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.

Under-age Vaping

Steve Brine Excerpts

Wednesday 12th July 2023 Commons Chamber

[Steve Brine (Winchester) (Con)]

As the Chair of said Committee, I am very conscious of the importance of these issues, and I am pleased to see them debated in the House. I welcome the debate, but anywhere I have seen this issue debated, including in my cross-party Select Committee—many of its members are here—I do not see an awful lot of politics in it. I have a lot of time for the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), but I thought that he was uncharacteristically partisan in his remarks—a Labour Government this and a Tory Government that. I thought that that was misplaced, but maybe that’s just me.

Our Committee heard from the chief medical officer back in February at the start of our major inquiry on prevention. Professor Whitty highlighted then what he called “an appalling situation” whereby vaping, which he described as

“an addictive product with…unknown consequences for developing minds”,

is being marketed to children. I absolutely agree with him that that is totally unacceptable and out of control. As a parent of secondary school-age children, I see, hear and read letters home about the subject in a way that I never imagined I would only a couple of years ago, let alone when I started in this House 13 years ago.

Professor Whitty noted that

“rates of vaping have doubled in the last couple of years among children”,

which is consistent with what we are all hearing as constituency MPs. That situation cannot be allowed to continue, which is why I agree with the part of the Opposition’s motion that calls for plain packaging for vaping. The record will show that I most certainly did not vote against new clause 4 to the Health and Care Act, tabled by the hon. Member for City of Durham (Mary Kelly Foy), in November 2021. I support that part of the motion—it is consistent and in line with what happens for cigarettes. I do not think anybody would argue that we should go back to the days of the Marlboro Man and branding on cigarette packets, so I urge my hon. Friend the Minister to take that point away.

[Kirsten Oswald]

I am grateful to the hon. Gentleman for giving way as he is getting into the meat of his speech. Does he share my concerns about the impact that advertising on sports kits could have on any attempts to bring down the number of children vaping?

[Steve Brine]

Yes, I do. I suspect that point may be raised later in the debate by one of my fellow Committee members, if she catches your eye, Mr Deputy Speaker. The Blackburn Rovers issue has been raised, and it is not a historical sports deal, either: some may think that it was something that happened last season, but they have renewed it for the new season, which in my opinion is the opposite of “totally wicked”. I have young children who use that expression, and I can see why that would be attractive to a company wishing for Blackburn Rovers to carry its advertising on their shirts—I can only think that is the company’s motivation. I would ask Blackburn Rovers to look themselves in the mirror about that deal as much as the company that is doing the advertising, because it takes two to tango. Yes, I am concerned about that.

A couple of weeks ago, the Health Committee held one of our topical oral evidence sessions on youth vaping. We did so because we are very concerned about increasing media reports of children taking up vaping, as well as what we are hearing in the House and from our own constituents. During that evidence session, we heard from representatives from the health policy world and the medical and education sectors about the impact of the rising trend in child vaping. As was mentioned by the shadow Minister, the hon. Member for Denton and Reddish, we heard directly from a headteacher from the constituency of my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson)—a fellow Committee member—about the disruption that vaping is causing in her school. She did indeed talk about the impact on education of students vaping in the toilets and setting off the fire alarms.

We heard about the cost associated with putting heat sensors on top of fire alarm sensors—teachers have got enough to be doing! We heard about the disruption, which has an impact on education. During exam season recently, there were examples of exams being impacted by alarms being set off. As the headteacher told us,

“I became really concerned about interruptions to the exam season, so I had to change the smoke sensors to heat sensors really quickly to prevent us being in and out while students were sitting GCSEs and A-levels.”

That beggars belief. Young people have suffered enough in the past few years, their education has been disrupted enough, and now this—an epidemic of vaping that we are allowing to happen.

I raised the same point with the children’s doctor who gave evidence to the Select Committee. The issue of toileting in schools has wider impacts than just the disruption of education: children do not want to use the toilets, because they do not want to walk into an environment where people are vaping. They are worried about that, so toilets have become off-limits places. There is a much wider issue around toileting in schools and schools closing toilets. There is a very good charity called ERIC that works in the area of children’s bowel and bladder health, and without getting into too much detail, there is an impact on the retentiveness of children who do not use the toilet when they are at school. That can have serious medical implications, so once again, it beggars belief that we find ourselves in this situation because of vaping.

