Oral Answers to Questions
Andrew Gwynne Excerpts(6 months, 3 weeks ago)
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Andrew Gwynne (Denton and Reddish) (Lab)
The whole purpose of integrated care systems is to join up social care and NHS services in a better way. We know, for example, that fracture liaison services keep 100,000 people out of hospital, but only 50% of English NHS trusts have them, and despite the commitment given by the Under-Secretary of State for Health and Social Care—the hon. Member for Lewes (Maria Caulfield—to providing more, nothing has happened, and Lord Evans has walked back from her commitment. I realise that I am pushing at an open door in directing this question to a Minister whose leg is strapped up, but when will the Government finally deliver for the “back better bones” campaign to help older people to survive and thrive?
Helen Whately
As the hon. Member has mentioned, I have a broken ankle, and I am taking my responsibility as Minister with oversight of urgent and emergency care very seriously in making use of several of those services. As for my oversight of integrated care systems, what I am seeing is that they are making a very good job of enabling the integration of services. For instance, we are seeing real success in the growth of virtual wards—or “hospital at home”—which bring together acute and community services to look after people in their homes and help them to be discharged earlier. The NHS has achieved its target of having 10,000 “hospital at home” places ready for this winter.
LGBT+ People and Spouses: Social Care
Andrew Gwynne Excerpts(7 months, 3 weeks ago)
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Andrew Gwynne (Denton and Reddish) (Lab)
It is a pleasure to serve under your chairmanship, Sir Robert, and to respond to the debate on behalf of the shadow Health and Social Care team in my first outing as the newly appointed shadow Minister of State for Social Care. It is always good to see the Minister for Public Health in his place.
I sincerely thank my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes) for securing the debate and for all her work on this important subject. Her contribution this afternoon was heartbreaking —the way in which her constituent was treated was utterly shameful. I also thank my hon. Friend the Member for York Central (Rachael Maskell) for her contribution. She ended on such a powerful poem, which speaks to so many who suffer in care home settings.
The Care Quality Commission guidance for all providers of adult social care clearly states that people using care services
“must not be discriminated against in any way and the provider must take account of protected characteristics, set out in the Equality Act 2010.”
As we have heard today and as we know from other studies, however, that is not always the case.
A survey conducted in 2017 found that 23% of open LGBT+ respondents who had been in a care home or other form of institutional care reported that being gay, trans, bisexual or lesbian, or having other protected characteristics, had a negative effect on the care that they received. Those examples are varied, but each and every one of them is concerning. Some respondents to the 2017 survey said that they felt invisible. Other responses related to use of language—for example the assumption that a partner or spouse is of the opposite sex, when that is not necessarily the case.
At their worst, the experiences of LGBT+ people in care home settings can be traumatic, as demonstrated by the story of Noel Glynn and his partner Ted Brown, who is a constituent of my hon. Friend the Member for Dulwich and West Norwood. Before he died, it is reported that Mr Glynn, who had dementia, suffered bruising across his body and had a cigarette burn on the back of his hand because of abuse from care staff. Other residents warned his partner Ted not to reveal to staff that he and Noel were a couple, saying, “That won’t be good for either of you”.
Mr Glynn and Mr Brown sued Lambeth Council, but Mr Glynn very sadly died before any compensatory payments were made. This case is beyond abhorrent. I hope the Minister will set out how it happened and what steps the Government are taking to ensure that it never happens again. The Minister will know that the Care Quality Commission does not currently consider the extent of homophobia or transphobia in inspections, despite its fundamental standards. Following this case, will the Minister look again at that guidance?
More generally, what this issue comes down to is the importance of personalised care. A report by the Women and Equalities Committee published in 2019 points to research showing that 72% of care workers do not consider sexual orientation to be relevant to one’s health needs. That same report states that
“most health and social care professionals feel under-equipped to deal with LGBT people’s needs rather than intentionally discriminating.”
The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 are clear on this subject. Regulation 9 states that people using a service should have care or treatment that is personalised specifically for them. It is important that care providers respond to the serious concerns raised by LGBT+ people and ensure that those accessing services feel respected and safe, and benefit from care that is tailored to their needs.
My questions to the Minister are as follows. Given the extraordinary shortages in adult social care staff—sitting at around 165,000—what work are he and his Department doing to protect the principle of personalised care? Further, what steps is the Department taking to monitor the experiences of LGBT+ people in social care settings? In the 2018 LGBT action plan, the Government pledged to develop best-practice guidance for monitoring and to make this openly available to the public sector. Why were these pledges not implemented? Have they simply been abandoned alongside a plethora of other Government commitments, from banning conversion therapy to tackling waiting lists? Finally, LGBT+ organisations have called for better guidelines and staff training for those working in care settings. Can the Minister outline whether the Government support these calls?
The next Labour Government will address the vacancies in social care by delivering a new deal for care workers, guaranteeing fair pay, training, terms and conditions and career progression.
Richard Foord (Tiverton and Honiton) (LD)
I am curious to know from the shadow Minister what fair pay in the social care sector would be. What does he think of the Liberal Democrat proposal to pitch an additional £2 per hour minimum wage for social care workers?
Andrew Gwynne
If the hon. Gentleman had been at the TUC conference today, he would have heard the shadow Deputy Prime Minister, my right hon. Friend the Member for Ashton-under-Lyne (Angela Rayner), outline precisely what Labour’s fair pay deal will be for the social care sector, but we need to go beyond that. We need to ensure that social care becomes a valued profession again, rather than just assuming that agency staff can fill the vacancies. We need to make sure that social care once again has parity with the rest of the healthcare system and that care workers want to work in the care sector not just because of pay, terms and conditions, but because it is a profession—which, sadly, many feel it no longer is.
We will work in partnership with users and families and develop a set of national standards based on existing minimum entitlements and legal rights, including legal rights that exist in the Equality Act 2010—a piece of legislation of which I am fiercely proud, and which the last Labour Government took through Parliament and put on the statute book. We need to make sure that all service delivery, particularly in social care, meets the ambitions and legal expectations of the Equality Act—sadly, that has let down so many LGBT+ people in the social care sector, as we have seen from the statistics in the surveys that I have cited this afternoon.
We would also ensure that our commitment to raise standards right across the sector is upheld by requiring all care providers to demonstrate financial sustainability and, crucially for this debate, to deliver high quality care for service users before they are allowed to receive contracts from local authorities, making sure that local authorities commission care providers who are capable of delivering the care that people need at the standard we should expect. That would result in more personalised and ultimately higher-quality care for all individuals.
