Tobacco and Vapes Bill

Lyn Brown Excerpts

2nd reading
Tuesday 16th April 2024 Commons Chamber

[Victoria Atkins]

I am extremely grateful to my right hon. Friend and close Lincolnshire neighbour. He knows that on any piece of legislation I will always want to listen to and do business with colleagues. The principle behind this legislation is that these emerging generations will never take up smoking. That is the point.

[Ms Lyn Brown (West Ham) (Lab)]

rose—

[Sir Jake Berry (Rossendale and Darwen) (Con)]

rose—

[Victoria Atkins]

I will just finish this point. We are bringing forward this legislation so that we stop the start from 2027. Future generations will not have that addiction to nicotine.

[Ms Brown]

Let me say from the outset that I completely support this Bill. In Newham, 22% of sales last year were to under-age children—higher than alcohol, knives, fireworks and so on—and a total of £135,000-worth of illicit tobacco products were seized in just six months. Will the Secretary of State ensure that councils get the resources they need to continue the vital work of keeping these products out of the hands of the young?

[Victoria Atkins]

Yes, I can assure the hon. Lady, because the illicit trade is often the greatest in the most deprived areas of the country, and I am about to develop exactly how we will help law enforcement. I very much understand the concerns across the House about ensuring that the illicit trade does not flourish.

--- Later in debate ---

[Wes Streeting]

I admire the right hon. Gentleman for sticking to his convictions as a libertarian in making that case, even though I strongly disagree with him, but how far does his commitment to libertarianism go? He is defending the right of our country’s children to become addicted to nicotine for the rest of their life, which is an extraordinary argument. There are 356,000 people in his local area on NHS waiting lists. Does he want a future where that gets worse and the disease burden and cost pressures rise? When he was in government, the low-tax Conservatives crashed our economy and sent people’s mortgages through the roof, and rents, bills and the tax burden rose. That is their record. I wish he would do more to stand up for his low-tax convictions than his libertarian desire that children growing up in our country today should become addicted to nicotine. I have to respectfully disagree with him.

Compared with three years ago, half a million more people are out of work due to long-term sickness. People’s careers are being ruined by illnesses that prevent them from contributing to Britain’s economic success. We cannot build a healthy economy without a healthy society. Not only is there a moral argument for backing this progressive ban, based on the countless lives ruined by smoking and our shared determination to make sure that children growing up in Britain today will not die as a result of smoking, but there is an economic argument, too.

It is certainly true that vaping is less harmful than smoking and is a useful smoking cessation tool, but vapes are harmful products none the less. In the past few years, entirely on the Conservatives’ watch, a new generation of children have become hooked on nicotine. An estimated quarter of a million children vape today, and there is no doubt that this is the result of vaping companies’ decision to target children. On any high street in the country today, people can buy brightly coloured vapes and e-liquids with names such as “Vimto Breeze” and “Mango Ice”. They are designed, packaged, marketed and deliberately sold to children. The effect of this new nicotine addiction on our country’s young people should trouble us all.

[Ms Lyn Brown]

A couple of years back, Newham did a survey and discovered that 4% of year 6 children—that is 10 and 11-year-olds—had already vaped. I met Community Links in Canning Town in January, and it has been working on projects to tackle misinformation. Its students explained to me that they and their friends have been encouraged to believe that vaping is somehow safe and will not cause them the same problems with nicotine. Surely we can all agree that the voices of young people need to be heard and that they need to be encouraged and assisted to tackle the misinformation about vaping that is clearly out there.

[Wes Streeting]

I strongly agree with my hon. Friend, and I am very familiar with Community Links, which does brilliant work. We should take the voices of children and young people seriously—the right hon. Member for Chelmsford (Vicky Ford) made that point earlier.

Teachers monitor school toilets where children congregate to vape. Kids are making up excuses to leave their classroom in order to satisfy their nicotine cravings, and children in primary school, aged 9 or younger, have ended up in hospital because of the impact of vaping. Paediatric chest physicians report that children are being put in intensive care units for conditions such as lung bleeding, lung collapse and lungs filling up with fat. One girl who started vaping at school told the BBC that she has

“no control over it…I start to get shaky and it’s almost all I can think of.”

