Tobacco and Vapes Bill

Helen Hayes Excerpts

2nd reading
Tuesday 16th April 2024 Commons Chamber

[Helen Hayes (Dulwich and West Norwood) (Lab)]

I rise to speak in support of this important Bill. Smoking is entirely harmful and there are no benefits. Cancer Research UK is clear that tobacco remains the single biggest cause of cancer in the UK, causing an estimated 125,000 deaths per year—one person every five minutes. On average, smokers lose 10 years of their life expectancy and face lifelong health complications.

Despite the protestations of tobacco companies, smoking also has a detrimental effect on our economy. Action on Smoking and Health estimates that the overall cost of productivity losses and health and care needs caused by smoking costs the UK a staggering £17.3 billion every year.

We have come a long way in recent decades in reducing smoking rates. The last Labour Government led the way on smoking harms, raising the legal smoking age to 18, banning cigarette advertising in shops and introducing the transformative ban on smoking in enclosed public spaces and workplaces. It is now hard to recall just how society ever thought that smoke-filled restaurants, pubs and tube carriages were remotely acceptable.

[Brendan Clarke-Smith (Bassetlaw) (Con)]

Will the hon. Lady give way?

[Helen Hayes]

I will not give way at this stage, I am afraid.

It is still the case that more than one in 10 adults—around 6.4 million people—are smokers. I wish to pay tribute to my constituent, Gower Tan. Gower began to smoke at the age of 13. His father was also a lifelong smoker and died early at the age of just 66 from lung cancer. This was devastating for Gower and his family and led him to give up smoking at the age of 40. Gower has since become a tireless campaigner for Cancer Research UK—first as an ambassador and more recently as part of the staff team. Gower and his family know as well as anyone the pain and heartache that smoking can cause and the deep sorrow that comes from knowing that the death of a loved one was preventable.

Like my hon. Friend, the shadow Secretary of State, I fully support the Bill’s measures to ban smoking for anyone born after 2009, freeing future generations from the health impacts of tobacco. I also welcome the Bill’s urgently needed measures to regulate advertising and restrict the availability of vapes to children and teenagers. We on the Labour Benches have been calling for action on this for a long time. Last year, I introduced a ten-minute rule Bill on the advertising of vapes to children. One in five 11 to 15-year-olds in England used vapes in 2021, and under-age vaping has dramatically increased by 50% in the past three years. Five years ago, vaping was not a significant concern, but now it is raised with me in every school that I visit. Teachers are routinely having to manage the disruption in the classroom that addiction causes.

Vaping has a really important role in smoking cessation and that role should not be undermined by this legislation, but although vaping is far less harmful than smoking, it is not a harmless activity. Last year, 40 children were admitted to hospital with vaping-related issues. There is evidence of respiratory harm and impacts on mental health and concentration levels.

We can see the strategy of the vaping companies. They are seeking to secure future demand for their products by getting children addicted today. It is frankly absurd for e-cigarette manufacturers to claim that they are not targeting children. In displays across the country, brightly coloured advertising for vapes mimic popular brands and characters. Flavours such as gummy bears, skittles, tutti-frutti and cherry cola are clearly designed to appeal to children and vapes are being openly promoted to children on social media.

Although I support the Bill today, it would be remiss of me not to ask what has taken the Government so long. They have had repeated opportunities to introduce new regulations on the marketing of vapes. My hon. Friend the Member for City of Durham (Mary Kelly Foy) put forward an amendment in November 2021 to the Health and Care Bill to ban the branding of vapes that appeal to children, while the Electronic Cigarettes (Branding, Promotion and Advertising) Bill introduced last year would have banned e-cigarettes and vaping products from being advertised to appeal directly to children. These delays will have led to more children experimenting with e-cigarettes and becoming addicted to recreational vaping.

Today, we have a genuine opportunity to stops the harm of nicotine addiction and free future generations from the health impacts of smoking. We on the Labour Benches are clear that we will put the health of children and young people first. A Government who cannot command the support of their own MPs for a flagship piece of legislation should surely step aside, call a general election and allow someone else to do the job.

Young Adults with Spinal Injuries

Helen Hayes Excerpts

Thursday 29th February 2024 Commons Chamber

[Helen Hayes (Dulwich and West Norwood) (Lab)]

I am grateful for the opportunity to open this debate, which I sought on behalf of my late constituent Tom Lazarides and his family, some of whom are present in the Public Gallery. Tom was a 20-year-old student at Durham University when, on 13 June 2020, he dived into a swimming pool and suffered a catastrophic spinal cord injury that left him paralysed.

In preparation for the debate, I reread an interview that Tom’s mother Bridget gave to a newspaper in October 2020. In that interview, Bridget spoke about her talented, sporty son, about how loved he was by all who knew him, and about the overwhelming outpouring of support for him from across the country. Bridget’s interview was also full of determination—Tom’s determination and hers—and hope that, despite the devastating nature of his injuries and the many challenges that he faced, with the love and support of his family and friends and good treatment and care, somehow Tom would be okay. I am sorry to report to the House that Tom Lazarides sadly passed away in November 2023.

Tom and his family were devastated by his injury. Instead of helping them to come to terms with what had happened, and enabling Tom to live as well as possible with his injury, the systems that should have been there to support him failed utterly to deliver the care that he needed. Tom’s spinal cord was permanently injured in two places. He was tetraplegic as a consequence, and had many health complications. He had a potentially fatal condition called autonomic dysreflexia, which causes unpredictable and dangerously high spikes in blood pressure. His skin was very fragile, leading to grade 4 bedsores. He had a tracheostomy, leading to communication difficulties. He was unable to cough, leading to repeated inhalation of food particles, which caused pneumonia and pulmonary oedema, and he suffered from muscular complications.

Tom had spent 18 months in hospital, including a year of rehabilitation at Stoke Mandeville. His injuries were permanent and unequivocal. They were well understood by his doctors, and were fully and properly documented. The injuries gave rise to a need for ongoing clinical care from qualified nurses, which could not possibly have been delivered by local authority social care. Tom was discharged from Stoke Mandeville in the autumn of 2021. Under the policy of discharge to assess, he was referred for consideration for NHS Continuing Healthcare funding.

According to the NHS, eligibility for Continuing Healthcare funding is determined on the basis of a person’s needs, rather than a particular diagnosis. There should be no limits on the setting where it can be provided or the type of support, and it is determined according to an assessment by the local NHS integrated care board. The assessment comprises two parts: the NHS continuing care checklist, which can be completed by a nurse, doctor, other healthcare professional or social worker, followed by a full assessment undertaken by a multidisciplinary team.