In 2023 people who are lesbian, gay, bisexual, trans and others should not feel ostracised by a system that is there to support them. They should not feel ignored and that their personal needs are not being met. Ultimately, they should not feel the need to hide the fact that they are gay, lesbian, bisexual, trans or other. I hope that the Minister will agree with me that we can get to work on delivering that higher standard of care for all service users. The testimony that we have heard today from my hon. Friend the Member for Dulwich and West Norwood should stand as that end point. Never again should somebody from the LGBT+ community be treated as we have heard. “Never again” should be more than a slogan. It should be deeds.
HIV Action Plan Annual Update 2022-23
Andrew Gwynne Excerpts(9 months, 3 weeks ago)
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Andrew Gwynne (Denton and Reddish) (Lab)
It is always a pleasure to see you in the Chair, Dame Caroline. I congratulate the hon. Member for West Bromwich East (Nicola Richards) on securing this important debate. It has been a good debate, and we have had consensual contributions from Members across the House. I pay tribute to my hon. Friend the Member for Vauxhall (Florence Eshalomi), the right hon. Members for Romsey and Southampton North (Caroline Nokes) and for Dumfriesshire, Clydesdale and Tweeddale (David Mundell), and the hon. Members for Cities of London and Westminster (Nickie Aiken) and for Darlington (Peter Gibson), for their thoughtful contributions. I thank them individually for the work they are doing here in the House of Commons on this important topic.
The publication of the first HIV action plan update in Parliament last month showed real positive progress in ending new HIV cases and HIV-related deaths in England by 2030. However, as the number of new HIV cases falls, it will become harder to find people living with undiagnosed HIV—something we have recognised in the debate. I therefore welcome the opportunity to press the Minister on some key points, particularly regarding the HIV action plan update. The first relates to opt-out HIV and hepatitis testing. The inclusion of opt-out testing in areas of high HIV prevalence—something for which Labour has called for some time—has been hugely successful. Across London, Manchester, Blackpool and Brighton, we have seen 343 people newly diagnosed with HIV, over 1,500 people newly diagnosed with hepatitis B and C, and 473 people previously lost to care found. Those are incredibly encouraging statistics, and they point to the effectiveness of opt-out testing. I would be grateful if the Minister set out what assessment the Government have made of opt-out testing being implemented in areas of high prevalence—and if not, does he have any plans to do so?
The second thing I want to focus on were those people lost to care. By “lost to care”, we mean those previously diagnosed with HIV who have not attended an HIV clinic in the past year. In general, those people are disproportionately likely to be black women, and most likely to be from the most deprived parts of the country, to have caring responsibilities, or to be subject to the misuse of drugs and alcohol.
I also commend the Terrence Higgins Trust, which does brilliant work and I thank those there for their support for me in my role. The trust estimates that the number of people lost to care, but alive and still in the UK, could be as high as 13,000. That is extremely concerning and means not only that individuals are at risk of developing serious HIV-associated illness, but that they risk passing the virus on to others. What action is the Department taking to re-engage those individuals? What further work is the Minister planning nationally to support people back into care?
The third and final point I want to ask the Minister about is access to PrEP and sexual health services more generally. As we have heard in the debate, there are serious inequalities in PrEP identification and initiation. Even when people access care, they face extraordinarily long waiting times, with 57% of people waiting more than 12 weeks to receive PrEP. The Terrence Higgins Trust is aware of people who have, tragically, acquired HIV while waiting to access PrEP. That is clearly unacceptable. Such cases were entirely preventable and should seriously alarm Ministers.
The HIV action plan included a commitment to develop a plan for PrEP access beyond sexual health services. However, more than a year on from that commitment, there is no pharmacy or GP surgery in the country where PrEP is accessible. I know from responses to written parliamentary questions that the Minister is still committed to that aspect of the HIV action plan, so when can we expect it to be set out in detail? The Government initially promised their PrEP plan in the autumn of 2022. We are now three days away from summer recess in 2023. Where is the plan?
In closing, I want to raise the issue of sexual health services and ask the Minister about Government proposals to change schedule 1 to the Health Protection Notification Regulations 2010, which lists notifiable diseases. What guarantees will the Minister give that that will not impact the important anonymity of those accessing sexual health services or increase stigma?
Labour stands ready and waiting to support the Government in driving down HIV prevalence. I am sure that the Minister will agree that, across the House, we have a responsibility to redouble our efforts so that we can eliminate all new transmissions of HIV by 2030. I hope that, with cross-party action, we can make that a reality.
Radiotherapy: Accessibility
Andrew Gwynne Excerpts(9 months, 3 weeks ago)
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Andrew Gwynne (Denton and Reddish) (Lab)
As ever, it is a pleasure to serve under your chairmanship, Dame Maria. I thank the hon. Member for North Devon (Selaine Saxby) for securing this important debate and for all her work on this issue, which is not a party political one. As we have found today, there is great consensus across the House on this cause, because it is the right thing to do to use our voices as Members of Parliament to champion it. I commend her and other hon. Members present for their work.
We have had a good debate. There has been a lot of repetition, because these issues need reinforcing, and I fear that I will be reinforcing some of the arguments that we have already heard. I commend my hon. Friend the Member for Easington (Grahame Morris) for all his work over a long time. He is always championing the cause of radiotherapy and bending the ear of shadow Ministers, and no doubt of Ministers, about its importance. I also commend the hon. Member for Westmorland and Lonsdale (Tim Farron) for his work as chair of the APPG for radiotherapy. He brings great knowledge to these debates.
This issue is close to my heart, too. As the hon. Member for Westmorland and Lonsdale said, all families are touched by cancer. Some have good experiences, where loved ones survive; others have less good experiences. I lost both my parents to cancer: my mum died from ovarian cancer when I was 19, and my dad died last year. In fact, last week was the first anniversary of his death. He lived to the age of 77. He had a very rare and aggressive form of rectal cancer; sadly, it could not be treated, because by the time even the earliest symptoms had been discovered, the cancer had already spread in various places throughout his body.
