Children and Young People with Complex Needs

Charles Walker Excerpts

Friday 10th December 2021 Commons Chamber

[Sir Charles Walker (Broxbourne) (Con)]

Sadly, some children and young people are not able to live safely with their families. The significant majority of these children have experienced trauma at a point during their developmental years, resulting in a range of behaviours, many of which cause distress to them or others. Those behaviours include self-harm and an increased vulnerability to criminal exploitation.

If a young person is unable to live safely at home, he or she may come into the care of the local authority or require hospital care. There is currently an insufficient supply of specialist care to meet the needs of such young people. As a result of the challenges posed by covid-19, health and social care professionals describe an unprecedented level of complexity and acuity of need, making an already difficult situation worse.

When a young person comes into care they will require either a children’s home, with staff skilled and experienced in meeting complex needs, or in some instances a court-directed placement into a secure unit, to keep them safe. Over the past 18 months, Hertfordshire children’s service has made three applications to the national secure bed bank. Despite repeated referrals, a secure placement was achieved for only one child. The most recent referral was made approximately six weeks ago, and on that occasion the local authority was advised that there were 50 referrals for only four available beds. That means that a secure bed was not available for 46 young people who had been assessed as requiring such accommodation to keep them safe. In each of those cases, the relevant authorities, including Hertfordshire, were required to make their own arrangements while the secure referral remained active.

Increasingly, local authorities turn to the courts for a deprivation of liberty order in the absence of more appropriate secure placements. Such orders are sought as a last resort, even though when granted they can place local authorities in the invidious position of having knowingly to place children in environments that are not best suited or equipped to meet their complex needs. Similarly, young people who require psychiatric hospital care find such care unavailable because of a shortage of appropriate hospital beds. In Hertfordshire, a number of young people have been assessed as detainable under the Mental Health Act 1983 and are waiting for appropriate hospital beds. The number waiting for a placement often rests at around 10 children, which means that in each of their cases their needs are not being met.

Despite people’s best efforts, the whole system is creaking because it is unable to cope with the demand. Problems with recruitment and the increasing complexity of some children’s needs mean that Ofsted and the Care Quality Commission too often find themselves in the position of having to close providers down, or reduce their bed capacity. It is important to note that there is a difference between physical beds and usable beds. Many beds are not in service because, in meeting the increasingly complex needs of children in care, there is not the staff capacity safely to service all the available beds in a home.

Not only is the current situation having a detrimental impact on young people, but its impact on the public purse is significant. Delivering bespoke care to a young person, often through a commissioned provider, is very expensive, particularly because these young people, due to the risks they present, will require high staffing levels. Placements are expensive: they can cost from £4,500 a week to upwards of £30,000 a week. Often, a child who has difficulty accessing support further down the needs scale quickly ends up requiring a far most costly set of interventions and specialist care.

It is of course important to intervene early to work with young people in the community to prevent family breakdown and the escalation of needs, but the current placement situation must be addressed, so in this debate I wish to ask regulators to work with the care sector to reopen closed beds through the development of a specialist taskforce that supports providers—be they mental health providers, social care providers or specialist schools—that struggle to deliver good-quality care. Alongside such efforts, we should make a national intervention to reassure providers that their Ofsted rating will not be negatively impacted if they admit children with the most challenging of needs. Too often, specialist care providers will refuse these children because they are concerned that if a child absconds or creates a high level of service demand, that will negatively affect their Ofsted rating.

We also need a national campaign both to challenge the stereotypes about children in care and to recruit residential childcare officers. Such schemes are already in place for fostering and adoption, and we have Teach First and Think Ahead. A similar programme now needs to be introduced to attract people into child social care and, in particular, the care of children with high levels of need.

Backing up this recruitment drive, we need a programme of support to design children’s homes that can accommodate children with the most complex needs but, as I have already said, without extra specialist staff the Government programme to match fund local authorities to develop new children’s homes will face significant challenges. New homes require skilled staff if they are to be viable. Also, in wanting to build new specialist homes, we need to appeal to the better part of people’s human nature, as too many of these specialist homes, when they come up for planning approval, are opposed by local communities.

When it comes to registering specialist residential care homes and facilities, we need to find a way of expediting the Ofsted registration process, which can take upwards of three months. In an emergency, a local authority will sometimes use one of its bedroomed properties as a care setting for a vulnerable child or adolescent, with a rota of specialist social care staff in attendance. Without Ofsted registration, such facilities will be operating outside the regulatory framework.

[Darren Henry (Broxtowe) (Con)]

I hear my hon. Friend’s point about care in the community, which is essential and something we need to focus on. Children and young people with complex needs too often end up in hospital, which is not the right place for them, as they end up being affected by people in hospital with other issues. Care in the community is essential. How can we give local authorities the onus and the investment to make this happen?

[Sir Charles Walker]

I thank my hon. Friend for his intervention, and I will come on to that. We need to have the right setting delivering the right care—the care that the child needs. The child needs to be at the centre of that care.

How does a care emergency arise? That question is often put to me. Beyond the national shortage of beds, a provider can notify a local authority, with only a few hours’ notice, that it will be terminating a young person’s placement in its facility. They can say, “In just a few hours, you will have this child back. This child is now your problem again.” This practice needs to be eliminated, but eliminating it will only alleviate the need for the provision of emergency accommodation and care; it will not end it. That will be done only through the provision of more beds, in both the social care sector and the psychiatric care sector. In the psychiatric care sector, it is not just the overall quantum of beds that counts; it is also the type of bed. These will cover general adolescent units, eating disorders, low-secure units and psychiatric intensive care units.

Almost all the concerns I have highlighted and will highlight this afternoon were identified in Sir Martin Narey’s independent review of residential care and in the Government’s response of 2016. We need to implement the findings of this report and tie them into a review of the Care Standards Act 2000 and the children’s homes regulations.

If anyone watching or listening to this debate wants to learn more about what is happening in this sector, I refer them to an excellent report by the BBC correspondent Sanchia Berg that can be found on the BBC website, dated 12 November, “The court orders depriving vulnerable children of their ‘liberty’”. The report contains harrowing accounts of what is happening, and they are framed throughout by the concerns of the High Court judge Sir Alistair MacDonald, who is deeply concerned about what he is witnessing in the courts and family courts.