Tom’s assessment was completed in January 2022. His family raised concerns with me that the assessment process appeared to start with a blank sheet of paper and did not take into account anything that was already known about Tom’s injuries and their impact on his health. For example, he was asked by an assessor whether he got around the house on a Zimmer frame, and to show that he could not use his hands when he was clearly tetraplegic. His family were left with the constant impression that no one involved in the assessment, or in reviewing the decision later in the process, had ever properly read Tom’s medical records.

In May 2022, a decision was reached that Tom was not eligible for Continuing Healthcare funding. For Tom and everyone who knew him, the decision was as astonishing as it was devastating. Tom’s level of clinical need was crystal clear. As Tom’s mother has said to me on a number of occasions, all that needed to happen was for Tom’s very clear medical notes to be read. Tom’s family appealed the decision. The process was beset by difficulties, including changes of personnel at the case manager level, records being lost and constant delays. Tom found the visits to his home intrusive, and they had a detrimental impact on his already fragile mental health.

There was no prescribed timescale for the assessments and appeals, and no clear point of contact for Tom and his family to liaise with during the process. Tom and his family felt that there was constant pressure for him to move to a care home, despite the study published by Professor Brett Smith 12 years ago, which documented the very poor outcomes for young adults with spinal cord injuries who live in care homes, arising from their lack of agency in the decision to move to the care home, the shortage of properly skilled and qualified staff who can meet the needs of residents with spinal cord injuries, the lack of independence, and isolation. Tom was a bright young person with so much to contribute. What he wanted and needed was care and support at home, so that he could live well with the consequences of his spinal cord injury. In the last few months of his life, Tom repeatedly expressed a wish to end it. He simply could not see a positive future, when the struggle to access the care and support he needed was so difficult.

Tom Lazarides’ family have asked me to raise a number of issues that arise from his experience, which indicate the ways in which the healthcare system is simply not working for young adults with spinal cord injuries. The first is the discharge to assess policy. Discharge to assess is not designed for people with a catastrophic injury. What may be appropriate for a frail, elderly person who has had an emergency hospital admission, giving rise to concerns about their care needs at home, or for someone with a progressive condition that may be reaching the point at which more care is needed, is simply not appropriate for someone with a catastrophic permanent injury. It gives rise to a lack of continuity from hospital to home, and requires the person to be assessed by people who do not have the same detailed or specialist knowledge of their needs as the hospital clinicians who have been caring for them as an in-patient.

The second concern is that the patient has no involvement in decisions about their care. Tom was clear and consistent that he did not want to live in a care home. He was a bright and articulate young man whose paralysis should not have resulted in the removal of all agency in his own life, yet the completed decision support tool, the first stage in the assessment process, was submitted without being checked by Tom or his family. Panel meetings took place in a context of secrecy—about their membership, the dates and times of meetings, and the content of discussions. A system is not delivering patient-centred care when the patient is completely shut out of the decision- making process.

The third concern is the lack of any certainty or transparency about the timelines for decision making. The processes relating to Tom’s care took years, and the lack of continuing healthcare support had a profound impact on his day-to-day life during that time. Tom and his family simply had no idea when they would have any news about the next steps.

Everyone, the Lazarides family included, is acutely aware of the pressures on our health and social care system and the need to ensure value for money for the public purse, as well as ensuring safe, appropriate and high-quality care for individuals who need it. Tom’s case, however, was not a matter of resources. In the end, following the appeal, the ICB decided that he was eligible for continuing healthcare funding. The tragedy is that his family were only informed of this after he had died.

It is devastating for any young person to suffer a spinal cord injury that has life-changing consequences but, with the right care and support, it is possible to live a good life with independence and dignity. Depression is not inevitable, but poor mental health is sadly all too common. Tom Lazarides and his family encountered a system that seemed incapable of delivering the safe, appropriate, high-quality care and support that he needed and was entitled to. As a consequence, they spent the two years from Tom’s discharge from Stoke Mandeville Hospital in the autumn of 2021 to his untimely death in the autumn of 2023 constantly fighting a system that ultimately failed them.

What attention is the Minister paying to the experiences of young adults with spinal cord injury and the quality of care that they are able to access? What action is she taking to ensure that the quality and availability of care for young adults with spinal cord injury is consistent across the country? Will she look at the policy of discharge to assess and its appropriateness for patients with a sudden and permanent life-changing injury? Will she look at the assessment process for continuing health- care funding and take steps to ensure that a patient’s existing healthcare records always play an integral part? Finally, will she take steps to ensure that the assessment process for continuing healthcare funding has increased transparency and accountability, and increased certainty on the timescales and decision-making processes?

No one who reads the facts of Tom Lazarides’s injury and subsequent health needs could be in any doubt that he needed long-term nursing care to be safe and to live well with the consequences of his injury, yet the tragedy of his injury was compounded by the failure of our healthcare system to deliver the care that he needed, or indeed to treat him and his family with respect and dignity.

Tom’s family have asked me to raise his case, in order to press for accountability and for improvements for others. I look forward to the Minister’s response.

Oral Answers to Questions

Helen Hayes Excerpts

Tuesday 5th December 2023 Commons Chamber

[Helen Whately]

I am really sorry, but the hon. Member’s memory appears to be very short. I was working in healthcare when there was a Labour Government and I remember very well problems for the NHS during winter. She does not even need to look back into the past; she can look at the Labour-run NHS in Wales, where they are having so much difficulty with A&E performance that they even fudged the figures and hid a whole load of patients so people would not notice what was going on.

[Helen Hayes (Dulwich and West Norwood) (Lab)]

5. What steps she is taking to help reduce vaping by young people.

[The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)]

The hon. Lady raises such an important question on a subject that is dear to both our hearts. We all know it is an offence to sell vapes to children under 18, yet one in five children tried a vape in 2023 alone and the number trying vapes has tripled in the last three years. We know the industry is targeting children, quite cynically. That is unacceptable. Our tobacco and vapes Bill will restrict the appeal and availability of vapes to children, and we are consulting on that right now.

[Helen Hayes]

As the Minister rightly said, under-age vaping has increased by 50% in just the past three years. Ministers had the chance to stop this trend two years ago, during the passage of the Health and Care Act 2022, when Labour tabled an amendment to prohibit branding that appeals to children, but Ministers would not support it and Conservative Members voted it down. Does the Minister regret the fact that the Government did not act sooner? When will the planned new legislation be brought to the House? The consultation is welcome, but there is consensus on the issue and action is urgently needed.