I will be forever grateful for the loving care that my dad received, principally from The Christie in Manchester, but also from the satellite at Oldham. He received palliative care, chemotherapy, immunotherapy and, indeed, radiotherapy. It gave him at least a year longer than he should have survived. My dad was a sporting man and a bit of a gambler, so he was willing to take those odds. Anyway, it gave him an extra year with his great-grandson, as well as with the rest of his family. That is precisely why radiotherapy is key. It was a game changer. The chemotherapy and the immunotherapy did not work; it was the radiotherapy that probably prolonged his life for those extra months.
As we know, radiotherapy is a key treatment for many people affected by cancer. It can be used to try to cure cancer completely, it can make other treatments more effective; it can reduce the risk of cancer coming back post surgery, and it can relieve symptoms in palliative care. Unfortunately, as we have heard today, radiotherapy services are under significant pressure, which is all too evident in the treatment statistics that have been cited. For example, the proportion of people in England having their first cancer treatment within two months of an urgent GP referral has fallen to 58.7%, which is down from 61% in April. As we heard from my hon. Friend the Member for Easington, the target is 85%, but that target has not been met on an annual basis since 2013-14. That really needs the Government’s urgent attention. We cannot just blame the pandemic for these statistics, because way before the pandemic the targets were not being met, although I am sure it exacerbated the issue and made the challenge even harder.
My first question to the Minister is what action he is taking to reverse this concerning decline in treatment within two months. We all know that the key to treating cancer is catching it early, but it seems that a significant number of patients are waiting far too long even to begin care, which potentially harms their chances of receiving successful treatment.
There are also serious concerns about technology and infrastructure within radiology services, as we have heard from hon. Members today. In a response to the Government’s long-overdue NHS workforce plan, the Royal College of Radiologists stated that
“we all know how frustrating it is to try and do our jobs with systems and infrastructure that simply aren’t fit for purpose.”
The RCR also cited an interview in which
“Tom Roques, Vice President for Clinical Oncology, talked…about needing to use seven passwords for seven separate systems in order to provide information to one patient”.
When the Opposition talk about embracing new technology and giving NHS staff the tools they need to do their job, that is precisely what we mean. We must embrace new technology. For example, there are tools that can map radiation therapy to cancer cells, avoiding organs more precisely and more quickly than a human can. That is standard technology in the United States of America, but is used by just one in three radiotherapy planning centres in England. Alongside the workforce plan, what is the Minister planning to do to address this problem? Staff already face an uphill battle. The last thing they need is inadequate equipment or overly complex systems.
Regarding the workforce plan, Cancer Research UK has highlighted what it calls
“a lack of detail on cancer-specific professions”.
What assessment has the Minister made of that? Can he set out what engagement his Department is having with organisations such as Cancer Research UK on ensuring that services such as oncology are adequately staffed into the future?
The final point on which I wish to press the Minister relates to the inequality in access that all hon. Members have spoken about. Approximately 30,000 extra cases of cancer in the UK each year are attributable to socioeconomic deprivation. Studies have consistently shown that there is unwarranted variation in radiotherapy access rates. We have heard about poor access in rural parts of England, which is an issue that specific hubs linked to the main centres of excellence would start to tackle. I certainly welcome the calls from the hon. Members for North Devon and for Westmorland and Lonsdale. It is crazy that their constituents are missing out on key treatments because access requires them to travel too far, and some who do access such treatments give up their treatment early. We should be doing everything we can to encourage people to access those treatments and keep on them until they are completed.
There are issues with monitoring the inequalities. Cancer Research UK has called for improvements to be made to radiotherapy data collection so that policymakers can understand the scale of the problem and set about addressing it. Does the Minister agree? What action is he taking to ensure that we eliminate the inequalities in radiotherapy access that we have heard about today, and certainly to try to get England to the average level of kit needed, if not to exceed the average? I do not just want England to be average at these things; I want us to be an exemplar.
The next Labour Government will work tirelessly to improve access to radiotherapy, alongside providing the NHS with the staff it needs. We will reform our health system and embrace new technology that has the potential to transform the way we deliver care. We will build an NHS that is fit for the future, and we aim to achieve all relevant cancer waiting time standards within our first term. That is a pledge that we have made: we have done it before, and there is no reason we cannot do it again, with the political will.
Until then, however, we need to see this Government engaging with clinicians and experts, and doing everything in their power to ensure that the treatment is there for patients when they need it most. As I said, this is not a party political point. We are a responsible Opposition. We encourage the Government to do more. We want them to meet those targets and to expand services—particularly in rural areas, so that access is equal across the country. We encourage Ministers to do that, and to do it at pace. If they do, we will support them.
Under-age Vaping
Andrew Gwynne Excerpts(9 months, 4 weeks ago)
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Andrew Gwynne (Denton and Reddish) (Lab)
I beg to move,
That this House is concerned that children are being inappropriately exposed to e-cigarette promotions and that under-age vaping has increased by 50% in just the last three years; condemns the Government for its failure to act to protect children by voting against the addition of measures to prohibit branding which is appealing to children on e-cigarette packaging during the passage of the Health and Care Act 2022 and for failing to bring forward the tobacco control plan that it promised by the end of 2021; and therefore calls on the Government to ban vapes from being branded and advertised to appeal to children and to work with local councils and the NHS to help ensure that e-cigarettes are being used as an aid to stop smoking, rather than as a new form of smoking.
It is a pleasure to open this debate on behalf of His Majesty’s Opposition. We are witnessing an incredibly alarming rise in under-age vaping. In many ways, the statistics speak for themselves. A recent study conducted by Action on Smoking and Health found that in the last three years alone, the number of children taking part in so-called experimental vaping has increased by 50%. That has come alongside significant growth in awareness of e-cigarette promotions, with 85% of children now conscious of e-cigarette marketing either in shops or online.
What does that promotion look like? If hon. Members walk down any high street in the country and pop into a vaping shop or off-licence, they will see it at first hand. Brightly coloured e-liquids with names such as “blue razz”, “cherry cola” or “vampire vape” line the shelves. Some liquids are even designed to imitate well-known brands. We can find “Len & Jenny’s mint Oreo cookie” alongside “pick it mix it sherbet lemons”. In fact, it really is not an exaggeration to say that some stores selling vapes resemble old fashioned sweet shops, with pretty much any flavour we can think of covered in cartoon-led packaging. Let us make no mistake, this is not packaging marketed towards adults. It is deliberately designed to appeal to children and, most concerningly, it appears to be working.
