Tobacco and Vapes Bill (Fifth sitting)

Gregory Stafford Excerpts

Committee stage
Tuesday 14th January 2025 Public Bill Committees

[Andrew Gwynne]

These clauses make it an offence in England, Wales and Northern Ireland for someone over the age of 18 to buy or attempt to buy tobacco products, herbal smoking products or cigarette papers for someone born on or after 1 January 2009. That is called proxy purchasing. Clause 2 replaces the current offence under the Children and Families Act 2014 of someone aged 18 or over buying or attempting to buy tobacco products or cigarette papers on behalf of someone who is under 18 in England and Wales.

Clause 69 amends the offence of proxy purchasing in Northern Ireland to align to the change in the age of sale. That applies to tobacco products, herbal smoking products and cigarette papers.

[Gregory Stafford (Farnham and Bordon) (Con)]

The Minister said that this measure was to prevent people from buying cigarettes, cigarette papers or tobacco products for people under the age of 18. Obviously, when the Bill is first passed, that will be true, but with every progressive year, it will prevent buying for people aged 19, 20, 21 and 22. Why has the Minister not made a differential in law to ensure that, once the Bill is in place, there is a separate and more serious offence of buying tobacco products for someone under 18, however far in the future, and a separate offence of buying them for an adult who is ineligible to have them?

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[Dr Johnson]

Clause 2 makes it an offence for a person aged 18 or over to make a proxy purchase of tobacco products, herbal smoking products or cigarette papers for a person born on or after 1 January 2009. It essentially stops an older person going in and buying those products for a younger person, which we are aware has been happening for many years with both tobacco and alcohol. If found guilty, the person committing the offence faces a level 4 fine on the standard scale, which hon. Members will recall is £2,500.

The clause replaces the current offence under section 91 of the Children and Families Act of someone aged over 18 buying or attempting to buy tobacco products or cigarette papers on behalf of someone aged under 18 in England and Wales. In many ways, that seems a sensible consequence to clause 1. If we want it to be illegal for people born after a set date to have tobacco, it makes sense to ensure that people cannot buy it for them.

However, I have some questions, particularly in relation to cigarette papers. I did not particularly talk about cigarette papers in our discussion of clause 1 because they are more rightly talked about in relation to clause 2, which treats cigarette papers differently, in so far as it makes them illegal unless a person can prove that they are using them for something else. I looked into what that something else might be. I naively thought that cigarette papers were essentially just bits of paper of a particular thinness that could be rolled up and stuck together with a little gum arabic once somebody had rolled whatever they wanted to roll inside them; in fact, that turns out not to be the case because of the law.

The papers contain ethylene-vinyl acetate, which makes them more fire-resistant. The sad situation is that every year people smoke in bed or in their armchair, fall asleep and cause themselves burns, and sometimes even cause death or house fires. The ethylene-vinyl acetate—a sort of plastic—added to cigarette papers helps them to self-extinguish and reduces the risk of fires; we know that some particularly dreadful fires, such as the Kings Cross fire, are believed to have been caused by loose cigarettes.

The cigarette papers are essentially made from plant fibre, such as bamboo flax and rice, but they can be flavoured and coloured. In the evidence given to the Committee last Tuesday, we heard about the tobacco industry’s aim of ensuring that younger people are enticed by colours and flavours. A quick look at Amazon—other sellers are, of course, available—reveals that people can buy cigarette papers in a whole range of bright colours. People can also buy cigarette papers with pictures of cherries, apricots, bubbles and all sorts of things on them. I thought it was interesting that that has not been covered in relation to cigarette papers. Why give an exemption allowing them to continue to be sold when the reality is that they will continue to be used for rolling either illegal tobacco or other forms of illegal drug?

[Gregory Stafford]

Is my hon. Friend saying that cigarette papers have a specific definition in law and therefore that the papers she talks about, which have chemicals to make them fire-resistant and so on, will be banned, or is she saying that the clause will ban anything that could be used as a cigarette paper within the law? If she does not know the answer, perhaps the Minister can pick that up when he responds.

[Dr Johnson]

Clause 48, which we obviously have not come on to yet, gives the interpretation of part 1 and all the definitions. The definition of cigarette papers in the Bill includes

“anything…to be used for encasing tobacco products or herbal smoking products for the purpose of enabling them to be smoked”.

Different chemicals are put in, believe it or not, to make the ash whiter—people are concerned, when they have burnt their cigarette, with the colour of the ash that has fallen from it, which seems remarkable to me. Calcium carbonate, magnesium carbonate and titanium oxide can be added to affect the colour of not just the paper, but the ash produced. Seignette salts—sodium potassium tartrate and sodium citrate—are also added to make it burn faster, so that people go through cigarettes slightly more quickly. Then there is the glue of the acacia gum.

As far as I can tell, it is impossible to find out what is in the cigarette papers that one might wish to purchase; if one looks online, it is very hard to work out what is in them. I have seen medical reports of people allergic to the ingredients having: cheilitis, or inflammation of the lips; circumoral—around the mouth—inflammation; and finger dermatitis. If one is selling a ham sandwich, it is important to include the ingredients so that people know what it is in it, but it seems that for cigarette papers that is not the case and I am not entirely sure why. It is also the case that some commercially available papers contain copper, chromium and vanadium. As they burn, the pigments can lead to very high levels of exposure. These are not inexpensive; Amazon sells a random choice of eight flavours for £9.99. The issues are worth considering. It has been proposed that individual cigarette papers have on them a message saying “Smoking is bad for you” or something along those lines, but does that not involve adding further chemicals to the paper and therefore further risk?

Clause 2(3) states:

“It is a defence for a person charged with an offence”

of proxy purchasing

“to prove that they had no reason to suspect that the other person intended to use the papers for smoking”,

To which the somewhat obvious question is, “What on earth else would one use cigarette papers for?” With some trepidation, I asked Mr Google. Initially, all I could find was that they are used for smoking joints of cannabis, which did not seem to me a particularly good reason—the smoking of another illegal substance—for the Government to exclude them. Then I found out that some people use them for woodwind instruments. They place them underneath the key and press the key down, which allows extraneous water to be soaked up. They then release the key and pull the paper out. That helps to dry the instrument, prolong its life and prevent damage. Clarinet players—I did learn the clarinet but I did not know this; maybe that is why I was not so good at it—or players of the oboe, bassoon, flute or saxophone can buy cigarettes papers for that purpose.

The question of whether the Government need to provide an exemption for cigarette papers hinges on whether there is an alternative for the public to use for their woodwind instruments—and there is, of course. It is obvious in some respects that the market would provide one were cigarette papers banned. Connoisseurs of such instruments tell me that cigarette papers are not ideal to use for this purpose because of the additional, potentially toxic chemicals they contain—one is potentially inhaling bits of the chemicals back in—and because it is not ideal to get traces of the gum on one’s instrument. It is possible buy Superslick Pad and Yamaha cleaning papers. As far as I can tell, they do not contain toxic chemicals, because nobody would be interested in whether the ash burnt from them was white or otherwise since no one is going to set fire to them. Is it therefore really necessary to have a specific exemption for the use of cigarette papers for instruments, when in practice that is unlikely to be what they will be used for? There is an alternative and the most likely use—I think the Minister will understand this—is that they will be used for smoking joints.