[Dame Andrea Leadsom]

The hon. Lady knows full well that making decisions that change legislation requires consultation. That is both the convention and the requirement. The Government have brought forward the consultation as soon as possible. It will close tomorrow and we will introduce legislation as soon as possible in the new year. I think the hon. Lady will find that that legislation really will tackle the problem of the cynical targeting of children.

LGBT+ People and Spouses: Social Care

Helen Hayes Excerpts

Tuesday 12th September 2023 Westminster Hall

[Helen Hayes (Dulwich and West Norwood) (Lab)]

I beg to move,

That this House has considered the treatment of LGBT+ people and their spouses in social care settings.

It is a pleasure to serve under your chairmanship, Sir Robert. I sought this debate because of the horrific experience of my constituent Ted Brown and his late partner, Noel Glynn. Ted is present in the Public Gallery this afternoon. Ted and Noel were together for almost 50 years. They met at the first Gay Pride event in 1972, which Ted helped to organise. They were civil partners; they were devoted to each other. Sadly, Noel developed dementia in older age and, in 2018, he was placed in Albany Lodge care home in Croydon after Lambeth Council was unable to find a place in a care home any closer to Ted in Brixton.

One day, Ted noticed that Noel had suffered bruising and a cigarette burn to the back of his hand, and two whistleblowers at Albany Lodge confirmed that Noel was being subjected to homophobic abuse from some of the staff. The whistleblowers recounted two staff members asking him, “Are you a gay man? Do you like gay men?” before dragging him to his room, where other residents heard a disturbance going on and Noel’s voice. In January 2019, Noel told a social worker, “I don’t like it here—they beat me up”. The social worker recommended moving Noel to another care home, but he remained at Albany Lodge for nine more months. Throughout that time, Ted was paying £1,400 a month to Albany Lodge for Noel’s care. Ted told me that staff at the care home refused to recognise his relationship with Noel, and that he was warned by two other LGBT residents in the home not to tell staff that they were a couple, because, “It won’t be good for either of you”.

Noel was a vulnerable man with dementia. He should have been safe in Albany Lodge. The abuse he suffered was horrific and inexcusable, and it was a clear breach of his human rights. That was recognised in a court judgment against Lambeth Council, which placed Noel in Albany Lodge, that awarded the couple £30,000 in compensation. Sadly, Noel died in 2021 before the compensation was paid.

Ted told me that when Noel was first placed in Albany Lodge, there was a delay in undertaking a necessary medical assessment. He contacted the care home to chase this on Noel’s behalf and received an email notifying him that an assessment would be done that day on his father. He was not invited to attend this appointment, which would usually be supported by a spouse or close family member since the aim of the assessment was to gather information about the person’s health history, including matters such as allergies and eating habits. Noel, by then, had dementia.

Ted went to the home anyway and was initially not allowed into the room with Noel, despite bringing documents demonstrating their civil partnership, his power of attorney for Noel and evidence that they had been partners for 49 years. As Ted waited outside the room, he could hear Noel calling out for him. This utterly distressing situation speaks to a total lack of dignity for LGBT+ couples in the care system that urgently needs to be addressed. Prior to being admitted to Albany Lodge, Noel initially received care at home. Ted believes that Noel was also subjected to homophobic abuse by one of the carers, who he observed treating him roughly. In an indication that these experiences are not at all uncommon, Ted also told me that prior to the carers coming in, he had been warned by a friend to remove all traces of his relationship with Noel as a couple from their home.

In a report titled “Stripped of all Pride”, Compassion in Care documented 486 reports of homophobic abuse in care settings and of LGBT+ staff who were afraid to disclose their sexuality. I strongly encourage the Minister to read the report, if he has not already done so; the testimonies are shocking and devastating. One whistleblower wrote:

“There was one gay resident in the home, staff were so cruel to them, some staff treated this poor man as if he had something catching. I saw one staff member spit on this man whilst telling him to repent as he was a filthy pervert. Another staff member slapped this man around the back of his head, really hard. I reported it, I was horrified. The staff started shouting at me are you a pervert lover? Are you gay? Nothing was done, I went to the authorities and left”.

That is hate crime, happening behind closed doors and being perpetrated against some of the most vulnerable people. There are many similarly shocking testimonies in the Compassion in Care report.

[Tulip Siddiq (Hampstead and Kilburn) (Lab)]

My hon. Friend is giving a powerful and emotional account of her constituents. I welcome Ted to the Chamber; I wish it was under happier circumstances. I want to raise something that happened in my constituency a few years ago. A gay couple were taunted with offensive and degrading questions about their sexuality on a bus in West Hampstead. They were then brutally attacked. It was in the news, so my hon. Friend might have heard about it. This year, Rainbow Europe announced that the UK has fallen to 17th place in terms of safety for LGBTQ people. Nine years ago, it was in first place. Does my hon. Friend agree that crimes that are targeted at someone’s LGBTQ identity should have tougher sentences?

[Helen Hayes]

I thank my hon. Friend for her intervention and for raising that shocking case, which I remember from media reports at the time. We cannot ever take progress on equality for granted, and it is vital that we take seriously that drop in protections for LGBTQ+ people and that the current increase in hate crime is met with the toughest possible sanctions that can be delivered.

Perhaps even more shocking than the testimonies in the Compassion in Care report is the fact that, of the 486 services involved in the testimonies, 481 were still rated as good by the Care Quality Commission. A 2016 CQC-commissioned report found that older people were hiding their sexual orientation and gender identity because of fears of discrimination. The abuse that Noel suffered and the abuse documented by Compassion in Care are utterly abhorrent, and there should be no place for them anywhere, still less in settings that are trusted to look after our most vulnerable loved ones—older people who are physically frail or suffering the disorientation of dementia.

For the current generation of older LGBTQ+ people, such abuse can also be a re-traumatisation. Those aged 75 and older were adults before homosexuality was decriminalised in 1967. They lived through the long years of section 28, have experienced life in a deeply homophobic society, are very likely to have spent a significant period of time concealing their sexuality, and have lived through the trauma of the HIV/AIDS epidemic—suffering the loss of much-loved partners, friends and community members while society stigmatised them. Older people who are LGBTQ+ are also disproportionately likely to have become estranged from family members and may lack people around them to advocate on their behalf in the care system.

