apparently, loneliness is even worse and more isolating for BAME communities, despite the stereotype about them living in extended families. The north-west London data shows that it is really bad there, but it is bad everywhere.

Although the Government have attributed unprecedented food and fuel prices to Putin, in reality the perma-crisis that we inhabit flows from political choices—more than a decade of austerity and the chronic underfunding of public services starved of cash by Cameron and Osborne—but we are beyond that now. To repeat myself, strategising should not equal stigmatising people and implying that they are the problem.

When we drill down, it is difficult to find issues that do not contribute to health outcomes. I do an advice surgery every week, and people come and show me pictures of mould and damp. At the end of last year, I think mould was, for the first time, mentioned on a death certificate, and air quality has been identified on a death certificate as well. Well-designed quality and affordable housing directly impacts on physical and mental health, as does access to green spaces and play spaces.

We have longer than we thought because it is not yet 10 o’clock. I do not know if anyone else saw, but there was half a page in a Murdoch newspaper today attacking little old me in connection with a proposed housing scheme in Ealing that is not going ahead now. It is quite a bizarre article—a whole half-page rant about me—and I did not know that it was coming. Everyone here knows that MPs do not decide housing applications or policy, but in that particular developer-led scheme, the private developer pulled out because it would not pay for the post-Grenfell fire safety measures that are now law—it did not want to foot the bill for that. As a west London MP in a borough neighbouring Kensington and Chelsea, I think that, after that enormous and avoidable loss of life, we should never scrimp on fire safety.

Anyway, I said that I was going to conclude. I did not even get to the removal of maternity functions of Ealing Hospital in Southall, or the fact that pre-term deaths in pregnancy are experienced four times as much by black mums as by the population at large, and that poorer communities living by main roads breathe more polluted air—plus, in north-west London we have Heathrow airport, which is ever hungry to expand despite the climate crisis. I did not get on to any of that because the debate could have gone on and on, but I will say that acting on health inequalities improves lives and livelihoods, cuts costs to the NHS, to the benefit of wider society, prosperity and the economy, and it would save the Exchequer billions in lost productivity through long-term sickness.

We should be bold. We should act and think beyond eye-catching short-term targets aligned to electoral cycles —me in particular, as I have seen so many snap elections in my lifetime; it does not work to think in terms of normal electoral cycles any more. Let us think more long term and be honest with people, not treat them like idiots. Let us take a multi-pronged approach to levelling up—the Government’s watchword. In the meantime, if anyone has any clue about where the £350 million per week that was promised on the side of the Brexit bus is, please inform our local NHS folk. I took a wide range of soundings to come up with this content, but no one says that they have seen that money.

I look forward to the Minister’s response—I know that he is a good man. I do not think it beyond the wit of man to do this. We can do it.

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

Well, how to follow that? I pay tribute to the hon. Lady for securing this important debate and for her wide-ranging speech. It was so wide ranging that I think I will struggle to follow or match it, but I will do my best. It was a speech with everything from Tina Turner and Bruce Springsteen to loneliness and ethnic minority participation in clinical trials. Let me try and structure my response by starting with the health service, working back to primary care, and then addressing public health.

The first and most central thing is, of course, to have a high standard of healthcare. That is why, between 2010, when we came into office, and the end of this Parliament, we will have increased spending on healthcare by 42%, even when adjusted for inflation. That has enabled us to hire about 37,000 more NHS doctors than there were in 2010, and 52,000 extra nurses. That is a huge increase in resource and people, enabling us to start hacking through the covid backlog. We have already eliminated the two-year waits and have very nearly eliminated the 78-week waits. We are now moving on to eliminate shorter waits as we work through and cut the NHS waiting lists.

Of course, that is downstream—that is secondary care, hospitals and treating disease—and we all agree that the name of the game is to try to prevent disease and to treat things upstream, which is why we made further investments in primary care last week. In general practice, we have about 2,000 more doctors than we had in 2019 and about 25,000 more other clinicians. Compared with 2017, total spend on general practice is nearly a fifth higher. So more resource is going into that primary care.

