Under-age Vaping

Baroness Winterton of Doncaster Excerpts

Wednesday 12th July 2023 Commons Chamber

[Kirsten Oswald]

Will the hon. Gentleman give way?

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. I would gently say that the hon. Lady has made a long contribution, and I do have two other speakers to get in. That is the only problem.

[Jerome Mayhew]

Thank you for that indication, Madam Deputy Speaker.

To wrap up my submissions, I will say that the Government are absolutely right to have put out a call for evidence. That evidence has now been obtained, last month, and the Government should take every second that is needed to assess it and come up with draft proposals, but not a second longer, because this is a very important issue. As a parent, I share the concerns that have been expressed across the House. We need to address this issue—we cannot waste time—but we should do so based on the evidence.

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[Rachael Maskell (York Central) (Lab/Co-op)]

Twenty-nine years ago I handed in my dissertation for my degree. It was focused on tobacco advertising, and the very arguments being made today by the industry were being made back then as to why it was so important that advertising should not be prohibited further. That is why today’s debate should be as much about the business model, driven by the industry, as about the harm from these products to children and young people. I congratulate my hon. Friend the Member for Denton and Reddish (Andrew Gwynne) on bringing this motion before the House, because the timing is so important. Some 30% of children and young people across Yorkshire have already tried vaping and we know, as we move into that summer period, that more and more children will be socialising outside of school time, and those risks will go up, as will the number of adults we see vaping.

I was honoured to sit on the Health and Social Care Committee as we took evidence from the industry, health professionals and an articulate headteacher talking about their experiences. What I have to say back is that over the past 29 years, we have seen an industry that has become far cannier in how it advertises and markets its products than it was in yesteryear. The situation calls on the Government to step up and be far cannier in being able to expediently put in place the full range of measures that we know will have an impact on the number of young people taking up vaping.

We welcome the reduction in the number of children smoking cigarettes, and we have seen that important shift over the decades. We know the measures that have levered that in—increasing the cost has certainly had an effect, and making smoking less accessible and less attractive has had an impact—but what also needs to be learned is that the very mechanisms put in place around cigarettes need to be applied immediately to vaping, too.

If we look at some of the measures introduced over the past 20 years, we have seen the billboards taken down along with newspaper and magazine advertising, the removal of tobacco from promotions, its removal from sport, its access taken away in shops, the shutters put down, vending machines taken away and these products being put out of use. There were also important public health measures to move away from indoor smoking and, as my hon. Friend the Member for Stockton North (Alex Cunningham) has just said, smoking in cars where there are children. We also had that important intervention on plain packaging, which we know Israel and Finland have already introduced for e-cigarettes. There is therefore no reason for a delay here.

The industry is using every reason it can consider as to why it needs to continue using advertising. I cross-examined the industry at the Select Committee. To summarise some of the exchange, we were discussing why Blackburn Rovers had those products on the shirts of the heroes of that town. The industry was saying, “It’s really important that we distract people from tobacco products on to our products, because that is our public health measure.” I challenged back and said, “Why don’t you have public health messaging on those shirts instead?” Of course, they argued that that would not work, because they wanted to draw in the next generation of people to use their products. That is what the industry has always been about: it is about generating profit for its shareholders. When it did that with tobacco-based products, ultimately its customers died. That was not the best business model it could induce. With vaping, the industry wants to make sure it has a continuous stream of addicts, and we need to understand that business model to introduce the public health measures needed around harm reduction.

If we look at the figures, we see that a YouGov survey showed that of the 3.6 million adults who are vaping, 2 million are ex-smokers who have now returned to using a nicotine-based product, 1.4 million are current smokers and 200,000 have never smoked and are vaping. Another survey showed that of the people who were vaping, only 47% were also smokers, and 53% were not. We can deduce from that that the reach of these measures and the availability of vaping products means they are being used far beyond the purposes that Public Health England intended and that Javed Khan put in his report to reduce people’s use of tobacco-based products. As a result, we are seeing more people drawn into an addictive habit, addicted to nicotine and able to use it more regularly and with far more availability. They are therefore taking on higher quantities of this drug, and we are seeing the consequences of that.

The call for taking all the same measures currently in place for cigarettes is therefore vital. ASH and others recommend putting an excise tax of £5 on the product, and we will need to adjust the cost of cigarettes in line with that to ensure that they remain less attractive. We need to ensure that we have investment in the trading standards workforce to address the illicit trade we see in counterfeit products, with the dangers they cause. On branding, it is very clear that plain packaging is required. We must remove the cartoons, the sweet names, the colours and the flavours that are currently being propagated. We must also ensure that promotion is not possible in any sphere. Ultimately, we need to ensure that these products are used only for harm reduction and take that really important whole approach to public health as opposed to looking at one product or another.

