Tobacco and Vapes Bill

Simon Clarke Excerpts

2nd reading
Tuesday 16th April 2024 Commons Chamber

[Wes Streeting]

I think that is extraordinary. I do not think that smoking is slightly harmful; I think it is the single biggest cause of cancer, and I think that the costs to people’s health, to our national health service and to our economy are enormous. This sort of argument—that if we ban smoking for young people, we have to ban everything else—is absurd. I think that the Secretary of State just pointed out the absurdity of it when she pointed to a whole range of harmful things in our country that are already banned.

Let me put the question back to the libertarian wing in the corner of the Chamber. Will the new modern Conservative party not ban anything? Will we have a libertarian dystopia in which people are free to do whatever they want in the name of liberty? [Interruption.] I am just trying to help the Secretary of State by taking on the libertarians in the corner. I would be very sad if she wants me to give in to them but, with 187,000 people on the waiting list in the local area of the hon. Member for Rother Valley (Alexander Stafford), I think we should do something about it.

[Sir Simon Clarke (Middlesbrough South and East Cleveland) (Con)]

I proudly call myself a libertarian, because I believe in the fundamental value of freedom of decision making. On what we should and should not ban, I would argue there is a very substantial difference between banning class A and class B drugs, which do immense harm in all our communities, and banning tobacco. We already struggle to stop the former, so why on earth would we try to create and police a huge black market in the latter?

[Wes Streeting]

I admire the right hon. Gentleman for sticking to his convictions as a libertarian in making that case, even though I strongly disagree with him, but how far does his commitment to libertarianism go? He is defending the right of our country’s children to become addicted to nicotine for the rest of their life, which is an extraordinary argument. There are 356,000 people in his local area on NHS waiting lists. Does he want a future where that gets worse and the disease burden and cost pressures rise? When he was in government, the low-tax Conservatives crashed our economy and sent people’s mortgages through the roof, and rents, bills and the tax burden rose. That is their record. I wish he would do more to stand up for his low-tax convictions than his libertarian desire that children growing up in our country today should become addicted to nicotine. I have to respectfully disagree with him.

Compared with three years ago, half a million more people are out of work due to long-term sickness. People’s careers are being ruined by illnesses that prevent them from contributing to Britain’s economic success. We cannot build a healthy economy without a healthy society. Not only is there a moral argument for backing this progressive ban, based on the countless lives ruined by smoking and our shared determination to make sure that children growing up in Britain today will not die as a result of smoking, but there is an economic argument, too.

It is certainly true that vaping is less harmful than smoking and is a useful smoking cessation tool, but vapes are harmful products none the less. In the past few years, entirely on the Conservatives’ watch, a new generation of children have become hooked on nicotine. An estimated quarter of a million children vape today, and there is no doubt that this is the result of vaping companies’ decision to target children. On any high street in the country today, people can buy brightly coloured vapes and e-liquids with names such as “Vimto Breeze” and “Mango Ice”. They are designed, packaged, marketed and deliberately sold to children. The effect of this new nicotine addiction on our country’s young people should trouble us all.

--- Later in debate ---

[Sir Simon Clarke (Middlesbrough South and East Cleveland) (Con)]

It is a pleasure to be called in this debate, although I confess it is one that has depressed me, because this is fundamentally illiberal legislation. If I am in the House for any reason it is because I believe in liberalism—in the ability of people to make better choices for themselves than can the state.

It strikes me that we are witnessing an encroaching tide whereby ever more of our liberties are taken away from us—the speech by my right hon. Friend the Member for Rossendale and Darwen (Sir Jake Berry) was very good on that. We are fortunate in Britain to live in a country where we do not get our rights from the state; we have them inalienably from birth, and it is only the things that we proactively proscribe that we cannot do, but we are adding more and more things to that list.

I say that as someone who is totally clear that smoking is a terrible idea, and I would not recommend it to any young person. I have spent a lot of time with Mr Jonathan Ferguson at James Cook University Hospital in Middlesbrough and have seen the pioneering work he has done on lung cancer. It is absolutely crystal clear that smoking damages your health and damages your wealth and is an antisocial habit in so many ways, but—and it is a big but—I do not believe it is my right to tell my fellow citizens that they cannot do it, any more than it is their right to tell me that I cannot have a glass of red wine with dinner. These are not things that the state ought sensibly to be proscribing.

I actually think we have reached a relatively sensible point with regard to smoking legislation. Not allowing smoking in public places where it can impinge on others is very reasonable and sensible, and I do not think anyone would want to go back to the situation before the 2006 legislation. However, whether we smoke at all in private should be up to us, not the state. We risk creating a huge philosophical as well as practical problem, which will undoubtedly lead to further rights creep as the years go by, because it is likely that the health lobby—the interventionist lobby, as the shadow Secretary of State put it in his speech—will use this as a logic to allow them to move into other fields, and what will our ability then be to resist that argument if we have conceded it here today? So there is a profound philosophical problem with this.

I also believe that it will in practice be a nightmare for shop workers up and down the country to be asked to enforce this. It will place them in an invidious position, which is likely to lead either to them facing real trouble in their shops or, frankly, to them passing the buck and ignoring the law, and making a mockery of its existing at all.

