Eating Disorder Awareness

Wera Hobhouse Excerpts

Tuesday 1st April 2025 Westminster Hall

[Wera Hobhouse (Bath) (LD)]

I beg to move,

That this House has considered eating disorder awareness.

It is a pleasure to serve with you in the Chair, Mr Stuart.

Eating disorders are among the most serious and life-threatening of all mental illnesses, but they have been overlooked and underfunded for too long. Because of this, they have one of the largest treatment gaps in modern healthcare, and we must ask why that is. In the face of overwhelming need, why are we still ignoring this crisis, especially as it is a documented fact that recovering from an eating disorder is possible, no matter how long and complex the illness has been?

In the past decade, we have seen an alarming rise in eating disorders—a trend that only worsened during the pandemic. What was already a struggling support system for those affected by eating disorders has collapsed under pressure. Too many people are waiting, too many people are failed and too many people are feeling neglected by the system. The eating disorders all-party parliamentary group, which I chair, recently published its report, “The right to health: People with eating disorders are being failed”, which highlights the increasing neglect we are seeing across eating disorder services—but that is by no means to say that those who are working in eating disorder services are not working their socks off. People with eating disorders are being told that they are not thin enough, that they are too complex, and in some situations are being moved on to palliative care and identified as treatment-resistant. That is why we are pushing for a complete reformation of eating disorder treatment alongside the development of a stand-alone eating disorder strategy.

During Prime Minister’s questions on 19 March, the Prime Minister emphasised the NHS’s goal of bringing eating disorder care closer to home. This is an important goal, but it requires equitable access to intensive community and day treatment, as highlighted in Beat’s report, “There’s no place like home”. Such services can reduce the need for costly hospital admissions and shorten stays for those who need in-patient care. However, Beat’s report shows that only one in six NHS integrated care systems in England currently offer enough intensive community and day patient treatments for both children and adults. Alongside this, it is crucial that we do not focus on only one end of the spectrum. Day services cannot always meet the needs of those with extreme malnutrition, and in-patient care is critical for many people who need high levels of physical, behavioural and psychological support.

The strain on family carers, who often lack medical expertise, must be considered too. In-patient and day patient care must be part of a well-integrated, stepped care system. If those services are not co-ordinated nationally, gaps will form in the care pathway and patients may fall through the cracks. I agree with the Government that if people are treated in a timely manner in the community, there will be less need for costly in-patient care, but before we make any changes, we must ensure that all levels of care are adequately funded and can work in tandem to provide the best possible support.

I recently had the privilege of hearing Nicky Smith share the story of her courageous daughter, who has been in in-patient services for over a decade. Unfortunately, during her long stays, she has not always received the treatment she needs. Her current stay is now in its 21st month. For the last eight months, her team has been trying to find an alternative placement for her complex needs. Sadly, she has been rejected by every service she has applied to and now faces discharge. Nicky and her daughter acknowledge that although some in-patient units are better resourced than others, being in in-patient care has saved Nicky’s daughter’s life and continues to do so. Over the last 12 years, the community eating disorder teams provided limited, inconsistent support. That caused rapid relapse, sometimes in just a few weeks, leading to low body mass index and frequent readmissions, often to inappropriate units such as general hospitals or acute mental health wards. Ultimately, she was readmitted each time to a specialist eating disorder unit, under section 3 of the Mental Health Act 1983. That is the only way she can complete meals without the need for nasogastric feeding.

In addition to being deeply moving, this story drives home the importance of well-resourced specialist eating disorder units. We cannot cut back on those essential services and force those who are unsuited for discharge into community care. Specialist units are essential for keeping people alive, safe and supported, as they work towards recovery and reintegration into everyday life. That must continue, alongside investment in community and day-treatment programmes.

To tackle eating disorders and develop effective treatments we need to understand them fully. Worryingly, the International Alliance of Mental Health Research Funders found that eating disorders accounted for just 1% of the UK’s already severely limited mental health research funding between 2015 and 2019. That is despite people with eating disorders accounting for around 9% of the total number of people with a mental health condition.

Recent funding announcements are even more cause for concern. The Royal College of Psychiatrists found that 24 of the 42 integrated care boards planned real-terms spending cuts to children’s eating disorder services in the current financial year. That would result in real-terms cuts of well over £800,000. Those planned spending cuts come against a background of severely stretched children’s and young people’s eating disorder services: a 13% increase in referrals in the past 12 months; high thresholds to access services, resulting in more young people being in crisis; almost 800 urgent referrals still waiting for treatment at the end of December 2024; and a 30% true vacancy rate for all eating disorder consultant psychiatrist positions across England, as of March 2023. Following those troubling findings, will the Minister assure all of us here and across the country that all ICBs will invest sufficiently in those vital services in 2025-26 and beyond?

As well as providing an increase in funding, we must take a close look at measures to protect children from harmful online eating disorder content. There is growing evidence that social media is linked to an increase in eating disorders among young people. Algorithms are showing harmful content to vulnerable people. Those include posts promoting fasting non-stop for days on end as a healthy lifestyle. There is an online trend of “thinspiration” posts, which glorify unhealthy weight loss. There have also been cases where, even after users have blocked certain accounts, they still see content that promotes eating disorders.

In research conducted by the Center for Countering Digital Hate, a fictional UK-based 13-year-old user watched a video about eating disorders for the first time. Following the video, one in four suggested videos were for harmful eating disorder content. More than half were for content relating to eating disorders or weight loss. Under the Online Safety Act 2023, YouTube will have a responsibility to protect children from primary priority content such as eating disorders. Yet, YouTube still does not appear to be taking that seriously. In fact, algorithms are pushing the content in order to increase engagement.

Harmful content viewed online can push children further into eating disorders that have a drastic effect on their health, wellbeing and life chances. From the evidence I have seen, I am concerned that, even when the provisions of the Online Safety Act 2023 come into force, the actions of those media giants may not change, which truly worries me. Social media is not the cause of eating disorders. Users who post much of this content are unwell and are not doing so maliciously, but social media can lead those who are already suffering further down the path of disordered eating. More needs to be done to hold social media companies accountable to legislation such as the Online Safety Act.

Another issue of grave concern is the need for more accurate recording of eating disorder-related deaths, and a better understanding of the factors contributing to them. As we know, eating disorders are one of the most life-threatening mental illnesses, however, all too often they are not explicitly listed on death certificates, despite being a significant factor in the person’s death. For example, someone suffering from anorexia and severe malnutrition may have their cause of death recorded as organ failure, without any mention of the underlying eating disorder. That is a crucial gap that we must address.

The APPG has heard first hand from people who have experienced the heartbreak of losing a loved one to an eating disorder. One particularly moving example is that of the Laurence Trust, a Northern Irish charity founded by Laurence’s family after his tragic death. Laurence had struggled with bulimia and depression, and eventually suffered a fatal heart attack. His mother Pam shared with the APPG that his death certificate did not list the eating disorder as a contributing factor. Instead, the cause of death was recorded as undetermined. That misclassification not only deprives families of closure, but hinders our understanding of the true scale of eating disorder-related fatalities.

To better prevent such deaths in future, we must ensure that coroners’ reports accurately reflect eating disorders as contributory factors. Only by tackling these deaths can we gain a clearer picture of the impact of eating disorders, and take meaningful steps towards prevention and improved care. Accurate recording will raise awareness and ultimately save lives. It is high time that eating disorders are treated with the seriousness they deserve. We are all well aware of the many different parts of the NHS that require additional funding, but I have simply heard far too many harrowing stories about delays to treatment, inadequate care and premature inpatient discharge. Now is the time for change.

[John Milne (Horsham) (LD)]

In my constituency of Horsham, we had a particularly upsetting case of a constituent whose daughter had significant mental health and behavioural issues that were very difficult to deal with and, as a consequence of those not being dealt with, she also developed an eating disorder. The only place they could send her to that could cope with that combination of factors was in Yorkshire—my constituency is in West Sussex. That was an extraordinary burden on the family. We need provision across the country to deal with the cases that present.

[Wera Hobhouse]

I totally agree. Unfortunately, there is a massive postcode lottery. Services need to improve across the country so that everybody, like my hon. Friend’s constituent, can get the treatment they need as close to home as possible, because carers are so important, and so that families can see their loved ones.

In the last year alone, more than 30,000 acute admissions for eating disorders were recorded—that is a vast number. What was already an overstretched and under-resourced support system for those affected by eating disorders has now become a national emergency. Our APPG report sadly proved these systemic failures are costing lives. It is clear we need an urgent and comprehensive overhaul of eating disorder care and treatment in this country to ensure that we do not lose our important inpatient care, and to massively improve community and day treatments. I add to what my hon. Friend the Member for Horsham (John Milne) said, that if eating disorders, or the underlying mental health disorders, are not prevented or cared for early enough, everything becomes so much worse further down the line.

I repeat that we must address the role social media plays in promoting eating disorders and harmful content, especially to young people. We also cannot even begin to understand the depth of this crisis without accurate data regarding eating disorder-related deaths. I hope the Government have heard what I said today, and will act fast and decisively to ensure that eating disorder sufferers finally receive the treatment and care they all deserve. I have been chair and vice-chair of the APPG on eating disorders for the last six years. That is a long, frustrating time to see get worse something that one wants to get better, so I hope that today may be the start of us turning a corner.

