Liver Disease and Liver Cancer

Preet Kaur Gill Excerpts

Thursday 25th April 2024 Westminster Hall

[Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)]

It is a pleasure to serve under your chairship, Sir Christopher. I thank the hon. Member for Glasgow Central (Alison Thewliss) and my hon. Friend the Member for Stockport (Navendu Mishra) for securing this debate. I thank my friend, the hon. Member for Glasgow Central, for sharing her personal experiences. I know that both Members are great champions for improving health outcomes for all, and I am grateful to them for bringing forward this debate to discuss a neglected but major killer. I also thank my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) for sharing the shocking figures on liver disease in her constituency.

As my hon. Friend the Member for Stockport highlighted, new data released this month shows that we are facing the worst mortality and hospital admission rates for liver disease in a generation. Over 70,000 people die of liver disease and liver cancer each year, over half of whom are people of working age—15 to 64—at a huge cost to the NHS and the economy. We have heard from Members that 90% of liver disease is preventable, and if diagnosed at an early stage damage can often be reversed and the liver can fully recover. It is an avoidable epidemic, which is being driven by obesity, alcohol and viral hepatitis. All those issues increase in prevalence in the most deprived communities, and drive the health inequalities that we are debating today.

The debate is timely because it comes in the week when we received the sobering news that annual figures for alcohol-specific deaths had passed 10,000 for the first time ever. Seventy-six per cent of those deaths were from liver disease, including liver cancer, and it is the third year in a row that deaths have risen across the United Kingdom, breaking previous records each time. The rise was not inevitable and it cannot be explained away as the product of the pandemic. It is a policy failure, and Ministers today must answer for it.

Outcomes for many types of cancer have seen huge improvements over recent decades, but as we have heard, deaths from liver cancer in the United Kingdom have increased by 40% in the last decade alone. It is the fastest-rising cause of cancer death in the United Kingdom. It has a shockingly poor five-year survival rate of just 13%. Public awareness remains very low, with liver cancer patients overwhelmingly diagnosed at a late stage.

To her credit, the Minister for Social Care, the hon. Member for Faversham and Mid Kent (Helen Whately), recognised the problem when she committed in a letter to the chief executive of the British Liver Trust that the Government would make fibroscans available for use at 100 community diagnostic centres by March 2025. I have used one of those fibroscans, and they are a fantastic piece of kit that can tell if someone has liver damage or early signs of liver disease.

Why then, in the answer to my parliamentary question, which I received in February, did the Minister say that the Government had plans for fibroscans not in 100, but rather 12 diagnostic centres at the end of March? What about the other 88? It is all very well the NHS announcing funding for a new diagnostic pathway, but without the kit in local communities, how will that actually work? How and where will patients access scans and tests? Will they be available in the most deprived communities, where outcomes are far worse? What about in GP practices and pharmacies?

Perhaps the Minister could take up Labour’s fully costed plan for a “fit for the future fund” to double the number of MRI and CT scanners, so that we can catch illness earlier and treat it faster, before it is too late. To tackle health inequalities, we must get serious about public health and a prevention-first approach. Under this Government, for the first time in a century, life expectancy has dropped in England, and a growing number of people live more of their life in ill health.

While the decline affects us all, as we have heard from many Members it is not spread equally across the country. Over a third of all premature deaths were reported in the north of England in 2022, and in my city of Birmingham, life expectancy has dropped by nearly two years in just three years. A person in Blackpool is three times more likely to die from chronic liver disease than people living elsewhere in England. In parts of that town, life expectancy for men is just two years above the retirement age—but what do we expect when the Prime Minister boasted about changing funding formulas to take money away from deprived urban areas?

As I mentioned, alcohol consumption alone caused more than 7,500 untimely deaths from liver disease in 2022, and those mortality figures have risen three years in a row. Yet faced with that, the Government have decided to dismantle the central public health function and, as far as I can tell from the non-answer that I have received to written questions on this, they have abolished the Department of Health and Social Care’s alcohol policy team. Can the Minister confirm whether it is the case that there are no dedicated alcohol specialists in the Office for Health Improvement and Disparities, and that that team have now been redeployed? Should we take that as an indication of how much Ministers care about this issue, and does that help us to understand why there was no real-terms increase to the public health grant in the spending review in March, even as alcohol treatment services have been hollowed out over the last 14 years?

It does not bode well for the prevention strategy that the Health Secretary has promised before the summer recess. I hope that that does not go the same way as the major conditions strategy and the health disparities White Paper before that. I am encouraged to hear that measures to tackle the obesity epidemic should feature in it, if not alcohol. Fatty liver disease and excess weight significantly increase the risk of premature death due to not just liver cancer but colon, breast, prostate, lung and pancreatic cancers, not to mention heart disease. When one in six children are obese by the time they finish primary school and one in four children with obesity are estimated to have fatty liver disease, this Government have been sitting on a ticking time bomb for the last 14 years, without taking action. Labour is committed to ensuring that all children get a healthy start to life, with free primary school breakfast clubs serving healthy food, an active and balanced curriculum and a pre-watershed ban on advertising junk food. Can the Minister confirm that concrete prevention policies to tackle the obesity epidemic will be included in the prevention strategy, and will she finally publish the consultation on the junk food ban and get on with legislating for it?