The question that must be asked of Conservative Members should not be whether they will take action today, but what has taken them so long. In 2021, Labour supported an amendment to the Health and Care Act 2022 to ban the branding and marketing of vapes to appeal to children—Conservative MPs voted it down. In 2023, my hon. Friend the Member for Denton and Reddish (Andrew Gwynne) led a debate on an Opposition day motion on the same proposed ban—once again, Conservative MPs failed to support it. Thanks to their delay in acting against this, and thanks to their awful, shocking complacency, thousands more children have taken up vaping and become addicted to nicotine. Can the Health Secretary tell the House whether the Government’s delay in acting against youth vaping had anything to do with the £350,000 donation her party received from the boss of a major vaping company that sells vapes with flavours such as “Blue Razz Lemonade” and “Strawberry Mousse”?

We are an ageing society facing rising chronic disease. We are approaching these challenges with an NHS already in the worst crisis in its history, with the longest waiting lists and lowest patient satisfaction on record, 121,000 staff vacancies across the health service and 14,000 fewer hospital beds than in 2010. If we do not act today to ease the pressures coming down the track, they threaten to overwhelm and even bankrupt the health service.

Prevention is better than cure. This progressive ban must be the beginning of a decade in which we shift the focus of healthcare in this country from sickness to prevention, which is mission critical to making sure the NHS can be there for us in the next 75 years, just as it has been there for us in the past 75 years.

If the Government are serious about taking on this challenge, Labour has many more plans that they can adopt before they finally call the general election. They could adopt our children’s health plan to give every child a healthy start to life. They could ban junk food ads aimed at kids so that children are not targeted by unhealthy food. They could tackle the mental health crisis facing young people, with support in every school, hubs in every community, and 8,500 more mental health professionals to cut the disgracefully long waiting times for treatment.

They could treat the 152,000 children who have been on NHS waiting lists for more than 18 weeks, ending long waits for children for good. We will do it by providing 2 million more operations, and by providing evening and weekend appointments to beat the Tory backlog. We will have supervised toothbrushing in schools to tackle the moral emergency of children needing to have their rotting teeth pulled out, which is the No. 1 reason why children aged six to 10 end up in hospital. We will have breakfast clubs in every primary school so that kids start the day with hungry minds, not hungry bellies. We will digitise the red book, making sure that all kids are up to date on their checks and vaccines. And we will once again put an end to measles in this country, after it has been allowed to return on the Government’s watch.

We want the next generation to be chasing their dreams, not a dentist appointment. They should aspire to reach their potential, not to reach a doctor. Labour’s plan is to make sure that today’s children are part of the healthiest generation that has ever lived, and this ban is just the start.

The Prime Minister may be too weak to whip his MPs to vote for this important Bill, but Labour will put country first and party second. We will resist the temptation to play games on votes. Instead, we will go through the Lobby to make sure this legislation is passed so that today’s young people are even less likely to smoke than they are to vote Conservative.

I commend this Bill to the House.

Oral Answers to Questions

Lyn Brown Excerpts

Tuesday 5th March 2024 Commons Chamber

[Ms Lyn Brown (West Ham) (Lab)]

15. What steps she is taking to improve healthcare for women.

[The Secretary of State for Health and Social Care (Victoria Atkins)]

Women’s health is one of my top priorities. As we approach International Women’s Day, we have already improved access to contraception and the treatment of urinary tract infections through Pharmacy First, announced £50 million of funding for research on maternity disparities and other health conditions affecting women, and set the expectation that each integrated care board area will have at least one women’s health hub operating this year.

[Ms Brown]

For more than a decade I have been raising the appalling, often agonising treatment of many women who need hysteroscopies in the NHS. They are being left with unnecessary trauma and are reluctant to engage further with doctors, which is quite simply life-threatening. However, the medical establishment continues to resist change and the Government shirk their leadership role. Earlier this year the Secretary of State set out her priorities for the women’s health strategy, and access to pain-free hysteroscopy was not included. Why?

