A&E Services: Solihull Borough

Danny Chambers Excerpts

Monday 27th January 2025 Commons Chamber

[Saqib Bhatti]

I cannot disagree with the hon. Gentleman. He makes a really valid point. Of course, it is about not just the travel time, but the time that is spent there. As I will come on to say, there is discussion about the A&E at Heartlands hospital, which has similar issues.

[Dr Danny Chambers (Winchester) (LD)]

On the point about time spent waiting in A&E, one issue we have found in Winchester is that a significant proportion of the caseload consists of people with mental health issues—sometimes suffering a mental health crisis. Many of them are already on a waiting list, but some mental health waiting lists are hitting 18 months or two years from the point of referral to the necessary specialist treatment. That is putting a huge amount of pressure on our A&E departments, as it takes a huge amount of resources to deal with mental health crises. Does the hon. Gentleman agree that investing heavily in mental health services will also help to reduce A&E waiting times?

[Saqib Bhatti]

Of course, investment will make a big difference. That is why I think integrated care boards play an important role, because there is accountability all the way up to the Minister. It is also about how resources are distributed locally for the needs of the community.

I spoke about the journey to Heartlands hospital. At any given time, it can take 40 minutes, and it quite regularly takes more than an hour. In a situation where every minute matters, I am afraid that is just not good enough for my constituents. It could quite literally be a matter of life or death.

Solihull borough has a population of approximately 216,000 people, and that is set only to grow.

Tobacco and Vapes Bill (Eleventh sitting)

Danny Chambers Excerpts

Committee stage
Thursday 23rd January 2025 Public Bill Committees

[Gregory Stafford]

The hon. Lady makes an interesting point. I will not labour my point any further, because I think I have made it; I am sure that the Minister can respond to it when we get there.

The only other thing I will mention is the online advertisements mentioned in a number of the clauses. Is the intention to do with the website displaying the advert, the person who has put forward the advert or the intermediary companies? Online, a lot of adverts are now tailored via cookies. When the Minister goes on to a website, the adverts that he sees are tailored to the things that he has been looking at. I could go on to exactly the same website at exactly the same time and receive a different set of advertisements based on my internet viewing preferences—[Laughter.] I do not know why my hon. Friend the Member for Windsor is laughing. I get a lot of weird stuff, mostly for hoof trimming videos—I am not sure what I typed in to get those. Maybe it is my rural seat. I do not know.

My point is that those advertisements are totally unconnected to the website that I am looking at, which essentially has no control over what adverts are being displayed, as far as I understand it. Because the internet is so complicated, what thoughts does the Minister have about the fact that essentially, the internet provider and the website may not have any knowledge of what adverts are being put on?

[Dr Danny Chambers (Winchester) (LD)]

As part of the solution, legislation must already be in place, because human and veterinary prescription-only drugs are not allowed to be advertised to the public, but they can be advertised to medical professionals. There must be legislation that prevents rogue companies from advertising in the UK products that they are not allowed to advertise to the general public, and I imagine that it should be incorporated into the Bill to address the problem that the hon. Gentleman talks about.

[Gregory Stafford]

Forgive me; I am not sure I fully understand the hon. Member’s point in relation to what I was just saying, but that is probably because I have not explained myself well enough, not because he has misunderstood it. I entirely agree that the advertising of tobacco and vape products should be banned, and I agree with the sentiment and the outline in the law. All I am saying is that when the Minister or the relevant authority seeks to prosecute somebody for this offence, there may be occasions, given the complexity of the internet these days, when people may not know that their website is hosting said adverts. I do not want to labour that point again, but I am sure the Minister can respond.

Tobacco and Vapes Bill (Twelfth sitting)

Danny Chambers Excerpts

Committee stage
Thursday 23rd January 2025 Public Bill Committees

[Dr Danny Chambers (Winchester) (LD)]

To reinforce the point that athletes may be uncomfortable wearing that type of branding, they are not only role models for children, but the epitome of health, fitness and what the human body can achieve. It seems outrageous that they should be advertising harmful products.

[Andrew Gwynne]

Well, some of them are—the way Man City have been playing this season, I am not quite sure. Anyway, we will get back on to the Bill as quickly as possible.

The ban will apply to agreements entered into after the clause comes into force, two months after Royal Assent. It will be an offence if a contribution is made from either party after the specified date, which will be set out in future regulations. The ban will apply to any agreements entered into after that date, and will therefore not apply to existing contracts. The reason for the two-month period is to provide businesses with advance warning and to prevent them from entering into new agreements.