Mortality rates from liver disease are now four times higher in our most deprived communities than in our most affluent. That makes a mockery of the Government’s rhetoric on tackling health inequalities and levelling up. To build an NHS fit for the future, Labour is committed to hitting all NHS cancer waiting time and early diagnostic targets within five years. We will drive a prevention revolution, with measures to tackle alcohol harms and the obesity epidemic: banning junk food ads to children, boosting capacity in local public health teams and recruiting thousands of mental health staff to give more people access to treatment before they reach a crisis. As part of our 10-year health mission, we will improve healthy life expectancy for all and halve the gap in healthy life expectancy between different regions of England.

Oral Answers to Questions

Preet Kaur Gill Excerpts

Tuesday 23rd April 2024 Commons Chamber

[Mr Speaker]

I call the shadow Minister.

[Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)]

At the last general election, the Government promised to deliver 6,000 more GPs by 2024-25, but there are still 2,000 fewer GPs than in 2015. Part of the problem is that morale has plummeted in the past decade, meaning that experienced family doctors and newly qualified GPs are hanging up their stethoscopes. What does the Minister say after scrapping two GP retention schemes last month? Will she come clean today about another broken manifesto promise?

[Dame Andrea Leadsom]

The hon. Lady is choosing numbers out of the air. She will be aware that there are almost 3,000 more GPs now than in 2019, and very importantly the long-term workforce plan is scheduled to introduce 6,000 new training places by 2031-32. In 2022, we had the greatest number ever of new trainee GPs. That is great news for GP practice, as they are crucial to primary care.

--- Later in debate ---

[Mr Speaker]

I call the shadow Minister.

[Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)]

Today, we have seen alarming figures pointing to the systematic de-prioritisation of women’s health, with 600,000 women in England waiting for gynaecological treatment, 33,000 women waiting more than a year, and under two thirds of eligible women screened for breast cancer in the last three years. Will the Secretary of State come clean and admit that under this Government, women’s health has become an afterthought?

[Victoria Atkins]

That is absolute nonsense. As I say, I have prioritised women’s health. I am pretty sure that I invited the hon. Lady to the women’s health summit earlier this year.

[Preet Kaur Gill]

indicated assent.

[Victoria Atkins]

She is very graciously saying that I did. The point is that I want women to receive the sort of care that we would all hope and expect them to have. I have prioritised that precisely because there are conditions, including gynaecological conditions, that have historically not received the attention they deserve. As our women’s health ambassador Dame Lesley Regan says, the NHS was created by men, for men. I am the Health Secretary who is sorting that out.

Dentistry: Access for Cancer Patients

Preet Kaur Gill Excerpts

Wednesday 17th April 2024 Westminster Hall

[Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)]

It is a pleasure to serve under your chairship, Mr Dowd.

I thank my hon. Friend the Member for Stretford and Urmston (Andrew Western) for securing the debate and for speaking so powerfully about how the dentistry access crisis affects cancer patients and survivors such as his constituent, Michele. I had the pleasure of meeting Michele with my hon. Friend earlier today, and it was eye-opening to hear the stories about what cancer patients and survivors face. I am delighted that Michele is here today. I thank her for all her campaigning and the support that she provides for those suffering pretty much what she had to go through.

I am afraid the state of NHS dentistry under this Government is Dickensian. Most of us might think that our teeth would be the least of our worries if we were diagnosed with cancer, and as we have heard, oral health is incredibly important. Many cancer patients, who previously had few or no dental issues, can experience the loss or crumbling of teeth, together with a host of other dental problems during or after treatment. Poor dental hygiene can lead to infections, which can interfere with a patient’s chemotherapy. Radiotherapy can cause acute complications for teeth and gums through tissue damage. In rare cases, extractions afterwards can result in bone necrosis, whereby the jawbone essentially dies.

It is therefore crucial that timely access to dentistry, including any required treatment and preventive advice, is provided before, during and after cancer therapy to maximise positive outcomes. The last thing that any cancer patient needs is to find that they cannot access a dentist when they need one. However, as the Minister knows, the current crisis in access to dentistry is shocking. After more than a decade of neglect, patients are desperately queueing round the block to see a dentist. Eight in 10 practices are not taking on new adult NHS patients and, as we have heard, one in 10 people have tried DIY dentistry. Some of the most vulnerable people in society, who need to get seen, are missing out.

I want to share with the Minister some of the stories that were shared with me before the debate. Michaela from Alresford said:

“I lost all my root canals and my teeth just started falling to bits on chemotherapy. I wasn’t able to see an NHS dentist and I couldn’t afford private. I’m awaiting treatment again for cancer (for the second time) and urgently need my teeth sorted before I have chemotherapy again, but I can’t get in to see a dentist.”

Carole from Shropshire said:

“I was with an NHS dentist but missed a check-up while going through chemo—was very ill. So got knocked off. I had problems when taking ibandronic tablets for bones, had to go for emergency treatment. NHS dentist in Shrewsbury 17 miles from home. This was two years ago—still not been able to register. Tried surrounding towns. I know I am not on my own. There are hundreds in the same situation as me.”

What does the Minister have to say to Carole and Michaela? Has the Department made any estimate of the impact of the access crisis on cancer patients and survivors?

As we heard today, according to research by Macmillan Cancer Support, four in five cancer patients are hit with an average cost of £570 a month as a result of their illness. If patients face oral health complications because of their treatment and they cannot be seen on the NHS, most will simply go without. A two-tier system, whereby those who can afford to go private and the rest go without, is obscene. How are the Government working to minimise the financial cost of cancer for patients and survivors? Those costs can knock back their health.

