Dementia Research in the UK

Rupa Huq Excerpts

Thursday 10th February 2022 Commons Chamber

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

I beg to move,

That this House has considered dementia research in the UK.

I thank the Backbench Business Committee for granting this important debate, the all-party parliamentary group on dementia, of which I am the co-chair with the wonderful Baroness Sally Greengross, and the Alzheimer’s Society for all its work to support the APPG. I also thank the many Members who agreed to sponsor the debate, although being just before recess it is obviously a difficult slot to fill.

Dementia is one of the biggest health challenges that we face today. It is the UK’s biggest killer and, with an ever-aging population, the number of people living with dementia in the UK and around the world is set to grow. Indeed, figures from the Alzheimer’s Society show that around 900,000 people are currently living with the condition in the UK, and that number is set to grow to 1.3 million by 2030. There will be few of us who do not know somebody who is either living with dementia or affected by it.

That includes me. My mum was 64 when she was diagnosed with Alzheimer’s disease and unfortunately she died 10 years later. The work I do on the APPG is in her memory, and in recognition that there are millions of families affected by dementia and who are currently caring for people they love who have one of the many degenerative brain diseases that cause dementia. We frequently talk about dementia as though it was just one disease, but it is not. Dementia is a set of symptoms, but there is an array of degenerative brain diseases that make up dementia, of which Alzheimer’s disease is probably the best known.

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

My hon. Friend talks movingly about her mum. My mum also had frontotemporal dementia as the cause on her death certificate in 2017, 10 days before polling day—thanks, mum! Towards the end they have a mixture of intransigence, stubbornness, regression and paranoia. A minibus from Ealing Council used to come and take her to a memory clinic in Acton, but it was largely old chaps playing dominoes, and that was not really her scene. She loved entertaining, and it was so sad that someone who used to cook for so many forgot how to swallow by the end. Does my hon. Friend agree that, as well as the shocking “moonshot” that we were promised in the 2019 Conservative manifesto, which has never happened, research should look at culturally and gender-appropriate solutions to this awful disease? As she says, so many of us know people who are afflicted by it.

[Debbie Abrahams]

I thank my hon. Friend, who makes a powerful point about her own experience with her mum’s frontotemporal dementia and the importance of ensuring that we understand, from different cultural perspectives and different ethnicities, the impact of dementia and how we care for our loved ones who have it.

I want this debate to be about hope. That is so important. My hon. Friend has just spoken about her mum, and it was very hard for my mum. She could not speak and could barely move. She could not feed herself. It was a very sad state. However, there is huge optimism and reasons for hope, and that is what I want this debate to be about. I firmly believe that, as with many other conditions, research will find a cure for dementia.

We have one of the best life sciences sectors in the world, as we have seen over the past few years with the work that the University of Oxford and others have undertaken with the covid vaccination programme. Our researchers are rarely talked about, but they are our unsung heroes and we should be immensely proud of the work they do and the significant contribution they make to the economy. I believe it is a matter of when, not if, we will see the breakthroughs that are desperately needed for therapies in dementia research.

However, that is fundamentally dependent on adequate investment. Despite the ever-increasing prevalence of dementia, research into it is consistently and disproportionately underfunded. There is news from the United States of treatments such as aducanumab, which has just been approved by the Food and Drug Administration and is expected to help people when they are diagnosed with dementia. This is a great and exciting opportunity for the Government to support the field and cement the UK’s place as a world leader in dementia research.

As my hon. Friend has just mentioned, we know that during the 2019 general election the Conservative party promised to double dementia research funding from £83 million to £166 million a year over a 10-year period—the “dementia moonshot”. Similarly, the Labour party has committed to that. We have cross-party consensus, but we are still waiting for the Government to bring forward any of that additional funding. Last year, in fact, there was a 10% fall in the amount of funding provided to dementia research, so it received only £75 million instead of £83 million. That is a huge missed opportunity to expand our research capabilities in that area, to support the inspiring academics working in the field and to provide hope to the millions of people affected by dementia across the UK. It also does not make economic sense, as I will move on to later.

Children’s Mental Health

Rupa Huq Excerpts

Tuesday 8th February 2022 Commons Chamber

[Dr Allin-Khan]

As always, my right hon. Friend is a powerful advocate for all groups, but particularly when it comes to black and minority ethnic groups. We do not have the data—we do not collect the data—even to understand the scale of the issue. I think that that is convenient for the Government, because it means they do not have to accept that there is a problem which needs to be dealt with.

That is one of the issues for the future. We have to understand the true scale of the issue when it comes to some minority groups, and tailor support that helps them specifically. When people from minority groups are seeking help, often it is so difficult for them to make a connection with people who understand some of the particular social pressures they live with at home and some of the societal issues they have to deal with that also contribute to mental ill health—for example, systemic racism. My right hon. Friend is absolutely right to bring that up.

We have a range of public health measures in place for children—check-ups for eyesight, hearing and growth—and vaccinations to protect against measles, mumps and rubella, yet we ignore the wisdom of the ages when it comes to children’s mental health. As a doctor, I know that adverse childhood experiences are a key contributing factor to poor mental health in adulthood. In A&E, I see increasingly younger children coming in having self-harmed or living with eating disorders. It is simply heartbreaking, and for parents it is absolutely agonising. Parents bring their children to A&E wondering why they are fainting repeatedly and are constantly exhausted.

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

Does my hon. Friend agree with me as a parent—we are both parents and many of us here are parents of school-age children—that the coronavirus crisis hit everyone with kids? I have 13 private schools within my constituency boundary, and I even have parents of children there emailing in that their kids, who were happy and outgoing children, are zonked in front of Teams meetings all day and have turned into blithering wrecks of what they used to be. Coronavirus exacerbated what was a problem with CAMHS all the way along and that has hit all children in this country, and the only people who will not recognise it are Conservative Members, who are in denial because they have their own internal problems to be dealing with.

[Dr Allin-Khan]

I thank my hon. Friend for her very powerful point. When it comes to mental ill health, no group is unaffected. It is really important that we acknowledge that, while some groups are disproportionately affected, mental ill health can affect anyone. Children can live in a £3 million house, and still feel they want to take their own life or want to self-harm. The pressure that puts on parents is extremely painful, and it causes many parents to give up their job to sit at home and care for their child, because they are so crippled and so worried about what may happen if they leave the house and go to work. That is why it is so important that we acknowledge the real difficulty we have with waiting times for CAMHS.

Covid-19: Immunology Research

Rupa Huq Excerpts

Thursday 9th September 2021 Westminster Hall

[Dr Rupa Huq (in the Chair)]

Before we begin, may I encourage Members to wear masks when they are not speaking, in line with current Government guidance and that of the House of Commons Commission? Although the Xs on the seats have now gone, please give each other and members of staff space when seated, and when entering and leaving the room.

Members should send their speaking notes to our colleagues at Hansard—the email address is [e-mail]. Similarly, officials should communicate electronically with Ministers rather than pass them notes, as happened in the old days.

[Jim Shannon (Strangford) (DUP)]

I beg to move,

That this House has considered the role of immunology research in responding to the covid-19 outbreak.

Thank you for calling me to speak, Dr Huq. I thank the Backbench Business Committee for allowing me the opportunity to highlight one of the many successes for this nation. Unlike yesterday, the Minister will have an easy ride in responding to my comments, and hopefully to the comments of other Members as well.

Every one of us across this great nation of the United Kingdom of Great Britain and Northern Ireland recognises the good work that has brought about the vaccines, to deal with covid-19 in a way that could never have happened if we had still been in the European Union. I am not looking for any discussion about Brexit, but we had the independence to roll out the vaccines. The Government had the foresight to do that, and the Prime Minister put the Minister for Covid Vaccine Deployment, who is present, in charge of making that happen.

Every one of us recognises that the Minister and his team across the whole of the United Kingdom, in co-operation with all the regions of Scotland, Wales and Northern Ireland, have made this happen. We are eternally grateful to them for that. I wanted to put that on the record first, because it is so important to say that we are where we are today because of the strategy of our Government, the work of the vaccine Minister and—I say this as a Christian—the prayers of God’s people. We have seen the championship of community working together.

I participated in a Westminster Hall debate over in Portcullis House; it is so nice to come back to the real Westminster Hall and to claim my seat in this corner of the room. Hon. Members have asked me why I sit here. It is because I always sit here—I think my name is written on the seat. We had a fantastic debate in Portcullis House on the issue of communities working together, and many of us took the opportunity to speak of how our communities had come together. As elected representatives, we can all subscribe to the belief that whenever the chips are down, the goodness of people always shines through. From a community point of view, I am able to convey some of the good things from my community, and I know that others can do so as well. I have been double-vaccinated, as I suspect everyone present has been. The many victories that have happened behind the scenes should be celebrated.

The topic of the debate is immunology research into covid-19, and I thank the Library for its very helpful briefing. Page 3 gives a really good introduction to the subject:

“immunology has changed the face of modern medicine…From Edward Jenner’s pioneering work in the 18th Century that would ultimately lead to vaccination in its modern form (an innovation that has likely saved more lives than any other medical advance), to the many scientific breakthroughs in the 19th and 20th centuries that would lead to, amongst other things, safe organ transplantation, the identification of blood groups, and the now ubiquitous use of monoclonal antibodies throughout science and healthcare.”

Immunology has helped our great health service to move forward. I asked for this debate some time ago, and I want to put on the record our thanks to the immunology experts and scientists. I am going to mention a lot of people in this debate today, because there are a lot of people to thank; I apologise in advance if some people are not mentioned, but that is not because we have forgotten about them. I recognise that, singly and as a team, we all came together to make this happen.

I will then speak to some of the successes that immunology research has had during the pandemic in furthering our understanding of covid-19 and the effects that SARS-CoV-2 has on our immune systems, as well as developing the technologies and therapeutics that are currently allowing us to emerge from lockdown restrictions and return to normal life—this here is the normal life we had prior to covid-19 in Westminster Hall. As I progressed around Westminster Hall, the House of Commons and the House of Lords and Portcullis House, I noticed these wee circles on the carpet. I wondered what they were all about, but then I realised: that is where the wee “Keep two metres apart” signs were. They have all gone away.

Normality is returning for a number of reasons, and I know that the Government and the Minister are committed to returning to normality in every way we can. Yesterday in the House, I asked the Minister how we can better have an agreed covid vaccine strategy within the four regions where one size fits all, as I put it. It would be nice to see that, although I know that the restrictions differ; I know that Scotland is going to do something different, as the hon. Member for Airdrie and Shotts (Anum Qaisar-Javed) may mention shortly. Lots of things have been happening, but from a news and media point of view it would have been nice at least to have had the same strategy for everywhere across this great United Kingdom of Great Britain and Northern Ireland.

