Draft Healthcare (International Arrangements) (EU Exit) Regulations 2023

Karin Smyth Excerpts

Wednesday 28th June 2023 General Committees

[Karin Smyth (Bristol South) (Lab)]

The regulations are vital to implement international healthcare agreements following our exit from the European Union. Reciprocal healthcare agreements support our constituents to access healthcare in the listed countries. Those faced with the stress and worry of a healthcare emergency abroad will rightly expect suitable agreements to be in place where possible. That is particularly true of people with a disability, who are older or who perhaps live with a chronic condition. The Opposition will therefore support the statutory instrument.

It is important to note, however, that the regulations confer further powers on the Secretary of State. It would be helpful if the Minister outlined further details about the Government’s plan for other international healthcare co-operation outside the European economic area and Switzerland, and perhaps gave an idea of what that might look like. From our understanding, payments can be made only if both the following conditions are met: the healthcare treatment is in a country with which we have an international healthcare agreement; and the Secretary of State considers exceptional circumstances to justify the payment.

I appreciate that the public consultation on this matter has recently closed, but will the Minister say what would constitute exceptional circumstances and how the policy framework might work? An early indication of the results of the consultation would be most welcome. Otherwise, we are happy to support the regulations this morning.

New Hospital Programme and Imperial College Healthcare NHS Trust

Karin Smyth Excerpts

Tuesday 13th June 2023 Westminster Hall

[Karin Smyth (Bristol South) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Mark. It is good to see the Minister; the day after we were last opposite one another, he decided he would not continue after the next general election. I hope we have a good exchange today, and I wish him well.

I am pleased to be in the debate. I declare an interest in that I was born in the Chiswick branch of the old Hammersmith Hospital. The groundworks at Ealing were dug by my father and thousands of Irish labourers from across west London, and I used to visit that hospital as a child. My brother was born in Hillingdon. These places matter to local people.

We are here to discuss something called the new hospital programme, but what we quickly learned was that it was not new, they were not hospitals and there certainly were not 40 of them. It is an absolutely sorry saga, and as we have heard it is a hammer blow for people in west London. It is also a saga that is recognised across the country. Members should not just take my word for it; according to the National Audit Office, the NHS estate does not meet the demands of a modern health service. The growth in backlog maintenance risks harm to patients, and the need for capital is being consistently underestimated. Billions of pounds in capital have been diverted to cover inadequate revenue funding, and yet some capital cannot be used for technical reasons, so there are underspends. Assets are sold to fund day-to-day activities.

In July 2020, the Public Accounts Committee recommended a capital strategy and guidance, including expectations on how backlog maintenance costs will be addressed alongside other priorities. In October 2021, the NHS Confederation stated that NHS leaders had concerns about safety standards because they cannot sufficiently maintain their estate, enable positive digital innovations and reduce the elective backlog without further worsening health inequalities. It described a disjointed and opaque allocation system and unresolved issues about how integrated care systems will allocate and prioritise capital spend.

There is more. In September 2022, the King’s Fund reported that levels of capital investment had changed dramatically over the past 15 years—and don’t we know it! The transfer of NHS funds from capital budgets to support day-to-day spending and relieve the pressures in the NHS has come at a huge cost. NHS buildings and equipment have fallen into increasing disrepair and patients have experienced safety incidents.

The Government’s own review, chaired by Patricia Hewitt, recommended that there should be a cross-Government review of the entire NHS capital regime, with a view to implementing recommendations from 2024. Section 5.43 of the report makes suggestions that a review should consider. My first question to the Minister is, will the Government conduct a review in the light of the Hewitt recommendations? The Opposition would like that update.

NHS estates and capital are a subject that has always interested me in my time as a Member of Parliament. My first involvement as an NHS administrator working on NHS estates was in the late 1980s, when I was a junior planner in Enfield working on the final stages of Chase Farm Hospital, liaising with architects and clinicians and producing updates for the planning director. Later, in the noughties, I was part of the Bristol health service plan to reconfigure acute services and develop the primary and community estate as a non-executive. Yet, my real interest in capital, and part of my motivation in becoming an MP, was the disaster of the Tories’ Health and Social Care Act 2012. Nowhere is the destruction caused by that legislation more apparent than in the management of estates and capital planning, which was not even an afterthought. We cannot provide quality healthcare in leaky, dangerous and collapsing buildings.

Local taxpayers deserve to know how their money is being spent, and another key point made by Patricia Hewitt was about accountability. The MPs here today can get no clarity from their local NHS, and that is frankly outrageous. They have come here today from west London, and from across parties, to try to get some answers as to why the promises made to them have been reneged on. They also want some clarity and, as my hon. Friend the Member for Reading East (Matt Rodda) said, some certainty about the capital programme. It is entirely opaque why some schemes go ahead while others languish somewhere in a possible queue—I am not even sure there is a queue. Indeed, my second question is, can we see that queue? Can we understand the criteria for assessing what is in and what is out, and the timings?

There have been questions about enabling works. We need much more detail on what is in the system now, the original bids and the assessment of the capability to deliver. Who is designing? Who is project-managing? Who is freeing up the clinical time and paying for it to lead and advise on what is needed? Who is tackling safety and the sustainability of these future public buildings so they can meet the challenge of climate change? Because of the damage of the last decade, such skills are in short supply across the public and private sectors.