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[Dr Caroline Johnson]

I searched quite extensively for other uses of cigarette papers and had not come across that one; that is very interesting. I do not know whether the hon. Gentleman thinks they need to have pictures on them—perhaps that helps with the art. I think there is still a difference in a cigarette paper that contains extra toxic chemicals to help it burn a particular colour, for example. I am not sure whether there is any particular art or model making application for having the cigarette paper with all the chemicals in, as opposed to any other type of paper that is produced for the purpose. Inevitably, the market would produce a non-cigarette paper for the purpose, which would reduce the amount of toxic chemicals that are used and therefore also the amount of toxic chemicals in our environment—given that, inevitably, once they finish being used, they get wasted.

The point stands that the papers themselves contain toxins that would not be required for any other uses, whether that be for models, art or music. Therefore, since such products are available on the market to buy separately from cigarette papers, though they may currently be slightly more expensive, the Minister may want to consider removing that exemption, because it inevitably creates a loophole for these products to be used for the smoking of illegal tobacco or a joint.

[Gregory Stafford]

It is interesting—now that we have moved on to the alternative uses—to note that anyone who has ever had children knows that pipe cleaners are an essential part of any craft kit. Obviously, they can be used for cleaning a pipe, as well as making a spider or whatever else. The Minister has not sought to ban pipe cleaners in the same way. I wonder why he has picked out cigarette papers, which have alternative uses, but not pipe cleaners, which clearly have alternative uses as well.

[Dr Johnson]

The hon. Gentleman is bringing back painful memories of trying to create things with pipe cleaners for my children, and trying to make them stand up straight when they simply are not quite that stiff—but some fun memories, too. Yes, I do see that they are used in art. That suggests another question. The Minister can correct me if I am wrong, but I presume that the Government have chosen to ban cigarette papers because they want to reduce the amount of people smoking illegal tobacco; it is also an opportunity to reduce the amount of availability of papers for smoking cannabis and other illegal products, but why have they not included filters?

For many years, the tobacco industry has implied that smoking through a filter is safer and many in the population believe that smoking through a filter is safer, but it is a single-use plastic—and I am sure the Minister is very worried about the environment and the use of single-use plastics. The previous Government banned quite a lot of single-use plastic items to reduce waste. The cigarette filter is the most littered item globally every year and it is a single-use plastic. It contains a cellulose acetate filter, which I am told is a plastic pollution. It also increases the risk of a particular form of lung cancer, because the tiny little itty bits of plastic are inhaled into the individual who is smoking. They also increase the way that people draw on a cigarette, which means they could take in more of the toxins when there is a filter than when there is not. Will the Minister discuss whether he plans to include filters on Report?

Let us look at international examples. In 2011, the United States said that all cigarette papers should have Food and Drug Administration approval for their ingredients. Is the Minister considering publishing the ingredients on the packet here in the UK, so that if they are to continue to be sold, people are aware of the toxins they contain? Further, where these products are being used for modelling or art purposes, perhaps such steps will start to reduce the number of toxins contained in them.

As part of clause 2 we are also going to discuss clause 69 stand part. Clause 69 substitutes for article 4A of the Health and Personal Social Services (Northern Ireland) Order 1978. That is, essentially, identical to clause 2, except for the fact that subsection (4) states someone guilty of an offence under the article is liable to a fine “not exceeding level 5”, whereas clause 2 says “not exceedingly level 4.” As the Minister is looking for consistency across the four countries of the United Kingdom, could he explain why he has chosen to have a lower level of fine for the proxy sales offence here than he has in Northern Ireland?

It should be noted that, although we have already discussed clause 50, that part of the Bill provides for legislation for proxy sales in Scotland, where the fine threshold is also set at level 5. I understand that the Minister is a fan of devolution, and wants devolved nations to be able to have different fines, so why has he chosen the fine level for this particular part of the country to be at level 4, which is lower than in Scotland and Northern Ireland? Additionally, section 5 of the Tobacco and Primary Medical Services (Scotland) Act 2010 says that it is illegal to buy, or attempt to buy, for oneself if under 18. Is it the Minister’s intention to amend that? That is my final question on clause 2.

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[Dr Johnson]

I thank the hon. Lady for that.

[Gregory Stafford]

My hon. Friend is making, I think, an important point about whether Ministers, either in England or in the devolved Administrations, can put signs together in order to reduce the burden on a business of having multiple, potentially confusing signs. I understand the point about devolution, but most ordinary people will look for a single regulated sign for this. I wonder whether there is any discussion—even if the Minister cannot legally enforce it within the Bill—about working in tandem with the relevant Ministers in Scotland, Wales and Northern Ireland, so that there can be a standardised sign, so that it is abundantly clear, whether someone is in England, Wales, Scotland or Northern Ireland, that that is the sign, and that it is both clear to consumers and it is clear to businesses what they are supposed to be displaying.

[Dr Johnson]

I thank my hon. Friend for his intervention. It is of course correct that we have devolution, and the hon. Member for Worthing West is of course right that Welsh Ministers—in the same way as Scottish Ministers, and, as I will come to, Northern Irish Ministers—have the capacity to deal with changes to the signs, but it will be easier to have clarity. I am merely suggesting that the Minister could discuss these details with his devolved counterparts and put such measures on the face of the Bill now, rather than not do so and then require, for example, as I said before, the Scottish Ministers to then introduce an SI for something that could be changed much more cheaply with drafting now. It would require much less time and energy from the civil service in Scotland—and spend less taxpayers’ money—to achieve that.

I am interested by the comment from my hon. Friend the Member for Farnham and Bordon about joint signs. The point I was making was about the display space: if someone has to put a lot of different signs up—particularly given that the Minister has shown reluctance on the principle of a nicotine-free generation, which I suspect is where we will end up—and we need to do that at a later date, we will end up with yet another sign with yet another date on it. There comes a point at which the amount of display space available to retailers starts to become smaller, given the required font size.

Before I finish, I have one more quick point, which is just to note that clause 72 is the Northern Irish equivalent added to the Health and Personal Social Services (Northern Ireland) Order 1978, so it is the same as clause 5, with the same effect.

Ordered, That the debate be now adjourned.—(Taiwo Owatemi.)

Hospice and Palliative Care

Gregory Stafford Excerpts

Monday 13th January 2025 Commons Chamber

[Gregory Stafford (Farnham and Bordon) (Con)]

Hospices provide vital care for adults and children with life-limiting conditions, offering end of life care, pain management and bereavement support to families, but despite being this essential part of healthcare, the hospice sector has challenges due to inadequate Government funding and the taxes that they are putting on it, and to workforce shortages. That is all compounded by rising costs and economic uncertainty.

