Tobacco and Vapes Bill

Steve Brine Excerpts

2nd reading
Tuesday 16th April 2024 Commons Chamber

[Steve Brine (Winchester) (Con)]

I start with a spoiler alert: I will be voting to give the Tobacco and Vapes Bill a Second Reading this evening. As we might say, prevention is the new cure. I will not spend my time reading out the screeds of statistics that we have already heard, but the bottom line is that smoking products are the only product on sale legally in our country today that—if you follow the instructions—will kill you. Both Labour and Conservative Governments have acted in the past, and we have seen smoking rates tumble as a result. It is now time to finish the job, and this Bill can be part of that.

Here is where I am coming from. We talk a lot about the pressures on the NHS. Indeed, there have been some new waiting list figures published while we have been away. We talk about public satisfaction—colleagues will be aware of the latest British social attitudes survey last month. We talk endlessly about systems, budgets and staffing, which is all quite proper. They are all issues that we face, and my Health and Social Care Committee does not duck any of them.

We can increase the budget, and we have done so hugely. The NHS in England has never had more money. We can put in a place a properly funded workforce plan, as my Committee called for—and we have. We can produce credible recovery plans for urgent and emergency care, primary care and elective waiting lists, and the Government, to their credit, have done all of those things. We can make use of a much wider workforce—Pharmacy First is a good example—but the truth is that demand continues to outstrip supply, and we cannot continue to increase the health budget faster than our economy is growing. We have to think long-term about population preventive health.

For me, there is no more obvious and glaring candidate for healthcare gains from prevention than action against smoking. When looking at this legislation, I ask not whether we want to finish the job on smoking, or whether it is right to save tens of thousands of lives lost to cancer, heart disease and stroke by doing that—I lost both my parents to cancer before I was 50—but whether the proposed measures aimed at creating a smoke-free generation will actually work. I also ask: how strong is the resolve of Ministers to swiftly use the powers they are taking in the Bill to tackle the use of vapes among children? An issue often overlooked is whether we will we keep the focus on the current smokers we must also help to quit.

Modelling from the Department shows us that if the age of sale were increased by one year every year, as proposed in the Bill, smoking rates among 14 to 30-year-olds are likely to be zero by 2050. I have said this since the Prime Minister announced his intention to bring forward these measures in his conference speech last year, and he deserves so much credit for bringing this change to the House. The Government must win the argument on this as well as the vote, now that the Bill is before Parliament. The Secretary of State, who is no longer in her place, did that today, and I pay credit to the shadow Secretary of State for his part in that.

I wish to touch on an issue that we have already heard of today. The fact is that at some future point we will have a situation in which a 50-year-old can legally smoke while a 49-year-old cannot. There is no getting away from that. That is a possible scenario for sure and, yes, it is rather inelegant, but it also misses the very point of the smoke-free ambition at the heart of the Bill. The clue is in the name: smoke free. The Bill does not criminalise existing smokers, and it ensures that the purchase of tobacco by those under the legal age of sale will not be criminalised. Compliance will be the responsibility of the business, as is the case with the current age-of-sale laws in England. The Bill makes it illegal to sell tobacco products to anyone who is born on or after new year’s day 2009. That includes my 13-year-old son, William. By passing this legislation, the state is saying to him that it is not okay to start smoking when he reaches 18—I think that when we look back we will ask how we ever said it was—and by doing so my son never becomes that 49-year-old. End of story.

We are told that raising the age of sale will fuel the black market, and the next generation of smokers will pick up the habit via illicit sales. A comprehensive anti-smuggling strategy, updated over time, has succeeded in halving the illicit market share from 22% to 11%. I welcome the fact that the anti-smuggling strategy of Border Force and His Majesty’s Revenue and Customs has been updated in the light of this proposed legislation. Am I just being hopeful in thinking this will work? Select Committee Chairs do not just do hope; they do evidence. I do not think I am just being hopeful. When the age of sale was raised from 16 to 18 in 2007, the illicit market did not increase.

Of course, all this—and, as I have said, we must continue to give help to current smokers to quit—needs funding. I welcome the investment of £70 million a year for the next five years into stop-smoking services, but that is a lot of money, so I cannot for the life of me see why Ministers do not look again at the Khan review call for a “polluter pays” principle in the form of a tobacco industry levy. Let us make that a reality.