Over the past 18 months, immunology has had a disproportionately large effect in driving forward our understanding of the science of, and helping us to recover from, the covid-19 pandemic. Immunology has built our understanding of how the body responds to covid-19—and, crucially, has delivered us highly safe and effective vaccines. We all know that. I have had the vaccine, as have others: it does not give us the ultimate assurance, but it gives us a 96% or 98% assurance of being safe and secure, which I believe is our way out of the pandemic.

Immunology is the linchpin linking together many of the sciences that have been used in tackling the covid-19 pandemic, such as virology, respiratory science and epidemiology; for the latter, immunologists have been working with epidemiologists to help make their mathematical models more accurate. I chair the all-party parliamentary group on respiratory health. We have recently had an inquiry on this issue and have done a number of things relating to respiratory health. Through the work of my constituency office, I have become aware of so many people who have issues in relation to asthma, chronic obstructive pulmonary disease or other respiratory problems. I am aware of those issues, and I am interested in them.

We know that a multitude of different reactions of the immune system manifest themselves through the many different symptoms and severities of covid-19 that have been observed—from the acute disease right the way through to long covid, which more and more people are reporting they are suffering from post-infection. I have had a number of people contact me about long covid; I am not sure whether there is a real understanding of how long covid affects people, and why it affects some people and not others.

A lady in my constituency contacted me just the other day, looking for some advice about her job and where she stands. Legally, there may not have been the protection that she had hoped for, but I think the Government have set in process a benefit system whereby if a person has a health condition that prevents them from working, they can claim employment and support allowance, personal independence payment or universal credit. I was pointing her in that direction, but this lady had been perfectly healthy. She worked in a wee bakery just down the street from my office. I got to know her quite well. I had not seen her about as often, but I thought that that was maybe because we were working different shifts.

Perhaps in his response the Minister could give us some idea about how we can help those with long covid. There are a number of them out there—not just that lady, but others who have contacted me recently; we got them on to benefits and tried to help them through the system. However, what that lady really wants, and what they all want, is to return to work and to normality. It may be some time before that happens. The benefits system is in place at least to help them financially, but we need to do more so that they can deal with the issues themselves, now and in the future.

Significant patient benefit and public health improvement directly demonstrate the huge value of investing further in immunology research. The Library paper referred to the

“Important research questions that will take time to answer”.

Research and development are working towards having in place vaccines and responses to diseases as they happen. I will comment on that later. The important research questions that take time to answer are:

“What is the rate of asymptomatic spread, and how does this contribute to transmission? What proportion of infected individuals mount a protective immune response? How long is natural and vaccine immune protection likely to last? What immunological factors correlate with protection to SARS-CoV-2 by vaccines and how effective are vaccines at protecting older people? What is the role of immunogenetics in SARS-CoV-2 infection and what can this tell us about potential therapeutic targets?”

Those are all key questions for those involved in R&D, and they are clear. They help us to prepare for the future. In the research that I did—I want to refer to it later on—I found that R&D was actually working towards this vaccine even before the disease came about. When the Government announced the vaccine, there had already been a number of years of investigation and research and development into this particular subject matter.

Some of the questions that the UK Coronavirus Immunology Consortium were asking were as follows:

“How long does immunity from COVID-19 last? Why are some people’s immune systems better able to fight off the virus?”

That relates to those who can recover quickly and those who have long covid.

“Why do some people’s immune responses cause damage, especially to the lungs? How does the virus ‘hide’ from the immune system and how can this be tackled?”

Right across the United Kingdom of Great Britain and Northern Ireland, again, perhaps the Minister can give us his response to this question as well.

Ulster University in Northern Ireland was working in partnership with some of the larger pharmaceutical companies on vaccine research. How important we all believe those R&D partnerships between universities across the whole United Kingdom—including Ulster University in Northern Ireland, obviously—are in bringing about some of the vaccines that we have!

Vaccines, of course, are no doubt having the most effect on people’s day-to-day lives. Immunology has made other important contributions to the science of covid-19. That includes diagnosis, for example, through antigen testing; the screening of antibodies to determine whether people have had covid-19 previously; and prognosis and patient stratification, such as triaging patients and seeing who will benefit from early ventilation and therapeutics. Why is it, for instance, that, as I heard one of the experts on BBC news say this morning, someone can be free of the symptoms of the disease but unknowingly be a carrier of it, even though they are vaccinated? Again, there are questions to be asked.

Immunology research during covid-19 has been supported well by Government, funding agencies and institutions. Our Ministers and our Prime Minister made it a priority. That is why we are where we are today, to the envy of much of the world. Immunology, especially population-based studies of actual immune responses in real people with and without disease was already a real strength of UK research to start with, and we should be grateful for that. The population-based research is facilitated by standardised procedures for researchers to access patients and their samples across the UK through the NHS. Again, we are eternally thankful for all that. The National Institute for Health Research played a major role in bringing together academic researchers and clinical services during the pandemic, and has played a crucial role in ensuring that we learn as we go, in real time. I especially thank the NIHR for that contribution. Many others have contributed as well, but the NIHR did a fantastic job.

The rapid adaptation of our funding processes to ensure that the Government research funding flowed to collaborative groups of researchers who were well placed to deliver answers to crucial questions quickly was also a major strength. For example, UK-CIC, which I have mentioned, is another visionary group that strategised, planned and responded in a positive way. Its UK-wide study was launched to tackle some of the key questions about the immune system’s response to SARS-CoV-2 and help us control the covid-19 pandemic. It received some £6.5 million in funding over 12 months from UK Research and Innovation and NIHR; that is the largest immunology grant awarded for tackling the covid-19 pandemic. Critically and crucially, it also incorporated a large element of patient and public involvement, bringing laypeople and those who had covid-19 into the scientific process in a scheme of work run by the British Society for Immunology. UK-CIC was funded in a way almost unique to covid-19 research, to encourage collaborative team science, individually but also through teamwork, sharing ideas, coming together, working together, and partnering. Rather than research groups competing against each other, which could have happened, the consortium brought them together with a singular target, a singular goal, and a way of doing it better together.

In UK-CIC some 20 of the UK’s leading immunology research institutes, including Ulster University in Northern Ireland—again, team UK of GB and NI working together in a very positive way—are funded as a consortium and are focused on five themes: primary immunity, protective immunity, immunopathology, cross-reactive coronavirus immunity and immune evasion. Its successes and novel discoveries are numerous. We look at that collective and how 20 different groups came together and how they solved problems collectively. We are four regions of the United Kingdom of Great Britain and Northern Ireland, but we can share the ideas, so we can have the ideas in Scotland in Northern Ireland, Wales or England, and vice versa.

UK-CIC has contributed to the development of covid-19 therapeutics through exploration of the role for interferon therapy and determining the effectiveness of dexamethasone. It has made a major contribution to vaccine development studies including through showing that an extended dosing schedule is more effective than, for instance, a three-week interval. It has shown that there is a stronger antibody response to mRNA vaccines such as Pfizer and that there are stronger cellular immune responses to vaccines such as AstraZeneca. Furthermore, it has curated the largest collection of covid-19 post-mortem tissue in the world, so the evidential base is significant and ready for further investigation. It has defined the four main sub-types of inflammation in covid-19 and opened up avenues for further investigation of therapeutics. It is not just about today; it is about tomorrow and that is what I love about where we are. We are already preparing for the next one. I know the Minister will respond to that because he knows vastly more about it than I do and will be able to explain and explore that for us. UK-CIC has found that our T cell immune responses are likely to overcome mutations in the virus and remain effective. This is an incredibly complex subject matter, and so important as we look to the future and whatever comes our way.

The UK Coronavirus Immunology Consortium model has proved highly effective, and should be strongly considered as a blueprint for future funding of research. Perhaps the Minister will give his thoughts on that. I believe that it is vastly important that we do that. A number of strengths of doing research that way were identified, including avoiding duplication of research, with complementarity built into the project design instead; the standardisation of protocols, to allow science to move forward more quickly; and the ability to carry out larger studies by using patient samples from multiple sites. Again, the teamwork and connectivity brought everyone together. That led to more robust findings being produced and more diverse patient cohorts, as well as regular engagement between groups in the consortium, helping to engender ambition and to foster a sense of scientific community, working better together.

Retaining that funding model will ensure that the infrastructure is already in place should another pandemic event occur. We hope that it does not, but we did not expect the last one; we have to be prepared for the next. That is what the debate is also about: to thank the Minister, our Government and others for our response and to ensure that we are equipped and ready for the future. That infrastructure would also tackle other societal and public health challenges, such as antimicrobial resistance, cancer immunotherapy, and ageing and dementia. In the debate on social care the other day in the House, many referred to dementia, Alzheimer’s and Parkinson’s as diseases that are perhaps more prevalent in society now than in the past. I can vouch for that, as I seem to be dealing with more of those issues in my constituency. Again, these are complex matters, and it is about working better together to try to address them.

No debate on immunology research and covid-19 in the UK would be complete without talking about the world-leading work done by the University of Oxford team in developing the Oxford-AstraZeneca vaccine. We are eternally grateful for all that they have done. It was not until 11 March 2020 that the World Health Organisation declared covid-19 to be a global pandemic, but the work that preceded the release of the Oxford-AstraZeneca vaccine had begun years before. I referred to that earlier, and it is the truth: the Oxford team began its work in 2015. I do not know whether many people know that. I did not until I researched the issue.

That work was funded by the UK Vaccine Network, a partnership between the Department of Health and Social Care and UK Research and Innovation’s Medical Research Council and Biotechnology and Biological Sciences Research Council, to find a vaccine for middle eastern respiratory syndrome, an illness caused by a different coronavirus. Not all the research was in place, but it was during this time that the team fine-tuned the adenovirus vaccine platform, and in 2018 the vaccine entered safety trials and was shown to cause no adverse responses while eliciting both cellular and antibody immune responses, and the trials suggested that two doses would be more effective than one. The lessons learned at that time could be initiated for our response to covid-19 when it started just last year.

The MERS virus has a spike protein on its surface similar to the SARS-CoV-2 spike protein, which meant, along with the previous testing of the vaccine platform technology, that the Oxford team already had an adaptable vaccine that had been tested and proved to be safe in humans. People should be made more aware of that information when they say, “You’ve brought this in. You’ve vaccinated everybody. Where’s the trial?” Well, the research started in 2015 and the trials started in 2018, then were adapted to deal with this particular virus. We should be encouraged by what has taken place. The vaccine has been tested and proved to be safe in humans.