It was disappointing to hear from Michele that when she was diagnosed with breast cancer her doctor did not tell her about the impact her treatment could have on her oral health. I know the Minister accepts that such advice should be routine. The Department of Health and Social Care guidance for delivering better oral health states that cancer patients should receive appropriate care to manage and stabilise their oral health before treatment, but it appears that not all cancer patients are getting that support. I urge the Minister to address the matter and raise it when possible.

In my team, a parent of one of my staffers was diagnosed with throat cancer in 2020, but did not get his orthodontist appointment to have four teeth removed until a year after his treatment. Will the Minister comment on the fact that the latest estimates show that in February 2024 more than 325,000 patients were waiting for oral surgery in England? That is up by nearly 200,000 since 2015, almost a decade ago, which was the last time the NHS target was met. How many cancer patients’ treatments are delayed as a result?

There is also the dire issue of cancer diagnoses themselves. Oral cancer is now one of the fastest-growing types of cancer in the United Kingdom, with mortality rates up by 46% on a decade ago. It now kills more than 3,000 a year in the United Kingdom. But if diagnosed early, oral cancers have a survival rate of roughly 90%, compared with 50% if diagnosis is delayed. Given that dentists are often the first to spot the early signs of the disease, will the Minister say whether she has made any assessment of the contribution of the dentistry crisis to the appalling mortality figures?

As my hon. Friend the Member for Bolton South East (Yasmin Qureshi) said, the Health Secretary claimed in the Commons in February:

“There is £200 million on top of the £3 billion that we already spend on NHS dentistry in England.”—[Official Report, 7 February 2024; Vol. 745, c. 264.]

But that is not true. Notwithstanding the fact that £1 billion of that is covered by patient charges, not central Government, the Health Secretary also subsequently admitted that the money will come from existing budgets. So really it is only £200 million as part of the money that she might spend on NHS dentistry if the £400 million yearly underspend persists.

The Health Secretary also claimed:

“The Opposition’s ambitions reach only as far as 700,000 more appointments. Our plan will provide more than three times that number of appointments across the country—that is 2.5 million”.—[Official Report, 7 February 2024; Vol. 745, c. 255.]

But that is not true either, is it? It is not true because the Government’s scheme will run for only one year, while Labour’s plan would deliver both in the here and now and into the future. Perhaps the Health Secretary might correct the record on that, too.

My hon. Friend the Member for Stretford and Urmston shared his thoughts on how joining up services in hospital for cancer patients could address access to dentistry for very high-risk patients. NHS dentistry is dying a slow death under this Government, and the people who rely on NHS care cannot wait another five years for a Tory Government to decide that, this time, they really mean it and they will reform NHS dentistry for good. Labour’s fully funded plans would provide 700,000 more urgent appointments a year, supervised tooth-brushing schemes in areas of deprivation, and a targeted recruitment scheme in left-behind areas, all paid for by cracking down on tax dodgers. We would get on with the reform to the NHS dental contract that this Government have put off for 14 years. Cancer patients, new mothers, those in rural communities and millions of others are being failed every year that we let the decay in NHS dentistry continue.

Tobacco and Vapes Bill

Preet Kaur Gill Excerpts

2nd reading
Tuesday 16th April 2024 Commons Chamber

[Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)]

It is a pleasure to respond to the debate on behalf of the Opposition. We have heard powerful contributions from Members on both sides of the House in favour of the Bill to bring an end to the smoking epidemic and crack down on vaping companies that are preying on kids. I thank the right hon. Member for Bromsgrove (Sir Sajid Javid), my hon. Friends the Member for Stockton North (Alex Cunningham) and for Blaydon (Liz Twist) and the hon. Members for Winchester (Steve Brine), for Harrow East (Bob Blackman), for Erewash (Maggie Throup), for Boston and Skegness (Matt Warman) and for Stroud (Siobhan Baillie) for their moving contributions on the harms of smoking and the importance of the Bill. Let me also thank my hon. Friends the Members for North Tyneside (Mary Glindon), for York Central, (Rachael Maskell) and for Dulwich and West Norwood (Helen Hayes) for the excellent points they made about the growth in vaping.

We have also heard opposition to the Bill. The right hon. Member for Rossendale and Darwen (Sir Jake Berry) cited the example of people openly taking class A drugs in public without reprimand as evidence that bans do not work. I dare say that he made more of a point about the decline in policing and local enforcement under his Government than about age-of-sale legislation. To the former Prime Minister, the right hon. Member for South West Norfolk (Elizabeth Truss), I simply say that if wanting to stop future generations from getting addicted to products that may eventually kill them makes us the health police, then the health police we are.

There is no argument about the harm that tobacco does to the people of this country every day. Smoking is the single biggest preventable cause of ill health. It leads to 80,000 deaths a year in the United Kingdom, and it is responsible for one in four cancer deaths and more than 70% of lung cancer cases. Smokers lose an average of 10 years of life expectancy. As we have heard, smoking is not a free choice; it is an addiction. Raising the age of sale will help to reduce pressure on the NHS by improving health and wellbeing.