Let me return to Sir Martin Narey’s independent review. Beyond its implementation, we need better joined-up care between the NHS and local authorities. The continuing healthcare framework has much to recommend it in relation to children and adolescents, but it is still heavily slanted towards their physical health. A robust commitment to parity of esteem would see the framework cover clinically diagnosed mental illness, as well as the challenges caused by trauma, attachment difficulties and, increasingly, autism. Let me say, as an aside, that all Department of Health legislation should make it perfectly clear that health means mental health and physical health; we cannot have one without the other.

Why is mental health so important? There are still far too many lengthy debates between local authorities and the NHS as to whether a child is suffering from a mental illness or a behavioural difficulty. To many, this seems like dancing on the head of a pin, as the debate does not change the fact that at the heart of the discussion is a child in crisis, as referred to by my hon. Friend the Member for Broxtowe (Darren Henry). A good solution has to be more joint commissioning between health, education and care providers, thereby removing barriers to joint funding. An example of best practice can be found in my own county of Hertfordshire, where we are opening up a three-bed unit that will be jointly staffed by social care professionals and mental health professionals. Perhaps this initiative could pave the way for a national programme of hybrid mental health children’s homes, with a hybrid model of worker.

I must conclude by returning to staffing and recruitment. There really is a need for an enhanced programme of training for residential workers that recognises the unique challenges of the role and the high level of skill required to deliver an effective service. Residential work currently requires a lesser qualification than social work, yet those working in residential settings have significantly more direct contact with the most vulnerable children with the most complex needs. Better training would lead to better pay and an enhanced profile, thereby making the role a career of choice and one which is attractive to graduates.

I have made these recommendations and observations today on behalf of the excellent Hertfordshire County Council, which does a fabulous job across my county, and, of course, on behalf of the children for which it cares. Both Hertfordshire County Council and I want to support the Government’s programme to develop more beds in the secure estate, but we want an estate that is compassionate and able to provide the high levels of care and support that I know, the Minister knows and Madam Deputy Speaker knows, it wants to provide.

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[Maggie Throup]

My hon. Friend makes a very good point, and I will come to that later in my speech.

The lead provider works collaboratively with other providers to ensure the appropriate level of in-patient provision in their area; it is important that we have the right mix of provision, whether it is in-patient or community support. They also ensure that the right community services are available to support children and young people when they are discharged to prevent further crises.

Wherever possible, collaboratives will aim to provide high-quality alternatives to admission. However, where stays are required, they should be short and close to home in a high-quality, safe and therapeutic service. We must of course ensure that the rights of children and young people who are placed under the Mental Health Act 1983 are respected.

We published our White Paper on reforming the Mental Health Act in January 2021, setting out proposals to make the Act work better for people. We are committed to ensuring that the reforms we want to make to the Act also benefit children and young people. We will work to ensure that the rights we plan to introduce for patients are also available to children and young people detained under the Act. Reforms to the Act will limit the scope to detain people with a learning disability or autistic people, helping to reduce unnecessary detentions. To ensure that in-patient settings are therapeutic for autistic people, we are providing £4 million to enable in-patient settings to become more autism friendly.

In children’s social care, we are committed to doing everything we can to support local authorities in ensuring that the most vulnerable children are protected and that there are sufficient places for children in their care. The Government have given more than £6 billion in un-ringfenced funding directly to councils to support them with the impact of covid-19 spending pressures, including in children’s social services.

I take the opportunity to refer briefly to the a point made by the Secretary of State for Health and Social Care in the House a few days ago. He set out that we will be taking further measures to support and protect social care against the threat posed by the omicron variant. We will set out a package of measures at the earliest opportunity. I reassure hon. Members that the timing of the announcement will not have an impact on our ability to implement those protections on the intended date.

The Government are also taking additional steps to support local authorities to fulfil their statutory duties. The spending review 2021 announced £259 million over the spending review period to maintain capacity and expand provision in secure and open residential children’s homes. That will provide high-quality safe homes for some of our most vulnerable children and young people.

We recognise that those in the secure estate are some of the most vulnerable in our society. Children and young people in secure settings are more likely than other young people their age to have additional healthcare needs. The integrated care framework aims to support trauma-informed care, and formulation-driven evidence-based whole-system approaches to creating change for children and young people within the children and young people secure estate.

My hon. Friend the Member for Broxbourne talked about beds. In the NHS long-term plan, we committed to investing at least an additional £2.3 billion in mental health services by 2023-24. That will see 345,000 children and young people a year accessing NHS-funded specialist mental health support if they need it. On 5 March, we announced an additional £79 million of funding that will be used to expand children’s mental health services significantly in this financial year. It will also help to improve access and reduce waiting times for NHS community mental health support.

There is much to be said about how we are supporting and should further support children and young people, not least those who, because of mental illness, learning disabilities, being autistic or complex trauma, are some of the most vulnerable in our society.

[Sir Charles Walker]

On a point of order, Madam Deputy Speaker. The Minister’s Department asked for my speaking notes, which I provided earlier in the week, but barely a question I raised was answered by her. It is not her fault, but I have just had generalities; we got on to social care when I was talking specifically about care for children with a high amount of need. I am confused: what is the point of providing notes to officials in advance of an Adjournment debate if the Minister is not equipped—it is not her fault—with the speech to respond?

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[Sir Charles Walker]

Further to that point of order, Madam Deputy Speaker. I thank the Minister for that kind offer. It was not an attack on her—I think she is as disappointed as I am.

[Madam Deputy Speaker]

I appreciate the points that the hon. Gentleman and the Minister have made.

Question put and agreed to.

Covid-19 Update

Charles Walker Excerpts

Monday 29th November 2021 Commons Chamber

[Sajid Javid]

I heard what the hon. Lady had to say, but the UK does not believe that waiving patent rights and intellectual property rights on these vaccines would be helpful. It would certainly mean that in the future there would be a huge disincentive for pharmaceutical companies to come forward and help the world with their technology.

[Sir Charles Walker (Broxbourne) (Con)]

I say to the Secretary of State that injecting people, not just in this country but around the world, is a huge logistical undertaking. I believe that in India nasal vaccines are used for the administration of the flu vaccine. Please can the Government bring forward nasal vaccines? We did it in nine months for an injectable vaccine—March 2020 to December 2020. It is now nearly December 2021 and there is still no nasal vaccine, despite high levels of efficacy being proven in trials.