Stella Creasy (Walthamstow) (Lab/Co-op)
Like my hon. Friend, I have been horrified to see custard, banana, bubble gum and doughnut-flavoured vapes, clearly targeted at younger palates. They are clearly not about helping people cease smoking. One of the challenges is that we know children are increasingly moving from vaping to actual cigarettes. Does he agree that there is no case for any further delay in the Government’s work to look at how we take vapes out of the hands of young people all together? Our generation all fought so hard against Nick O’Teen; now, we have Mr Vape to deal with. Does he agree that it must be an urgent public health priority?
Andrew Gwynne
My hon. Friend is absolutely right. There is a place for banana, custard and even doughnuts, but that is not on a vape package. She is right that we need to close the loophole and protect children’s health. That is why we have tabled this motion.
In a recent evidence session on youth vaping, Laranya Caslin, the headteacher at St George’s Academy in Sleaford, told the Health and Social Care Committee:
“we have a significant proportion of students vaping. They vape regularly”.
The problem is so bad that St George’s has had to change smoke sensors to heat sensors, to clamp down on young people leaving the classroom to vape.
I would love that to be an isolated case, but we all know, across the House, that it is not. In Hartlepool, concerns have been raised about an increase in primary school children using vapes—that is just shocking. In Devon, schools have reported confiscating e-cigarettes from children as young as seven. Those claims seem to be reinforced by the fact that last year 15 children aged nine or under were hospitalised due to vaping, with health experts warning that the excessive use of e-cigarettes in children could be linked to lung collapse, lung bleeding and air leak. In Yorkshire and the Humber, it is estimated that 30% of secondary school students have tried vaping, which equates to around 109,000 children. It is just staggering.
Daisy Cooper (St Albans) (LD)
I am grateful to the shadow Minister for giving way. I have heard really shocking reports from parents and teachers in my constituency that children as young as 11 are using vapes and that one young person, at the age of 17, is now addicted. In the worst cases I am hearing, some young children are being targeted and are taking the vape apart to carry much harder drugs on the inside, which is causing an even bigger problem. Does the hon. Gentleman agree with me that we simply cannot wait any longer? We need urgent action from the Government to stop that happening.
Andrew Gwynne
The hon. Lady makes a powerful case. Those are precisely the reasons why we have called this debate. It should shock each and every one of us. The ease of access to e-cigarettes for children, many younger than the ages she gave as an example, just cannot be allowed. We must be doing all we can on e-cigarettes, as we did to tackle the packaging and advertising of actual cigarettes, to ensure that children are weaned off their nicotine addiction and that other children do not start vaping in the first place.
Barbara Keeley (Worsley and Eccles South) (Lab)
My hon. Friend is making a very effective speech to open this debate. He quoted the figure of 30% for Yorkshire and the Humber. The figure for the north-west is 29%, which shows very little difference. Those figures are twice that for London, so it may be that some hon. Members are not aware of how bad the problem is getting. The Royal College of Paediatrics and Child Health has warned that youth vaping is fast becoming an epidemic. Worryingly, the number of children admitted to hospital as a result of vaping has almost quadrupled. Is my hon. Friend, as a fellow Greater Manchester MP, concerned about how many more children might suffer those health impacts before the Government take the action that is needed?
Andrew Gwynne
I am very grateful to my hon. Friend. As a Greater Manchester MP, I see the problem in my constituency and she will see it in hers. It concerns me greatly, because within our city region there are already communities that have some of the worst health inequalities. A lot of those health inequalities have been exacerbated by a higher than average prevalence of smoking. Even now, as smoking rates have declined, there are still communities in the areas we represent that have an abnormally high number of smokers. I do not want, in tackling smoking and reducing some of the health inequalities that are caused through smoking, to be storing up future problems with a new generation caused as a direct consequence of vaping or, more sinisterly, as a gateway to smoking later on in life. She is absolutely right.
Gareth Johnson (Dartford) (Con)
I am grateful to the shadow Minister for giving way; he is making a very good speech. No one in this country has ever been shown to have died from vaping, whereas thousands of people die each year from smoking. Yes, the emphasis should be on stopping children from gaining access to vaping and dissuading adult non-smokers from taking up vaping, but does he agree that we should not lose sight of the benefits of vaping for adult smokers in giving up smoking and therefore leading a healthier lifestyle?
Andrew Gwynne
The hon. Gentleman is absolutely right, and later in my speech I will discuss the fact that vaping is a really important tool to assist people who want to stop smoking—indeed, Javed Khan, in his smoke-free 2030 review, made it clear that vaping has an important role to play in that respect. We certainly do not want to throw the baby out with the bathwater, but we absolutely should be ensuring that children’s access to vapes is restricted and that the marketing of vapes is not done in way that attracts a new cohort of people who would never have smoked or vaped. While vaping is better for people than smoking, not vaping is better than vaping or smoking, and we do not want to create new problems.
Dr Alan Whitehead (Southampton, Test) (Lab)
I am sure my hon. Friend has seen the study by King’s College London and Action on Smoking and Health on the attraction of vaping, which concluded that among teenagers de-branding vapes had a deterrent effect on their purchasing them, whereas it had no effect on adults. Does he agree with that study and does he support action being taken along those lines?
Andrew Gwynne
I am grateful to my hon. Friend for succinctly stating the reason for this debate. That study is very clear: for adults, the appearance of the packaging makes no difference, but children and young people are attracted to the bright colours and cartoon characters and so on. The same arguments were made about smoking and led to us moving several years ago to standardised cigarette packaging. The evidence on children vaping is now so overwhelming that Parliament must take the lead. Industry will not act without a nudge from us. We must make sure that vapes are not packaged and advertised in a way that attracts children.
In a recent article penned for The Independent, a teacher in Oxfordshire described having been:
“rostered on to control numbers of students in the toilet block in an attempt to prevent the constant vaping that goes on in there.”
She went on to describe discovering
“a stash of over 50 vapes stored above a ceiling panel in the toilets—a tactic learnt and shared on TikTok.”
Worryingly, ASH estimates that most children who vape make the purchases themselves, despite it being illegal to sell vapes to those under the age of 18.
Tonia Antoniazzi (Gower) (Lab)
My hon. Friend is making an excellent speech. Only yesterday, I had a call from a head of year in Gowerton School in my constituency who wanted to know why the police and social services were not acting on his reports of sales of vapes in a barber’s shop in Swansea city centre. Does my hon. Friend agree that it is up to the police, social services and trading standards to take a stand and stop the face-to-face sale of vapes to under-age children?