My constituent Eric knows that too well. He is one of thousands of constituents whose lives have been put at risk by smoking. Like the vast majority of smokers, he began smoking when he was a child, at age 14. It was not until his 50s that he was able to give up cold turkey, at the request of his daughter, who urged him to do so on behalf of his newborn grandson. Eric has suffered a heart attack and stroke, and he lives with hypertension, high cholesterol and COPD. As he said:

“COPD is an incurable, mortal disease and makes getting around harder and harder for me.”

The experience of people like Eric is why the last Labour Government took radical action with the smoking ban in 2007: a defining public health achievement. It is also why, while in opposition, we welcomed the Khan review and proposed the generational smoking ban a full 10 months before the Prime Minister made his announcement at his party conference.

There is wide support for the Bill from everyone in the NHS, in the wider health sector and among the general public. The only people who seem to be fighting it tooth and nail are the tobacco companies and Conservative Back Benchers. The former Member for Blackpool South called it “health fascism”, and the former Prime Minister, whose chief of staff worked for Philip Morris and British American Tobacco, has called it “unConservative.” What is it about the tobacco industry that some Tory MPs love so much? Every year the NHS bails out big tobacco to the tune of billions. The Prime Minister might not feel he has the strength to take on those vested interests and whip his MPs to vote against them, but he can rest assured that if they cannot get it over the line, Labour will.

As welcome as this Bill is, the Government have had 14 years to take stronger action on smoking. Four years ago, the Government said that their ambition was a smoke-free Britain by 2030, but they are currently estimated to be at least seven years behind their Smokefree 2030 target and not on course to meet it in the poorest areas until 2044. The generational smoking ban will help us get there, but it will not help the 6 million to 7 million adults who already smoke.

As many Members have said, stop smoking services have faced savage cuts. The number of smokers who quit through stop smoking services has dropped from 400,000 a year in 2010 to around 100,000 today. Does the Minister regret not doing more to bring down smoking rates over the past 14 years? The Government have belatedly committed more funding to stop smoking services, but the uplift in funding that the Minister offers will not take us back to the number of people setting quitting dates that we achieved in 2010. What assurance can she offer that her measures will get the Government on course to hit the 5% smoke-free target by 2030?

The Bill is strong on tackling the take-up of cigarettes and vapes by young people, but it does little to help those already addicted to quit. Recently, a school in my constituency had to apologise after handing out a leaflet to a child that suggested smoking as a self-help measure. Does the Minister agree that it is scandalous that the myth that smoking reduces stress and anxiety still persists? Does she agree that her Bill should include a requirement to make tobacco companies include information to dispel that myth in their products?

The Bill also includes a range of powers to tackle youth vaping, which Labour welcomes. For years, Labour has been warning about the explosion of young people getting addicted to nicotine with products that look like teddy bears and sippy cups, and come in flavours like unicorn shake. That is why Labour voted to ban the marketing and branding of vapes to children in 2021. Once again, Labour leads and this Government belatedly follow. In the meantime, an estimated 255,000 more children aged 11 to 17 have become addicted to vapes, according to ASH survey data. Does the Minister regret taking so long to wake up to this issue?

According to the Chartered Trading Standards Institute, while youth vaping has soared, so has the number of illegal products flooding our market, as many Members have raised. Up to one in three vapes sold in shops is estimated to be illicit, which means that children are being exposed to vapes that contain heavy metals, antifreeze and poster varnish, as well illegal levels of nicotine getting them hooked for life. Will the Minister explain how she expects to bring in effective new regulations on vapes when her Government are barely in control of the black market now? Does she agree that a cross-Government strategy is needed to tackle the smuggling of potentially dangerous products into our country? Has she considered giving the MHRA new powers to screen products before they come on the market? Will she confirm that her Bill will provide powers to tackle not just the sale but the import of dangerous products?

To conclude, after 14 years of the Tories, healthy life expectancy has dropped for the first time in modern British history. Labour supports this Bill but, after 14 years of failure and with the NHS in crisis, we regret that it marks a last desperate attempt of this Government to rescue a legacy on public health. For 14 years they have played politics with public health, putting off prevention measures, knowing that taxpayers tomorrow will pay the price. But the country is paying for this now. Labour will always put public health first, prioritise prevention to ease pressure on the NHS, improve access to smoking cessation services and take on the tobacco and vape companies that are profiting off people’s health.

Prescription Charges: Long-term Health Conditions

Preet Kaur Gill Excerpts

Monday 11th March 2024 Westminster Hall

[Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)]

It is a pleasure to serve under your chairship, Dame Maria. I thank my hon. Friend the Member for Neath (Christina Rees) for opening the debate, and for sharing Mia’s story and her reasons for creating the petition. I thank Mia for doing so, and I pay tribute to the more than 20,000 people who signed the petition to bring this issue to Parliament. I hope that my remarks do justice to this important subject.

As we know from the Budget debates this week, this Parliament is set to be the first in modern history in which living standards have dropped over its course. Faced with a crippling cost of living crisis since the Government tanked the economy and sent prices soaring, people are having to make impossible choices that they never would have dreamed of making in the past—between eating or heating their homes, between paying their rent or going into debt, or, for people with chronic conditions, between paying for their medicines or forgoing other essentials. It is a shocking situation that far too many people in this country find themselves in.

We all understand the immense challenges faced by people with chronic or long-term conditions. That is part of why the next Labour Government have made it our mission to reform health and care services to build an NHS fit for the future by improving capacity and providing it with the staff, technology and resources it needs so that all patients get the treatment they need where and when they need it. We will deliver 2 million more NHS appointments a year, and reform primary care so that people with long-term conditions can request face-to-face appointments with a doctor of their choice, meaning better continuity of care and better outcomes for patients.