Let me turn to vapes. The Bill gets 10 out of 10 for intention, but on planned enforceable action I am not so sure, because we just do not know enough. Increasingly, the genie is already out of the bottle—or out of the unknown, untested, bubble-gum flavoured canister—when it comes to vaping, but the kids are not alright on this. Let us make no mistake: users are mostly youngsters, who these days will seldom even think of trying the fags. Vapes are no longer only or even principally aimed at adults who are trying to quit cigarettes. Just when smoking by children was decreasing, vaping by children has started to rise hugely. Between 2018 and 2020, vaping rates doubled.

The benefit of vaping as a safer option for those who currently smoke tobacco is clear, but it is also increasingly obvious that for those who have never smoked it is certainly not risk free. The World Health Organisation has said that vapes are harmful. Schools are worried, as colleagues will hear from any headteacher in their constituencies. In my Committee’s oral evidence hearing on vaping, our witnesses repeatedly raised concerns about the health and behavioural effects of vaping-led nicotine consumption and addiction in schools, including on concentration in class.

The long-term effects of vaping are simply not known, so I cautiously welcome the fact that the Bill takes powers to crack down on youth vaping through regulations to restrict flavours, point-of-sale displays in retail outlets and packaging. However, I cannot go further, because the Bill states throughout:

“The Secretary of State may by regulations make provision”,

and by virtue of the fact that we do not have those regulations before us, it is hard to get a sense of their scope. In winding up, will the Minister update the House on when we might see those regs?

I am pleased to see the new excise duty on vaping products to discourage non-smokers and young people from vaping. I know that the Department for Environment, Food and Rural Affairs will lead on the ban on the sale and supply of disposable vapes, and that the draft Environmental Protection (Single-use Vapes) (England) Regulations 2024 were out for consultation until the end of March. Again, I would be grateful if the Minister updated the House on when that legislation will be taken forward and whether the Bill must first receive Royal Assent? Obviously, I understand the environmental case for a ban on disposables, but I have concerns about us taking away a ladder for adult smokers to climb down. We must be super careful not to tip adults who use vapes to quit cigarettes back to smoking by taking away options.

There has been some talk of a retail licensing scheme—we heard the Secretary of State refer to it earlier. We could perhaps disregard such a scheme if we went down the road of a prescription-only model for vapes so that they are used only under clinical guidance to help adults smokers to quit. In truth, I do not think our current regulatory environment, courtesy of the Medicines and Healthcare products Regulatory Agency, makes it easy to bring a prescription vape to market. The speed of innovation in the sector alongside the slowness of regulation would make it a real challenge for providers, and unless Ministers address that, I do not see how we advance that cause.

We will hear today—we certainly have in the media—about banning things. We will hear about the nanny state, and perhaps even an echo from the distant past about Anglo-Saxon England. Well, as the MP representing the capital of the former Kingdom of Wessex, I do not hold much truck with that. I prefer to listen—fool that I am—to the four chief medical officers of our nation, who say:

“To be pro-individual choice should mean being against the deliberate addiction of children, young people and young adults to something that will harm them, potentially fatally.”

I have always believed that in a publicly funded healthcare system we have a right and, indeed, a responsibility to act on public health, because it becomes everyone’s problem when we do not. Conservatives for whom a smaller state is their thing—although I can never pinpoint which part of the state they do not want their constituents to have—should be right behind a healthier society, because it is one that needs the state less, relies on the state less and costs the state less.

In the light of the important points that I have tried to cover, I will vote to give this important and historic Bill a Second Reading.

--- 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.

--- Later in debate ---

[Bob Blackman (Harrow East) (Con)]

I rise to support the Bill and to make two declarations. First, I chair the all-party parliamentary group on smoking and health. The group’s objective is to encourage people who smoke to give up and young people not to take up smoking at all in the first place, which the Bill aims to achieve. My second declaration is personal. I do not want anybody else to go through what I went through, which was seeing my two parents dying of cancer—a smoking-related disease. I well remember my late mother, at the age of 47, gasping for her last breath. She had been smoking since she was 12. At the time, smoking was almost encouraged by doctors and the medical fraternity, as the implication was that it was a good thing to do.

I want to see a smoke-free generation. We have the opportunity to achieve that now. New Zealand was going to be at the forefront of this effort, but has decided not to go ahead, which means that we can now be in the vanguard of creating the first smoke-free generation in the world. However, the stakes could not be higher. Research from University College London says that 350 young people between the ages of 18 and 25 take up smoking every day. That means that 50,000 young people have taken up smoking since the Government first announced their proposals. They will face a lifetime of addiction and early death as a result.