Andrew Gwynne
Absolutely. There has to be a strategy that is not just about restricting packaging and advertising. There has to be more enforcement at the local level. I have some sympathy with local government, which has had to endure massive cuts over the past 13 years, so that things such as trading standards have been cut right back to the bone, but there can be no excuse whatsoever for shops selling these products to children. Every action should be taken to prevent that and to enforce the law.
Caroline Nokes (Romsey and Southampton North) (Con)
The hon. Gentleman is making an interesting and important speech, but he is focusing on advertising, marketing, the bright colours and the sweet flavours, and he has not mentioned price. Price promotions are banned for tobacco, yet vapes can sometimes be bought for three for £12, which is pocket money territory.
Andrew Gwynne
The right hon. Lady is absolutely right. We tabled the motion because we believe that the action it calls for is something we can do quickly, but the price of vapes is also a driver, and she is right that we should look into deals whereby vapes can be bought really cheaply—as she says, with pocket money—because that would be another step to take vaping out of the reach of children and young people.
As I said, ASH estimates that most children who vape make the purchases themselves. Put simply, children are then increasingly being hooked on to addictive substances that are deliberately packaged—and, indeed, sometimes priced—to catch their eye. This affects not only their health but their education.
Who could have seen it coming? Well, not the Government, it turns out. In November 2021, my hon. Friend the Member for City of Durham (Mary Kelly Foy) tabled an amendment to the Health and Care Bill that would have given the Secretary of State the power to prohibit branding that appeals to children on e-cigarette packaging. It received cross-party support but was voted down by the Government. When the Minister stands up in a few minutes and claims that the Government are on top of the epidemic of youth vaping, I hope he will explain to the House—to Members from all parties who supported that measure—why the Government voted down that sensible amendment in 2021, and why they are still failing to do something about this acute problem now.
Sadly, this approach to public health has become all too familiar when it comes to the Conservatives. We were promised a tobacco control plan; that was binned. We were promised a health disparities White Paper; that was binned. We were promised a ban on junk food advertising to children; that was binned. Why? Because the Prime Minister is too weak to take on those on the fringes of his own party who view public health with suspicion. That is why, on the Conservatives’ watch, health inequalities have widened, and why vaping companies have been given free rein to profit off children and young people.
The next Labour Government will not allow the trend to continue, which is why in Labour’s health mission we have been clear that we will ban the packaging and marketing of vapes to children, and we will come down like a ton of bricks on those who sell vapes illegally to children.
Caroline Ansell (Eastbourne) (Con)
I agree with the shadow Minister that this is an increasingly serious issue that we must arrest. Does he agree that this is not just a health mission but an education mission? The surest reason why young people will now either give up and desist or not take up vaping is if they understand the harms and the risks, so the new education provision that the Government are helping to bring forward in schools, whereby children themselves will speak to their peers to communicate the risks, is a really important and welcome intervention.
Andrew Gwynne
Of course education has a role. When I went to secondary school, we were educated about the harms of smoking, although it did not stop a number of my peers becoming addicted to cigarettes—to nicotine and tobacco. Education has a role, then, but it does not have a full role. We only really clamped down on smoking and cut the numbers of people who smoke when we introduced regulations on smoking, including the smoking ban, which I am incredibly proud that a Labour Government introduced because it has had massive public health benefits for many people in the years since.
My hon. Friend the Member for Southampton, Test (Dr Whitehead) referred to the research conducted by King’s College London in conjunction with ASH, which suggests that the removal of child-friendly imagery and colours on e-cigarettes can reduce their appeal to children while, crucially, not discouraging their use by adult smokers to quit. This is precisely the balance that the next Labour Government want to strike, so that vapes are used exclusively as a stop-smoking tool by adults, not as a way of getting young people hooked on highly addictive substances such as nicotine. I would hope that ambition was shared on both sides of the House but, unless the Minister changes his mind at the Dispatch Box, the Government are still refusing to commit to a promotion ban. That is bizarre because, in a recent interview, the Prime Minister was asked about the marketing of vapes to children, and he said:
“It looks like they are targeted at kids, which is ridiculous.”
The Prime Minister also said:
“The marketing and the illegal sales of vapes to children is completely unacceptable and I will do everything in my power to end this practice for good.”
Apparently, everything in his power does not include banning the practice of advertising vapes in this way.
Instead, the Government have announced yet another call for evidence, further kicking into the long grass the action that academics, teachers, parents and Members on both sides of the House all agree is essential now. The Government can try all they like to feign outrage at the current situation, but it is partly because of their inaction that we find ourselves in this mess. The Department of Health and Social Care could easily have included these measures in its tobacco control plan, had it not decided to scrap that plan.
The measures are eminently sensible, and we do not need another call for evidence to tell us what we can all see in our own communities. When the Minister responds, I am sure he will point to the illicit vape enforcement squad that the Government announced back in April to enforce rules on vaping and to tackle illegal sales. The squad is obviously welcome, but a few things remain unclear. First, when will the squad start its fieldwork? In a recent answer to a written parliamentary question, the Minister admitted that it will not be until “later this year”. When specifically? We are now in July. What are parents and guardians who are concerned about their children’s vaping expected to do in the meantime?
What the Minister announced in April simply does not add up to a comprehensive tobacco control plan or a strategy for a smoke-free 2030, nor will it stop the companies that are specifically targeting vapes and e-liquids at our children. The Minister knows it and we know it, so let us drop the pretence.
The next Labour Government will end the 13 years of Tory public health neglect that have seen health inequalities widen and healthy life expectancy stall and go into reverse in some communities. In our health mission, we pledged to make this country a Marmot nation, to tackle the social inequalities that influence health and to ensure that children have the very best start possible, to give them the building blocks for a healthy life.
There has been no joined-up plan for public health for 13 years, and the British people have paid the price. That is why Labour will put a mission delivery board right at the heart of Government—one that works across the whole of Whitehall to deliver secure jobs, fair pay, adequate housing, safe streets and clean air. The next Labour Government will build on our legacy of smoking cessation and take the bold steps needed to reach a smoke-free future, a future that has drifted further and further away under this rudderless Government. We will tackle underage vaping and work alongside councils and the NHS to ensure that vapes are used exclusively as a stop-smoking aid.
In short, prevention is better than cure. We will reform our healthcare system so that it focuses relentlessly on preventing the causes of ill health in the first place. For voters, the next general election will be a crystal-clear choice: choose a Conservative Government who have undone decades of progress when it comes to public health, or choose a Labour Government who will work day in, day out to give everyone in Britain the opportunity to lead a happy, healthy and fulfilling life.