[Victoria Atkins]

I thank the hon. Lady for her work in this regard, and I absolutely acknowledge the issues that women are experiencing with this highly invasive procedure at what is often an extremely distressing time in their lives. We are waiting for the Royal College of Obstetricians and Gynaecologists to update its guidelines on best practice in hysteroscopies. Following consultation last year that is under peer review, and is due to published soon. However, as the hon. Lady knows, I am clear that it should not be the responsibility of women in those very distressing circumstances to ask for pain relief. Clinicians must assume that a woman wants it, and discuss that with her before the procedure.

Mental Health Treatment and Support

Lyn Brown Excerpts

Wednesday 7th June 2023 Commons Chamber

[Ms Lyn Brown (West Ham) (Lab)]

Can I tell Members on the Government Benches a little bit about the mental health crisis in Newham? We have a rocketing population that is young, with no commitment from this Government that health funding will rise to match it. We have almost 41,000 children living in poverty. We have the highest proportion in the country of people living in damp, mouldy, overcrowded temporary accommodation. All of these people have no sense of security in their home at all: they do not know when their local ties will be shattered yet again by a forced move.

As we know, all of this impacts on mental health, and particularly on the mental health of children. I see that constantly in my casework, and local health leaders tell me exactly the same thing. It can hardly be a surprise to the Government that the number of young people being referred to mental health services is 30% up in Newham alone. Cases are increasingly more complex, more urgent and more in danger of spiralling into deep crisis.

Newham is the most diverse borough in the country, with the second highest rate of GP registrations by migrants. Our diversity has massive benefits, and I love it, but it requires clinicians to adapt their way of caring for people with different cultural backgrounds and languages. Despite all that, Newham’s mental health spend is the lowest in London. With all those challenges, our clinicians and our health leaders are obviously struggling to meet their targets. Average waits in Newham between referral, assessment and treatment were at 12 weeks in 2021. Some patients are waiting for as long as a year, and that is after they have had a referral, which as we know is terribly difficult to access.

Our local mental health unit, which deals with only the most severe needs, is at 98% occupancy—far in excess of the clinical standard. Quality of care and patient care and safety are suffering. There is a dire shortage of specialist mental health beds for our older adults. We have older people waiting for long periods on utterly inappropriate wards and in beds that are no doubt sorely needed for those waiting for other hospital treatments. Many patients with mental health crises are waiting in emergency departments for more than 12 hours, and local health leaders are worried that those numbers will increase. Our mental health services are struggling even to react to some of the most dire situations, let alone being able to offer proactive support that prevents mental illnesses getting worse.

We are creating even more problems—greater problems for the future, greater costs for the Government, greater costs for the NHS, more antisocial behaviour, more homelessness and rough sleeping, and massive wasted economic and social potential. People’s lives are being devastated by treatable ill health and completely avoidable misery. If we are not sitting in this place to avoid that, why are we here?

Labour’s plan to transform mental health treatment is desperately needed in Newham, along with thousands more mental health staff and professionals in every school and accessible mental health hubs in every community. We sorely need a preventive approach so that we can bring this crisis to an end, and we need it now. Can I use my last 30 seconds to look at the Minister and ask whether she will meet me and my health providers and health leaders in Newham to talk about the massive underfunding that our borough and my community face?

--- Later in debate ---

[Maria Caulfield]

Unfortunately, given the time I have left, I will not give way any more.

As for the challenges we face, we are seeing rising numbers, but we are seeing that in all parts of the country. The shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), talked about not judging Labour on its track record on health in Wales, where Labour has produced smaller funding increases for its health service; its 7.8% increase compares with the 8.6% increase that we have given in England. Mind Cymru has said that hundreds of people across Wales are currently waiting more than a year to access psychological therapies. The target is supposed to be that 80% of people in Wales access therapies within six months, but that target has never been met. It gets worse, because since 2020 the number of people waiting longer than a year in Wales for mental health support has increased by 17%. Labour talks a good game, but its actions speak louder than its words. I urge shadow Ministers to acknowledge that these problems exist in all countries and that we all face these pressures. A grown-up conversation would be about sharing best practice and working together to make that happen.

