Health Bill

Steff Aquarone Excerpts

Report stage
Monday 7th September 2026 Commons Chamber

[Janet Daby]

I thank my hon. Friend. He could not have said that more clearly. This is absolutely about inequalities in the health service. He has explained and expressed that extremely well. I know that he, like me, will continue to advocate for people from ethnic minority and diverse backgrounds.

New clause 162 would require the Secretary of State to do two things: first, to lay an annual report before Parliament on the performance of specialised services against national standards; secondly, to ensure the regular publication of data on quality and outcomes of the kind currently captured in the specialised services quality dashboards, which NHS England has maintained on a non-statutory basis. Without legislation, those dashboards could quietly disappear when NHS England does, and that must not happen. The new clause would make their continuation, or the continuation of something equivalent, a legal requirement.

I want to be clear about the modesty of this ask. We are not asking the Government to build new services, ringfence budgets or second-guess local commissioning decisions. We are asking them to measure, publish and report, in order to ensure basic accountability for patients with rare conditions, and for geographically dispersed people, predominantly from black and minority ethnic backgrounds, so that they have services that work.

The patients who rely on specialised services are often marginalised twice over: once by their condition, and again by a system that does not always see them clearly. New clause 162 would require the Secretary of State to identify them, and to report back to this House on what they find. I urge the Government to take this new clause seriously and to respond appropriately.

[Steff Aquarone (North Norfolk) (LD)]

Amendment 19 closes a dangerous gap in the Bill and commands the support of Members from across the House. It is right that clause 4 calls for the Health Secretary to reduce inequality of access to health services, but the Bill must explicitly cover rural and coastal health inequalities, or else less densely populated communities will always lose.

At face value, it makes sense to measure success by the greatest number helped; however, in the long run, that is a false economy, as delayed diagnosis and treatment ultimately cost the NHS more. It is a little bit like access to high-speed broadband—we rolled out the first phase to the places where the most people could be connected, which rewarded the Government and providers with some impressive-sounding numbers while disguising failure in the margins. Rural and coastal communities are literally and politically at the end of the line, and are therefore reached last.

[Sarah Dyke (Glastonbury and Somerton) (LD)]

As my hon. Friend will know, the chief medical officer’s rural health report is due later this year. Rural health cannot be seen as an afterthought. That is why I tabled new clause 120, which would create a farmer-friendly general practice scheme, similar to the veteran-friendly accreditation scheme; it would recognise GPs who proactively reach out to isolated farming communities. Does my hon. Friend agree that the Government must treat the rural health report’s recommendations as a genuine test of action, and not just warm words?

[Steff Aquarone]

I absolutely agree. In order to achieve genuine equality of access, the Government must go outside-in; in other words, they must design provision around the hardest places to serve—my hon. Friend gives a great example—and then work inwards from there.

“If Australia can effectively serve communities living in the remote outback, we can meet the needs of people living in rural and coastal England.”

Those are the words of the right hon. Member for Ilford North (Wes Streeting) when he was Health Secretary. Not only do I agree with him, but I challenge the current Health Secretary to turn her Government’s own words into law. We got it wrong with broadband; we cannot afford to get it wrong with people’s health.

In North Norfolk, I see the struggle for health access and outcomes at first hand. People living on the coast start with half the access that those in inland areas have. Conventional service models assume that people can access healthcare from any direction, but for our coastal communities, half of the area is the sea. The sea may be beautiful, but it does not run a bus service, staff a clinic, or provide a patient catchment. Coastal communities, which may have sparse populations and poor transport, need more local points of care, not fewer. On top of that, the services we do have are burdened by exceptionally long waits. We are not unique in this; some of the poorest healthcare access and outcomes can be found in communities like mine.

We know the challenges for health and wellbeing in these areas from the excellent work of Professor Sir Chris Whitty. He spelled out that we suffer from shorter life expectancy and higher rates of major chronic illness, higher rates of alcohol and drug-related harm, and more cardiovascular and chronic lung conditions. These are very serious problems, and they cannot remain an afterthought in national health policy. National systems must not mistake population density for severity of need.

Besides, when problems are caught earlier and treated faster, it leads to better outcomes. That is one of the reasons why I was so frustrated to be told by the Government before recess that they have “no plans” to provide an urgent treatment centre at Cromer hospital in my constituency, although it would transform access to urgent care across North Norfolk. I am putting the Department on notice today: my constituents and I will continue pressing the case until Ministers reconsider.