I commend our motion to the House.
Andrew Gwynne
What we are here to talk about today is advertising and packaging. I made it very clear in my contribution that the next Labour Government would act robustly on both those issues.
Neil O’Brien
Act robustly? I think we all want to act robustly. The shadow Minister said in his speech that he did not like banana-flavoured vapes, but would they be banned? I am happy to take an intervention if the shadow team have an answer. I do not think that we have an answer. That, ladies and gentlemen, is why we need to have evidence. We need to have an evidence-based approach, and we need to have not just the evidence about what drives these things, but clear definitions of these things on which we can actually take action. We have to be clear about what we are and are not doing within all these fields.
All I was trying to do is to demonstrate that, while we are committed to taking action—I feel very strongly about taking action on this—and while we have done a whole range of different things on this point, we need evidence to make good policy, which is why we are having a call for evidence.
Oral Answers to Questions
Andrew Gwynne Excerpts(9 months, 4 weeks ago)
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Andrew Gwynne (Denton and Reddish) (Lab)
From this complacent Minister’s replies already, one would think that health inequalities in England were improving, not widening. Last year, 11,000 people, including 312 children, were hospitalised for malnutrition in the United Kingdom. That is the highest number since comparable records began. Why are so many people in Britain going hungry under the Tories?
Neil O’Brien
We need to have care in discussing these subjects. Eating disorders are a sensitive subject and the statistics the hon. Gentleman is quoting are a mix of different things. I have already talked about the £3,300 of cost of living support that this Government are providing to the average UK household, with more targeted help for more vulnerable households. It is something we are seized of and are working on.
Draft Tobacco and Related Products (Amendment) (Northern Ireland) Regulations 2023
Andrew Gwynne Excerpts(9 months, 4 weeks ago)
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Andrew Gwynne (Denton and Reddish) (Lab)
It is a pleasure to see you in the Chair, Ms Harris, and to speak on the behalf of His Majesty’s Opposition.
As set out in the explanatory note, the statutory instrument means that from October this year it will be illegal in Northern Ireland to produce or sell heated tobacco products that have a characterising flavour. As the Minister set out, the change is happening because of the requirements of the Windsor framework and is being made in response to a policy change implemented by the European Union. Of course, we would prefer the Northern Ireland Assembly to be sitting, so that the Windsor framework democratic scrutiny committee could involve local representatives in the process, but we are where we are.
It is important to reiterate that heated tobacco products are very different from e-cigarettes: while e-cigarettes heat liquids or salts that typically contain nicotine, HTPs heat tobacco leaf directly, producing a nicotine aerosol that is then inhaled. Unsurprisingly, some in the tobacco industry have made the claim that HTPs are less harmful than conventional smoking, and point to a number of studies that purport to demonstrate this. However, as recent analysis by the University of Bath has shown, a majority of those studies were either affiliated with or funded by—you’ve guessed it—the tobacco industry. Conversely, the European Respiratory Society has pointed to independent research that shows that HTPs emit substantial levels of carcinogens, as well as toxic and irritant substances. Although use of these harmful products is very low in Northern Ireland, as the Minister says, they are increasingly being marketed without the requisite evidence base as a healthier alternative to smoking.
Obviously health is a devolved matter and the Minister represents public health in England, but I wish to press him on whether he plans to adopt similar legislation here so that there is parity between England and Northern Ireland. If not, why not? Have the Government made any assessment of the prevalence of heated tobacco use across the rest of the United Kingdom, and principally in England, along with the wider health implications of such use? Similarly, can the Minister outline what action his Department is taking to combat the increased marketing of such products—marketing that is often underpinned by spurious tobacco industry-backed research?
Finally, can the Minister set out how the Government will assist Northern Ireland in the implementation of the ban, especially given the possibility of illegal importation from England? It does seem odd that following the implementation of the draft regulations there will be more stringent legislation in place to clamp down on heated tobacco in Northern Ireland than in the rest of the United Kingdom. Perhaps the Government considered implementing such a ban in their tobacco control plan or in their health disparities White Paper—but we will never know, because they have both been unceremoniously binned, leaving England lagging behind on tobacco cessation, where we should be leading the way.
The next Labour Government will build on our smoking cessation legacy by taking bold, decisive action to improve public health and empower those addicted to tobacco to quit, but until then we need to see the Government drastically improving their own efforts. However, His Majesty’s Opposition fully support the draft regulations.
Ultra-processed Food
Andrew Gwynne Excerpts(10 months, 2 weeks ago)
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Andrew Gwynne (Denton and Reddish) (Lab)
It is good to see you in the Chair, Dr Huq. I commend the hon. Member for Stourbridge (Suzanne Webb) for securing this crucial debate and for all the work that she and others in the Chamber today are doing on this important topic. We have had a small but perfectly formed debate. I thank my hon. Friend the Member for Strangford (Jim Shannon) and the hon. Member for Stoke-on-Trent Central (Jo Gideon); the hon. Member for Erewash (Maggie Throup), who recently led for the Government on these issues and maintains a keen interest in these matters, which is good to see; and the hon. Member for Linlithgow and East Falkirk (Martyn Day), who leads on health issues for the Scottish National party. I also thank the right hon. Member for East Yorkshire (Sir Greg Knight) and the hon. Member for Glasgow North West (Carol Monaghan) for their interventions. All made crucial points.
Ultra-processed foods are defined as foods that tend to include additives and ingredients that are not typically used in home cooking. They include, but are not limited to confectionery, fried snacks and processed meats. Typically, they are produced to be convenient, quick to eat and appealing. Diets that revolve around UPFs can lead to poor health outcomes, as we have heard, and leave less room for more nutritious meals. We know that balance is essential to a healthy diet, so for most people, cutting out UPFs entirely is not a realistic option. What matters is supporting people to make informed, healthier choices and addressing the wider social determinants that influence their ability to lead a healthy, active life.
That action is important because rising obesity rates pose a profound threat to public health. I would argue that the Government have, unfortunately, responded to this threat wrongly by delaying the ban on junk food advertisements targeted at children and then scrapping the health disparities White Paper. Those are retrograde steps. Instead, the Government have announced a series of pilots, most recently built around the weight loss drug semaglutide, but the reality is that drugs of that sort, while useful for acute cases, are not long-term population-level fixes; they address the extreme end of the problem rather than the cause. My first question to the Minister is: beyond those pilots, what action are the Government taking to tackle rising obesity rates across the United Kingdom? The Government pledged to tackle childhood obesity in their 2019 general election manifesto, but cases have increased, so does the Minister recognise that more needs to be done to improve public health?