I am particularly concerned about the poor response to Noel’s case. Once the horrific abuse he suffered was identified, it should have been the job of the care home, the local authority, the CQC and the Government to ensure that it could never happen again, but the reality was far from that. When Noel’s abuse was reported, staff were suspended, but Ted understands that they were allowed to return to work on a different floor of the same home. Following inspections in 2019 and again this year, the CQC continued to rate Albany Lodge as good. The fact that one local authority placed Noel in a care home in a different local authority has also presented problems in ensuring accountability.

No one should have to fear that they or a loved one will be abused in a place that has a responsibility to care for them. No one should have to fear that their sexuality or gender identity might result in such abuse. In 2016, the CQC recommended that commissioners, providers, and health and care staff should

“consider the needs of LGBT people in planning and delivering end of life care services”,

that health and care staff should

“communicate openly and sensitively about sexual orientation and gender identity as a routine part of their delivering good quality, personalised end of life care”

and that commissioners and providers should

“collect data on sexual orientation and gender identity as part of an equalities approach to monitoring end of life care outcomes.”

The Government also mentioned the need for improved monitoring in their 2018 LGBT action plan, but there is little evidence of progress. There are examples of good practice, both in the delivery of LGBT affirmative retirement housing, such as Tonic Housing in Lambeth, and in the Pride in Care quality standard championed by Care England, but it is unacceptable that monitoring the experiences of LGBT+ residents is not a mainstream part of CQC assessments. Albany Lodge should not have continued to be rated “good” while an LGBT resident was being abused under its roof, and it certainly should not have continued to be rated “good” after that abuse had come to light.

What progress does the Minister believe has been made following the publication of the Government’s LGBT action plan five years ago in 2018? What action is he taking to protect the rights of LGBTQ+ residents in adult social care? Will the Government ensure that gathering the experiences of LGBTQ+ residents and their spouses forms part of the CQC inspection framework for care homes? Will he take steps to ensure that no care home or care agency found to have allowed homophobic, biphobic or transphobic abuse can continue to be rated “good” by the CQC? Will he consider further support to roll out the Pride in Care quality standard to more care homes across the country?

When Ted spoke with me about Noel’s experience, he told me about the guilt he feels about being unable to protect the man he loved from abuse. I am sure all of us can understand that guilt, even though it is entirely misplaced. Ted should have been able to trust Albany Lodge to care for Noel and that trust was fundamentally broken. We cannot undo what happened to Noel, but we can work to ensure that it does not happen to anyone else. I hope that the Minister will set out the meaningful action that he will take to this end.

--- Later in debate ---

[Helen Hayes]

Let me put on record a matter that I should have done at the beginning of my opening speech: I co-chair the all-party parliamentary group on adult social care—apologies for not mentioning that earlier.

I thank my hon. Friend the Member for York Central (Rachael Maskell) for her moving and powerful speech, particularly for the poem with which she finished; sometimes prose is not quite enough to convey the depth of emotion on such issues, but that poem did so very well. I thank my hon. Friend the Member for Denton and Reddish (Andrew Gwynne), who was right to locate this issue within the wider pressures facing social care and to discuss the esteem within which the sector is held. There are many good people working extremely hard every single day to deliver high-quality care, but the pressures of social care, the difficulty local authorities have finding placements and the difficulty of recruitment and retention faced by many organisations certainly do not help with the issues of scrutiny and accountability that we are concerned with today.

Finally, I thank the Minister for the tone of his remarks and his commitment to address the issue. I urge him to look more at an issue that he did not mention in his response: the Pride in Care standard, which shows already what good can look like for LGBTQ+ people in care settings, and can give assurance to relatives looking for care placements for their loved ones that the setting understands and takes seriously the very specific personalisation needed, and the need to ensure absolutely that homophobia, transphobia, discrimination and abuse are eradicated from such settings.

Question put and agreed to.

Resolved,

That this House has considered the treatment of LGBT+ people and their spouses in social care settings.

Under-age Vaping

Helen Hayes Excerpts

Wednesday 12th July 2023 Commons Chamber

[Helen Hayes (Dulwich and West Norwood) (Lab)]

I am grateful to all right hon. and hon. Members who have taken part in what has been a largely consensual debate. We have heard from colleagues across the House about the growth in the number of children who are vaping, concerns about physical and mental health impacts, the disruption to education and the drain on staff time in schools.

The Chair of the Health and Social Care Committee, the hon. Member for Winchester (Steve Brine), spoke of the evidence that the Committee has heard on the impact of vaping on the education of students, including interruptions to exams. My hon. Friend the Member for Ealing, Southall (Mr Sharma) highlighted the ongoing prevalence of smoking and the need for further work to tackle illegal tobacco sales as well as work to tackle vaping. The right hon. Member for Romsey and Southampton North (Caroline Nokes) spoke about the important role of vapes in smoking cessation. There is no disagreement from the Opposition on that. I am not so grateful to her for taking me back to the revolting smoke-filled environment of the toilets in my secondary school in the 1980s, which is a memory that I had long since sought to banish.

My hon. Friend the Member for North Tyneside (Mary Glindon) spoke about the need for better enforcement of the existing age verification regulations regarding vapes. The hon. Member for Erewash (Maggie Throup) highlighted the sophistication of the packaging, design and presentation of vaping products in retail outlets and how attractive that makes them. My hon. Friend the Member for City of Durham (Mary Kelly Foy), who has a long track record of work on this issue, highlighted the extent of the evidence on vaping that is already available to the Government. The hon. Member for Darlington (Peter Gibson) highlighted the impact of disposable vapes on the environment and the increase in plastic pollution. My hon. Friend the Member for Birmingham, Erdington (Mrs Hamilton) spoke from her experience as a former nurse and highlighted the serious problem of vaping equipment being used to distribute more dangerous substances by young people.

The hon. Member for Sleaford and North Hykeham (Dr Johnson), who spoke from her extensive work on this subject, highlighted concerns about the accuracy of data on the safety of vaping. The hon. Member for Tiverton and Honiton (Richard Foord) spoke about work in his constituency that shows it is possible for retailers to take a different approach to vapes. My hon. Friend the Member for Stockton North (Alex Cunningham) highlighted the Government’s failure to act on advertising. My hon. Friend the Member for York Central (Rachael Maskell) spoke about the lessons that can be learned from the anti-smoking measures that have been so successful as well as the need to recognise this issue as one of addiction and to locate it in the wider landscape of the addiction economy.

Vaping has shifted from a smoking cessation tool to a recreational activity in its own right, driven by the rapacious desire of tobacco companies—which fund many of the largest vape suppliers—to keep making a profit from the highly addictive substance of nicotine. The growth in the use of vapes by 11 to 15-year-olds has been rapid, increasing by 50% in the past three years. One in five 11 to 15-year-olds in England used vapes in 2021. The figure will be higher now.