Many Members talked about preventive and early intervention therapies. My hon. Friends the Members for Bosworth and for Devizes (Danny Kruger) talked about that and about moving away from the medicalisation of mental health. That is why we are investing in talking therapies. For anyone who has not been on the Every Mind Matters website, let me say that it provides practical support for people who are anxious, distressed or not sleeping. It also provides for self-referrals to talking therapies. Since we introduced that, more than 1.2 million patients have accessed NHS talking therapies in the last year, helping them to overcome anxiety and depression. More than 90% of those people have had their treatment completed within six weeks.

Many Members talked about schools, and we are introducing mental health support teams in schools. We have almost 400 now, covering more than 3 million children, and about 35% of schools and colleges. More than 10,000 schools and colleges have trained a senior mental health specialist, including more than six in 10 state schools. That work is happening already and it is making a difference right now. My hon. Friend the Member for Newcastle-under-Lyme (Aaron Bell) highlighted how we need to move that into universities, and I would be happy to talk to him about how we can do that further.

On in-patient services and the quality of care, we have recently conducted a rapid review of mental health in-patient settings. The Secretary of State will announce the results of that soon. We have also introduced a three-year quality transformation programme, which seeks to tackle the root cause of unsafe, poor-quality in-patient care, particularly for those with learning disabilities and autism.

On suicide prevention, our forthcoming strategy will target high-risk groups and locations of concern. We will also provide £10 million of funding for charities that do so much good work in this space. I say to my hon. Friend the Member for Penrith and The Border that I would be very happy to meet the 3 Dads Walking, Andy, Mike and Tim. I know that they have met the Prime Minister.

[Ms Lyn Brown]

Will the Minister give way?

[Maria Caulfield]

I am just answering a question on suicide. I would be very happy to meet the 3 Dads Walking to learn the lessons for our suicide prevention strategy.

[Ms Brown]

Will the Minister give way now?

[Maria Caulfield]

I will not give way. I only have a few minutes left.

It is disappointing that Labour Members cannot understand the progress that has been made and are determined to make political points, damaging the work that our NHS staff up and down the country do day in, day out, backed by record levels of investment that have never been seen before in mental health services.

It is true that we have tabled an amendment this afternoon, in which the Prime Minister acknowledges how much work we have done in this space. With a rising number of people accessing mental health support, which is a good thing and not something to be criticised, we are investing in those services and in 27,000 extra staff.

[Ms Brown]

Will the Minister meet me?

[Maria Caulfield]

Madam Deputy Speaker, I will continue if I may.

Despite the disingenuous motion proposed by the Labour party, it is my privilege to hear about the valuable contributions being made up and down the country. It is so easy to talk down our services, but if Labour Members are serious about improving mental health services, perhaps they should talk to their Welsh counterparts. Action speaks louder than words. Mental health services in England are performing better than those in Wales. We all know that this is not really about improving mental health services; it is about using mental health as a political football, but we on the Government Benches will not play that game.

Question put (Standing Order No. 31(2)), That the original words stand part of the Question.

NHS Workforce

Lyn Brown Excerpts

Tuesday 6th December 2022 Commons Chamber

[Ms Lyn Brown (West Ham) (Lab)]

Across north-east London, our population is set to grow by the total of the population of Dover in just the next five years. By 2042, the added population will be the size of Milton Keynes. We have the highest rate of NHS vacancies in London. We simply cannot go on without long-term workforce planning and investment in staff and in services. We have lost a large number of international staff since Brexit, and retention is a massive problem, with an annual staff turnover of almost 17% in the Government’s recruitment campaign for nurses.

We have the highest spend on agency staff in the region—10% of some staffing budgets goes to agencies. But even with all that money being spent, our operating theatres are struggling to find enough bank and agency staff to fill the gaps. How on earth are we going to tackle the backlog if our theatres cannot be used to full capacity? How are we going to get patients in and out of hospital quickly if their operations are being delayed?