[Sajid Javid]

My hon. Friend is right to raise the importance of vaccine delivery mechanisms. If there was an approved nasal vaccine delivery mechanism, it would be helpful. He will understand that we have to allow the regulators the time to assess new delivery mechanisms, but we do take this very seriously.

Down Syndrome Bill

Charles Walker Excerpts

Friday 26th November 2021 Commons Chamber

[Gillian Keegan]

Yes, some of those conversations have happened but I will very much continue them. The scope of this Bill covers only England, but of course health, care, education and housing are also devolved matters. I know that there is a commitment to improve the outcome for people with Down’s syndrome in Scotland, Wales and Northern Ireland, including through legislation, and I look forward to working with other Health Ministers on this matter. I know that they are committed to doing that as well. I look forward to aligning policy, practice and the guidance wherever possible, so that best practice for social inclusion for all people with Down’s syndrome can be realised across the whole of the UK.

[Sir Charles Walker]

I heard a lovely story a few years ago of a young man who was living at home but was travelling to a day care centre independently on a bus. He did that for many months and then his parents got a telephone call saying, “We haven’t seen your son for a month. Where is he?” They said, “Well, he is leaving in the morning and he is coming home in the evening.” So the next morning they followed him discreetly. Halfway along the bus route, he got off the bus and walked into a builder’s merchant, where he had got himself a job. That was surprising, but perhaps we should not be surprised—we should liberate these young people to make great decisions.

[Gillian Keegan]

I completely agree. As several hon. Members have mentioned, employment is important—to all of our lives, actually: it gives us purpose, structure, friendships and relationships. The shocking statistic that only 6% of people with Down’s syndrome are in employment was mentioned and we all must work hard to overcome that problem. That is the case for other learning disabilities, too: the figure for young people with autism is, I think, 22%, which again is not good enough. I hope to address that in my role as Minister for Care and Mental Health, whose brief includes learning disabilities.

To conclude, we are working towards an inclusive society for people with Down’s syndrome. The Bill takes one more step towards making sure that authorities are supported in delivering services that meet the unique needs of people with Down’s syndrome, and making sure this can happen consistently across the country. Once again, I congratulate my right hon. Friend the Member for North Somerset on this important work. I was happy and glad to be the Minister in place when he came forward with his private Member’s Bill and am delighted to be able to offer the Government’s full support.

Covid-19 Update

Charles Walker Excerpts

Friday 26th November 2021 Commons Chamber

[Sajid Javid]

The hon. Lady makes a good point about the need to follow guidance and the rules currently in place. The plan A policies that we put in place remain the policies we need at this time, but she will not be surprised to know that we keep them under review and, if we need to go further, we will.

[Sir Charles Walker (Broxbourne) (Con)]

The shadow Minister mentioned the number of people who are unvaccinated. Please, Secretary of State, can we bring a nasal vaccine to market? Stage 2 trials are proving really positive, with high rates of efficacy. We have to throw the kitchen sink at this. I cannot understand why we are not making nasal vaccines, which would increase the uptake of vaccines in this country and across Europe, available.

[Sajid Javid]

My hon. Friend is right to point to the continued importance of the vaccination programme. There are some 5 million people in the UK who have not received a single shot of any type of vaccine. He is right to talk about the importance of the delivery methods of a vaccine and, as he has mentioned, there are trials of nasal vaccines. However, I am sure he will understand that until such vaccines are approved by our independent regulator, we will not be able to pursue them.

Health and Care Bill

Charles Walker Excerpts

Report stage
Tuesday 23rd November 2021 Commons Chamber

[Sajid Javid]

Yes, absolutely, I can confirm that. My right hon. Friend is absolutely right to stress the importance of that. The NHS will be spending the best part of £150 billion a year, and it is vital that the best value is achieved with every penny that is spent.

[Sir Charles Walker (Broxbourne) (Con)]

May I thank my right hon. Friend and his ministerial team for taking into account my concerns about parity of esteem between mental health and physical health? Although I was unsuccessful in amending the Bill at this stage, I thank him for being willing to look at that, or to have colleagues look at it in the other place. I really do appreciate that level of engagement.

[Sajid Javid]

I am happy to give my hon. Friend the commitment that we will look at that. I think everyone in the House agrees that the principle is vital, and I am sure it is supported across the House.

Let me briefly highlight the changes that we have made. First, we have heard the desire of the House to rate and strengthen the safety and performance of the integrated care systems. Working with members of the Health Committee, we have introduced an amendment that gives the Care Quality Commission a role in reviewing ICSs.

Secondly, we have heard concerns about the independence of integrated care boards. While it has never been our intention that anyone with significant involvement or interests in private healthcare should be on an ICB, following a productive meeting with the hon. Members for Nottingham North (Alex Norris) and for Ellesmere Port and Neston (Justin Madders) we tabled an amendment that ensures we write that principle into the constitution of ICBs.

Thirdly, we heard concerns from hon. Members about the potential impact of our proposed restrictions on advertising less healthy food and drink. We must, of course, do that in a pragmatic way, so we have introduced amendments to ensure we do not unintentionally impact UK businesses when they advertise to overseas audiences. Further, we will consult with stakeholders on any further changes to the nutrient profiling model.

Fourthly, and very importantly, the Bill now reflects our commitment to end the crisis in social care and the lottery of how we all pay for it. It is not right and not fair that the heaviest burdens often fall on those who are least able to bear it, so we are introducing a cap on the costs of care so that no one will have to pay more than £86,000 over their lifetime. That cap that will be there for everyone, regardless of any conditions they have, how old they are, how much they earn, or where they live. We will introduce a far more generous testing system, so that everyone will be better off under the new system.

We move a Health and Care Bill that is stronger than before, with those three underpinning principles reinforced: embedding integration, cutting bureaucracy and boosting accountability. On integration, it is not about simply telling the NHS, local authorities and others to work together; it is about helping them to do it by doing things like merging NHS England and NHS Improvement into a single statutory body and establishing integrated care boards to deliver as one.