The important role of vaping in smoking cessation has led to a widespread perception that it is a harmless activity, rather than a less harmful activity than smoking. Last year, 40 children were admitted to hospital for suspected vaping-related disorders. Young people using e-cigarettes are twice as likely to suffer from a chronic cough than non-users. There are reports that nicotine dependency contributes to cognitive and attention deficit conditions, and worsened mood disorders.

[Dr Caroline Johnson]

The brain develops gradually over time, and is thought to continue developing in people until they are 25. Some countries have different age limits for different things. Does the hon. Member think that 18 is the right age limit for vaping?

[Helen Hayes]

The hon. Member speaks from her experience on this issue. We have set out a motion containing some immediate actions that the Government can take, which are well-evidenced, particularly from the approach taken to combat smoking. I agree that the Government should look urgently at other aspects of the regulatory framework on vaping, some of which we have heard about today.

Vaping products are marketed directly to children, named after sweets such as gummy bears, Skittles and tutti frutti, in brightly coloured packaging decorated with cartoon characters. There is also evidence, including from research undertaken by one of my constituents who I met during evidence week last week, of the burgeoning growth in vaping among 18 to 25-year-olds, almost entirely unrelated to smoking cessation. A new generation of vaping products has been designed to be desirable objects in their own right. If action is not taken to tackle the accessibility of vaping to children, we can only expect vaping among young adults to continue to grow.

[Maggie Throup]

The hon. Member talks about children and 18 to 25-year-olds. What age does she think is appropriate to ban vaping—16, 18 or 25?

[Helen Hayes]

The current law prohibits the sale of vapes to under-18-year-olds. We are not proposing a change in the law on the prohibition of sale. I was simply highlighting that young people grow, and those who become addicted to vaping under the age of 18 are much more likely to carry that addiction into young adulthood. That was the point that I was seeking to make. We can expect a pipeline of young people becoming addicted to vaping, which may stay with some of them for the rest of their lives.

This Government have been asleep at the wheel on children and vaping. They had the opportunity to vote for measures to protect children from vaping last year but failed to do so. The measures that the Minister has announced most recently are better late than never, but are simply inadequate to the task. ASH is clear that while educating young people on the risks of vaping through a new resource pack for schools is welcome, the evidence suggests that education alone will not stop children from vaping.

There is substantial evidence on what worked in reducing smoking rates among children. In 1982, when England first started monitoring smoking rates among children, just one in five children was a current smoker. Eighteen years later in 2000, the proportion was exactly the same—not because children were not educated about the dangers, but because adolescents are risk takers. Between 2000 and 2021, smoking rates among children fell from 19% to just 3%—not because of better education or enforcement but because the regulatory framework during that time ratcheted up year by year. Under the last Labour Government, all point of sale advertising and display of tobacco was prohibited. A comprehensive anti-smuggling strategy was implemented by HMRC and the UK Border Force, which dramatically reduced sales of illicit tobacco, and cigarettes were put in standardised packaging, with all the brightly coloured glamourised packaging removed.

What is true for the strategy to tackle smoking is true for the challenge of vaping. Without much tougher regulation, we will not succeed in driving down vaping among children and young people. Regulations on packaging, advertising and labelling are essential. Labour is calling on the Government to ban vapes from being branded and advertised to appeal to children, and to work with local councils—

[Peter Gibson]

I am very grateful to the hon. Lady for giving way. She has taken a number of interventions from colleagues. The motion refers to children. The shadow Minister commented that there is no proposal, under a Labour Government, to change the age of 18 for purchasing tobacco. By process of elimination, does the word “children” in the motion refer to anyone under the age of 18? Will she clarify that point?

[Helen Hayes]

I am sure Members across the House do not need much help from me to identify the definition of a child in law as being a person under the age of 18. I will simply move on from there.

What I will say about the motion is that it sets out measures over which I think there can be no disagreement. There can be no disagreement about advertising targeted at children. Measures to deal with packaging that appeals to children could be introduced right now and would have a direct impact on the very alarming numbers of children and young people who are vaping. This has been a very consensual debate, which has acknowledged and set out some of the complexities around the issue, as well as some areas where the Government should be looking at additional regulations and the wider regulatory framework around vaping. I do not think there is disagreement on that either. What we are setting out today is immediate action that is long, long overdue. Frankly, we struggle to see why the Government have been dragging their heels, refusing to act and not accepting these measures.

As I said, Labour is calling on the Government to ban vapes from being branded and advertised to appeal to children, and to work with local councils and the NHS to help ensure that e-cigarettes are used as an aid to stop smoking, rather than as a new form of smoking and addiction. It is inexplicable that the Government are resistant to those entirely proportionate and evidence-based proposals. If they will not act to protect children and young people, the next Labour Government certainly will.

Government PPE Contracts

Helen Hayes Excerpts

Tuesday 6th December 2022 Commons Chamber

[Angela Rayner]

My hon. Friend is absolutely right. He made two points, which I will come to in greater detail in my speech, but one was the lack of PPE for those on the frontline, as well as the total disrespect in the way that contracts were handed out through the VIP lane, at the expense of businesses up and down the UK that had experience and could have helped during the pandemic, but which were not party to WhatsApps or whatever else got them to Ministers and access to the VIP lane.

Take the mystery of a PPE company with links to a Tory politician. While it is for the authorities to decide whether any law is broken, and I will not comment on the ongoing investigations, we do know that PPE Medpro was referred to the VIP lane by a sitting member of the Cabinet after lobbying from another Tory politician five days before it was even legally registered as a company. The House may recall that that particular company was subsequently awarded two contracts worth £203 million to supply PPE, with £81 million to supply 210 million face masks awarded in May 2020 and a £122 million contract to supply 25 million surgical gowns awarded in June 2020. The face masks were bought by the Government from PPE Medpro for more than twice the price of identical items from other suppliers, and the surgical gowns were rejected for use in the NHS after a technical inspection. All of them were never even used. It points to a total failure of due diligence and the rotten stench of cronyism.

[Helen Hayes (Dulwich and West Norwood) (Lab)]

During the early months of the pandemic, I was contacted by PPE suppliers known to the NHS—they were long-term suppliers—who told me that their offers of help were being rejected. One wrote to me and said that before April 2020

“there was a degree of total incompetence about government handling of PPE purchases. However, by the way they scrutinised our own offers, thereafter, we believe they knew, at least specification-wise, exactly what they were doing and that senior managers were taking steps to use ‘preferred suppliers’, even though they were aware these suppliers had neither the track record nor the level of competence to produce compliant goods”.