The hon. Member for South Northamptonshire asked whether this could create a rush to get sponsorship deals in place within that two-month window. That is a fair question, but I think that is unlikely for a number of reasons. First, sponsorship deals are pretty tricky contracts and it tends to take more than two months to reach contractual agreement. Secondly, even if matters were expedited, most clubs already have their deals in place, and they would not replace something when they already have a contractual arrangement for something else. Were that unlikely scenario to play out, we would be looking at only a small number of cases anyway.

When drawing up the regulations, we will have to be careful to ensure that no new contract can be signed, and certainly not for the kind of time period that the shadow Minister set out. That would be really out of the spirit of this legislation and the Government might have to come back to tighten it up further.

New Hospital Programme Review

Danny Chambers Excerpts

Monday 20th January 2025 Commons Chamber

[Madam Deputy Speaker (Judith Cummins)]

I call the Liberal Democrat spokesperson.

[Dr Danny Chambers (Winchester) (LD)]

In Hampshire and across the country in 2019 and 2024, Conservative MPs stood on the promise of delivering new hospitals, including one for Hampshire. However, it turned out that there was never any funding for that, and that those were just false promises to try to get votes. I have fought tirelessly to save and improve Winchester’s A&E and consultant-led maternity unit. With the announcement that construction of a proposed new hospital in Hampshire will not even start until between 2037 and 2039, we absolutely need to ensure that the current services are invested in and improved so that they remain fit for purpose.

Given that the new hospital programme is delayed, it is more urgent than ever to increase capacity by fixing social care, so that those who are well enough to leave hospital can be cared for in the community, thus freeing up beds immediately. We cannot endure both insufficient social care packages and crumbling hospitals. Given this delay to the new hospital programme, will the Secretary of State commit to prioritising more social care packages now, rather than waiting three years for a review to be complete?

Although the Health Secretary is not responsible for the state of the NHS or the state of the economy, which the Government inherited, the new hospital programme was seen as part of the solution to the crisis in the NHS, and people across the sector have warned that delaying the programme will only mean more treatments cancelled and more money wasted plugging holes in hospital buildings that are no longer fit for purpose. We are therefore concerned that one of the biggest announcements to affect the NHS over the next few years is coming out right now, during Donald Trump’s inauguration, because it will not get the media attention it deserves. Liberal Democrats therefore urge the Health Secretary to promise to release a full impact assessment on how the delays to the new hospital programme will affect patients and NHS staff.

[Wes Streeting]

I will take those points in turn. With enormous respect for the momentous democratic event taking place in Washington today, I do not think that the new President, last time I checked, had declared an interest in any of our hospital schemes. I am sure he will forgive us for getting on with the job of British government, even as the American handover takes place.

I committed some time ago to coming to the House in the new year. I have kept that promise and I dare say that the decisions that we are taking and setting out today will receive good coverage. I reassure the hon. Gentleman, and other Members across the House with an interest in particular schemes, that my hon. Friend the Minister for Secondary Care and officials from the programme team will be happy to meet as early as tomorrow to take questions on individual schemes.

The hon. Gentleman raises broader challenges for the NHS and social care pressures in our country. That is why the Chancellor prioritised investment in our NHS and social care services in the Budget, with £26 billion of additional funding for my Department of Health and Social Care. On social care specifically, we have taken a number of actions in our first six months: fair pay agreements for care professionals, the biggest expansion of the carer’s allowance since the 1970s and an uplift in funding for local authorities, including specific ringfenced funding for social care. We will be setting out further reforms throughout this year, as well as phase 1 of the Casey commission reporting next year for the duration for this Parliament.

Opposition Members cannot have it both ways. They cannot keep on welcoming the investment and opposing the means of raising it. If they do not support the Chancellor’s Budget, which is their democratic right, they have to say which services they would cut or which alternative taxes they would raise. Welcome to opposition, folks. We’ve been there. Enjoy the ride: you’ll be there for some time.

Finally, let me just say this to the Liberal Democrats, who have constructively raised a range of challenges. This is at the heart of the challenge facing this Government. The hon. Gentleman is right to mention the capital challenges facing the secondary care estate. The same is true of the primary care estate and of the community and mental health estates. As I have spelled out, every single one of my Cabinet colleagues also has significant capital pressures. That is the consequence of 14 years of under-investment in our public infrastructure and in our public services, which means that we are paying a hell of a lot more for the Conservatives’ failure than we would have if they had built on, rather than demolished, Labour’s record of the shortest waiting times and the highest patient satisfaction in history.