In Newham, maternity is one of the worst affected NHS services. As we know, high-quality accessible maternity care saves lives, and local need is massive. We have very high levels of poverty, as well as demographic pressures from our rapid population growth. There is a 19% vacancy rate on our maternity wards; almost a fifth of roles have no one to do the job, so non-specialist nurses are filling in for midwives. Surely, that has an impact on the quality of care. Sometimes, even women who have been assessed as having a higher risk cannot be admitted because there are, frankly, not enough fully staffed beds, so they are sent home instead, with an obvious increased risk.

One of our birth units is being closed repeatedly so that staff can transfer elsewhere and keep hospital services running. Those forced closures took place for almost 10% of the year to August. Surely, that increases costs for the NHS, as lower-risk births end up having to take place in hospital.

Every part of the NHS is creaking, and we are getting closer to collapse because workforce issues have been neglected. We have known that these problems have been getting worse for years now, exacerbated by austerity. This ain’t just about midwives and doctors; there is a shortage of admin staff, too, which is leading to a higher number of antenatal appointments being missed. So, when patients have to go into hospital even though they could be treated more effectively in less expensive settings, and when appointments are missed and preventive care does not take place, what happens? Costs go up for our NHS. The Government’s failure to recruit and retain enough staff is making our NHS less effective in terms of value for public money and is, let us face it, putting lives at risk, too.

In north-east London, we have the most diverse integrated care system population and the highest birth rate in the country. We know that if maternity patients do not get the care that they need, the risks are high. We have all heard the terrible statistics about women from black communities being four times more likely to die in childbirth than women from white communities. If we are to address that shameful injustice and end those deaths, Newham is one of our frontlines. But the reality is that our response is being held back and women put in greater danger because our NHS simply does not have the staff. The Government need to understand that many of those difficulties could get even worse without change. As we know, so many of our health and care staff are simply exhausted. They are working all the harder to fill in for vacancies. Often, they are offered less flexible work because the demand on services is so acute and no one can fill in the gaps.

A decade of austerity and the cost of living crisis have taken a huge toll. Locally, 17% of our skilled and experienced nursing staff are over 55. Many of those who keep our services going—or barely running—do not have many working years left in them. We can see that this is completely and utterly unsustainable. The dedication of our NHS staff, for which we rightly praised them so highly during the pandemic, has its limits. How much closer to collapse will our NHS get if these pressures continue to build? How many more patients will be let down? Frankly, a Labour Government cannot come soon enough.

Gynaecological Services: Waiting Lists

Lyn Brown Excerpts

Wednesday 6th July 2022 Westminster Hall

[Ms Lyn Brown (West Ham) (Lab)]

It is an absolute pleasure to serve under your chairship, Mr Robertson. I will not detain hon. Members long with my speech, but I do want to say how grateful I am to my hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy) for securing this important debate and what a privilege it is to follow her excellent contribution. So much of what she said about waiting causing harm and the attitude of health services to women I will echo in my speech, because today I want to talk about waiting lists for women who need hysteroscopy.

The thing that I want to emphasise today is that many of those women are having to make a terrible choice—a Hobson’s choice. Either they have that really important procedure—it will determine their health prospects—as soon as they need it and without an anaesthetic, or they can wait and wait and wait until an anaesthetist and a theatre are available. I have now spoken about the issue of painful hysteroscopy in the House nine times, trying desperately to get Ministers to secure a change in the behaviour of the NHS towards women. And every time I speak, more and more women contact me afterwards to tell me about the brutalisation that they have experienced. The stories never stop. Although I am assured by Ministers that action is being taken, will be taken and so on, the stories just go on.

I will share just two stories today. Had I known that only my hon. Friend the Member for Kingston upon Hull West and Hessle and I would be here on the Back Benches, I would have brought more—because I love to watch a Minister squirm—but I have only two stories with me today.