[Steve Brine]

On the “what next?” point, when I was Public Health Minister, we brought in the sugar tax with the soft drinks industry levy. That encouraged the industry to reformulate drinks and took quite a lot of sugar out as a result, because industry followed that trend. If we reformulated processed food to take a lot of salt out and saved a lot of lives from stroke, would that be a good or a bad thing?

[Sir Simon Clarke]

That would arguably be perfectly sensible, but it is different from a ban. The point is about the degree of harm. I strongly support the ban on illegal drugs, but I do so because cocaine, heroin and the like wreck lives and destroy communities. Tobacco does not do that, but we already have enough difficulty enforcing the existing bans that we have in place, which already stretch our resources to the utmost. Frankly, as we all know, we all too often fail to enforce those bans. Adding a new ban risks creating something that will be unworkable from the outset, while creating a huge black market in which criminal enterprise will thrive. Meanwhile, the state will have forgone the tax revenues—some £10 billion or £11 billion a year—that are ploughed back into our public services, including the health service, to combat the effects of smoking. That revenue simply will not be there anymore. We will likely still have people smoking, but we will have offset many of the revenue streams that allow us to combat it.

I simply do not understand how a Conservative Prime Minister thought it appropriate to bring forward legislation that is the opposite of why we are sent to this House, which is to defend and uphold the principle of individual choice and individual liberty. As we have heard, where this legislation has been introduced, it has already been repealed, as in New Zealand. I fear that in this country we will face a choice in the years ahead: either eventual repeal because the legislation does not work or, as my hon. Friend the Member for Rother Valley (Alexander Stafford) said, an outright ban, because of the sheer unworkability of trying to ascertain in practice whether the person in front of you in the queue is aged 39 or 40. We will doubtless simply see a Labour Government move towards an outright ban to make the situation simpler, tidier and neater. That would be a real red line, but we would have forgone the ability to make the principal case against it.

[Daniel Kawczynski (Shrewsbury and Atcham) (Con)]

My right hon. Friend says that drugs destroy lives, but tobacco does not. What about the people who are dying from emphysema and long-term lung cancer? Many families in the United Kingdom are seeing their relatives die a long, lingering death as a result of using tobacco.

[Sir Simon Clarke]

With respect to my hon. Friend, I said that those drugs destroy communities. There is a profound difference. The ripple effect of illegal drugs is to prompt real social harm to others, because those habits are so destructive that people steal and rob to fund them. Tobacco does not do that. It is obviously extremely bad for people, but it does not drive patterns of behaviour as destructive as those associated with crime. That is a fundamental difference, and it is why we should focus our efforts on stopping those trades, rather than on banning something that has been legal for hundreds of years. We all recognise it carries real medical harms, but it is not, I submit, our job to try to take it away from people. We should rely on education and the tax system, but we should not rely on legislation to tell other people what to do when they are grown adults in a free country.

Lung Cancer Screening

Simon Clarke Excerpts

Monday 26th June 2023 Commons Chamber

[Steve Barclay]

My hon. Friend raises an important and topical point. The chief medical officer estimates 50,000 to 60,000 smokers a year may potentially give up through vaping, which is something the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O'Brien), is particularly focused on. However, there is a marked distinction between vaping as a smoking cessation tool and vaping products that are targeted at children, which is why we have both toughened the approach and closed some loopholes. A call for evidence closed a couple of weeks ago and we are looking at what further measures we can take.

[Sir Simon Clarke (Middlesbrough South and East Cleveland) (Con)]

I warmly welcome today’s announcement, and know people across Middlesbrough South and East Cleveland will do likewise. Across Teesside, a targeted lung health check programme has been running for over a year, led by the extraordinary Jonathan Ferguson, who is the clinical lead at the outstanding James Cook University Hospital in my constituency. The programme identified a curable cancer every two days, through scanners operating 12 hours a day, 7 days a week, from mobile units in supermarket car parks. As the new programme is established and proves its value to millions of people across the country, will my right hon. Friend commit to speaking to Mr Ferguson, who has valuable practical lessons about how the pilot has worked on Teesside, which could benefit many other communities?

[Steve Barclay]

I welcome the work that Mr Ferguson and those at James Cook University Hospital have been doing on the programme. We would be very keen to learn from any experience that they have to share. My right hon. Friend also draws attention to the innovative ways of working that are being piloted, including using scanners for 12 hours a day and looking at how they can operate in different ways. That is what this programme is about: delivering far better patient outcomes, much earlier detection and, as a result, far longer survival for those who otherwise may not have realised they have lung cancer and would have been diagnosed at too late a stage.

Bill presented

Relationships and Sex Education (Transparency) Bill

Presentation and First Reading (Standing Order No. 57)

Miriam Cates presented a Bill to make provision to require the sharing with parents and guardians of copies of materials used in relationships and sex education lessons in schools in England; to prohibit schools in England from using externally produced teaching resources for relationships and sex education that have not been published; and for connected purposes.

Bill read the First time; to be read a Second time on Friday 24 November, and to be printed (Bill 334).