Tobacco and Vapes Bill (Sixth sitting)

Danny Chambers Excerpts

Committee stage
Tuesday 14th January 2025 Public Bill Committees

[Dr Johnson]

I thank my hon. Friend for his intervention. Last Tuesday, we heard in evidence from various medical sources, and both the Select Committee and our processor Bill Committee heard in evidence that nicotine is, of itself, harmful, and that the chemicals added to vapes are harmful. In some cases, they are extremely harmful. I will talk more about vaping chemicals later. Indeed, sometimes the products do not contain what they are expected to contain, and that can be worse still. I will return to that subject later, too.

Nicotine is highly addictive and can permanently affect the development of the adolescent brain. We have heard how the industry targets young people, and that is because the adolescent brain is particularly vulnerable. Nicotine can permanently affect its development. Nicotine also fulfils all the criteria for drug dependence. Giving it up is very difficult, and withdrawal symptoms can include cravings, irritability, anxiety, trouble concentrating, headaches and other mental symptoms. Symptoms associated with nicotine and dependence are often not recognised by novice smokers, particularly if they are young.

[Dr Danny Chambers (Winchester) (LD)]

On the subject of how nicotine affects the brain and brain development, one thing we have not really touched on—and we have touched on many physical health issues—is the incidence of smoking among people with mental health issues. One submission was from the Mental Health and Smoking Partnership, which said that 45% of people with a serious mental health issue smoke, and around 25% of people with clinical anxiety. It would stand to reason that the impact on a young person’s brain could also start to lead to serious mental health issues, as well as all the physical health and development issues.

[Dr Johnson]

The hon. Gentleman is right to raise the importance of managing nicotine dependence for those with mental health conditions. We know that smoking, in particular, is more likely to take place among people with mental health conditions or those who are in mental health in-patient units. I am sure we will go on to discuss the issue of vending machines.

Last May, in the previous Bill Committee, we heard evidence from the Mental Health Foundation about the myth that tobacco helps with anxiety, and how that myth needed busting. We also heard about the importance of giving extra support to people with mental health conditions to enable them to kick the habit of nicotine—whether that habit is smoking or vaping—because it will help both their physical and mental health. However, it can be more challenging for them to complete. I am grateful to the hon. Gentleman for raising that important issue.

Returning to clause 10, a study considering the effects in adolescents of nicotine dependence after the initiation of smoking cigarettes found that the symptoms of nicotine dependence can appear only a few days after initiation. Given that oral nicotine pouches contain similar or higher levels of nicotine, similar symptoms may appear following initiation of oral nicotine pouch use, which is why it is particularly important for children that we pass clause 10 and ensure that children are protected from these nicotine products.

Tobacco and Vapes Bill (Fifth sitting)

Danny Chambers Excerpts

Committee stage
Tuesday 14th January 2025 Public Bill Committees

[Andrew Gwynne]

That is precisely the point I was coming to. We will take the argument away because it is a reasonable argument, and we will perhaps consider returning to this issue on Report.

I know that the shadow Minister has every sympathy with the fact that cigarette papers are dangerous when used for the consumption of tobacco, which is what we want to bear down on. As I have said, there are powers in part 5 to restrict the flavours of cigarette papers, but we want to get the balance right so we will take the argument away and consider it.

[Dr Danny Chambers (Winchester) (LD)]

I am reticent to extend the discussion about cigarette papers; I was unaware it was possible to discuss something to such an extent. I am not legally trained, so I ask this for my own understanding as someone who is not a learned Member. If the exact same product was renamed and rebranded as model paper or musical instrument paper, would this law still apply to it?

[Andrew Gwynne]

That is a good question. Of course, if it was to be used for the consumption of tobacco, it would come within the scope of the Bill. We have to be clear that many of these products have dual uses, as we have heard. I am as guilty as anybody of making pipe-cleaner characters for my children and grandchildren—grandchild, rather, because I have only one so far.

We want to make sure that those who want to continue smoking are able to do so, but that obvious restrictions and boundaries are put in place regarding the accessibility of these products, so that no child born after 1 January 2009 will ever legally be sold them.

Tobacco and Vapes Bill (Third sitting)

Danny Chambers Excerpts

Committee stage
Thursday 9th January 2025 Public Bill Committees

[Dr Johnson]

Wisdom or age, but I shall be cautious not to answer too closely.