Health and Care Bill

Charles Walker Excerpts

Report stage
Monday 22nd November 2021 Commons Chamber

[Edward Argar]

I think my right hon. Friend is talking about executive posts. Yes, there will be processes in place to ensure that employment rights are respected. There will be some roles that are completely new and there will be a competition, but I would expect that those with a significant track record and experience would therefore find themselves in a strong position. I will not prejudge any of those individual decisions.

[Sir Charles Walker (Broxbourne) (Con)]

rose—

[Edward Argar]

I will give way to my right hon. Friend.

[Sir Charles Walker]

I am not a right hon. Member, but I am very happy to take the promotion.

I have tabled a number of technical, totemic amendments on parity of esteem that appear on today’s amendment paper and tomorrow’s. They propose taking general references to “health” in the Bill and changing them to “physical and mental health”. I hope that the Minister will receive those amendments with his usual generosity and make the necessary changes over the next two days.

[Edward Argar]

I take my hon. Friend’s amendments in the spirit in which they are of course intended. I recognise the importance and value that those on both sides of this House put on parity of esteem of mental and physical health. I suspect that we may debate the amendments in subsequent groupings and I look forward to responding then.

We have, in the process of drafting this amendment, heard suggestions that we should simply ban private company employees completely from the boards of ICBs. I am afraid that doing so is not so simple, nor would it achieve the desired result in all cases. In fact, our amendment goes further to underline the importance of NHS independence than would an amendment that focused purely on banning employees of private providers. There are clearly some candidates who would be suitable but may have minor interests in private healthcare. GPs, for example, do provide, and have provided, their excellent knowledge and experience of their patients in guiding commissioning decisions, and some may have private practices as well. Excluding them would be to lose their experience from the NHS, and therefore such an involvement with the private sector would clearly not risk undermining the independence of the NHS.

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[Bell Ribeiro-Addy (Streatham) (Lab)]

I rise to speak against the Bill overall but in favour of new clauses 56 and 57, tabled in my name, and those amendments and new clauses tabled by any Member who has sought to change the pernicious outcomes of the Bill.

Our NHS is really one of the best things about this country, but the Bill is the biggest threat to it yet. It rolls out the red carpet for private companies, ramps up the Government’s long-standing attempts to privatise the NHS, and makes easier what we have witnessed over the past 18 months: the awarding of contract after contract without a competitive process, and the rewarding of failing companies with new contracts again and again.

The Bill will be the destruction of our NHS as we know it, and will widen the inequalities that the pandemic has exacerbated. We now have more than 5.7 million people on NHS waiting lists. Of course, that is not solely because of the pandemic—far from it. After the Government won the 2010 election, around 500,000 to 750,000 people were on NHS waiting lists, and the number rose every year before the pandemic, so the waiting lists are the long-term effect of the Conservative policies of underfunding and privatisation.

Waiting lists have now doubled, and our NHS is in danger of toppling over. All the while, health inequality is rising. That is why, with the support of the Health Foundation, I tabled new clause 57, which would compel the NHS to set out data-collection guidelines on health inequalities. We know that health inequalities exist and have seen them play out with the worst consequences, from postcode lotteries to racial disparities, and it is time that we accepted that, collected the proper data—it is a farce that we do not already do so—and set out to make real change.

Since 2010, improvements in life expectancy in England have slowed more than in any other country in Europe, and the gap between rich and poor in respect of the number of years people can expect to live in good health has widened even further. During the pandemic, that was shown by the higher death rates among people who live in more deprived areas and among certain populations, most notably disabled people and people from black, Asian and minority ethnic communities. Among people younger than 65, the covid-19 mortality rate was almost four times higher for the 10% living in the most-deprived areas than for those living in the least-deprived areas. This is nothing new; the Marmot reviews have covered that many times.

Earlier this year, the King’s Fund found for the NHS Race and Health Observatory that any success we have in tackling health inequalities is always drowned out by other strains, such as waiting times and other clinical priorities. Put quite simply, we cannot tackle inequalities because this Government have never put equality at the front and centre of their policy making. That makes their so-called levelling-up agenda meaningless.

The Bill will enshrine in law the new so-called triple aim to promote various different factors, but the Government are so short-sighted that they have declined to incorporate health inequalities into the triple aim. What a complete missed opportunity that is—or a clear indication that the Government really could not care less. Before anybody says any different, and that the NHS has other means of doing that, we need to look at the state of the outcomes, because what is happening is clearly not working.

The Government continuously and repeatedly fail to accept examples of institutional discrimination, let alone meet their duties under equalities law. We recently heard about how the issues in respect of oximeters and dark skin will have contributed to worse outcomes. The Secretary of State for Health and Social Care has called for a review of gender and race bias in medical equipment; quite frankly, that is groundbreaking—all we seem to do is have reviews. We would already have these types of policies had we just heeded past Government reviews and looked at the equality impact assessments. There is no excuse for the Government to keep ignoring the requirement that is already set out in law for them to meet their equalities duties to people right across this country.

[Sir Charles Walker]

I caught your eye half a minute ago, Madam Deputy Speaker, and you indicated to me with that look that I was next. My heart rate quickened. I am always nervous when I speak in this place because we do really important stuff here—all of us do—and this is an important Bill.

Before the Health and Social Care Bill became an Act in 2012, it was amended by the Conservative Government. It was amended in pursuit of parity of esteem. The Coalition Government changed general references to health to “physical health and mental health”, which was not a courageous thing to do—it was entirely the right thing to do.

I have tabled a series of amendments—10, if I have counted them correctly—for debate over the next two days. They ask the Government to change all general references to health to “mental health and physical health”. It is a call to arms. These changes are not just totemic, but hugely important. Over the next few years, we need to recruit 9,000 more mental health nurses to look after our constituents and more than 800 new psychiatrists, and we need to give all organisations charged with delivering healthcare that nudge, that push, that call to arms that they need to make these important things happen. We also need to send another message from this place—on top of all the other messages that we have sent over the past nine years—that we believe that there is no physical health without good mental health, and that good mental health means good physical health.