Relatively few people in my constituency smoke—the numbers are way below average rates. None the less, smoking-related diseases accounted for 1,300 hospital admissions in the year before the pandemic. People suffer the same inequalities as a result. Some say that if we implement these measures we will not have the taxation coming into the Treasury, but in 2023, smoking cost the economy £21 billion. That is more than double the revenue that the Government get from tobacco levies. Some say that people who die early are doing us a favour by not being an imposition on the national health service. That is absolutely outrageous. We want people to live longer and healthier lives.

Let me make this clear for all those who believe in freedom of choice. I am a dyed-in-the-wool Conservative and I believe in free choice, but the only free choice that a person makes if they take up smoking is to take that first cigarette, because after that they are addicted for life; the craving is there. Although most adult smokers want to give up, the reality is that it takes 30 attempts to succeed. Only one in 10 smokers achieve that each year. Therefore, if a person smokes, they will die a horrible death, probably as a result of a smoking-related disease.

This Bill has the opportunity of creating a smoke-free generation and of making sure that young people do not get addicted in the first place. If they wish to take up smoking when they are an adult that is their choice—their free choice—but, importantly, this Bill does not criminalise those people who smoke at the moment for either purchasing or using tobacco. The legal obligation will be on the retailers not to sell tobacco to those who are underage.

Like many people, I am concerned about the number of young people taking up vaping. The reality is that we do not yet have the evidence of what that will do to their lungs in the future. We know that it will get them addicted to nicotine, which is the most addictive drug known to man or woman. Once they are addicted to some form of nicotine, the temptation is to go further. We do not know what damage is being done to people’s lungs by the delivery mechanism of vaping, but medical evidence on that will emerge. It is important that we take action now rather than waiting to see what happens.

There is clear public support for these measures. Sixty nine per cent. of the public, including more than half of all smokers, back the Prime Minister’s age of sale proposal. There is support for the Bill across the political parties. The majority of people who vote for each of our parties across the Chamber support this proposal, and that should not come as a great surprise, because no one wants to see their children or grandchildren become addicted.

Sadly, big tobacco is fighting back. Tobacco companies have even attempted to classify themselves as allies of public health. Philip Morris International threatened to take legal action against the Government to delay the legislation. I am not sure what it thinks it is saying with its new corporate slogan, “Delivering a smoke-free future” when its whole aim is to get people addicted in the first place. The other reality is that big tobacco has been trying to get many of its products, such as heat-not-burn and cigars, exempted from the Bill—exemptions that would undermine the Bill before it even takes effect. Those products still contain tobacco and harmful products, and still cause damage to people’s health. We cannot allow those exemptions to happen. Another thing that we should change is the current exemption for cigarillos from standardised packaging laws—maybe we could consider that as the legislating take place.

The other reality that I want to mention is the discrepancies between Scotland, Northern Ireland, Wales and England. Scotland has a clear requirement for retailers to identify people by their age. I welcome that, as it is the right thing to do. As it stands, the Bill does not appear to require that in Wales or in England. I hope that we can amend the Bill as it goes through Committee to allow the provision that exists in Scotland —we should support what they have done there—to apply in England, Wales and Northern Ireland.

I know that you require me to sit down, Madam Deputy Speaker, but this is a subject that I have been passionate about for rather a long time. The reality is that the smoking ban back in 2007 was led from the Back Benches. Indeed, many Labour Ministers voted against the tobacco ban—

[Steve Brine]

Including the Deputy Prime Minister.

[Bob Blackman]

Including the Deputy Prime Minister. From that ban through to the 2015 progress on tobacco control, such measures have consistently come from the Back Benches. In fact, colleagues from across the House have helped to implement many of them. I am delighted that the all-party parliamentary group’s recommendations have been included in the Khan review. I thank the Prime Minister for going even further than what we asked for, which was a rise in the age of sale to create a smoke-free generation by raising the age of sale by one year every year. The reality is that tobacco control measures have consistently passed through this Chamber and the other with overwhelming support from across parties every single time they have been proposed. I am confident that this Bill will be no different.