Before I became a Member of Parliament, I have to confess that I had, perhaps fortunately, very little contact with the hospice sector, despite having worked in health and social care for the majority of my career and being a local government councillor for 17 years. During the election campaign, I was invited to the Shooting Star children’s hospice, which has been mentioned by numerous Members across the House. I visited Christopher’s, which is its in-house care facility in Guildford. I think it is actually in the constituency of my right hon. Friend the Member for Godalming and Ash (Jeremy Hunt)—I am sure that the hon. Member for Guildford (Zöe Franklin) will correct me if I am wrong. There I saw the true meaning of selfless day-to-day acts of kindness and care, with people looking after some of the most vulnerable children and their families. They are the absolute exemplar of people providing dying well.

I also have the Phyllis Tuckwell hospice in my constituency, which is currently going through a multimillion-pound rebuild funded by donations from people who have either used or care for our hospice in Farnham. When it is open—hopefully by the end of the year—it will provide 18 new palliative care beds alongside rehabilitation and services for the families as well, along with therapy sessions. Both are shining examples of what dying well should look like.

As other hon. Members have mentioned, the one good thing to come out of the assisted dying debate has been a much greater focus in this House, and indeed across the country, on what it means to die well. I echo some of the comments we have heard: let us get palliative care and hospice care right first, before we start thinking about whether or not we should be allowing people to kill themselves.

Despite the Government’s announcement just after Christmas, which I would be churlish not to welcome, the reality is that adult hospices and children’s hospices are almost totally reliant on charitable donations. The rest comes through the integrated care boards and, as the hon. Member for Scarborough and Whitby (Alison Hume) just mentioned, it is a complete postcode lottery.

I am grateful to the hon. Member for Wimbledon (Mr Kohler) for securing the debate, and he mentioned the significant variation in per person funding depending on where they are in the country and at which hospice they are being treated. The children’s hospice sector is the starkest example, with some places funding just under £30 a head, whereas others fund over £500 a head. This inequity in care clearly leaves some families worse off.

The Government really have not made it easy for the hospice sector. It is still not clear to me that the Health Secretary and the Department of Health had any clue that the national insurance contribution changes were coming down the line. If they were aware, had they allocated this funding beforehand? Was this in their plan, or have they been scrabbling to try to make up the difference since they heard this announcement? Despite asking questions, I have not heard an answer.

We also have not heard whether the Government will cover the costs of the national insurance contribution rise. My personal view is that they must, because the hospice sector, alongside so much of the care sector, is vital not just to the people who use it, but to the wider health economy. Underfunding and taking money from hospice care will have a significant cost impact on other parts of the health service.

[Jim Dickson (Dartford) (Lab)]

The hon. Member seems to welcome the additional £100 million for the hospice sector and, indeed, the additional investment in the NHS that have come out of the Budget, but he seems not to welcome the way in which that revenue is being raised. How would his party raise the revenue needed for the NHS and the hospice sector?

[Gregory Stafford]

Well, the simple fact is that what the hon. Members and his Front-Bench team are doing is ensuring that the NHS is worse off, because raising the money will have a greater impact on the rest of the service. [Interruption.] The Minister for Care is shouting at me from the Front Bench, and I am sure that, in his response to the debate, he can outline whether he and his team knew about the national insurance contribution rises and whether they planned for them.

The other part of this is the workforce, who have been touched on briefly. There is a real shortage of qualified healthcare professionals. Vacancy rates for hospice nurses have risen to nearly 19%, and the corollary is that staff morale is low. Again, the Government need to make sure that the long-term workforce plan that they and the NHS are rolling out includes how we will ensure that hospice staff are part of the long-term funding. Hospice UK has warned, seriously, that without urgent action, some, indeed many, hospices may be forced to close their doors in the next 12 months.

I have some requests of the Government. First, as the hon. Member for Birmingham Erdington (Paulette Hamilton) said, we need them to commit to a long-term sustainable funding model for hospices. That is not to say that hospices should be brought into the central NHS—I personally believe that the innovation of the hospice sector is down to its independence from the NHS—but they need multi-year funding to understand where they stand.

Secondly, as has been mentioned, we need to scrap the postcode lottery that comes from the integrated care boards. Some kind of ringfenced funding, particularly for children’s hospice grants, would prevent a lot of the delays and inequities in the service. As I said, we need to make sure that hospice staff are integrated into the NHS long-term workforce plan and are paid in parity with similar NHS roles.

[Dr Al Pinkerton (Surrey Heath) (LD)]

Will the hon. Gentleman join me in paying tribute to the Phyllis Tuckwell hospice, which does great work in his constituency and mine? I have been speaking to the hospice over the last few days, and it requires £25,000 a day to maintain its services. The hospice has told me that it desperately needs multi-year funding settlements to offer a guarantee of future financial security, as well as a clearly articulated workforce plan to ensure continuity of high-quality staff.

[Gregory Stafford]

I think I mentioned Phyllis Tuckwell at the beginning of my speech, so I entirely agree with the hon. Gentleman. It does fantastic work in Farnham and across Surrey and Hampshire. I am sure like all hospices around the country, it relies on donations but requires secure funding from the Government.

I welcome the £100 million of capital investment. We need to remember that hospices and palliative care are not a “nice to have.” They are absolutely essential charitable services, and they must be fully integrated into the funding and planning frameworks of the Department of Health and the NHS. They provide compassionate, life-changing care to thousands of adults and children every year. However, this vital work is being undermined by short-sighted Government policies.

If the Government are serious about improving end of life care and reducing hospital pressures, they must deliver fair funding, address workforce challenges and ensure that no family are left without the care they need, regardless of where they live. This is not just about numbers—the Minister might listen to this. It is about dignity, it is about compassion and it is about humanity at the most vulnerable time in people’s lives.

[Several hon. Members rose—]

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[Stephen Kinnock]

The hon. Gentleman will not be surprised to know that I have a section in my speech on employer national insurance contributions. I will get to it.

A number of colleagues raised concerns about regional variations. Facts and evidence are very important in that context. To address that issue, NHS England has developed a palliative and end of life care dashboard, which brings together all the relevant local data in one place. The dashboard helps commissioners to understand the palliative and end of life care needs of their local population, enabling ICBs to put plans in place to address, and track the improvement of, health inequalities, and to ensure that funding is distributed fairly, based on prevalence.

[Gregory Stafford]

Will the Minister give way?

[Stephen Kinnock]

I will, but I have to finish at 9.58 pm, so there is only about five minutes left of my contribution.

[Gregory Stafford]

It is generous of the Minister to give way, so I shall be brief. Would funding continue to be produced through ICBs, or will the system be funded centrally?

[Stephen Kinnock]

That is precisely the topic of conversation for officials in my Department and NHS England, who are looking at this issue in the round and deciding how we will work. We need a system that empowers ICBs to deliver at the coalface, but we also need accountability from the centre to ensure that things are delivered. Getting the balance right is never easy, as I am sure the hon. Gentleman will understand; that is what we are trying to navigate.