Whether it is the debilitating pain faced by many people with endometriosis, Ehlers-Danlos syndrome or polycystic ovary syndrome, the struggle of living with chronic anxiety or depression, or the fatigue and disabilities associated with conditions such as multiple sclerosis or POTS, I cannot do justice, in the time I have, to the many daily hurdles that many people living with such conditions face, but being able to afford essential medications should clearly not be one of them. I thank my hon. Friend the Member for Neath for sharing some people’s stories today.

I recognise that the cost of prescriptions in England, which is currently £9.65 per item, is a burden on many people living with chronic conditions that are not on the medical exemption list. I acknowledge the Government’s argument that the prescription prepayment certificate scheme can reduce the outlay, and that there are a number of exemptions from paying for prescriptions for certain demographics, including those on low incomes. However, paying up to £111.60 a year for medication is a heavy outlay for many ordinary people during a cost of living crisis, and the issue of fairness in how different conditions are treated remains.

When the medical exemptions list was first drawn up in 1968, it was limited to readily identifiable permanent medical conditions that automatically called for continuous, lifelong, and, in most cases, replacement therapy, without which the patient would have become seriously ill or even died. There has been only one review since then, under the last Labour Government, when cancer was rightly added to the list. Many Members and our constituents have criticised the medical exemptions list as being out of date, inconsistent and arbitrary, based on patterns of illness and treatment that have changed significantly since the 1960s.

Previously, when this issue was debated in relation to exemptions for cystic fibrosis, the then Minister, the right hon. Member for Charnwood (Edward Argar), stated:

“We do think it would not be right in this context to look at one condition in isolation, separate from other conditions, because others would rightly argue that their condition was potentially equally deserving of an exemption if it fitted the same criteria.”—[Official Report, 2 February 2022; Vol. 708, c. 185WH.]

As the petition focuses on a range of conditions, will the Minister say whether the Government see a case for looking again at the medical exemptions list now?

Will the Minister also tell us what she knows about the take-up of the prepayment certificate, and whether its price is a barrier to some people getting the medication they need? What assessments have the Government made of how the addition of cancer to the medical exemptions list improved outcomes for people with cancer? Does the Minister agree that no one suffering from debilitating chronic illness should be priced out of the medication that they need?

At a time when the cost of living is continuing to rise, the Government should consider what more they can do to support people with these essential costs. Applications to the NHS low-income scheme have surged on the Government’s watch, up from just over 267,000 in 2021 to 361,000 in 2022—a 35% rise in a year. That surely reflects the scale of the problem.

It is appalling that people have been rationing their own medication simply because of cost. It is not just a matter of fairness; skipping medication risks costing the NHS more money in the long term and putting even more pressure on primary care if that person’s health deteriorates. Indeed, last year, when looking at the impact of potentially increasing prescription charges, the Government’s own impact assessment raised several concerns, including that some people towards the lower end of the income distribution may struggle to afford all of their prescriptions, which can result in future health problems for the individual and subsequent cost to the NHS. That is worrying. What estimate has the Minister made of the number of people in England who are currently unable to afford medicine, and what assessment has she made of the knock-on impact on NHS services, which are already at breaking point? Research published by York Health Economics Consortium in 2018 found that removing prescription charges for IBD and Parkinson’s alone could save the NHS up to £20 million a year. What assessment has the Minister made of the economic case for looking at this again?

Labour recognises that the cost of prescriptions in England, currently £9.65 per item, is a burden on many people living with chronic conditions. Prescription charges have risen 34% under this Government, and with costs continuing to rise, there are valid concerns about people being priced out of accessing vital medicines. While I recognise that there is a broad system of exemptions from charges, including for those on low incomes, I hope the Minister has heard the concerns raised and the representations made by the petitioners. No one should be forced to choose between paying for their prescription and risking their health.

Tackling Obesity

Preet Kaur Gill Excerpts

Tuesday 27th February 2024 Westminster Hall

[Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)]

It is a pleasure to serve under your chairship, Mr Dowd. I thank the right hon. Member for Bexleyheath and Crayford (Sir David Evennett) for securing this debate. He has been a strong campaigner for tackling childhood obesity over many years, and I thank him for his remarks today.

As many colleagues have rightly highlighted, the obesity epidemic is a genuine crisis. It will be the next big public health issue that we will all be talking about in a few years. Some 60% of us are now overweight. One in four children in England are now obese by the time they leave primary school. That means that those children are five times more likely to go on to develop serious and life-limiting diet-related conditions in adulthood, such as diabetes, cardiovascular disease, liver disease and certain forms of cancer. Of course, that means more pressure on the NHS, which, as we know, is already buckling under the weight of demand after years of mismanagement by this Government. It is a disaster for the taxpayer: Frontier Economics estimates the impact of obesity to be £98 billion a year in NHS and social care costs, lost productivity, workforce inactivity and welfare payments.

I thank many Members for rightly focusing their remarks today on the poor food environments in which children are growing up, and what we as policymakers can do about that. In recent decades, action on obesity has overwhelmingly focused on measures to get people to change their behaviours without tackling the structural factors that influence them. We know that that is not enough. For example, 99.9% of us know that it is important to get our five a day, most of us can tell each other what a healthy diet looks like, and every week there seems to be some new fad diet. The bottom line is the nation’s waistline: Britain is getting fatter.