Once the Chinese investigators had shared the genomic sequence of SARS CoV 2, it could then be inserted into the adenovirus to produce the prototype covid-19 vaccine that entered into human trials in April 2020—about the time that covid-19 restrictions came into play. The ability to deliver such a vaccine at pace was a product of long-term funding through UKRI over more than a decade, which ensured there was an existing vaccine platform technology, alongside optimised manufacturing methods.

The Oxford-AstraZeneca vaccine development was also facilitated by a £2.6 million UKRI-NIHR rapid response grant in March 2020, just at the time we needed it. Again, our Government were in place to do that at the right time. That provided funding to conduct pre-clinical investigations and phase 1 and 2 trials, and to scale up production of the vaccine to 1 million doses by summer 2020. The researchers and all those involved were able not only to produce a cure but initiate production at the level that was needed. How grateful we are for all those superhuman efforts to bring out the vaccine to immunise the whole of the United Kingdom of Great Britain and Northern Ireland, and help third-world countries.

That is truly demonstrative of previous immunological research into infectious diseases speeding up our response to SARS-CoV-2. However, after the previous outbreaks, research into these viruses tapered off, which hampered our ability to respond to SARS-CoV-2 with as much information as we would have liked. That was unfortunate. The gaps in knowledge at the beginning of the pandemic led to some of the decisions that were made in public policy and, indeed, some mistakes that, perhaps with hindsight, could have been avoided. We have all made mistakes in life—I include myself in that, and I am sure everyone is the same—and we would change them, but we make decisions at the time that we make them.

We must not make the same mistakes again. Instead, we must continue to invest in SARS-CoV-2 and covid-19 research, immunological and otherwise, so that we are properly prepared should an event like this happen again. We should be ever thankful for where we are. Coronaviruses have particular pandemic potential, as they are able to replicate efficiently on entry to the human population and are thought by experts to be the biggest threat, so we need to get ready for the future. I know the Minister will give us some of his thoughts about how we are doing that so we are ahead of the game when it comes to responding to whatever the future may hold.

The covid-19 pandemic has also acutely illustrated that the importance of both global disease networks and global disease surveillance cannot be overstated. With the truncation or termination of many non-covid-19 immunological research projects that formed the basis of these networks and surveillance due to cuts to the official development assistance budget, it is through investing in covid-19 immunology research that we can build international collaboration, as has happened in the past, and use those relationships to ensure that we are more prepared for future infectious disease outbreaks. Perhaps the Minister can tell us a wee bit more about how we are working internationally. Again, we can do that to everyone’s advantage. We should not be claiming it for ourselves; we can do that with other countries, and do it better together.

Of course, there are still many questions surrounding covid-19 that remain unanswered, including major ones like what the longevity of vaccine-mediated immunity will be and why some people contract long covid and others do not. I refer again to the constituent I spoke about this week. Covid-19 is unlikely to disappear completely, so it is crucial that we invest in discovering the answers to those and other key questions.

If we revert to pre-pandemic-style grant funding for covid-19 research, we will lose the progress that we made on the R&D infrastructure and the good will of the research community, which is needed to tackle these challenges properly. I seek an assurance from the Minister that we will not revert to that, but we will move forward and give the commitment that the R&D sector clearly wants. We must ensure that the current levels of funding are continued. Small studies that look at small numbers of people are not robust enough to achieve statistically significant results that can inform patient care and policy. We need to ensure that the R&D success of the past is a policy and strategy for the future. We must continue to conduct studies at the same scale, with the involvement of hundreds of thousands of people. That is the success of the covid-19 vaccine, and that is the success we want for all other pandemics that come along, to ensure long-term immune monitoring that can be applied to real-world questions and situations.

There has been an immense investment in immunology and covid-19 research over the past 18 months, which has allowed the UK to achieve some truly impressive bench-to-bedside science, such as vaccines that have gone from the laboratory to people’s arms in record time. I know there has been lots of research into how that is done, and we can only be truly impressed by it.

There has also been great leadership from the Government’s chief scientific adviser, Sir Patrick Vallance, and chief medical officer, Professor Chris Whitty, in driving forward conditions that have led to the progress and discoveries made. The pandemic has illustrated the importance of the NHS. We all love the NHS and we know how important it is. There is not a debate where we do not revere what it has done for those it has helped to heal, save and make better, and for the comfort it gives people when they need it most. It is vital to ensure that is not forgotten in future, as it allows science to operate at a huge scale.

We owe a debt of gratitude to the scientists and researchers of many different disciplines, including immunology, for their work during the pandemic. The fruits of their labour can be seen everywhere from the vaccine roll-out to today’s better survival rates for covid-19 patients in hospital, for which we are thankful. It reminds us that the work going on in labs across the country has a tangible effect on everyday life in this country. It is the working together and the investigations and tests done in universities and pharmaceutical companies with the financial backing of our Government and the push from the vaccine Minister and his team. We must ensure in the post-pandemic future that UK R&D is properly funded and given the resources needed to continue having a positive effect for everyone in society.

--- Later in debate ---

[Dr Rupa Huq (in the Chair)]

Since no other Back-Bench MP wishes to catch my eye, I will go to the first of our three Front Benchers. For the SNP, we have Anum Qaisar-Javed.

--- Later in debate ---

[Jim Shannon]

I am very impressed and pleased by Scotland’s long covid planning strategy, which the hon. Lady has outlined. However, it is not all about plans. For many families, it is about how they will survive financially—they all want to get better, but they are not sure if that will happen in the timescale they wish. Apart from the benefits system that we have in place, does the hon. Lady have any ideas as to how we could help them financially?

[Dr Rupa Huq (in the Chair)]

On the Clerk’s advice, let me gently remind the hon. Member that, as we are talking about the Westminster Parliament, she should not stray too much into what goes on in the devolved Parliaments.

[Anum Qaisar-Javed]

I do not know off the top of my head, so I will get back to the hon. Gentleman on that matter.

In light of the statistics and the current rates of covid-19, it is crucial that there is continued investment in immunology research, which will allow us to develop an ongoing public health strategy to minimise and manage the impact of the virus on our population. Thanks to the production of the vaccine, when compared to those who are unvaccinated, those who are double vaccinated are at less risk not only of catching the virus, but of an infection turning into long covid.

Furthermore, it has been found that two doses of the Pfizer or Oxford-AstraZeneca vaccine are 96% and 92% effective against hospitalisation with the delta variant, respectively. While the delta variant is prevalent throughout the country, it is reassuring to know that because of the work of immunologists, our population is trying to live life as normally as possible. The vaccine produced by immunologists has both literally and figuratively provided us with a lifeline—without their work, our economy would remain at a standstill.

Despite the steps we have taken in the battle against covid-19, there is still so much we do not fully understand. By continuing to fund immunology research, population-based studies—a key strength of UK research—can continue to provide us with this knowledge. For example, the National Institute for Health Research has played a major role in bringing academic research together with clinical services during the pandemic, ensuring that we learn as we go. It is this continual production of real-time information about covid-19 that will allow us to overcome and stay ahead of the virus and its long-term impacts.

I therefore ask that the UK Government follow the lead of the Scottish Government’s actions and continue to invest in immunology research and ensure the necessary investment in England’s NHS. It is through further investment in this research that we will get the pandemic under control. In turn, this will ensure that the country is far better prepared for any future outbreaks of emerging diseases. Immunology research has undoubtedly played a pivotal role in our overcoming the pandemic, and it will continue to form the foundation of our public health response and our knowledge of the ever-changing landscape of the pandemic.

[Dr Rosena Allin-Khan (Tooting) (Lab)]

It is a pleasure to wind up for the Opposition with you in the Chair, Dr Huq. I thank the hon. Member for Strangford (Jim Shannon) for securing this extremely important debate. I know he is hugely passionate about so many issues, and it has been wonderful to hear him set out exactly why this topic is so close to his heart.

So many heroes have emerged from this pandemic: our frontline NHS staff, shopworkers, carers, posties, delivery drivers—the list goes on and on. It is absolutely right that these people’s efforts are recognised, but today we have the opportunity to express our gratitude to a different group of people—a group that is more often found behind the scenes in labs and research facilities up and down the country. Their commitment and dedication to understanding and then eradicating deadly diseases has saved millions of lives over the last two centuries. Immunologists and all their colleagues in biomedical research deserve all the gratitude we can offer.

It is through immunological research that we can treat and prevent the spread of diseases. Although it can be difficult to remember a time when we were not consumed by information surrounding covid, it is important to remember how we got here so quickly. Without this research, we would not be able to develop vaccines or even understand basic principles in reducing infection rates. This work allows us to identify who is most at risk of certain diseases and informs both public health messages and interventions to limit outbreaks.

The work of immunology researchers and scientists led to an almost immediate understanding of this virus. We understood how to limit its spread and, ultimately, how to develop a vaccine to stop it. Considering that very little was known about the coronavirus before it began to spread ferociously around the world, this achievement is even more remarkable. Without this work and dedication, the loss of life worldwide would be far greater. For that, we already owe a huge debt.

It is only right to begin my contribution today by paying my respects to those who work in this field. In particular, I pay respect to the British Society for Immunology and the Royal College of Pathologists. I am sure colleagues will join me in doing so. Those institutions refused to be fazed by covid-19, and the work of their members has been pivotal in delivering a route out of the pandemic. We have a long and proud tradition in this country of pushing advancements in medicine, especially on immunisation. The work of UK scientists has led to vaccines being developed for numerous infectious diseases.

Edward Jenner, often referred to as the father of immunology, discovered the first ever smallpox vaccine in 1796. It had been theorised that exposure to cowpox would protect against infection with the more lethal smallpox. Jenner tested this theory and it was a resounding success. A tribute to Blossom, the cow whose cowpox was used as the first vaccine, can still be found on the wall of the St George’s medical school library, which is attached to the hospital where I work. From that achievement in 1796 to covid vaccines today, we should be proud of this legacy.

The scientific community has always fully endorsed collaboration and working across borders and cultures to foster innovation. Let us be clear: the unsung heroes are our scientists, who went to work day and night throughout the pandemic, even though they were putting their own lives at risk and were concerned for their own families. They are the reason we have a vaccine today—a vaccine that has saved so many lives. For them, we are truly grateful. By collaborating with researchers all over the world, UK scientists have played their part in preventing deaths from some of history’s deadliest diseases. These efforts have resulted in no less than 26 vaccine-preventable diseases, and are estimated to prevent over 2 million premature deaths globally every year.