I am looking at the Minister because he has made a couple of staggering interventions on colleagues tonight. Colleagues in full flow, prostrating themselves at the feet of Government, have suddenly been rewarded with his stylish, charming intervention of, “The Government have heard your cries, and they shall act on them.” I looked at the joy that spread across the face of my right hon. Friend the Member for Basingstoke (Mrs Miller), and across the face of my right hon. Friend the Member for South West Surrey (Jeremy Hunt), the former Secretary of State, who spoke before me. I look at the support I have from my right hon. Friend the Member for West Suffolk (Matt Hancock), the most recent former Secretary of State—there are a few of them—and from a former Prime Minister. May I ask the Minister to make one of those generous interventions on me this evening? I am still here. I want to sit down, but if he is not going to make that generous intervention right now, I shall be back tomorrow. I shall also be travelling up to the other place and knocking on its door to make sure that these amendments are tabled there, so that, eventually, we get our way.

[Karin Smyth]

I came to this place largely on the back of the disastrous Lansley Act, and I am pleased to see it banished to the dustbin of history, which is what this Bill essentially does. It also banishes to the academic shelves that example of how not to make policy. Lansley took a sledgehammer to our work in primary care trusts, to partnerships, to morale, and to our capacity to forward-plan. Along with the austerity funding that came with it, the Act directly led to the poor state in which we entered the pandemic, and that must be front and centre of any review of the pandemic.

This Bill is a seminal point in the history of the NHS, because it banishes again to the history books experimental competition as an organising principle and a driver of efficiency. The key issue is what replaces it. Now we have in its place local cartels dominated by hospital trusts, and the supreme power of the Secretary of State to interfere in all local decisions. There is no power here for local elected representatives, no power for primary care or community care or mental health, no voice for patients, no voice for the public, and no voice for the taxpayer, who is asked to pay ever more. As we move to an ever more costly health service, accountability and transparency of our NHS in this role has to be at front and centre in order to bring people with us on that journey of paying more.

I have tabled two amendments to this part of the Bill. One is on the need for the local boards to be cognisant of palliative and end-of-life care. The other is on local improvement finance trusts, the local public private sector bodies introduced under the last Labour Government that are instrumental in providing good primary and community care estate—something that this Government are allowing to wither on the vine. My own South Bristol Community Hospital needs more support through these trusts in order to thrive, so that people have decent, good-quality estate from which to receive their care.

I also draw hon. Members’ attention to my new clause 23 on a good governance commission, which will be discussed tomorrow. I genuinely offer it as a helpful way forward. If it were enacted by the Government, it would avoid the cronyism that we have become used to, and would ensure that local bodies are more democratically accountable to their populations and more cognisant of the needs of their local populations. It would ensure that the people leading the local bodies are fit and proper, meet basic criteria regarding what is expected of them and have crucial accountability to local populations. It is akin to the Appointments Commission, which was abolished in the abolition of the quangos; that was a huge mistake. If the Government took notice of it, the new clause would really help us to get around some of the real concerns about how our local health services are governed.

Let me finally address new clause 49 on social care. It is a disappointment and unexpected. We had six weeks in Committee. In that time, we could have looked carefully at the proposal and shone a bit of light on it. The right hon. Member for West Suffolk (Matt Hancock), who is no longer in his place, clearly tried to say what this provision is really about, in that one part of the state should not be subsidising another part of the state. He started to say that that was a true Conservative principle and he was absolutely right. This provision will remind people who are in receipt of benefits that they are in receipt of those benefits, and that anything they may have built up should not be counted towards their future. It is a punitive property tax. I am old enough to remember what happened to the last Conservative Government who introduced a regressive property tax; this Government really ought to think again.

Tobacco Control Plan

Charles Walker Excerpts

Tuesday 16th November 2021 Westminster Hall

[Bob Blackman]

I could not have put it better myself. My right hon. Friend quite clearly makes the comparison between covid-19 and smoking. People cannot help catching covid, but when they smoke they make the choice as to whether they inflict life-changing circumstances on themselves.

[Sir Charles Walker (Broxbourne) (Con)]

Like my hon. Friend, I had a parent who died in their 40s from throat cancer. As we try to migrate 7 million people away from burnt tobacco, the challenge is to move them to less harmful forms of nicotine. Their addiction is to the nicotine; they crave nicotine, not the burning of tobacco. If we can make these transitions, we can reduce harm at a much quicker rate.

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[Sir Charles Walker]

The hon. Member for North Antrim (Ian Paisley) makes an interesting point about taxation. Would it be possible for politicians, with all their imagination, to use the taxation system to encourage cigarette and tobacco companies to transition their products away from combustible tobacco to less dangerous nicotine-delivery mechanisms?

[Bob Blackman]

My hon. Friend makes a good point; clearly, research could be undertaken to establish how we could use the taxation system to transition people in that way. I personally welcome the escalators that have been put on tobacco products and continued by the Chancellor.

Despite the enormous profitability for those companies, major tobacco manufacturers pay very little profit tax in the UK. That probably reflects their global engagement in diverse and elaborate tax avoidance strategies, which allowed Imperial Brands to lower its UK corporate tax bill by an estimated £1.8 billion over the past 10 years, and British American Tobacco to reduce its bill by an estimated £760 million over the same period. Public support is strong for such a measure, with 77% of the public supporting making tobacco manufacturers pay a levy or licence fee to the Government for measures to help smokers quit and to prevent young people from taking up smoking, and just 6% opposing it.

The covid-19 pandemic has put huge pressure on public finances, and there is a desperate need for bold, properly funded policies to level up public health after the pandemic. Our recommendations on the “polluter pays” approach are backed up by a much more detailed policy paper on how this would work, which we commend to the Minister and her officials. Will the Minister commit that the recommendations for a “polluter pays” mechanism will be included in any consideration of how the tobacco control plan should be funded?

My last major point is about raising the age of sale. If England is to be smoke-free by 2030, we need to prevent people from starting smoking at the most susceptible ages—when they are adolescents and young adults. Two thirds of those who try smoking go on to become regular smokers, only a third of whom succeed in quitting during their lifetime. Experimentation is rare after the age of 21. Therefore, the more we can do to prevent exposure and access to tobacco before that age, the more young people we can stop from becoming hooked into this deadly addiction.