[Dr Danny Chambers (Winchester) (LD)]

I accept the view that having to provide ID will be inconvenient and frustrating for some people, but all the expert witnesses on Tuesday pointed out that many smokers do not wish the younger generation to continue smoking. I think that most of them would probably be of that view that the slight infringement of their civil liberties in having to carry ID is a small price to pay for the knowledge that they are preventing smoking from being taken up.

[Dr Johnson]

The hon. Gentleman is right that the measures have broad support. Certainly, the pollsters who have investigated people’s views of this legislation—that proposed by the previous Government and the legislation as it is now, with some tweaks to it—have found the public to be overwhelmingly positive. We legislate because we are elected by those people. On the basis of their opinions and given that policing in this country is done by consent—

Tobacco and Vapes Bill (Second sitting)

Danny Chambers Excerpts

Committee stage
Tuesday 7th January 2025 Public Bill Committees

[Euan Stainbank (Falkirk) (Lab)]

Q Do you believe that the generational smoking ban might cause an increase in the use of other nicotine products such as vapes, smoke-free tobacco or even illicit products?

Alison Challenger: We are ultimately trying to reduce the harm caused by smoking—that is the big killer, and we really would not want to lose sight of that. The Bill also brings in elements around the second-hand smoke agenda. It is important to recognise that there are many vulnerable people who would potentially be harmed by breathing in second-hand smoke, so we welcome the fact that the Bill includes that element. As for whether it will increase vaping, it is really hard to know at the moment how that will work out. Potentially more people might switch to vaping, but ultimately, the Bill brings in a progressive approach to taking out smoking tobacco, which is to be welcomed.

[Dr Danny Chambers (Winchester) (LD)]

Q You might not have the answer here, but do you have a rough estimate of what it costs the NHS financially to deal with passive smoking and second-hand smoking every year?

Alison Challenger: I do not have the actual figure, but it is significant. One of the early benefits of the Bill going through will be the impact on children, particularly around asthma. Obviously, second-hand smoke will be exacerbating some of those respiratory illnesses, particularly for children. There is a considerable burden on the NHS as a result of breathing in second-hand smoke. We must also consider those who have cardiovascular disease and those who have existing respiratory illness. It is not always evident that somebody is vulnerable, so it is really important that the measures in the Bill serve to protect those who are vulnerable from inhaling second- hand smoke.

[Dr Chambers]

Q I am assuming that from a public health point of view, looking at the epidemiology, certain communities and demographics will be more greatly affected by this. Is that something that you are mindful of? How do you see the Bill changing health inequalities?

Alison Challenger: We are very mindful of that. Some of the statistics we give around smoking prevalence are an average smoking prevalence for often quite large geographical areas. For my own area in west Sussex, our local survey suggests there is a variance of 4.3% in our most affluent area compared with 16% in our least affluent area. Those are still averages. We also know that in households in the most deprived part of our area, 40% of children are exposed to cigarette smoking from a parent or carer. That is through our own survey.

The point I am trying to make is that there is very much a health gradient, and in those who are most disadvantaged and living in our most disadvantaged areas, we see both higher rates of smoking and more children exposed to that smoking. Those children are more likely to take up smoking if they have been exposed to it.

[Jim Dickson (Dartford) (Lab)]

Q This is to Councillor Fothergill. Are there any circumstances you can envisage where local enforcement would not be enough and the Secretary of State would need to utilise the powers granted in the Bill under clauses 130 and 131 to intervene?

David Fothergill: We have discussed this outside the room, and I think the area we would be most concerned about is illegal sales online. Our local teams could not get into those, and therefore we might need more national resources to break into how people are bringing illegal substances into the UK.

--- Later in debate ---

[Dr Chambers]

Q Dr Ahmed asked almost word for word what I was going to ask, but from a population medicine point of view, do you have a rough estimate of how much smoking is costing the NHS and how much would be saved if the measure was implemented properly?

Professor Linda Bauld: I do not have in front of me the cost to the NHS—other witnesses will probably have it at the tip of their tongue—but it is substantial. If you look at the number of admissions to hospital from smoking, there are over 500,000 every year in England, and we still have over 75,000 deaths. By reducing smoking prevalence, you are going to see very significant impacts and cost savings.

The other thing we know from our research, as previous witnesses have said, is the effect on productivity and workplace absence. As you all know from your constituencies, smoking is also driving some of the loss of people from the workforce in their 50s, early 60s or even younger that we have seen recently. I think that you will see cost savings and an impact on productivity.