I am proud to be part of the UK scientific community—as, I am sure, are you, Dr Huq. I am truly honoured to have met so many of the specialists who have been relentless in their struggles to get a handle on covid-19. It is imperative that the Government do all they can to support this work and to facilitate as much international collaboration as they can during the final stretch of covid-19 and long beyond. Despite all we have learned about the virus, there is still so much we do not fully understand: exactly how long immunity lasts following vaccination and whether immunity completely prevents individuals from passing the virus on, or simply prevents them from developing symptoms. Research into those questions is, of course, ongoing, and as greater numbers are vaccinated we should be in a better position to answer them.

With the ongoing threat of new variants emerging, it is vital that we understand their potential effect on immunity. Closely monitoring new variants and their impact on our immune system will help get us to a position whereby we can begin to control the virus and exit the pandemic. It is easy to assume that, now that we have a vaccine, the hard work is over and life will inevitably return to normal. While that is what we all strive for, we cannot allow complacency to creep in. By continuing to support the work of immunologists, pathologists and the wider scientific community, we will be able to face any new emerging challenges and react accordingly.

The UK is a global leader in immunology and infectious disease research, both in the academic environment and in our industrial capabilities. We need to build on those strengths and invest in our workforce, who are the lifeblood of the discipline, to ensure that excellence continues to be recognised at home and abroad. I would be grateful if the Minister could commit to this and outline what support the Government will provide for this highly skilled workforce.

Now is the time to encourage people to take up careers in this field. We need to attract high levels of talent from around the world, while training and developing our own staff and encouraging them to forge long and successful careers here. We must continue to break down the barriers in STEM to ensure that immunology has a representative workforce who can inspire future generations, regardless of their gender, ethnicity or class.

The response from the research community to covid-19 has been immense, but it has also highlighted the need to be better prepared for the next pandemic, whatever it may be and whenever it may come. Governments around the world recognise that and must never lose sight of it. Here in the UK, we cannot afford to take our eyes off the ball. Doing so would jeopardise the results of the sacrifices we have all had to make over the past 18 months, including those in our scientific community. I implore the Government to continue to support our world-leading biomedical science sectors long after covid becomes a distant memory. We were not as prepared as we could have been for the virus’s onslaught. We must learn from that and ensure that we are better prepared for the next threat, even if we do not yet know what it will be.

[Dr Rupa Huq (in the Chair)]

Finally, from the Government, Nadhim Zahawi. It is good to see him in person, and not on a conference call on a Friday.

--- Later in debate ---

[Nadhim Zahawi]

I completely share the hon. Gentleman’s concerns about that issue, and it is important that we look at it very seriously. He also asked whether we have enough supply of monoclonal antibody treatments. I can tell him that the regulatory approval and clinical policy will provide information on which patients could benefit from the treatments and how much supply is needed. We are working with the companies to ensure that we have a supply of those products in the coming months. Which patients are likely to have access to those treatments? Again, the NHS England antibody expert group is currently designing clinical guidance on how the NHS should use the treatments, which includes defining and identifying the eligible patient cohorts that are likely to benefit following a positive covid test.

In terms of deploying the treatments, part of the work of the NHS England expert group is on the clinical guidance on identifying potential deployment in hospital and possible pathways, especially through clinics and at-home services following a positive test. The hon. Gentleman also asked what research is looking at long-term immune response in individuals who are vaccinated. The Department is funding a number of important studies into immune response: the SARS-CoV-2 immunity and reinfection evaluation, or SIREN, study in healthcare workers; the Vivaldi study in care home residents and workers; and the coronavirus infection survey led by the Office for National Statistics, with repeat household visits looking at who has antibodies to covid from either vaccination or previous infection.

The hon. Gentleman asked about vaccine manufacturing in the longer term. I can tell him that in 2018, UKRI announced £66 million for the UK’s first dedicated vaccine manufacturing and innovation centre, VMIC. The goal was to promote, develop and accelerate the growth of the UK vaccine industry. When the pandemic began, UKRI reacted at unparalleled scale and speed to ensure that all investments were ready and able to respond to the challenge, and that they were plugged in to the UK’s wider vaccine, life science and pharmaceutical ecosystem. An additional £131 million was made available as an investment in, I think, May 2020, bringing the total for VMIC to just shy of £200 million, at £196 million. VMIC will be able to deliver about 200 million doses of vaccine, of any technology, at scale per annum, so it is a big investment.

The hon. Gentleman also asked what the Government are doing to support the development, production and procurement of vaccines for the future. As well as VMIC, we are planning for all scenarios in the fight against covid and its variants. Some of the recent analysis supports our understanding that both the Pfizer BioNTech and AstraZeneca vaccines currently being deployed in the UK appear to work well against the current dominant variants of covid, and continuing to administer those vaccines at scale remains our key to bringing the virus under control.

We are also assessing our existing portfolio against current variants, working closely with vaccine manufacturers and Public Health England, to understand the efficacy of our portfolio. We think we are in a good place vis-à-vis the interim advice from JCVI on the booster campaign, which we hope to begin later this month.

Finally, the hon. Gentleman asked whether there was any existing research that had helped to accelerate the development of vaccines. He quite rightly cited the work of the Oxford team, but even before the covid-19 pandemic, they were already doing that research because of funding from UKRI—and thank goodness for that.

To conclude, I fully recognise the tremendous impact that the pandemic has had on so many people. Commissioning high-quality immunology research is an essential part of our armoury in fighting this virus. We will continue to implement research findings and, at the same time, commission and fund new projects that will deepen our understanding of the disease and identify further defences that will keep us safe. Throughout this pandemic, the Government have been there to support and invest in research. As we shift our focus from the initial impact of the pandemic, we intend to continue to provide funding and support for covid-19 research, underlining precisely why the UK has long been, and continues to be, a great place for world-leading research and researchers.

[Dr Rupa Huq (in the Chair)]

Finally, in this debate where all hon. Members have demonstrated quality, if not quantity, I call Jim Shannon to wind up.

[Jim Shannon]

I thank everyone for their contributions, starting with the hon. Member for Airdrie and Shotts (Anum Qaisar-Javed). She spoke about devolved matters, as you said Dr Huq, but it is good to share strategies across the whole of the United Kingdom, and I look forward to doing so.

[Dr Rupa Huq (in the Chair)]

Absolutely. I was confused by what was going on as Members were speaking at the same time. I completely agree that the hon. Lady made a powerful speech.

[Jim Shannon]

The hon. Lady referred to 83 venues across the whole of Scotland that are doing research to find and perfect a strategy. We can all take an interest in and learn lessons from that.

I thank the shadow Minister, the hon. Member for Tooting (Dr Allin-Khan), for her hard work during the pandemic. She has been on the frontline, and I think we all want to thank her personally for that. I do not think I have had the opportunity to, so I thank her on behalf of a great many patients who are indebted to her and to others for that work.

The shadow Minister also referred to the advances in medication and the cross-border culture of countries working internationally to find a cure, control the virus and exit the pandemic, with the UK as a global leader. Those words are very true and represent the consensus of opinion, as the debate has made clear.

I thank the Minister. Although I said that at the beginning and have just said it again, it does not take away from the quality of our gratitude to the Minister for the work that he does. He referred to all those working in the back room. We all know that there is a team behind the Minister who make it work, and I thank them, because they are the strength behind how it works.

The Minister referred to a better understanding of the immune system and how it works for some and does not work for others. One crux of the matter is about how we can find out why. If we do excellent research on that, we can find a cure. There are 15 new research studies, with significant amounts of money set aside. Many would have tried to accumulate that money, but it has been massive.

We are in a better place today because of our Government and the Minister. This debate has brought everyone together to say the same thing. I thank everyone for their participation and contributions, particularly the Minister.

Question put and agreed to.

Resolved,

That this House has considered the role of immunology research in responding to the covid-19 outbreak.

Covid-19 Update

Rupa Huq Excerpts

Monday 6th September 2021 Commons Chamber

[Nadhim Zahawi]

Without putting words into the mouth of the chief medical officer for England, Chris Whitty, I can tell my hon. Friend that the work that he is conducting with his fellow chief medical officers looks specifically at the impact on 12 to 15-year-olds. However, the JCVI looked particularly at the area in which its competence lies and made a recommendation that the chief medical officer should look beyond that to mental health and other areas. That is why he is convening a group of experts from local public health, as well as the royal colleges.

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

The Minister has some quite fantastic figures about the 16-to-17 cohort, but as a mum of one in west London, may I say that my own boy and all his circle are being diverted to the national booking system? Their generation like doing things at the last minute, so instead can we have more pop-ups and more festivals like the scenes that we saw at Twickenham earlier this year? They do not want to go down the oldies’ routes. Failing that, there are schools, which in my day meant the nit nurse.

[Nadhim Zahawi]

Yes, absolutely. We are making it as easy as possible for them to simply walk in and get their jab.

Covid-19 Update

Rupa Huq Excerpts

Thursday 22nd July 2021 Commons Chamber

[Nadhim Zahawi]

My hon. Friend’s constituency of Cleethorpes has now done 122,397 cumulative total of doses, which is a tremendous achievement. I will take away his request and come back to him once I have had the chance to discuss it with NHS England.

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

I must thank the Minister for our Friday mornings together. It is not just me; every Member of this House is grateful for that weekly fixture—the highlight Zoom-fest. Is he aware that there are already glitches in the shiny new NHS covid passport that he mentioned? Two of my constituents, Konnie and Charlie, have been going for a year for Novavax trials and now they are being treated as if they are vax deniers, with the texts they get from the NHS, and they are grounded. Another guy, Karl, returned to his native US to have his two jabs because he is not eligible for NHS treatment. He says that it is xenophobia that he cannot access events that Brits can. I am sure it is unintentional. People think that they are being punished for doing the right thing. Will the Minister rectify that?

Covid-19 Update

Rupa Huq Excerpts

Monday 19th July 2021 Commons Chamber

[Nadhim Zahawi]

I hear the hon. Member and I absolutely understand. That is why the JCVI will continue to review the data on the vaccination of children. Specifically on his question, it has a concern. It has received data from around the world; from countries that are already vaccinating. We are with those countries at the forefront, but at the moment we are an outlier as they have chosen to move forward on children’s vaccination and we have not fully; we are moving forward for children who are vulnerable and those who live with vulnerable adults. It wants to look at second-dose data; at the moment it has first-dose data. There is a very rare signal of myocarditis that it is concerned about and it wants to see second-dose data from places such as the United States before it makes its decision. That decision, however, is under review.

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

It is good to see the Minister still standing on this freedom day, when it feels like half the Cabinet has been struck down, knocked out or whatever it is. Does he agree that, at a time when worryingly we hear of increased threats to vaccination centres, be they from the vile anti-vax propagandists outside this building right now or even people so keen to get jabbed that they leave vaccinators feeling vulnerable, nobody should feel intimidated when seeking perfectly legal healthcare? Does he also agree that there is scope for investigating an offence of violence towards NHS professionals, whether verbal or physical, in such a setting? It would bring the law into line with the “protect the protectors” legislation we already have for ambulance staff and the police. That was suggested to me by the Florence Nightingale nursing trainees I met last week. If he did that, he would be a hero among them—even though they did not get their pay rise. What does he think?