In case the Minister is not across this and does not have the detail from his civil servants, I will end with a little advice. From my 30 years in and around NHS capital schemes, I know they are complex and require a huge range of knowledge and skill throughout a long process that sometimes lasts for decades. We cannot land modular buildings in major towns and cities, with buildings surrounding them that are hundreds of years old. These are complex facilities that need to augment local services; they are not Amazon warehouses. Decanting clinical facilities and patients is not a matter of unplugging a few computers and moving desks into a portakabin.

Crucially, as the people of Hammersmith and Paddington, Hillingdon, and Uxbridge and South Ruislip certainly know, this is a Government of vague but still broken promises. They could not run a bath; they could not deliver a pizza. They are totally incapable of running this hospital programme. I hope the NHS is not waiting for them to deliver a 75th birthday card, because it will never arrive. They need to go.

Obesity and Fatty Liver Disease

Karin Smyth Excerpts

Thursday 8th June 2023 Westminster Hall

[Karin Smyth (Bristol South) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Hollobone, and to respond on behalf of the Opposition health and social care team. As the hon. Member for Linlithgow and East Falkirk (Martyn Day) said, it has been a very well-informed debate. I thank my hon. Friend the Member for Caerphilly (Wayne David) for the exceptional work that he and the other members of the APPG on liver disease and liver cancer are doing to raise awareness of this vital issue.

As has been demonstrated, rising obesity poses a profound threat to public health. We have heard today—from Strangford to Erewash, and from Southall to Linlithgow—that this is an issue across the United Kingdom. Before we hear from the Minister, I want to say how impressed I am with how everyone has tackled their own health and wellbeing through exercise, and I will certainly try to do better the next time I come to one of these debates.

As we have heard, obesity can impact on cardiovascular disease, as well as a variety of other conditions, not least non-alcoholic fatty liver disease. The British Liver Trust estimates that deaths as a result of liver disease have doubled in the last 20 years—that is a sobering statistic—with mortality rates are four times higher in the most deprived areas, as we have heard. Childhood obesity is also rising at the fastest rate on record, with 39% of obese children estimated to be suffering from non-alcoholic fatty liver disease. Not only is obesity rising and costing lives, but it is also causing people to live less prosperous and enjoyable lives and harming our economic productivity, as my hon. Friend the Member for Caerphilly said.

The case for action could not be clearer. If we want to lead happier, healthier lives, while also reducing pressure on our NHS and turbocharging our economy, we must get serious about addressing the obesity crisis. That can be done only by placing prevention at the heart of our work.

Despite our best efforts, individuals cannot tackle obesity alone. Too often, we have a narrative of personal responsibility, but it fails because it promotes harmful, outdated ideas about our bodies, and that is particularly true for women. We need a step change in how we tackle obesity as a society.

I am proud that Labour’s recently launched health mission set out a blueprint for shifting the focus of Government Departments, the NHS, and wider public services to prevention. Most relevantly to today’s debate, we want to give every child a healthy start in life, with a children’s health plan.

I pay tribute to the hon. Member for Erewash (Maggie Throup) for her work as a public health Minister—she knows of what she speaks. We would want to implement that long-overdue 9 pm watershed for junk food advertising on television and to ban paid advertising of less healthy foods on online media. That would come alongside establishing fully funded breakfast clubs in every school and a balanced and broad national curriculum with a wide range of compulsory physical activities.

That is the start of our vision for Government. For far too long, public health problems such as obesity have been viewed as falling exclusively under the purview of the Department of Health and Social Care but, as we have heard, the causes of obesity are multifaceted. It is about what we eat, but also about our access to green spaces, our genetics, the money in our pocket, our access to community care, and so much more. If we want to tackle obesity and, by extension, this disease, every cog in the Government machine must recognise its responsibilities.

For that reason, Labour has committed to embedding health in all policies through the creation of a cross-departmental mission delivery board. That would bring together all Departments with an influence over the social determinants of health and act as an accountable body akin to the Climate Change Committee. That is the kind of bold, ambitious thinking that will define the next Labour Government.

I am aware that those suffering, or at risk, from NAFLD want action from the Government now. With that in mind, I would like the Minister to address some questions. First, in relation to obesity and prevention more generally, the Government recently launched their consultation for the major conditions strategy, singling out six major groups of health conditions but, unfortunately, there is no mention of obesity in the consultation documents, although cases of several of the diseases mentioned are rising in part because of obesity. It would therefore be helpful if the Minister set out what role preventive obesity policy will play in those major disease conditions. Similarly, concerns have been raised that there was no mention of liver disease in the strategy. Will he therefore set out how he plans to address increases in liver disease, and specifically NAFLD?

I also want to press the Minister on health inequalities. The British Liver Trust describes liver disease as, effectively, a barometer for underlying health inequalities. It points out that the main risk factors—obesity, alcohol misuse and viral hepatitis—are most prevalent in marginalised communities, and we heard some shocking statistics from my hon. Friend the Member for Ealing, Southall (Mr Sharma). That goes back to the point made earlier about the wider determinants of health. Unless the Government implement a coherent strategy for health inequalities, we will never be in a position to drive down liver disease.