[Several hon. Members rose—]

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[Danny Kruger (East Wiltshire) (Con)]

I acknowledge and thank the hon. Member for Bath (Wera Hobhouse) for her long campaign on this topic, for securing this debate and for all that she has done and will probably have to continue to do on this agenda for a while. I entirely endorse the campaign and the things that need to happen that she and the hon. Member for Salford (Rebecca Long Bailey) have outlined.

Eating disorders present an utter tragedy to families and to young people. Last week I met a family in my constituency whose daughter is in the grip of anorexia. We had a long conversation about both the services available and the nature of the illness itself. I asked the simple question, “What is anorexia and where does it come from?” Despite the extent of their experience and all the reading they have done, it was a very difficult question to answer. The answer included that it is like an addiction, or has the qualities of an addiction. There is apparently a genetic component, and a link with autism. As the hon. Member for Bath suggested, there is a clear element of social contagion—her points about social media are extremely important. It strikes me that in many ways anorexia is an illness of modernity. It is a consequence of the pressures that young people and, indeed, older people can face in this very difficult world we live in. That suggests that a multiplicity of responses are appropriate.

I pay tribute not just to colleagues here, on the APPG and across the House who campaign on this issue, but to campaigners from outside Parliament, including Chelsea Roff, Hope Virgo, Agnes Ayton and others, whom I have got to know in the last couple of years. I honour their expertise and commitment.

As the hon. Member for Bath said, and as cannot be pointed out too often, eating disorders, and anorexia in particular, are treatable illnesses. The services are in absolute crisis, as we have heard, but we should never lose sight of the fact that the illnesses are treatable. There is clearly desperate confusion in the NHS between the physical and mental dimensions, particularly when it comes to the extreme acute phase of anorexia. We know it is the most dangerous mental illness in terms of the tragedy of death. There is clearly a lot to do in reconciling the mental and physical sides of our health service.

The hon. Member for Bath and I are on different sides on this, and the Minister and I have been debating it over the last month or so, but I have to acknowledge my concern about the Terminally Ill Adults (End of Life) Bill. Currently, there are patients in our NHS who are diagnosed with eating disorders—anorexia in particular—who are categorised as terminally ill by the system and put on a palliative care pathway, because the system decides that their condition is not in fact treatable. It is scandalous and tragic that people who have a condition that is eminently treatable are categorised as terminally ill.

My great concern is that if we were to pass that Bill, we would end up with people being diagnosed as eligible for an assisted death. It is important to acknowledge that in other countries that have assisted dying laws, our understanding is that, in all those jurisdictions, people with anorexia have qualified for and been given an assisted death. In 100% of the cases that we know about, they passed the capacity test that we would apply here in our country. That is my great concern.

[Wera Hobhouse]

It is important that we stress that an eating disorder is not a terminal illness and therefore should not fall under that legislation. I know that the hon. Gentleman and I agree on that; I think we disagree on his worries about how it would be treated, practically, in the future. An eating disorder is not a terminal illness.

[Danny Kruger]

I am grateful to the hon. Lady, and I entirely agree. It is vital to stress that point, and I am sure the Minister agrees.

I agree with the hon. Lady and the hon. Member for Salford that we need a complete reformation of the system—I will not repeat the points of the campaign, which I endorse. I am deeply concerned about the prospect of cuts to eating disorder services. It is a great shame that the proportion of NHS spending on mental health is declining. That is very significant.

I pay tribute to the sufferers—these amazing people who battle through this awful illness. They are mostly girls but also young men—I know a young man who is still in the grip of the condition. And I pay tribute to their families. I emphasise, as I am sure the hon. Member for Bath would, given her experience, that there is hope. We must not give up on these young people. We must absolutely provide the services that are needed. We need to get our systems and our society right.

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[Perran Moon (Camborne and Redruth) (Lab)]

Meur ras, Mr Stuart; thank you for your chairship. I thank the hon. Member for Bath (Wera Hobhouse) for securing this important debate. I declare an interest: I am also a member of the eating disorder APPG.

As has been mentioned, recent data suggests that one in eight 17 to 19-year-olds in England have an eating disorder—a massive increase from fewer than 1% in 2017. On average, young people are now waiting for almost three and a half years to get treatment.

My relationship with anorexia began nine years ago. It is a story that I am sure resonates with many thousands of other parents the length and breadth of Britain; frankly, it is a massive part of why I became an MP. My story began when I took a phone call from a teacher at my daughter’s school. She asked me to come and collect her, as she had passed out, having not eaten breakfast or dinner.

Over the next few months and years, my daughter, whose relationship with food had already become terribly distorted, unbeknown to me, was clutched by anorexia. Its claws dug deeper and deeper into her as she slipped into a desperately poorly state. She became too unwell for school, and the pressure of her exams was like a ton of bricks on her as the anorexia gave her a cruel outlet for the control—something that sits behind so much of this—that she sought in her life.

As parents, our most solemn undertaking is to protect and nurture our children. Against this terrible illness, I was utterly useless. As my daughter’s illness took hold, I became more and more angry: first with her, then with others, and then with the system. It was only years later that I had to have it explained to me that that anger was actually driven by fear. I was impotent to support my daughter. Worse still, I was incapable of finding anyone else who could provide her with the care that she so desperately needed.

Here is the killer blow. The only way she could qualify for lifesaving support was if she became critically ill—so ill that she was staring death in the face. Imagine sitting at the kitchen table for hours, watching your emaciated child looking terrified at a small plate of food in front of her and hoping that she does not eat it, so she becomes so ill that she qualifies for the support that she needs. Those truly shameful thoughts are etched on my conscience and visit me every single day. They have left an indelible stain on my soul. For having those terrible thoughts, to my daughter, wherever she is, if she sees this speech, I want to say, “I’m sorry, my lamb.”

[Wera Hobhouse]

I congratulate the hon. Member on being so brave in talking about his own experience. I, too, have a daughter who suffered from an eating disorder; she was not quite as ill as he describes his daughter being, but I am still visited by those hours—though they were many years ago—when I was gripped by fear and anxiety. It is only by sharing these stories that we can ultimately bring all this to light, so again I thank him for being brave enough to share that.

[Perran Moon]

I thank the hon. Member. How could a system be so warped as to make a parent feel that way about their own child—the thing they love most, more than anything else in the world? Measuring the criticality of eating disorders through BMI is a medieval evaluation, hopelessly inadequate to the needs of the sufferer. Proper psychological assessments must be undertaken at the earliest identification of a problem, with a package of appropriate measures applied thereafter, dependent on the severity of the case.

My daughter spent two periods of six months in hospital. She recovered her health and is today working in the NHS in mental health services as a senior assistant psychologist, using her own painful experience to offer others the care and support she never had. Under-investment has left mental health services stretched beyond capacity, and young people like my daughter become desperately unwell while sitting on waiting lists, with the cost of their recovery, both emotionally and financially, spiralling by the day.

I know the Department of Health is taking the issue incredibly seriously, but we must prioritise a rapid overhaul of the system to offer hope to young people and their families. This Government must prioritise investment into mental health and eating disorder services. Today, I ask the Minister to say to all the families going through that hellish tornado of pain, to all those angry dads, tearful mums and terrified children, “Hang in there. We will come for you. We know your pain and we will act swiftly to help you to relieve it.”

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[The Minister for Care (Stephen Kinnock)]

It is a pleasure to serve under your maiden chairship today, Mr Stuart. I am extremely grateful to the hon. Member for Bath (Wera Hobhouse) for securing the debate and raising this important topic. I know that, as a Member of this House and chair of the APPG on eating disorders, she has been a doughty champion for those living with eating disorders, their families and supporters. I am also grateful to other hon. Members for their valuable contributions, many of which were deeply personal and profoundly moving. I pay tribute to hon. Members for making those contributions.

I share the desire of the hon. Member for Bath to improve the lives of people affected by an eating disorder. Raising awareness of eating disorders and improving treatment services is a key priority for the Government, and a vital part of our work to improve mental health services. We know that living with an eating disorder can be utterly devastating, not just for those battling the condition but their loved ones and those who witness their struggle. We know that eating disorders can affect people of any age, gender, ethnicity or background. However, we also know that recovery is possible, and access to the right treatment and support can be lifechanging, as we have heard today.

Although record investment and progress has improved access to eating disorder services, the reality is clear: demand has surged, especially since the pandemic, outpacing the growth in capacity. We must do more to ensure that everyone who needs support can get it without delay.

[Wera Hobhouse]

The Minister is making a powerful point. Demand is surging, yet it seems that investment from ICBs is going to fall. How can that be possible, and how is it morally acceptable?

[Stephen Kinnock]

National funding has increased over the years, as the hon. Lady will know. The question is whether that funding channels through to ICBs. The Government’s view is that ICBs are best placed to make decisions as close as possible to the communities that they serve and to target and, if necessary, reallocate funding accordingly. As a Government, we are constantly trying to get the balance right between setting frameworks and targets and ensuring that those are being met, while also ensuring that ICBs are not being micromanaged from the centre. We do not think it is right that people sitting in Whitehall or Westminster micromanage what is going on at a local level. We are absolutely clear that every ICB must meet its targets, while also being clear that it is up to the ICB to take decisions as close as possible to the communities that they serve.