What does my right hon. Friend think about that?

[Angela Rayner]

I think it absolutely stinks, and my hon. Friend is absolutely right, in that the public can see through it, as can those businesses, who are pretty angry. They knew that Britain faced a situation with a global pandemic that it had not faced before and they wanted to do the right thing by doing their bit. The frustration—my hon. Friend is right to quote her business—is that there is no question that the specifications should have been known. Therefore, why was all this PPE bought knowing full well it could not be used?

NHS Workforce

Helen Hayes Excerpts

Tuesday 6th December 2022 Commons Chamber

[Wes Streeting]

I am grateful for that intervention. We are in the worst of all worlds on immigration and the NHS. The Government try to have it both ways. They talk tough on rhetoric, so we end up with a very bureaucratic, ineffective and costly system, but because they fail to invest in our own homegrown talent, they are over-reliant on immigration from other countries, including those who desperately need their own doctors and nurses. I do not think it is good enough, after 12 years of Conservative Government, that we are turning away bright potential doctors, nurses and allied health professionals because the Government cannot be bothered to pull their finger out and train our own homegrown talent. We need to see improvement, so we that can draw the best international talent and make the system smooth, efficient and effective, but it is also crucial that we train our own homegrown talent.

Turning to more of the Conservatives’ excuses—we have heard the excuses of the pandemic—let us now look at the excuse they are planning to deploy this winter. There is no denying that this winter could be the most challenging the NHS has ever faced. The Royal College of Nursing, for the first time in its more than 100-year history, is planning to undertake strike action. Just this lunchtime we got strike dates from Unison, the GMB union and Unite the Union. That raises the question: why are the Government not even trying to stop the strikes in the NHS from going ahead? Surely, when the NHS already lacks the staff it needs to treat patients on time, the Government ought to be pulling out all the stops, getting around the table and negotiating to stop industrial action? So why aren’t they?

The Secretary of State said in Health questions earlier that his door is open—as if we can just sort of wander in off the street into the Department of Health and Social Care, where there will be a cup of tea and a biscuit waiting, and he will be just waiting for the negotiations. That is not how this works. Everyone knows that is not how it works. He had a nice little meeting with unions after the summer, after Labour complained that we had not seen a meeting between a Secretary of State and the unions since the right hon. Member for Bromsgrove (Sajid Javid). Goodness me, we have had three Secretaries of State since then—and two of them are the Secretary of State on the Front Bench today. Why on earth are they not sitting around the table and conducting serious negotiations? I will tell you why, Mr Deputy Speaker: they know that patients are going to suffer this winter and they do not have a plan to fix it, so instead of acting to improve care for patients and accept responsibility, they want to use nurses as a scapegoat in the hope that they avoid the blame. We can see it coming a mile off. It is a disgusting plan, it is dangerous and it will not work.

If I am wrong, perhaps Conservative Members could explain why the Government are not trying to prevent the strikes from going ahead. Perhaps they could explain why the Secretary of State ignored all requests from the health unions for meetings and conversations this summer while the ballot was under way. Perhaps they could explain what the Government’s plan for the NHS is this winter. Perhaps they could explain why a Government source told The Times newspaper that

“Ministers plan to wait for public sentiment to turn against striking nurses as the toll of disruption mounts”.

They said the quiet bit out loud and they gave the game away.

What else would explain the unedifying and embarrassing spectacle of the chair of the Conservative party going on national television to accuse nurses of doing the bidding of Vladimir Putin? I should not have to make this point, but nurses are not traitors to this country. They bust a gut day in, day out to look after all of us. We clapped them during the pandemic and now the nurses are clapped out. They are overworked, overstretched and undervalued by this Government. Let me say to the chairman of the Conservative party that he would speak with greater authority on what is in Britain’s national interests if he did his patriotic duty in his own tax affairs.

When it comes to sending a message to Vladimir Putin, why does the burden consistently fall on the working people in Britain? Why is it that NHS staff must make huge sacrifices because of the invasion of Ukraine, yet people who live in Britain but do not pay their fair share of taxes here do not have to lift a finger? When it comes to paying the bills, the first and last resort of this Conservative Government is always to pick the pockets of working people, yet the enormous wealth of tens of thousands of non-doms is left untouched. They may blame covid, they may blame health professionals, they may even blame the weather, but it is 12 years of Conservative mismanagement and under-investment that has left the NHS without the doctors, nurses and staff it needs, and patients are paying the price.

I am sure every Member of this House, indeed everyone in the country, knows someone who has been let down when they needed healthcare in recent months. They all say the same thing: the NHS staff were brilliant, but there simply are not enough of them. There is no NHS without the people to run it, yet today there are more vacancies in the NHS than ever before: 9,000 empty doctor posts, 47,000 empty nursing posts, and midwives leaving faster than they can be recruited. There are 4,600 fewer GPs than there were a decade ago, and the right hon. Member for Bromsgrove admitted last year that the Government are set to break their manifesto promise to recruit them back.

[Helen Hayes (Dulwich and West Norwood) (Lab)]

I was looking at a message from a constituent this morning who told that he went to A&E having waited four weeks for a GP appointment. Does that not speak to a lack of investment in the NHS workforce over 12 years and a lack of adequate planning? I know how hard GPs work in my constituency, but the lack of GP availability to staff surgeries and provide those appointments is placing unneeded pressure on A&E. That is on this Government’s watch.

[Wes Streeting]

I wholeheartedly agree with my hon. Friend. As we see so often with this Government, they make promises but break them. They try to fool the public into thinking they are delivering more GPs—or indeed more police officers—when it was the Conservative party that cut them. They try to give with one hand, but they take with the other, and after 12 years people have had enough.

Of course, it is not only the promise to recruit more GPs that the Conservatives are breaking. We had the promise of 40 new hospitals, which the Secretary of State repeated today, yet in response to the question posed by the right hon. Member for Uxbridge and South Ruislip (Boris Johnson), the Secretary of State said that of those 40 new hospital schemes

“five hospital schemes are in construction, two are now completed and we aim to announce the next eight by the end of this year.”

So, where are the other 25? Where are these 40 new hospitals? As far as I can tell, they exist only in the imagination of the former Prime Minister. Yet the script has not changed—Ministers are still here claiming 40 new hospitals.