The Minister will remember that in 2019 the Government pledged to extend healthy life expectancy by five years by 2035 and reduce the gap in healthy life expectancy by 2030. The clock is ticking. Not only is the target on track to be missed, but things are actually getting worse—inequalities in life expectancy are widening. Given that the Government binned their health disparities White Paper, will the Minister provide an update on how he plans to reverse the health inequalities that have widened on this Government’s watch?

We know that liver disease is largely asymptomatic in its early stages and that diagnosis is essential in providing effective treatment. As we have heard, one in four people diagnosed with alcohol-related liver disease in hospital die within 60 days, and there is evidence of huge geographical variation in the pathways for early diagnosis. Given that grim picture, what assessment has the Minister made of current diagnostic provision for liver disease, and how will he improve that picture so that, no matter where someone lives, they can receive a timely diagnosis?

In conclusion, our current trajectory must not be allowed to continue. Unless we address obesity and rising fatty liver disease, more lives will sadly be lost, and our health service will come under existential pressure. Labour stands ready and waiting to address this crisis, but we cannot afford to wait. The Government must get to work now. We look forward to hearing from the Minister.

Oral Answers to Questions

Karin Smyth Excerpts

Tuesday 6th June 2023 Commons Chamber

[Karin Smyth (Bristol South) (Lab)]

From Sittingbourne via Bristol and Oldham, people are fed up with not being able to speak with a GP when they need to. GPs are warning that rising demand and increased costs may lead to workforce cuts or even closures. They are fed up with the bamboozling of numbers—more of which we have heard this morning—whether on GPs, full-time trainees, locums and now appointments. Whatever the metric, can the Secretary of State or the Minister tell us how many more GPs or GP appointments they think are necessary for people to access the care that they need?

[Neil O’Brien]

We committed in our manifesto to increasing the number and availability of appointments by 50 million. We are well on our way to meeting that target, as I have mentioned—we had 10% more appointments in the year to April than in the year before the pandemic. That is the result of the additional staffing that we are putting in: the extra 29,000 other clinicians and the nearly 2,000 more doctors in general practice. We have made that investment, but the reason why GPs are doing more appointments is not just that we have provided a fifth more funding since 2017 up to 2021; it is also that GP teams are working incredibly hard, and I pay tribute to them for all they are doing.

Eye Health: National Strategy

Karin Smyth Excerpts

Wednesday 17th May 2023 Westminster Hall

[Karin Smyth (Bristol South) (Lab)]

It is a pleasure to serve under your chairmanship, Mrs Harris. I pay tribute to my hon. Friend the Member for Battersea (Marsha De Cordova) for bringing forward this debate. I agree with my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) that my hon. Friend the Member for Battersea works tirelessly as a great ambassador and advocate, not just on the subject of eyesight, but for people living and working with disabilities. She has offered me lots of advice for people I work with. We all want to be exemplars, and to make sure that we give people opportunities for employment. She keeps us all on our toes, and does it with superb grace and compassion.

As my hon. Friend knows, living with sight loss from birth, and as many others find out, sight loss can be devastating—it affects work, how we travel through the world and how we interact with those around us. There is not only the physical impact, but the effect on our mental health, and on confidence, which is crucial for how we live our life. The RNIB estimates that there are more than 2 million people living with sight loss in the UK. Shockingly, at least half of that sight loss might be avoidable.

Those who have treatment for sight loss and eye conditions often find it transformative and life-enhancing; however, people with sight loss are waiting too long for that vital treatment, with more than 24,000 ophthalmology patients waiting over a year for treatment in 2022. Last year, the then Minister stated, as we have heard, that the national eye care recovery and transformation programme remained a top priority. As my hon. Friend the Member for Ealing Central and Acton (Dr Huq) has said, it does not seem to be the case locally in our plans that it is a top priority, so we would appreciate an update from today’s Minister.

Findings from the recent workforce census of the Royal College of Ophthalmologists found that 63% of eye units estimate that it will take at least a year to clear their backlogs, and a quarter estimate that it will take over three years. As we have heard, the demand for ophthalmology services has risen rapidly, and is set to increase again by 40% over the next 20 years. The current estimated economic cost of sight loss is around £36 billion, as my hon. Friend the Member for Battersea said. We really cannot afford not to address that.

Prevention is key. The role of optometrists in primary care is essential in supporting good eye health. Regular eye tests can help to catch and treat conditions such as glaucoma, which is the leading cause of irreversible blindness; however, as we have heard, the report last year showed that 17.5 million adults had not had their eyes tested in the past two years, as recommended. My hon. Friend the Member for Battersea spoke about the importance of raising awareness of eye health by creating better public health messaging. Again, we need an update from the Minister on that.