Sadly, we have seen the prevalence of eating disorders in children and young people sharply increase since 2017. In 2023, NHS England published follow-up results to its survey on the mental health of children and young people. The report found that the prevalence of eating disorders in 17 to 19-year-olds rose from 0.8% in 2017 to 12.5% in 2023. Unfortunately, we are also seeing the prevalence of eating disorders rising among adults. The 2019 health survey for England showed that 16% of adults over 16 screened positive for a possible eating disorder. The figures do not mean that the individual had a confirmed eating disorder, but they present a worrying situation that we must address by continuing to promote both awareness and early intervention.

The surge in demand has inevitably made meeting our waiting time targets more challenging. However, our services and clinicians, backed by new funding, are supporting more people than ever before. These services are changing and saving lives. As hon. Members will know, we have kept in place the access and waiting time standard for children and young people who are referred with eating disorder issues. This sets a 95% target for children with urgent cases to begin treatment within one week, and for children with routine cases to start treatment within four weeks.

Figures released last month show that although the number of referrals and demand for services has begun to stabilise during the past year, the number of children entering treatment reached a record high of 2,954 last quarter. This shows that the extra funding is enabling services to begin to meet the extra pressures caused by the pandemic. Similarly, the number of children entering treatment within the target time has reached a record high. Of the 2,954 children entering treatment last quarter, 2,414 were able to access that treatment within the one-week urgent target or the four-week routine target—a rate 81.7%. That is the highest figure recorded since NHS England began collecting that data in 2021.

However, we recognise that there is still far more to be done to ensure that patients with eating disorders can access treatment at the right time. The hon. Member for Bath rightly focused the debate on the importance of awareness. Raising awareness of eating disorders is the first step towards early intervention to prevent the devastating impacts that eating disorders can have on people’s lives. To support this, NHS England is currently refreshing guidance on children and young people’s eating disorders.

The refreshed guidance will highlight the importance of awareness and early recognition of eating disorders in schools, colleges, primary care and broader children and young people’s mental health services. A number of colleagues asked when that guidance will be published; my officials are working hard with specialists on that, and it will be published later this year.

The existing mental health support teams, supplemented by the specialist mental health professionals that we will be providing access to in every school in England, will support school staff to raise awareness and identify children and young people showing potential early signs of an eating disorder. Through these interventions, children and young people can be given early support and help to address problems before they escalate.

Community-based early support hubs for children and young people aged 11 to 25 also play a key role in providing early support for young people’s mental health and wellbeing. Early support hubs provide open-access drop-in mental health services that assist children and young people with a range of issues, such as eating disorders, at an early stage without the need for a referral or doctor’s appointment.

I am pleased to say that this year, thousands more young people will receive support with their mental health, thanks to £7 million of new funding for 24 existing community-based early support hubs to expand their current offer. That funding will deliver 10,000 more interventions such as group sessions, counselling therapies and specialist support over the next 12 months. Looking forward, we are also committed to rolling out open-access young futures hubs in communities. This national network is expected to bring local services together and deliver support for young people facing mental health challenges, including support for those with eating disorders.

We should also be concerned about the widespread availability of harmful online material that promotes eating disorders, suicide and self-harm, which can easily be accessed by people who may be vulnerable. We have been clear that the Government’s priority is the effective implementation of the Online Safety Act, so that those who use social media, especially children, can benefit from its wide-reaching protections as soon as possible. Our focus is on keeping young people safe while they benefit from the latest technology. By the summer, robust new protections for children will be enforced through the Act to protect them from harmful content and ensure that they have an age-appropriate experience online.

It is right to focus on awareness and early intervention, but we know that some people simply need access to high-quality treatment in order to get better. A key priority of this Government is therefore to expand community-based services to treat eating disorders, so that people can be treated earlier and closer to home. NHS England is working to increase the capacity of community-based eating disorder services. By improving care in the community, the NHS can improve outcomes and recovery, reduce rates of relapse, prevent children’s eating disorders continuing into adulthood and, if admission is required as a last resort, reduce the length of time that people have to stay in hospital.

I am pleased to say that funding for children and young people’s eating disorder services has increased, rising from £46.7 million in 2017-18 to a planned £101 million in 2024-25. With this extra funding, we can focus on enhancing the capacity of community eating disorder teams across the country. We are also committed to providing an extra 8,500 new mental health workers across child and adult mental health services to cut waiting times and ensure that people can access treatment and support earlier. Through the 10-year health plan, this Government will overhaul the NHS and ensure that those with mental health needs, including those living with eating disorders, are given the support that they need.

I share the concern of the hon. Member for Bath about accurate recording of deaths to understand the extent to which eating disorders and other factors have caused or contributed to deaths. This matter is being explored with the national medical examiner for England and Wales, the Office for National Statistics and the Coroners’ Society of England and Wales.

Hon. Members also raised concerns about BMI. It is not right that any individual is being refused treatment based on their weight or BMI alone. National guidance from the National Institute for Health and Care Excellence is clear that single measures such as BMI or duration of illness should not be used to determine whether to offer treatment for an eating disorder. I am ready to receive any representations from colleagues who have evidence that that is happening, and I would be happy to raise that with the appropriate channels.

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[Wera Hobhouse]

First, thank you Mr Stuart for chairing your first Westminster Hall debate so well; you kept us in order and on time. I thank all Members for their wide-ranging, thoughtful and moving contributions. Sharing our stories can raise awareness, but it takes a lot of courage. As we have heard, eating disorders do not discriminate on the basis of age, gender or background. Although they disproportionately affect young women, it is important that we keep an eye on young men—we heard very good contributions on that.

Eating disorders are a national emergency—I reiterate that even after hearing the Minister’s response. Although some things might be improving, as I said at the beginning, I have been here for six years and, on the whole, things have got worse, not better.

We have heard about the Minister’s sharp elbows, and we have heard that there is hope. This debate is an annual event, and I hope that next year I am able to come here and say that the situation has got better, not worse. We owe it to all sufferers. As my hon. Friend the Member for Chichester (Jess Brown-Fuller) said, it is a moral outrage that we have continued to let the situation deteriorate. It has to get better. Next year, I want to be able to say that we have made real progress. The APPG and I want to work with the Government to make the situation better. Campaigners are there to help; we need to work together. I hope that it does not get worse for another year.

Question put and agreed to. 

Resolved,

That this House has considered eating disorder awareness.

Tobacco and Vapes Bill

Wera Hobhouse Excerpts

Report stage
Wednesday 26th March 2025 Commons Chamber

I reiterate my full support for this legislation, and how important it is that we stop the start and bring about a smokefree generation. I commend the work of Action on Smoking and Health in supporting and shaping an excellent Bill that will be a great law.

[Wera Hobhouse (Bath) (LD)]

I rise to speak to new clause 1 in my name. It would strengthen the Bill by requiring the Secretary of State to conduct a review and publish a report on the impact of contaminated e-liquid and ways to reduce its prevalence. It would also give the Secretary of State power to make regulations to kerb the harm caused by contaminated e-liquid.

I have been campaigning on the issue of Spice-spiked vapes ever since it came to my attention last summer. The Bill is an opportunity to make a real change on this hugely concerning problem that is sweeping through schools across the country. New clause 1 would improve our understanding of contaminated e-liquid and ensure that the necessary regulations could be introduced to reduce the harm that it causes. The issue was first uncovered by Professor Chris Pudney at the University of Bath, who found that one in six vapes confiscated in schools contained the synthetic drug Spice.

Spice is a dangerous prison drug that causes serious harm to users, including hallucinations, dizziness, chest pain, breathing difficulties and damage to vital organs. The highly addictive nature of Spice makes it a gateway to criminal activity, coercion and abuse. It is tragic that anyone would take this drug, but it is especially tragic when young people do, who are often unaware of the dangers. Many young people inadvertently smoke Spice under the impression that it is cannabis. Worryingly, recent investigations have found that vapes are being contaminated with not just Spice but ketamine and MDMA, which are particularly harmful when taken in high doses. The landscape of contaminated e-liquids is evolving rapidly, and it is likely that this issue will worsen if the Bill passes unamended.

An unintended consequence of banning disposable vapes is that it will drive more users towards refillable vapes, which are the primary vehicles for contaminated e-liquids. Refillable vapes are more susceptible to being spiked with harmful substances than disposable vapes. This shift could exacerbate an already significant public health threat, making it even harder to control the spread of dangerous substances in the market. I welcome the ban on disposable vapes, but we must take action to safeguard against these unintended consequences.

The Metropolitan police have warned about children accessing illicit vapes through social media platforms such as Snapchat and Telegram. There is clearly a link between social media-driven drug dealing and the rise of vaping in schools. The ease of access to vapes and their widespread use makes them even more difficult to regulate, and makes it difficult to protect individuals from unknowingly consuming illicit substances. There is a lack of knowledge and oversight, and counterfeit or illicit vape products are slipping through the cracks, exacerbating the already alarming rise in drug-related incidents. There is much more to understand about how illicit vapes and e-liquids are obtained. New clause 1 would set us on our way; it would ensure that we built on the research of Professor Pudney at the University of Bath by conducting a review of the impact and prevalence of these illicit e-liquids.