It is therefore disappointing to see the Secretary of State say that she believes the priority for preventing obesity is to give people information about nutrition with no measures to fix the food environment. It appears to be at odds with her views on tobacco, where the Government have rightly taken up measures to further protect children from tobacco harm. She does not believe that measures to inform children about the dangers of tobacco are alone sufficient to solve that issue, so why does she believe this for obesity? If giving people more information is the solution, can the Minister explain why obesity rates are twice as high in our poorest areas than the richest?

Labour believes that every community in the UK should be a healthy place for children to grow up, learn and play. Businesses need a healthy workforce to drive economic productivity and sustainable growth. It is the Government’s job to make the healthy choice the easy choice. There was a moment in 2020 when it looked like every party across the House believed this. The Government brought forward the 2020 obesity strategy, welcomed by doctors, parents and health charities, and as the right hon. Member for Bexleyheath and Crayford said, it received cross-party support.

The strategy contained evidence-based measures to begin to fix the food system by stopping our children from being bombarded with junk food adverts as part of a major commitment to halve childhood obesity by 2030. I would like to ask the Government today what has happened to that commitment, since they kicked that flagship policy into the long grass, delaying the policy for the next Government to deal with in October 2025. Are the Government still committed to halving childhood obesity by 2030, and what have they done since delaying the junk food advertising policies?

The need for action has not gone away, as we have heard today. The health of our children is in a dire state, and it is getting worse. It was once thought that it was essentially impossible for children to develop type 2 diabetes so early in life as a result of their diet, but as mentioned by the right hon. Member for Bexleyheath and Crayford, we are now seeing thousands of cases of children developing the condition, with more every year. Nearly four in 10 children with obesity are estimated to have early stage fatty liver disease, and tooth decay remains the single largest cause of hospitalisations for young children in England.

The Government assure us that the regulations on junk food advertising were delayed merely to give industry more time to prepare. If this is the case, why have the Government refused to bring out the supporting secondary legislation for these regulations, which are now months overdue? Surely the Minister agrees that it would help the industry prepare for these regulations to have this detail available to them now. Industry will want to tackle the structural drivers of ill health and be led by evidence, not ideology. That starts with delivering the measures the Government have failed to implement to protect children from junk food.

We will restrict adverts for foods high in fat, sugar and salt in favour of healthier options. We will improve children’s diets by finally implementing the 9pm watershed for junk food advertising on television and ban paid-for advertising of less healthy foods in online media. Tackling health inequalities is a central part of Labour’s health mission. We will not resort to the tired excuses that would blame families in Blackpool for having poorer health than someone in Banbury. Instead, we need to focus on making healthy food more affordable and accessible. Schools will have a role and responsibility within that, which is why our fully funded breakfast clubs in every primary school in England will serve healthy and balanced food to embed healthy habits and boost children’s concentration and development.

The Government undertook some assessments of the health impacts of the national school breakfast programme when it was running. It would be really good to hear what some of the evidence was. We heard from schools that it improved pupil behaviour, their readiness to learn, social skills and their eating habits. To conclude, I want to leave Members with a statistic to reflect just how stark this issue is. Not only are our children fatter than their peers in other European countries, but they are actually shorter than their European peers.

National HIV Testing Week

Preet Kaur Gill Excerpts

Thursday 8th February 2024 Commons Chamber

[Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)]

It is a great pleasure to speak for the Opposition in this debate to mark National HIV Testing Week. We have heard great contributions today from Members on both sides of the House, and it gives me hope that we can continue to make progress on this issue in the years ahead. I thank my hon. Friend the Member for Warrington North (Charlotte Nichols), the hon. Member for Worthing West (Sir Peter Bottomley), the hon. Member for Strangford (Jim Shannon) and my hon. Friend the Member for Hammersmith (Andy Slaughter) for making powerful speeches on the enormous progress made on HIV.

Incredible advances mean that people living with HIV on effective treatment can now enjoy normal life expectancy and are no longer at risk of passing on the virus. The reality of living with HIV in the 2020s is a world away from the 1980s. As colleagues have remarked today, we might just have the chance to be the generation to make Britain the first country in the world to end new cases of HIV for good. It is an enormous credit to a generation of activists, fantastic organisations such as the Terrence Higgins Trust, many great campaigning MPs across the House and the all-party parliamentary group on HIV and AIDS that we have got to this point. More treatments have become available. Thousands of people are now living with HIV at levels undetectable or intransmissible to others, and the stigma and misinformation that the LGBT+ community suffered through the ’80s is not what it was.

For Labour’s part, we are incredibly proud of our record on HIV. It was the last Labour Government who switched spending so people could get the new drugs as they became available after 1997. We passed the Equality Act in 2010 that gave legal protections to people living with HIV. Chris Smith became the first MP to talk about living with HIV in 2005, and in 2018 my hon. Friend the Member for Brighton, Kemptown (Lloyd Russell-Moyle) was the first MP to talk about living with HIV here in the Commons. But there is much more to be done.

There are around 4,500 people in the UK living with HIV who are undiagnosed. The earlier those people can be found and linked to care, the better their health outcomes will be and the closer we will be to stopping new transmissions. Some 44% of people diagnosed with HIV in England last year were diagnosed at a late stage. Late diagnosis rates are even higher for women, at 51%, and that means some women are diagnosed so late they are already on their death beds.