We have got to question why young people are taking up the use of nicotine. Yes, there is peer pressure—of course, we understand that, and that is really important. We heard about how children discuss the different flavours and try them out, using the product more and more as a result. Yes, there is the power of advertising—why else would companies advertise but to attract custom? But why is it that young people need a dependency on a drug? We need to get to the heart of that question through a wider public health approach. I am very disappointed that the Government have pulled away from some of their public health strategies, including the health disparities White Paper and bringing forward a more holistic approach to public health. Ultimately, we have got to protect young people from becoming the addicts of the future. That is the role of this Parliament

[Madam Deputy Speaker (Dame Rosie Winterton)]

I call the shadow Minister.

National Carers Week

Baroness Winterton of Doncaster Excerpts

Thursday 8th June 2023 Commons Chamber

[Dame Caroline Dinenage]

I reiterate my thanks to the Backbench Business Committee for allowing us to have this debate today. I thank both the Minister and the Front-Bench spokesman, the hon. Member for Leicester West (Liz Kendall), for showing that they both understand and care about this issue. I also thank all the Members who have taken part: the hon. Members for Worsley and Eccles South (Barbara Keeley), for North East Fife (Wendy Chamberlain), for Ceredigion (Ben Lake) and for Motherwell and Wishaw (Marion Fellows), the right hon. Member for Hayes and Harlington (John McDonnell), and my hon. Friend the Member for Cities of London and Westminster (Nickie Aiken).

Many Members shared their own personal experiences; I kicked off by talking about mine, when my mum cared for my grandmother who lived with dementia. I think it is only now that I am probably at a similar age to my mum in that caring role that I fully understand what she was going through and the toll that it would have taken on her own wellbeing. I put on record today—because I have never had the opportunity to do so—my thanks to her, and to the 7,000 carers in my constituency of Gosport and the millions across the UK. They deserve our thanks.

In many cases, what those carers do is so invisible. I know that they do not do it for thanks—they do it because they love the people who they care for—but that does not mean that we should take it for granted. It means that we need to recognise them and value them, and to put our money where our mouth is when we do that. It means that we need to provide them with support, funding and respite, and with everything they need to continue doing their role, because it is thankless and hard. I know that they probably would not have it any other way, but that does not mean that it should be done for free. The final thing I will say to the Minister today is that we need a national carers strategy to bring together all that good work, and to demonstrate to carers that we do care.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I know that the young people from Balby Central Primary Academy will have enjoyed the contributions made about carers, particularly young carers.

Question put and agreed to.

Resolved,

That this House has considered National Carers Week and respite for carers.

Mental Health Treatment and Support

Baroness Winterton of Doncaster Excerpts

Wednesday 7th June 2023 Commons Chamber

[Mary Kelly Foy (City of Durham) (Lab)]

As we have heard today, England is in the midst of a mental health crisis, and that is certainly true in the north-east. I join my hon. Friends the Members for Middlesbrough (Andy McDonald) and for Darlington (Peter Gibson) in calling for an independent inquiry into the Tees, Esk and Wear Valley NHS Trust. The testimonies I have heard have shocked me. I know that I can speak only in broad terms, but they include serious cases of improper care and misdiagnosis, and of putting people on waiting lists despite their feeling suicidal.

The Care Quality Commission reports that we have seen raise concerns about risk assessments, communications and record keeping, and a lack of observation. There have also been concerns raised about the lack of beds for children, as well as poor staffing levels, high staff turnover and a lack of neurodiversity training. Horrifically, young people have even taken their lives while in the care of the trust. We owe it to them, and all those who have been harmed, to investigate what is going on within the trust. Will the Minister commit to an independent, judge-led inquiry into the trust? She can either respond to me now or I can wait for her response in her closing speech. One thing is clear: this cannot go on.

I want to highlight the crisis in children’s mental health. In my region, children spent over 1,000 hours in A&E because they were in a mental health crisis. There are over 30,000 children on waiting lists. Across England, one in six children aged five to 16 are likely to have a mental health issue. Children’s happiness and sense of wellbeing continues to decline. With mental health trusts raising the threshold of how ill under-18s must be, we have seen a quarter of a million children being denied help for their mental health. Poor mental health compounds. Left untreated, it can spiral out of control, as we have heard many times today. No one should be in a mental health crisis, let alone children. The Government must invest in children’s mental health today—no more delays and no more referrals. The Minister must allow children the happiness that they deserve.

[Madam Deputy Speaker (Dame Rosie Winterton)]

Before I call the shadow Minister, I must say that I am very disappointed that seven Opposition Members who spoke in the debate are not back in the Chamber for the wind-ups, as well as about three Government Members. I must emphasise again that it is really important for people to get back to hear what the shadow Minister has to say, as well as the Minister. I hope that message will be conveyed back to those Members who are not here. I will say it again in the hope that they are back by the time the shadow Minister has finished his speech.

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[Andrew Gwynne]

I will not give way. We have heard enough from the right hon. Lady, supporting her “Through the Looking-Glass” amendment which bears no relation to the reality.

As we have heard today, people who require mental health support, no matter where they live—except in the right hon. Lady’s part of England—will be confronted by a system that is buckling under the pressure of 13 years of Tory mismanagement, neglect and incompetence. The right hon. Lady shakes her head, but the figures speak for themselves. Last year, patients suffering with mental health issues waited more than 5.4 million hours in accident and emergency departments. There are 400,000 children currently waiting for mental health treatment, and 1.2 million people are waiting for community mental health care, with some patients being forced to travel more than 300 miles because there are no beds in their local area. My hon. Friend the Member for Hemsworth spoke powerfully about that. The Resolution Foundation has found that, of the 185,000 young people who are unable to work, nearly two thirds cite mental ill health as the reason. Suicide is now the leading cause of death in adults under 34, with about 18 people losing their lives every single day. As the cost of living crisis has worsened, we have also seen a knock-on effect on addiction and rehabilitation. Drug-related deaths are at a record high, and last year there were 9,641 deaths in the UK from alcohol misuse, a 27% increase on the year before.

Make no mistake: the emergency in mental health has become a public health crisis, and we need to see action. Our motion calls on the Government to adopt Labour’s plan to recruit 8,500 mental health staff to expand access to treatment, to provide specialist mental health support in every school, and to establish open-access mental health hubs for children and young people. That would be paid for by the closing of tax loopholes, because politics is about priorities, and Labour’s priority is to ensure that those who need mental health support have access to it in all parts of the country. Our priority is to build a Britain where patients start receiving appropriate treatment within a month of referral. I hope that those on the Government Benches will demonstrate that they share these priorities by voting for Labour’s motion today.

Staffing is just one part of the equation. Like any public health issue, addressing mental health requires a holistic approach that recognises its complex nature. That is why Labour has committed to a whole-Government plan to improve outcomes for people with mental health needs and to address the social determinants that drive mental ill health for many people. Our mental health can be influenced by a multitude of different things. Secure jobs, fair pay and good housing are all building blocks for a healthy life, physically and mentally, and unless we improve people’s lives in the round, positive change will remain out of reach.

It is for this reason that the next Labour Government will focus as much on prevention as we do on treatment. We will pioneer a transformative cross-departmental agenda with a mission delivery board at the heart of the Government ensuring that all Departments work to improve the wider determinants of health. We will boost capacity in mental and public health teams so that people can get the support they need before presenting at A&E or turning to substance abuse. We will also encourage the integrated care systems to identify opportunities to join up services within the community. Our aim will be for more patients to have one point of contact for appointments with a range of professionals and services. This neighbourhood team will include the family doctor, carers, health visitors, social prescribers and mental health specialists.

Our vision is to turn the national health service into a neighbourhood health service with the patient right at the heart of it. The benefits of this kind of work will travel far beyond improving the lives of individuals suffering from mental ill health. For instance, in my own region of the north-west of England there were over 140,000 calls to 999 from people in a mental health crisis last year, and in my own constituency local people spent over 6,500 hours waiting in A&E for mental health treatment. If we were to help people before they reached these crisis points, we would drastically reduce pressure on the wider health system and thereby improve patient outcomes right across the board.

The same is true of wider economic productivity. As we have heard in the debate, the Mental Health Foundation and the London School of Economics have estimated that poor mental health costs the British economy £117 billion a year. That is a phenomenal amount of money and a huge loss to our country’s economic power. Improving mental health outcomes is therefore not just a moral imperative—although it is certainly that—but a practical one, and one that is essential if we want the United Kingdom to prosper, as I hope and believe we all do. That is what we come to this House for. We want to leave our country in a better shape for our children than it has been for ourselves.

That brings me again to the motion. All Members of the House have the opportunity today to support a fully funded plan to improve mental health treatment. Those on the Government Benches can choose to put party politics first, but that will not change the fact that this Government have failed people on mental health. No matter what amendments they put before us, that does not change people’s real, lived experiences or the experiences of Members on both sides of the House who deal with the impact of mental ill health in their constituency casework. The system is crumbling and more of the same will just not cut it, so I am enormously proud to be supporting Labour’s motion today and I would strongly urge Members on both sides of the House to back it. It is time to give those suffering from mental ill health the treatment and support they deserve, and I commend our motion to the House.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I reiterate for those who were not here that it is incredibly important that people get back in good time to hear the Opposition wind-up as well as the Government wind-up—that includes Ministers. I would expect anybody who was not here at the beginning of the Opposition wind-up, some of whom are still not here, to write to Mr Speaker to apologise. I take it that people will do that.

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[Yvette Cooper (Normanton, Pontefract and Castleford) (Lab)]

On a point of order, Madam Deputy Speaker, on Monday, the Home Secretary gave inaccurate information to Parliament when she said that

“the asylum initial decision backlog is down by 17,000”.—[Official Report, 5 June 2023; Vol. 733, c. 557.]

The asylum initial decision backlog is clearly defined by the Home Office. It is the total backlog of initial decisions before and after June of last year, and Home Office figures show that it has gone up from 132,000 to 137,000 for main applicants since the beginning of December. It has gone up from 160,000 to 172,000 for all applicants in the first quarter of this year. On either measure, that backlog is up, and not down.

I raised this matter as a point of order on Monday, and the Home Secretary refused to correct the record then. I have written to the Home Secretary this morning, but have still heard nothing back. The ministerial code requires

“that Ministers give accurate and truthful information to Parliament, correcting any inadvertent error at the earliest opportunity.”

I know that the Home Secretary has a history of breaching the ministerial code but, Madam Deputy Speaker, would you agree that facts matter and that it is not acceptable for Ministers to fail to correct the record if they have given inaccurate information to Parliament? Have you heard from the Home Secretary about her intention to come and correct the record?

[Madam Deputy Speaker (Dame Rosie Winterton)]

I thank the right hon. Lady for her point of order. As has been said before, and I think this was said when she raised the point of order yesterday, it is obviously not for the Chair to adjudicate in cases of differing interpretations of statistics. That said, if a Minister has made a mistake in the House, I would of course expect them to correct it. The right hon. Lady has put her perspective on the record. Ministers will have heard it, and I am sure the Home Secretary will reflect on whether a correction is required in this case. I see that the Whip, the hon. Member for Beaconsfield (Joy Morrissey), is writing this down and it will be fed back, and I am sure Ministers will do the same. I thank the right hon. Lady, and I think we will leave it at that.

Recovering Access to Primary Care

Baroness Winterton of Doncaster Excerpts

Tuesday 9th May 2023 Commons Chamber

[The Secretary of State for Health and Social Care (Steve Barclay)]

With permission, I would like to make a statement on the primary care recovery plan. For most of us, general practice is our front door to the NHS. In the last six months, over half the UK population has used GP services, and GPs in England carry out around 1 million appointments every single day. They are doing more than ever. General practice is delivering 10% more appointments a month than before the pandemic—the equivalent of the average GP surgery seeing about 20 additional patients every working day. There are more staff than ever, with numbers up by a quarter since 2019, and we are on track to deliver our manifesto target, with an additional 25,000 staff already recruited into primary care. We are investing more than ever, too, with the most recent figures showing that funding was around a fifth higher than five years before, even once inflation is taken into account.

But we know that there is a great deal still to do. Covid-19 presented many challenges across the health service, leaving us with large numbers of people on NHS waiting lists, which need to be tackled. In general practice, patient contacts with GPs have increased between 20% and 40% since before the pandemic. As well as recovering from the pandemic, we face longer-term challenges, too. Since 2010, the number of people in England aged 70 and above has increased by a third, and this group attends five times more GP appointments than young people. Not only that, but advances in technology and treatments mean that people understandably expect more from primary care systems.

Today I can announce our primary care recovery plan, and I pay tribute to the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien), for his work on this plan. I have deposited copies of the plan in the Libraries of both Houses. Our plan will enable us to better recover from the pandemic, to cut NHS waiting lists and to make the most of the opportunities ahead by focusing on three key areas: first, tackling the 8 am rush by giving GPs new digital tools; secondly, freeing up GP appointments by funding pharmacists to do more, with a “pharmacy first” approach; and thirdly, providing more GPs’ staff and more appointments. NHS England and my Department have committed to make over £1.2 billion of funding available to support the plan, in addition to the significant real-terms increases in spending on general practice in recent years. Taken together, our plan will make it easier for people to get the help they need.

The plan builds on lots of other important work. Last year, we launched the elective recovery plan, which is making big strides to reduce the backlog brought by covid-19. We eliminated nearly all waits over two years by last July, and 18-month waits have now decreased by over 90% since their peak in September 2021. By contrast, in the NHS in Labour-run Wales, people are twice as likely to be waiting for treatment than in England. They still have over 41,000 people waiting over two years and nearly 80,000 waiting over 18 months. In addition, this January, I came before the House to launch our urgent and emergency care plan, which is focused on how to better manage pressures in emergency departments, with funding to support discharge to improve patient flow in hospitals. Today’s plan is the next important piece of work.

Turning to the detail of the plan, our first aim is to tackle the 8 am rush. We will do that by providing GPs with new and better technology, moving us from an analogue approach to ways of working in the digital age. An average-sized GP practice will get around 100 calls in the first hour of a Monday morning. No team of receptionists, no matter how hard-working, can handle such demand. About half of GPs are still on old analogue phones, meaning that when things get busy, people get engaged tones. We are changing that by investing in modern phone systems for all GPs, including features such as call-back options, and by improving the digital front door for even more patients. In the GP practices that have already adopted those systems, there has been a 30% improvement in patient feedback on their ability to access the appointments they need. That also reflects the fact that online requests can help find the right person within the practice, such as being directed to a pharmacist for a medicine prescription review or to a physio for back pain.

In doing that, we will make the most of the 25,000 more staff we now have in primary care. Today’s plans fund practices without this technology to adopt it, while also providing them with staff cover to help them manage a smooth transition to the technology. Indeed, many small GP practices in particular find it hardest to fund new technology, or to manage the disruption that comes with transitioning to new ways of working, so we are funding locum cover alongside the tech itself. Notwithstanding that, people will always be able to walk in or ring if they prefer; if someone wants to ring up and see someone face to face, these investments will make that easier, too.

We also want to make sure that patients know on the same day that they make contact how their request is going to be handled. Clinically urgent issues will be assessed on the same day, or the next day if raised in the afternoon. If the issue is not urgent, an appointment will be scheduled within two weeks, but crucially, people will not be asked to call back the following day. Instead, they will get their appointment booked on the same day or be signposted to other services.

The second area of the plan is Pharmacy First. As well as giving GPs new technology, I know that we need to take pressure off GPs where possible by making better use of the skills of all clinicians working in primary care. We saw the incredible role that pharmacists played during the pandemic—their capacity to innovate and deliver for the communities that they served, freeing up GP appointments in doing so—so the second part of our plan is to introduce a new NHS service, Pharmacy First, on which we are already consulting with the Pharmaceutical Services Negotiating Committee.

Some 80% of people live within a 20-minute walk of a pharmacy, so making it easier for pharmacists to take referrals can have a huge impact. Referrals might be from GPs, NHS 111 or, from next week, urgent and emergency care settings. Community pharmacies already take referrals for a range of minor conditions, such as diarrhoea, vomiting and conjunctivitis, but with our Pharmacy First approach we can go further still. We will invest up to £645 million over the next two years so that pharmacists can supply prescription-only medicines for common conditions, such as ear pain, urinary tract infections and sore throats, without requiring a prescription from a GP.

One of the most significant shifts we are making is on oral contraception. Pharmacists can already manage the supply of contraception prescribed elsewhere; from later this year, they will also be able to start women on courses of oral contraception. This is another way in which, in light of our women’s health strategy, we aim to reduce the barriers to women accessing contraception. Pharmacists will also be able to do more blood pressure checks, which is one of the most important risk factors for cardiovascular disease. Not only will those kinds of steps make it easier for people to get the care they need, we expect them to release up to 10 million appointments a year by 2024-25.

The third part of our plan is about providing more staff and more appointments. We are making huge investments in our primary care workforce, and are on track to meet the manifesto commitment of 26,000 more primary care staff by next March, meaning that we have more pharmacists, physios and paramedics delivering appointments in primary care than ever before. In 2021, we hit our target of 4,000 people accepting GP training places, and our upcoming NHS workforce plan will set out how we will further expand GP training. We are also helping to retain senior GPs by reforming pension rules, lifting 9,000 GPs out of annual tax changes. These are the pension reforms that the British Medical Association welcomed, describing them as “significant” and “decisive” changes and citing them as “transformative for the NHS”.

As well as freeing up more staff time, our plan cuts bureaucracy, too, so that GPs spend less time on paperwork and more time caring for patients. We will remove unnecessary targets, improve communication between GPs and hospitals, and reduce the amount of non-GP work that GPs are being asked to do. For example, patients are often discharged from hospital without fit notes, meaning that they then have to go to their GP to get one. By the end of this year, NHS secondary care services, which understand those patient conditions better, will be able to issue fit notes, and we have streamlined the number of targets on primary care networks from 36 down to just five. Taken together, this work will free up around £37,000 a practice.

Today’s primary care recovery plan funds and empowers our GPs and pharmacists to do more, so that we can prevent ill health, keep cutting NHS waiting lists and improve that vital front door to the NHS for many millions of people. I commend this statement to the House.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I call the shadow Secretary of State for Health and Social Care.

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[Steve Barclay]

The hon. Member started with the message to the public, and the message to the public can be seen by what key figures in the sector say about this recovery plan. Let me just share that with the House. The Pharmaceutical Services Negotiating Committee says that the plan is

“the most significant investment in community pharmacy in well over a decade”.

The Boots chief executive says that this is

“great news that they’ll be able use their clinical expertise more widely”.

The Company Chemists Association says that it is a

“real vote of confidence for the future profession”.

The message to the public from the industries in this sector is clear that this is a well thought through plan which will have a beneficial impact for patients. I will give one final quote: the chair of the Royal Pharmaceutical Society says that this plan will be

“a real game-changer for patients”,

and that is what our focus has been.

The hon. Member raised the issue of our delivery against the 18 months target. It is very generous of him to give me the opportunity to share once again with the House the contrast with Wales, but perhaps he missed it first time around. We have reduced the wait for 18 months by over 90%, yet Wales still has vastly more—over 80,000 waiting there—and that is from a much smaller population. Wales still has over 40,000 waiting more than two years, a target that we virtually eliminated as long ago as last summer. Those who want to see what a Labour Government would mean for the NHS can see it with the performance against the two-year waiting list and the 18-month waiting list in Wales, so it is very generous of him to give me the opportunity to share that once again with the House.

The hon. Member talks about what the recovery plan is for. Clearly, the pandemic has placed huge pressure on primary care, and we can see that just from the increased volumes of appointments that primary care faces. Again, I touched in my opening remarks on the fact that GPs and primary care are seeing more than 10% more appointments than before the pandemic—1 million appointments a day. It is clear why we need to invest in new forms of working, online booking technology and cutting bureaucracy: it is so that GPs can focus on the aspects of their role that apply purely to GPs and we can better use the 25,000 additional roles that are being recruited into primary care.

The hon. Gentleman talked about his direct referral policy. We actually announced our policy guidance in December, a month before his announcement, so it is something of a stretch to say that we are following his approach. He again kindly raised the issue of mental health, which gives me the opportunity to remind the House of the increased funding that this Government are making in mental health. That was a key priority when my right hon. Friend the Member for Maidenhead (Mrs May) was Prime Minister and a cornerstone of the long-term plan, with an extra £2.3 billion going into mental health. But we did not stop there. At the Budget, the Chancellor further prioritised mental health—for example, mental health digital apps were a cornerstone of the measures for economically inactive people. We are recruiting an additional 25,000 roles into primary care in recognition that specialists are needed, whether physios, pharmacists, paramedics or specialists in mental health support.

The hon. Gentleman spoke about other aspects of primary care such as dentistry. We have said frequently that we have a recovery plan for dentistry that we will announce shortly, so that should not be news. On funding, it is slightly bizarre that, although this plan announces more than £1 billion of new funding for primary care, investment in tech, new ways of working, additional staff and empowering our pharmacists, who bring great clinical expertise that we can better harness, the hon. Gentleman, rather than welcoming that, went back to the hackneyed non-dom funding. We have heard that so much before and it has been spent so many times. We have set out ways of best using the skills of our GPs and of the additional roles, where we are delivering on our manifesto with an extra 25,000 already recruited. Above all, we have set out ways of best using our pharmacists, who are a huge resource that we can better use. That is why we are targeting more than £600 million additional funding into pharmacists, which will allow people to better access the care they need in a timely fashion.

[Madam Deputy Speaker (Dame Rosie Winterton)]

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

[Steve Brine (Winchester) (Con)]

I welcome the plan, which I note the Government have released at the first possible moment after the local election purdah period. Members of the Health and Social Care Committee and I will study it carefully, and I know the primary care Minister has already agreed to come before us so that we can give it a good going over. My question is about timing. How quickly can investment in the 8 am scramble part of the policy make a difference to those practices that do not have it? The Secretary of State said that they were already negotiating with the Pharmaceutical Services Negotiating Committee, so how quickly can that very welcome new investment get to the frontline of community pharmacy?

Junior Doctors’ Strikes

Baroness Winterton of Doncaster Excerpts

Thursday 30th March 2023 Commons Chamber

[Steve Barclay]

The urgent question was on the junior doctors—[Interruption.] I am sure I will quote—[Interruption.] There is a rare point of agreement between us. The hon. Gentleman is chuntering, but let me go through the list of things that he did raise pertaining to the junior doctors’ dispute. He said that the Government should get the junior doctors committee in for talks; we have done so—his third question made reference to the fact that we have. We have had the junior doctors in for discussions—[Interruptions.] I will run through the questions.

The hon. Gentleman questions whether there are preconditions attached to those discussions. I have checked the minutes of the meeting and there was a list of conditions —a pay restoration of 35%, and a range of other factors that were put on the table— that were preconditions that the Government had to commit to. The point is that he has said in the media that he does not support those preconditions. He says that 35% is unaffordable, so what is his position? One minute he says that he supports the junior doctors and that they should not go on strike, yet the next minute he says that he does not actually support the precondition that the junior doctors have said is the requirement for them to enter into discussion.

The reality is that the Government have taken a constructive and meaningful approach to trade union negotiations. That is why we have reached agreement with the “Agenda for Change” trade unions. It is why the Royal College of Nursing, Unison, the GMB and the Royal College of Midwives are all recommending the agreement that has been reached, covering more than 1 million staff across the NHS, to their members. The junior doctors have set a precondition on those talks which the hon. Gentleman does not agree—[Interruption.] That is a precondition. He does not seem to understand the terms the junior doctors—[Interruption.] He asked the question, he is getting the answer and the fact that it points to the contradiction in his own position is one that he seems to be having trouble with. Conservative Members are used to contradictions from those on the Opposition Front Bench. He supports the use of the independent sector, whereas his deputy does not. He wants to nationalise the GP estate, but his shadow Chancellor does not. The Opposition are full of contradictions. The reality is that there is a position in terms of the—[Interruption.] The right hon. Member for Islington South and Finsbury (Emily Thornberry) chunters again. There is a position in terms of precondition. The shadow Secretary of State asked me to confirm at the Dispatch Box whether it was a precondition of the junior doctors. Ahead of the urgent question, I checked the minutes—[Interruption.]

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. We cannot have this constant chuntering.

[Steve Barclay]

The Opposition do not seem to like their question being answered. The shadow Secretary of State asked me to confirm the position, for the avoidance of doubt, at the Dispatch Box. That is exactly what I am doing. I have checked the minutes. I have spoken this morning with officials to confirm, before I made the statement to the House, that it was a precondition of the talks. We were told, in terms of the pay erosion of 26.1%, that that needed to be restored at 35%, alongside other things. The reality is that he does not support that. He is facing both ways, wanting to support the junior doctors, but not actually willing to support the pay that they are demanding.

Future of the NHS

Baroness Winterton of Doncaster Excerpts

Thursday 23rd February 2023 Commons Chamber

[Margaret Greenwood]

The right hon. Member is being generous. I completely disagree with him about charging people for missing appointments. I remind him that 7 million adults in this country are functionally illiterate and huge numbers of people have dementia, so if a letter comes through the door, they may not understand it. Does he not agree that it would be much better to put resources into understanding why people do not come to appointments?

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. The right hon. Gentleman has been generous in taking interventions, but I am conscious that there are quite a lot of speakers, and if everybody takes nearly half an hour, we will not get everybody in.

[Matt Hancock]

I apologise; I have tried to be generous in taking interventions. It has been a positive and good-natured debate, which is valuable. I entirely recognise the point made by the hon. Member for Wirral West (Margaret Greenwood), and it has to be done sensitively, but the point made by my hon. Friend the Member for The Cotswolds (Sir Geoffrey Clifton-Brown) about the sheer quantity of missed appointments is a problem that must be resolved.

My final point is that too often, the NHS is a national hospital service that fixes people after they get ill—that happens in this country far more than elsewhere. The effective prevention of ill health is central to ensure that the NHS can continue to thrive in decades to come. The gap across the country is huge and it needs to be addressed. For example, the gap between the life expectancy of 74 years for a man in Blackpool and 81 years for a man in Buckinghamshire is far too high. About half that gap, however, can be put down to the difference in smoking rates—it is not about the NHS service in Blackpool at all, which is excellent.

We have to support people to prevent ill health in the first place; hitherto, the NHS has not put nearly enough effort and attention into that. I hope that the Minister will confirm the importance of prevention. I know that the Select Committee is about to launch an inquiry into prevention policy. I was delighted to set up the National Academy for Social Prescribing when I was the Secretary of State to try to drive the agenda further, but there is clearly much more to do.

The NHS is our national treasure. For those of us who care deeply about a service that is free when people need it, where the nation collectively comes together to look after those who are ill, it has deep moral force and is efficient and effective. If people care about its future, however, we need to reform it and ensure that we bring it into the modern age—only then can that promise to the nation continue to be fulfilled for the rest of our lives.

--- Later in debate ---

[Rob Roberts]

It has—although if Opposition Members want to argue with the King’s Fund, that is fine. But if NHS funding was okay under Labour and has increased in real terms since then, how is it not okay now? I agree that it is not okay now, but that is because of all the reasons I have already mentioned: we are keeping people alive longer, and sicker, there are more of them, and it is more expensive to diagnose and treat them. They are not political issues.

To draw my remarks to a conclusion, I am not familiar with the machinations of how to go about these things, but it seems perfectly reasonable to have, finally, some kind of royal commission—some kind of massive public engagement exercise—on the future of health services in the United Kingdom. We must tackle it head-on. We must not be afraid to go wherever that debate takes us in search of better outcomes for people. I just wish we would keep in mind that we are here for people. We are here to serve them and give them the best outcomes we possibly can, not to get caught up in form and process, or dogma and ideology. We are trying to make people better. We have to do whatever we can to get to the root causes of the issue, because as my former NHS and now private sector nurse partner tells me all the time—I quote—“You could fix so much if you’d just stop politics getting in the bloody way.”

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. I call Paulette Hamilton.

--- Later in debate ---

[Rob Roberts]

On a point of order, Madam Deputy Speaker. I apologise to the House for interrupting the debate. At the end of my speech, I may have used a little bit of intemperate language, which was not necessarily in best keeping with the traditions of the House. I apologise to you, Madam Deputy Speaker, and to the House.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I thank the hon. Gentleman for his apology. As he said, it is important that we use moderation in our language.

Draft Mental Health Bill 2022

Baroness Winterton of Doncaster Excerpts

Thursday 26th January 2023 Commons Chamber

[Dr Poulter]

I thank the hon. Member for his question. As part of our work, we looked at elements of reform that are being considered across the devolved Administrations. The fusion of mental health law and mental capacity law is already well under way in Northern Ireland, so it may be a question of the UK Parliament learning from the Northern Ireland Assembly, rather than the other way round. We in this place will continue to watch with interest how the proposed changes to legislation in Northern Ireland progress, as they may improve what we do when we look in the future, I hope, at a fusion of mental health law and mental capacity law.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I thank the hon. Member for his statement and all colleagues who participated.

NHS: Long-term Strategy

Baroness Winterton of Doncaster Excerpts

Wednesday 11th January 2023 Commons Chamber

[Madam Deputy Speaker (Dame Rosie Winterton)]

I inform the House that amendment (a), tabled in the name of the Prime Minister, has been selected.

NHS Dentistry: Salford and Eccles

Baroness Winterton of Doncaster Excerpts

Monday 19th December 2022 Commons Chamber

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

rose—

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. I gently say to the hon. Gentleman that if he wanted to intervene, he ought to have been here right at the beginning, because it is the hon. Lady’s Adjournment debate, and it is about Salford and Eccles? I leave it to him to decide whether he wishes to intervene.

[Neil O’Brien]

I am happy to take whatever interventions are appropriate.

We know that there are still further improvements to be made. Although I am pleased that over 75% of the patients who tried to get a dental appointment over the last two years were successful, this is not back to the level that we were seeing pre-pandemic, which was 92%. That is why in July and in our plan for patients, which the hon. Lady mentioned, we announced some improvements to the 2006 contract to ensure that patient access was improved, although I want to reassure her that we do not regard those as the end of the story; they were a stepping stone.

Those changes included: making sure that dentists were remunerated more fairly for complex work, which will improve access for patients; implementing a minimum value of £23 for each unit of dental activity, boosting incomes in the places where the UDA value is lowest; and enabling dental practices to deliver up to 110% of their contract levels, to increase activity and allow those practices that are delivering NHS care most effectively to deliver more. This effectively takes away the cap that has been in place since the 2006 contract, which the hon. Lady mentioned.

This package will increase and improve access to dental care for patients across the country. We have already taken action to implement these changes, including through regulations that came into effect on 25 November. The changes have all been decided with careful consideration, working collaboratively with the dental sector. The Department has worked with the General Dental Council on legislative proposals that will make registration processes for dental professionals qualified outside the UK more proportionate and streamlined, making the process to join the UK workforce more efficient for dentists from overseas. These changes are another way in which we are seeking to improve access for patients.

Finally, to make it easier for patients to find dentists taking on new patients, we have made it a requirement for NHS dentists to update their information on the NHS website, which has historically been out of date, but of course we are looking to go further to ensure that those appointments are there. These changes are just the beginning. They are the necessary first steps of our work to improve NHS dentistry. These are the measures that we can take immediately, and they will have a noticeable impact, but we will go further.

Looking forward into the new year, we have been working with NHS England and the sector on further changes to improve access. Our priorities for this next phase of reform include: improved access to urgent care for patients who need to see someone immediately; better access to care for new patients; and further workforce and payment reform. We aim to take the necessary steps to implement these changes next year, but I am keen to seek every opportunity to take action wherever I can, and ahead of those reforms we are also actively considering what support we can offer to help patients who do not currently have access to the dental system and those who are not attached to a practice, who have the worst access. We are also considering how the recruitment and retention of dentists can be improved, particularly in the parts of the country where the need is greater. We are also thinking further about how overseas qualified dentists can be supported to start working in the NHS more quickly.

I am strongly committed to improving our NHS dental system wherever I can for all those who need it. The hon. Lady has set out a powerful case today on why we need to go further, and we will go further. I thank her for raising this important debate, and I hope that she will be reassured that although the reforms we have made so far will make a difference, they are far from being the end of the story, and that we will continue to take action to improve access to NHS dentistry across the nation.

Question put and agreed to.

Cancer Services

Baroness Winterton of Doncaster Excerpts

Thursday 8th December 2022 Commons Chamber

[Several hon. Members rose—]

[Madam Deputy Speaker (Dame Rosie Winterton)]

We have a further debate this afternoon. In order to ensure equality of Back-Bench contributions across the afternoon, I advise colleagues to speak for no more than about 10 minutes, which will enable remaining Back Benchers to get in later.

--- Later in debate ---

[Several hon. Members rose—]

[Madam Deputy Speaker (Dame Rosie Winterton)]

I call shadow Minister Liz Kendall.