I am proud that my party has already committed to establishing at the heart of the next Labour Government a mission delivery board that will ensure that all Departments with an influence over the social determinants of health work in tandem to reduce inequalities and to ensure that health is part of all Government policies. The work will not stop there, though. Under the next Labour Government, every child will benefit from fully funded breakfast clubs and a broad and balanced national curriculum containing a wide range of physical activities. We will end the promotion of junk food targeted at children by implementing the ad ban which the current Government should have introduced—the watershed about which the hon. Member for Stourbridge spoke so passionately. We know that poverty is a key driver of obesity, so we will work tirelessly to tackle child poverty and to ensure that families can afford to feed their children and keep them well.
This is Labour’s vision—positive, ambitious and led by what works—but we cannot afford to wait until the next general election for action on obesity, so I hope that the Minister accepts that more needs to be done and that he will set out how the Government will develop their strategy to tackle obesity, reduce health inequalities and improve access to good, affordable food now. The Labour party stands ready to support him in this action, but it must come sooner rather than later.
Smokefree 2030 Target
Andrew Gwynne Excerpts(10 months, 2 weeks ago)
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Andrew Gwynne (Denton and Reddish) (Lab)
It is a pleasure to see you in the Chair, Mr Sharma. At 9.30 am, it would have been a pleasure to see anybody in the Chair. I place on the record my thanks to you and Mr Evans for stepping into the vacancy. I congratulate the hon. Member for Harrow East (Bob Blackman) and my hon. Friend the Member for City of Durham (Mary Kelly Foy) on securing this important debate and on their tireless work on this issue. When we create a smoke-free England—the consensus here today is for a smoke-free Britain—it will be in no small part thanks to their tremendous efforts and campaigning.
I also pay tribute to my hon. Friends the Members for Birmingham, Erdington (Mrs Hamilton) and for Blaydon (Liz Twist), and the hon. Members for Southport (Damien Moore), for Strangford (Jim Shannon) and for Arfon (Hywel Williams), as well as the hon. Member for Linlithgow and East Falkirk (Martyn Day), who leads for the Scottish National party on health issues. There is consensus across the Chamber on where we need to go.
In 2019, the Government committed themselves to a Smokefree 2030. As Members across the House will be aware, that means a smoking prevalence of around 5% of the population. The commitment was welcomed across the House, and for good reason: despite significant progress in driving down smoking rates over the past 40 years, smoking, as we have heard today, is still the biggest cause of cancer and death in the United Kingdom. Smoking causes around 150 cancer cases every day, and smoking tobacco kills one person every five minutes.
Those deaths are made all the more tragic by the fact that they are avoidable. By creating a smoke-free England, we would empower people to live happier, longer and healthier lives, and substantially reduce pressure on our NHS, as Cancer Research UK estimates that up to 75,000 GP appointments could be freed up each year if we put an end to smoking. That would all come alongside substantial economic benefits, as smoking costs the public finances an estimated £20.6 billion. The argument for a smoke-free future is overwhelming. We just need to get there.
In a recent response to a written question I tabled, the Minister stated that his Department is “confident” that it is
“on course to achieve…Smokefree 2030,”
but Cancer Research UK estimates that the Government are, as we heard from the hon. Member for Harrow East, on track to miss their Smokefree 2030 target by around nine years. Smoking cessation services have faced cuts of 45% since 2015-16, and in some of the most deprived areas of England, smoking rates are increasing, not decreasing.
That increase is incredibly concerning, and it risks exacerbating health inequalities that are already widening, in some cases at an alarming rate. Therefore, I would be grateful if the Minister explained why his Department is so confident that the 2030 target will be met, and where the Government’s modelling is, as well as why it differs from that of Cancer Research UK.
The announcements the Minister made in April were undoubtedly welcome, but they do not seem to me to be ambitious enough or wide-ranging enough to get us back on track. If that is the case, and if we are to miss the 2030 target, the Department of Health and Social Care needs to fess up and say how it plans to keep its pledge. The truth is that the foot has been taken off the pedal with regard to Smokefree 2030. The Government wasted precious time, and unless they act swiftly the target will be beyond reach. I do not want that. I want the Minister to succeed in achieving the target, and I do not think anybody in the Chamber wants us to miss it.
We need action, so I will press the Minister on a few key points. First, will he confirm whether the Government plan to announce any further measures to tackle smoking prevalence, or whether the April announcement is intended to replace the tobacco control plan and the health disparities White Paper?
Secondly, the April announcement referred to an updated strategy to tackle illicit sales and imports of tobacco due to be released at some point this year. There is a backlog of reports to be published sometime this year. We would like this one to be at the front of the queue, not the back. Will the Minister update Members on where the work has got to and when we can expect publication of the strategy?
Thirdly, the Minister will no doubt be aware that Cancer Research UK and ASH have made several recommendations to the Government, most notably on an increase in the age of sale and a “polluter pays” tobacco levy. I would be interested to hear what recent assessment he has made of those proposals and whether they will inform his Department’s work moving forward.
Finally, cross-Government guidance on protecting public policy from the vested interests of the tobacco industry was published yesterday. That is a step in the right direction, but will the Minister set out how the guidance will be disseminated to all branches of Government, given that it is cross-departmental?
The last Labour Government had a proud history of taking bold action to drive down smoking prevalence. We implemented the indoor smoking ban and took action to tackle cigarette advertising, and we are still feeling the benefits of those policies to this day. We want to continue that legacy and, indeed, the measures that were brought in more recently. That is why creating a smoke-free England within a smoke-free United Kingdom will be an absolute priority for the next Labour Government.
Our recent health mission launch set out the first steps of our road map to a smoke-free Britain. They include making all hospital trusts integrate opt-out smoking cessation interventions into routine care and expecting every trust to have a named lead on smoking cessation, so that every single clinical consultation counts towards health improvement. We would legislate to require all tobacco companies to dispel the myth that smoking reduces stress and anxiety. We would also ban vapes from being advertised to children and instead work with councils and the NHS to ensure that vapes are being used to stop smoking—full stop.