[Nadhim Zahawi]

I thank the hon. Lady, who made an excellent video about the vaccination centre in Acton—she had a bit of a go at me for not delivering it within a few weeks, but we finally got it delivered in Acton. She has done a tremendous job in leading the vaccination communication in her community.

I agree that it is abhorrent and completely wrong for anyone to intimidate people looking to get their vaccination, the incredible NHS staff delivering it, the volunteers or anyone else in the extraordinary mobilisation we have experienced of the nation coming together and delivering the largest vaccination programme in history. I will look at anything we can do to continue to protect our frontline staff. A senior responsible officer embedded in the vaccination deployment team looks seriously at security every single day, and we will not hesitate to take action against anyone who threatens any member of staff or volunteer taking part in the vaccination programme.

Injectable Vitamin B12

Rupa Huq Excerpts

Wednesday 26th May 2021 Westminster Hall

[Dr Rupa Huq (in the Chair)]

I remind hon. Members that there have been some changes to normal practice in order to support the new hybrid arrangements. Well, only one Member is here physically, so I do not think that I need to read all of this out. If everyone present here in the Boothroyd Room could clean their spaces before using them and before leaving the room, that would be great. I remind Members that Mr Speaker has stated that masks should be worn in Westminster Hall—apart from by me in the Chair, as I may need to speak at any second.

[Jane Hunt (Loughborough) (Con)]

I beg to move,

That this House has considered proposals to remove classification of prescription-only medicine from injectable B12 vitamin.

It is a pleasure to serve under your chairmanship, Dr Huq. First, I thank my constituent Tracey Witty who, since being diagnosed with B12 deficiency in 2012, has worked tirelessly to support others to secure the treatment that they have desperately needed and campaigned for, and to increase public awareness of vitamin B12 deficiency as well as the issues surrounding access to treatment. It is clear that she is making a real difference to the lives of people across the country; and much of the information that I will share today has come from her extensive investigation and research into this disorder.

Vitamin B12 deficiency is a progressive neurological disorder with a wide range of symptoms that affect all body systems and, importantly, people of all ages. Statistics from the National Institute for Health and Care Excellence show that, in the UK, 6% of people below 60 years of age are deficient in B12, and the figure rises to 20% in people aged over 60 years. That means that hundreds of thousands of people are struggling with the symptoms of B12 deficiency, which can have a devastating impact on both physical and mental health, leaving sufferers unable to contribute to either family life or society.

Crucially, and in part because of the wide range of symptoms associated with the disorder, sufferers often struggle to receive the correct diagnosis. They are commonly misdiagnosed with conditions such as Alzheimer’s disease, bipolar disorder, multiple sclerosis, chronic fatigue syndrome, autism, ADHD—attention deficit hyperactivity disorder—and fibromyalgia. That means that they do not receive proper treatment and, in the long term, that can lead to significant complications, including permanent neurological damage.

Over the years, many people have contacted my constituent, Tracey, to discuss their experiences of living with B12 deficiency and the difficulties that they have faced in getting the right diagnosis. I would like to share a couple of their stories The first is of a mother, with three young children, whose serum B12 level first indicated a deficiency nearly a decade ago. Sadly, however, that was overlooked and, despite being unable to physically function because of her disorder, the woman was repeatedly denied access to B12 injectables by GPs. After spending a number of years being passed from pillar to post— seeing a psychologist, endocrinologist, haematologist and gastroenterologist, attending a pain clinic and chronic fatigue clinic, and being sent for a brain scan—the woman felt that she had no choice but to resort to sourcing injectable B12 online. Thankfully, she is now fully functioning, but can she be certain of having a trusted source of injections through the internet?

The second story is of a woman who, following four unsuccessful attempts at IVF decided to explore B12 deficiency as a possible cause of her fertility problems, as she also had a myriad of severe neurological symptoms and a known family history of B12 deficiency. More than a year ago, she found out that she was indeed deficient when her serum B12 test result was flagged as abnormal. However, along with the test result was a note stating that no action was to be taken and so, instead of being treated for a clear B12 deficiency, she was advised to take oral supplements and was referred to a chronic fatigue clinic. This woman is only just starting B12 injections with her GP this week, after repeatedly supplying evidence to them of the need for correct treatment. It is understood that oral vitamin B12 cannot be absorbed when the patient is B12 deficient; it requires an injection to be effective. Even when patients are correctly diagnosed, they often face an uphill battle to access the treatment they need when they need it. As the NHS website states:

“The treatment for vitamin B12 or folate deficiency anaemia depends on what's causing the condition. Most people can be easily treated with injections or tablets to replace the missing vitamins.”

It goes on to state that, “At first”, patients will

“have these injections every other day for 2 weeks or until…symptoms have started improving…After this initial period,”

if a patient’s B12 deficiency is not caused by a lack of the vitamin in their diet, they will

“usually need to have an injection of hydroxocobalamin every 2 to 3 months for the rest of”

their life.

Sadly, however, for many people that maintenance dose is not enough, leaving them to deal with debilitating symptoms while trying to juggle the stresses of everyday life. That was the case for another woman who has been in contact with Tracey in recent months. During lockdown, that woman who had previously been diagnosed with pernicious anaemia, which is one cause of vitamin B12 deficiency, was exhausted, constantly nauseated, stumbling, struggling with brain fog and unable to function properly. She therefore asked her GP whether she could have her B12 injections more regularly than the eight-weekly regime she was on.

Subsequently, however, that woman had her regime reduced to just four injections per year, after her GP took advice from a professor of haematology who it seems incorrectly stated: “A typical dose survives in the body for up to two years and once the patient has the first few injections, there is no ongoing deficiency. We can be confident that these fluctuating symptoms are not related in any way to B12.” That statement is at odds with NICE guidance, which is clear:

“Treatment of B12 deficiency in people with neurologic involvement should include”

injections

“on alternate days until there is no further improvement”.

A single mother who was trying to cope with the additional stresses of home schooling two autistic children due to covid-19 restrictions was left with no other choice but to purchase B12 online from a pharmacy abroad in order to function properly.

It is because of such cases that I presented a petition in the Chamber calling for the classification of prescription- only medicine to be removed from injectable B12, so that those who have been diagnosed with B12 deficiency may access treatment over the counter at pharmacies when they need it. As the petition mentioned, that would bring the UK’s

“approach in line with that of other countries, affording those with B12 deficiency the same dignity and control over their own health as a diabetic using insulin, and reducing the workload and financial burden on GP practices, District Nurses and other NHS services”.—[Official Report, 23 September 2020; Vol. 680, c. 1077.]

The latter point has become increasingly important given that covid-19 has placed significant pressure on NHS services and, in recent months, intensified demand for GP services.

It is also worth noting that, since I presented the petition, Tracey’s Change.org petition on that very subject has garnered more than 96,300 signatures, reflecting the public interest in the matter. I am grateful for the Government’s response to the petition that I presented. However, it raised a number of new issues, which I will put to the Minister now.

The Government’s response stated:

“Clinically urgent treatment must always be provided, with the patient's clinical needs being paramount. Any patient who wishes to discuss their need for vitamin B12 injections can request a review with their GP or other responsible clinician.”—[Official Report, 2 November 2020; Vol. 683, c. 6P.]

In Tracey’s experience, however, and as evidenced by the stories I shared earlier, clinically urgent treatment is frequently denied to those with B12 deficiency. That situation has been worsened by the covid-19 restrictions, when many people with the disorder and pernicious anaemia were told by their GP that they no longer needed B12 injections and could instead take a B12 tablets. Tracey heard how some of the GP practices came to that conclusion after taking blood to check B12 levels. That is despite NICE guidance and The BMJ stating that no testing should be carried out once a patient is on vitamin B12 injections, as there is no indication of what is happening at a cellular level.

The Government’s response also stated:

“Vitamin B12 could not legally be classified as a medicine that can be made available for sale without prescription in pharmacies because it is an injection and because the condition it is licensed to treat, pernicious anaemia, needs a clinician to diagnose it, and monitor its treatment.”—[Official Report, 2 November 2020; Vol. 683, c. 5P.]

It is important to make a distinction here because, as I mentioned, pernicious anaemia is only one cause of vitamin B12 deficiency. B12 injectables are also required by those who are B12 deficient for other reasons. Tracey feels that there is a widespread lack of understanding of this subject among clinicians, which is compounded by the inaccuracy of B12 testing.

As the NHS website acknowledges,

“the current widely used blood test only measures the total amount of vitamin B12”

in a patient’s body, rather than what form the B12 takes. This means that a blood test may show that a patient has normal B12 levels, even though their body cannot use much of it, leaving many patients without access to help or treatment. I would welcome the Minister’s comments on whether the Government will be working with the NHS to further clinicians’ understanding of B12 deficiency, in particular the limitations of testing, to ensure that those who are deficient receive better care.

Finally, I will pick up on the wider point in the Government’s response about the classification of B12 injectables. The response stated:

“Before a medicine can be switched from a prescription only medicine (POM) to a pharmacy (P) medicine, Ministers must be satisfied that it would be safe to allow it to be supplied without a prescription. This means that it is a medicine which no longer meets any of the criteria for a POM.”

The response went on to imply that, as B12 injectables are normally prescribed by a doctor for parenteral administration, they cannot be considered safe to be supplied without a prescription.

That position seems to be at odds with the fact that private clinics are able to provide the very same injectables to clients, provided they advertise them using such terms as wellness, boost or supplement, and do not market them as treatments for B12 deficiency or make any medical claims. That is because the Medicines and Healthcare Products Regulatory Agency does not consider vitamin B12 injectables to be medicines in this instance. Indeed, in a statement to Tracey, the MHRA said:

“Our current advice to private clinics administering vitamin B12 injections which are not licensed medicinal products intravenously for non-medicinal purposes is that we do not regard these to be medicines and that they fall outside of the remit of the MHRA. It must be absolutely clear in the advertising of such products that they do not have a medical purpose.”

Furthermore, staff at private clinics do not need any medical training to administer B12 injectables to clients. The implication of this is that B12 injectables are simultaneously licensed medicinal products, which are not safe to be administered by someone without medical training, and non-medicinal products, which are safe to be administered by someone without medical training. Moreover, unlike with insulin, the risk of toxicity or overdose with injectable B12 is considered to be extremely low, and so would be relatively safe for those with a deficiency to self-administer. I would welcome the Minister’s comments on those points.