When I visited Leeds with the shadow Chancellor, my right hon. Friend the Member for Leeds West (Rachel Reeves), I saw a vast pile of dirt where a new building was due to go up. We heard today that the Government cannot even negotiate an agreement with the hospital to get the site working and get the new facilities built. With every minute, every month and every year of delay construction costs are going up, so taxpayers are left in the worst of all worlds: broken promises, no 40 new hospitals, and paying through the nose for the ones that are being built because of Government incompetence.

We see the tragic consequences of the shortages and broken promises in the NHS. My hon. Friend the Member for Rotherham (Sarah Champion) raised the tragic case today at Health questions of a five-year-old boy who had what his doctor described as the worst case of tonsilitis he had ever seen. He was turned away from hospital, with his parents told there were no beds and not enough doctors. His infection worsened and five-year-old Yusuf later passed away. His death certificate recorded the primary cause of his death as pneumonia and the secondary cause as tonsilitis. What kind of country are we living in when a five-year-old boy can die of tonsilitis? This is criminal.

I met Yusuf’s uncle, Zaheer Ahmed, last week, and I did not know what to say to that poor man and his grieving family, who lost that little boy in the most unimaginable circumstances. I invite the Secretary of State to meet Yusuf’s family to hear how that little boy was failed and to hear at first hand about some of their interactions with the NHS, which I thought were completely unacceptable and intolerable. On that note, I welcome the independent inquiry that has been committed to. That is really important for the family who have been failed in this heartbreaking case. We do not want to see more cases like that.

At the heart of the crisis in the NHS—as with so many of the problems facing our country—is a failure to plan. The NHS has not had a workforce plan since 2003. That would be unacceptable in a multinational company one one-hundredth the size of the NHS. The failure to plan means that short-term fixes are always favoured over what is in patients’ long-term interests. That is why the Government cut the nursing bursary and why, this summer, in the middle of the biggest crisis in the history of the NHS, they took the infuriating decision to cut a third of medical school places.

Oral Answers to Questions

Helen Hayes Excerpts

Tuesday 6th December 2022 Commons Chamber

[Helen Hayes (Dulwich and West Norwood) (Lab)]

T1. If he will make a statement on his departmental responsibilities.

[The Secretary of State for Health and Social Care (Steve Barclay)]

We know that women can benefit from more personalised care, especially in pregnancy. The Tommy’s app is a new clinical decision tool for the NHS and for women, another example of how we are using artificial intelligence to improve our maternity system. That will help to end some of the variation in maternity care from hospital to hospital. I am pleased to tell hon. Members, particularly my hon. Friend the Member for Rutland and Melton (Alicia Kearns), who is a great champion of improved mental health, that today my Department, through our National Institute for Health and Care Research, has agreed to provide the funding needed for the next stage of the app’s development. I pay tribute to Sienna and all those other babies born stillborn to their parents and thank all those in this Chamber who have campaigned passionately on this important issue.

[Helen Hayes]

Another dental practice in my constituency recently handed back its NHS contract. When I contacted local NHS management about the impact of the closure, it stated that the area in question was adjudged to be well served for NHS dentistry practices because there are 11 practices within a half-mile radius. The experience of my constituents, now left searching for NHS dental services, is that none of those practices is accepting new NHS patients. What is the Secretary of State doing to ensure that assessments of the sufficiency of NHS dental services reflect the real situation on the ground, and when will we see a sustainable solution to the problems my constituents face?

[Steve Barclay]

The hon. Lady raises an important issue that is of concern across the House, as we have already seen in the exchanges the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien) answered. That in part was why, during the pandemic, we used £1.7 billion of funding to protect dentistry and why we got a commitment through the £3 billion a year funding of dentistry, but we are looking at how we localise that commissioning to get better value out of the contract, which was the point my hon. Friend raised.

Pulmonary Embolisms: Diagnosis

Helen Hayes Excerpts

Wednesday 30th November 2022 Commons Chamber

[Helen Hayes (Dulwich and West Norwood) (Lab)]

I am grateful for the opportunity to bring to the House the issue of the diagnosis of pulmonary embolism. Given the content of this debate, I put on the record that my husband is employed by the NHS.

I applied for the debate on behalf of my constituent Tim Edwards, who is watching the debate from the Public Gallery. Tim’s mother, Jenny, taught for 27 years in Lewes, East Sussex, before retiring in 2012. Jenny sadly lost her life to pulmonary embolism in February 2022. My speech is about the experience of Jenny and her family, and the research that Tim has undertaken in the aftermath of his mother’s death, which points to a significant issue with preventable deaths occurring as a consequence of misdiagnosed pulmonary embolism.

First, I want to put on the record my sincere condolences to Tim and his family on the loss of his beloved mother. I understand that in the weeks immediately prior to her death, Jenny had been enjoying time with her first grandchild. I am sure that, as Tim and his wife watch their daughter grow, they are constantly reminded of the relationship that she will now not be able to enjoy with her grandmother. Tim is motivated by his loss to seek to ensure that positive learning is derived from his mother’s case and many similar cases, so that diagnosis and the prompt treatment of pulmonary embolism is improved.

Globally, venous thromboembolism, which presents clinically as either deep vein thrombosis or pulmonary embolism, is the third most frequent acute cardiovascular syndrome behind heart attack and stroke. Pulmonary embolism is a blood clot in the vein passing to the lung and causing heart failure. The disease is serious but eminently survivable—if it is promptly diagnosed and treated, the death rate is 8%. Unfortunately, many pulmonary embolisms are misdiagnosed and attributed to other acute cardiovascular conditions because of the overlap of symptoms and the greater ease in identifying heart attacks and strokes.

My constituent has undertaken considerable research since his mother’s death, working with the charity Patient Safety Learning. He has estimated that there was a minimum of 400 excess pulmonary embolism deaths across England from April 2021 to March 2022, and that that excess figure is attributable to cases that were missed. He also looked at the age-adjusted mortality rates for pulmonary embolism across counties in England and Wales. There are some regions where the number of fatalities from the condition is almost three times the national average. The Minister may want to inquire as to what drives that discrepancy.

Let me give a sense of what can and does go wrong. In early February 2022, despite exhibiting risk factors and sudden symptoms, including fainting and collapse, my constituent’s mother, Jenny, was wrongly misdiagnosed in the care of an emergency department as having had a heart attack. She was then needlessly fitted with a stent. Upon her discharge from hospital, Jenny’s condition got worse again at home. She was dying. Yet she was reassured by a cardiac nurse who, over the phone, missed the clinical signs that indicate pulmonary embolism: shortness of breath, chest pain in the centre of the chest and fainting. The nurse advised that if these symptoms continued, Jenny should call her GP, and she did so, but she never made her GP appointment. My constituent does not want this to happen to other family’s loved ones, because it was entirely avoidable.