I have had several conversations with Ministers about this issue. First, in response to my Adjournment debate, the Minister for Policing, Fire and Crime Prevention committed to addressing the issue through the Bill. I also met the former public health Minister, who assured me that the Government and health officials were taking the issue very seriously. I appreciate that Ministers want to make changes in this area; I urge them please to follow through and make this change by supporting new clause 1.

As I have a little time, I note new clause 19, in the name of the right hon. Member for Melton and Syston (Edward Argar), which would require the Government to report on the availability of illegal tobacco and vaping products. This is a serious problem to which attention is rightfully being brought. I support that addition to the Bill, but the new clause does not quite get to the heart of the issue that I am focusing on. New clause 1 calls for a specific review of contaminated e-liquid and ways to reduce its prevalence, and gives the Secretary of State power to make regulations to combat the harm that contaminated e-liquid causes.

[Jenny Riddell-Carpenter (Suffolk Coastal) (Lab)]

I welcome the amendments to the Bill. This is now a strengthened piece of legislation that will create the first smokefree generation. The chronic health issues that stem from smoking and their impact on our NHS are well known. The Bill, the amendments and what they will go on to achieve will be critical in supporting the NHS and improving health outcomes.

Smoking costs the economy and wider society more than £20 billion a year, including a cost of £3 billion to the NHS and social care. That is equivalent to the annual salary of almost 700,000 nurses or 500,000 GPs, and is the cost of more than 500 million GP appointments.

While the Bill will create the first smokefree generation, the Government recognise that we need to do more to help people quit smoking. That is why I was so glad to welcome the additional funding announced in December to support local authority-led stop smoking services. Suffolk was allocated an additional £900,000 for this year, which means that people in Suffolk Coastal will be able to access support and live healthier, smokefree lives. I know from personal experience just how hard that is. On the very day of the Bill’s Second Reading in November, I gave up smoking, because I had just voted on a Bill that would mean that my nieces and nephews would never legally be able to smoke. I have tried to give up smoking before—the last time was just before the general election, when in truth I never stood a chance of succeeding—but I was able to succeed this time only because I have moved to vapes. To quote something that has already been said, “If you smoke, vape; if you don’t smoke, don’t vape.” It is simple and true.

I spoke on Second Reading about the important role that the Bill will play in preventing young people from taking up vaping. The dramatic rise in children taking up vaping should be nationally recognised as one of the most concerning crises facing young people and children. The Bill will make it harder for young people to be drawn into vaping and will bring the law on vape advertising in line with that for tobacco advertising: there will be a total ban on vape advertising and sponsorship. There will also be a consultation on the vape flavours that we all know are far too appealing to children.

However, we need to do more. As I stand here delivering this contribution, new products are appearing on the market that seek to exploit the loopholes in the upcoming ban on single-use vapes. I understand that the Bill explicitly gives the Secretary of State power to regulate further to limit the size of vapes, and to ban the so-called big puff vapes, which provide more than 600 puffs per pod. Since Second Reading, we have seen products come on to the market that allow people to attach refillable 10 ml pods, creating, in effect, a 3,000-puff vape. That is not a big puff vape; it is a colossal puff vape.

[Wera Hobhouse]

The hon. Lady is talking about refillable vapes. Does she agree that contaminated refills are a huge problem, and that the Government should take that seriously and amend the Bill further?

[Jenny Riddell-Carpenter]

I thank the hon. Lady for her intervention. We have heard that point made articulately, and not just by her. I look forward to the Minister’s response to that.

The issue of the 3,000-puff vape and the additions that can be made to vapes are why I tabled new clause 21, which builds on themes that have been spoken about in the Chamber this afternoon. I welcome the power in the Bill for the Secretary of State to regulate further to standardise the size of reusable vapes, but my new clause would allow us to limit their size sooner and prevent rogue vape manufacturers from circumventing the rules while the Secretary of State undertakes further consultation on such measures. Though the Bill provides the power to standardise vapes, I am asking the Government to legislate now to standardise and regulate puffs per vape, so that we do not see an explosion of new vapes in the marketplace that are trying to get around the single-use vapes ban in this legislation.

I close by thanking the Minister and the Department for their work in bringing the Bill forward, and for the cross-departmental push to make vaping safer and reduce its appeal to children. I hope that it is welcomed in all parts of the House.

--- Later in debate ---

[Wera Hobhouse]

I hear what the Minister is saying, but the Metropolitan police and other forces tell us that it is incredibly difficult. The Bill gives us an extra opportunity to protect young children from a terrible pathway into addiction and crime. Is it not the task of this Government to stop that?

[Ashley Dalton]

The entire Bill is about preventing addiction among our young people and preventing their move into crime. These things are already illegal and the Government believe that existing legislation will allow for them to be dealt with.

On cigarette filters, I understand hon. Members’ concerns about tobacco litter, but new clause 2, tabled by the hon. Member for Gosport (Dame Caroline Dinenage), could lead to greenwashing, improving the reputation of tobacco manufacturers while not necessarily improving environmental outcomes.

NHS England Update

Wera Hobhouse Excerpts

Thursday 13th March 2025 Commons Chamber

[Wes Streeting]

The frustrating thing is that we are delivering the wrong care in the wrong place at the wrong time, which is delivering poorer outcomes for patients and poorer value for taxpayers. People cannot get a GP appointment, for example, which might cost the NHS £40, and then they end up in accident and emergency, which could cost £400. If people cannot find a bed for a delayed discharge and rehabilitation outside of hospital, they end up stuck in a hospital bed, wasting away at greater cost. In fact, when I was up in Carlisle earlier this year, such intermediate care was being offered by a local social care provider, commissioned by the NHS, at half the cost and of a much better quality than the hospital bed that patients had been discharged from. That shift to the community is about delivering better outcomes for patients and better value for taxpayers, and that will be reflected in our 10-year plan.

[Wera Hobhouse (Bath) (LD)]

I declare an interest as the vice-chair of the newly formed all-party parliamentary group on emergency care. A&E staffing across the country is dangerously low, especially at night, putting unacceptable pressure on staff, who warn persistently about the risks to patient safety. Hundreds of keen applicants are being turned away from emergency medicine training. Last year, there were 359 places for 2,718 applicants. Following this announcement, how quickly will emergency care and A&E departments see changes and have more permanent staff and consultancy places, but especially more training places?

[Wes Streeting]

We will shortly set out our emergency care improvement plan so that we can deliver the year-on-year improvements that people deserve. The long waiting times, not just in emergency departments but in ambulance response times and across the entire system, are completely unacceptable. I refuse to use terms such as “temporary escalation spaces” to describe the true grim reality of corridor care. That is a shameful situation, and I am genuinely sorry that patients are being treated in those conditions and that staff have to suffer the moral injury of working in those conditions. From the moment we came into government, we have worked to ensure that we got through the winter as well as we could. That is reflected in the fact that, despite the winter pressures, waiting lists fell five months in a row throughout the winter.

On the targets and standards challenge set out by the Royal College of Emergency Medicine, ahead of the winter I was very clear with frontline leaders that patient safety must come ahead of performance targets—particularly the four-hour target—but the 12-hour target is absolutely related to patient safety, as I think the royal college would agree. We must work together to get waits of longer than 12 hours down as a priority, because those waits are directly linked to safety and patient outcomes.

Women’s Health

Wera Hobhouse Excerpts

Thursday 27th February 2025 Westminster Hall

[Wera Hobhouse (Bath) (LD)]

It is a pleasure to serve under your chairmanship, Dr Huq. I thank the hon. Member for Hastings and Rye (Helena Dollimore) for bringing forward this very important debate.

The UK currently has the largest gender health gap in the G20 and the 12th largest in the world. It is high time that we focus on these disparities. Let me start with breast cancer. Breast cancer does not only affect women, of course, but the vast majority of cases are in women, with one woman being diagnosed with breast cancer every 10 minutes.

Over the last 20 years, the prognosis for women diagnosed with breast cancer has improved significantly. Women diagnosed with primary breast cancer today are 66% less likely to die from the disease within five years. That is encouraging news, but we cannot stop there.

Detecting breast cancer in its early stages drastically improves a woman’s chances of survival, but young women face huge challenges when it comes to being diagnosed. That is particularly harmful, because younger women are more likely not only to develop aggressive forms of the disease, but to be diagnosed at a later stage when the tumours are larger and have spread to the lymph nodes. As a result, younger women have a significantly worse prognosis, a higher risk of recurrence, and a greater chance of death compared with older women.

Even more alarmingly, cancer cases in women under 50 have increased by nearly 80% worldwide over the last 30 years. In the UK, breast cancer diagnoses in women under 50 have been steadily rising, and in 2013, we saw over 10,000 cases for the first time. Yet despite that growing trend, routine breast cancer screening still does not begin until women turn 50. Why do we start so late? It is an alarming trend and the Government must look at it. I know that the UK National Screening Committee advises on the decision about who to screen, and I have been assured that it will be looked into, but I mention it today to urge the Government to make progress.

Another issue affecting many women in Bath is gynaecological care. A new report from the Royal College of Obstetricians and Gynaecologists said the UK has a “gynaecology care crisis”, with over 750,000 patients currently waiting for treatment for a serious condition.