Alongside NHS England, my officials and I will continue to proactively engage with our stakeholders, including the voluntary sector and independent hospices, to understand the issues that they face. In fact, I will meet the major hospices and palliative care stakeholders, including Hospice UK, early next month to discuss potential solutions for longer-term sector sustainability. That will inform our 10-year health plan.

Tobacco and Vapes Bill (Third sitting)

Gregory Stafford Excerpts

Committee stage
Thursday 9th January 2025 Public Bill Committees

[Dr Johnson]

I thank my hon. Friend for his helpful intervention. I do not know whether any Member present has worked in a small corner shop and could tell us whether they have the same level of technology. Perhaps the Minister or his officials know whether the same level of technology is used in shops across the board. I am afraid that I do not know the answer to that.

[Gregory Stafford (Farnham and Bordon) (Con)]

On that point, will my hon. Friend give way?

[Dr Johnson]

Yes; if my hon. Friend knows the answer, I would be delighted to hear it.

[Gregory Stafford]

I do not know the answer to that question, although I suspect that many such shops do not. Although I agree with my hon. Friend about the thrust of the Bill, something that does concern me comes not from the retailer point of view but the consumer point of view. At the moment—please do not disabuse me of this view—when I go and buy a bottle of wine or a pint of beer, I am very rarely, if ever, IDed. But I accept that if, on the rare occasion that I am IDed, I do not have a form of identification, it is not the biggest problem in the world. Most of the time, however, people can see that I am over the age of 25 or over the age of 18, so it does not happen.

If the Bill were to go forward in its current form, every smoker would essentially have to carry a form of ID all the time. Some, especially the older generation, might not have a suitable form of identification and some—if they are, like me, a civil libertarian—might not want to carry ID, so how do we get around that point in the Bill to ensure that we do not end up having ID cards for older people by the back door?

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[Dr Johnson]

I thank the Minister for his intervention, although I am not sure what he is implying about the age of my hon. Friend the Member for Windsor—

[Gregory Stafford]

Wisdom!

[Dr Johnson]

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

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[Dr Johnson]

The hon. Gentleman is exactly right, in my personal view, to say that. As we heard before, the previous Government wanted to ensure that in bringing forward a Bill, they were not going to criminalise people with an addiction to a product that they could not quit, and therefore leave them in a situation where they could no longer buy the product they needed to feed that addiction. Obviously, we want them to stop, but we do not want to make them stop by making them criminals. So, yes, I would be concerned that sticking in a sudden increase to 25 would mean that any smokers legally accessing tobacco products between the ages of 18 and 25 would find themselves somewhat stuck. That is not something I would wish to see.

[Gregory Stafford]

As a point of clarification, what the proposals in the Bill, and indeed the amendment, deal with is the selling of tobacco products, not the consumption. So when we are talking people not being able to smoke, they would be able to, but a retailer would not be able to sell them tobacco products. I say that just so we are clear what we are talking about.

[Dr Johnson]

According to clause 1, my hon. Friend is right.

[Gregory Stafford]

Yes, under this clause.

[Dr Johnson]

Under this clause, it is true that somebody would not be able to purchase tobacco, but clause 2 means that somebody cannot purchase tobacco on behalf of somebody else. It would not be possible legally for somebody under the age of 25, if the clause was amended, or somebody born after 1 January 2009, if it was not, to buy tobacco, but it would also be illegal for them to use it because, under clause 2, which provides for proxy purchase, the person who gave the younger individual tobacco would themselves have broken the law.

Tobacco and Vapes Bill (First sitting)

Gregory Stafford Excerpts

Committee stage
Tuesday 7th January 2025 Public Bill Committees

[The Chair]

I will go to Gregory Stafford first, and then I will move over to the Government side.

[Gregory Stafford (Farnham and Bordon) (Con)]

Q Do you have any concerns about the impact of the Bill on vapes as a smoking cessation tool? As my hon. Friend the Member for Sleaford and North Hykeham said, vaping in children is abhorrent, and I am glad that the Bill is addressing that, but how can we ensure that, as a cessation tool, vapes remain part of the panoply of options for smokers who are trying to give up?

Professor Sir Chris Whitty: That is a very important question. I think everybody would agree on two things, and then there is a way of making sure that we get to the exact middle point of this argument.

First, as you imply, in this country—it is not universally true—there is a strong view that we should try to continue our support to allow current smokers who are finding it very difficult to get off because of their addiction, which has taken away their choice, to move to vaping as a step in the right direction. I think that is broadly accepted in this country. As I say, there are some countries where that is not accepted so, to be clear, that is not a universal view.

At the other extreme, as you imply—or state directly, actually—I think everybody would agree that the marketing of vapes to children is utterly abhorrent. I think almost everybody would agree that marketing vapes to people who are current non-smokers, given that we do not know the long-term effects of vapes because we have not had them for long enough, is a big mistake. We should not allow ourselves to get into a position where, in 20 years, we regret not having taken action on them.

The question then is: how do you get the balance? In my view, this is sometimes made more complicated than it needs to be. I think it can be very simply summarised: “If you smoke, vaping is safer; if you don’t smoke, don’t vape; and marketing to children is utterly abhorrent.” That is it, although it is sometimes made a lot more convoluted. Our view is that the Bill gets that balance right.

In general, if people’s profession is getting people who are current smokers off, they tend to be more at the pro-vaping end, because they see the dangers for current smokers. People who deal with children, such as Dr Johnson, who has taken great leadership in this area and is very much in the centre of her profession, and the Royal College of Paediatrics and Child Health take a very strong anti-vape view, because they have seen the effects on children. It is getting the balance between those two, and I think that the Bill does that.

But—and it is an important but—the Bill takes powers in this area, and that means that if we go too far in one direction or the other, there is the ability to adjust that with consultation and with parliamentary secondary legislation. That allows for the ability to move that point around if it looks as if we have not got it exactly right. It may also change over time as the evidence evolves.

[Dr Cooper]

Q My question is around inequalities. How effective or otherwise do you think the Bill will be in reducing inequalities? Are there any areas of the UK that have specific challenges related to tackling smoking prevalence that you would like to highlight?

Professor Sir Michael McBride: That is a really important question. We talked before about the blatant marketing of tobacco and vapes. There is also the preying of the industry on those more socioeconomically deprived areas.

If we look at smoking rates in those more socio- economically deprived areas, they are two to three times higher than in less socioeconomically deprived areas. If we consider the death rate from smoking-related conditions, it is twice as high. If we look at lung cancer rates, they are two and a half times as high in those areas. That is a direct consequence of the smoking incidence in more socioeconomically deprived areas. The health inequalities associated with the consumption of tobacco are significant and great.

If we look at smoking in pregnancy and all its consequences in terms of premature birth, stillbirth and low birthweight, we see that smoking among women from more socioeconomically deprived areas is four and a half times higher than among those in less socioeconomically deprived areas. The health inequalities argument and the case to be made for addressing that within the Bill is huge. This is an opportunity that we must not pass up to narrow the adverse health consequences.