Jenny was waiting in accident and emergency for more than 12 hours, and there were nine independent decision-making points, at any one of which pulmonary embolism could and should have been diagnosed, but the condition was only discovered in an autopsy. My constituent has subsequently been motivated to write a report about what went wrong, given the mistakes that Jenny experienced and his sense that the NHS trust involved was unable to learn from what happened. His background is in the financial services sector, working in reinsurance, and he has a strong understanding of risk management. From a review of Jenny’s case and a report released by the Healthcare Safety Investigation Branch on this topic, part of the problem contributing to misdiagnosis appears to be that many emergency departments are frequently under-resourced and over-reliant on junior staff who may be ill-equipped to reliably suspect, assess and then treat pulmonary embolism, which is a relatively complex condition. That is supported by information provided by the Royal College of Radiologists, which commented on the lack of workforce sufficiency and a shortage of equipment.

Clinical staff in these settings have commented that either they do not have time or, astonishingly, do not feel that they need to follow clinical guidelines on how best to diagnose pulmonary embolism. On that last point, my constituent observes that there appears sometimes to be a culture of excessive leeway for clinicians to make their own decisions and a reluctance to follow clinical best practice. This is a source of concern.

My constituent has also discovered by interviewing a leading European professor in this area that the British clinical guidelines for diagnosing pulmonary embolism are out of step with those adopted across Europe and appear to exacerbate the risk of misdiagnosis, because the guidelines are thought of as subjective. He welcomes the news that these clinical guidelines are currently being reviewed. My constituent is also concerned that prior covid-19 infection has complicated the process of diagnosis in recent years, because some symptoms may be dismissed as linked to covid. However, this is inexcusable, as covid-19 was first established as an additional risk factor for pulmonary embolism by studies across Europe and the US in 2022. Prior covid-19 infection should give rise to greater, not lesser suspicion for patients presenting with symptoms.

In Jenny’s case, well-documented symptoms of pulmonary embolism were discounted because of her prior covid-19 infection, although it had been asymptomatic and she had made a full recovery. My constituent reports that it seemed that clinicians were assuming that covid-19 had been beneficial to Jenny’s health. Upon my constituent’s complaint to the NHS trust responsible for Jenny’s care, a serious incident report was commissioned and an inquest took place. However, in my constituent’s opinion, the NHS trust appears to have exhibited what he describes as a “shrug of the shoulders, these things happen” conclusion, inhibiting sufficient learning.

My constituent demonstrates in his report that the clinicians who treated his mother are at odds with academic literature on the symptoms of pulmonary embolism when they discuss the rationale behind their decisions. That is deeply troubling, given the alarming rise in pulmonary embolism fatalities across the country. The trust used the lowest level of investigation to contribute to its serious incident report, meaning that the subject matter experts chosen to contribute to the report were all involved in Jenny’s original care. The report’s conclusion was that a pulmonary embolism could not have been detected, even though Jenny displayed symptoms consistent with 90% of pulmonary embolisms. My constituent disagrees with the report conclusions, and he is concerned that it lacks objectivity and that there is insufficient learning to prevent such misdiagnosis from happening again. A higher level of investigation would have ensured independent contributors to the report, and the lack of that gives rise to concern about how many other cases may have been inadequately reviewed.

The sadness and frustration that my constituent feels at the circumstances of his mother’s death have been compounded by the intransigence he has witnessed in the NHS trust responsible for her treatment and the discovery that Jenny’s case was not alone. My constituent has been working with the charity Patient Safety Learning and his report will be published in December. The report contains nine calls for action. I have read the report and I have also received a response from NHS England to the recommendations in the draft. I share my constituent’s concerns that the response falls back on existing guidelines and current practice. It does not acknowledge my constituent’s finding of around 400 potentially preventable deaths a year due to misdiagnosed pulmonary embolisms. It makes no commitment to any process of review or change.

The Royal College of Radiologists has also expressed concerns consistent with my constituent’s observation about resourcing issues in emergency departments, and workforce and equipment sufficiency to enable scans to be undertaken. It stated that clinicians do not always have the equipment necessary to provide optimum care. The current vacancy rate in clinical radiology consultants is 8%.

My constituent’s research on this issue following the tragedy that his family has suffered is commendable. It highlights serious problems with excess deaths and misdiagnosis, raises serious questions about a postcode lottery, workforce sufficiency and the availability of equipment, and raises concerns about the culture of learning in the context of misdiagnosis.

I ask the Minister to agree to work with NHS England to commission a review of the data set out in my constituent’s report and the concerns raised by the Royal College of Radiologists, with a view to ensuring that the rate of misdiagnosis of pulmonary embolism is greatly reduced, and fewer families have to suffer the loss that my constituent and his family have suffered.

Urgent and Emergency Care

Helen Hayes Excerpts

Monday 5th September 2022 Commons Chamber

[Steve Barclay]

That, I think, relates to the point that I just made about the need for flow in the system and an appropriate step-down capacity. Sometimes patients are not yet ready to be discharged to their homes, but some additional physio or other support may enable them then to go home, which is where they usually want to be. This is all part of taking a much more integrated approach, and part of that must be improving the quality of data in relation to the activity that takes place within community settings.

[Helen Hayes (Dulwich and West Norwood) (Lab)]

In July, the average wait time in London for an ambulance needed by someone describing the symptoms of a stroke was more than an hour—more than three times longer than the target time. Many of my constituents have told me that they are living with genuine anxiety and fear that if they or a loved one were stricken by illness or involved in a serious accident, the emergency help that they needed would not arrive in time. The Secretary of State has announced some measures today, but what my constituents want to know is when we can expect the time targets in London to be met once again, so that they can rest easy in the knowledge that if they need an ambulance, it will be there.

[Steve Barclay]

One of my reasons for going out with the London Ambulance Service—among others—over the summer was to answer the charge about what Ministers were doing, and to observe at first hand the challenges that the service had been facing. As the hon. Lady will know, performance has improved since the summer, but the service remains challenged. That is why we are considering a range of measures, such as boosting emergency departments, looking at pre and post-cohorting, looking at how we work with the taskforce, and looking at single points of access. One issue that paramedics emphasise to me is the need for, in particular, a better way for frail elderly patients to gain access to a single point for social care provision. We are working closely on that range of measures with colleagues in the London Ambulance Service.