Cancer Outcomes: Tees Valley

Simon Clarke Excerpts

Monday 16th January 2023 Commons Chamber

[Mr Simon Clarke (Middlesbrough South and East Cleveland) (Con)]

I would like to open my remarks tonight by paying tribute to the late Professor Stephen Bonner, whose obituary features in The Times today. Professor Bonner delivered marvellous service to the people of Teesside in his various roles delivering critical care at James Cook University Hospital, including the major expansion in the number of our intensive care and high dependency beds and his astonishing success in making James Cook the best place for junior doctors and student nurses to train in intensive care in 2016. It is entirely fitting that in a debate on health services in the Tees Valley we should recognise his enormous contribution to our lives locally. So many of my constituents have reason to be grateful to him. Professor Bonner’s obituary tragically relates:

“With their sons growing up, Bonner and his wife planned for a gradual retirement, but just as he was about to put the plan into action he received a diagnosis of inoperable bowel cancer. Bonner had spent decades improving the system, but the bowel screening test that would have diagnosed the cancer early…had been cancelled during the pandemic.”

That brings me squarely back to the subject of this debate and the particular importance of cancer screening, because ultimately that is at the heart of making sure we improve cancer care nationally as well as locally on Teesside.

A cancer diagnosis is news none of us ever wants to receive, but the reality is that someone in the UK does every 90 seconds. One in two of us will be diagnosed with cancer at some point in our lives. Even those of us not directly affected will undoubtedly have family members and friends who are. Some of the most emotional conversations I have had with constituents have been about the struggles faced by loved ones supporting relatives in their final weeks.

The scale of the challenge posed by cancer is particularly acute in the Tees Valley. The north-east of England has the highest age standardised cancer rate of any English region for both men and women. The incidence rate for female patients is 15% higher than in London, which is the region with the lowest incidence. The difference for male patients who experience higher incidence rates overall is more than 8% higher than the best performing region. The Tees Valley’s industrial heritage is, I am afraid, yielding a grim harvest. There are particular challenges with regard to historic exposure to environmental carcinogens resulting in higher rates of lung cancer and myeloma in particular.

My home area is now at the forefront of progress on much of what is good about the Government’s levelling-up programme under the leadership of Ben Houchen, but the legacy issues persist from our very challenging economic past and the deep deprivation our area continues to suffer from. Smoking and obesity rates are higher than the national average. That context at the very least contributes to Middlesbrough being ranked 140th out of 150 local authorities for premature cancer deaths by Public Health England.

The good news is that thanks to research, many more people are either beating cancer or living much longer with cancer. Macmillan estimates that in 2020, 3 million people across the UK were living with cancer. That is forecast to rise to some 5.3 million by 2040. Median cancer survival has improved hugely as a result of advances in diagnosis and treatment, but there is a lot further to go. We ought to pay tribute at this point to the fantastic effort of those individuals and community groups who are touched by this horrible disease and have decided to make a positive difference to the challenge they have faced. I refer here to Guisborough-raised jockey Bob Champion, who has done a huge amount through the Bob Champion Cancer Trust. He has raised some £12 million over the last 30 years.

On a smaller and more local scale, I pay particular tribute to Claire Starsmore and the amazing East Cleveland Pink Ladies, who have raised £131,000 for Cancer Research UK over the past decade in memory of their much-loved friend Jacqui Hampton. The annual Pink Ball is one of the highlights of the East Cleveland social calendar—I am very much looking forward to attending the 10th version in November, which is firmly in my diary. That kind of event makes the cancer fight very personal and very tangible.

[Alex Cunningham (Stockton North) (Lab)]

I am pleased that another Tees MP is so engaged with the subject. I join the right hon. Gentleman in paying tribute to Professor Bonner for all his work for people in my constituency as well as in his own.

The right hon. Gentleman has already recognised the importance of the early diagnosis of cancer and other diseases to tackling health inequalities in his constituency and mine. Will he join me in congratulating North Tees and Hartlepool NHS Foundation Trust and Stockton-on-Tees Borough Council on their joint campaign over many years to secure a diagnostic centre for our new-look town centre, which was confirmed by the Minister earlier today?

[Mr Clarke]

The hon. Gentleman is absolutely right: this is a subject that crosses party boundaries and constituency boundaries. The contribution of everyone who has fought to ensure that we deliver the best possible cancer care across Teesside is undoubtedly to be applauded. I look forward to hearing the Minister’s remarks about what the Government’s pioneering work to deliver community diagnostic centres will bring to the Tees valley.

I referred a moment ago to the Pink Ball. On the same note, I pay tribute to Councillor Craig Holmes of Skelton West in my constituency, who has raised thousands of pounds for cancer charities through events including the annual Minersfest, an extraordinary music festival in East Cleveland, at which you would always be welcome, Mr Deputy Speaker. Such efforts are incredible tributes—in this case, a tribute to Craig’s mum Alison, who sadly lost her battle with cancer in 2013—and bring huge enjoyment to thousands of local people.

There is much more that we need to do to reduce the average of 460 deaths per day from cancer in the United Kingdom. One of the strongest predictors of cancer outcomes is how early a diagnosis is made and treatment is started. It is estimated that for every week earlier that the treatment of cancer commences, the chance of five-year survival increases by at least 1.5%, so it makes a material difference.

[Andy McDonald (Middlesbrough) (Lab)]

May I share in the warm words of tribute to Professor Bonner from the right hon. Gentleman, my constituency neighbour? Like me, he is very much aware of the superb, world-class work that goes on at the James Cook University Hospital’s oncology department. It has six linear accelerators with a lifespan of about 10 years, but half of them are now reaching the end of their natural life, and as they break down they are becoming less efficient. Does he share my plea to the Department of Health and Social Care and the Treasury to ensure that the necessary funding is made available to the James Cook University Hospital and the trust to carry on their vital, life-saving work for our constituents across Teesside and beyond?