[Sir Peter Bottomley]

I am glad the hon. Lady is making the important point that women are particularly at risk of non-diagnosis. She rightly mentions some Labour people who made important contributions. We ought to remember Norman Fowler. I do not normally talk about my wife’s work, but if I may say so, when she was Secretary of State for Health, she got the insurance companies in and said, “Do not charge higher premiums, or refuse cover to, people who have taken an HIV test. That is not the way to move forward.”

--- Later in debate ---

[Preet Kaur Gill]

I thank the hon. Gentleman for his remarks, which he has now put on the record.

There were 13% fewer people tested for HIV in 2022 than in 2019. That is why we have seen cross-party support today for National HIV Testing Week. Testing is free, quick and easy. You can even test from home, and you can order a free test online; I urge colleagues to share that information with their constituents.

Turning to what the Government can do to help eradicate new transmissions of HIV, I was very pleased to see the Government finally commit to rolling out opt-out testing to all 32 areas of high HIV prevalence in England. The pilots have been a resounding success, and Labour has fully supported bringing them to other high-risk communities across England. The shadow Health Secretary, my hon. Friend the Member for Ilford North (Wes Streeting), was on the HIV Commission that first made the recommendations. Will the Minister provide an update on progress towards rolling out the programme to the 47 new hospitals? Can she provide reassurance that in the long term, opt-out testing in emergency departments will be embedded as a cornerstone of the UK’s plan to end new HIV transmissions? Receiving an HIV diagnosis can be alarming, especially if you are not expecting it, so has she considered setting aside a portion of funding to ensure that people who are diagnosed through the scheme are given support to help them to come to terms with their diagnosis? Has she made an assessment of whether opt-out testing could be rolled out to other settings in primary care?

The Minister will know that the HIV action plan included several commitments on HIV testing, including the commitment that local authority commissioners would set the standard that sexual health services would achieve a 90% testing offer rate to first-time attendees. Two years on from the publication of the plan, there has been no reporting on its progress. Will the Minister say what progress the Government have made against commitments in the HIV action plan to increase the number of people tested in sexual health services?

Finally, I want to ask the Minister about the Government’s commitment to the prevention agenda. Under the Government, we have widening health inequalities, life expectancy stalling, and a record high of 2.8 million people out of the workforce due to ill health. Any Government interested in supporting the NHS would put prevention front and centre of their agenda, but for 14 years, there has been no joined-up plan for health, and services and institutions that promote good health have been run down. This week we heard that England’s national public health agency, the Office for Health Improvement and Disparities, has been “effectively dismantled”. OHID leads on sexual and reproductive health and HIV, as well as a wide range of public health issues, ranging from tobacco to obesity and children’s health. Will the Minister explain how the Government can be committed to the prevention agenda when they are dismantling our national public health function? Will she do us the courtesy of confirming how many full-time equivalent staff have been cut from OHID, and can she explain why the Government have not had the courtesy to make a statement to Parliament on what has been reported, which sounds like quite significant cuts?

The remarkable progress on HIV has been hard won, and it puts ending new cases of HIV within reach. We have only one Parliament left to do that by 2030. I want to put on record clearly that Labour is committed to getting us over the line. That is why we would immediately get to work publishing a refreshed HIV action plan. It will not be easy, but we know what it will take. We owe it to everyone we have lost to the virus, everyone who has faced that stigma, and everyone who is living with HIV today to end new transmissions once and for all.

Pharmacy First

Preet Kaur Gill Excerpts

Wednesday 31st January 2024 Commons Chamber

[Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)]

I thank the Minister for advance sight of her statement.

Let me start by paying tribute to the many organisations that have been involved in preparing for this launch and the thousands of pharmacies across the country that have embraced this initiative. Labour has long been arguing that pharmacists should play a greater role in the NHS, so we support this move.

As the Minister has said, pharmacies already do far more than just dispense repeat prescriptions and sell shampoo: they are medicine experts within the NHS; they are highly trained; they are easily accessible right across the country; and, as we saw during the pandemic, they are a highly trusted part of their communities. But their skills and knowledge are often under-utilised. Therefore, bringing more services to British high streets for patients to get treated more quickly and conveniently is absolutely right. It is why, as we announced last week, we want to bring NHS out-patient appointments closer to people through high street opticians too.

The Minister is right to say that pharmacists can take pressure off GPs. However, let us be clear: this announcement will not make up for the 1,000 pharmacies which have been closed under the Conservatives, or the 2,000 GPs that have been cut since 2015. Patients today are waiting over a month to see a GP, if they can get an appointment at all. When Labour was last in office, people could get an appointment within 48 hours.

That is the thing with this Government: they give with one hand and take with the other. Will the Minister explain what has happened to the Government’s pledge to deliver 6,000 more GPs this year and what she is doing to support community pharmacies, which are already facing a perfect storm of inflationary pressures for running costs, recruitment challenges and an unstable medicines market?

The Government press release issued today claims that patients in England will be able to get treatment for seven common conditions at their high street pharmacy from today. I would like to dig down into whether that is actually the case. Healthwatch England has warned that it will take time for pharmacists to be trained in order to provide the services that Ministers have announced, so can the Minister tell us when she will be able to guarantee that the services advertised will actually be available?