I praise the hon. Member for Hendon (Dr Offord) for making a really important point about macular degeneration. Many people will recognise that feeling. It is something that I have in my own family: people feel that they do not know what it will mean for them. I pay tribute to my constituent, a former Member of Parliament for Bristol West, Valerie Davey, who has macular degeneration. When she was a Member of Parliament 15 years ago, she felt that perhaps she could not do the job. The then Secretary of State Lord Blunkett said to her very firmly, “I have not campaigned for services for disabilities all this time for you to give up because of that. We need to find ways to support you.” She continues to be a great supporter of me and a very avid campaigner, keeping me well up to date with the issues around macular degeneration.

Two thirds of eye units are finding it more difficult to retain consultants and over half are finding it harder to recruit. It is not just about consultants. Non-medical staff are indispensable in eye units, and that has to be recognised if we have a strategy. That really is the key question for the Minister: whether the workforce plan, if we ever see it, will include a commitment to fund the workforce that we need to meet patient demand.

The next Labour Government will take eye health seriously. Sticking plasters are simply not enough. We need a Government who will grasp the root causes of the staffing crisis in the NHS, which is why we will end tax breaks for non-doms and use the money raised to expand our NHS workforce. The next Labour Government will train a new generation of doctors, nurses and midwives to treat patients on time again, doubling medical school places to ensure that we have the workforce that we need, including across ophthalmology.

It is essential that everyone can access the right care when and where they need it. Moving more care to the community will help to support those suffering from sight loss, focusing on the provision of non-clinical community support to complement the work of community optometrists, ophthalmologists in hospitals and rehab officers. My hon. Friend the Member for Mitcham and Morden made an excellent point about the specialist service that we need for children and those with special needs particularly.

If opticians could refer patients to eye specialists themselves, patients would be seen faster and it would free up time in A&E and GP surgeries. As an NHS manager before coming to this place, I was involved in setting up a project to do just that over 10 years ago. It grieves me somewhat to see that across the country such schemes are still not happening, because we need to use all our resources and capacity across the NHS and private health services to bring down waiting lists in the short term. Ophthalmology is an area where the private sector can do more to address waiting lists for some of those procedures. That can skew the rest of the system, but commissioners need to take note of that. We need to make full use of that capacity, as we did when we were in Government last time.

As my hon. Friend the Member for Battersea said, data is vital to ensure that we are targeting strategies to address the problem in the right places. Minor eye conditions services provide eye care for patients who have had sudden changes to their eyes, but only 23 integrated care systems commission them, with five having none at all. What is the Minister doing to address disparities in eye care across the country? Many of my constituents are affected by sight loss. They and people around the country need to have reassurances from the Government that the Government are doing everything possible to address the concerns of healthcare leaders, staff and patients. We all welcome the thoughts of the Minister on the matter.

Allergy Awareness Week

Karin Smyth Excerpts

Thursday 11th May 2023 Westminster Hall

[Karin Smyth (Bristol South) (Lab)]

It is a pleasure to serve under your chairship, Ms Ali. I pay tribute to my hon. Friend the Member for Dagenham and Rainham (Jon Cruddas) for securing this debate and for his continued commitment to this issue. The petitions that are coming forward highlight the level of concern and interest in this area. It is right that we are debating it in this place.

We are witnessing a burgeoning rise in allergic disease in the UK. This country is in the top three in the world for the highest incidence of allergies. One third of the UK population are living with a condition and, perhaps more worryingly, 50% of children are affected by one or more allergic disorders. They are stressful and worrying conditions, with continual and often costly adjustments to guard against allergic reactions. In a few tragic cases, they can be fatal. Allergies can cause not only symptoms such as sneezing, itches, rashes and falls in blood pressure, but airway narrowing, shortness of breath, wheezing and swelling, which in the mouth area leads to severe difficulty in breathing and can be life-threatening.

As we have heard, allergies are most common in children. As my hon. Friend said, it is terrifying when people, particularly children, are rushed to A&E, sometimes with tragic results. My hon. Friend the Member for Pontypridd (Alex Davies-Jones) highlighted her experience with her own child, and it is something that I too have witnessed with a family member.

We have heard about the too frequent fatalities, mostly of young people, including Natasha Ednan-Laperouse. It is thanks to her parents and others that full ingredient and allergen labelling on pre-packed food for sale was introduced in October 2021. We pay tribute to them and to all families who have raised awareness in such circumstances. It is not something that any parent would want to have to do.

We have also heard about the incredible rise in hospital admissions over the past 20 years. I agree with the hon. Member for Linlithgow and East Falkirk (Martyn Day) that it was perhaps not recognised much when we were at school. The growth has been quite phenomenal. The hon. Member for Old Bexley and Sidcup (Mr French) has found out what we have all found out: that the great privilege of coming to this place is learning so much from our constituents and campaigners about issues that we may not have been aware of, and being able to present them in this place.

We now know that there are only 40 allergy consultants in the UK, and even fewer in paediatrics—the equivalent of only one per 1.3 million of the adult population. As far back as 2003, the Royal College of Physicians advised that 200 consultant allergists were required. Despite further warnings and criticism over the past two decades, the provision is wholly inadequate. The first Health Committee report highlighting the inadequacy of service was in 2004. In 2006, there was a report so scathing that the then Labour Government’s Department of Health conducted a review. In 2007, 2010 and 2021, we had further reports from the House of Lords Science and Technology Committee, the Royal College of Pathologists and most recently the APPG, all of which further acknowledged the continued failures without much progress.