[Mr Clarke]

I echo what the hon. Gentleman says about the importance of ensuring that our equipment is absolutely the best it can be. I had the privilege of seeing the new equipment at the James Cook’s interventional radiology department before Christmas, which was incredibly impressive. The hon. Gentleman is absolutely right that such investment is vital to ensuring that once treatment commences, people can get the best possible care.

[Tim Farron (Westmorland and Lonsdale) (LD)]

The right hon. Gentleman is being staggeringly generous in giving way; it is noted and appreciated. The technology is important, but what is also important is where it is. I echo the call for linear accelerators to be up-to-date so that radiotherapy treatment is as up-to-date as possible. That is incredibly important, but the National Radiotherapy Advisory Group also says that nobody who needs radiotherapy should have to travel for more than 45 minutes to get it. Areas a little more rural than Middlesbrough may face lengthy journeys; there is nobody at all in Westmorland who lives within 45 minutes of our nearest radiotherapy centre. Does the right hon. Gentleman agree that having satellite units, with linear accelerators placed away from the main centre—for us, that would be in Kendal—would be one way of ensuring that people in more remote and rural communities get the treatment they need so that their life can be longer?

[Mr Clarke]

The hon. Gentleman is absolutely right. Representing East Cleveland as I do, I have some insight into the challenges of distance in rural areas. Bringing care to people to the greatest extent possible and commensurate with the challenges is vital, particularly for things like screening.

That leads me neatly to a point raised by Mr Jonathan Ferguson, the consultant lung surgeon at the James Cook University Hospital in Middlesbrough and clinical cancer lead for South Tees Hospitals NHS Foundation Trust. He has done much to bring to my attention the fantastic work that is already going on in the Tees Valley to increase early diagnoses. Much of that work is clearly led by him, although he is far too modest to say so. Jonathan is a linchpin of our local healthcare system, and a hugely impressive consultant. In the light of the impact of covid, this progress is more vital than ever. Macmillan estimated that by March last year there were still at least 37,000 fewer cancer diagnoses than expected as a result of the disruption caused by the pandemic. It is clearly vital for us to address that.

Over the last 12 months, Mr Ferguson has been the driving force for the new targeted lung health check programme in the Tees Valley. That region-wide service is now up and running, identifying curable cancers that would otherwise have been undetected for longer through effective collaboration between local NHS teams and an independent-sector diagnostic specialist. This approach has identified a curable cancer every two days, which is fantastic, through scanners operating 12 hours a day, seven days a week, from mobile units—a subject raised by the hon. Member for Westmorland and Lonsdale (Tim Farron)—in supermarket car parks, with the facility operating at a 97% occupancy rate, which is wonderful. The facility is staffed and appointments are managed by the independent partner, with target patients identified through NHS records and an initial telephone questionnaire.

This enables our brilliant local NHS teams to focus on treating patients and tackling the backlogs, which we know will allow them to deliver great results. The superb clinicians at the James Cook University Hospital have an excellent track record of innovating to improve patient care, with recent initiatives including the Macmillan-supported thoracic surgery community nursing programme, which won the Nursing Times award for the best surgical nursing team. It has reduced both the length of hospital stays and readmission rates for patients following thoracic surgery. Many of those are, of course, lung cancer patients.

It is exciting to hear the proposals for a new Tees Valley diagnostic hub in Stockton, which I think the Minister will say more about in her speech—I look forward to that. It was originally not expected to welcome patients until 2025, but it has been fast-tracked and is now expected to open much sooner. Mr Ferguson believes passionately that opening the hub this year would

“save more lives on Teesside than I have throughout my surgical career”,

so we should all welcome it warmly, given the practical difference it will make on the ground.

I know it is a mission of this Government to ensure that we address health disparities, and there is probably nowhere in England where a greater difference can be made than on Teesside. I am joined tonight by my hon. Friends the Members for Stockton South (Matt Vickers), for Redcar (Jacob Young) and for Sedgefield (Paul Howell), and we are all very grateful for the action that the Government have taken.

When we are looking at our future options, we should bear in mind that the more we can do with the private sector as well to increase our capacity, the better. Through what he has been doing with his supermarket car park screening, Mr Ferguson has shown the value of such partnerships in unlocking extra capacity. I urge the Government to look at all the options to ensure that we can get the maximum number of people through the system, receiving the care that they need through all parts of our healthcare system.

Coupled with last week’s exciting announcement about the cancer vaccines trial partnership between the Department of Health and Social Care and BioNTech—which could allow eligible patients in England early access to revolutionary personalised mRNA therapies through trials as soon as next autumn—are the Government’s significant steps to give cancer patients improved chances of survival, and to give families and friends more precious time to spend together. I know that colleagues on both sides of the House will join me in welcoming those efforts, which will make an enormous difference to our constituents.

This is a practical and tangible debate on an issue that touches nearly every family at some point. I would be grateful if the Minister could tell us what the Government are doing to ensure that cancer outcomes across Teesside continue to improve in the way that has been so encouraging to us all so far.