I want to talk about Emily, who is in her 70s. She gave birth twice—once without pain relief, after a very long labour. Therefore, we are talking about a woman who can cope with a certain level of pain without difficulty. When Emily, who is, I repeat, in her 70s, had her hysteroscopy, she was not offered any pain relief, and her procedure was excruciatingly painful. The word that she uses and that many, many women who have written to me use also is “brutal”. The pain was so bad that Emily, in her 70s, passed out. It is appalling, and every single person sitting in this room and watching from home knows that. Emily should have been given the decent, fair choice of having the procedure with an effective anaesthetic and without having to wait months.

We all know that hysteroscopies can be absolutely essential to investigate and diagnose serious medical conditions. But frankly, given the state of the NHS at the moment, women are in effect told to tolerate no pain relief or wait months. That is not acceptable. It means week after week of waiting while knowing that they may have a cancer. It is not acceptable to give them the choice of either having the procedure without pain relief or waiting months to have it with pain relief. They remain undiagnosed and untreated for months.

Imagine being one of the increasing number of women who are aware that hysteroscopy could cause, or has caused, them horrific pain and lasting trauma. Imagine having to wait to make a decision about the diagnostic tool. Imagine what it is like waiting. Imagine having to make that decision.

Let me highlight the pressure that women are under by talking about Francesca. Francesca was referred for a hysteroscopy after experiencing heavy bleeding, but the procedure was so painful that she asked the consultant to stop halfway through. These stories go on and on in the same vein—women begging for procedures to stop and being ignored. In that instance, shamefully, the consultant made light of Francesca’s discomfort, making her believe that she was making a fuss about nothing.

As it turned out, Francesca had pre-cancerous cells in the lining of her womb, and she required a follow-up procedure. This time, she insisted that she was given a general anaesthetic. The consultant’s response to that totally reasonable request made Francesca believe that she was asking for the impossible. The consultant warned Francesca that delaying her appointment could increase her risk. Francesca knew—we all know—that leaving cancerous cells untreated is truly dangerous, and having asked for pain relief from the chronically underfunded NHS, she believed that she was guilty of asking for something that she could not and should not have. She felt belittled and bullied, and she was terrified, so she gave in and agreed to have the procedure without the pain relief that she needed. That is so obviously wrong.

Women should not have to choose between their basic right not to suffer avoidable pain and their right to decent, prompt and respectful treatment from our NHS. They should have an anaesthetist there and a range of effective anaesthetics, so that the women are given a real choice. I beg this Government finally to understand that that cannot go on any longer. The NHS needs to be funded to create the capacity, so that women get the treatment they need in time and free from pain. They need to be treated with dignity because, frankly, what is the point of the Government’s women’s health strategy if it cannot even do that?

--- Later in debate ---

[Edward Argar]

I do not want to prejudge the specifics of that strategy. In broad terms, I hope that I can reassure the hon. Member that we are seeking to look at all the drivers of the challenges that she and other Members have highlighted, and seek to address improvements. Without prejudging, there are points made by hon. Members that I would expect to see included around information, engagement, guidance and empowerment. The importance of empowering women, believing them and engaging with them came through very clearly in the hon. Member for West Ham’s comments.

[Ms Brown]

I am grateful to the Minister for what he is saying. It is about empowerment, but there is no empowerment when the choice is either to go for it now or to wait for months. Over and over, I have correspondence from women who are being belittled by those in gynaecological services, telling them not to make such a fuss “dear”. That is despite the fact that getting up off the floor after something is often awful. I have had meetings with Ministers; what I really want is some action.

[Edward Argar]

I am grateful once again for the hon. Lady’s typical forthrightness. I have debated with her on a number of occasions—I was going to say “crossed swords” but that is unfair—and I know that she means it with good intentions, even when she is being rightly firm with Ministers in pressing a case. She is absolutely right. When I talk about empowerment, I envisage that encompassing a whole range of things. That includes believing people, treating them with respect and listening to them.