The final thing that I would say on that, despite not having the figures in front of me, is that this is an area that causes such a burden to the NHS. One of the things that our CMOs did not make clear earlier, although they said it indirectly, is that if you look at non-communicable diseases in the UK, smoking is the only risk factor that is linked to all four of our NCDs—respiratory conditions, cancer, diabetes and heart disease. It is the only one that is directly linked to all of those. If you think about all of those diseases, and the burden of disease that Sir Gregor mentioned, of a 21% increase by 2040 in my own nation of Scotland, we are going to make an impact on that, and that will achieve cost savings for the NHS—and, importantly, for social care.

[Dr Chambers]

That is well articulated. Thank you.

[Dr Cooper]

Q Thank you for coming along this afternoon. You mentioned the New Zealand case. Could you talk briefly, in case anybody does not know, about what happened and why the standards were dropped? What learnings might we take from that for our legislation?

Professor Linda Bauld: I think there are political aspects to that, which I will not comment on, but obviously the understanding was that it was a very comprehensive and ambitious set of measures that was introduced. Like this Bill, it was about not just the smoke-free generation but other measures as well, including, interestingly, on the density of retail outlets, which might be something for another day or another, potential future measure. A new Government came in and decided not to take it forward.

The learning that we need to take from that, from my understanding and from speaking to colleagues there, goes back to the CMOs’ evidence about the lobbying that is going to occur. The tobacco industry and partners around the industry are very powerful, so persuading colleagues that this is undermining choice and that it will be a burden in terms of regulation, cost to retailers and so on—those were the arguments that were used in New Zealand.

We need to keep a watchful eye, as we think ahead to the regulations and the next steps for the legislation, that we do not open that door too widely and allow those arguments to become too powerful. As you heard earlier, that industry is continually looking for new recruits to replenish those it loses through morbidity and mortality, and that will happen in the UK as well unless we get this right.

--- Later in debate ---

[Andrew Gwynne]

Q The Bill seeks to reduce youth vaping. How do you think we can best achieve that while not deterring adult smokers from quitting?

Professor Steve Turner: That is a really good question. I think that the balance in this Bill—between supporting the 6 million smokers to quit and not engaging children in nicotine addiction—is the right balance. Going back to what I was saying earlier, getting the message across to young people is a multifaceted intervention that requires education as well as legislation. It is a really difficult balance, but I do believe that the Bill, as it is, has that balance just right.

[Dr Chambers]

Q Thank you for coming all the way down from Aberdeen; I worked there for a few years, so I know it is a long way. We have been trying to ask some panellists approximately what this issue is costing the NHS. As a consultant, in your clinic, doing respiratory paediatrics, what proportion of your patients are in some way involved with smoking or second-hand smoking?

Professor Steve Turner: The impact on the whole of society of second-hand smoking in children is complex, but there are various pieces of the jigsaw. First of all, children come to the clinic, are admitted to hospital, come to the emergency department, or go and see the GP, so there is that healthcare side. If any of you have children, however, when your child is off school, that has implications for you as a family; there are some difficult discussions over breakfast about who is going to work and who is not. Therefore, there are a number of different impacts on us as a society, economically and to the NHS from second-hand smoking.

I am not clever enough to put a number on it, but it is a lot bigger than I think people know. I do know that £46 billion is the number cited as the direct health cost to the NHS of smoking—it is almost too big to consider—but I suspect that the wider societal cost will probably be a magnitude greater than that.

[Dr Chambers]

Q Is there a ballpark figure for a general day? When you have a list of paediatric respiratory cases, are maybe 10% or 20% due to this?

Professor Steve Turner: The children who are exposed to second-hand smoke in the home are over-represented among children with respiratory symptoms. Parents do not want their children to smoke, so they feel torn. They are conflicted: they are addicted to nicotine, but they do not want their children to smoke, and having a smoke-free generation will address that almost impossible parental conflict.

[John Whitby]

Q The Bill makes it illegal to sell vaping products to under-18s, and to proxy-buy vapes for children, but it does not make it illegal for under-18s to buy vapes. What is your view on that?

Professor Steve Turner: I support the Bill as it stands. I think that the onus has to be on the vendor not to sell, not on criminalising the customer or the child.

Winter Preparedness

Danny Chambers Excerpts

Wednesday 18th December 2024 Commons Chamber

[Karin Smyth]

I am working very closely with the UK Health Security Agency to make sure that, week on week, we are aware of the movement of different diseases and viruses through the system, and we will continue to publicise the campaign to get people vaccinated. Anything that hon. Members can do to support that campaign, and to make sure that people support themselves and their loved ones, will be gratefully received by the entire system. The campaign is something that everyone can get behind.