NHS Industrial Action: Government Preparations

Simon Clarke Excerpts

Monday 12th December 2022 Commons Chamber

[Will Quince]

The average pay settlements in the private sector range between 4% and 6%, and we want to have a fair deal for both NHS staff and the taxpayer. The hon. Lady makes reference to the pay review bodies, but it is important to stress that they are made up of independent experts. They recommended the uplifts for NHS staff, and in formulating their recommendations, the review bodies carefully considered evidence from a wide range of stakeholders, including NHS system partners and trade unions. The independent pay review body is a respected mechanism, and we should accept its recommendations, which we have.

[Mr Simon Clarke (Middlesbrough South and East Cleveland) (Con)]

May I commend my hon. Friend on his response to the urgent question, and say how much I agree with him? Can he set out his thoughts on how things would be likely to proceed in the NHS if we ended up in the scenario which the shadow Secretary of State appears to want, in which Ministers negotiate directly with unions on pay every winter? Does he think that that would lead to upward pressure on pay at the expense, crucially, of the public, whom we serve and who need those operations and the elective care for which we have budgeted, and that that should not be eroded by unrealistic pay demands of 19%?

[Will Quince]

My right hon. Friend is right. We have an independent pay review body mechanism for a reason, and it has worked for a number of years. That is why I made reference to the First Minister in Scotland. Is this a procedure we are going to go through every single year when a pay review body recommendation is made and unions do not like it, and politicians have to get involved? The point of the independent pay review body is that it depoliticises the issue, and Ministers do not negotiate directly with unions. The independent pay review body looks at the issue in the round, along with the wider economy and a number of other factors, then forms a recommendation which the Government can choose to accept or refuse. It is important to stress that in this case the Government accepted the recommendations in full.

Covid-19 Update

Simon Clarke Excerpts

Tuesday 14th September 2021 Commons Chamber

[Sajid Javid]

There are measures that, when it makes sense, we must remove. The reason that we can take a different approach to contact tracing than we did a few months ago is largely down to the high rates of vaccination we are seeing throughout the country. Of course we want them to increase, but as we vaccinate more, that allows us to start removing these restrictions, additional costs and burdens on individual livelihoods. It is right that we take a balanced approach and keep increasing vaccination so we can keep removing other restrictions.

[Mr Simon Clarke (Middlesbrough South and East Cleveland) (Con)]

I welcome the Secretary of State’s statement. May I raise the plight of care home residents, many of whom have been kept apart from their families and loved ones owing to outbreaks being declared in their home? Obviously, we need to strike a proportionate balance here, but the threshold for intervention by declaring an outbreak is really quite low. Will the Secretary of State commit to looking at that so we can ensure that people can see their loved ones throughout the winter ahead?

[Sajid Javid]

Yes, I can give my hon. Friend that commitment. He may also be interested to know that, with the booster announcement today, care home residents will be an absolute priority.

Public Health

Simon Clarke Excerpts

Wednesday 6th January 2021 Commons Chamber

[Mr Simon Clarke (Middlesbrough South and East Cleveland) (Con) [V]]

I am in total agreement with the Government that the emergence of the new, more transmissible strain of the virus has, once again, changed the logic of where we stand and how we should act. This week, we have effectively ended the difficult balancing act of trying to split the difference between containing the virus and keeping as much of our economy and society open as we can. A combination of having two safe and effective vaccines and the emergence of the new covid variant means that our focus is now overwhelmingly on containment. That is the right choice and, indeed, probably the only choice that any Government could make at this moment in time. For Ministers to acknowledge this is not to show weakness, nor was it wrong to try to do everything in our power to retain some semblance of normality, especially in our schools. Let us not for a moment pretend that there are not very serious trade-offs in re-entering lockdown: the pain felt by the lonely; the struggling business owners; children unable to attend class and parents trying to raise them at home while working. This is all real and deep and miserable. None the less, the data is impossible to argue with. One in 50 people in our country is ill with this virus, and the numbers are rising. I therefore warmly welcome the Prime Minister’s announcement that we will vaccinate all those in tiers 1 to 4 of the Joint Committee on Vaccination and Immunisation’s strategy by the middle of next month.

It is great news that 1.3 million people have now been vaccinated—more than in the rest of Europe combined—but we have no time to waste in accelerating the roll-out. Every week that we are in this situation costs thousands of lives and billions of pounds. I have the highest regard for the vaccines Minister, the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Stratford-on-Avon (Nadhim Zahawi), and wish him every success in mobilising every deployable resource to combat this monster. Any business that can fight weak links in the supply chain should be enlisted to help. Any building that can sensibly be turned into a vaccination hub should be requisitioned. Administering the vaccine should include the full use of the armed forces, dentists, community pharmacists, vets and retired medical professionals. We must not be encumbered by needless bureaucracy, and we must not be constrained by normal working hours. I welcome the new daily vaccine statistics that we will receive from Monday. To help monitor progress, it would also be helpful to know our projected weekly trajectory for getting priority groups vaccinated.

I want to focus quickly on one other issue: maintaining the highest quality education offer this winter. Our schools must not hesitate in accepting the children of key workers, and, if a school has an unusually high proportion of key workers’ children, options should be looked at with neighbouring schools to provide support. We need to focus on ensuring rigorous attendance by children in remote learning, and to ensure that no child misses out because of a lack of internet or appropriate devices in their home. I warmly welcome today’s announcement from the Education Secretary on that point.

This is a national crisis and I am absolutely confident that we will overcome it together.