In my opinion, the industry has not gone anywhere near far enough in ensuring that its products do not appeal to the young demographic, and it is disingenuous for it to claim otherwise. Shops are able to display wide ranges of vapes in colourful, flavoured varieties and in locations that do not usually sell similar products: for example, we heard about vapes being sold in chicken shops and pound shops. That is in sharp contrast to tobacco products, which must be locked away and packaged in standardised plain packaging containing health warnings.

Evidence given to us by ASH from its surveys shows that flavour is a reason but not the main reason why young people who have never smoked start vaping. The most common reason for trying vaping among young never smokers is “just to give it a try”, at 54%, followed by “other people use them so I join in”, at 18%, and then there is “I like the flavours”, at just 12%. It is worth putting that statistic on the record, because there was a bit of a debate earlier between those on the Front Benches about flavours.

I have a few other points. Vapes are an age-controlled product; it is not legal for people under the age of 18 to buy them. There are a number of ways that young people obtain vapes anyway—for example, through the lack of age verification in shops or by buying them from other sellers who are often older teenagers who buy in bulk to sell them on, sometimes in school settings. I know schools take a very tough line on that, and rightly so, but teachers have better things to do than play trading standards officers on campus. We are particularly concerned in the Select Committee about online ordering, which is an area I think would benefit from more Government attention in order to avoid the law being circumvented. Overall, there is a need for much better enforcement of the law on not selling the products to under-18s. It is crucial that trading standards officers tackle non-compliant vendors, and of course are resourced to do so. I know the Minister is seized of that, and he rightly put that in his recent tobacco plan. I say tobacco plan, but I mean the tobacco strategy; as someone who has written a tobacco control plan, I was careful about using that word.

Price is another important issue, particularly the price of disposable vapes, as others have mentioned. They are much cheaper than tobacco products—much cheaper—in part because they are not subject to the same levels of excise duty. I understand that that is clearly not a matter for the Minister on the Front Bench, but maybe he could take that up with his Treasury colleagues. ASH told us that there is evidence that children are highly price-sensitive when it comes to buying these products, and that adding an excise charge of £5 on the battery, which is what we have often heard about, would act as a significant deterrent.

There are a lot of young people in the Gallery, and I wonder what they are thinking listening to this debate. I would urge right hon. and hon. Members to talk to young people, as I am sure we all do, either in their own homes or in the schools in our constituencies, and to ask them their motivation for vaping and what story they know about vaping, because their stories are interesting. I dropped into a vape shop in my constituency just the other day. I made a full disclosure: I told them who I was and that I chair the Health and Social Care Committee. High street vape shops are often very responsible in what they do, and this shop was very clear about how it approaches young people who come in. It told me about a product that basically looked like a bag of Skittles—other nice sweets are available. Skittles took the producer to court and the producer then had to withdraw that product. It does not take a genius to understand why someone might want to brand a vape to look like a bag of Skittles. Popping into vape shops and talking to them about how they do their business is time well spent on a constituency Friday.

To conclude, I have so many serious concerns about disposable vapes and the way they are marketed to children. However, I have to say that I do not support a total ban because, as ASH told the Select Committee in evidence, they can play an important part in helping people to quit smoking. We have to be very careful about a broad-brush ban, but the Government need to step forward even more than they already have, and this debate may help the Minister to form his views. I know he is personally very seized of this issue; he has spoken to me about it on a number of occasions.

The Government need to stay on this issue as an urgent case. A number of friends who also have children at secondary school have asked me, “What are the Government doing about this?” because they know what I do. The concern out there in parent land is growing by the day, and we parents are concerned—very concerned—about this. We on the Select Committee are also very concerned about it, and we will be writing to the Minister and the Secretary of State off the back of our session a couple of weeks ago to set out some of our concerns and some of the recommendations we may make. I hope the Government will take that on board, and come back to us promptly as part of the ongoing consultation the Minister has told us about.