Oral Answers to Questions

Steve Brine Excerpts

Tuesday 5th March 2024 Commons Chamber

[Mr Speaker]

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

[Steve Brine (Winchester) (Con)]

While we are talking about the recovery of primary care and the Secretary of State is at the Dispatch Box, the recovering access plan released last May talked about high-quality online consultation, text messaging services and online booking tools. They were due in July, but that became August and then December, and I understand that it has now been delayed indefinitely due to a claim made against NHS England in what is a £300 million project. That delay is hitting access to primary care. Will the Secretary of State update the House?

[Victoria Atkins]

We are determined to bring not just primary care but the whole NHS up to speed with technology. We are firm advocates of the idea that technology can help free clinicians’ time and ensure that they are spending time looking at their patients rather than at computer screens. In primary care, we are working to ensure the digital telephony services that have played such a critical role in providing those 50 million additional appointments, as I described. I will take away my hon. Friend’s points, and look into them carefully.

NHS Dentistry: Recovery and Reform

Steve Brine Excerpts

Wednesday 7th February 2024 Commons Chamber

[Mr Speaker]

I call the Chair of the Select Committee.

[Steve Brine (Winchester) (Con)]

I welcome the plan. Recovery and reform is right, and the Select Committee will study the plan carefully. The dental Minister, my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom), has already been invited to come before us, so that we can talk it through with her to see whether it reflects our aforementioned report on the subject. The golden hellos, the toothbrushing for pre-schoolers—as long as the workforce can handle it—and the mobile vans are good, but even a day longer of a contract focused on units of dental activity is a problem. Can the Secretary of State say how she plans to entice professionals into returning to NHS dentistry? So many have left, and that is key.

[Victoria Atkins]

Very much so, and that will be primarily through the patient premium, which will mean that from next month dentists will be able to turn their signs from “closed” to “open” for NHS patients. We wanted to use levers that could be deployed immediately in order to help our constituents.

Oral Answers to Questions

Steve Brine Excerpts

Tuesday 23rd January 2024 Commons Chamber

[Steve Brine (Winchester) (Con)]

The pressure on services is acute this winter, as it is every year. So far, we have heard very little mention in these 20 minutes of the biggest headache facing trusts, integrated care boards, patients and, of course, the Prime Minister’s pledge to cut the waiting lists further. Given that the British Medical Association ballot on consultants’ action closes today, and that the dispute among doctors in training continues, can the Secretary of State update the House on her message to those voting today, and on where we are in wider industrial disputes, which are a drag anchor on the NHS right now?

[Victoria Atkins]

My hon. Friend is right to point out that we are in the final few hours of the consultants’ ballot on the pay reform programme that we have offered the British Medical Association. I very much hope that consultants will feel able to support that programme, because it is about bringing together the frankly quite bureaucratic system that they have to deal with at the moment, so that they are assessed in a shorter time with less bother and paperwork, while respecting their need to train and keep up their education and supporting professional activities commitments. I hope that they will agree with us on that. As I have said to the junior doctors committee from this Dispatch Box, should they return with reasonable expectations, we will, of course, reopen negotiations.

NHS Dentistry

Steve Brine Excerpts

Tuesday 9th January 2024 Commons Chamber

[Steve Brine (Winchester) (Con)]

Last July, the Health and Social Care Committee, which I chair, published an important report on NHS dentistry, and I urge colleagues to read it if they have not already done so—it has been mentioned a few times. That inquiry was more necessary than ever, and I would argue that the issues our constituents face in accessing an NHS dentist now are a greater challenge for my Front-Bench colleagues than the much higher-profile health promise to “cut the waiting list” that features in the Prime Minister’s five pledges. I say that because every Member faces this challenge. The Secretary of State’s amendment rightly references the pandemic and the massive impact it has had on dentistry; to ignore that is to ignore basic facts. Our Committee concluded that NHS dentistry is facing a crisis of access—no understatement—resulting in a decline in oral health.

Our report was described by the British Dental Association as

“an instruction manual to save NHS dentistry.”

Based on the evidence—I stress the word evidence—received by the cross-party Committee, it sets out what the Government should do to address the crisis. I thank the Secretary of State for coming before the Committee just before Christmas and for ensuring that we received a formal response to our report, albeit a few weeks later than I would have liked.