After 13 years, we look forward to the Minister giving us a bit of hope for the future. It is vital that there are allergy services across all integrated care systems, but as we heard from my hon. Friend the Member for Dagenham and Rainham, more than half of ICBs have said that they do not hold that data and are not across the issues in their own populations. Last year, the then care Minister, the right hon. Member for Chichester (Gillian Keegan), said that

“we will continue to support people living with allergies through NIHR research and exploring and investing in new treatments.”—[Official Report, 9 March 2022; Vol. 710, c. 134-135WH.]

We would welcome an update from today’s Minister on what steps have been taken to ensure that allergy services are available in all ICS areas.

The NHS’s capacity to tackle allergic disease has been lowered by the unprecedented pressures it is facing under this Conservative Government. More than 7 million people are waiting for NHS treatment, compared with more than 4 million before the pandemic. They are waiting in pain and discomfort, on record waiting lists, and there are staff vacancies of more than 100,000. Those awaiting treatment for allergies face long wait times as well as delayed diagnosis and treatment. That, in turn, increases the chance of more severe allergic reactions developing, which will often require admission to secondary care— something that none of us should want to see. Again, that is increasing the pressure on services by taking up time in A&E and is resulting in more expensive treatments.

Will the Minister explain what her Government are doing to tackle the waiting times for diagnosis and treatment? Last year, the then Minister also stated:

“The FSA is currently undertaking a programme of work to improve the quality of life for people living with food hypersensitivity and provide support to make safe, informed food choices to effectively manage risk.”—[Official Report, 9 March 2022; Vol. 710, c. 134WH.]

Those are words that I am sure today’s Minister recognises. Again, we would all welcome an update on where that work has got to.

There is hope for people living with an allergy. Given the right amount of research funding in the next couple of decades, treatments can be found that will potentially eradicate many allergies. I would be grateful if the Minister set out what action is being taken to support forward-looking research into potentially lifesaving treatments.

Branded Medicines Voluntary Scheme and the Life Sciences Vision

Karin Smyth Excerpts

Wednesday 3rd May 2023 Westminster Hall

[Karin Smyth (Bristol South) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Sharma. I understand that Parliament is technically in recess, but here we are working hard to the last on this very important debate. I am grateful to the hon. Member for Newton Abbot (Anne Marie Morris) for securing it. I agree with my hon. Friend the Member for Cambridge (Daniel Zeichner) that she used her expert knowledge to provide a detailed outline of the issues.

As the hon. Lady said, the scheme has a number of objectives, including improving patient access to medicines, getting the best value and most effective medicines introduced more quickly, and supporting innovation in a successful life sciences industry here in the UK. It is a complex area, balancing what often seem to be competing priorities around keeping costs low and getting a fair return for the industry. Ultimately, we need to remember that this debate is about people: our constituents, ourselves and families. People expect to be treated with the best medication available and for the NHS to provide good value to the taxpayer.

Last week the Minister outlined that

“we are seeking a mutually beneficial voluntary scheme that supports patient outcomes, a strong life sciences industry and a financially sustainable NHS.”—[Official Report, 25 April 2023; Vol. 731, c. 584.]

I hope he will today update us on where that work has got to, and on whether the Government are any closer to a solution. That would be most welcome, as other Members have outlined.

I will take the objectives that the Minister outlined one by one. Supporting patient outcomes is vital; we all want the best for our constituents. There are a number of heartbreaking cases where people have not been able to get the drugs they need. Many colleagues have raised those cases in this place and have become experts on behalf of their constituents. It is a devastating issue for many people. I think that people do understand that this is complex and difficult, particularly for rare diseases. Although we recognise the need for commercial confidentiality, people need greater empowerment. The taxpayers who fund our system need to understand the transparency and accountability associated with those agreements.

The second issue that the Minister outlined is the life science industry, which is crucial to our economy. It is disappointing, as the hon. Member for Newton Abbot outlined, that there is a decrease in our share of global investment in R&D. It is worrying that companies are leaving the UK to seek other markets. We are all hugely grateful to the sector that got us through the pandemic. We all learned a lot more about the sector in that period, but it was able to do that because of previous, sustained, long-term investment. That is where we need to get back to.

We have consistently led in the field of life sciences research and development, an industry that employs more than 260,000 people across more than 6,000 businesses and generates a huge annual turnover. We need it to thrive. However, the Government are not serious about science. Due to their lack of investment and strategy, we are not converting our rich science base into the high-skill, high-wage, high-productivity economy that we all want to see. There is not a detailed plan to get us to where we need to be.

The Labour party is committed to harnessing the potential of the sector. Investment and reform of research and funding is key to improving outcomes. At the centre of our science policy is a target to raise total investment in R&D to 3% of GDP by 2030. Targeting that investment will help us to develop the treatments and innovations we need for the future. It will be part of our wider industrial strategy to build the high-wage, high-growth and more productive economy that we want to see.