Raising the age of sale from 16 to 18 was associated with a 30% reduction in smokers aged 16 and 17 in England, as was increasing the age of sale to 21 in the United States among 18 to 20-year-olds. University College London estimates that increasing the legal age of sale from 18 to 21 would immediately result in 95,000 fewer smokers aged 18 to 20 in 2022, and an additional 77,000 fewer smokers over the long term, to 2030. That would reduce smoking prevalence among 18 to 20-year-olds to 2%, compared to 9.6% without the intervention. It would be simple and inexpensive to introduce, as ongoing enforcement costs are already factored into the existing age regulations. This is the regulatory measure that would have the biggest impact on reducing smoking prevalence among young adults.

Compared to non-smokers aged 18 to 20, smokers in this age group are more likely to be from lower socioeconomic backgrounds. As such, the effect in increasing the age of sale would be particularly beneficial in poorer and more disadvantaged communities. It could also have knock-on benefits. Smoking during pregnancy, for example, is concentrated among young, disadvantaged mothers, and whether a woman smokes during pregnancy is significantly affected by her wider environment. Discouraging experimentation and the uptake of smoking among young, disadvantaged people would prevent smoking in young women who may go on to become pregnant, as well as their male partners, friends and family members. That then reduces the likelihood that young women and their children will be exposed to toxic second-hand smoke during, or indeed after, pregnancy.

In keeping with the current age of sale legislation, raising the age to 21 is not about criminalising those under that age, but about making it much more difficult for them to get hold of tobacco. Increasing the age of sale is supported by a majority of the adult population, with 63% in favour and just 15% opposed. The support is consistent among Conservative, Labour and Liberal Democrat voters—I do not have figures for the Democratic Unionist party. That is also true for those aged 18 to 24, among whom 54% support the measure and just 24% oppose, and for 11 to 18-year-olds, of whom 59% support and 14% oppose.

Given the strength of the evidence and the public consensus that this is the right thing to do, I and other members of the all-party parliamentary group urge the Government to launch a public consultation on raising the age of sale. It is particularly important to encourage children and young adults, who will be most affected by the policy, to participate.

Experience of smoke-free law implementation in England in 2007 showed that a public consultation can help raise awareness and bolster compliance with legislation. For example, 98% of all premises and vehicles inspected in the first nine months after the law was implemented complied fully with the legislation, and 81% of business decision makers thought the law was a good idea.

When the Government rejected the amendment to the Health and Care Bill that would have provided the power to raise the age of sale to 21 by regulation, they said that they would like to review the evidence base for increasing the age of sale to 21 in more detail. That seems to me and others a very good idea. The best way to do that would be by carrying out a consultation, which is what we are calling for in the revised amendment on Report. I urge the Minister not to wait for the debate but to give her support to the consultation now.

My final question for the Minister is this: will she give a commitment to conducting a consultation on raising the age of sale from 18 to 21 within three months of Royal Assent of the Health and Care Bill? That brings me to my conclusion, Mr Bone. I welcome the opportunity to have this debate and look forward to contributions from right hon. and hon Members and the replies from the Front Benchers.

--- Later in debate ---

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

It is a pleasure to serve under your chairmanship, Mr Bone. First, I thank my hon. Friend the Member for Harrow East (Bob Blackman) for securing this important debate and for sharing his personal story with us. I also thank members of the all-party parliamentary group on smoking and health for their tireless work on tobacco control, as well as the APPG on vaping for their work.

The UK is rightly recognised as a world leader on tobacco control. That is because it has invested in a range of interventions over the past two decades, including a strong regulatory framework that has led to, among other things, the introduction of standardised packaging, the end of tobacco displays, and protection from the harms caused by second-hand smoke. Thanks to those interventions, smoking rates in England are down to a record low of just under 14%. However, although we celebrate that success, there are still around 6 million smokers in England, and therefore there is more to be done.

[Sir Charles Walker]

As we have heard, addictions are very powerful, and if we want to get to a smoke-free 2030, we need to break the link between a nicotine fix and smoking lit tobacco.

[Maggie Throup]

I could not agree more with my hon. Friend. The burden of tobacco harms is not shared equally: smoking rates are far higher in poorer areas of the country, and among the lowest socioeconomic groups. Alongside the tragedy created by illness and early deaths, the NHS bears the heavy financial burden of £2.5 billion every year from smoking. In 2019-20, smoking was responsible for nearly half a million hospital admissions and around 64,000 deaths.

The Government have set the bold ambition for England to be smoke free by 2030. To support that ambition, we have been building on the successes of our current tobacco control plan. We will soon publish a new plan with an even sharper focus on tackling health disparities. That new plan will form a vital part of the Government’s levelling-up agenda and will set out a comprehensive package of new policy proposals and regulatory changes, to enable us to meet our smoke-free 2030 ambition.

We are, of course, carefully considering the recommendations of the all-party parliamentary group on smoking and health. Our new tobacco control plan will look to further strengthen our regulatory framework. We are exploring various regulatory proposals, including those put forward as amendments to the Health and Care Bill. We will conduct further research and build a robust evidence base in support of such measures, and will include the strongest proposals in the new plan.

One continuing concern is that one in 10 pregnant women are still smokers at the time of delivery, which is something that the Government are determined to tackle. The maternity transformation programme contains some important measures, and we have made a commitment under our NHS long-term plan that pregnant mothers and their partners will be offered NHS-funded treatment to help them to quit. I know that issue is close to the heart of my hon. Friend the Member for Harrow East. Our new plan will continue to have a strong focus on pregnancy and will encourage more innovation and new approaches to help mothers to quit.

The evidence is clear that e-cigarettes are less harmful to health than smoking. It remains the goal of the Government to maximise the opportunities presented by e-cigarettes to reduce smoking while managing any risks. Our regulatory framework enables smokers to use e-cigarettes to help them to quit, but we do not want to encourage non-smokers and young people to take up those products. In the current tobacco control plan we have actioned the MHRA to help bring medicinal e-cigarettes to the UK market. On 29 October, the MHRA published updated guidance to encourage manufacturers to do so.

Stop-smoking services remain at the heart of our tobacco control strategy, producing high quit rates of 59% after four weeks. Since 2000, they have helped nearly 5 million people to quit. We have protected the public health grant over the course of the spending review, to ensure that local authorities can continue to invest in stop-smoking services and campaigns specific to their areas. We will continue to support local authorities to prioritise those services.