The motion proposed by the Labour party today contains some reasonable parts: it is obvious that some people are resorting to DIY dentistry and it is a fact that some people are attending A&E because of dental challenges. The Opposition talk about the provision of 700,000 urgent appointments a year, but I cannot support the motion because I hear no detail or explanation about how that will be done, who the dentists are who will fulfil all those appointments or where they will happen. The Opposition talk about recruiting new dentists to the areas that are most in need but, as the Secretary of State said in her opening remarks, we are increasing dentistry training places by 40% as part of the NHS long-term workforce plan, which is the biggest expansion of places on record. That is important and should be recognised, as it was from the Government Dispatch Box.

When giving evidence to the Select Committee’s inquiry, the then Parliamentary Under-Secretary, my hon. Friend the Member for Harborough (Neil O’Brien), described the Government’s ambition for NHS dentistry, saying:

“We do want everyone who needs one to be able to access an NHS dentist—absolutely”

The Committee welcomed that ambition but, if I am honest, we were surprised by it. In their most optimistic reading of the reality on the ground, what leads the new ministerial team to believe that that is deliverable? When she sums up, will the Minister repeat that ambition, as her predecessor did?

Do not get me wrong, Madam Deputy Speaker: I absolutely believe that everyone should be able to access an NHS dentist when they need one, wherever they live, but given the reality of where we are now, I question whether that is possible. In our report, we asked the Government to set out how they intend to realise that ambition and the timeline for delivery as a matter of urgency. They accepted the recommendation, but the detail, as we have heard, is still lacking. Now is the time, please.

Let me touch on the dental contract. It is right to recognise that action has been taken. Some initial changes were made to the dental contract in July 2022, and we had assurances of fundamental reform from the then Minister, and again from his successor as Minister responsible for dentistry, my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom), who is on the Treasury Bench.

My Committee believes that a fundamentally reformed contract must be implemented at the earliest possible stage. It has to represent a full move away from the current system of units of dental activity—UDAs—in favour of a weighted capitation-based system that provides financial incentives for seeing new patients and those with greater dental need, and in turn prioritises prevention and person-centred care. Failure to do so risks more dentists stopping NHS work, or not starting it, and exacerbating the issues that my constituents are experiencing with accessing care.

As I have said in the House before, my dentist recently gave up NHS work, which was a big, emotional decision for her. Any reform to the contracts now is too late for her. The Opposition and the Government have to work out how they are going to get people to come back to NHS dentistry, and reform the contract to stop more people accessing the exit door.

It is not just about contract reform: workplace reform is greatly important. We did not get significant acknowledgement of the lack of accurate data about the dental workforce in our report, so will Ministers revisit that? There were many other recommendations that I do not have time to go into today, but the report is available, as is the Government’s response.

The Secretary of State has made a good start and said she has begun to lay the foundations of change. I am encouraged by that but, to my Committee’s continued frustration, there is still no date for the publication of the dental recovery plan. If we do not solve this crisis, we will continue to hear about it in the House and from constituents. The crisis places additional pressures on already stretched services. Today is too late for dentists who are thinking of leaving and for patients who have run out of options. We need a short-term set of actions for constituents who are suffering pain today, and we need a fully reformed dental recovery plan hot on its heels. There cannot be any further delay.

NHS Winter Update

Steve Brine Excerpts

Monday 8th January 2024 Commons Chamber

[Mr Deputy Speaker (Sir Roger Gale)]

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

[Steve Brine (Winchester) (Con)]

Happy new year. The Secretary of State will know that it is far from all doctors in training who have taken part in this strike. In my trust, Hampshire Hospitals, it was just over 60%, and the average across the south-east was little more than 50%. Many doctors were hard at work this past week caring for their patients. Does my right hon. Friend share the concern of many in the health service that the longer this dispute drags on, the more we lose the good will of the consultants who have been filling in and the more we do serious damage to the career pipeline that sees today’s doctors in training become tomorrow’s consultants?

[Victoria Atkins]

I thank my hon. Friend for asking that question and for noting the enormous efforts that clinicians across the NHS have gone to in order to cover these strikes. We are conscious of the personal impacts that has had for many, and clinicians have had a very tough few Christmases. We were all collectively hoping that this Christmas would be just a little bit easier for them, but sadly these strikes have a real impact on people who are working to pick up the slack from junior doctors not turning up. I am grateful to everyone who has gone into work, who has worked extra shifts and who has cancelled time off with their families. We must find a fair and reasonable solution to this industrial action, which is precisely why I was so very disappointed that the BMA junior doctors committee chose to walk away from these discussions.