The third point the Minister made was about a financially sustainable NHS. The current backlogs of care and the workforce shortages that have put the NHS under increasing operational and financial pressure are immense. Those pressures will only be exacerbated by maintaining an environment that fails to encourage much-needed innovation. Again, there are clear lessons to be learned from the pandemic, but in a stretched system that had over 4 million people waiting for treatment before the pandemic, research and clinical trials can become less of a focus. They are people-intense—I have been part of them in a previous role—and require focus. Support for the wider health sector is crucial in helping that move along.

Investment in health and futureproofing our system is good not only for patients, the public and the life science sector but the wider economy. The cost of ill health is substantial, and we have much evidence of the link between the health of the nation and societal wellbeing.

In conclusion, we are seeing growing concern about the current scheme. Over the past year, the supply of branded generics in particular has been dented by steep increases—linked to high price inflation—in VPAS payments. It is impacting on shortages—we look forward to hearing the Minister’s comments on that—and the supply of medications. Issues in the scheme are made evident when major companies leave it. It would be helpful to hear from the Minister what action he has taken to support the life sciences industry in this country, and to give clarity and support, which we would all like to see, to those undertaking research into potentially life-saving drugs. We want support to be given to the key industries, particularly in places such as Cambridge, as outlined by my hon. Friend the Member for Cambridge, but also in all our constituencies across the country. It is vital that the Government get that plan in place.

Medicinal Cannabis: Economic Contribution

Karin Smyth Excerpts

Thursday 20th April 2023 Westminster Hall

[Karin Smyth (Bristol South) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Stringer, and to be present for this debate. I take what the right hon. Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell) said about it being in a late slot on a Thursday, but it is an important debate, and I am pleased that we have had time for contributions.

The right hon. Gentleman clearly outlined the case for a legitimate industry of the future. He asked the Government for consistency and coherence in their approach to the industry. I wish him luck on getting Government coherence on policy for many nascent industries, but the point was well made about good standards of production and the importance of jobs, particularly in rural economies such as the one he represents.

Many people present—and, on other occasions, many who could not be here this afternoon—have spoken movingly about constituents, as the hon. Member for Strangford (Jim Shannon) did. He spoke about the difference that earlier movement would have made to his nephew.

We welcome the constituents of the right hon. and learned Member for Kenilworth and Southam (Sir Jeremy Wright), who were present to hear the debate, as they have been on many similar occasions over the past few years. He made the sensible point that the 2018 decision logically necessitated action from the Government, and said that the insecure supply chain is worrying for so many families across the country. Having an industry in this country would alleviate that worry.

Finally, we heard from the hon. Member for Inverclyde (Ronnie Cowan), who has raised the issue 36 times. I work well with him on Committees, and he is a persistent campaigner on this and many other subjects, so I suspect he will be here for a 37th and a 38th time as well. He has done a huge amount of work in the area. He took us on a trip into history, and spoke about the importance of many such plants to the wider economy, and on the need for the Government to have more knowledge when it comes to the logic of their decision making on supporting the industry.

This debate is about the economy, and points have been made well. As we have a Health Minister present, however, it is worth recapping why we have not made greater progress since 2018, in particular for those campaigners who worked so hard. Despite that 2018 decision, the trials and clinical research that would help the wider industry have moved at a glacial pace, so across the NHS, since 2018 only five people have been prescribed medical cannabis. That is ridiculously slow, and so many people have to go private.

Five years later, it is totally unacceptable that so little progress has been made. It would be helpful if the Minister could set out what steps he is taking to empower and accelerate research in this space. I hope he will not dodge the question by saying that the issue is simply one for clinicians. The Government have a responsibility—the Minister is nodding, and we await his reply with interest, but there seems to be a lack of urgency on the issue, which is concerning. People are suffering right now. We have heard again this afternoon about children who are fitting, sometimes 100 times or more. Accessing care is, in some cases, pushing families to the brink of destitution. We should do everything we can to support those people.

If research is needed before clinicians feel comfortable prescribing, then it is incumbent on the Government to support clinicians. We need more streamlined clinical trials and better engagement with clinicians. We do not want to be back here in another two years, having a rerun of this debate. In 2020-21, the then Minister said:

“It will take time to generate further evidence and see the results of clinical trials. The Health Secretary and I are committed to doing everything in our power to accelerate this work.”—[Official Report, 4 November 2021; Vol. 702, c. 1120.]

If the Minister could update us on where this work has got to, and whether the Government are any closer to finding a solution, that would be welcomed by people tuning in today, and to the families present.

Finally, I would be grateful if the Minister set out what action he has taken to support people in the system right now—those living in extreme pain who are paying thousands of pounds to access treatment. There is consensus on this issue, as we have heard. The debate has been had and a decision has been made, but we can and should do better. In that spirit of consensus, we would all like to see some progress from the Minister.

Covid Pandemic: Testing of Care Home Residents

Karin Smyth Excerpts

Wednesday 1st March 2023 Commons Chamber

[Helen Whately]

My hon. Friend is right. The right thing for us to do as a country is to reflect overall on how we handled the pandemic, on the decisions that we made and, indeed, on how prepared we were in the first place. That is the right way to do it. Of course we regret every life that was lost; I think about the families who lost mothers, fathers, brothers, sisters and grandmas. It is so deeply sad that so many lives were lost, but that is something that affected us here in England, across the UK and, indeed, across the world. But the right thing for us to do is to look at these things in the reasoned environment of the inquiry and then use the lessons learned and the reflections from that inquiry to make sure that, in the event that we ever have to face another pandemic like it, we can do better.