In terms of action, one Opposition Member—forgive me; I do not remember who—mentioned the need for a clear delivery plan. I have been in the Department for almost three years now. Governments of all complexions are often very good at coming up with strategy documents, which are important. However, the key to whether they deliver the outcomes for all of our constituents is how we deliver and implement them on the ground. We have to get the strategy right; that is the first step and we anticipate publishing that before the summer recess. However, it is then important that we focus on delivery, and that we work not just with the NHS but with patients and relevant campaign groups to work out how we deliver on the intentions in that strategy.

More generally, we set out in our elective recovery plan how we intend to build back from covid-19 and reduce waiting times across all elective services, including gynaecology and menstrual health. The plan included our commitment to tackling long waits, eradicating waits of longer than two years by the end of July 2022, and eliminating waits of over one year by March 2025. We will also ensure that 95% of patients waiting for a diagnostic test will receive it within six weeks by March 2025. To support that, we have committed to spend more than £8 billion from 2022-23 to 2024-25, in addition to the £2 billion elective recovery fund and the £700 million targeted investment fund already made available to systems.

That will hugely increase the capacity in the system. However—this also relates to the point made by the hon. Member for West Ham—one of the aims of the elective recovery plan, My Planned Care, and similar, is to increase, not just in the space of gynaecological services but more broadly, the opportunities for patients to exercise choice over whether they want something immediately or would prefer to wait, and potentially where they would prefer to have that procedure performed. We are continuing, through this, to try to build in more choice, not just for the patients—although that is crucial—but to help maximise the capacity within the system, to help avoid people having to wait longer than necessary.

[Ms Brown]

What research, if any, has the Minister done on hospital trusts, for instance, that might have people in a number of different geographical areas being served by a group of hospitals, and whether there is any real choice about which hospitals in those families people can elect to visit?

[Edward Argar]

The challenge that the hon. Lady poses is that if we are talking about, essentially, the multi-hospital trusts or similar, as they have grown up, they have often designed their services in x specialism in one hospital, and moved things around like that. In those cases, there are often only one or two hospitals within the trust that do it. We are seeking to try to create greater choice across the entire system, including regionally, which genuinely builds choice. That is a big challenge—Governments of both complexions have tried it with varying degrees of success—but that is what we are seeking to do here. However, there is a lot of work to do in that space. I hope that when she sees the strategy she will recognise the degree of underpinning research that has been done. It may not necessarily cover every point that she has focused on, but I hope she will recognise the amount of work that has been done.

Civil Proceedings

Lyn Brown Excerpts

Tuesday 29th March 2022 Commons Chamber

[Andrew Gwynne]

My hon. Friend is absolutely right. Many of the people who are classed as clinically vulnerable, clinically extremely vulnerable or immunosuppressed are looked after by members of the family or friends who will come into the house to look after them, rather than by paid carers. Were free lateral flow testing to be extended at least to the CV, CEV and IS communities—not for those people themselves, but for the people coming in to communicate and interact with them—it would at least give them some degree of confidence that coronavirus is not being brought through the front door.

[Ms Lyn Brown (West Ham) (Lab)]

I reiterate what my hon. Friends the Members for Oldham East and Saddleworth (Debbie Abrahams) and for Chesterfield (Mr Perkins) have said about the immunosuppressed community and the most vulnerable. I too have had numerous emails from those who are very concerned about the direction of travel. The lack of access to lateral flow tests is particularly concerning, not only for those people, but for those they come into contact with. My general practitioner has spoken to me about his concerns about antivirals. Does my hon. Friend agree that the limited cohort to whom antivirals are available is very small? My GP and I are concerned that the Government are missing a trick on this one: allowing GPs to prescribe antivirals where they think it is essential might help massively to keep people out of hospital.

[Andrew Gwynne]

My hon. Friend hits on an important point for debate at some stage in the near future. There is a concern that the cohort that has been drawn up for access to antivirals is not as wide as it could be, and certainly not as wide as in other European countries. We must also think about how we provide the maximum level of confidence to those communities.

For me, an ideal package to protect the immunosuppressed and clinically vulnerable would be the availability of free lateral flow tests for people coming to visit those who are clinically vulnerable or immunosuppressed, a drug such as Evusheld that would give at least 70% confidence—similar to the efficacy of the vaccine—to those people who are not able to be protected by the vaccine, and then access to antivirals if they become symptomatic.