I agree with some of the interventions that have been made. The Khan review was commissioned by the Government and it is a robust piece of work containing with lots of evidence. There is an awful lot to be seized of. I appreciate that it is challenging to get grid slots and get stuff through No.10, but the Prime Minister has personally identified himself with this issue and is concerned about it. I therefore say to the Minister that in that regard he would be pushing at an open door if he banged on a black door with a No.10 on it.

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:

Oral Answers to Questions

Steve Brine Excerpts

Tuesday 11th July 2023 Commons Chamber

[Mr Speaker]

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

[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. I look forward to the Select Committee’s report but, with some of the reforms already in place, we are boosting the number of patients treated. There were a fifth more dental treatments in 2022 than in the previous year. We are also making NHS dentistry more attractive with some of the changes to the previous 2006 contract, but we recognise that there is more to do, which is why we will shortly set out our dental recovery plan.

NHS Long-term Workforce Plan

Steve Brine Excerpts

Monday 3rd July 2023 Commons Chamber

[Mr Speaker]

I call the Chair of the Select Committee.

[Steve Brine (Winchester) (Con)]

This is a serious piece of work, and it is very welcome. Despite calls from people like me to get on with it, it was right for the Government to take their time and get it right. The Select Committee will scrutinise it—as we do—on 12 July.

The training piece is very strong. Doubling the number of medical school places has to be right, and I am glad that the Secretary of State thought of it. On retention, if we are saying—rightly, I would contest—that it is not all about pay, what role does he envisage the integrated care systems and, therefore, the trusts having in supporting staff as he makes the “one workforce” that is mentioned in section 5, with which I agree, come to pass?

[Steve Barclay]

Characteristically, my hon. Friend the Chair of the Health and Social Care Committee makes an extremely pertinent point about the role of the ICSs. As we move to place-based commissioning and look to integrate more, the interplay between the workforces in the NHS and in social care will be a key area where the ICSs will be extremely important.

The ICSs will have a particular role in the apprenticeship and vocational training, which are key retention tools in those parts of the country where it is hard to recruit, as well as in offering more flexibility to staff. When I talk to NHS staff, they often talk about having different needs at different stages of their career—whether for childcare commitments, which relate to the measures the Chancellor set out in the Budget, caring for an elderly relative, or wanting to retire and work in more flexible ways—and the ICSs have a key role to play in that. I welcome my hon. Friend’s comment that this is a serious and complex piece of work, and that it was right that we took our time to get it correct.

Lung Cancer Screening

Steve Brine Excerpts

Monday 26th June 2023 Commons Chamber

[Madam Deputy Speaker (Dame Eleanor Laing)]

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

[Steve Brine (Winchester) (Con)]

I remember dear James Brokenshire saying the words that the Secretary of State repeated today in the House. James made this happen—this is a fantastic prevention announcement. Although this nationally expanded programme cannot prevent lung cancer, will the Secretary of State confirm that we will stick by the principle of making every contact count? When people come forward for a lung risk assessment, we can offer emotional support where a problem has been detected, provide smoking cessation services to those who are still smoking, or just put our arms around people where there are comorbidities. When people come into contact with the health service, will we make every contact count for them?

[Steve Barclay]

I know that my hon. Friend was a Health Minister at the time that James was raising these points, and that he takes a close personal interest in the issue. He is right about the importance of the point at which people come forward. I was having a discussion this morning about the fact that when most patients come forward for screening, they will not be diagnosed with cancer, but it is still an opportunity for smoking cessation services, for example, to work with them on reducing the risk that continued smoking poses. My hon. Friend is right about using the opportunity of screening to pick up other conditions and to work constructively to better empower patients on the prevention agenda.

Oral Answers to Questions

Steve Brine Excerpts

Tuesday 6th June 2023 Commons Chamber

[Mr Speaker]

I call the Chair of the Select Committee.

[Steve Brine (Winchester) (Con)]

Women living with HIV of course have the right to healthcare on the same terms as anyone else, except that now they do not when it comes to starting a family. Many people living with HIV are currently excluded from accessing fertility treatment, both by law and by the Government’s microbiological safety guidelines. So will the Government now follow the scientific evidence, particularly on undetectable viral load, and remove what are surely discriminatory restrictions on the basis of HIV status?