[Karin Smyth (Bristol South) (Lab)]

The Government entered the pandemic unprepared, ignoring the lessons from Operation Cygnus, and ran the NHS at 96% capacity. That was part of the problem. We all know that mistakes happen. We all know that it was really difficult. However, today is disappointing, because some humility should have been brought to this place. More than 17,000 people lost their lives. It is our job as the Opposition to scrutinise decisions. The former Secretary of State has thrown his colleagues under a bus because of his own vanity, but I suggest that Government Ministers need to use this time before the inquiry to ease families’ suffering by coming forward with more detail on actually what did happen.

[Helen Whately]

There has already been a legal investigation into some of the aspects that we are talking about today. Given the huge number of decisions that had to be made and the period of time that we are talking about, the right way to do this is to bring all the evidence together, in the form of a public inquiry, and have it fully examined. That is the best way to answer the sorts of questions that the hon. Lady suggests.

NHS Workforce Expansion

Karin Smyth Excerpts

Tuesday 28th February 2023 Commons Chamber

[The Minister for Social Care (Helen Whately)]

I am grateful for this chance to come to the House and talk about the NHS workforce. I am happy to begin with something that I expect is a point of agreement with those on the Opposition Benches: praising our fantastic NHS workforce and all they have done through the pandemic and are doing now as we recover from covid. Hon. Members will not be surprised to learn that my colleagues the Secretary of State for Health and Social Care and the Minister for Health and Secondary Care, who has responsibility for workforce, are today focused on discussions with the Royal College of Nursing, so it is my particular honour to speak on behalf of the Government today and to take a moment to re-set the tone, and indeed raise the bar, in this debate.

I am very happy to talk about our NHS workforce at a time when we have record numbers of doctors and nurses working in our health service. I am equally happy to talk about our social care workforce, the very people the hon. Member for Ilford North (Wes Streeting) seems to forget time and time again. I note that they are forgotten in his motion again today. In contrast, the Government are working with our whole health and social care workforce, not only training record numbers of doctors and nurses, and recruiting a whole host of healthcare professionals into the NHS, but bringing historic reforms for the social care workforce—all that despite the global pandemic, which created the most challenging backdrop any Government have faced for decades.

[Karin Smyth (Bristol South) (Lab)]

Will the Minister give way?

--- Later in debate ---

[Helen Whately]

My hon. Friend makes a very good point about the selective use of figures by Opposition Members.

[Karin Smyth]

I want to pick up the point about social care, on which, as the Minister knows, I am very keen to see progress. Her Government shelved their social care plans. The former Prime Minister said he had fixed social care, leading the entire country through that dance. He promised people that it was fixed and that people in their older age or with disabilities could be secure, so it is rather shameful for her to raise that point without then saying—maybe she will go on to do so—when we will actually see any progress on social care. Why have her Government shelved their plans?

[Helen Whately]

On the contrary, we have already made progress on some things in our social care White Paper published just over a year ago. We will soon publish next steps, particularly focused on workforce reforms. I have been talking to several stakeholders involved in exactly that area over the last few weeks. If the hon. Lady is patient she will see some of that coming forward.

I was talking about some of the things that we have done to vastly increase the number of healthcare professionals in the NHS. As part of our ambitions for the future, more than 26,000 students were accepted on to nursing and midwifery courses in England last year—a 28% increase on 2019. We are on track to meet our manifesto commitment of 50,000 more nurses by 2024. Much as we continue to strive to go further and faster, those are the figures as they stand. We might wish to make a comparison with Labour-controlled Wales, though it is sometimes hard to do so because it does not collect crucial data such as vacancy rates. One has to wonder why. That is the same Labour-run Wales where patients are twice as likely to be waiting for treatment as in England. Some 50,000 people are currently waiting over two years, while here in England we eliminated two-year waits last year.

I will move on from the situation in Wales, as I am sure Opposition Members will be glad to do so. The Leader of the Opposition has said that he thinks we are hiring too many people from overseas in health and care. The same gentleman spent several years campaigning for a second referendum on freedom of movement. Whatever his views this week, it is the work of a responsible Government to look at every available option to give this country the health and care workforce that it needs. Alongside training more doctors and nurses, recruiting from overseas and giving people from other countries a chance to work in the NHS is the right thing to do.

--- Later in debate ---

[Dr Whitford]

That is not true—and 99% of our trainee posts last year have already been filled. Perhaps the hon. Gentleman should look at the statistics. We have more GPs per head of population than any of the other nations in the UK, including Wales, which his party runs.

So what do we need to do about this? Clearly we need to train more staff, but we must also not only increase the number of both nursing and medical student places, but look at the cost of studying and the student debt that those people will be left with. We do not have tuition fees in Scotland and our nurses receive a bursary of £10,000 a year, which means that we are investing £20,000 in every student nurse in Scotland.