[Helen Maguire (Epsom and Ewell) (LD)]

My constituent, a GP, got in contact after she recently had to cut specialised contraception services in her practice due to national insurance hikes and inadequate funding. The services were running at a loss, making them unsustainable. Does my hon. Friend agree that that lack of funding is short-sighted and will harm health outcomes, and that all women should have equitable access to contraception?

[Wera Hobhouse]

I could not agree more. We already have a crisis, which that will only exacerbate, so I thank my hon. Friend for rightly highlighting that issue.

My Bath constituents are at particular risk. A recent report said that appointment waits have doubled since the pandemic—another serious trend that the Government need to look at. A constituent recently reached out to me about the length of time it takes to get an endometriosis diagnosis in the NHS, which has already been mentioned today. That is not only a problem in Bath; far too many women wait far too long. The Government need to look at that.

In better news, the national maternity survey 2024 found that Bath’s Royal United hospital received a top Care Quality Commission rating over its treatment of patients. The survey found that those giving birth felt confidence and trust in staff during their care at the RUH. There was also praise for the dignity and respect people that were treated with. I am grateful to the RUH and all its staff for setting such a brilliant example, and offer them my congratulations.

In such a debate, I cannot, as chair of the eating disorders APPG, leave out eating disorders. Although they affect more women than men, it is not only women who suffer from them. One issue of particular concern is online platforms recommending harmful eating disorder-related content to young users. The Center for Countering Digital Hate, whose representatives I met this week, recently published research on the dangerous eating disorder videos recommended by the YouTube algorithms. It set up an account for a 13-year-old girl searching for body image and dieting content, and found that, of the next videos recommended by the YouTube algorithm, one in four was harmful eating disorder content. That is alarming.

I urge the Government to look into that and to hold these powerful digital platforms to account. In 2025, it is not acceptable that there are continuing disparities in women’s health and, in particular, young women’s health on this issue. I urge the Government to take action.

[Dr Rupa Huq (in the Chair)]

I am sorry to do this, but I am imposing a newly reduced time limit of three and a half minutes.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Ashley Dalton)]

It is a pleasure to serve under your chairship, Dr Huq. I congratulate my hon. Friend the Member for Hastings and Rye (Helena Dollimore) on securing this really important debate on women’s health. She and all Members who have participated today have raised a number of important points.

Let me begin by agreeing that reading the Ockenden review is harrowing, and progress on women’s health has been far too slow. I want to address some of the key issues that Members have raised; I will attempt to cover as many as I can, but if I miss anything, please get in touch, and I will endeavour to fill any gaps after the debate.

My hon. Friend the Member for Hastings and Rye raised the story of our very good friend Margaret McDonagh and how her experience feeds into the medical misogyny that has been highlighted on a number of occasions. In addition, it was very powerful to listen to my hon. Friend the Member for Washington and Gateshead South (Mrs Hodgson), who put an important focus on women’s voices and said how important it is that those are heard in this space. Those voices can lead to the important cultural shift that my hon. Friend the Member for Stafford (Leigh Ingham) raised and that underpins all of this.

The hon. Member for Strangford (Jim Shannon) and my hon. Friend the Member for Cumbernauld and Kirkintilloch (Katrina Murray) spoke about the devolved Governments. We are committed to ensuring that we have closer working between the UK and devolved Governments so that we can share insight and best practice and cut waiting lists right across the UK.

My hon. Friend the Member for Cumbernauld and Kirkintilloch and the hon. Member for Wimbledon (Mr Kohler) raised issues relating to eating disorders and women in online content. The Government inherited a broken NHS, in which patients wait too long for eating disorder treatment. The 10-year plan will overhaul the NHS, and the Online Safety Act 2023 will prevent children from accessing harmful online content on eating disorders.

The hon. Member for Canterbury (Rosie Duffield) raised the differences in heart attack symptoms between men and women. NHS staff can now access guidance through the British Heart Foundation, and there are learning sessions available to support training. NHS England ensures that there is clear messaging on atypical symptoms in women in all public campaigns, and training on heart attacks and the identification of gender and sex are a core part of the cardiology curriculum. The hon. Lady will be aware that the National Institute for Health and Care Research has a very clear definition of sex and gender, which has an important impact on delivering the right healthcare to everybody.

I was really interested to hear from my hon. Friend the Member for Dudley (Sonia Kumar), who has expert knowledge of perinatal pelvic health services, which are being rolled out across England to ensure that women have access to physiotherapy for pelvic health issues during pregnancy and for at least one year after birth. Those services incorporate a range of interventions aimed at improving the prevention and identification of perinatal tears and other perinatal conditions.

The Chair of the Women and Equalities Committee, my hon. Friend the Member for Luton North (Sarah Owen), spoke about the Committee’s recent report, which we welcome and take extremely seriously. We are grateful to everyone who gave their time and expertise to the inquiry, and to the Committee for its thoughtful recommendations. My Department has looked closely at the findings, however chunky they are, and has worked with NHS England to consider the recommendations and develop a Government response. I assure her that it will be published very soon.

The hon. Member for Epsom and Ewell (Helen Maguire) spoke about contraception. Let me make one thing really clear: we are committed to ensuring that the public receive the best possible contraceptive services, which are vital in helping women to manage their gynaecological health. Since 2023, the NHS Pharmacy Contraception Service has allowed pharmacists to issue ongoing supplies of contraception that have been prescribed by GPs and sexual health services. That service was relaunched in December 2023 and will be continued.

We have also talked about fertility issues. Access to fertility treatment across the NHS has been varied across England, and funding decisions are made by integrated care boards, based on the clinical needs of the people they serve. We expect those organisations to commission fertility services in line with the guidelines set by the National Institute for Health and Care Excellence. We recognise that provision is variable across England, and we intend to support ICBs to implement the updated evidence in the revised guidelines to benefit all affected groups.

We recognise the significant physical and psychological consequences of birth trauma and the devastating impact it has on women. I thank hon. Members for their contributions to the report of the APPG on birth trauma—the hon. Member for Canterbury was intrinsic to it. The Government will ensure that lessons are learned from the recent inquiries and investigations, including the APPG report, and that the experiences of women and their families are listened to and woven into our efforts to improve services.

For too long, women have been let down by their healthcare. The system is broken—it does not work for them. This Government are committed to fixing women’s health as a key part of building an NHS fit for the future. As a first step, we have delivered 2 million more appointments since July, in line with our manifesto commitment of delivering 2 million more appointments in the first year. We have achieved that seven months early. That includes appointments for breast cancer care, for gynaecological conditions such as endometriosis and for many other conditions.

However, we are still nowhere near satisfied with the state of women’s healthcare. Kate’s story, which my hon. Friend the Member for Hastings and Rye shared, is testament to that state.

[Wera Hobhouse]

I do not mean to be pompous, but the Minister did not mention me—it was me who mentioned the online harm.

[Ashley Dalton]

I am getting there.

[Wera Hobhouse]

May I ask whether the Minister would meet the eating disorders APPG to talk about online harm, particularly in relation to sufferers of eating disorders?

[Ashley Dalton]

I thank the hon. Member for her intervention, and I will get there and mention her. I am more than happy to have that conversation with her.

For the benefit of the shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans), I would like to clear something up and dispel some misinformation. We have not scrapped the women’s health strategy, nor have we abandoned women’s health hubs—far from it. We are using women’s health hubs to beat the backlog. The future funding decisions around those health hubs will be taken in due course. I can also confirm for the shadow Minister that Baroness Merron is the Minister with responsibility for women’s health, and she regularly meets Dame Lesley, the women’s health ambassador. Dame Lesley attended the 10-year plan round- table in January, which was chaired by Baroness Merron. I can reassure the hon. Gentleman on that.

When we came into government, we inherited an appalling legacy of nearly 600,000 women on gynaecology waiting lists. That is why the Prime Minister kicked off 2025 with our elective reform plan. The plan states our commitment to offer women gynaecological care closer to home, an approach that has been pioneered by those women’s health hubs. As of December, nine in 10 integrated care boards had at least one women’s health hub, and some have more.

National Cancer Plan

Wera Hobhouse Excerpts

Tuesday 4th February 2025 Commons Chamber

[Andrew Gwynne]

First, may I send my condolences to my hon. Friend and his family on the loss of his brother Alex?

Of course rarer cancers are important, and they are a crucial part of what will be in the national cancer plan. It is in these areas that we must focus our efforts on diagnosis, treatment and, more importantly, getting the research done, so that we can find ways of tackling some of the very rare but deadly cancers that affect many families, including my hon. Friend’s.

[Wera Hobhouse (Bath) (LD)]

In 2013, the number of breast cancer cases in women under 50 topped 10,000 for the first time, but routine breast cancer screenings are given only to women aged 40 and over. Will the Department review that and ensure that, when appropriate, initial appointments can be given to younger women? While I am at it, although the Minister might not have time to attend, may I invite everyone else to swing by my drop-in event this afternoon to discuss local health inequalities in breast cancer?

[Andrew Gwynne]

I am grateful to the hon. Lady for the work that she does in this regard. The decisions on whom to screen are made by the UK national screening committee and their advice comes to Ministers, but I am aware of the case that she has made. Screening women earlier for breast cancer should perhaps be looked at, and I will ensure that my officials look into whether we can make some progress on that for her.