Covid-19 Vaccine Roll-out

Simon Clarke Excerpts

Tuesday 8th December 2020 Commons Chamber

[Matt Hancock]

We have a programme under way to ensure that those without an NHS number can get vaccinated; the NHS number is the basis of the calling system to invite people to be vaccinated, but of course not everybody has an NHS number, and we must ensure that those without one get called forward too.

[Mr Simon Clarke (Middlesbrough South and East Cleveland) (Con)]

I pay tribute to everyone involved in administering the vaccine from The James Cook University Hospital in Middlesbrough today. Looking ahead to the next stage of the roll-out, I have been contacted by a GP surgery in Berwick Hills in my constituency that is concerned about the resource implications of delivering the vaccine, since it is severely under strength and serves one of the most deprived communities in England. Will my right hon. Friend agree to look at their case and discuss what extra support might be made available to surgeries that find themselves in that position?

[Matt Hancock]

The way we have organised the primary care roll-out is through networks of GP practices—primary care networks, as they are called—so that if one GP practice is under particular pressure, for instance because it may be carrying vacancies, the effort can be put together over a wider network of GP practices. The funding support for GPs to deliver this vaccine, as with the flu vaccine, is negotiated and agreed with the British Medical Association and is part of the operational roll-out of the vaccine in my hon. Friend’s constituency and elsewhere across the country.

Pectus Deformity Treatment: NHS Funding

Simon Clarke Excerpts

Tuesday 24th November 2020 Westminster Hall

[Mr Simon Clarke (Middlesbrough South and East Cleveland) (Con)]

I beg to move,

That this House has considered NHS funding for treatment of pectus deformity.

It is a pleasure to serve under your chairmanship, Ms McVey. I will also discuss e-petition 329161 on the same subject, which I am delighted to say has been signed by more than 6,000 people, including 183 from Middlesbrough South and East Cleveland. I thank everyone who has taken the time to sign the petition, as well as its organisers.

The lack of treatment for pectus excavatum on the NHS is an issue by which I have been deeply moved and for which I am determined that we should deliver lasting change. The situation as it stands amounts to an injustice for a young girl in my constituency and many more like her across the country. It is, however, a matter that can be simply solved. The solution would not be particularly expensive and is not controversial, so I sincerely hope it attracts ministerial support.

About six weeks ago, I was contacted by the parents of Autumn Bradley, a 14-year-old girl from Guisborough who suffers from pectus excavatum. Caused by an overgrowth of cartilage, the condition means that as she grows, her breastbone is being pushed inwards towards her spine. In her case, that inward growth has advanced to the point where her sternum is now just 25 mm from meeting her spine.

For many people living with less severe forms of pectus, its impact is predominantly psychological, but for Autumn, the condition has been nothing short of life-changing. Her parents have watched the physical condition of their once active, energetic daughter deteriorate beyond recognition. Growing up, she excelled at athletics and competed at county level, but today she struggles to blow up a balloon. Complications of the condition have led to numerous hospitalisations, so her school attendance and academic performance are being increasingly affected. It now causes her pain even to hiccup.

Treatment for the condition is effective, routine and widely available across the developed world. It is available free of charge on the NHS in Scotland, Wales and Northern Ireland, but since early 2019, it has not been available to patients in England. Because about 90% of surgeries to treat pectus are deemed to be cosmetic, last year the decision was made that the treatment would no longer be funded by NHS England.

Ruling out treatment for psychological reasons is a debatable proposition, but it is not inherently unreasonable. What is unreasonable is that the 2019 NHS policy document is clear that treatment for pectus will not be available, irrespective of the seriousness of the symptoms. As a result, Autumn’s surgeon, Mr Dunning, has found it impossible to make the case for treatment on an exceptional basis, even in cases where the physical impact of pectus is as devastating as it is for Autumn.

Mr Dunning is based at the wonderful James Cook University Hospital in my constituency. He estimates that, as a result of this situation, about 50 patients a year in England—overwhelmingly teenagers—are left suffering life-limiting symptoms that could easily be fixed. The symptoms include shortness of breath, heart rhythm disturbances and even episodes of collapse.

Mr Dunning spoke recently on BBC Radio Tees about how the current NHS policies affect Autumn:

“I believe it is a complete disaster and a mistake that we cannot turn this around. We’ve found it impossible to change it. We’re looking for anything we possibly can to try and get this poor short-of-breath person an operation. I couldn’t be more confident in being able to fix this poor girl with an operation”.



He said that if he were allowed to carry out the procedure, Autumn would be in hospital for four days with three weeks to recover at home, and after that,

“she’ll be a new person for the rest of her life.”

The average cost of surgery to correct pectus deformity is between £7,000 and £16,000. Treating 50 such patients a year would therefore cost less than £1 million, which, in the context of the wider NHS budget, is a minute sum of money.

Mr Dunning’s passion for helping patients such as Autumn has led him to campaign extensively on the issue and to dedicate a significant amount of time to supporting those affected. His commitment to her care and that of her fellow pectus sufferers is beyond all praise. He represents the best of our national health service. I am equally grateful to BBC Radio Tees and campaigning newspapers such as TeessideLive and The Northern Echo for helping to raise the profile of the issue.