Let me tell the House what these inequalities mean in human terms. They mean that constituents like Kelly, who has been waiting more than 70 weeks for a hip replacement, are living every day in pain. Another constituent, Samantha, told me that she waited 30 weeks to see a gynaecologist. The NHS standard is 18 weeks. Appallingly, our wait times made a young woman so unwell that she was forced to sacrifice her education; during the wait, her symptoms worsened to the point that she had to step back from the degree that she was studying for.

I heard from Ian, who has metastatic prostate cancer and requires treatment at the Norfolk and Norwich hospital. It is a half-day trip for him by car to get the essential treatment that he needs. He told me that he considered using a local bus service, but that it would be an hour just to get there. He lives with a damaged bladder, due to his condition, and he told me that it makes life “very unpleasant”. I would go further and say that it is undignified and dehumanising.

[Graham Stuart]

The hon. Gentleman is giving a powerful speech on behalf of rural and coastal areas. One word that he has not used yet is “age”. Age is the clearest proxy for health need that there is. It is not deprivation or anything else—it is age. The distribution of health funding in this country has, under successive Administrations, failed to recognise that and allocate funding accordingly. That is why cancer patients in his constituency and mine find themselves with chronically less spent on them than cancer patients in areas where there are many fewer of them.

[Steff Aquarone]

I could not agree more. That is one of many respects in which rural and coastal communities around the country have much more in common with each other than with their inland neighbours just a few miles away. Theoretically available treatment becomes practically inaccessible if it requires a journey to be made without reliable toilet access, as in Ian’s case, and in cases where access to private transport is more limited, as in the cases that the right hon. Gentleman raises.

Kelly, Samantha, Ian and so many more are entitled to the same access to good treatment and the same chance of good health as people living in urban and inland communities. It is absolutely right for the Government to pursue this Bill, and I support their aim wholeheartedly, but I challenge them to assess the Bill based on who is left behind, not just who can be helped. Accept this amendment, or explain why rural and coastal communities do not merit explicit protection.

[Dr Simon Opher (Stroud) (Lab)]

My remarks will focus mainly on new clause 69, which is in my name. Getting rid of NHS England is one of the best things that this Government have done. As working clinicians, we can at least now get away from so much admin and management.

My amendment is a simple one about self-care and health literacy. Demand for healthcare has increased enormously. Since 2019, for example, GP consultations in Stroud have gone up 30%. When I started work as a GP, patients saw me on average three times a year; it is now about eight times a year. Indeed, A&E attendance has gone up 20% over the last decade, yet the health of the nation remains the same. This is the demand side of the NHS that we very rarely discuss, and this is what I am asking the Secretary of State to address.

Let me turn to the causes of this increase in demand. There is a concept in medicine called the symptom iceberg. Most of us get symptoms every day, but we do not go to the doctor. We only go to the doctor when we have certain symptoms, and it is a very small number of symptoms, but that has increased over the last 20 years. Then there is the role of something that we call lay referrals; people used to have mums who lived next door, but now they are often much further away. We are socially isolated in an atomised society. We also have a much higher expectation for our health. We cannot fault that, but it means that, for example, people go to the doctor with very minor things. There are also factors such as AI. In my surgery, we use AI, but I believe that creates its own demands. There is also good old Dr Google, who in this country is consulted over 50 million times every year—and those who go to Dr Google usually end up thinking that they have cancer or need an ambulance, so that is clearly driving demand.

There are also doctor factors. If we carry on treating sore throats with antibiotics, people will carry on coming back. Earaches generally get better, and people do not usually need to see a doctor for headaches. We are over-diagnosing and over-medicalising everything. NHS factors includes the algorithms for 111 and litigation. I would also like to talk about health literacy. That means knowing about our health, and understanding that we are not always in totally good health, but we do not have to consult the health service just because we are feeling a little bit low or a little bit tired.

One of my colleagues in Stroud, Dr Hugh van’t Hoff, started Facts4Life, a school-based education service that goes into schools. In the last 10 years, he has worked with over 200 primary schools. He has shown that if we teach young children about health and how it is normal sometimes to feel tired or have a sore throat—stuff like that—we can reduce consultations in the NHS. We can also teach children how to understand information on the internet, so that when they look at statistics, they know what they mean, instead of thinking, “Ooh, my risk of cancer has been doubled by doing this.” That is really important.

We are also over-medicalising patients. In this country, 9 million patients in England alone—one in five adults—are on antidepressants. That is a scandal.