Professor Sir Gregor Ian Smith: It is my very clear view that the provisions within the Bill will help us to tackle some of the inequalities associated particularly with tobacco smoking. If I look at the situation in Scotland, 26% of our lowest socioeconomic group are smokers, compared with 6% of our highest socio- economic group.

The gradient that Sir Michael has spoken about in terms of the subsequent tobacco-related disease that those groups then experience is really quite marked, whether that be cardiovascular disease or the numerous cancers associated with smoking. All of those can be addressed by trying to tackle the scourge of these tobacco companies preying on more vulnerable groups within our society, whether that be those who experience socioeconomic circumstances that are much more difficult and challenging for them, or whether that be particular groups that are more likely to experience mental health conditions.

All of these must be tackled; people must be assisted not to develop addictions that lead to lifelong smoking and problems with their health thereafter. I am very clearly of the view, both in terms of smoking and, it is important to say, of vaping, that the targeting of those groups that creates those inequalities within our society is something that this Bill can address.

Oral Answers to Questions

Gregory Stafford Excerpts

Tuesday 7th January 2025 Commons Chamber

[Andrew Gwynne]

Local authorities were pre-selected using the income deprivation affecting children index average rank scores, with a rural and urban weighting applied. Tackling child inequalities in health and outcomes is crucial. As resources allow, it is the ambition of the Government to ensure that Start for Life services reach every child.

[Gregory Stafford (Farnham and Bordon) (Con)]

15. What steps he is taking to ensure that brain tumours are included in the national cancer plan.

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

Let me start by commending the hon. Gentleman for his fundraising efforts to fight cancer in Surrey and his support for the Brain Tumour Charity. We are committed to ensuring that people with brain tumours have access to more effective treatments and excellent care through, for instance, our national cancer plan, and we will give more details shortly.

[Gregory Stafford]

I thank the Minister for his answer, and for his googling of my background! Early detection is essential in ensuring that brain tumours do not fall further behind other cancers in priority. Will the Minister update us on the Government’s progress to ensure that screening is prioritised?

[Andrew Gwynne]

We absolutely want to ensure early detection of these cancers, and I recently met representatives of the Brain Tumour Charity to discuss how we can roll that out. The Government are investing an awful lot of money in tackling cancers, but there is a great deal more that we can do on brain cancer.

NHS Backlog

Gregory Stafford Excerpts

Monday 6th January 2025 Commons Chamber

[Gregory Stafford (Farnham and Bordon) (Con)]

I welcome this debate, although we have had a number of health debates over the past few sitting days that have crystallised the real problem that we see in the NHS. It is stark that none of the Government Members have mentioned covid thus far and its massive impact. [Interruption.] The hon. Member for Carlisle (Ms Minns) is pointing at herself; she might have mentioned it, but she did not set out the absolute devastation that covid wreaked on our services.

Before I came to the House, I worked for the Getting It Right First Time programme, an NHS England programme that was initially funded by my right hon. Friend the Member for Godalming and Ash (Jeremy Hunt) when he was Health Secretary, and again when he was Chancellor of the Exchequer. The programme made a significant difference in getting rid of “unwarranted variation” within the NHS, because while there is some amazing service, treatment and patient care in the NHS, we have to admit that there is also some poor and inefficient patient care.

The Getting It Right First Time programme tried to improve patient care and ensure that the worst-performing trusts were brought up to the level of the best-performing trusts; I hope that the programme will continue to try to achieve that under the current Government. Areas for improvement include high-volume, low-complexity work, such as cataract, hip and knee operations. There are massive backlogs of such procedures in the NHS that could be cleared if some failing trusts reached the level not of the top-performing trusts, but of the top quartile, or the top 10%.

[Lewis Atkinson (Sunderland Central) (Lab)]

The hon. Gentleman worked in the NHS before covid, as did I. He mentions the impact of covid, but does he not recall that in December 2019, before covid hit, standards had already fallen, and only 84% of patients were being treated within the 18 week target? Why was that allowed to happen under the previous Government?

[Gregory Stafford]

I accept that the pressure on the NHS went way beyond covid, as the hon. Gentleman will remember, but to use the Secretary of State’s term, covid was the point at which the NHS was “broken”, and it is taking a long time to recover.

The Government are right to push for more localised services, and to bring services closer to the patient. Access to GPs is a fundamental part of that, but we know that GPs are overstretched. The previous Government really pushed Pharmacy First, which was a superb programme. This Government want to go further with it, but there are disincentives for general practitioners to embrace Pharmacy First. What will Ministers do to ensure that there is no financial disincentive to work with pharmacies? If we are to deal with the backlog, there has to be a financial incentive.

What was concerning about today’s statement from the Secretary of State was the lack of genuine reform. There was a lot of rehashing of previous policies, perhaps eking them out a tad further than the previous Conservative Government did, but I think the Secretary of State himself said that if anyone is able to reform the NHS, it is a Labour Government. While I was quite interested in what he was saying as shadow Secretary of State, I have been deeply disappointed by what he has said since. It appears to me that unfortunately the union paymasters and the inertia in the NHS have captured him and his Front Bench. I hope that I am wrong, and that the Minister will tell me differently this evening, but that is what I have seen.

Locally, the reality is that there is a problem with being able to bring services closer to home. My hon. Friend the Member for Runnymede and Weybridge (Dr Spencer) mentioned the problem of accountability for ICBs. I have the fortune, or misfortune, depending on how one looks at it, of having three ICBs in my constituency. To use a previously mentioned term, there is a lot of unwarranted variation in how they deal with my constituents, and with me as a Member of Parliament. A big issue in Bordon is that we want a brand new surgery in the area, but there has been no conversation with the ICB about how that might go ahead. Likewise, we are really keen for Haslemere hospital to move from being a district hospital to having an urgent treatment centre. It is vital that we get that moving. The community hospital in Farnham could also be somewhere treatment is done closer to home. I urge the Government not to sit back, but to use their majority and reform the NHS for the benefit of all our constituents.

--- Later in debate ---

[Gregory Stafford]

Will the hon. Gentleman give way?

[Peter Prinsley]

May I carry on, as I have very little time?

I am glad that the Prime Minister has made general practice and care in the community a central part of his plan. General practice is the front door to the NHS. Patients who have a genuine connection with one or two GPs are less ill and live longer.

There is an illuminating article entitled “Closer to home” in this month’s Fabian Review by my Suffolk GP colleagues Drs Reed and Havard, who reimagine GP as a comprehensive community health service close to the patient, with multiprofessional teams of health workers and with mental health services and district nursing all in one place. Patients know who their doctors are and know that the community health centre is the place to go. Let us call them Bevan community health centres. We really can manage most clinical problems in the community, and investing in our brilliant GPs is truly the key to the crisis. Community hubs with diagnostic capabilities for larger populations would send to hospital only people who need to go to hospital.