What, then, has gone wrong with the NHS commissioning process? The process, which began in 2015, resulted in a 2018 literature review that considered only six papers, all of which focused on the psychological benefits of surgery. It resulted in the following judgment:

“The evidence that was found is not sufficient to conclude that the physical, psychological, social and behavioural benefits of surgical treatment of pectus deformities are sufficient to justify its use.”

That is despite the fact that the final policy document acknowledged:

“The impact of a pectus deformity can vary substantially, ranging from mild and symptomless to severe and impacting on both lung…and heart…function.”

During the consultation process, the Society for Cardiothoracic Surgery submitted nine additional papers that it felt contained important evidence that should be considered. All nine were rejected, some for what seemed dubious reasons. One study of 168 patients from the United States was rejected on the grounds that a single surgeon performed all the operations, yet most of the papers included in the 2018 review are single-centre studies, and one included paper is explicitly a single-surgeon case series. A 2015 NHS England policy document stated, with reference to previous papers from 2007 and 2010:

“Leading US centres report inclusion criteria for surgery as severe pectus excavatum that fulfils two or more of the following: CT index greater than 3.25, evidence of cardiac or pulmonary compression on CT or echocardiogram, mitral valve prolapse, arrhythmia, or restrictive lung disease”.

For reasons that are unclear, those impacts were not considered by the 2018 literature review. I find it concerning that a submission was not corrected even when highlighted by thoracic surgeons.

The case for allowing surgery for more extreme cases of pectus seems clear, based on the expert reviews that I have seen, which show measurable improvements in cardiopulmonary function in patients with a Haller index of between 4.5 and 5. The Haller index is used to describe the severity of an individual’s pectus deformity. I will outline those reviews, and it is worth remembering that Autumn’s condition is far more severe: she has a Haller index of 9.7.

A 2011 French study of 120 severely affected patients with a mean Haller index of 4.5 showed that surgery delivered sharply improved heart function. Prior to surgery, the maximum rate of patients’ oxygen consumption was just 77% of their age-predicted maximum. One year after surgery, it had increased to 87% of their age-based prediction. A 2013 Danish study with 49 patients with a mean Haller index of 4.9 showed that patients with pectus had a 20% lower cardiac index than healthy control patients of the same age prior to surgery. Three years after surgery, the cardiac index of treated patients had normalised to be similar to the controls.

I am clear that the NHS commissioning process has failed on this occasion. It has excluded crucial evidence about the benefits of pectus surgery for those presenting severe physical symptoms, and it is written too prescriptively to allow any discretion for individual funding requests. Autumn has already been rejected for an IFR twice, despite her life being made an increasing misery by the condition. I defy anyone to explain how in severe cases such as Autumn’s a normal, healthy life is possible without surgical correction of the deformity.

I pay great tribute to Autumn and her mum Sarah. Until now, Autumn has been known publicly as Katie to protect her anonymity, but ahead of this debate she has bravely waived that anonymity for the first time. She has asked me to share with the House, in her own words, how her life has been affected by the condition. She said the following:

“For as long as I remember I have had pectus excavatum.

When I was younger I embraced it as it made me unique. It didn’t affect me massively.

I loved sports, I ran and did long jump for the County competitively, I surfed, climbed mountains, played football with friends, went to scouts and much more.

I spent free time caring for animals in a pet rescue. However as the years went on, my pectus has got progressively worse.

The dent deepened. I began to suffer with my health. Every cold I had went on my chest and needed antibiotics and steroids and I often ended up in hospital.

I began to miss massive amounts of school and all the things I loved.

Fast forward to now. I can’t do any sports, all the clubs I loved have gone. I feel so tired constantly, my ribs and back are in so much pain I take painkillers all the time, but it still hurts.

I can’t breathe.

I can’t take a deep breath—it feels restricted and like my chest is being crushed and I can feel my sternum touching my spine.

Climbing stairs leaves me breathless. I don’t even attend school now.

My dream was to be an athlete or a nurse, my chance of the first dream is gone.

I’m so worried about what the future holds for me as my school grades will start to suffer.

All I am asking is that you reconsider the decision not to offer pectus surgery as it would give not only me, but lots of teens like me, a chance of a normal life like those who are not born with this condition.”

What should be done? I am grateful to the Minister for his time and the consideration he has given the issue in the days leading up to the debate. He is an excellent Minister, and I am all the more grateful given the many other demands on his time because of the wider national situation. Likewise, I am thoroughly appreciative of the time that my right hon. Friend the Secretary of State for Health and Social Care gave me a fortnight ago. He could not have been more attentive, and he joined me and my hon. Friend the Member for Bury South (Christian Wakeford) in a good discussion about what we might do to move the situation forward. Last week he raised the matter personally with the NHS chief executive Simon Stevens.

My central request is that the NHS should be asked to reconsider its wider policy on the issue as a matter of urgency. While such a review is being conducted, and in the interim, it would be fantastic if a holding position could be established, by which there would be a facility for surgeons to appear in person to discuss the evidence for pectus surgery in the most severe individual cases—effectively a kind of extraordinary carve-out from the wider policy. That would reflect a suggestion made by four of the five stakeholders during the commissioning process. It would make sense to allow that subset of severe patients to be identified so that selected centres could perform the operation on the NHS and report their findings in a registry. That commissioning through evaluation would allow a continuation of surgery for that small subgroup, along with monitoring of the impact of the surgery, and the provision of valuable new data to inform a wider policy review.