That being said, as the Government’s response to the petition rightly highlighted, self-administration would not be suitable for everyone, so it would be only right that patients retain the ability to receive their injection at a GP practice. Tracey has also expressed that pharmacists who are already trained to administer vaccinations should be allowed to administer injections to those with a prescription. That would allow pharmacists to play a greater role in community healthcare, relieving pressures on GP services.

Here is another email I received directly from a constituent: “I suffer from B12 deficiency. At present I require an injection every other day to keep serious neurological decline at bay. I was diagnosed last summer and rapidly declined, to the point of almost being in a wheelchair. I was helped by the GP initially, but would not expect them to continue my intensive treatment owing to resources. However, if they could train us and supply the details, it would be better than as now, when many of us are forced to research this ourselves.

“I currently have to purchase ampules of hydroxocobalamin online from Germany, which I am sure you will agree is an expensive, lengthy and unnecessary process when they could easily be bought over the counter in the UK. The injections have enabled me to regain my peripheral vision, resume driving, function normally in a busy household and even get a new part- time job. I cannot overstate the impact they have had on me, especially since the doctor suggested I might have terminal neurological decline. Please, please state the case for hundreds or possibly thousands of us in the same position, and for those who have not yet been diagnosed and are struggling with poor mental and physical health for the sake of a low-cost vitamin.”

I hope that the overriding message the Minister takes away with her is the desperate situation in which those whose stories I have shared have found themselves—so much so that they have had to source their own injections just to be able to function as she and I can. The debate has been advertised on the “B12 Deficincy.info” Facebook page and, this morning, one lady left the following comment:

“Fingers are crossed. This would be life changing for me and so many others, no more battling with my doctors. I can only dream of what it’s like to feel alive.”

I ask the Government please to reconsider their position urgently.

[The Minister for Patient Safety, Suicide Prevention and Mental Health (Ms Nadine Dorries)]

It is a huge pleasure to serve under your chairmanship, Dr Huq, for what I think is the first time. I remember chairing a debate when you were an MP speaking, so the tables have turned. I thank my hon. Friend for bringing forward the debate. She raised many points in her speech, and we have only 15 minutes, so to do them justice in detail I will ask my officials, who are listening in, to provide a detailed answer to each of her questions.

I will speak about something that I have not prepared for, but I will use this time because it is so important and because my hon. Friend said something in her speech that made me think about something else. First, I thank your constituent Tracey Witty, and your constituents and other women who suffer from B12 deficiency. Every time you spoke about an individual case, you mentioned a woman; you did not once mention a man. I furiously fired off a few questions while you were speaking, and it is true that more women suffer from pernicious anaemia and vitamin B12 deficiency than men. That leads me to the women’s health strategy.

On 18 March, we launched a call for evidence for women to tell us about the problems they have in accessing healthcare services. I hope Tracey is listening, but if not, I hope you will get this back to her. Tracey will have a network of contacts of women suffering with this issue and, for it to be addressed, we need to hear those women’s stories. There is a simple link to the women’s health strategy on gov.uk, and it will take three to four minutes to complete a response on a phone or iPad.

It is so much less difficult—rather than easier—to change policy if you have the evidence. The default in health is male and I am afraid that it is very difficult to get change for many conditions that affect women. To cite an example, the response by Dame Sally Davies is from, I think, three or possibly four years ago and there has still been no major change. NICE will come forward with recommendations, but that may not be for another 12 or 18 months. It is not fast enough. My point is that that is because it is women, and women’s voices are just not listened to. I am trying to change that. I am trying to put women at the heart of health strategy and health policy.

I am sorry to use a few minutes of my response to get this point over but, as well as you raising this issue here, which is vital, Tracey could have a massive impact if she and the women she knows use the forums and platforms she is aware of to post the link to ensure that women are aware and can respond to the women’s strategy call for evidence. It is vital that my hon. Friend is here raising this on behalf of Tracey, but if we could have hundreds or possibly thousands of women responding, that would be incredibly powerful, because that would give us evidence—data. It would be not one constituent of yours putting a story forward; it would be lots of them.

[Dr Rupa Huq (in the Chair)]

Order. Minister, you will remember the thing about saying “you”—you used to say it—and you have done it a few times. Dame Eleanor Laing, who is our boss nowadays, is quite hard on it and said, “Don’t let anyone get away with it.” I let you do it a few times, but if you can use “my hon. Friend”, that is better.

[Ms Dorries]

When I was in Chair, I told people off all the time for exactly the same reason. I am absolutely sure that because we had a big gap with no debates over covid, I have slipped back into a habit I had prior to becoming an MP 20, 16 or 15 years ago, or whenever it was. I apologise.

[Dr Rupa Huq (in the Chair)]

You don’t look that old!

[Ms Dorries]

Well, I am, I can assure you.

To finish my point, if my hon. Friend could ensure that her constituent responds to the call for evidence, that would absolutely be more powerful and useful than anything I have to say in my response to her speech. We will respond to her points in detail.

I will address some points made by my hon. Friend. She asked specifically about making B12 injections available to purchase from pharmacies. As she said, the MHRA is the body responsible for medicines licensing in the United Kingdom, and it is committed to making more medicines available over the counter, so I think we would be pushing at an already open door. The MHRA is committed to doing that where it is safe to do so, as an important element of the self-care agenda to empower patients.

My hon. Friend mentioned the role of pharmacists. We have seen them step up during the covid pandemic and the vaccination programme. That was an incredibly important point. The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), whose portfolio includes pharmacy, is constantly looking at ways to increase and enhance the role of pharmacists, and this could be a useful way of doing so.

I used to be a nurse and gave vitamin B12 injections years ago. I was trying to rack my brains, but do not remember ever having given one to a man, but I am sure that I did, because men suffer from such symptoms, too. It is a really interesting phenomenon and, with a bit of imagination, working with clinicians and harnessing the expertise and knowledge of pharmacists, we could find a new way of doing this.

The MHRA has an established process and procedure for moving medicines from prescription-only status to over the counter, which I will refer to as OTC, when it safe to do so. An OTC is a medicine that is not likely to present a direct or indirect danger to human health, even when used incorrectly, if used without the supervision of a doctor; or is not frequently and to a very wide extent used incorrectly, and as a result is not likely to present a direct or indirect danger to human health; or does not contain substances or preparations—there is an entire list, which we will include in the letter to my hon. Friend.

To date, the legal classification of all currently authorised medicines for injection, including vitamin B12, is prescription only. Other factors support that position, in addition to the fact that the product is injectable. The main reason why it would not be a suitable candidate for reclassification under existing guidelines is that the product is considered to meet the prescription-only medicines requirements, as set out in legislation.

Pernicious anaemia, or any other cause of vitamin B12 deficiency, cannot be self-diagnosed and requires the expertise of a medical doctor. Contrary to my hon. Friend’s remarks NICE guidance also states that when a patient presents with the signs and symptoms of pernicious anaemia, they should undergo a full blood count as part of the diagnostic process.

We are also aware that there is a high risk of off-label use by patients. She mentioned that private clinics are injecting for wellness. That is currently authorised for use only in maintenance therapy for pernicious anaemia every two to three months, depending on the type of pernicious anaemia. Anecdotally, we hear that patients consider that a more frequent administration of the medicine would be appropriate to their particular clinical symptoms. Any reclassification of the medicine would not change either the dose or the frequency of the treatment set out in the terms of the product’s marketing authorisation.

I am also led to believe that the evidence of lifestyle abuse of unlicensed formulations of B12, which, although not necessarily relevant to the patient group including Tracey and others whom my hon. Friend mentioned, is also taken into account in determining the legal classification of the medicine. That is an issue that has to be considered: there are people who would abuse those formulations.

Just because there is a particular group that would over-use and abuse the availability, we should say that we are not going to look at this. Although that is not in my speech, and it has not been advised to me, I am making that point. We should not use that as a reason to say, “We don’t go there”. This affects more women than men—I do not apologise for banging on about that point—and therefore we should be pushing those barriers back as part of the women’s health strategy and looking at different ways to deal with it.

Taken together, these issues mean that the criteria for prescription-only medicine have been reached, and changing the classification would therefore not be appropriate—but that part of the information that I have been given needs to be challenged. We need to ask, “Why not?” It is vital that we get the evidence back from the network to the forums that Tracey knows. I note that this issue has been before Health Ministers in recent times, and as I mentioned, Dame Sally Davies, our previous chief medical officer, did engage with the medical royal colleges to raise awareness of the condition. However, it has taken too long—I think Dame Sally retired three years ago.

Following on from that interaction, NICE has worked to develop and publish an updated clinical knowledge summary on pernicious anaemia, which sets out clinical guidance on diagnosis, treatment and management of the condition that should be followed by general practice physicians and others responsible for the care of patients who suffer from this condition. The updated guidance was published in July 2020, and it should now be a regular part of clinical interventions in general practice and secondary care.

I would be interested to know what Tracey’s experience of that is, and whether she believes that the guidance has been implemented, particularly based on the experience of other women that she has been speaking to on these forums. Has it been implemented? Are GPs aware of it? If those women could let us know those answers in their responses to the women’s health strategy, that would be incredibly important. It is also important to evaluate the impact that this guidance has had on the clinical management of pernicious anaemia before considering further regulatory options. NICE usually produces guidelines as quickly as possible—it is an amazing organisation that does very good work—but we need to move a little bit faster on this and other women-related issues.

As for my hon. Friend’s question about private injections of B12, as I said, there are two separate types. Licensed products must be administered by prescription and by a suitably qualified healthcare professional, so that is where we are at the moment. It is important to note that private clinics are not providing the same injectables to clients as GPs are; they are providing injectable vitamin B12 products that are not licensed medicines for general health and wellness purposes. Of course, if clinics make medicinal claims for unlicensed vitamin B12 products that they offer, the MHRA would take action. Also, when classifying products, the MHRA are bound by case law to consider products on a case-by-case basis and cannot automatically classify all vitamin B products as medicine, so they do not all meet the criteria to be classified as licensed medicines. That is another important point.

In closing, I thank my hon. Friend for continuing to raise this important issue on behalf of her constituents and everyone affected by the condition. We will continue to work with and support the NHS and NICE—which are actively engaged with this issue— and clinicians to understand the importance of B12 deficiency and guarantee that patients are receiving the best possible care. I think the women’s health strategy will really help with that and will possibly be the boost we need to move this forward through the evidence we can gather.