[Maria Caulfield]

I thank the Chair of the Health and Social Care Committee for his question, as he raises an important point. Last year, we asked the Advisory Committee on the Safety of Blood, Tissues and Organs to reconsider this specific issue. It set up a working group in June last year to look at it and we expect its recommendations this month. We will take them seriously and address them swiftly once we have its advice.

Patient Choice

Steve Brine Excerpts

Thursday 25th May 2023 Commons Chamber

[Madam Deputy Speaker (Dame Eleanor Laing)]

I call the Chair of the Select Committee.

[Steve Brine (Winchester) (Con)]

This form of patient choice has of course been available for at least 15 years; it just has not been made available to patients. Can the Secretary of State confirm that the referral management centres sitting at integrated care board level will be compelled, not asked, either to change that or to get out of the way altogether? Given that the vast majority of people on the waiting lists are already there with a specific trust, how exactly will they be given the option either to stick where they are, or to twist and exercise that choice to receive treatment sooner?

[Steve Barclay]

My hon. Friend, as ever, makes a shrewd point. Yes, the referral centres are part of this system. The key focus is on the initial GP referral and how we facilitate that with better data, transparency and tech, but the referral centres are a part of this. We want to roll it out to the 40-week waits from October, and to bring waits down to 18 weeks. There is a clear plan to achieve that wider scope, and that is what I have set out to the House today.

New Hospitals

Steve Brine Excerpts

Thursday 25th May 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 am grateful for the statement; the Select Committee will want to have a good look at it, and we will start when the Secretary of State comes to see us next month. At the last election, I promised my constituents significant investment in Winchester Hospital. That is already happening, and now with early work in cohort 4 we have the promise of the elective hub to scale the orthopaedic list. Can the Secretary of State be clear with my constituents that, as the new Hampshire hospital comes together as part of the wider cohort 4, it will be for clinicians to make the clinical case on what safe and sustainable services look like in the long term for those people?

[Steve Barclay]

There are different issues around construction and service design. In terms of service design, there will need to be discussions with local clinicians and others. As my hon. Friend knows, with his scheme in North and Mid Hampshire, there are issues around the new site for junction 7 of the M3, where there is significant work on potential land acquisition and what upgrading of the motorway would be required. There is a question about the size of the hospital versus other services offered locally. Those are the issues we are keen to get in discussion with the North and Mid Hampshire trusts on, and that will be part of the rolling programme we take forward.

Food Labelling and Allergies

Steve Brine Excerpts

Monday 15th May 2023 Westminster Hall

[Steve Brine (Winchester) (Con)]

It is good of you to call me so early, Sir Graham. I was really keen to make a contribution to today’s important debate, the subject of which was ably laid out by my hon. Friend the Member for Don Valley (Nick Fletcher). Congratulations to the many people who signed the first petition: 13,000, as my hon. Friend said. I think the second highest number of people who signed it live in the Winchester constituency, and I will explain why that was the case.

This is a subject that I am interested in, not only because I chair the House of Commons Health and Social Care Committee and am a former Public Health Minister and who has sat many times in the seat where the Minister is today, but because I am the constituency MP of Emma, who is here today and whose lovely brother Owen gives his name to part of today’s debate—one of the petitions—and, of course, to the Owen’s law campaign. The House will wish to note that I met up with Emma on Friday in Winchester and heard a bit about her little brother, the tragic circumstances in which he lost his life and the brilliant campaign that she and the family have put together in his memory. They have hotfooted it from Manchester, where they were on the “BBC Breakfast” sofa this morning, so it is really great to have them here in the Public Gallery today.

As I have said a number of times in this Chamber, the Health and Social Care Committee recently launched a major new inquiry into prevention of ill health. It is a subject that I am passionate about, and it is one of my top priorities as Chair. Obviously, prevention covers a huge range of topics, and that is one of the reasons why we decided to theme the inquiry around 10 key workstreams, which we will be exploring over the remainder of this year and probably into next. A high number of the submissions that we received to our initial call for evidence were related to food. Although perhaps more obvious topics spring to mind when talking about food and prevention, such as the obesity agenda, it is important that we do not lose sight of how crucial preventive work is when supporting people with food allergies and intolerances. Today’s debate on the two e-petitions perfectly illustrates that point.