We must do something about productivity. I started my career with four workers in the theatre operating on eight children, only to reach a situation today of operating on four children with eight workers. As we reform and rebuild our NHS, let us bring the 1.5 million staff members with us on this great journey, for it is on them that we and the NHS depend. The measures announced today will surely help, but only if we find enough staff and invest in training. Let us look after those who look after us, with fair pay, fair conditions and a great deal of respect. That must be our mission.

Healthcare: Hampshire

Gregory Stafford Excerpts

Wednesday 20th November 2024 Commons Chamber

[Dr Chambers]

I completely agree with the hon. Gentleman. As a vet who has worked in public health programmes around the world, I know that it has been proven time and again that it is always more cost effective to treat people in their communities and keep them healthy, than to treat them in hospital when they get sick. We need to focus on that. I know the Government have said that they want to move treatment from hospitals into the community.

[Gregory Stafford (Farnham and Bordon) (Con)]

I suspect the hon. Member understands that I probably will not agree with him on the thrust of his argument about Basingstoke hospital. However, on the point about local community services, in my seat, in Whitehill and Bordon, there is a debate about whether we should keep the old Chase community hospital or build a new health hub. There are arguments on both sides, but the one thing that unites the two is the lack of communication from the Hampshire and Isle of Wight integrated care board. Does the hon. Gentleman find it as frustrating as I do that that ICB seems to not want to communicate with residents across the county?

[Dr Chambers]

I agree with the hon. Gentleman; when there is a lack of communication with residents, decision makers and any other interested stakeholders, that is when there are difficulties, such as rumours and unnecessary anxiety. Improved communication, whether in healthcare or in any Government Department, solves a huge number of problems.

On the point made by the hon. Member for Strangford (Jim Shannon) about accessing healthcare when people live in rural areas, I have a story about Margaret, who lives just south of Winchester and who wrote to me saying that she had been given an appointment at Basingstoke for a particular type of X-ray. Her journey to Basingstoke hospital took well over an hour and involved multiple buses and a train, plus considerable walking time. Margaret has chronic obstructive pulmonary disease and gets exhausted walking long distances, and she cannot easily afford a taxi all the way from Basingstoke back to Winchester. She asked me whether people without cars were to become second-class citizens and be denied access to decent healthcare options. We have to look at individuals’ situations, and that can include needing really good public transport. The more community care we have in people’s towns and villages, the quicker they can get there from their homes.

The other side of emergency care and A&E departments is social care. We have said many times that we cannot fix the NHS without fixing social care. We know that in the Hampshire hospitals NHS foundation trust, there are between 160 and 200 people at any given point who are well enough to be discharged and more appropriately cared for in the community with social care packages, but who are currently stuck in a hospital bed and cannot be discharged. That means that patients cannot be moved out of A&E and people cannot be removed from ambulances as quickly as they could be, which means that ambulance waiting times are longer.

When I spoke to the CEO of Winchester hospital, he said that the single biggest help they could get from Government would be another 160 social care packages. Although people ask where the money will come from, we know it is more expensive to keep someone in a hospital bed than to give them a social care package. We have winter pressures coming up—indeed, winter has already started—and the CEO has told me on more than one occasion that, to help with those winter pressures, more social care packages would probably be the single biggest intervention that would make a huge difference. Local authorities struggle to afford social care packages and the NHS trusts have to fund some of those packages out of their NHS budget, which is primarily meant for treating people in hospital.

One of the biggest concerns raised by Winchester residents is the potential removal of consultant-led maternity services at Winchester hospital. That means that if a woman were to haemorrhage or require an emergency C-section during labour, she would need to be transferred. To put that into perspective, in April 2024, 22.7% of births were performed via emergency C-section at Winchester hospital. It is clear that surgical interventions are not an unusual eventuality, but something that will affect more than one in five mothers.

An emergency transfer in such a situation would inevitably put the lives of some women and babies at serious risk and, tragically, some could be lost. A constituent wrote to me about her daughter, who had recently haemorrhaged badly after giving birth to a baby who was in a breech position. The blood transfusion and lifesaving surgery to remove her placenta needed to happen within minutes, and it is unthinkable what would have happened had there been no consultants on hand. As someone who has performed many emergency caesareans—on animals rather than on humans—I know that time is of the essence, and anything that delays surgical intervention can make a huge difference, not just to whether the person and the baby survive but to whether the baby has potential brain damage and other life-changing complications.

As the Liberal Democrat mental health spokesperson, I see this debate as a chance to highlight how desperately we need more resources put into mental health, alongside a more holistic approach to treatment. When speaking to residents in Winchester, one of the most common concerns is the difficulty in accessing mental healthcare, and that is especially true for parents who are struggling to access mental healthcare for their children.

I spoke to a constituent near Swanmore who was struggling to access the mental healthcare and support they needed for their child who was anorexic and had an eating disorder. They had been informed that their child had to reach a lower BMI to qualify for the threshold to get treatment, because resources are so stretched. That would not be considered even remotely acceptable for any other disease. A person with cancer would never be told that they needed to reach stage 4 before they qualified for treatment. We know that outcomes with delayed treatment for mental and physical health disorders, of which eating disorders are a combination of both, will be much less successful and much less cost-effective, requiring longer and less successful treatment the longer that the condition is left. I urge the Minister to look with particular concern at the mental health of young people and children. Delays in mental health treatment for anyone can be catastrophic, but a three-year delay for someone who is only 13, 14, or 15 is a huge chunk of their life.

As part of that, we urgently need to invest in primary care. Failing to address this will only place greater pressure on our already overstretched hospitals. I have spoken to people who have spent extended amounts of time in hospital beds, because they cannot get the mental healthcare that they need.

Similarly, the lack of NHS dentists often forces patients to turn up to hospital, sometimes needing a general anaesthetic, to sort out tooth root abscesses, which costs more than providing NHS dental care. It seems as though all the dentists I speak to say that their current contract for performing NHS care is not fit for purpose. I urge the Minister to look at this as an urgent priority, because so many people are not receiving the dental care that they need. It seems as though this whole issue will not be resolved until the NHS contract is looked at.

The other issue that affects people getting healthcare in their communities, especially around Hampshire, Winchester and the Meon Valley, relates to struggling pharmacies. The situation for pharmacies seems to be very similar to that of the dentists in that their arrangement with the Government for providing prescription services does not seem to be fit for purpose. It seems to be costing pharmacies money to provide prescription drugs, and they are telling me that their businesses are no longer viable. The more pharmacies that we lose, the further people will have to travel to not only collect drugs, but get medical advice and vaccines.

In conclusion, I wish to pay tribute to NHS staff. I imagine that they dread the winter coming up. Every year, it is a stress for them. Every year, they are overworked. And every year, we know that both clinical and non-clinical staff will work longer hours than they are contracted to do. I know that they will be bracing themselves right now. They will be busier, and they will be putting themselves at risk from getting things such as flu, covid and the other respiratory diseases that we see in the winter. One thing that we can all do, both as the public and the Government, is to encourage everyone to get vaccinated ahead of these winter pressures. Anything we can do to prevent a trip to hospital will make their job easier and make it less likely that they will get sick.