Obesity: Food and Diet

Wera Hobhouse Excerpts

Monday 20th January 2025 Commons Chamber

[Dr Simon Opher (Stroud) (Lab)]

I beg to move,

That this House has considered the impact of food and diet on obesity.

I thank the Backbench Business Committee for allocating parliamentary time to this crucial issue. We were actually going to have this debate before Christmas, but we decided that before Christmas was not a good time to discuss obesity; we were then going to have it last week, but it was postponed. I am really grateful to colleagues across the House for supporting the debate.

Our country has an obesity crisis that is threatening the health and wellbeing of the whole nation. It is a cross-party issue: since 1990, rates of obesity have doubled. Two thirds of all adults in the UK are carrying excess weight, and a quarter of adults are classified as obese. The figures are even more worrying in children: 10% of children aged four, when they enter school, are obese; that figure rises to 22%—nearly one in four—in year 6. One problem with obesity is that, as many of us know, once someone becomes overweight, it is difficult to shift. That is why the most important age group to concentrate on is young people.

Obesity is now the single most important modifiable risk factor for the prevention of disease, and I will briefly go through its effects—as a doctor, I cannot resist. Around 4 million people in this country have type 2 diabetes, which is five times more likely in obesity. Type 2 diabetes almost doubles a person’s mortality rate, with 22,000 people with diabetes dying early every year. Ischaemic heart disease, the leading cause of death in the UK, is much more common in obesity, as is hypertension and osteoarthritis, which causes joint pain and reduced mobility. Something that a lot of people do not know is that 13 cancers are directly attributable to obesity—it is actually also the second commonest cause of cancer.

As a GP, there are other things I see quite regularly, such as reflux, varicose veins, infertility and even thrombosis, all of which diminish quality of life. The commonest cause of liver disease is now obesity. I will not go into the cost too much but, as we can imagine, obesity costs the country an absolute fortune: on average, four extra sick days a year; and, taking into account the cost to the NHS and so on, an estimated £98 billion a year, or 4% of GDP. The cost to the NHS is £19 billion a year.

What is the cause of obesity? From the evidence, it is clear that the main cause of obesity is diet—it is what we eat. The food system in this country is fundamentally broken. I welcomed the statement from the Secretary of State for Environment, Food and Rural Affairs, my right hon. Friend the Member for Streatham and Croydon North (Steve Reed) about sustainable food production: nutritious foods grown while restoring nature, and farms with good food production at its core, rewarded properly. There is a complicated relationship in food production, whereby farms mostly exist on Government subsidy with very small profit margins and then the supermarkets make profits out of what they sell. We need to look into that complicated relationship.

One problem is that unhealthy and ultra-processed foods—UPFs—that are high in fats, salt and sugar are often the easiest, cheapest and most convenient. Crucially, they make the most profit for the food industry. The other problem with these types of food is that they are addictive—salty, fatty foods are addictive. Another problem, revealed by the Food Foundation, is that healthy foods, calorie for calorie, are twice as expensive as less healthy foods. So there are a lot of issues there to unpick.

Inequalities and deprivation are very, very strong causes of obesity, with less well-off people being twice as likely to be overweight. Therefore, one strategy has to be to increase the living wage, reduce child poverty, improve health and social services, and invest in education —all of which the Government are doing.

On pregnancy, obesity actually begins in the womb—it does not even begin when we are born. In one fascinating experiment, one group of pregnant women were fed a lot of carrots and another group did not have any carrots. The children of the women who ate carrots loved carrots, so a memory is made in utero. It is therefore really important that pregnant women have a very healthy diet, as this is a risk factor for obesity in young people. Another is formula feed. Breastfeeding protects against obesity, but formula feeds do not. Follow-on feeds, hungry baby feeds, are just normal milk packed full of calories, so they tend to increase obesity. That is perhaps something we need to discuss, too.

[Wera Hobhouse (Bath) (LD)]

I am the chair of the eating disorders all-party parliamentary group. To make any progress, we have to understand that eating disorders are highly stigmatised. Many people with obesity also have an eating disorder. To make real progress, is not the first thing to take the stigma away from obesity and get to the people who really want to improve their lives?

[Dr Opher]

I absolutely agree with that. We must treat people in a fair and compassionate way. We must point that out to them, as medical professionals, and help them to get better. I agree with the hon. Lady about stigma.

On obesity strategies, since 1990, we have had 700 separate policies to tackle obesity, yet it has doubled. Clearly, we are doing something wrong. Having looked at the evidence, it is clear that voluntary targets do not work. Voluntary targets for the food industry and relying on individual agency—giving us choice in what we eat—cannot reduce obesity. The food industry, of course, has a vested interest in making money. While education and exercise are really good, there is not much evidence to suggest that they reduce obesity. It is all about food.

There has been a lot of research. Nesta, the Obesity Health Alliance and the House of Lords Food, Diet and Obesity Committee have done multiple reports on obesity, and it is clear that we can halve it. All we need to do is reduce everyone’s calorie intake by 200 calories a day. That is the difference between McDonald’s large fries and standard fries—other fries are available—so it is not a massive thing, but we all have to do it. As always with public health, small drops in what we take can have a massive effect on the population.

Tobacco and Vapes Bill

Wera Hobhouse Excerpts

2nd reading
Tuesday 26th November 2024 Commons Chamber

[Wes Streeting]

My hon. Friend is absolutely right. I am afraid that one of my first experiences of death was watching my grandmother die a very long, slow, painful death from lung cancer as a result of a life of chain smoking. That is the consequence of this cruel addiction. People who start smoking come to regret it. They struggle to stop, and I am afraid that the stolen years that they could have spent with children and grandchildren are only part of the cost. Part of my argument today, particularly to some Opposition Members, is about better use of public money and reducing the taxation burden. Other arguments, too, may have some currency with Members who might be opposed to these measures for libertarian reasons. We should not forget for a moment the impact of this cruel addiction and the harms caused by smoking on people’s quality of life, family life, and memories.

[Wera Hobhouse (Bath) (LD)]

rose—

[Wes Streeting]

I must make progress, otherwise we will not hear from anyone else in this debate—and I think that it will be a debate.

Taking action requires a reforming Government who are unafraid to take on the orthodoxies of both the right and the left. As I said, my right hon. Friend the Work and Pensions Secretary is today proposing radical reforms to the welfare system. Earlier this month, I set out a package of reforms to drive better productivity in the NHS. Today, we are proposing the biggest public health reform in a generation: phasing out smoking for the next generation by raising the legal age at which tobacco can be sold by one year every year, so that anyone aged 15 and under today will never legally be sold cigarettes. That will phase out smoking altogether.

Almost 20 years ago, the last Labour Government introduced the ban on smoking indoors in public places, as my hon. Friend the Member for Harlow (Chris Vince) said. We heard many of the same arguments, frankly, from opponents of that measure as we hear from opponents of the Bill today. They are free to correct me if I am wrong, but I do not think that Opposition Members who oppose the Bill are also proposing scrapping the indoor smoking ban. We have political consensus on the issue because of its success. The year after the ban came into force in 2007, hospital admissions for heart attacks dropped by 1,200. Admissions for children with asthma had been rising by 5% a year before the ban. After it was introduced, admissions fell by 18% in just three years. Since 2007, smoking rates have been cut by over a third, and as our understanding of second-hand smoke grew, the ban sparked a cultural change. People no longer thought it acceptable to smoke in front of their children, and many stepped outside, even in their own homes. It is time to build on that success.

No smoker intends to cause harm to others, but that is unintentionally what they do through second-hand smoke. The harms from second-hand smoke are less than from actively smoking, but the evidence shows they are still substantial. If people can smell smoke, they are inhaling it. Smoke near schools and playgrounds exposes children to smoke. Hospitals, by definition, have high numbers of medically vulnerable people on their grounds. The Bill will allow Government to extend the ban on indoor smoking to certain outdoor settings, and we will consult on banning smoking outside schools, playgrounds and hospitals to protect children and the most vulnerable.

As we act to prevent harms from smoking, we must also tackle the rising problem of youth vaping. It has more than doubled in the last five years, and one in four 11 to 15-year-olds tried vaping last year. A new generation of children is getting hooked on nicotine, and there should be no doubt about the cause, and no illusion that this has happened by accident. On any high street in the country, we can see shop windows filled with brightly coloured packaging for vapes, with flavours like blue razz lemonade and tongue twisters sour apple. Those products are designed, made, packaged, marketed and sold deliberately to children. This industry has cynically targeted its harmful products to kids.

Action is long overdue. We promised to stamp out youth vaping in our manifesto, and the Bill delivers the change that we promised. It will close loopholes that allow vapes to be sold or given away to children, provide powers to regulate the flavours, packaging and display of vapes, and introduce on-the-spot fines of £200 for under-age sales. Just as we took action on the advertising and sponsorship of tobacco products, we will bring the law into line for vaping products, too.

[Wera Hobhouse]

I do not know whether the Secretary of State will still be in the Chamber when I talk about Spice-spiked vapes. I see a gap in the Bill: it does not talk about refills. The harmful practice of spiking vapes with Spice comes from the refills. I hope that the Government will listen to my concerns and be flexible, as they have already shown themselves to be in other places. Perhaps, during the passage of the Bill, we can include something about refills. Would he agree to that?