Owen’s sad death at the age of just 18 gave rise to the campaign for Owen’s law, and we have also heard about Natasha. These were simply avoidable deaths. They really could have been prevented if better information about allergens had been available. I agree with the hon. Member for Dagenham and Rainham (Jon Cruddas) about levelling that playing field—he put that very well. To avoid other families suffering the same awful loss that Owen and Natasha’s families have experienced, it is essential that the Government look at what more can be done to pull together all the work carried out over many years, to ensure that people with allergies have the information they need to make informed decisions about what they can and cannot eat.

I was encouraged to see in the Government’s response to the petition on Owen’s law that the Food Standards Agency met the Carey family to discuss their proposals, and that the agency committed to working with the Department to consider how to improve the provision of information to people with food hypersensitivity. That response, however, was issued back in 2021, so I hope that the Minister will provide us with an update on how that work is progressing.

Alongside improving the provision of information about allergens, it is important, as we have heard, that research continues into food allergies, so that there is an improved understanding of how to prevent complications relating to those allergies in the future. Ministers should look to the work proposed by Professor Adam Fox at the British Society for Allergy and Clinical Immunology. I was encouraged to see in the Government’s response to the second e-petition that the National Institute for Health and Care Research has allocated more than £2 million for research into food allergies over the preceding five years. Again, however, that response dates from 2021, so I hope we can have an update today.

I understand that the Food Standards Agency will discuss the changes proposed under Owen’s law at its June board meeting, which is very good news. Will the Minister ensure that the strength of feeling in the House today is fed to the FSA ahead of that meeting? Specifically—and specifics are important here—we are talking about regulation 5 of the Food Information Regulations 2014, which simply obliges restaurants to provide allergy information accurately “by any means”. That could mean anything—it could mean just a passing verbal reference. In short, the Owen’s law campaign wants to change the words “by any means” and to oblige restaurants to write that vital information on the menu. That is critical for the reasons we have discussed. Many people do not want to discuss their allergies and personal health circumstances when they are going for a birthday meal. That is not unreasonable.

I trust the Minister will agree that it is essential we make progress in this area, and do so fast. The hon. Member for Dagenham and Rainham talked about the work that has gone on over a decade or more. I say to the Minister that the bottom line is that the music stops when they sit in that chair. I have been in that chair, and it is a wonderful job—the best job in Government. It gives the Minister a great opportunity. He must grab it. As we have heard, the architecture for Owen’s law is already in place in the Republic of Ireland, so will the Minister promise the House that he will look at that example and learn from it?

We need to see changes in law, regulations, guidance and industry practices, as well as in research into allergies. I will not repeat every ask of the campaign, because my hon. Friend the Member for Don Valley did that when opening the debate. We intend to keep working until we get progress on this issue. I promise, as Chair of the Health and Social Care Committee, that I will put my weight behind the issue, and the Committee will look at it.

Owen had a range of allergies and, although he was just 18, he had become well versed in managing them. With school lunches, trips and holidays, I heard they had to work so hard to manage them. Owen did not have to die, but he did because he went out for a meal to celebrate his 18th birthday. I asked his big sister on Friday what she thought Owen would be doing today—he would be 23 years old. Emma said she thought he would be somewhere in Wales—the family’s spiritual home—probably on the Gower beaches where his brother Daniel, who is also here today, taught him to surf. He was due to go to Swansea University, and Emma thinks he most definitely would be working in something clever, probably tech or computing, living an outdoors life to the fullest and playing that guitar he loved so much. He cannot do any of that now and that is a tragedy, but we can do something to ensure that his death and Natasha’s were not in vain and to ensure that others do not end up in the same position.

There is a saying that I often like to refer to in this place—I used to have it on my desk when I had the Minister’s job—and that is, “For a moment like this.” That sentence can be completed with anything you like. For a moment like this, we are in Parliament—please let us seize the opportunity.