--- Later in debate ---

[Andrew Gwynne]

As I said before the hon. Gentleman’s intervention, ultimately these are local decisions, and they must be clinically led. If the trust has decided that certain outcomes that he would like to see are out of scope of the consultation, we must take it as read that there are sound clinical reasons for that. If he thinks otherwise, I am sure that he can bring that up with my hon. Friend the Minister for Secondary Care, but ultimately we must be guided by the clinicians. They know, more than we Ministers in Whitehall will ever know, what the better outcomes for their areas are.

The hon. Gentleman mentioned primary and community care. We know that patients nationally and in Hampshire find it increasingly difficult to see a GP. We are committed as a Government to fixing the front door to the NHS, to ensure that patients receive the care that they deserve. If patients cannot get a GP appointment, they end up at accident and emergency, which is worse for them and more expensive for the taxpayer. That is why we will shift the focus of the NHS out of hospitals and into community. One of our three big shifts is from hospital to community; the others are from analogue to digital, and from sickness to prevention. Those three things, taken as a whole, could be quite transformative in how we deliver primary care.

[Gregory Stafford]

I agree entirely with the Minister on the shift from hospital to community. I do not want to labour the point that I made when I intervened on the hon. Member for Winchester (Dr Chambers), but in the Hampshire part of my seat, we have a debate about whether we will still have Chase community hospital or a new health hub there. They are both essentially local services. The ICB is dragging its feet and will not make a decision on which it will be. Local people do not know what will happen, and decisions are being kicked down the road by the ICB. As my hon. Friend the Member for Hamble Valley (Paul Holmes) said, the leadership of the Hampshire and Isle of Wight ICB is not fit for purpose. Will the Minister meet us and them to ensure that we can get this moving?

[Andrew Gwynne]

I hear loud and clear what Conservative Members say about the leadership of their ICB. I hope that the ICB management will obtain a copy of today’s Hansard and read not only those comments, but the Minister’s reply. I expect them to make decisions in a timely fashion, so that there is some certainty for the local population about the new make-up of health and care services in that area—not just for the sake of patients and the local population, but staff. As we redesign services and change towards more preventive, community-focused care, some parts may become obsolete, and it is absolutely crucial that we take the workforce, as well as the population, on that journey of change in services. I very much hope that the hon. Gentleman’s ICB leadership will have heard the message from the Minister at the Dispatch Box, which is that they really need to crack on, make a decision, communicate it and work with Members of Parliament, the public and staff on whichever changes they propose.

I return to primary and community care. As I said, our manifesto commits to moving towards a neighbourhood health service, with more care delivered in local communities, so that problems are spotted earlier. We will bring back the family doctor by incentivising GPs to see the same patient, so that ongoing or complex conditions are dealt with effectively. In doing so, we will improve continuity of care, which is associated with better health outcomes for patients, and our plan will guarantee a face-to-face appointment for all those who want one; we will deliver a modern booking system that will end the 8 am scramble. That is crucial in improving access to general practice.

The hon. Member for Winchester rightly raised the huge problems with dentistry in his area, which are not that uncommon across the whole country. I do not believe that the previous Government’s dentistry recovery plan went far enough; too many people were still struggling to find an NHS appointment. We are working to ensure that patients can start to access additional urgent dental appointments as soon as possible, and we will target the areas that need the most—the so-called dental deserts. Integrated care boards have started to advertise posts through the golden hello scheme. This recruitment incentive will see up to 240 dentists receive payments of £20,000 to work in the areas that need them most for three years. The common reason why children aged five to nine are admitted to hospital—this is absolutely shocking in the year 2024—is tooth decay. We will work with local authorities to introduce supervised toothbrushing for three to five-year-olds in the most deprived communities. These programmes are proven to reduce tooth decay and boost good practice at home.

To rebuild dentistry in the long term, we will reform the dental contract with the sector, with a shift to focusing on prevention and the retention of NHS dentists. To be fair, this has been an issue for all Governments, going back to the Labour Government who introduced the dental contract. They did so for the right reasons, but in 2010, we recognised that the dental contract was not working in the way we envisaged, and that it had to change. It is shocking that 14 years have passed since then with no real action having been taken—we are determined to fix that. At the same time, we will not wait to make improvements to the system to increase access and incentivise the workforce to deliver more NHS care. We are continuing to meet the British Dental Association and other representatives of the dental sector to discuss how we can best deliver our shared ambition of improving access for NHS dental patients.

I have to say that the statistics for Hampshire and Isle of Wight integrated care board make sorry reading. Only 36% of adults were seen by an NHS dentist in the 24 months to June 2024, compared with 40.3% across England, and 54% of children were seen by an NHS dentist in the 12 months to June 2024, compared with 56% across England. In 2023-24, there were 46 dentists for every 100,000 people in the hon. Gentleman’s trust, whereas the national average across all ICBs in the same year was just under 50 dentists, and in 2024, the general practice patient survey success rate for getting an NHS dental appointment in the past two years in the Hampshire and Isle of Wight ICB area was 72%, compared with 76% nationally. They are not great statistics nationwide, but they are certainly not brilliant in the ICB of hon. Members present, and we look for real improvements there.

Turning to the pharmacy sector, we want to take pressure off GPs by increasing the services offered in community pharmacies. There is so much more that our pharmacists could and should be doing to deliver basic healthcare services on the high street and in the community, as part of the shift from hospital to community. That would free up thousands of GP appointments in cases where people do not really need to see a general practitioner for their condition. We are committed to looking at how we can further expand the role of pharmacies and better use the clinical skills of pharmacists as more become independent prescribers—that is where the potential gets really exciting. Now that the budget for Government has been set, we will resume our consultation with Community Pharmacy England shortly. I hope Members will understand that I am unable to say more until that consultation has concluded. Suffice it to say that Pharmacy First and community pharmacies have a huge role to play in improving health outcomes in the community.

Oral Answers to Questions

Gregory Stafford Excerpts

Tuesday 15th October 2024 Commons Chamber

[Andrew Gwynne]

My hon. Friend is a doughty fighter for her constituents. I am aware that the decision she mentions is an interim measure made by the critical care network, the Lancashire and South Cumbria integrated care board and the NHS trust. The decision will be kept under review and patients impacted will receive the appropriate support. The Government recognise that more must be done to improve the sustainability of the NHS both nationally and in rural and coastal areas.

[Gregory Stafford (Farnham and Bordon) (Con)]

Services at Chase community hospital in my constituency, in Whitehill and Bordon, are being run down by the ICB. This is based on a promise that a brand-new health hub will be built in place, which is much welcomed. It has the support of the Defence Infrastructure Organisation, which owns the land, East Hampshire district council and the community, but the ICB is suffering from inertia. Can the Minister speak to the ICB and suggest that it either builds this new health hub or refurbishes and renovates the Chase community hospital?