We also see primary care doing more than ever. GPs are doing about 10% more appointments every month than they were before the pandemic, in 2019. That is the equivalent of about 20 extra appointments per practice per working day, which is a huge increase in output. That is partly because of the extra resource and partly because GPs are working extremely hard, and I pay tribute to everyone in general practice for doing that. That activity in general practice is a big part of the prevention story, helping people to stay healthy and to stay out of hospital.

However, as the hon. Lady alluded to, a lot of health is about the social determinants of health and about getting further upstream and tackling the underlying causes of the disparities that she talked about with great passion and understanding. Taken together, the public health grant, the drugs grant and the Start for Life grant will grow by about 5% in real terms after inflation over the next two years, enabling us to do more, particularly on problems such as drug dependency and drug addiction, which are particularly serious across all of London.

Part one is to have the funding there for those streams, but we have also been making major institutional changes to public health. We have set goals to increase healthy life expectancy and to the narrow gaps between different parts of the country. We have created the Office for Health Improvement and Disparities, and we and the NHS have created the Core20PLUS5 framework, which is a way of thinking about and tackling disparities. We have also put a new duty on integrated care boards to have due regard to disparities and to try to tackle them.

In quite specific ways, we have been taking action—this is of course relevant to north-west London—to tackle the problems of particular ethnic minority groups. In particular, we have been driving up vaccine uptake, particularly in groups where there is a degree of hesitancy, through targeted advertising and outreach to faith groups and local community groups, and I pay tribute to everyone who has been involved in that in the NHS.

We have been tackling the challenges thrown up by energy, which I will come back to, and by social housing—the hon. Lady was quite right to raise that issue in relation to west London. I pay tribute to my right hon. Friend the Secretary of State for Levelling Up, Housing and Communities for the vigorous action he is taking to tackle some of these challenges through the Social Housing (Regulation) Bill and extending the decent homes standard to the private sector, and the action he is taking to make developers pay to clean up the mess they have caused and to make sure we never have a Grenfell again.

So action is being taken across a wide range of areas. Let me just delve into a few of them in the time remaining. On drugs, the Home Office, the Ministry of Justice and the Department of Health and Social Care are investing about £900 million extra in the drugs strategy, which will grow local authority funding for treatment by about 40% between 2021 and 2024-25, and create about 50,000 extra places in treatment. As well as that investment in more treatment for people with drug addictions, we are increasing access to naloxone, which helps treat overdoses, and looking at spreading new technologies and new treatments, such as slow-release buvidal. When I visited a health centre in Brixton I saw the effect that some of these new drugs can have on improving treatment for those who have serious drug dependencies.

However, again on the point about getting upstream, our Start for Life programme is a major investment in new and expanded family hubs in about 75 local authorities. Its universal offer in those areas combines peer support for breastfeeding, help for those who are difficult to help and lots of face-to-face support with issues such as mental health. Right from the very start, as the hon. Lady mentioned, this is about trying to improve the disparities that emerge at an early stage.

Across the course of life we are taking action to prevent some of the most important major conditions, and our major conditions paper, which succeeds the health disparities White Paper will say more about this. The NHS long-term plan already announced the ambition to prevent 150,000 heart attacks, strokes and dementia cases by 2029. We supplied about 220,000 blood pressure monitors to those with high blood pressure. We are modernising and updating the NHS health check and creating a digital version. We have already pretty much got back to pre-pandemic levels of health check. We will be setting out more about the prevention of these major conditions in that forthcoming paper.

[Dr Huq]

The Minister is giving a constructive response with a lot of numbers in it. Is there a date for the major conditions strategy? I have asked him before and we have sparred on this question. At the time of the health disparities White Paper, the Secretary of State at the time—just two Secretaries of State ago—said that we should level up health as well as levelling up economically. The strategy does feel like a watering down, and it is yet to see the light of day. Do we know when it is coming out?

[Neil O’Brien]

There is not actually a date for that paper yet, but it will be out relatively shortly. We are tackling the major conditions because these health disparities that we are all concerned about are not mediated by magic; they are mediated by physical things that happen. First among them is probably smoking.