I will finish on that point, because Tracey and the others who use the same platforms, my hon. Friend, and others who complete the women’s health strategy could give us important evidence that we need to enable us to push forward. I am not saying that means we do not know what policies we are going to develop from the women’s health strategy, but if enough women respond and say that this is an issue, that gives them a voice and it gives us a lever to pull. However, one of the biggest issues here is the time it has taken to bring about change. The guidelines have gone in; I would be interested to know how they have bedded in, and whether people such as those on Tracey’s forums think they are being used and have led to any benefit. We would also be interested to hear what the problems are with prescribing, and the issues that they have with administration.

Question put and agreed to.

Coronavirus

Rupa Huq Excerpts

Thursday 25th March 2021 Commons Chamber

[Matt Hancock]

I have not seen that article in The Times—I have read parts of The Times, but not that bit—so I cannot confirm, but I can write to my right hon. Friend with details on this point. However, I would stress that the focus only on modelling is not really where the ultimate judgment on the timings of the road map is; it is about being able to observe progress and then take the next step with confidence. The central point here is that cases may well rise. In fact, I would say cases are likely to rise, not least with schools going back. The critical thing is that the automaticity—cases going up having an impact on hospitalisations—is no longer there. However, if cases got extremely high, even with a much weaker link from cases to hospitalisations, that is something we clearly have to guard against and it is set out in test 3 of the Prime Minister’s four tests.

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

The Health Secretary has talked of protections for the over-60s. Can he appreciate why, for some of our constituents who crave a foreign holiday, it looks very odd that a Stanley Johnson loophole seems to have been negotiated, so that someone over 60 with their own property abroad can get around that? Can he also appreciate that a lot of our constituents think that these measures—the Prime Minister used to talk about women who look like bank robbers—have now mandated us all to wear these masks?

[Matt Hancock]

I am not quite sure what point the hon. Member is making, but this is what I was going on to say. The critical point where I ended the exchange with my right hon. Friend the Member for Forest of Dean (Mr Harper) is that we must restore the freedoms that we all cherish, but in a way that does not put the NHS at risk. Throughout the crisis, we have successfully protected the NHS, and I am delighted to be able to inform the House that there are now record numbers of NHS doctors and NHS nurses in England. New data published this morning show that there are over 300,000 nurses in the NHS in England for the first time in its history. So we have protected our NHS and we are delivering our commitments to it. Nobody wants to have to reimpose measures, as we have sadly seen elsewhere in Europe only this week, so we must follow this cautious and, we hope, irreversible road map.

Social Care Reform

Rupa Huq Excerpts

Thursday 18th March 2021 Westminster Hall

[Dr Rupa Huq (in the Chair)]

I remind hon. Members that there have been some changes to normal practice, in order to support the new hybrid arrangements. Members participating physically and virtually must arrive for the start of the debate in Westminster Hall and are expected to stay for the entire debate. I must also remind Members participating virtually that they are visible at all times, both to one another and to all of us in the Boothroyd Room. If Members attending virtually have any technical problems, they should email the Westminster Hall Clerks’ email address, which I think has been emailed to everyone. Members attending physically should clean their spaces before they use them and before they leave the room. We do not have any Members in the Gallery today, but Members should speak only from the horseshoe, where the microphones are.

[Barbara Keeley (Worsley and Eccles South) (Lab) [V]]

I beg to move,

That this House has considered social reform and the social care workforce.

It is good to have you in the Chair for this important debate, Dr Huq. I am pleased to open the debate. I pay tribute to the House staff who have enabled Westminster Hall debates to return with virtual participation.

The covid-19 pandemic has exposed the failings of our social care system. With more than 30,000 deaths of care home residents, the care sector has been hit hard over the past year. However, the fundamental problems in social care long predate the pandemic. A decade of underfunding meant that we were in a situation, even before the pandemic, where 1.5 million people were not getting the social care they needed. While social care is, rightly, the last thing to be cut by local councils, the reality is that areas that have seen half of their central funding cut since 2010 are left with little choice. Underfunding has led to fewer care packages, cuts to care packages and providers being asked to take contracts that do not even cover their costs.

One clear illustration of how this is going wrong can be found in long-stay in-patient wards, where 2,000 autistic people and people with learning disabilities are detained, at enormous cost to the NHS. One reason for that is the lack of resources in the community to support them. When local authorities cannot afford care and support in the community for autistic people and people with learning disabilities, it becomes easier to put them into inappropriate NHS in-patient units, even though community support would be cheaper and more appropriate. We also have older people forced to sell their homes because they are unable to access publicly funded care support until they have exhausted almost all their assets.

There has been much focus on care in care homes during the pandemic, due of course to the tragic death toll among people living in those homes, but we must also focus on the fact that social care is needed by working-age disabled people too, and that proposals for reform must cover their needs. In fact, one in three users of publicly funded care is under the age of 65, whereas only one in four is an older person in a care home, so the crisis in our care system affects more than vulnerable older people. It is a crisis not only of catastrophic costs, but of hundreds of thousands of people being denied the opportunity to live their lives as they would choose.

This is not a new problem. The reality is that social care has been struggling for more than a decade now. That is why the last Labour Government published a White Paper in 2010 proposing major reforms to the way social care is delivered and funded. However, once in government after the 2010 general election, the Conservative-Liberal Democrat coalition decided to drop those proposals in favour of starting another commission on reform. That led to the provisions of the Care Act 2014, including legislating for a lifetime cap on care costs, based on the recommendations of the Dilnot commission. That would have addressed some of the issues with the social care system, although I do not think any of us believed that it was anything like the full solution. Since that change was first delayed by the new Conservative Government in 2015, we have had any number of promises of future reform.

Ahead of the 2017 election, the then Prime Minister promised far-reaching reforms but promptly abandoned them. After that election, a Green Paper was promised by the end of 2017. At the end of 2017, the cap on care costs was completely abandoned and a new deadline of mid-2018 was set for the Green Paper. That was pushed back to autumn 2018, and then to the end of 2018. In early 2019, we were told to expect a Green Paper by April 2019.

When the current Prime Minister took office, he claimed to have a social care plan ready to go, and he repeated that claim during the 2019 general election. The Conservatives’ manifesto at the last election said that they would seek a “cross-party consensus”, but they have not tried to seek that consensus. In fact, a fairly broad consensus on the future of social care has developed. Politicians from across the spectrum, including the Health and Social Care Committee and the House of Lords Economic Affairs Committee, have endorsed the model of free personal care as introduced by Labour in Scotland. That system is not perfect, but it should be a strong position to start from. However, rather than acting on that consensus, we are still waiting for proposals nearly 18 months after the 2019 election.

When the Minister speaks, she may tell us that the Government are working hard on their proposals and will publish them shortly. She would be the third Minister of State to tell me that since the Government dropped their commitment to the cap on care costs, and we have already missed at least 10 deadlines for reform. That simply is not good enough. We need action now, not the promise of jam tomorrow.

If there is a team of civil servants working on this issue, there a few points that they should consider in order for reform of social care to work. First, reform must deliver a fair deal for care staff. If the crisis of the pandemic showed us anything, it was that without the hard work put in by care staff our care system simply would not work, but too often care staff are underpaid, undervalued and given few opportunities to progress. To fill the more than 100,000 vacancies we have for care staff, social care needs to become a career of choice, with better pay and conditions and better training. When the average starting salary is only £15,000, it is little wonder that people are not turning to a career in social care.

As a starting point, reform should mean that all care staff are paid the real living wage, as my own local authority of Salford is now doing. We need to see investment so that the social care sector offers training opportunities and real career progression for staff, recognising their skills and experience. If we are to fill the vacancies in social care, we need a wide strategy working across Departments to recruit and train the workforce that we need.

The Prime Minister has said that he wants to end the scandal of people needing to sell their homes in order to pay for care. It is right that we should address the issue of catastrophic costs, but that cannot be the only ambition of social care reform. If all we do is end catastrophic costs, we will still have nearly 2 million people not getting the support they need. With providers struggling to make ends meet, local authorities are left with no choice but to cut budgets even further.

We need reform that expands access to social care services. Over the past five years, we have seen fewer older people receiving care every year as eligibility thresholds have crept up in response to budget pressures. Preventive care is increasingly uncommon, with intervention mainly coming after a crisis. Rather than providing low-level support to enable people to continue living independently at home, we are increasingly providing care only once there is no prospect of someone living independently.

When the Health and Social Care Committee looked at access to care, one witness, Anna Severwright, told us:

“I feel that I am not able to live a normal life. I do not have enough hours”—

of care—

“to be able to go out at the weekends and in the evenings, and do a lot of the normal things that make life worth living.”

That is not good enough. People should not see their horizons limited solely because they need social care, but with budgets under ever-increasing pressure, money for anything other than the basics of care is rarely available. There is a better way to deliver social care than 15-minute care visits, and people should not have curfews on their lives because care is not available in the evening.

As well as funding care properly, we could embrace the spirit of the Care Act 2014 and ensure that care packages meet people’s social and emotional needs as well as their physical ones. That kind of person-centred support would enable more working-age disabled people to be productive members of society while also supporting older adults to enjoy later life. At root, social care should be about supporting people to live happy and fulfilled lives without facing financial ruin.

There is a very poor level of support for unpaid carers. There are 13.6 million people providing care to a friend or family member. Without them, our social care system would not cope. Funding for respite care is increasingly hard to get. Many carers say that they would use a respite break to attend a medical appointment.

Responding to an Adjournment debate that I led last Friday, the Minister for Patient Safety, Suicide Prevention and Mental Health said that

“45,000 carers have received respite or other carer support delivered to the person they care for.”—[Official Report, 12 March 2021; Vol. 690, c. 1212.]

We have 13.6 million unpaid carers, including 4.5 million who started caring during the pandemic. For a Health Minister to report that only 45,000 carers received respite care is an appalling record. We must do much more to support unpaid carers, and we could improve their lives by funding formal care services better.

It is now seven years since we put the Care Act into law, but the Government still have not delivered for people who use social care. After years of broken promises and delayed announcements, there is anger at the way social care has been underfunded and reform neglected. This has led to people who rely on social care going without the support they need to live fulfilling lives.

Underfunding has led to care staff being paid the minimum wage and not being given the time they need to provide high-quality care. It has also led to many thousands of people facing catastrophic costs of care, often having to sell their homes to pay for it, and over the past year it has meant 30,000 care home residents dying with covid-19. They were caught in a perfect storm of an NHS discharge policy that seeded infections into care homes before providers could implement infection control measures.

People who use social care deserve better than all of this. They deserve reform that delivers a fully funded, person-centred care system that meets their needs, and they need it now, not at some point in the distant future.