[Andrew Gwynne]

I have every sympathy with the case that the hon. Gentleman has put forward. This Government want to see a shift of health services from hospital to community, from analogue to digital, and from sickness to prevention, but these decisions are not taken through inertia; they are taken because of the Government’s inheritance from the Conservative party. We have had 14 years of running down our health services, with needless reorganisations that have destroyed and set back the progress that the last Labour Government made on the NHS. This Government will fix the NHS, including in the hon. Gentleman’s local area, but he has to recognise that the root cause of many of the problems faced by Members across the Chamber lies at the feet of the former Secretary of State and the last Government.

NHS Performance: Darzi Investigation

Gregory Stafford Excerpts

Monday 7th October 2024 Commons Chamber

[Dr Luke Evans (Hinckley and Bosworth) (Con)]

Thank you, Madam Deputy Speaker. I have removed my neck collar, which I am allowed to do, but if Members see my head wobbling, I ask them to intervene and I will put it straight back on. I welcome the hon. Member for South Norfolk (Ben Goldsborough) to his place. With the respect that he talks about and commands, I am sure he will be an asset to the House.

I come to the debate with a slightly unique perspective, and three minutes is very little time to make my point. I have been a doctor since 2007; I sat on the Health and Social Care Committee for three years; and, most recently—and probably most obviously—I recently had spinal surgery on my neck. However, that is not my only foray into the NHS: I have had both knees and my shoulder operated on and my appendix out, and I ended up in intensive care with bilateral pneumonia after that, so I have seen a fair amount of it.

[Gregory Stafford (Farnham and Bordon) (Con)]

The bionic man.

[Dr Evans]

Absolutely. In this debate, health is a political football. It always strikes me that there is a rising tide across the western world, and at the four points of the nation. In Scotland, the NHS is run by the SNP; in Wales, it is run by Labour; in Northern Ireland, it is also separate; and we had the Conservatives, who have now handed it over to Labour. All of them are struggling, and we would do well to remember that. I came into politics not to change the world but to solve that—that sounds cheesy. In my last two minutes I have a set of suggestions—as any good doctor would do, I will look at the short term, the mid term and the long term—to try to improve it.

We could start with a root and branch review into prescribing, which is one of the most wasteful things in the NHS. On top of that, it is worth looking at the European working time directive, which hampers doctors when they study. Overnight, that could increase the ability to see more patients by a couple of percentage points. I spent nine months waiting for my operation, and there were a number of appointment letters. I had the ability to understand them and work my way through them, but a root and branch review of communications—the simple bread and butter of the NHS—would be very welcome. Comparable data across the nations, to see what goes on, is so important.

For the medium term, I would like statementing when people go into the NHS. Everyone knows how much it costs when they go to America—£40,000 for a ski accident. It costs that much here, and people would do well to remember that when they do not turn up to their appointments. On the IT system, we focus a lot on patients but I would like more focus on the staff and how they can use IT. I would like capping of GP lists—a sensible way, now that we have a workforce plan in place, to grow our staffing.

Finally, for the long term, in the 20 seconds I have I suggest a national service for SEND, taking education and health together to deal with mental health. Some 40% of the child and adolescent mental health services referrals in Leicestershire relate to autism and ADHD. That is a real problem that could easily be solved. In my final five seconds, I suggest an NHS centre for clinical excellence to share best practice. It is not good enough.

--- Later in debate ---

[Gregory Stafford (Farnham and Bordon) (Con)]

I have worked in healthcare for most of my career and, as I said in my maiden speech, I think we need an honest discussion with the public about how we fund, provide and deliver healthcare in England. I worked in the NHS for seven years prior to my election, and I worked every day to improve clinical outcomes and patient care, including in the surgical hubs mentioned by the shadow Secretary of State, my right hon. Friend the Member for Louth and Horncastle (Victoria Atkins).

I can assure the House that, although it has significant challenges, the NHS also has significant opportunities, including the opportunity for us to reshape it not only to meet the needs of today but to ensure its survival for future generations. Lord Darzi’s report, like many others, makes it clear that, although it is not broken, the NHS is at a tipping point. His report is wide-ranging, but it could not cover everything. For example, post-natal female care received little attention, but it is essential to ensuring a universal standard of post-birth care for mothers and children.

Despite significant investment from the previous Government, we must be honest with the public not only about the true state of the health service, both nationally and locally, but about the difficult choices that lie ahead. First, we need to rethink how we deliver healthcare closer to home and more efficiently. Expanded partnerships with the private sector, whether in diagnostics, elective surgery or mental health services, can relieve some of the burden on NHS facilities. By fostering public-private partnerships, we can enhance capacity and efficiency while ensuring that the NHS remains free at the point of use.

Technology and innovation are essential to transforming the NHS. Artificial intelligence, digital records and telemedicine have enormous potential to improve outcomes and reduce costs, but the NHS lags behind in digital transformation—the catastrophe of Labour’s IT system casts a long shadow.

Equally, we must have an honest conversation about patient choice and responsibility. The NHS has historically promised to be everything to everyone, but we must ask ourselves if this is realistic. Encouraging patient choice could drive competition and improve service delivery, but we also need to ask patients to take greater responsibility for managing their health, particularly in areas such as preventive care and chronic disease management.

Finally, funding is key to this debate. For too long we have relied on promises of increased funding without fully grappling with how we can sustainably finance the NHS. More money is part of the solution, but where should that money come from? I want an NHS that is free at the point of use, but we need to explore social insurance models, encourage private investment or potentially increase taxes. These are tough questions, but they must be answered. We need a radical rethink of NHS bureaucracy.

In conclusion, although the NHS is one of the major achievements of our time, now is the time to take action to reform it.

Government Policy on Health

Gregory Stafford Excerpts

Monday 9th September 2024 Commons Chamber

[Wes Streeting]

I would be delighted for either myself or one of my ministerial colleagues to take my hon. Friend up on that offer. What a refreshing change from so many of the contributions that we have had this afternoon from the Opposition. Of course we want to learn from people with experience and expertise in getting it right on the NHS and social care. Many of those people are outside Government. Many of them have valuable experience in other parts of the public sector, in our public services, in the voluntary sector and in the private sector—or indeed experience as patients, users or carers in our health and social care service. Our message as a Government is clear: when it comes to fixing the crisis in health and social care created by the Conservatives, we cannot get enough of experts, and we are looking forward to mobilising the country in pursuit of our mission, so that we can deliver an NHS that our country can once again be proud of.

[Gregory Stafford (Farnham and Bordon) (Con)]

Given the potential for commercial advantage to Alan Milburn, will the Secretary of State publish all the papers that Alan Milburn was able to read? If the Secretary of State gave them on Privy Council terms, as he seems to be saying, will he at least give them to any Privy Counsellor who wants them?

[Wes Streeting]

Given the state of the Opposition, I bet they would love to see what policy discussion papers we are putting forward in the Department of Health and Social Care. The hon. Gentleman is right: papers have been shared with my right honourable friend on Privy Council terms. The Opposition will, in time, be able to judge the fruits of the labour, in terms of my decisions and the decisions of this Government when it comes to fixing the mess that they created.