Smoking rates are highest in the poorest places, and that is a powerful driver of all of these other major health problems. I am proud to say that we have the lowest rate of smoking on record in England—just 13%, down from 21% in 2010—and that has happened because we have doubled duty on cigarettes and introduced the minimum excise tax on the cheapest cigarettes, and we have recently announced measures to go further. We are offering a million smokers help to “Swap to stop”, as they say, by giving them free vape kits, because that is so much less harmful, and we will also be introducing a financial incentive to quit, worth about £400, for all women who are pregnant and smoking. A shocking number of people still smoke in pregnancy, particularly in areas of higher deprivation. That builds on some of the things that the NHS is already doing, including the roll-out of carbon monoxide testing for people who are pregnant and smoke, and some of the innovative things that have been done at a local level.

The other big way that these health inequalities are mediated is through obesity. There are much higher rates of obesity in poorer places, for the reasons that the hon. Lady set out. She already mentioned some of the things. She talked about the so-called sugar tax—the soft drinks industry levy, as not a single person ever calls it—which has cut average sugar content in affected drinks by about 46% since we brought it in. We have introduced calorie labelling for out-of-home food in cafés and restaurants, and brought in location restrictions for less healthy food from October 2022. We are bringing in an advertising watershed in 2025. We spend about £150 million a year on healthy food schemes, such as school fruit and veg, nursery milk, Healthy Start and so on. We spend about £330 million a year on school sport and the PE premium. Through the youth investment fund, we are spending about £300 million on 300 new facilities for youth activities. We are also investing about £20 million a year on the national child measurement programme, which is all about trying to note these problems at an early stage and nip them in the bud.

In the hon. Lady’s speech, she talked about the challenges thrown up by the Russian invasion of Ukraine and the effect that has had on the cost of living. Again, we are taking decisive action. We are spending about £55 billion to help households and businesses with their energy bills, which is among the highest and most generous support plans in Europe, paying about half of people’s bills over the winter. On top of that, we have action directly to help with the cost of living for people who are less well off, including the £900 cost of living payment for about 8 million poorer households and the largest ever increase to the national living wage for 2 million workers. In total, we are spending about £26 billion on cost of living support next year. We are taking action on energy, but also at the same time taking further action both to improve the quality of rented and social housing through the Social Housing (Regulation) Bill and to invest more in energy efficiency so that people’s homes are cheaper to heat.

I have tried to tackle some of the subjects that the hon. Lady raised in her speech, which I thought was really interesting to listen to and covered many subjects. I will not be able to tick all of them off this evening, but it was a pleasure to hear about some of her thoughts and ideas, and a pleasure to commend to the House some of the action we are taking.

Question put and agreed to.

Oral Answers

Rupa Huq Excerpts

Tuesday 25th April 2023 Commons Chamber

[Helen Whately]

I thank the hon. Lady for giving me another opportunity to talk about what we are doing to support adult social care: an extra £7.5 billion was announced at the autumn statement to support adult social, an extra £700 million was spent on supporting discharges into social care over this winter, and we have already announced £600 million to support discharges to people’s homes with the provision of social care over the coming year, because we recognise how important it is for people to get the care they need at home. The workforce are crucial to that, which is why we are taking forward our reforms to the adult social care workforce as announced a couple of weeks ago.

[Dr Rupa Huq (Ealing Central and Acton) (Lab)]

T1. If he will make a statement on his departmental responsibilities.

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

The Government support the right to take industrial action within the law, but equally the law is there to protect patients and NHS staff alike. Following legal advice, NHS Employers and my Department are confident that the proposed strike action by the Royal College of Nursing goes beyond the mandate it secured from its members, which expires on 1 May at midnight. While NHS Employers has sought to resolve the issue through dialogue, the RCN’s failure to amend its planned action has led NHS Employers to request my intervention. Even as we work to resolve those issues through dialogue, I can tell the House that I have regretfully provided notice of my intent to pursue legal action. None the less, I am hopeful that discussions can still be productive, especially those between the RCN and NHS England on patient safety, and that they will continue to be guided by the imperative to keep people who use the NHS safe.

[Dr Huq]

The right to choose sounds attractive, but when diabetic eye disease and glaucoma seriously threaten the sight of millions, the fact that any qualified provider can and does cherry-pick reversible cataract work leaves the NHS with astronomical bills and all the complex cases. Will the Secretary of State praise award-winning clinicians Christiana and Evie at Central Middlesex Hospital and visit to see for himself how effectively writing a blank cheque for private treatment is destabilising NHS budgets and jeopardising the NHS’s ability to do award-winning research and to train junior doctors, who need routine work?