The UK has been recognised as a global leader in tobacco control. We are proud to be a member of the World Health Organisation framework convention on tobacco control. My officials played an active role in the ninth conference of the parties—COP9—last week, and reaffirmed our commitment to deal with the global tobacco pandemic. It was a robust meeting, with more people attending than ever. In my video statement to COP9, I set out the UK commitment to having comprehensive tobacco control policies, including a strong regulatory framework for e-cigarettes. Our commitment to the WHO FCTC is further demonstrated through the overseas development funding we contribute to the FCTC 2030 project, which is now entering its sixth year. That project directly supports the implementation of the WHO FCTC in 31 low and middle-income countries, helping to reduce the burden of death and disease from tobacco.

I will now address some of the issues raised by right hon. and hon. Members. My right hon. Friend the Member for South West Wiltshire (Dr Murrison) talked about restrictions imposed during covid. Covid has highlighted the health disparities across the country. Our ambition to be smoke free by 2030 will play a major role in tackling those disparities. I would like to reassure my hon. Friend the Member for Harrow East that I am conscious of the urgency of the publication of the tobacco control plan. However, I am determined that the plan will have robust and effective measures. He also highlighted measures that the APPG would like to see included. Along with my officials, I am looking carefully at each measure put forward.

Tobacco taxation was raised by my hon. Friends the Members for Harrow East and for Broxbourne (Sir Charles Walker), as well as the hon. Member for North Antrim (Ian Paisley). That is a matter for Her Majesty’s Treasury. However, the Department continues to work with HMT to assess the most effective regulatory means to support the Government’s smoke-free 2030 ambition, which includes exploring a potential future levy.

National Health Service

Charles Walker Excerpts

Tuesday 13th July 2021 Commons Chamber

[Helen Whately]

I am sorry, but I am conscious of the time left.

Several hon. Members have argued that we should continue the current approach to increasing uptake and indeed do more. Of course, we will continue to support care workers to take up the vaccine, but, as flagged by my hon. Friend the Member for Winchester (Steve Brine), the question is: how long do we give that? The vaccination of care home workers in England began in December last year, about eight months ago. We did take a similar approach to that in Scotland mentioned by the hon. Member for Central Ayrshire (Dr Whitford), where staff were vaccinated alongside residents in care homes. NHS teams went into care homes multiple times to offer the vaccination to staff. Indeed, we saw that that was effective and more staff took up the vaccination on subsequent visits. We also opened the national booking system to care home staff early on, before there was wider availability to everybody. We have worked with communities who have been particularly concerned and hesitant about vaccination. There have been materials in multiple languages. We have worked with faith groups. Local authorities have worked closely with care homes, alongside NHS vaccination teams, particularly care homes that have had lower vaccination rates. A huge amount has been done to raise the levels of uptake among care home staff.

We then have to ask ourselves the question: what more can we do? The No. 1 reason care home staff have given us for not yet being vaccinated is that they want some more time. Well, this gives them some more time through the summer in which to get vaccinated. Some care homes, as I have mentioned, are already doing this. One example is the Barchester care home group, which has over 16,000 staff. The vast majority, over 99%, have chosen to be vaccinated. Fewer than 0.5% have chosen not to be vaccinated. But the problem, if we leave it to care homes that are on the front foot to do this, is that others will be left behind and we will see inequality, where some residents are fortunate to be cared for in a care home where all the staff are vaccinated, and others will not be so safe. That leaves us with inequality for those care home residents, who will remain at greater risk. We know that the vaccination not only protects individuals, but reduces the risk of transmission.

Some hon. Members have raised the concern that care workers are being singled out in some way. That is not the case at all. This is about the setting of care homes, where we know there is the greatest risk and the greatest vulnerability to covid. This is about protecting individual residents in those care homes by requiring the vaccination of people who enter those care homes to work—so not only care home staff but NHS staff who enter care homes. This is about protecting residents in those care homes. Fortunately, at the moment, the rates are lower than they have been during peak times, but even in some of the recent outbreaks we have seen in care homes, the index case has been an unvaccinated staff member. That just emphasises the importance of us having high levels of vaccination among staff.

My hon. Friend the Member for Workington (Mark Jenkinson) asked me about the data I referred to earlier, the SAGE data on minimum levels and the extent to which that is being achieved by care homes. I shared the most recent data that I have. What we do know is that there are still hundreds of care homes that have not yet met that safe threshold, which is a minimum threshold for avoiding outbreaks in care homes.

I say to my hon. Friends that the question before us is: what more can we do to protect those who are vulnerable in care homes? This is what we can do and I commend the regulations to the House.

[Sir Charles Walker (Broxbourne) (Con)]

On a point of order, Mr Deputy Speaker.

[Mr Deputy Speaker (Mr Nigel Evans)]

I am afraid that the point of order will have to come after the Division. I am sorry.

Question put.

--- Later in debate ---

The list of Members currently certified as eligible for a proxy vote, and of the Members nominated as their proxy, is published at the end of today’s debates.

[Sir Charles Walker]

On a point of order, Mr Deputy Speaker. I was the Chairman of the Procedure Committee for seven years. It is absolutely incumbent on Government not to mislead the House and to behave honourably at all times. This explanatory memorandum is a parliamentary paper laid many days ago. This has been well rehearsed in this Chamber, but it needs to be rehearsed again. It clearly states:

“A full Impact Assessment has been prepared and will be submitted”—

not is being prepared; “has been prepared”. Through your good offices, Mr Deputy Speaker, may I ask that Mr Speaker and the Clerk of the House conduct an investigation into this memorandum to ascertain whether the House has been misled by the Government and whether the Minister’s conduct at the Dispatch Box was good enough this afternoon?

[Mr Deputy Speaker (Mr Nigel Evans)]

I thank the hon. Gentleman for his point of order. As I said earlier, it is a totally unsatisfactory situation, irrespective of whether anybody has been misled by the statement in one of the official documents. Those on the Treasury Bench will have heard the point of order and will make absolutely certain that it gets through to the Department. I will, as the hon. Gentleman has asked, raise it with Mr Speaker at the prayer meeting tomorrow morning.