[Wes Streeting]

We want to work in a genuinely collaborative and cross-party way, and I know that is true right across the House. As I look at the Opposition Benches, including Conservative Benches, I see long-standing campaigners for action on smoking and vaping. We want to listen and engage.

I feel strongly about the matter, as does the Prime Minister. In our manifesto, we set out Labour’s mission to improve the health of the nation. We will be far better served as a country if this is a truly national mission, and if we come together in common cause for action on public health.

--- Later in debate ---

[Dr Cooper]

I wholeheartedly agree. Vending machines are often forgotten, but they are used for sales and marketing, and sometimes in ways we do not understand.

[Wera Hobhouse]

We should also look at online sales. A lot of young people purchase products online. May I ask the Minister what the Bill says about that?

[Dr Cooper]

I do not disagree. The Bill will give the Government far greater control over the marketing side of vapes and the flexibility to adjust regulations in the future. Life evolves outside this Chamber, and we need to be able to evolve with it flexibly.

Alongside the measures in this Bill, this Government have made important commitments to integrating smoking cessation into routine care and ensuring that the most disadvantaged groups are not left behind as we move towards a smokefree Britain. When I was undertaking my training in public health, a director of public health told me that our profession is where medicine meets politics—I am not sure how he would feel about me going into politics, but there we go. In this Bill, I am delighted to see the evidence and data provided by my profession working in synergy with this Government’s policy development to bring forward a Bill that will allow our young people to enjoy healthier futures and allow us all to live in a healthier environment. I thank all Members across the House for their work on this issue, and I offer my wholehearted support for the Bill.

--- Later in debate ---

[Wera Hobhouse (Bath) (LD)]

I congratulate the Government on their very strong stance on tobacco and protecting children, but—the Minister will know what is coming—when it comes to refillable vapes, the Bill is missing the mark. Research by Professor Chris Pudney at the University of Bath discovered that one in six vapes confiscated in schools contained the synthetic drug Spice—a highly addictive and dangerous drug commonly found in prisons. It causes very dangerous health conditions, including damage to vital organs. On our streets, users are often slumped in a semi-conscious state, unable to function. In our schools, children are collapsing. Some are rushed to intensive care; others are left battling lifelong addiction. The highly addictive nature of Spice makes it a gateway to criminal activity, coercion and abuse.

I have spoken about this alarming issue on several occasions, and I have had some assurances from the Government, but so far I have not seen anything on it in the Bill. It will not do anything to stop the trend of Spice-spiked vapes in schools, because the vapes that contain Spice are almost all refillable. Refillable vapes are rechargeable and feature an empty pod that can be filled up with a liquid of choice. Banning disposable vapes will not address that problem. Many of the confiscated vapes containing Spice were made to look exactly like a normal product from a shop, and they are usually sold as containing THC—tetrahydrocannabinol—also an illegal product in this country. Children are inadvertently consuming Spice under the impression that it is cannabis.

Vapes containing THC are widespread in parts of the United States where they are legal, but importing them to the UK is costly and difficult. Spice, however, is cheap, readily available and highly addictive. Dealers exploit that by passing off Spice as cannabis, preying on young people and putting them at serious risk. This drug has the potential to condemn young people, in particular vulnerable young people, to a life of crime and addiction.

When such Bills come along, we have the opportunity to make them as strong as possible. There are other issues associated with Spice-spiked vapes, but I urge the Government to really look at what they can do to strengthen the Bill to address this serious problem. There are opportunities in the Bill, but focusing solely on disposable vapes risks backfiring; it may push demand towards refillable vapes, which are even easier to tamper with for illegal use. Have the Government really prepared for the potential unintended consequences? I hope that they acknowledge the points that I have raised. I look forward to seeing them addressed as the Bill progresses. I support the Government on their very strong stance and on what they want to achieve, but I hope that the Bill can be strengthened.

Oral Answers to Questions

Wera Hobhouse Excerpts

Tuesday 19th November 2024 Commons Chamber

[Karin Smyth]

My hon. Friend makes an excellent point on behalf of Rachel and many other women suffering from this disease. We are looking urgently at gynaecological waiting lists. They are far too high, including for endometriosis. I welcome the new National Institute for Health and Care Excellence guidelines. We will be looking at women’s health hubs and how they work, and future guidelines will help women to get a diagnosis more quickly and help with situations like Rachel’s.

[Wera Hobhouse (Bath) (LD)]

Respiratory health conditions are one of the main drivers of NHS winter pressures, yet only 32% of asthma sufferers in Bath and across the country can access the most basic level of care. What will the Government do to improve access to basic levels of care for the 68% of asthma sufferers who are currently missing out?

[Andrew Gwynne]

NICE is reviewing its guidelines for the diagnosis, monitoring and management of chronic asthma, and an updated version is due to be published in late November 2024. I am happy to meet the hon. Lady to discuss it further.

Breast Cancer: Younger Women

Wera Hobhouse Excerpts

Tuesday 12th November 2024 Westminster Hall

[Martin Vickers (in the Chair)]

I will call Vera Hobhouse to move the motion, and I will then call the Minister to respond. There will not be an opportunity for the Member in charge to wind up, as is the convention in 30-minute debates.

[Wera Hobhouse (Bath) (LD)]

I beg to move,

That this House has considered breast cancer in younger women.

It is a pleasure to serve with you in the Chair, Mr Vickers. I thank the Minister for being here to respond.

Every woman deserves a fair chance against breast cancer, no matter her age. It is the most common type of cancer in the UK. Most women who are diagnosed are over 50, and it is therefore a disease often associated with older women, but young women are at risk, too. Breast cancer in younger women is often caught later when it is more advanced. That is because there is no routine screening and too often symptoms get dismissed as something less serious. That must change. Awareness and early detection are crucial, no matter your age.

The issue arose for me during a constituency surgery when my Bath constituent Lucy shared her story, which resonated with me because my nephew’s mother died many years ago of breast cancer aged 35. In 2021 Lucy, who was 38, had two young children and was diagnosed with primary breast cancer. She underwent a mastectomy, chemotherapy and radiotherapy before being given the all-clear. In 2024, when she was 41, a self-initiated MRI scan tragically came back showing that her cancer had returned, leading to a diagnosis of secondary breast cancer, which is currently incurable. In both cases she found it a struggle to be diagnosed.

The first time, despite her mother having had breast cancer and Lucy presenting with a lump, at least three different doctors told her that it was likely to be hormones and nothing to worry about. It was not until she requested the biopsy, which ultimately came back showing it was cancer, that the diagnosis was made. The second time she repeatedly voiced concerns about a symptom that she was experiencing, but she was repeatedly assured that it was just a side effect of the treatment. Still concerned, she approached the GP, who did some initial tests but ultimately suggested that her worries were anxiety-driven. After that appointment she came out and sobbed in her car.

Searching for peace of mind, Lucy then paid privately for a breast MRI, which tragically revealed that the cancer had returned, but by then it was too late. In both cases—first by requesting the biopsy and secondly by initiating an MRI—it was up to Lucy to fight for a diagnosis.

[Helen Grant (Maidstone and Malling) (Con)]

I congratulate the hon. Lady on securing this important debate. Because of the age restrictions in accessing NHS mammograms and the importance of early diagnosis, which she highlights, does she agree that self-awareness and self-examination in young women is critical in the battle to beat breast cancer?

[Wera Hobhouse]

The hon. Lady is absolutely right that we need to continue to raise awareness, but I am pointing out that even when young women are aware and go to a doctor, the doctor says, “Don’t worry about it.” However, I agree that we need to continue to make sure that women examine their breasts and are aware of the risks of breast cancer, even when they are young.

[Jim Shannon (Strangford) (DUP)]

I spoke to the hon. Lady yesterday. This is a massive issue for me and my constituents back home, and they bring it to my attention all the time. It was great to attend the Breast Cancer Now “Wear It Pink” event last month to raise awareness of the most common cancer in the UK. Studies have suggested that breast cancer among younger women has a more aggressive pathophysiology, correlating to poorer outcomes compared with those for breast tumours in older patients. Does the hon. Lady agree that consideration must be given to lowering the age requirement for breast screening to ensure quicker intervention for younger women?

[Wera Hobhouse]

I will come to that later in my speech, but I absolutely agree with the hon. Gentleman. We are here to make the case for earlier screening programmes for younger women, because it is becoming such an issue—the rates are increasing. It is because of Lucy’s struggle to get a diagnosis that she felt the need to speak up on behalf of the countless young people who would not question decisions made by medical professionals.

[Clive Jones (Wokingham) (LD)]

I congratulate my hon. Friend on securing this important debate. After I survived breast cancer, one of my many emotional conversations with my daughters was about having the BRCA gene. Currently, there is a postcode lottery for the availability of counselling with proper genetic guidance for those who are identified as having the gene. Does my hon. Friend agree that NHS England should ensure equitable access to information and counselling services, and that fixing the system should be a feature of the Government’s future cancer strategy?

[Wera Hobhouse]

I am sorry to hear that my hon. Friend went through a cancer diagnosis, and I am glad that he recovered. Breast cancer in men is not as well known; people do not necessarily recognise that men can develop breast cancer. Once a diagnosis is made, it is quite traumatic for the whole family. Counselling services need to be adequate, and I agree that there should not be a postcode lottery.