Let me also ask about IT integration. To facilitate this roll-out, pharmacists were supposed to have access to GP Connect, so that details of patient consultations would automatically be sent to general practice through the clinical IT systems. The Government have had 12 months to get that ready, but from what I am hearing this morning it is still not live. Pharmacists are telling me that they can access only a summary of GP records, that they have to use another system to input what they have prescribed, and that they then have to download that and email it across to the GP. That is cumbersome. What estimate has the Minister made of the time that will be wasted at a local level to address that issue, and how long will it take before the system is ready?

Finally, what is the Government’s plan in the longer term to integrate the increase in independent prescribers who are being trained as part of the long-term workforce plan, and does the Minister agree with us that we should be accelerating the roll-out of independent prescribing to establish a community pharmacist prescribing service covering a broad range of common conditions? That would support patients with chronic conditions, which is the big challenge facing the NHS. Does the Minister agree that community pharmacies will have an important role to play in supporting GPs in the management of long-term conditions such as hypertension and asthma and in tackling the serious issue of over-prescribing, which is responsible for thousands of avoidable hospital admissions every year?

We agree that patients should be able to go to their local pharmacy to receive some services that they currently get at GP surgeries, such as vaccinations free of charge on the NHS, allowing patients to be seen faster and freeing up GPs to see more complex cases. By bringing healthcare into the community, patients will have greater control. The NHS should be as much a neighbourhood health service as a national health service, with healthcare on the doorstep, there when it is needed—and with Labour, it will be.

[Dame Andrea Leadsom]

Well, the very first appointment under Pharmacy First happened at 8.30 this morning.

Oral Answers to Questions

Preet Kaur Gill Excerpts

Tuesday 23rd January 2024 Commons Chamber

[Mr Speaker]

I call the shadow Minister.

[Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)]

I want to share with Ministers the experience of Emma from Grimsby, who said:

“NHS dentistry is a joke in the town at the moment. Thankfully I managed to get an emergency appointment in Scunthorpe (after being offered one in Doncaster originally) and I’ve now been referred to hospital to have 3 wisdom teeth removed. My dentist closed at the onset of the pandemic and I’ve not been able to register with an NHS dentist since.”

What does the Minister have to say to Emma and the millions like her who cannot get an appointment when they need one?

[Dame Andrea Leadsom]

The hon. Lady is absolutely right to point that out. Emma has my absolute sympathy and apology for the fact that since the covid pandemic we have not seen the recovery of dentistry that we would have liked. I can tell her that in July 2022 we brought in significant reforms to encourage dentists to take on more NHS patients, but we recognise the need to do more. The long-term workforce plan will increase training places and the overseas registration will improve capacity, as will the changes to dental therapists’ programmes. All those things will improve the situation, but in the meantime we will be bringing forward our recovery plan very soon, which will immediately expand the incentives to NHS dentists.

Draft Medical Devices (In Vitro Diagnostic Devices etc.) (Amendment) Regulations 2023

Preet Kaur Gill Excerpts

Tuesday 16th January 2024 General Committees

[Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)]

It is a pleasure to serve under your chairship, Dame Maria.

As the Minister set out, we are considering regulations that update legislation pertaining to in vitro diagnostic devices and make supplementary provisions for the EU IVDR in Northern Ireland. The SI appears to be an innocuous measure to support the implementation of new EU regulations that came into operation in Northern Ireland in May last year. Those will continue to be applied, per the annex to the Windsor framework, but with consequential amendments to other legislation, provisions for the fees for certificates and conformity assessment, and some practical provisions for the enforcement of the new regulations.

It is of course critical that we secure continuity of supply and trade in medical devices within the United Kingdom and with the EU. The draft regulations affect a diverse range of equipment and systems to examine specimens in vitro, including things like blood grouping reagents, pregnancy test kits and hepatitis B test kits. From catching killer diseases early to preventing infections, the medtech sector makes a huge contribution to our national health service and our vibrant life sciences sector. These products are found in doctors’ surgeries, hospitals and our own homes, and we saw during the pandemic how difficult it can be to replace them when supply is disrupted.

Although the explanatory memorandum sets out that the draft regulations should affect only 19 businesses in Northern Ireland and cost less than £5 million to implement, they are still a valued part of the UK medtech ecosystem. The Opposition therefore support the regulations to secure unfettered access to the GB market for NI businesses and continuity of supply. None the less, I have a few questions for the Minister.

We welcome the fact that the previous fee structure is being retained to reduce disruption for NI operators, but will the Minister say what assessment has been made of any impact on the MHRA’s responsibilities as regulator, and assure us that it will be resourced to fulfil them? Previously, Ministers have talked about future realignment of regulations on medical devices following our departure from the EU, including consideration of alternative routes to the GB market. Will the Minister comment on the opportunities in this area? What is the timeline for the future regulatory regime that the Government want to bring into force? The Government have still not set out their proposals; is there a timeline for doing so?

It is interesting that medical devices did not receive attention in the Windsor deal. I know that some suppliers are disappointed by this, citing the complexity of navigating the current system. Is the Minister considering adding other product classes, like medical devices, to its scope? Will he also clarify the status of devices on which a conformity assessment has been performed by a UK notified body? Will it be possible to place devices bearing a CE conformity mark as well as the EU(NI) mark on the EU market? To my knowledge, no UK notified body has been appointed; when will this be dealt with and why has it been delayed?

To reiterate, we support the amendments to secure continuity of supply for the critical medtech sector. I look forward to hearing the Minister’s response.