Oral Answers to Questions

Steve Brine Excerpts

Tuesday 5th December 2023 Commons Chamber

[Madam Deputy Speaker (Dame Eleanor Laing)]

No, no—you do not get another supplementary question. I was about to call Layla Moran for Question 16, which is grouped with this one, but unfortunately she is not present so I shall go straight to the Chairman of the Health and Social Care Committee.

[Steve Brine (Winchester) (Con)]

The Government previously committed to publishing a dental recovery plan, which the former dental Minister, my hon. Friend the Member for Harborough (Neil O’Brien), said that the Government would publish shortly. He also told my Committee:

“We do want everyone who needs one to be able to access an NHS dentist”.

We were surprised, but he said it. We were told that the plan would be published during the summer or before the summer recess. When will the plan be published, if that is still the intention? Presumably it will come alongside the response to our “Dental Services” report, which was due on 14 September.

[Victoria Atkins]

I thank my hon. Friend and I look forward to being grilled by him and his Committee in due course—at least, I think I do. Perhaps I can assist him, first, on the very important dental report that his Committee published. I am looking through it myself this afternoon and I will be publishing the response and sending it to the Committee imminently. In relation to the dental plan, both the Under-Secretary of State for Health and Social Care, my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom), and I are looking carefully into the needs of communities in rural and coastal areas, as well as in more urban areas, to understand not just the need but the answers that we can provide to help with urgent care and, importantly, preventive care, particularly for our children and vulnerable people in our society.

Community Pharmacies

Steve Brine Excerpts

Thursday 14th September 2023 Westminster Hall

[Steve Brine (Winchester) (Con)]

It is nice to see you in the Chair, Sir Mark. Well done to my hon. Friend the Member for Waveney (Peter Aldous), my dear friend with whom I entered Parliament in 2010: as always, he has set out the issues beautifully, with the forensic ability for which he is known. The people of Waveney are very lucky to have him, as is this House. It was my hon. Friend who inspired me to speak in this debate: he collared me in the corridor, as he often does. I am only too pleased to do so, both as MP for Winchester and Chandler’s Ford and as Chair of the Health and Social Care Committee.

When I was pharmacy Minister, I spent many happy hours where the Minister is sitting today, answering debates on the subject. We have moved on a lot, and I give credit to the Minister, the Secretary of State and this Prime Minister of all Prime Ministers—if they had not understood community pharmacy, we were never going to get there. All credit to them for the investment and the work that has gone on. As somebody once said, “Much done, more to do.”

My fellow Committee members, one of whom is here today, and I are all too aware of the challenges facing community pharmacies in all our constituencies. Nevertheless, there is great cause to be positive. In my opinion, pharmacies have huge untapped potential to transform the way patients access and receive healthcare services, and to support the building of a preventive healthcare approach, which the Minister knows I am passionate about and which I suggest is central to the future sustainability of the NHS itself.

Earlier this year, the Select Committee launched an inquiry into pharmacy. It will look broadly at pharmacy services including hospital pharmacy, which is often overlooked but is very important, but community pharmacy will form the largest part of it. The terms of reference include specific questions about funding, which my hon. Friend the Member for Waveney and the right hon. Member for Knowsley (Sir George Howarth) both mentioned; the commissioning arrangements for community pharmacy, which I know we will come on to; the locations of community pharmacies; and, of course, achieving the ambitions of Pharmacy First in the primary care recovery plan. I trialled Pharmacy First in the north-east when I was pharmacy Minister; I am a great believer in it, so it is great to see how the Minister has taken it forward.

A key question that our inquiry seeks to answer is, “What does the future of pharmacy look like, and how can the Government ensure that it is realised?” We will be very forward-looking, considering how the challenges of today can be addressed to ensure that the potential is realised. However, we will also look at the services that community pharmacies are already offering or are set to offer through the pharmacy-first approach. Crucially, we will also consider the areas in which there is a chance to go further.

Community pharmacists are highly trained clinical professionals. They are not retailers; they are clinical professionals. They want to do more, they can do more and we should trust them to do more. We will also consider some of the innovations in the sector—for example, how automation and hub-and-spoke arrangements, which we have not talked about much today, will come in and help. We will also look at the workforce challenges, which we have heard about, including issues around the retention of pharmacists in the community pharmacy sector and around training.