That is just the start of our road map to a smoke-free United Kingdom. The next Labour Government wholeheartedly believe in a smoke-free future, and we will not shy away from taking the bold steps that are needed to protect and improve public health. Until then, we are ready to work constructively and across party lines to build a smoke-free England within a smoke-free United Kingdom. I look forward to hearing how the Government plan to get us back on track.
Cancer Medicines: Appraisals
Andrew Gwynne Excerpts(10 months, 3 weeks ago)
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Andrew Gwynne (Denton and Reddish) (Lab)
It is a pleasure, as ever, to serve under your chairmanship, Mrs Harris, and to respond to this debate on behalf of the shadow Health and Social Care team.
I begin by congratulating the hon. Member for Strangford (Jim Shannon), who I call my hon. Friend, on securing this important debate, and I thank him for his tireless work campaigning on such issues.
Also, I pay tribute to my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) for the powerful case that she put to the Minister in respect of brain tumours generally and specifically the glioblastoma manifesto. I very much hope that the Minister is able to take up her challenge, because the inequalities in outcomes that she laid out are unacceptable. In the year 2023, we should not be looking at a situation in which there have been zero improvements in life expectancy from cancers such as glioblastoma since 2005-06 when we have seen dramatic improvements in the other areas that she mentioned. We owe it to Baroness McDonagh—Margaret McDonagh—and to others such as Tessa Jowell to ensure that we see improvements in this area, too.
As for the hon. Member for Chatham and Aylesford (Tracey Crouch), she said herself that she has been on the cancer treadmill, and it is lovely to see her back in her place and up to her old usual tricks. We welcome her.
Tracey Crouch
I just want to say that I was never not in my place; I was fortunate enough to go through cancer treatment during covid, when we were all working under a hybrid procedure. Actually, that experience has helped to form some of the contributions that I have made to the Procedure Committee about how we in this place support people who are going through significant illnesses.
Andrew Gwynne
Absolutely—the virtual Parliament hid a multitude of sins. I know that as somebody who struggled with long covid through that period. Many people would not have known just how ill I was, because I just appeared on a screen. However, it is nice to see the hon. Lady in person; I should put it like that. And she was entirely right to say that cancer touches us all, which is why we can all cite personal experiences of it. I lost my mum to ovarian cancer when I was 19; she was just 50. I lost my dad last year to rectal cancer. I am not alone; we all have people, including close family members and friends, who we have lost to cancer.
I also pay tribute to the hon. Member for Midlothian (Owen Thompson), who responded on behalf of the SNP, for his contribution to the debate and to the right hon. Member for Dwyfor Meirionnydd (Liz Saville Roberts), for her intervention.
I am sure that I speak for everybody from all parties in the House when I say that ensuring that patients have quick access to the most innovative and effective treatments is an absolute priority. This country has a proud history of medical innovation, a reputation that we should try not only to protect but to enhance, as we have already heard today.
We are talking today about the appraisal process for cancer patients, which, as we have also heard, has changed markedly over recent years in several areas. We have seen increased focus on targeted treatments and immunotherapies, as well as reform of the cancer drugs fund in 2016, a move that was taken to improve people’s access to cancer drugs while allowing NICE to collate more information on potential areas of clinical uncertainty.
In a recent report, the Association of the British Pharmaceutical Industry highlighted that 78% of medicines have been able to exit the cancer drugs fund with a positive recommendation, with most of them spending about two and a half years in the CDF process. It also recognised improvements as a result of the relaunched CDF, but raised concerns that the CDF has
“perhaps been overly relied upon”
in order to
“delay making routine recommendations.”
It states that
“a new balance may need to be struck between NICE and manufacturers in considering which treatments should enter the CDF to resolve genuine uncertainty surrounding long-term clinical outcomes and for how long.”
Given that NICE recently set out specific circumstances when committees may be able to accept a higher degree of uncertainty in routine commissioning decisions, can the Minister set out whether his Department has assessed the ABPI’s findings and whether more can be done to improve access to innovative treatments for patients via routine commissioning? That links to a wider point that I wish to raise on clinical research and trials.
Clinical trials provide an opportunity for the NHS, businesses and brilliant researchers to work together for the benefit of everyone. Unfortunately, however, in recent years the UK trials industry has collapsed. The number of commercial trials in the United Kingdom decreased by 41% between 2017 and 2021. Worryingly, the UK has dropped from fourth to 10th in the global rankings, behind Spain, France and Italy. Of most concern is that in 2020-21, the NHS lost £447 million in revenue due to a drop-off in clinical commercial trial activity. Those figures should seriously worry the Minister. They risk putting patients at a disadvantage for all kinds of innovative treatments, including cancer medicines.
In Labour’s recent health mission, we committed to putting Britain right at the front of the queue for new medicines and vaccines. Alongside our pledge to spend 3% of GDP on research and development across the public and private sectors, we want our clinical trials to be more competitive, efficient and accessible. Making those ambitions a reality means tackling unnecessary bureaucracy in how trials are set up and reducing the administrative burden on everyone involved in the clinical trial, including the NHS. Will the Minister set out how his Government plan to reverse the drop-off in clinical research and trials—a drop-off that is costing our NHS financially and clinically?
Finally, I want to touch on the issue of patient access to innovative medicines, including for cancer patients. In 2021, in its “Life Sciences Vision”, the Government committed to identifying and addressing “unwarranted variation” in the uptake of innovative medicines. But in February this year, in the innovation scorecard commissioned on behalf of the Department of Health and Social Care, it was found that a number of areas were still falling short of the NICE recommended levels of new medicine uptake.
Will the Minister provide an update on what work he is doing to improve regional variation in uptake of innovative medicines so that no matter where someone lives, they can access the treatment they need when they need it. Will he also commit to improving the data collected as part of the innovation scorecard to include information on cancer medicines so that we can meaningfully assess uptake and isolate areas for improvement where necessary? That is something that the life sciences sector has called for, so I would welcome more information on that from the Minister.
In conclusion, Labour is wholly committed to ensuring that cancer patients in this country receive access to the very best medicine and care. That means ensuring that appraisals for cancer medicines remain fit for purpose and adapt in line with evolving technologies and scientific advancements. It also means turbocharging clinical trials and tackling the unacceptable gaps in access to cutting-edge treatment. In his response, I hope that the Minister will meet the ambition set out by the Labour party and that we can work together towards making Britain a world leader in cancer care and treatment, because we owe it to all those people on the treadmill right now.