The description of Lucy’s story is in no way meant as an attack on the NHS. Since she was diagnosed, Lucy has received the top-class care for which the NHS is renowned, but she is not alone in having her age used against her. There are countless similar stories of women of a similar age or younger who have found it difficult to receive an initial diagnosis, with concerns often dismissed too early by doctors as hormones, anxiety or tiredness. This is by no means the doctors’ fault; they are forced to make difficult decisions about who to prioritise because of the impossible time and budget constraints that are imposed on them. That does not, however, make it acceptable.

There is a long-standing myth that breast cancer only affects older women, but there has been a global surge in cancers among the under-50s over the past three decades—sadly, the issue is not limited to breast cancer. Last year, a study found that cancer cases in under-50s worldwide are up nearly 80% in the last 30 years. More than a million under-50s are dying of cancer each year, and that figure is projected to rise by 21% by 2030.

I draw attention to the “Jess’s Law” petition, which has more than 350,000 signatures, to improve the awareness and diagnosis of cancer in young adults. It points out the struggles young adults face in getting diagnosed, even though adults aged 25 to 49 contribute around a tenth of all new cancer cases. According to Cancer Research UK, cancer rates in 25 to 39-year-olds in the UK increased by 24% between 1995 and 2019. In 2019 alone, almost 35,000 people in that age bracket were diagnosed with cancer.

The trend is especially alarming in breast cancer. Diagnoses of breast cancer have increased steadily in women under 50 over the past two decades, but in recent years the increase has been even more stark. In 2013, breast cancer cases in women under 50 topped 10,000 for the first time. To the alarm of experts, breast cancer diagnoses in women under 50 have risen by more than 2% annually over the past five years, so the trend is clearly an increase. That is deeply concerning, especially since women under 50 are nearly 40% more likely to die from breast cancer than are women over 50.

It is truly alarming that in the UK, breast cancer accounts for 43% of all cancers diagnosed in women aged 25 to 49. Despite that, we continue to wait until women are 50 or older to begin routine screening. Why are we delaying early detection when the rates of breast cancer in younger women are rising year on year? Cervical cancer screening is available to women from the age of 25, but of the top 10 cancers detected in those aged 25 to 49 in the UK, breast cancer outweighs cervical cancer by more than five times, so that discrepancy simply does not make sense. If we can screen for other cancers earlier, we should do the same for breast cancer. We all know that early detection saves lives, so we must ensure that all women, regardless of their age, have the opportunity to access lifesaving screenings.

Young women are more likely to develop aggressive forms of the disease. Breast cancer is the most common cancer in women, and it remains one of the leading causes of death in women under 50 in the UK. Unfortunately, as Lucy’s story shows, younger women often face more challenges to diagnosis. They are more likely to be diagnosed at a later stage of the disease, with larger tumours and greater lymph node involvement. Cancer in younger women is also more likely to be biologically aggressive: sub-types such as triple negative breast cancer are harder to treat and have poorer outcomes. As a result, younger women have significantly worse prognoses, with a higher risk of recurrence and death than older women. We cannot ignore that stark reality.

Premature death from breast cancer among women in their 40s accounts for the same years of life lost as those in their 50s, and substantially more than those diagnosed in their 60s. That is crucial. A death of a woman in her 40s or 50s represents not just a loss of life, but a tragic loss of potential life years.

Researchers also found an increase in the diagnosis of stages 1 and 4 tumours, which suggests that if stage 1 tumours are missed in younger women, they tend not to be found until they reach stage 4, at which point the cancer is incurable. Early detection can make all the difference. During the previous Parliament, a petition calling for funding to extend breast cancer screening to women from the age of 40 got more than 12,000 signatures. That widespread public support reflects the growing concerns about early detection.

The Government’s response was deeply disappointing. They continue to use the Marmot review as their main reference point, citing the lower risk of young women developing breast cancer and the fact that women below 50 tend to have denser breasts, reducing the accuracy of a mammogram. It is true that the risk of younger women developing breast cancer is lower, but statistics show that rates of breast cancer in women aged 25 to 49 are rising fast, and that upward trend demands urgent attention.

Although mammograms can be less effective in women with denser breast tissue, that should not limit our approach to early detection. We should continue to use modern digital mammography, but the Government should expand the use of automated breast ultrasounds. Ultrasounds are especially effective in detecting abnormalities in dense tissue that might be missed on a mammogram. The technology is not invasive; it is quick and radiation-free, and it is often used for secondary screening for women with dense breasts. Automated breast ultrasounds can detect up to 30% more cancers in women with dense breasts than mammograms alone. By embracing both mammography and ultrasound, we can significantly improve detection rates, ensuring early and more accurate diagnosis.

Last week, in the light of Sir Chris Hoy’s bravery in sharing his story about his struggle with prostate cancer, the Health Secretary asked the NHS to look at the case for lowering the screening age for prostate cancer, particularly for people with a family history of the disease. That is an important and welcome step, but we must look at extending that approach to breast cancer too. Both diseases share a significant genetic link, and a family history often increases the risk. Aligning the screening policies for prostate and breast cancers in recognition of the shared genetic risks would provide a better safety net for those affected.

Various parts of the NHS are competing for investment, but it is clear that short-term investment in this area will save money in the long term, with fewer women needing extensive long-term treatment if breast cancer is caught early. According to Breast Cancer Now, breast cancer will cost the UK economy almost £3 billion in 2024, and the annual cost could rise to £3.6 billion by 2034.

I call on the Department of Health and Social Care to review the national breast cancer screening programme to identify where changes can be made to increase capacity in the system, to ensure that, where appropriate, a woman’s initial screening appointment can happen at a lower age. I also call on the Government to investigate the merits of early optional ultrasound for women aged 30 to 49. Finally, we must educate healthcare professionals and increase resources so that younger women who seek help are always taken seriously and investigated thoroughly, and never dismissed.

It is about not just policy change, but giving people the best possible chance to fight back against cancer and live healthier, longer lives. I hope that the Minister has heard Lucy’s story and will actively look at changing the way we screen for breast cancer for good.

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairmanship, Mr Vickers. I thank the hon. Member for Bath (Wera Hobhouse) for bringing this debate to the House, as well as other hon. Members for their interventions. I also pay tribute to the hon. Lady for championing the story of her constituent Lucy and others, such as Jessica Parsons, who have done so much to raise awareness. We have a powerful role as Members of Parliament, and I commend the hon. Lady for doing an excellent job.

The hon. Lady is absolutely right that awareness raising is key to catching cancer early, and the most effective way to tackle breast cancer in younger women is to encourage them to check their breasts regularly. The NHS is going through the worst crisis in its history, and this Government will turn it around so that cancer patients are diagnosed and treated on time. The investments we are making now in breast cancer treatment and research are part of our plan to make the NHS fit for the future.

Although women of any age can get breast cancer, it is much more likely to occur over the age of 50. That is why our screening programme sends women their first invitation at 50. However, I will take this opportunity to emphasise that the take-up of breast cancer screening is currently below 70%. That is worryingly low, and we are determined to change that. I make a plea to all hon. Members to help the Government achieve greater take-up of breast cancer screening in women over 50. Women need to come forward for screening.

Taken as a whole, the evidence does not support regular mammograms for women below the age of 50. Decisions on screening, including the age at which to offer it, are made by experts on the UK National Screening Committee, and those decisions are kept under review so that they continue to be based on the best available research. Ultrasound can be used as a diagnostic tool, but it is not appropriate for screening. Mammograms provide a fuller picture of the breast, and are better able to spot early signs of cancer. As the hon. Lady said, mammograms used for screening are less reliable for younger women given their denser breast tissue. Change in the screening age could mean a greater risk of false negatives, where cancer is missed, and there would also be a greater risk of false positives, which may lead to invasive testing when there is no need for it. Our approach is in line with that of most European countries, which screen women between the ages of 50 and 69.

For younger women who have a greater risk because of their family history, we offer screening using mammogram or an MRI scan. As I have said, the most effective way to tackle breast cancer in younger women is to encourage them to check their breasts regularly, and to consult their GP straight away if they have any concerns.

[Wera Hobhouse]

Lucy did that and was dismissed. Today’s debate is particularly important for awareness raising among the medical profession to ensure that women, particularly those who know about a family history of breast cancer—some do not—are not dismissed and are taken seriously.

NHS Dentistry: South-west

Wera Hobhouse Excerpts

Tuesday 12th November 2024 Westminster Hall

[Richard Foord]

The hon. Gentleman is right. We want to move NHS treatment back into primary care and away from the most critical acute care, yet it seems to me that primary care services are moving in the other direction.

[Wera Hobhouse (Bath) (LD)]

Royal United hospitals in Bath saw nearly 260 people last year with serious dental issues such as abscesses, largely because those people could not get a preventive care appointment from a dentist in their community, forcing them to go to A&E. Does my hon. Friend agree that a lack of NHS dentistry drives up costs because people go to A&E when it should only be there for emergency cases?

[Richard Foord]

I agree that emergency care should not suddenly become the routine. It is there for the most critical cases, but we have not seen that, given the drying up of NHS dentistry provision in our towns and villages.