[Dr Rupa Huq (in the Chair)]

Given the popularity of the debate, and the fact that we have three Front-Bench spokespeople and a concluding statement from Barbara Keeley at the end, I am going to start with a time limit of three and a half minutes. There will be a clock visible at the side of Members’ screens, and the chaps here can pull the plug if they go over the limit. With all that in mind, I will start with Andrew Lewer.

--- Later in debate ---

[Margaret Greenwood (Wirral West) (Lab) [V]]

It is a pleasure to serve under your chairmanship, Dr Huq.

Social care is in a state of crisis as a result of severe underfunding by Conservative Governments. There is very little detail about social care in the White Paper. The Government say they will bring forward separate proposals later in the year, but under the plans they have put forward, integrated care systems will be given a single budget for the health and social of their area, and an ICS will have the power to increase resources in some places and reduce them in others.

Understandably, people are concerned that they might see a reduction in the NHS or social care offer in their area and that a stark postcode lottery will emerge. What is the sense in creating a system where local NHS and social care providers will be competing with each other for funding at local level? For all the talk of joint working, that is what will happen if this is put on a statutory footing: the system will be robbing Peter to pay Paul, and levels of services and jobs within the NHS and social care will be impacted.

The White Paper states:

“There will be a duty placed on the ICS NHS Body to meet the system financial objectives which require financial balance to be delivered.”

A senior health manager explained to me that the point of having a single budget for a local health and social care system, and the requirement for the system to manage that budget, was to drive efficiencies in the system. He also told me that there needs to be a drive to reduce the number of people in hospital, and the White Paper supports such a drive. The proposals make it easier for hospitals to discharge patients by removing the legal requirement to assess patients for NHS continued healthcare and NHS-funded nursing care before they are discharged from hospital.

What about patient safety? Anyone who has experienced seeing a friend or relative discharged from hospital too early, only to have to be readmitted, knows just how serious this is. What will this arrangement mean for the millions of unpaid carers who will be asked to take over once their family member has been discharged from hospital?

The question of the social care workforce is crucial. Retention is an issue, because carers generally earn a lot less than nurses and other NHS staff. Given the duty of the ICS NHS body to find financial balance within the system, there is a concern that responsible social care employers who look after their staff and pay well will be less likely to be awarded contracts, and that there will be a race to the bottom when it comes to the pay and conditions of care workers. There is concern, too, about the influence that private companies will have on the ICS health and care partnership boards and that providers are being given the power to help to design the very services they want to deliver—representing the opportunity for direct conflicts of interest.

The Government produced their White Paper in the middle of a pandemic, when NHS and care workers are exhausted. They should call a halt to the proposals and carry out a full public consultation once, and only once, covid restrictions are lifted.

[Dr Rupa Huq (in the Chair)]

Now we go to the last man standing: Kevin Hollinrake.

--- Later in debate ---

[Munira Wilson (Twickenham) (LD) [V]]

It is a pleasure to serve under your chairmanship, Dr Huq. Social care is and has long been the poor relation of healthcare that successive Conservative Governments have promised to fix yet taken no action on. Here we are, eight years on from when the coalition Government announced and subsequently put into law a new model of social care funding based on Andrew Dilnot’s recommendations, but the Conservatives refused to implement it.

Instead, we had real-terms cuts in social care funding, and now we have yet another top-down reorganisation of the NHS that promises integration, but will do nothing to address the structural or funding reform needed in social care. The Budget, at the start of this month, did not even mention social care. Is it any wonder that most people feel that 1.5 million people with unmet care needs are just not a priority for the Government? Thank goodness for our 9 million unpaid carers, who daily pick up the slack and pay an enormous price, both financially and in their own physical and mental wellbeing, without any recognition. Where would we be without them?

Our care system, as many have already said, was already in peril pre pandemic and is even more so now. Adult social care has consistently been an afterthought for Ministers throughout this pandemic, with more than 25,000 lives lost in care homes to coronavirus and delays in securing PPE and testing for the care sector during the first wave. Many care homes are now teetering on the brink financially. The sector is crying out—with one voice, loud and clear—for a proper, joined-up workforce strategy. We have a staggering 112,000 vacancies, and one in six of the workforce are migrant workers, yet the vast majority of social care roles do not qualify under the new points-based immigration system, even after recent changes.

With 1.6 million social care workers earning less than the living wage, a quarter of the workforce on zero-hours contracts and limited career prospects, how on earth can we expect to provide decent, sustainable care for the most vulnerable adults in our country? The hon. Member for York Central (Rachael Maskell) referred to our mums and dads. It is not only our mums and dads but our brothers and sisters, sons and daughters; a large number of those needing care are actually working-age adults—almost half.

It is time for urgent cross-party action. The letter from the Secretary of State for Health and Social Care to all MPs last March inviting suggestions for social care really does not cut it. Over the last year, the Liberal Democrats have twice formally requested that the Government initiate cross-party discussions. As the Health Foundation says:

“These problems are not intractable but solving them requires political will and government spending.”

Given the monumental challenge before us, when will Ministers make good on the Prime Minister’s promise to fix social care and invite others to the table to help develop those solutions?

[Dr Rupa Huq (in the Chair)]

The good news is that Members have been very good at sticking to time, so we actually have a little bit of extra time to play with. If the three Front Benchers all stick to 11 minutes, that will give the hon. Member for Worsley and Eccles South (Barbara Keeley) time to wind up the debate. First of all, we are off to bonny Scotland and Dr Philippa Whitford for the SNP.

--- Later in debate ---

[Liz Kendall]

The hon. Gentleman may know that I have been calling for cross-party work on this issue for the past five years. The principles are clear—we should not leave the costs to individuals alone. We should pool our resources and share risks. That is essential for the future. I do not think any sort of private insurance system works. One issue around the cap on care costs was that the Government thought a private insurance market would spring up. That was not the case, and it will not be the right solution for the future.

The Prime Minister stood on the steps of Downing Street 19 months ago and said he would fix the crisis in social care with a plan that he “had” developed—that he had it already. It is still nowhere to be seen. Lord Bethell recently said that now is not the time to have fundamental reforms, because we are busy dealing with the covid crisis. I argue that now is precisely the time for reforms to give people hope that, after the horrors they have been through, there is a better system for the future. That is why I was disappointed not to see anything in the Budget about social care reform.

Yesterday, there was an unprecedented statement from social care leaders, who called on the Government to end years of inaction and fix the system. They said that as well as emergency funding, we need longer-term plans to make social care a cornerstone of the modern welfare state. The crucial point is the potential for social care not only to transform the lives of millions of older people, disabled people and families who use care, but to create jobs and drive economic recovery.

In the remaining minutes, I will focus on this point. We often talk about the costs of reform, but the costs of not reforming the system are just as important. First, social care has huge potential to create good quality, valued jobs in this country. We need 520,000 more frontline care workers just to meet growing demand by 2030. The Resolution Foundation rightly argues that if we want to create jobs immediately in every community—that is what we need to do to level up all parts of the country—social care is the place we should start, and I completely agree.

Secondly, investing in social care is essential if we want all families to be able to balance their work and caring responsibilities. In today’s world, with our ageing population, social care is as important a part of our economic infrastructure as the roads and the railways. When one in three unpaid family carers have to give up work or reduce their hours because they cannot get the support they need to help their loved ones, it is bad for them, because they lose their job and income; it is bad for business, because they lose their skills; and it is bad for the economy.

Finally, investing in social care is vital to make the best use of taxpayers’ money. We should not be paying more for elderly people to be stuck in hospital when they could be cared for in the community and at home. As we seek to get our public finances back on a more sustainable footing, value for taxpayers’ money is essential. This issue is the biggest challenge of our generation. I hope the Minister will tell us when the Government will introduce their reforms, because reforming social care is not just a matter of social justice, but an economic necessity.

[Dr Rupa Huq (in the Chair)]

Finally, the last of the all-female Front Benchers, Minister Helen Whately.

Covid-19 Vaccine: Take-up Rates in London

Rupa Huq Excerpts

Tuesday 9th March 2021 Westminster Hall

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

We are now in the second year of coronavirus, and we have all experienced highs and lows throughout this period. At the beginning, we were told that this is a great leveller, given that Prince Charles and the Prime Minister had it. Rather than the “we are all in it together” narrative, it is maybe more fair to say that we are all in the same storm, but in different boats. Nowhere have we seen that differential impact more clearly than in the vaccine roll-out in London.

We all remember the pictures of the memorably named William Shakespeare having his jab early in December, but it took a good 10 days for the vaccine to reach the magnificent gothic splendour of Ealing town hall, and sadly the supply in London has lagged behind other parts of the country. It has been a magnificent effort. We have all seen the brilliant statistic that a third of the population have been done, but again, there is room for improvement here. We remember the highs and lows—the 50,000 fatalities figure came just before the miracle of the vaccine at Christmas that has given everyone hope—but that maxim of differential impact is one we have to look at.

There are two things that will take us to the other side of this: vaccine uptake among the population and the hesitancy that people talk about, and supply. London has nudging 10 million people—some 12% of the population. My own borough has 360,000 people. Initially, we had the town hall, then we had a second venue in Southall— in the west of the borough. Both those were closed last week. The latter did a record 1,200, I think, before shutting its doors until further notice. There has been a magnificent effort from volunteers and NHS staff, and everyone was poised. I have heard nothing but praise about the efficiency of the operation, but then they were all stood down.

There are old divides between the inner city and the leafy suburbs, but my seat has both: Ealing is known as “queen of the suburbs”, but there are wards of deprivation in Acton, where there has been no vaccination centre; it is a bit of a vaccination black spot. I hope the Minister will help me to address that issue. Acton is big enough to have a tube or rail station with every compass point on several different lines—Central, District, and Piccadilly—but there is no vaccination centre. Given the characteristics of its population, the Acton-shaped hole makes the issue even more urgent.

As a whole, London—our nation’s capital—sometimes seems to have experienced this over-promising, and this moonshot rhetoric. Not that long ago, we were promised 24-hour vaccinations in the capital. That was being said in January. The experience of our centres last week was far from that.

We are waiting for the second dose and hopefully there will be a big surge, but it concerns me that there seems to be a bit of anti-London rhetoric from the Government at times. That stretches to the fact that we have a towns fund with new bungs bringing in prosperity and opportunity—but not in London, which has been completely excluded in favour of red wall locations. I would caution the Government not to let that apply to vaccination supply. London is not immune from deprivation, poor housing and overcrowding: I have those in my wards in Acton. Localised need should drive allocation, not centralised supply.

[Sir Christopher Chope (in the Chair)]

Order. I am sorry to interrupt, but you have gone beyond your time limit. I do not know whether it is because you cannot see the clock. My job is to try to ensure that everybody is able to speak. I call Feryal Clark.

[Dr Huq]

Apologies; I did not see a clock.