That would offer both a short-term and a medium-term solution to the issue. No one expects a miracle solution overnight. The process of NHS commissioning is rightly complex and independent. None the less, we should try to kickstart the process today. I should be happy to meet further with the Minister or his officials, but the current policy on pectus excavatum is not right, and it should not continue. I agree with Autumn and her parents, and with experts in the field such as Mr Dunning, that there are cases where pectus surgery is anything but an aesthetic choice. For a small group of young people in this country, it is the only route to anything resembling a normal life, and we should restore the treatment free at the point of need at the earliest opportunity.

Dementia: Covid-19

Simon Clarke Excerpts

Thursday 12th November 2020 Westminster Hall

[Mr Simon Clarke (Middlesbrough South and East Cleveland) (Con)]

I congratulate the hon. Member for Oldham East and Saddleworth (Debbie Abrahams) on securing today’s debate. It is obviously an immensely important and sensitive topic, and it is right that it should be brought to the attention of the House.

We all know that the pandemic has caused great heartbreak across our country, nowhere more than in our care sector. Our care homes do vital work looking after the elderly and infirm and we owe them and their dedicated managers and staff a great debt of gratitude after all the challenges they have faced over the past year. I have had several very productive meetings with them in Middlesbrough South and East Cleveland. They want to do their best for the people in their care and their families, and some have shown great ingenuity in seeking to ensure that visits from loved ones are still possible.

None the less, as we have just heard from my right hon. Friend the Member for Tatton (Esther McVey), we know there is a real issue with family access for many sufferers with conditions such as Alzheimer’s and dementia, and that it is taking a devastating toll. That pain is not measured simply in mortality numbers; for many of the families of the sufferers with those conditions, it is the deterioration in their loved ones’ capabilities during the isolation they have endured this year that is particularly concerning.

We know that many residents in care homes have had hardly any visits, and some have had no visits, since the crisis began in the spring. How deeply sad that can be has been brought home to me by a number of moving messages from constituents such as Kelly Holmes from Coulby Newham. Her dad was diagnosed with dementia in February last year, and he does not understand why it is not possible for Kelly and her mum to visit. He regularly rings them, distressed and confused about why they have not visited and worrying that no one cares about him. The repetition of that conversation is obviously deeply distressing for the family.

Rebecca Skelton from Nunthorpe has spent 90 minutes in the past eight months with her mum, Ann, who suffers from dementia. She said:

“Before Covid my mother could not converse with me and my family but there was always a smile of recognition when going to visit her, as though she still knew who we were. The thought of not having this when I do get to see her is breaking my heart and causing me severe depression. The thought of her feeling that we have abandoned her by not visiting is causing more anxiety, I only hope that the smile is still there when I do get to see her.”

I have received so many other messages. I thank Mr Malcolm Guest, a constituent of my hon. Friend the Member for Redcar (Jacob Young), who raised the case of his mum Annie; and Lesley Turnbull, who contacted me on behalf of her husband Tim, who has Lewy body dementia. Her words have really stayed with me:

“I have begged him not to give up and I got a reaction, I always get a reaction when I say I will be with you soon.”

In the limited time available, I will make a simple plea: some of the new lateral flow tests—it is great news that they are being rolled out across large parts of the country, including to all authorities in the north-east—ought to be prioritised so that relatives can have access to their loved ones in care home settings. My hon. Friend the Member for Redcar and I have already written to the director of public health for Middlesbrough and Redcar and Cleveland with precisely that request, and I hope that the Minister might offer her thoughts on it. More broadly, I welcome the Minister’s commitment a few weeks ago to explore giving family carers key worker status. I hope that can be actioned, because it could make a real practical difference.

Finally, it would be remiss of me not to acknowledge the real upsurge in hope brought about by this week’s news of the Pfizer vaccine, which is obviously fantastic. I strongly support the Government’s proposed prioritisation of those who will receive the vaccine as soon as the necessary checks have been finalised and roll-out can begin. We must resist the toxic anti-vaccination propaganda that is circulating alarmingly widely on social media and state the truth that effective vaccination will be the end of covid-19 and will pave the way to ending the suffering of so many of our constituents living with Alzheimer’s, dementia and so many other conditions, and the suffering of their families. It can and will restore the love, company and sense of belonging that we all wish to experience at the sunset of our lives. It cannot come too soon. I commend the efforts of the Minister and her colleagues in helping to make sure that we are ready, as a society, as soon as the vaccine is ready to be given to the public.

Oral Answers to Questions

Simon Clarke Excerpts

Tuesday 6th October 2020 Commons Chamber

[Mr Simon Clarke (Middlesbrough South and East Cleveland) (Con)]

It is important that communities, such as mine in Middlesbrough, can see a way out of the tighter local restrictions that have now been imposed. Notwithstanding my right hon. Friend’s earlier, very reasonable answer to the hon. Member for Bradford South (Judith Cummins) about the impossibility of setting hard metrics for the release from lockdown, can he set out what would constitute a path out? Does it include, for example, a sustained fall in transmission rates?

[Matt Hancock]

The level of cases matters, but so too does the direction of travel, and when the number of cases is falling—especially if it is falling rapidly—that is the sort of indicator that we will look at. One example is the action we took in Leicester a few months ago now, where we removed some of the most restrictive measures when the numbers were coming down sharply.