[Dr Danny Chambers (Winchester) (LD)]

While we all pay tribute to the NHS staff who work over Christmas, we should remember that they are not only missing Christmas with their families, but putting their own health at risk in caring for us.

On Monday, Winchester hospital declared a critical incident, saying that it could admit no more patients and asking people to seek treatment elsewhere. For years, the chief executive officer of the hospital has been requesting 160 extra social care packages, because the lack of social care is stopping the flow of patients through the hospital. She said that providing such packages is the single biggest thing that would help deal with the winter crisis. In September, Winchester hospital applied for winter crisis funding to put an urgent treatment centre on the front of its A&E department to help deal with the anticipated extra caseload. It is now December, and the hospital has still not heard whether it will get the funding. Given the number of critical incidents being declared, will the Minister meet me and the CEO to discuss how we can support the hospital through this situation, and how we can avoid having a planned crisis next winter?

[Karin Smyth]

As I said earlier, different systems have different issues. Funding has been allocated in advance to the NHS so that it understands which systems require funding, and that has now been baked in for this year. I cannot address the hon. Gentleman’s points directly from the Dispatch Box, but I am very happy for officials to take note of them and to check with the system on what is happening in his particular community. Obviously, it is important that Winchester hospital works closely with its local authority with regard to discharge. We want to improve the better care fund, and I am sure that he will work with the local authority and his hospital to make sure that it works better.

Community Pharmacies: Devon and the South-west

Danny Chambers Excerpts

Tuesday 17th December 2024 Westminster Hall

[Dr Danny Chambers (Winchester) (LD)]

I pay tribute to my hon. Friend the Member for Tiverton and Minehead (Rachel Gilmour) for securing this debate, which is very timely because just yesterday the hospital in Winchester declared a critical incident. It has had so many infectious patients come in with various flus, the norovirus and other infectious diseases that it is short of beds. It has asked people to seek other healthcare arrangements, and has specifically mentioned pharmacies as a place to go for advice.

Alongside providing more social care packages to free up beds, one part of the solution to prevent the yearly NHS winter crisis is to increase the delivery of flu and covid vaccinations well before winter. We have seen that, with the right Government support, our community pharmacies are well placed to deliver vaccinations; they are not just accessible but convenient, and they deliver care right in the heart of a community.

I have been to many pharmacies in and around Winchester, including the Springvale pharmacy in Kings Worthy, the Wellbeing pharmacy on Winchester High Street and the Colden chemist in Colden common. I have spoken to the staff who work there and have heard at first hand that the NHS funding model really isn’t working for them. I was saddened to hear that, although those pharmacists are passionate about their work, they struggle to see how they will remain open for the next 12 to 24 months.

[Caroline Voaden (South Devon) (LD)]

Pharmacies in two of the major GP surgeries in my constituency, Leatside in Totnes and Compass House in Brixham, have closed in the past year because the private operators could not make a profit. Does my hon. Friend agree that it is urgent that we revise the funding model for prescriptions so that pharmacies, particularly in GP surgeries, can survive?

[Dr Chambers]

I completely agree. As other Members said, in some cases it costs pharmacies money to dispense NHS prescriptions. That is clearly not viable, especially given that the core NHS funding for pharmacies has been reduced by about 30% since 2015.

Some healthcare providers are really struggling and are on the brink of financial viability. They include pharmacies, hospices and some social care providers. The increase in national insurance contributions will cost the pharmacy industry approximately £50 million extra this year. Once again, we urge the Government to exempt some healthcare providers from the increase in national insurance or potentially repay that money through another mechanism, because it could be a death blow to social care providers, pharmacies and hospices that are on the brink of financial viability.

I thank hard-working pharmacists, such as the hon. Member for North Somerset (Sadik Al-Hassan), who really are part of the community. People come in; they trust them. Pharmacists have a really good personal relationship with their communities. Through the work they do and the hours they work, pharmacies are a lifeline for millions. They provide nearly a third of consultations outside normal working hours. They are often the only point of care for people living in rural areas. As our population grows older and faces increasingly complex health challenges, pharmacies must be empowered to step up and deliver the reliable, flexible care solutions that our communities desperately need.

As we talk about the strain on the public finances and the NHS budget, we cannot be tempted to see primary care—GPs, mental health provision, pharmacies or dentists—as a cost to be cut. We must invest in them and ensure we keep them viable, because it is always more cost-effective to treat people in their communities and prevent them from getting ill than it is to treat them when they end up in hospital.