The inquiry will be wide ranging. We are looking forward to getting started with oral evidence, hopefully in November. There is no shortage of enthusiastic people in the community pharmacy sector who are willing to share their experiences with us. We are incredibly grateful to all those organisations and individuals who sent in their written evidence, and we hope to continue seeing that positive engagement from the sector when we start the oral evidence sessions.

The Committee has the benefit of drawing upon the work of our expert panel, which is chaired by Professor Dame Jane Dacre, whom the Minister will know. The panel, set up by my predecessor, now the Chancellor of the Exchequer, evaluates the Government’s progress on meeting their commitments on an area that I ask it to look at. It delivers a Care Quality Commission-style rating as to where we are, which can range from “outstanding” to “inadequate”. I asked the panel to look at the pharmacy sector, based on its own members’ expertise and research and submissions by stakeholders, as well as some roundtable events with patients, people in receipt of social care, and pharmacy professionals.

The panel recently published a report on its evaluation of Government commitments in the pharmacy sector. It was assisted by several pharmacy professionals and leaders who steered its decision on which commitments to evaluate. Community pharmacies were an obvious area to focus on. The panel looked at two specific community pharmacy-related commitments, rating the position on both as “requires improvement”. I take a glass half-full perspective. There are good things in the report; I know that the Minister will look carefully at it. The first commitment was to maintain the pharmacy access scheme, which aims to protect access to local, physical NHS pharmaceutical services in areas where there are fewer pharmacies. The chemist may be the only shop in town—that is often the case in coastal communities.

The second commitment was to review the community pharmacy funding model and the balance between the spend on dispensing and new services within the community pharmacy contractual framework, which is negotiated between Community Pharmacy England—formally the Pharmaceutical Services Negotiating Committee—the Government and NHS England. The panel concluded that community pharmacies are struggling to meet increased demand. It is a good thing that demand is increasing, because it means that people are increasingly turning to the chemist, but they are struggling to meet that demand, to deliver services, and even to remain open with the current funding model, which was set in 2019 for five years and has not been reviewed significantly during that time.

As my hon. Friend the Member for Waveney suggested, pharmacies are also struggling as their staff are encouraged to take up roles in primary care, funded by the additional roles reimbursement scheme. The right hon. Member for Knowsley touched on the fact that IT systems can make it difficult for patient information to be shared between community pharmacies, hospitals and general practices. Taken together, those challenges can negatively impact community pharmacies’ ability to deliver services and support other parts of the health and care system.

The National Pharmacy Association does great work in this space and has been in touch with us. It commissioned an EY report, which found that almost three quarters of pharmacies in England face a risk of closure if a serious funding shortfall is not addressed, with 72% of them forecast to be loss-making within the next four years. The Minister will be aware of that report. It is sober reading, but it would be wrong to overlook it. It is a serious piece of work.

Going back to the expert panel, members also raised concerns about the lack of data collected on the performance of schemes designed to improve community pharmacy services, especially whether they were delivering the positive outcomes that we want for patients and people in receipt of social care. There is a lot for the Government to consider in the panel’s report. We still await their response, which, I hasten to add, has not timed out yet. We look forward to that.

I want to touch on a couple of other points. First, I co-chair the all-party parliamentary group on HIV and AIDS. We are calling for the HIV prevention pill, PrEP—pre-exposure prophylaxis—to be available through community pharmacies, with clear financial accountability for its provision. I think that would be a game changer for HIV prevention. It would be a critical part of ending new cases of HIV by 2030, urged by the HIV Commission, which I commissioned as the Minister and, after leaving Government, became a commissioner on, along with the shadow Secretary of State, the hon. Member for Ilford North (Wes Streeting). The Opposition Front Benchers have signed up to that 2030 ambition, and the Government have committed to it too.

Community pharmacies are well placed to prescribe PrEP. They carry out medicine use reviews for patients, and I think that they would be well placed to counsel on PrEP and to manage the prescriptions alongside other medications, because it is critical that medicines are prescribed in conjunction with each other. Community pharmacies are well connected to other parts of the health service, where integrated care boards have ensured that the IT is right and that the relationships are right. Furthermore, services provided by pharmacies act as a bridge between secondary and primary care, so that would complement sexual health prevention and treatment services and the advice that goes on. Will the Minister, in his summing up, touch on what progress has been made towards the commitment to make PrEP available beyond sexual health services and when it will be available in community pharmacies?