[Steve Barclay]

I am always happy to praise the brilliant work of clinicians up and down the NHS, who do a formidable job. Given the huge scale of the backlogs we face as a consequence of the pandemic, it is important that we not only use the full capacity available within the NHS, empowering patients through patient choice and technologies such as the NHS app to better enable that, but maximise the capacity in the independent sector.

Oral Answers to Questions

Rupa Huq Excerpts

Tuesday 24th January 2023 Commons Chamber

[Steve Barclay]

I am happy to meet my hon. Friend to discuss the issues in Shropshire. I draw her attention to the fact that we have more doctors, more nurses and more funding going into the NHS, and more people are being treated.

[Dr Rupa Huq (Ealing Central and Acton) (Ind)]

T9. In the light of the Government’s welcome announcement of the Strathdee rapid review of in-patient mental health services, can we revisit West London NHS Trust’s decision to make the covid closure of the Wolsey wing permanent, which leaves Ealing, the third biggest borough in London, with no acute mental health beds for under-65s?

[Maria Caulfield]

Local healthcare decisions are made by local commissioning groups, but I am happy to raise that on behalf of the hon. Lady. We are putting an additional £2.3 billion a year into expanding and transforming mental health services in the community and patient services.

Oral Answers to Questions

Rupa Huq Excerpts

Tuesday 6th December 2022 Commons Chamber

[Dr Rupa Huq (Ealing Central and Acton) (Ind)]

In a case that is sadly all too typical, a GP in Ealing, who has seen their patient list go up from 3,000 to 9,000 in the last decade, had plans approved for expansion, but NHS estates now will not cough up. What are the Government doing to support doctors in inadequate premises who cannot increase their patient lists to expand and modernise in the current climate?

[Neil O’Brien]

The total activity done by GPs was about 7% up in October compared with the previous year. We are actively looking at the way that capital works and the contributions of section 106 and the local integrated care board, to ensure that, as well as having those 2,300 extra doctors and 21,000 extra staff, GPs also have good facilities to work in.

Oral Answers to Questions

Rupa Huq Excerpts

Tuesday 1st November 2022 Commons Chamber

[Helen Whately]

I am very happy to commend the work of the Stroke Association, and I would be delighted to meet my hon. Friend to discuss this further.

[Dr Rupa Huq (Ealing Central and Acton) (Ind)]

A respected woman pharmacist in my constituency, with a lifetime of NHS experience, went solo with her own practice in the hope and expectation of an NHS licence, which she has been denied. Will the Secretary of State look into the opaque decision-making process? Our increasing population otherwise means increasing demand, and my constituent cannot survive on private alone.

[Steve Barclay]

I am very happy to look at this case.

Prison-based Addiction Treatment Pathways

Rupa Huq Excerpts

Wednesday 2nd March 2022 Westminster Hall

[Dr Rupa Huq (in the Chair)]

I call Dan Carden to move the motion. The Minister will respond, but there is no right for the mover to respond at the end, as is the norm in 30-minute debates.

[Dan Carden (Liverpool, Walton) (Lab)]

I beg to move,

That this House has considered prison-based addiction treatment pathways.

It is a pleasure to serve under your chairmanship, Dr Huq. Too many people with drug dependency

“are cycling in and out of prison. Rarely are prison sentences a restorative experience. Our prisons are overcrowded, with limited meaningful activity, drugs easily available, and insufficient treatment. Discharge brings little hope of an alternative…life. Diversions from prison, and meaningful aftercare, have both been severely diminished and this trend must be reversed to break the costly cycle of addiction and offending.”

Those are the words of Dame Carol Black in her groundbreaking independent review of drugs—a damning observation.

The treatment system and effective recovery pathways from addiction in prisons are in desperate need of repair, yet the effectiveness of evidence-based, well-delivered treatment for drug and alcohol dependence is well established. When it is properly funded, it works: it cuts the level of drug use, reoffending, overdose risk and the spread of blood-borne viruses.

Analysis of Her Majesty’s inspectorate of prisons data from 2019 reveals that 48% of men surveyed by the inspectorate who reported having a drug problem said that it was easy to get drugs. The proportion of prisoners who said that they developed a drug problem while in custody more than doubled between 2015 and 2020.