[Karin Smyth]

The hon. Lady talks a great deal about the inputs of the SNP Government in Scotland, but very little about the outcomes there. Does she not agree that, rather than carping about the contrast between how good things are in the rosy land of Scotland that she portrays—which is not a true picture, as we know from what is happening with the SNP leadership election—and how bad they are in Wales, England and indeed Northern Ireland, we should start learning from the different ways in which the different Governments are providing services and working people? We need to stop carping about those differences, learn from each other and recognise that outcomes are different, rather than just talking about the inputs. Is that something on which she might want to work with other people?

[Dr Whitford]

I think I have spent the last eight years demonstrating the different approaches that Scotland takes. The Minister talked about community pharmacies, which have been providing minor ailment care in Scotland since 2005. Our optometrists are allowed to refer people with cataracts directly to hospital, whereas in England, they are often made to go through a GP. So I am sharing and have shared ideas in that way. However, there has been a 5.8% increase in the uptake of nursing jobs in Scotland, so we also have more nurses per head of population.

--- Later in debate ---

[Karin Smyth (Bristol South) (Lab)]

Having spent most of my career in NHS management roles before becoming an MP, I often reflect on my own motivation for choosing two such unpopular careers—ones that, like the England manager job, virtually everyone can do better. One of our colleagues said recently that NHS managers are utterly useless and overpaid, which is what many of our constituents might say about us. As someone who has always been a manager and active in the Labour party, I was often told rather gently by my colleagues that I was too political to be a manager in the NHS, and my colleagues in the party often say that I am a bit too managerial to be an MP, so I think I am somewhere just about right.

The truth is that the NHS is an intensely political construct. NHS managers do not have the neutrality cloak of civil servants or the freedom of many business leaders. The lack of clarity around the role of NHS management is, I think, problematic, and it often leaves managers isolated and less able to do the job that we crucially need them to do. The Secretary of State’s pledge to cull managers yet again comes at a time when the challenges faced by the system are the greatest that we have ever seen, even without taking the pandemic into account. Industrial relations are at an all-time low, capacity and demand are massively out of kilter, the physical estate is crumbling, with £10 billion-worth of backlogs, and morale is at dangerously low levels.

We need much better management, but managers need to be clear with us. Ten years on from the Francis report and the introduction of a duty of candour, we—the public, Members of Parliament and patients—have to know where and when our system is and is not safe. We have to be informed about the trade-offs between cost and quality, and we should be active parts of the discussion about the future of technology and big data in healthcare. I am disappointed that the Minister has again trotted out the figures of inputs but has not addressed the crucial issues. We did not do that before the pandemic, and it is quite extraordinary that the Government are still not receiving the messages from the frontline.

The increased recruitment to NHS unions, more support for strikes and the reality of people’s experiences all tell us the same message. The Government’s current response is all about getting rid of the current crisis: the money that they are putting in is too little and too late to be of real value, and instead of collaborating with local authorities, which are now worrying about the pick-up rates, they are fragmenting many local relationships. The uncertainty about payment by results and the faltering steps towards better collaboration mean that the deckchairs are still moving, and for our constituents, things are not improving.

Our focus in government, of which I am enormously proud to have been a part in an NHS trust and then as a manager, was on patient choice. That was not because we think that the NHS is a market, as is often said, but because we think that the NHS needs a stronger patient voice to co-produce individual care, and because we are asking people to pay more in this age of long-term conditions and co-morbidity, so we have to ensure that they have more local accountability in the system. The system is not accountable locally.

I repeat my comments about Scotland and Wales. The Welsh waiting lists are not acceptable. The Scottish waiting lists are not acceptable. None of this is acceptable. As politicians, we all need to start addressing some of the underlying issues we share and start learning from one another.

I am proud of my time in the NHS and fully aware of the scale of the task ahead, but with good clinicians, good managers and, dare I say it, good politicians, we can develop a longer-term plan and turn this around, should we choose to. The workforce is the right focus to start with, but other improvements in quality of care can happen if we trust the local. Let us build improvements where we can and work with the willing. Let us rejoin the dots destroyed by the disastrous Lansley reforms.

I recently received an updated join strategic needs assessment from my local authority—the plan for my constituency. These are all things I worked on over 10 years ago, and it is utterly heartbreaking to see. Cervical screening coverage for all women in Bristol is lower than average. Bristol is below the national average for HPV vaccination in boys and girls. Breast cancer rates are 16% higher in Bristol than the England average, and the prevalence of osteoporosis is rising much faster in Bristol than in England. One in four attendances at A&E for falls is a resident of my constituency. I remember the old falls service 10 years ago. This is not a new disease to be eradicated; we do not need a new cure. These are all entirely, and fairly cheaply, preventable problems of public health.

The local NHS priorities are now excess weight management, harmful use of alcohol and falls in old age—all public health preventive work—but with child and adult social care taking up more than 60% of local authority revenue budgets, public health has been hollowed out and is entirely reliant on the voluntary sector. People living with profound disability and ill health are dying earlier and in worse condition. The next debate is about employment. Let us get those people back to better health and back to work. Let us help them care for the older people and people with disabilities they need to care for, but crucially, let us give them their life back. The Government need to join the dots. Instead of bad-mouthing and culling more management, let us give local government and the NHS the tools they need to do the job.