On the supply side, we have talked a lot about the bricks and mortar and the workforce, but the medicines supply chain, also mentioned by both previous speakers, is in need of serious love from Ministers. Pharmacies often have no idea of the prices being charged by wholesalers for some key generics, so they have no idea what is short, while pricing of products is often much higher compared with other European countries; consequently, margins in community pharmacies are often being eroded by uncertainty in the supply chain. I urge the Government to look at a robust system to plan for future pandemics and address shortages of key pharmaceuticals, because that undermines the sector and some of its great work.

There are so many things we could talk about, such as the ill-health prevention inquiry by the Select Committee, where I see pharmacies playing a key role. Much has been achieved. When I walked into the Department, I asked the special advisers what should be on my worry list, and they said: “General practice, Minister.” Some things never change. However, I passionately believe that community pharmacies are part of primary care, or pre-primary care as I used to call it. When I talked to parts of the primary care sector as the Minister, they would say to me: “We want to do more. We can do more. We are trained clinical professionals who can be trusted to do more.” The Government have picked up the mantle of that through the reform of, and new investment in, the contract, with the Prime Minister putting his personal authority behind the sector.

There is therefore much to be proud of, but we have to be careful that we do not end up losing community pharmacies. If we lose them, once they have gone, they will not come back, and we will have a supply-side problem in the bricks and mortar, as well in some of the pharmaceuticals. I thank my hon. Friend the Member for Waveney for securing the debate—it is, as always, an excellent subject for the House to discuss—and thank you, Sir Mark, for calling me to speak.

Countess of Chester Hospital Inquiry

Steve Brine Excerpts

Monday 4th September 2023 Commons Chamber

[Madam Deputy Speaker (Dame Eleanor Laing)]

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

[Steve Brine (Winchester) (Con)]

I place on record my sympathy to the families, who have conducted themselves with the utmost dignity throughout this process and who remain in my thoughts and prayers as well. I welcome the judge-led statutory inquiry that my right hon. Friend has announced. It is the right thing to do, as are the phases of the inquiry, which prevent stuff from taking too long to move fast. As that work moves forward, and the debate rightly continues to touch on how we regulate managers working in the NHS, and remove them, I ask that Ministers remain alert to any “us and them” thinking between managers and clinicians. Surely any successful hospital trust is one team working together, so that defensive medicine is all but impossible.

[Steve Barclay]

I very much agree with the Chair of the Select Committee on the need for a one-team approach, and on looking at how we encourage more clinicians into management roles. We need to be clear-eyed that often some of those in management positions were already regulated, because they were in medical or nursing regulatory positions, but it is important that we consider the right approach to ensure accountability for the families. That is why NHS England will look at this further.

Health and Social Care

Steve Brine Excerpts

Wednesday 12th July 2023 Ministerial Corrections

[Steve Barclay]

I am pleased to see those services going into Scunthorpe. That underscores the investment we are making now while preparing for the long term, through the largest ever expansion in workforce training in the NHS’s history. My hon. Friend is right about the importance of tie-ins. Let me explain why that matters in particular for dentists: around one third of dentists do not do NHS work. That is why the plan has looked at tie-ins for dentistry, which we will explore in the weeks and months ahead.

Topical Questions

The following is an extract from Health and Social Care topical questions on 11 July 2023.

[Steve Brine (Winchester) (Con)]

Back to NHS dentistry, I am afraid. Later this week, the Select Committee will publish its report on NHS dentistry services. Spoiler alert: it will be uncomfortable reading for some. Will the Secretary of State tell us when and how he plans to bring forward plans for the tie-in of newly qualified dentists? Could that go hand in hand with a “return to the NHS” campaign for dentists who have already left that part of the service?

[Steve Barclay]

It is characteristically astute of my hon. Friend to zero in on the tie-in, which is an important part of the long-term workforce plan. Around two thirds of dentists do not go into NHS work after training, so having a tie-in is more pertinent there than it might be elsewhere in the NHS workforce.

[Official Report, 11 July 2023, Vol. 736, c. 174.]

Letter of correction from the Secretary of State for Health and Social Care, the right hon. Member for North East Cambridgeshire (Steve Barclay):

An error has been identified in my response to my hon. Friend the Member for Winchester (Steve Brine).

The correct response should have been: