Oral Answers to Questions

Alex Norris Excerpts

Tuesday 13th July 2021 Commons Chamber

[Jo Churchill]

I go back to the answer I gave: we do not allow data to be used for commercial purposes. NHS Digital will not approve requests for data where the purpose is for marketing and so on and so forth. The hon. Member would not expect me to respond on behalf of another Department, but I reiterate that we are communicating and building trust. There will be a public information campaign. We will be working across the professions and across research to make sure that access is appropriate and proportionate. In the Health and Care Bill, we will be redoubling our efforts to make sure people have that confidence.

[Alex Norris (Nottingham North) (Lab/Co-op)]

At the previous health questions, we secured a commitment from the Minister to delay the implementation date for this data grab in order to properly communicate with the public. However, rather than a significant delay so there could be the public information campaign the Minister says she is so keen to have, on the basis set out by the BMA and the Royal College of GPs, what we have instead is a short pause. The Minister says she wants to listen and to build trust, so why on earth is this being snuck out during the summer recess? The reality is that the Government simply have not passed the test for informed consent. Will the Minister take this moment today to stop this process and commit to a proper engagement campaign, rather than running off during recess?

[Jo Churchill]

I really respect the hon. Gentleman, but nothing is being snuck out. We are not doing a data grab. I refer him to the answer I gave a few moments ago. It is important that we get this right. We have heard the concerns and will respond to them. We will take the appropriate amount of time—even if that means going beyond 1 September—to ensure that we have engaged properly.

Independent Medicines and Medical Devices Safety Review

Alex Norris Excerpts

Thursday 8th July 2021 Commons Chamber

[Alex Norris (Nottingham North) (Lab/Co-op)]

It is a pleasure to speak for the Opposition in this important debate and I commend the Backbench Business Committee for choosing it. It has been an excellent debate and that started with those who secured the debate. I congratulate my hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy) and the right hon. Member for Elmet and Rothwell (Alec Shelbrooke) on securing the debate and on their leadership of the all-party parliamentary group on surgical mesh. There were common themes: the hope we all felt when we read the Cumberlege review a year ago and how keen we all are to make further progress. The right hon. Member for Elmet and Rothwell said he wanted to reinvigorate the debate. I think that that has happened today—very much so.

I also recognise the contributions of the right hon. Members for Maidenhead (Mrs May) and for South West Surrey (Jeremy Hunt) because we probably would not be here without their personal leadership. I do not think it is a secret that we on the Labour Benches sometimes disagree with them on matters of health policy, but not in this regard and particularly not with their iron clad commitment to patient safety.

I want to pay a special tribute to my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson), my predecessor as shadow public health Minister. It tells us everything we need to know about her that she might have gone on to other roles on the Opposition Front Bench, but she is still at it on these issues. It is never just a job for her, but a campaign and a drive to do it. We are very lucky to have her. She helmed an all-star cast of Labour Members who have been working very hard on this issue: my hon. Friends the Members for Blaydon (Liz Twist) and for Lancaster and Fleetwood (Cat Smith) on sodium valproate; and my hon. Friend the Member for Bolton South East (Yasmin Qureshi) with her leadership and passion around Primodos. I thought their contributions were very good indeed.

Today is the first anniversary of the publication of the Cumberlege review. It was a seismic report, one that vindicated campaigners who in many cases had fought for decades. It showed how they had been denied, derided and ignored. Crucially, it gave us nine concrete ways forward—nine ways to start to meet the obligation we have to these women and the families affected. I wish we had heard in the oral statement the following day last year an acceptance from the Government of all the recommendations and I wish we were speaking about the progress we had made in implementing all nine. I am sad that we are not. However, I will start by recognising the progress that has been made.

The apology was very widely welcomed. The patient safety commissioner will have a really big impact in this area—we just need to get on with appointing them. I am very proud of the work the hon. Member for Central Ayrshire (Dr Whitford) and I did with the Under-Secretary of State for Health and Social Care, the hon. Member for Bury St Edmunds (Jo Churchill) on the identifiable database for medical devices. That will prove really valuable in time. Similarly, the network of specialist centres will be of great value to those who use them when they are fully operational.

However, it is still impossible to avoid the feeling that the Government are stopping short, particularly on the areas of redress and independent oversight. On recommendation 3, rejecting a redress agency—something that is used in other countries—is short sighted. A redress agency would have consolidated the various schemes and methods available to families in one place and given them a model that suits them, rather than one that seems to suit the Government and companies more. I hope the Minister, having heard what she has heard today, will look again at that.

Similarly, recommendation 4, on redress schemes for each of the interventions, is of course a good idea and would make the process simple and transparent. Families are struggling and need help now. Six months ago, the Government said they were thinking about that. Well, a year is more than enough time, and I hope to hear news from the Minister on that.

Similarly, on recommendation 8, a year is more than enough time to have scoped out a workable model on a doctors’ register of interests. Colleagues made points about that very well. On recommendation 9, the Government were wrong to reject an independent taskforce, which would have given impetus and drive. Perhaps that is why we have not made the progress that we want. Again, the Minister could still revisit that.

I want to highlight some of the points that campaigners raised with me in my preparation for this debate. As we have heard, it is striking that across the UK, approximately 25,000 women are still using sodium valproate. There is good reason for that in very many cases, but taking the report on board, that means 400 exposed babies every year, 200 of whom will suffer harm. That is an awful lot. The volumes of research on the topic of valproate date back to the ’70s and the causal link is well proven, so it is surprising that better information has not been made available to patients. It was right that, last month, NHS England wrote to all women of childbearing age it believes to be on valproate. It is clear that that should have happened sooner. Goodness knows that campaigners such as INFACT have been saying that for long enough. I would like to hear from the Minister today a commitment that that was not a one-off and that it will be a regular, perhaps annual, communication, because it is crucial that we communicate with those mothers and potential mothers.

Communication across Government and the health service is crucial too. I am aware that there are eight groups dealing with this issue across Government and the Department. It is right that that important work is going on, but how is it being pulled together? Who is leading on it? How do we measure the impact? How do we know it works?

The Government continue to refuse to accept responsibility for HPT/Primodos families without a proven causal association, and continue to rely on the 2017 working group review, which said that there was no conclusive association, despite later admissions to the review team that they did find a possible association. Baroness Cumberlege stated that Primodos should have been withdrawn from use in 1967 after the first substantial report from Dr Gal was published. The response from the Government was that the IMMDS review did not revisit the existing science. However, although the team did not review the existing science, it reviewed all the existing documents, including the scientific evidence available at the time, which formed a solid base for its conclusions.

That is what I mean when I say that it feels like the Government are stopping just short of what needs to be done. Where is the proper justice for these families? Ten members of the campaign group have died since the report was published, still without their justice. That is why a proper redress scheme is crucial. I hope the Minister addresses that point.

On surgical mesh, the point has been made a couple of times, but it bears repeating, that the use of such an intervention for stress urinary incontinence was paused for good reason. The conditions for resuming use have clearly not been met at this time, but I know there is pressure to do so. I hope the Minister will confirm that that will not happen unless and until those conditions are fully met.

When we discussed this issue a year ago, there was righteous anger and a sense of purpose to put these injustices right. A year later, colleagues’ frustration that we have not made greater progress is tangible. We are in danger of letting down those affected all over again. Hearing the campaigners talk about resuming campaigning is saddening. They should not have to; they did everything they needed to do. For Marie, Janet, Emma, Kath, all those who campaigned across the country over the years, including those we have now lost, and all those affected, we know what needs to be done; we now need to get on with doing it in full.

Covid: Vitamin D

Alex Norris Excerpts

Thursday 17th June 2021 Westminster Hall

[Alex Norris (Nottingham North) (Lab/Co-op)]

It is a pleasure to serve under your chairship, Mrs Murray, for the second time today. Aren’t you lucky to hear from me twice! I congratulate the hon. Member for Strangford (Jim Shannon) on securing this debate, and on the characteristically thoughtful argument that he set out. As he said, he and I do a lot of debates together, and as so often, I found myself agreeing with lots of what he said. However, the congratulations were not universal in my household as it is my wedding anniversary, and Emma was hoping I would be home sooner. So I congratulate him, but she reserves her congratulations, I am afraid.

I also want to congratulate the hon. Gentleman on his chairship of the all-party group for respiratory health. It is a really important issue, certainly for communities like mine, and for communities up and down the country it is right that we champion that in Parliament as best we can. He raised two points that stuck with me. The first was on pandemic preparation. As he said, we cannot predict the future—we wish that we could; it would be a lot easier—but the one thing we do know is that the best preparation for anything, certainly when it comes to significant global events that affect us so enormously, is good health, and vitamin D is an important part of that. Secondly, he spoke about therapeutics—when people end up in hospital, how can we best improve their outcomes? I will explore some of those points briefly myself.

It is a crucial task to evaluate all aspects of this awful pandemic to see what we can do best to tackle it. Some 128,000 of our countrymen and women have lost their lives, resulting in an awful lot of broken hearts, and we would do anything to stop there being any more. That is why debates such as this are so important. We should be cheered that the vaccination roll-out continues to be successful—80% of adults have had their first dose—but no vaccine ever provides 100% protection, so any other possible methods to protect or treat covid-19 should be considered.

It is striking that yesterday, exactly a year since low-dose steroid treatment was found to successfully combat the virus in some cases, another life-saving treatment was discovered, in the form of artificial antibodies—a treatment expected to save six lives for every 100 patients treated. The prospect of vitamin D as a preventive measure and a treatment should be duly considered, particularly as it is cheap and widely available.

The hon. Member for Strangford touched on the evidence base in his contribution. Last December, the National Institute for Health and Care Excellence issued guidelines that said

“there was little evidence for using vitamin D supplements to prevent or treat COVID-19.”

In terms of prevention, NICE found that

“low vitamin D status was associated with more severe outcomes from COVID-19.”

For instance, in an audit of covid-19 patients in hospital in Newcastle, only one in five intensive care unit patients had vitamin D levels that would be considered adequate for overall health, contrasted with two in five non-ITU patients.

However, there is much still to understand about whether that is a genuinely causal relationship or a correlating one. In its assessment, the British Medical Journal said it may at least be partially due to correlations between vitamin D levels and other risk factors, such as age, genetics and obesity. Clearly, the evidence base is still developing. I would be interested to hear from the Minister about the latest information that she knows and how we might develop that evidence base going forward. For example, the Barcelona study that was mentioned was new to me, so I will certainly look that up.

The hon. Member for Glasgow East (David Linden) made strong points about the fact that, outside covid-19, vitamin D levels are an important area for us to focus on in this country. Vitamin D is important to keep bones, teeth and muscles healthy. We know that in this country the right levels of vitamin D are not being routinely met; I wonder if I might fall into that category. Some studies suggest that one in five Brits have vitamin D levels lower than in concentrations necessary for general health, but due to our climate—we all know this; we have enjoyed our one week of summer and it seems like it might be coming to an end—that rises to two in five in winter. In fact, we are one of the most vitamin D deficient countries in Europe. We should recognise that when considering general good health.

As colleagues have said, the deficiency is notably unequal and staggeringly high among certain communities. For instance, in the UK over 50% of those from an Asian background are severely vitamin D deficient, leaving them particularly vulnerable to musculoskeletal disorders. Since 2016, Public Health England has recommended that everyone over five takes a 10 mcg vitamin supplement in the winter months, but that does not seem to be gripping quite yet, either in its practice or its adherence, as the rise in Victorian diseases such as rickets confirms.

We should come together across the UK to do much more to boost vitamin D levels. I would be interested to hear the Government’s latest thinking on the idea of vitamin D fortification in the UK, a solution that would provide a boost to public health.

To conclude, much more research needs to be done on assessing the value of vitamin D as a defence against covid-19. We need every tool we can get, so that is the right thing to do. However, we know that the value of vitamin D more widely is significant and there is more we can do to ensure that that is a feature of our population’s health. That is something we could all come together to do.

Draft Calorie Labelling (Out of Home Sector) (England) Regulations 2021

Alex Norris Excerpts

Thursday 17th June 2021 General Committees

[Alex Norris (Nottingham North) (Lab/Co-op)]

It is a pleasure to serve under your chairship, Mrs Murray, as we debate these very important draft regulations. The importance of tackling obesity and how it really ought to be a national priority was well rehearsed in a recent debate on the Government’s obesity strategy. Two thirds of us adults are overweight. The figure that the Minister just used—three in five children leaving primary school overweight—should be a sobering warning about the future of health in this country, and a call to action.

We know that excess weight has a profound impact on life outcomes; it creates a much-elevated risk of heart disease, diabetes and cancer, and potentially limits opportunities at work and at home. It is an unequally distributed problem, with hospital admissions due to obesity nearly three times greater in the poorest communities than in the best-off. Again, all that is a significant call to action. It is also a worsening problem, and one to which our response has weakened over the past decade.

The most effective interventions are community-based—ones that intervene early and promote a life of healthy cooking and eating. The evidence for such projects is really strong, but the cuts to public health over the past decade have put local authorities in an impossible position of trying to deliver those services. I remember having responsibility for the public health grant in Nottingham for the three years before coming to this place. Once demand-driven services such as sexual health services and services to tackle drugs and alcohol addiction have been funded, there really is not very much left for anything else. Full proposals to tackle obesity really ought to include the reinstatement of the monies lost.

The instrument forms part of the Government’s obesity strategy, which we broadly support. We want to see strong national leadership and action. I have raised concerns that the Government’s approach has been too consultation-heavy, so I am glad to see something concrete today and hope that this statutory instruments is the first of a series.

As we have heard, the purpose is to require large businesses—those with 250 or more employees—to display the calorie information of food and drink items that they sell to eat and drink. That information must be available at the point of choice for the customer, such as on menus, menu boards, online menus and food labels. In paragraph 63 of their impact assessment, the Government estimate that that happens already in about 59% of such venues, so this is a top-up measure. The aim is to ensure that there is clear and consistent information at the point of choice, so that we can all make healthier choices for ourselves and our families.

I think that the real value from the measure in the medium and long terms will be derived from transparency about the calorie content of meals, and the impact that will have in the reformulation of products and portion sizes. It is embarrassing for a big firm that has corporate social responsibility statements, and presumably seeks to have good public relations, to have a 3,000 calorie meal on its menu. I think that the measure will have a significant downward impact on that too.

To press the Minister on a number of concerns, in addition to displaying the calorie information of each item businesses are required to display the statement that

“adults need around 2000 kcal a day”

where it can be seen by customers when making their food choices. According to the NHS website, the recommended daily calorie intake is 2,000 calories a day for women and 2,500 calories for men. Although I appreciate the value of putting the calories for each item into a broader context, individuals’ total daily energy expenditures vary significantly and are based on a huge number of factors, some of which we have control over but some of which we do not. Of course, although this information is targeted at those consuming more energy than they burn, it will be visible to all. There is no mention of that in the impact assessment, so I hope the Minister can explain the divergence from NHS guidance in this case, and what consideration has been given to the impact of the recommendation, especially on those whose total daily energy expenditure is significantly less than 2,000 calories.

More broadly, calories are a very crude measure of what we put into our bodies. It is crucial that we understand better how much sugar and salt we consume. I know that there is an implied understanding that when we eat out, we generally eat less healthily than we do at home, but the playing field is very uneven between the retail sector and the out of home sector. Today’s measure will start to close the gap a little, but I am keen to understand what consideration the Minister gave to a model much closer to what we see on packets in supermarkets. That does not seem to have been considered in the options appraised in the impact assessment.

I do not intend to divide the Committee, because this is a yes or no proposition and we support the principle. More information is a good thing; more action on obesity is a good thing. I expect that we will be back in Committee in due course to extend this more widely, perhaps to medium-sized businesses, and I hope to hear a commitment today that before doing so the Government will seek to grow the evidence base. The evidence available is supportive, but far from perfect. The 2018 Cochrane review combined studies to show a potential reduction of about 8% to 12% per meal. That is a significant prize, but it is very much developing evidence. Will the Minister talk a little more about whether expansion is being considered and on what sort of timeline, and give an assurance that the research base will be grown before action is taken?

As we heard, the Government’s impact assessment gives a best estimate of net benefits amounting to over £5.5 billion over the next 25 years. The impact assessment makes it clear that most of the benefits come from a change in personal decision making, but my understanding is that the evidence base on reformulation is stronger. It is particularly important that an evidence base around personal choices is acquired, so that we can have fuller conversations based on all the evidence.

The Minister touched on those living with eating disorders. We all want to have a population approach to making society healthier, but none of us wants unintended consequences to make life much worse for an, admittedly smaller, group of people on whose lives the issue has a profound impact. It is striking that just four of the 230 paragraphs in the impact assessment relate to this issue. I have heard multiple Ministers say that they have listened to concerns about the impact that the measure will have, and the movement on schools is welcome, but I still do not think that enough has been done to mitigate the impact.

The Minister mentioned the option for a venue to offer a calorie-less menu option on demand. Why is that not being mandated? It would be relatively easy to do, and would mean that those for whom calorie counting is terribly triggering would have an alternative, albeit an imperfect one. There is still time between the decision that we make today and the implementation next April for the Government to continue to engage with those who have legitimate concerns about the draft regulations, to seek to address some of those points. Will the Minister make that commitment?

Similarly, we know that covid has turbocharged the growth of eating disorders in the UK, and the provision of services in the country is not good enough. We are failing people, especially children and adolescents. We must do much better there, so I hope again to hear a commitment that there is a plan for a national strategy and proper investment to catch up and to deal with the impacts of covid and the growth in such disorders that we are seeing more generally.

We want people to have the fullest information about what they put into their body. We wants to see bold action to tackle obesity in our population. What is on offer today is a step forward. On that basis, we will not oppose it, but we want to see a more thoughtful method of introduction and a more creative way of ensuring that it has the maximum positive impact. I hope that the Minister can address those points.

Tobacco Control Plan

Alex Norris Excerpts

Thursday 10th June 2021 Westminster Hall

[Alex Norris (Nottingham North) (Lab/Co-op)]

It is a pleasure to serve under you in the Chair, Mrs Miller. I say a big thank you to my hon. Friend the Member for City of Durham (Mary Kelly Foy) and the hon. Member for Harrow East (Bob Blackman) for their doughty leadership on this issue, for their work in the APPG on smoking and health and for securing this debate, which has been a particularly good one. The points that my hon. Friend made about regional disadvantage and the way in which that links to every indicator of social deprivation and then to smoking were really good ones. It was very interesting and pleasing to hear about the work that has been done in the north-east about closing the gap. That, to me, served as an endorsement of regional approaches and, beyond that, sub-regional approaches, which I think we have lost in recent years and which I hope, through this plan, we can rebuild.

On the regional theme, my hon Friend was joined by a fine array of north-east MPs, who surround me here— I did feel rather out of place. My hon. Friend the Member for North Tyneside (Mary Glindon) made a really strong and compelling case for alternatives such as e-cigarettes and vaping. The thing I took away from that was how unequivocal it was. There is a real danger of being squeamish and equivocal about these new models, and I do not think that serves anyone. That is a theme that I will come to shortly.

That theme was shared by the right hon. Member for Clwyd West (Mr Jones). I agreed with the points he made about the new regulatory framework and the regulations. The review gives us a real chance to look at these things, so I hope we will hear some more from the Minister on that. Similarly, the hon. Member for Windsor (Adam Afriyie) talked about data and evidence. We have a common goal: we want fewer people to smoke and die. It behoves us, therefore, to follow the data and evidence about how to do that and not to be squeamish when they point one way.

My hon. Friend the Member for Blaydon (Liz Twist) made very poignant points about baby loss and smoking during pregnancy. She and other hon. Members will have heard some of the reasons why women smoke in pregnancy, which include perceptions about having a smaller baby and family traditions of doing so. The reasons are complicated and various, so we need ground-level, peer-led services to tackle that. Much of the content of the Leadsom review will help us in that space, so I hope to hear a commitment to that from the Minister.

My hon. Friend the Member for Jarrow (Kate Osborne) talked about regional inequalities and made a point about having services nearer to people. I will return to that shortly. My hon. Friend the Member for Ealing, Southall (Mr Sharma) also talked about inequalities—this time around ethnicity. We should not lose that in this debate. He also talked about localised approaches by service leaders who know their communities and have effective ways to reach different people. I think that is the whole battle here.

The hon. Member for Harrow East spoke with characteristic plainness, but we needed a bit of that. The 2030 target is a stretching one. At the current rate, we are seven years behind, but in the poorest communities it is 14. That means that we need big ideas. The document that he co-authored through the APPG has big ideas, and I will touch on a couple shortly.

I agree with the points that the hon. Member for North Antrim (Ian Paisley) made about organised crime. Again, that can form part of a tobacco control plan. I think there is complete political consensus about that. I do not agree that increasing the cost has not been an effective way of reducing smoking. Over two decades, it absolutely has. I also do not agree that tobacco control plans over the past couple of decades have not had an impact. Clearly, they have, and I will touch on that shortly.

For me, smoking is the ultimate equalities issue. It accounts for half the difference in premature death between the best and the worst off, so if levelling up is to be the theme of this Parliament, post covid, it seems that smoking is a very good place to start. I have similar statistics to those of my colleagues. In Nottingham, where I live, smoking rates are well above the national average: 20.9% of our community smokes, compared with an England average of 13.9%; and 16.5% of pregnant women are smokers when their baby is born, compared with 10% nationally. The cost to us is about £75 million every year through health and care needs, lost productivity and premature death, so tackling this is a really big prize for a community such as mine.

We should be confident that we are building on a platform of two decades of good progress on smoking cessation. Under Labour and Conservative Governments, we have implemented a comprehensive approach to tobacco control, including banning smoking in public places and cars, point-of-sale display bans and standardised packaging. All that has contributed to driving down smoking rates and discouraging young people from starting. We are here in a spirit of cross-party co-operation, and we are in lockstep in support of the goal of being smoke free by 2030.

I very much welcome the APPG’s report, which sets out the bold steps that we ought to take if we are to achieve this extremely challenging ambition. Among other things—this is always a very good place to start—it highlights the strong public support for that ambition: three quarters of the public are in favour, and that includes majority support for key recommendations from voters of all political parties. There is a clear mandate for action. I want to take the opportunity to thank Action on Smoking and Health, both for its work as the secretariat to the APPG and for the support it has given me in developing policy.

In this debate and the one we had a few months ago, colleagues have given the Minister plenty of content for the new control plan—in fact, probably a whole control plan and a bit more—but I want to offer a few points myself. First, the focus must now be on inequalities. Yes, this is a national goal and effort, but to make the most progress, we need locally led, community-sensitive smoking cessation services. The evidence for those is very strong indeed. It is a source of sadness that the Government have lopped away at the public health grant to the point that it has reduced by more than 40% since 2013, and those cuts have of course fallen disproportionately on poorer communities. If we are wondering why progress is stubborn in those areas, that is a significant reason, so I hope to hear a commitment from the Minister today to restore funds lost, with a particular focus on need. The report helpfully suggests an industry fund to cover the cost. Frankly, we should never have disinvested in the first place—cutting smoking cessation services is the falsest of false economies—but if the Government come up with an alternative along those lines, we will of course be supportive.

I want briefly to mention raising the age of sale to 21. We know that the best way to reduce smoking is never to start and we know that young people who start smoking generally tend to regret doing so. Seventy per cent. of adult smokers in England want to quit and an even bigger proportion—three quarters—regret ever having started, which makes an interesting point about raising the age of sale to 21. One of the things that surprised me in the report was the level of public support for that proposal—I did not think it would be as popular as it is—so the recommendation of at least a public consultation is a sound one. I would be interested to hear the Minister’s views on that, because it would be a very interesting public debate to have.

Turning to e-cigarettes, vaping and similar, this must be a feature of the tobacco control plan. I hope that the Minister and the Government more generally, via their role in the World Health Organisation, can push harder for stronger and clearer messages, based on the data and evidence, at the WHO level. I looked at the WHO website yesterday, and while I fancy myself as quite a smart guy—I might hide it well sometimes—I could not fathom what it was trying to tell me. It was incredible. That sort of equivocation makes it really hard for people thinking about alternatives to know whether they are supposed to go ahead or not.

I always rely on the Public Health England position in 2018 that these products represent a 95% reduction in harm, which seems a pretty good place to start. The APPG report says that in 2017 they helped 50,000 people to stop smoking and that concerns around children’s starting have not materialised. The 2017 tobacco control plan included a promise that:

“The Medicines and Healthcare products Regulatory Agency...will ensure that the route to medicinal regulation for e-cigarette products is fit for purpose so that a range of safe and effective products can potentially be made available for NHS prescription.”

This has not happened; it now must happen, and I hope it is a main feature of the new plan. The Government should also seek to regulate this market through the regulations review, to ensure that it promotes quality, safety and protection of young people.

Finally, the 2030 target is a vital and unifying goal, but we cannot wait until 31 December 2030 to look at the stats and see whether we have made it. We know it is a stretching target and we know we are currently not on course, hence the need for a new plan as soon as possible, but that plan has to have interim goals so that we know whether we are making enough progress. Again, the APPG report made some very good suggestions on that.

The report also makes strong recommendations on the data we do not currently have, which is a particular challenge in the case of people living with mental health conditions, who we know have disproportionately high rates of smoking. Data is collected in primary care on smoking status and mental health, but not routinely analysed. Smoking status data can also be collected through the mental health services dataset, but this is not done routinely. As a result, our data for folks with serious mental illness and others in secondary mental health services is not good. Reliable data is an important part of being sure that we are making the progress that we want to in this area, so I hope we will hear a commitment from the Minister on interim targets and better data.

To conclude, if we want a big public policy win—and goodness, this is about as big as they come—whether it is early intervention we are into or reducing inequalities, this is a major chance to make a step change. We need a plan, we need a good plan, and we very much look forward to playing our role in that process.

[Mrs Maria Miller (in the Chair)]

May I remind everyone that only Members physically present can intervene on the Minister?

Oral Answers to Questions

Alex Norris Excerpts

Tuesday 8th June 2021 Commons Chamber

[Jo Churchill]

I pay tribute to all the cancer charities out there who have done sterling work during the pandemic. As I have said, GP services are open, and they are offering different forms of communication with patients. We are running the Help Us, Help You campaign so that people can come forward when they have symptoms. As my hon. Friend says, identifying cancers early to save lives is part of the long-term plan, but I would like to assure him that my latest data showed that in March 2021 we had the highest ever recorded number of GP referrals for cancer. GPs are working really hard, and if patients are worried about any symptoms, they need to come forward.

[Alex Norris (Nottingham North) (Lab/Co-op)]

For GPs and for the NHS more broadly, using data effectively is an important way to restore our health services. However, the current plans to take this data from GPs, assemble it in one place and sell it to unknown commercial interests for purposes unknown has no legitimacy whatsoever. There has been no public engagement and no explanation; this has simply been snuck out under the cover of darkness—[Interruption.] I will get there, Minister; do not worry. This is an NHS data grab. The news of the delay is welcome and I am glad that the hon. Lady has made that commitment, but within that, will she commit to ensuring that the 23 June opt-out date is also moved to 1 September and that there will be a full public consultation on whether people want their data used for these purposes?

[Jo Churchill]

I refer the hon. Gentleman to the answer I gave earlier to my hon. Friend the Member for High Peak (Robert Largan). We will be considering everything in the round. As I have said, I have spoken to many of the stakeholders involved and as we move forward we will be ensuring that we take all trusted individuals with us to build confidence in the system.

Obesity Strategy 2020

Alex Norris Excerpts

Thursday 27th May 2021 Commons Chamber

[Alex Norris (Nottingham North) (Lab/Co-op)]

It is a pleasure to open this important debate on behalf of the Opposition.

Obesity is a significant public health challenge in this country. It is a growing problem that compounds down the years in missed potential and accelerated poor health. I am glad the obesity strategy recognises that, as well as being a matter for individuals in their personal choices, there is a significant impact from our environment. As such, we have a responsibility in this place to do what we can to help people to maintain a healthy weight.

Almost two thirds of adults are overweight or living with obesity—I am one of them—and we have heard that a staggering number of our children leave primary school overweight. This is an unequally distributed problem, with hospital admissions due to obesity nearly three times greater in poorer communities than they are in the best-off communities. At a population level, it is clear that excess weight brings with it increased risk of diseases such as diabetes, cancer, heart disease, liver disease and, of course, associated mental health conditions. In 2019-20—this is such as staggering figure—there were over 1 million hospital admissions for which obesity was either the primary or secondary cause. That was up 17% on the year before, and represents a 600% increase on the previous decade. That is an extraordinary changing picture and one that should kick us all into action. We have also seen in the last year that living with excess weight makes us more vulnerable when fighting the effects of covid. As the Minister says, it is one of the risk factors we can actually make a direct and swift impact on. It is clear that we need to act.

I have said before when we have debated this topic that where the Government bring forward sensible proposals, we shall work with them to implement them in the national interest. Happily, the 2020 strategy contains many such proposals that we are very keen indeed to see implemented. The 9 pm watershed on unhealthy food adverts is prudent. Efforts to curb the promotions and prominent placements of things that we know are bad for us is a good idea, too. Sometimes, even when we are trying to make healthy choices it feels like we cannot escape reminders of those other options. An expansion of NHS weight management services is well overdue, and I hope we will empower such services to use all effective treatments and resource them to be able to do so, too. Traffic lighting is a valued and effective tool in understanding what our food comprises of. We will support proposals that strengthen and develop that system, and I hope we hear a little bit more about that later. A national-level publicity campaign is valuable and we will support its introduction. There is so much to agree with and I have consistently said so to the Minister. Indeed, the only addition I will contribute here is that we need to get on with it and that we do not have time to waste. There are elements, however, that I want to probe and seek reassurance on from the Minister.

On the total online advertising ban, I do not think it is a secret that the Government do not do online policy very well. I think the ever-running saga of the online harms Bill shows that. Online advertising is complex and sophisticated and is changing all the time. I am conscious of concerted efforts by those in the advertising industry to seek to offer the Government a way of delivering on this goal that reflects their expertise in this area. I hope to get an assurance from the Minister that officials are at least talking to them about that and taking it seriously.

On the restrictions on retailers, I hope that we will get a proper chance to understand and debate the qualifiers on square footage and staffing levels. I do not think we would want to be in a situation where this ends up affecting relatively few organisations, creating an unlevel playing field or promoting perverse outcomes, such as having fewer staff. I would be interested to hear from the Minister in that regard.

Crucially, we heard from the hon. Member for Bath (Wera Hobhouse) about calories on menus. I know that that has public support, and support from many campaigners, but if we effect that, it really must be done correctly and properly. I strongly do not believe that before they sought to publicise that and press on the Government have given enough consideration to those with eating disorders who will be negatively impacted.

[Richard Fuller]

I am grateful to the hon. Gentleman for cantering through his support for the Government. I just want to take him up on his first principles and the rationale, from his philosophical point of view, for why he believes the Government have a right and a responsibility to manage what people eat and how they look. Does he put obesity on the same level as the tobacco industry of the past? Obviously, health measures were taken because of the harmful effect that tobacco could have on people. If he does not put it on that level, what level does he put it on? Does he put it on the same level as alcohol, which causes a lot of poor health? If not, does he believe that we ought to be doing more on alcohol?

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[Alex Norris]

I thank the hon. Gentleman for that contribution. Philosophically, I believe that the state has a responsibility to act when we acknowledge evidence that we have an environment that promotes poor health in this way, so that it goes beyond our personal choices and the way in which we want to lead our lives to things that swamp us. I reject his characterisation of a hierarchy. I would consider the impact that it has on the public and, indeed, the pressures it creates. As for alcohol, I would absolutely support stronger alcohol strategy proposals from the Government, as I would an updated and refreshed version of the tobacco control plan, which we have been waiting on for many months. Again, I would not establish a hierarchy, but I think we can act in those areas and that we ought to.

The hon. Gentleman recognised the support that I had given so far, but I am afraid that that is now about to change—it is not just because of him, I promise. On calories on menus, we have seen the instrument. The impact assessment is comprehensive—it has five different options, 235 paragraphs, four annexes—yet eating disorders are afforded one mention covering three paragraphs before being discarded in a fourth. I do not think that that is sufficient or that due regard has been paid, and I hope that the Minister will revisit it. Alongside my hon. Friend the Member for Tooting (Dr Allin-Khan), I am seeking to bring together stakeholders who reflect a full range of views on this topic to forge a solution that realises important health benefits for one group but is not injurious to another section of society. I hope that the Minister is still in listening mode on the matter and might seek to do something similar.

That leads me to what I am saddest about with this strategy; the Minister knows about it, because I have raised it with her many times. Rather than having just an obesity strategy, we ought to have a healthy weight strategy. Eating disorders are increasingly common and can blight people for their whole lives, and their lives and voices are missing from the strategy. I have thought about this for a long time—since last July—and I think we can guess why that is: talking about eating disorders inevitably challenges us to talk about mental health services in this country, and of course, the Government are not keen to do that, as it would offer a reckoning of their leadership in this area over the previous decade. Access to high-quality mental health services of all kinds is too rare. People wait too long and the oft-repeated promises about a parity of esteem approach have not led to meaningful action. That gets worse when we talk about child and adolescent mental health services. The evidence is irrefutable that the root of challenging behaviours around food is at that time in life, but, as every right hon. and hon. Member knows, trying to get a young constituent into CAMHS treatment is simply too hard. We are failing a big and growing part of our population by not addressing that, too, so in that sense the strategy has missed a really important opportunity.

I turn to public health. As I say, I am glad that these proposals have been brought forward. It has to be said, though, that they follow a decade of the Government’s cutting services that improve the public’s health. I know that it is a core strategy of the current Administration to act as a new Government and run as far away as possible from their record over the last 11 years—I would want to do that if I were them—but they cannot do so.

The public health grant, even with the recent uplift relating to covid, is nearly a quarter lower in real terms than it was five years ago. I had responsibility for the public health grant in Nottingham for three years prior to entering this place. My experience was that, with the growing pressures for demand-driven services such as drug and alcohol services and sexual health services, added to the consistent cuts to local authorities, there just was not anything left for longer-term services such as those that deal with healthy weight. That has meant a withering of nutrition guidance, shared cooking programmes and specialist support. That has absolutely weakened our approach to taking healthy weight issues head-on in this country. These proposals should have included a commitment to reversing those cuts and, frankly, some humility for having imposed them in the first place. That point needs addressing.

Of course—I will make this my final point—this is an issue about poverty in this country, too. If we eradicated much of the poverty, we would take a lot of the obesity with it. As I said, there is compelling evidence that obesity is much worse in poorer communities. Again, that makes it all the more mystifying that those massive and ongoing cuts to local authorities have been targeted at the poorest communities, especially in the big cities. That is an extraordinary public policy disconnect and, again, it is something that we ought to address in the strategy if we really want an all-services approach, at all levels of government, to taking on this national issue.

This is a very important issue and it is right that the Government are seeking to act. We will support them to move at pace to implement evidence-based, effective interventions, but we will push them, too, to close the gaps in the strategy so that it becomes genuinely transformative. The stakes here are lofty, so our ambitions must be lofty too.

[Mr Deputy Speaker (Mr Nigel Evans)]

We will go, via video link, to Andrew Selous. Andrew, I have some great news for you; we have a bit more wiggle room, so you have four minutes.

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[Alex Norris]

With the leave of the House, I shall respond to the debate. The funny thing about opening and closing this debate for the Opposition is that I have already posed 10-minutes’ worth of questions to the Minister and now I am back for another round. I do want to hear the answers to my questions and to the many good questions posed by Members from all parties, so I shall not speak for long. I am not sure whether that is a kindness to the Minister, but we are keen to hear the answers.

I want to reflect on some of the contributions, because it has been a really great debate. I hope that the people watching—there is a lot of interest in this subject—will have seen the quality of the discussions. There have of course been differences of view, but that is a good thing, and I hope people will have seen the House at its best this afternoon.

I have worked a lot with the hon. Member for South West Bedfordshire (Andrew Selous) on modern slavery, and he always works with such compassion. The tone that he set on having a non-stigmatising debate was a very good one. The hon. Member for Strangford (Jim Shannon) picked up that theme too and I think we have managed to have such a debate. It is important that we continue that.

My hon. Friend the Member for Liverpool, Walton (Dan Carden) made some points on alcohol labelling, following his recent debate on the subject. It would be helpful to hear clearly from the Minister that the briefing that such labelling was to be dropped is wrong. I think that is what we heard from her, but it would be helpful is she was very clear that that briefing is inaccurate. Will she pick up on the idea of having a national alcohol strategy and say how she feels about bringing together some of the existing strategies to attack many of the commonalities—for example, in relation to mental health services?

I spoke about mental health services earlier, as did others, including my hon. Friend the Member for Sheffield Central (Paul Blomfield), whose points about treatment services for children were very well made. After a decade of real famine in this police area and the continued failures in CAMHS, there is a commitment in the strategy on investment in healthy-weight services; I am keen to hear from the Minister some extra detail about what form that is going to take. If she does not have those details today, will she say when we are going to start to hear some and when we will have a chance to debate what form that is going to take? My hon. Friend the Member for Sheffield, Hallam (Olivia Blake) and the hon. Member for Bath (Wera Hobhouse) picked up on a point I raised in my opening remarks about eating disorders and they strongly displayed just how people feel, certainly those who are working and active in supporting people with eating orders. We are very lucky to have those people still making that case after such a challenging year for their support services. I hope the Minister has heard that, because I strongly believe that the impact assessment does not pay prominent enough regard to it. I hope she will confirm that she is still in listening mode and perhaps give us a date for when we can hear about and debate that secondary legislation, now that it has been published. I hope she will use this time to seek to meet some of those concerns.

Let me turn to contributions from Conservative Members. I was struck by the one from the right hon. Member for Vale of Glamorgan (Alun Cairns) on knowledge and skills, because the cruelty in all this is that scratch cooking is not only better for us, but cheaper. It is one of the few things where doing the right thing really rewards us. If my wife was watching this—let’s face it, she’s not—she would roll her eyes and say, “It tastes better if you do it right.” She has tasted my cooking and scrutinised my app-based ordering late at night, so she might say that I am in danger of a bit of hypocrisy there, but nevertheless it is true that scratch cooking is cheaper and healthier.

The hon. Members for Keighley (Robbie Moore) and for Sleaford and North Hykeham (Dr Johnson) picked up on the idea of education programmes. Whether or not we characterise them, as he did, as a recommitment to home economics, these sorts of programmes are effective. It is not making a particularly aggressively partisan point to say that a decade of cutting the public health grant has meant that, in essence, these services have disappeared across the country, but they did exist and can do so again. I hope that we will see a reinstatement of them, and I do not think it is nannying to do that. When this is done intergenerationally as well, it can have a great social benefit. The evidence behind it was good, and I would love to see a report on it.

The point made by the hon. Member for Stoke-on-Trent Central (Jo Gideon) about public opinion was very important, as that issue has not been covered much. There has been a lot of talk about personal choice, to which I will turn shortly, but the public are ahead of us on this. On the vast majority of the interventions, even the ones I am most sceptical about, the public are more bullish than I am, so it is important that we do not lose that from the debate.

We heard contributions from the hon. Members for Woking (Mr Lord) and for Warrington South (Andy Carter) about the ad ban, which is not a silver bullet, as the Minister has said, although it is impactful. I might argue that the vigour with which those who oppose it say it is a bad idea shows why it might be a good one. Nevertheless, I hope the Minister will again demonstrate that she is in listening mode. When the industry comes together with proposals that meet the Government’s stated aims, I hope they will be given a fair hearing—that is entirely reasonable.

The right hon. Member for Forest of Dean (Mr Harper) made very good points about reformulation, which is the big goal here; whatever we do with menus, what we have seen from the sugar tax is that once firms really put their shoulder to the wheel on this, we can do some incredible things. The progress made in the past decade or so, certainly in the soft drinks industry on reformulation, is a really good sign. I did not quite agree with the point he made on demonising products, as I do not think that that is the purpose. For me, the goal here should be informed choice, which all Members have talked about, and our knowing what is in those products. I do not think manufacturers would fear that, and they should not either. The point about informed choice was also raised by the hon. Member for Buckingham (Greg Smith), who talked about “overreaching”. I would think the proposal we are talking about is quite modest; there are no bans in here, certainly not of products—it is just about ensuring clarity of what is in them, and we should do that.

I want to come to the point about free choice, as it was made by many Members, including the hon. Members for Northampton South (Andrew Lewer) and for North East Bedfordshire (Richard Fuller). If this is genuinely a matter of free choice—this is the thing I just cannot get past on this issue—why does obesity happen disproportionately on the same streets and estates, year after year, generation after generation, even though the people in those houses change? If this was purely a matter of free choice it would not happen that way and would be much more evenly distributed across the country, but all the evidence tells us that that is not the case, so I cannot quite accept that point, I am afraid.

I was not going to do this, but I thought the hon. Member for North East Bedfordshire was a bit unkind to me by suggesting I had offered “breathless” support to the Government. I might have been breathless but was trying to get a lot in and wanted colleagues to have a chance to contribute too, and I think there was balance in what I said. I know the hon. Gentleman now differentiates what is being proposed today from the sugar tax, but I remember even though I was not a Member at the time that he was very publicly and prominently against the sugar tax, saying it would not work. I do not think that has been borne out by the facts since then, and I gently say I think he is wrong again in the same way today.

I have now given a quick canter around all the contributions, which were very good, even the ones that perhaps I would not agree with and that were made by Members who might not have agreed with my contribution. We have got the strategy—we have had it since July—and what I want to hear from the Minister now is a real emphasis on delivery and implementation and on recognising the concerns raised by Members and those outside this place, and a real sense of how we will work together to implement it. As I have said, where that is done in an evidence-based way, we will be supportive, because this is a very big prize indeed.

Oral Health and Dentistry: England

Alex Norris Excerpts

Tuesday 25th May 2021 Westminster Hall

[Alex Norris (Nottingham North) (Lab/Co-op)]

It is a pleasure to serve with you in the Chair, Ms Bardell. I thank my hon. Friend the Member for Bedford (Mohammad Yasin) for securing this important debate. Like much of our health service and, indeed, British life during the pandemic, dentistry has had to stretch and adapt and tackle its own unique challenges. It is welcome and important for us to have the opportunity to discuss this today; the steps required to recover and rebuild; and the wider oral health issues that we have not been able to deal with during the pandemic.

My hon. Friend led us in a strong manner and clearly laid out for those watching the gravity of the situation and the amount of pain that has been building up. He made important points about contract reform that I will return to. I have felt among friends and perhaps, even the usual suspects, as a number of us have talked about dentistry throughout the pandemic and before: my hon. Friends the Members for Norwich South (Clive Lewis), for Bradford South (Judith Cummins), for Stockport (Navendu Mishra), for York Central (Rachael Maskell) and for Putney (Fleur Anderson). Their points were very pertinent, particularly the points made by my hon. Friend the Member for Norwich South about finances; by my hon. Friend the Member for Bradford South about prevention; and by my hon. Friend the Member for Stockport about disadvantage and his frustrations on data, to which I will also return. My hon. Friend the Member for York Central spoke about the crisis prior to the pandemic and my hon. Friend the Member for Putney has just spoken about recruitment. They were all very well-made points and I will be returning to them in my contribution.

On the Government Benches, we are very lucky to have the professional insights of the hon. Member for Mole Valley (Sir Paul Beresford). His points about fluoridation were excellent—I share much of them and will be returning to them. I could not agree with his points about decoupling deprivation and personal choice. Of course, personal judgments are always critical, but if we decouple deprivation, it would not explain why we see poor oral health generation after generation, year after year on the same streets and on the same estates, which are always the poorest ones. The hon. Member for Isle of Wight (Bob Seely) was dogged in his persistence around equity of access. His points were unique to the Isle of Wight but I share a lot of commonalities in my community, and from what I have heard, so do other parts of the country.

Where do we stand today? Two in three adults in the UK have visible plaque. Almost one in three have tooth decay. Three in four have had a tooth extracted—including me. Over 3 million people suffer from regular oral pain and there are over 8,300 new cases of mouth cancer every year. That is the scorecard for Britain’s oral health as we meet today. That is why it is so important that we act in this area. We are talking today about oral health and dentistry, but you cannot decouple those two things. Support for dentistry is support for our oral health, and good oral health in this country will mean that we are in a better and stronger position around dentistry.

I will begin with dentistry. In January, my hon. Friend the Member for Putney secured a debate in the main Chamber about the future of dentistry. It was well-timed and came just as the Government’s newly imposed activity targets on the profession were under way and just as we had re-entered another lockdown. I will reiterate what I said that day. Of course, activity is needed to ramp up to start to tackle the growing backlog of need in this country, but the failure of the Government to ensure that NHS England and those who negotiate for the dentists came to a workable, mutually agreeable deal was a significant failure of leadership. It led to significant anxiety and weakened dental services in the long run.

When the debate was announced, I submitted a number of written questions to help us to establish the facts regarding what has happened since that debate in January and they were named for response yesterday. I am sad and disappointed that the Department came back last night to say that we would not be able to get an answer in time, which is a shame. I am surprised the data is not more readily available and hope the Minister will help us with that today. The four questions were: how many practices hit the 45% target; how many missed the 45% target but hit the 36% figure to avoid clawback; how many have given their NHS contract back; and how many have served notice that they intend to do so? I hope that data is readily available. It would help us in our discussions about the future.

I understand that the mean UDA performance between January and March was 59%. The British Dental Association reports that the majority of practices have hit these targets by adopting approaches—such as working beyond contracted hours, cancelling annual leave and prioritising routine care over complex cases—that are at best unsustainable, and at worst dangerous.

Furthermore, they have surveyed their members to find out what impact the last quarter has had on them: 29% say they intend to stop doing NHS work entirely and nearly half intend to reduce NHS work. A similar proportion say that they are likely to change career or retire should the current restrictions stay in place. That is the staggering personal impact of an imposed settlement that has led to unsatisfactory working practices and extraordinary stresses.

Discussing the judgments that have been made in the past is important, but also as we go forward because now that target goes from 45% to 60%, which will last us through to September. I hope that the Minister can tell us what extra support the Government will provide to practices to enable them to increase the number of patients they can see to hit their increased target, to do it safely and to do it in a way that does not incentivise perverse working practices that we would not want to see.

We know how those in the profession feel about this from the same BDA survey. Nearly two thirds of NHS dentists do not think they will hit that target, and 88% of dentists report that the current conditions have had a high impact on their morale. We need to hear from the Minister what extra support they would get, particularly around the operating procedure, or perhaps, as the hon. Member for Mole Valley says, a roadmap from restrictions or access to technology to allow them to do more. Throughout this debate, we have heard that there has been far too much stick and never any carrot. I think it is time to recognise the contribution by working with the profession rather than against them.

As my hon. Friend the Member for York Central said, this pandemic has exposed a service built on sand. The NHS general dental practice is the only part of the NHS in England operating on a lower budget in cash terms than in 2010, as my hon. Friend the Member for Norwich South also said. In real terms, net Government spend on general dental practices in England has been cut by over a third over the past decade, with the number of NHS dental practices in England falling by more than 1,200 in the five years prior to the pandemic—then we wonder why we have an access issue.

Similarly, relentless cuts to the public health budget year on year for a decade have meant that supervised toothbrushing schemes, like the excellent Teeth Team in my community, are a rarity when they should be the norm. That is the Government’s legacy in oral health for the past decade. As we know, that has the greatest impact on the poorest and the youngest. In 2020, more than 70% of children did not see an NHS dentist, despite tooth decay being a leading cause of hospitalisation for 5 to 9-year-olds. We also know the massive impact that has on school absence. This is a serious social issue, and we are letting our children down.

Where can we go from here? I do not think it is hyperbolic to say that we are in the last chance saloon for NHS dentistry. All of the evidence shows that we are clearly on a trajectory that is pushing patients from the public sector into the private sector. This is happening with the workforce too, pushing them from the NHS into the private sector, but there is hope and there are opportunities, and we need to grasp them.

First, we need contract reform. I support what the Minister has said previously and publicly on contract reform. It is welcome that NHS England and the dental profession are in the same place and have agreed very sound basic principles for contract reform. That is very good news indeed. We, as Opposition, will support this process and help build consensus around it. My major call here is that we must go at pace to move beyond UDAs—my hon. Friend the Member for Bradford South made some excellent points there—into a new, more preventative future for oral health. We have got to be ready by April 2022, so I hope the Minister can update us there.

Secondly, I welcome the commitments made around fluoridation. I bear the scars of many years of saying that I believe Nottingham’s water should have fluoride in it, I do. The counter lobby, as the hon. Member for Mole Valley said, are aggressive, vicious and very similar in many ways to the anti-vax movement. However, if the Government bring forward sensible proposals, I would be very keen indeed to build consensus around them. This is a great national prize and a great opportunity for public health.

Thirdly, we need a renewal of oral health as a core element of public health. The Government should reverse their cuts to the public health grant so that local authorities can provide preventative services, particularly in the poorest communities and particularly targeted at their children. I am glad that the Government now want to consult on reintroducing schemes such as supervised toothbrushing, but it is hard not to have a slight sense of grievance given that local communities were already doing this before they had the means to do so taken away. That is what happened, but now we must move forward. Again, we should be doing that at pace.

Finally, we should take a robust look at the supply chain. The Minister knows I have concerns about the dentistry supply chain, particularly for dental labs, which have not been part of any of these contracting conversations but are significantly impacted by them.

To conclude, we entered this crisis having underfunded and under-supported dentistry. We have navigated this crisis by treating the profession as antagonists, rather than partners. If we want to build a new future for oral health and dentistry, we can do it by investing in it and all coming together. I hope to hear a commitment on that from the Minister.

Air Ambulance Funding

Alex Norris Excerpts

Monday 26th April 2021 Westminster Hall

[Alex Norris (Nottingham North) (Lab/Co-op)]

It is a pleasure to serve under your chairship, Mr Stringer, and to respond to the debate on behalf of the Opposition. I thank the hon. Member for Linlithgow and East Falkirk (Martyn Day) for leading it. I always admire the skill with which members of the Petitions Committee introduce a broad range of topics for discussion in Westminster Hall. His point about the extreme circumstances that crews face not just in transit but in what they find when they make their extraordinary journeys was really well made.

We often think most visibly about air ambulances landing in all sorts of places, whether that is motorways, as the hon. Member for Wakefield (Imran Ahmad Khan) just said, or playing fields. We perhaps do not think so much about the extraordinary care that they give on the other end, whether that is caesarean sections, as we heard, open heart surgery or general anaesthetics—all sorts of things. It really is an incredible range of skills to be able both to get to the right place and then to provide the right care. We are truly lucky to have these individuals in our country.

The biggest thanks, of course, must go to Bethany Billington, who started the petition. I pay tribute to her sister, Lee-Anne Parkin, who tragically lost her life alongside her partner, Steve Carroll, in March 2019, as we have heard. It happened seven days after being taken to the trauma unit in Teesside following a motorcycle accident. Great North Air Ambulance was on the scene within minutes of the accident, and Bethany has praised its incredible efforts, and followed those words with actions of her own. She can be very proud of herself, and her sister’s legacy.



There are lots of parliamentary e-petitions, but it takes one that is truly special to get the 100,000 signatures required for a debate to be considered. In this case, there were more than 130,000 signatures before the e-petition closed prior to the last general election, which seems a long time ago. Bethany managed to secure this debate, and we are glad that she did.

I commend the hon. Member for Wakefield for his typically thoughtful contribution. He spoke about Wakefield and the many ways in which his constituents might need these services. There are significant parallels with my constituency in Nottingham, not least in that many of the roads that he mentioned also serve my community, and that his constituents’ high regard for these services mirrors that of my own. Our constituents will want us, their parliamentarians, to address the petition seriously and constructively, as we are doing today.

Let me start by stating how brilliant a contribution air ambulances make. Across the UK, there are about 70 life-saving missions each day. That is an extraordinary service provided to people who, by definition, really need it. A lot of loved ones are saved and lives are changed. In politics, we are never meant to say that we feel conflicted or have thoughts on both sides of an issue. We are supposed to have a firm and unequivocal view, but I do not have that on this issue; I find it quite conflicting.

One thing that makes this country so special is our national health service, which is there for us whoever we are, whatever we need and whenever we might need it. It is free at the point of need and funded by our taxes. I confess to having always found it a little odd that really important services, such as air ambulances and hospices—they are both, I believe, fundamental parts of the health service—are funded principally through charity. In reality, I am conscious that this is, to some extent, going to be a mixed economy. In 2018, the then Chancellor announced £10 million of capital funding to support air ambulances. I hope the Minister will update us on how this was used, its impact and any future plans, because clearly there is demand for such support.

The service is not cheap. The petition says that it costs about £12,000 each day to run; it may well be more. Air Ambulances UK says that each mission costs about £2,500. If there are 70 missions a day, that would put the daily figure at more than 10 times the one suggested in the petition. The real answer may be somewhere in between; either way, we can all agree that the work is priceless and we would never countenance it stopping because of a lack of money.

That gives me a certain confliction about whether air ambulances should be funded as a core NHS service. Happily, whatever my conflictions, the sector has rather resolved the issue for me. It says that it does not want to change its operating model, so I certainly shall not advocate that. If it wants to run the model in this way, and if it thinks that that gives it the best of both worlds and enables it to keep doing the wonderful things that it does—well, it is the expert. It is doing this great job, and it has my full backing.

The Government, via NHS England, still have an important role. At a minimum, they are a backer of last resort. Since the petition closed, events have put extraordinary pressures on charities and charitable giving. The Government were right—we supported them—to give air ambulances a £6 million covid-19 grant. That will have ensured that services that could have been under pressure will have been able to continue. Hopefully, when we get back to normal fundraising activities—perhaps the Minister will announce that he is running the London marathon to raise money for such causes; I will leave that space open for him—it will not be necessary to rely on Government support. Nevertheless, Governments across the UK should always commit to standing behind this crucial sector, in good times and in bad. I hope the Minister will affirm that today.

To conclude, one thing I have held in my head is the profound understanding that—given the volume of missions every day—while we have been having this debate, multiple people will have had to rely on air ambulance services. That is how important this is, and how much of a difference it makes to such individuals and the people who care about them. That is why this petition and this debate are so important. Air ambulances are there for us, and we must continue to support them in their work.

Oral Answers to Questions

Alex Norris Excerpts

Tuesday 13th April 2021 Commons Chamber

[Helen Whately]

I thank the hon. Gentleman for his question, and if he will allow me, I will look into that and write to him.

[Alex Norris (Nottingham North) (Lab/Co-op)]

Prior to the pandemic, cancer services were understaffed and not meeting their targets. During the pandemic, our staff have made incredible efforts, but a cancer backlog has built up. The Government are now asking the same understaffed cohort to run their normal services and to deal with the backlog at the same time. This is unfair, will lead to burn out and will not work. Will the Government commit today to extra resources specifically targeted at cancer to give those staff a fighting chance?

[Helen Whately]

I thank the hon. Member for his question. The Government have already committed significant additional resources to support the NHS in recovering from the impact of the pandemic, and that will include cancer services as well as other areas of treatment.