Independent Medicines and Medical Devices Safety Review

Charles Walker Excerpts

Thursday 8th July 2021 Commons Chamber

[Emma Hardy (Kingston upon Hull West and Hessle) (Lab)]

I beg to move,

That this House notes the publication of the Independent Medicines and Medical Devices Safety Review, First Do No Harm; further notes the Government’s failure to respond to the recommendations of that review in full; notes the significant discrepancy between the incidence of complication following mesh surgery in the Hospital Episode Statistics and the British Society of Urogynaecology databases, as highlighted in the Royal College of Obstetricians and Gynaecologists’ Project Report, entitled Hospital Episode Statistics as a Source of Information on Safety and Quality in Gynaecology to Support Revalidation; notes that the Government’s plan to publish a retrospective audit to investigate the links between patient-level data to explore outcomes has not been fulfilled; notes that the moratorium on mesh implant procedures should not be lifted until that audit has been undertaken and the true scale of suffering established; notes Ministers’ failure to acknowledge recommendations relating to victims of Primodos; and calls on the Government to fully implement the recommendations for victims of mesh, sodium valproate and Primodos without further delay.

I thank the Backbench Business Committee for allowing this debate. Today is the one-year anniversary of the publication of the report of the independent medicines and medical devices safety review, entitled “First Do No Harm”. It is that report, and the Government’s response to its nine recommendations, that this debate is intended to address. I would like to take this opportunity to thank Baroness Cumberlege, who chaired the review, and her dedicated team. I am delighted that she is able to be here to listen to the debate.

The publication of the report gave hope to so many women who had felt ignored and belittled for years. Since it was published, Baroness Cumberlege has continued to campaign in the other place for the thousands and thousands of women impacted, and I am proud to be supporting her. I pay tribute to the women personally affected by the medical interventions under investigation and their bravery in sharing their stories. In the words of the report,

“They told their stories with dignity and eloquence, but also with sadness and anger, to highlight common and compelling themes.”

The review examined the hormone pregnancy test Primodos, which was thought to be associated with birth defects and miscarriages; sodium valproate, an effective anti-epileptic drug, which caused physical malformations, autism and developmental delay; and pelvic mesh implants, which have been linked to crippling, life-changing complications. The report had a damning conclusion:

“the system is not safe enough for those taking medications in pregnancy or being treated using new devices and techniques”.

[Sir Charles Walker (Broxbourne) (Con)]

I thank the hon. Lady for securing this debate. I do not intend to speak, but I am here today because a constituent has written to me. She has suffered horribly from appalling damage as a result of these procedures. I want to thank the hon. Lady sincerely for bringing this to the Floor of the House and allowing us all to be educated—well, those who need educating, like me.

Coronavirus

Charles Walker Excerpts

Wednesday 16th June 2021 Commons Chamber

[Sir Charles Walker (Broxbourne) (Con)]

I wish to try to be constructive about how we can improve SAGE. As you know, Mr Deputy Speaker, SAGE has huge power over our lives. It has power over whom we hug and hold. It has power over which businesses open and which businesses close. In essence, it has power over who keeps their job and who loses their job. We, too, in this place have great power, but our power is matched by accountability.

Accountability is very important in the exercising of power, so I want to suggest some reforms to SAGE—some quite technical reforms. First, there is a need for greater financial transparency from members of SAGE in line with that expected of Members of Parliament. For example, I think when we look at SAGE members, we should be able to see what their annual income is—not only from their substantive job, but from their pensions accrued or the pensions they might well be in receipt of. This is something that is freely available for all Members of Parliament. I think we should also know and constituents should know if they have any significant shareholdings in companies, in the same way that our constituents know if we have significant shareholdings in companies. We could also look at whether they get other forms of income—from rent, for example.

I am not suggesting for a minute that this would include the spouses or partners of members of SAGE in the same way this does not include our spouses and partners, but given that they are making huge decisions that have huge financial consequences for tens of millions of people, it is important that our constituents know whether or not the people making these decisions are sharing the pain or are insulated from the pain. For example, in the case of young people, many SAGE experts say that young people should be working from home. We know that young people are now tied to their small kitchen table or in their bedroom in miserable environments—the new dark satanic mills—and working endless hours in appalling circumstances, because people with nice gardens and comfortable homes think that is what they should be doing.

There should also be far greater personal accountability. There should be no more, “Here is Sir Mark Walport—of SAGE, but here in a personal capacity”. Nonsense! He is there because he is a member of SAGE. We should also have elections to SAGE, so we could see Sir Mark Walport, Professor Susan Michie, John Edmunds and regular talking heads in our TV studios challenged by people with a different perspective—people such as Professor Karol Sikora, Professor Paul Dolan, who is an expert on human behaviour and quality of life, and Professor Ellen Townsend, who has a huge interest in the welfare of children and adolescents who are now being plagued by anxiety and eating disorders.

[Mr Steve Baker]

My hon. Friend is making a great case, with which I largely agree, but does he agree with me that experts are only human and to an extent we have been asking the impossible of them? They are risk averse—they do not want to be blamed for a disaster—and they will choose to give advice that is cautious. Would he join me in recommending to the Prime Minister the reform that I have put forward, which is to have competitive multidisciplinary expert advice with red team challenge?

[Sir Charles Walker]

I think that is a fantastic and plausible suggestion. We need a diversity of voices, but of course if we had elections, we could get people elected from Independent SAGE, and we know what they want—harder lockdowns, tighter lockdowns and a permanent end to freedoms.

But there is an alternative to elections and to financial disclosure, which is that the Prime Minister could say to members of SAGE, “Here it is: you can either advise me or you can advise the “Today” programme, Sky and Channel 4, but you can’t do both. You can either be a serious scientist at this moment in time advising your Government or you can be a media talking head building a career outside SAGE, but you can’t do both”. I think that is a perfectly legitimate thing to do. We would not expect our generals to give a running commentary on a war, undermining politicians. It is just not acceptable. It is just not acceptable, Mr Deputy Speaker. Can you imagine if the Clerks who advise my Administration Committee were going out and briefing what they would like to see my Committee do and pushing us into a corner all the time? It would not be tolerable. It would not be tolerated in this place, and it should not be tolerated by No. 10.

So here it is: full financial disclosure from members of SAGE and full elections, or they advise the Government, and if they do not want to do that, but want to advise TV studios, they do that, but they do not do both.