I have asked the Minister on a number of occasions when we can expect information on the eligibility for free testing and have not even received an approximate date for when it will be published. That is totally unacceptable. We urgently need that clarity, given that we are three days away.

I draw colleagues’ attention to the provisions in the motions relating to sick pay that are set to expire. Here in the United Kingdom, we have one of the worst levels of sick pay in the OECD. Statutory sick pay currently sits at just £96.35; that, I am afraid, is shameful. I could not live on that and feed my family, and I am not sure the Minister could either. The 2 million low-paid workers who earn less than the lower earnings limit of £120 receive nothing. That is before we consider self-employed people, who continue to remain ineligible for statutory sick pay. Self-employed people were badly let down over the course of the pandemic. A recent study by the Community trade union shows that a majority of self-employed people were rejected from vital covid isolation support payments. In suspending the temporary provision that allowed workers to receive statutory sick pay from the first day of their illness, the Government are stubbornly sticking to their regressive attitude to sick pay, which will continue to have a lasting negative impact on public health.

In recent remarks, the Prime Minister urged the public to exercise “restraint and responsibility” to avoid spreading the virus. This Government love to lecture us on personal responsibility while also pricing people out of making the right decisions. We should not be forcing people to choose between putting food on the table or infecting their colleagues. As well as being morally reprehensible, the sorry state of sick pay in this country will lead to more workers getting sick, leading to worse public health outcomes and, in the long term, costing the country far more in reduced productivity.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Justice (James Cartlidge)]

We have had an interesting debate on these important measures. I am grateful to all colleagues who have contributed. Like the hon. Member for St Albans (Daisy Cooper), I thank all the workers in the NHS, and in social care, who put in such a shift over the pandemic. As a Justice Minister, I would say the same about all those working in the courts, particularly the clerks and others who had to go into work in the spring of 2020, when there was fear across society about the consequences of working face to face with others. They did that to keep justice going, and we owe them a great debt.

The hon. Lady asked about emergency legislation. Of course we want to learn lessons from covid-19, and we continue to review the effectiveness of our legal framework, and the lessons learned from our response to covid-19, as part of our preparedness for future pandemics and other health emergencies.

The hon. Member for Bradford East (Imran Hussain) movingly discussed an important subject that matters a great deal to him, and to his constituents, and I pay tribute to him for speaking up for his constituents. These are very important matters. I can confirm that the general register office measures on death registration have been replaced in permanent legislation, except for the provisions for telephone death registration. We are trying to identify a legislative vehicle through which to put those provisions in place.

There were a number of comments on the immunosuppressed. I understand the concerns on the subject; it is one that my colleagues in the Department of Health and Social Care take seriously. I remind colleagues that those who are immunosuppressed are eligible for three primary vaccine doses and a booster, and will be called forward for a spring booster when appropriate. We made 5 million doses of antivirals available for the immunosuppressed.

[Ms Lyn Brown]

Does the Minister agree with my GP that expansion of the use of antivirals might be a necessary tool in our campaign to keep people safe, as we learn to live with covid?

[James Cartlidge]

I am a Justice Minister, but I am happy to pass on from my health colleagues that they keep that issue under review. The hon. Lady raised a point about tests; from 1 April, free tests will be available for those in certain groups most at risk from the virus. More details will be set out shortly; I cannot say more than that at this stage, I am afraid.

The hon. Member for Denton and Reddish (Andrew Gwynne) is absolutely right—the hon. Member for Chesterfield (Mr Perkins) made a similar point—that we went through matters relating to remote hearings in detail when the Judicial Review and Courts Bill was in Committee. That was my first Bill as a Minister. We went through in great detail the support for vulnerable users, but let me restate this for the hon. Member for Denton and Reddish: remote technology has a huge role to play in our courts, and we should not underestimate the extent to which its use kept justice going, which was very positive for vulnerable users. He is right, however, that there must be measures in place, and we have set them out in detail. Only recently, we awarded a new contract that provides for a technical support line to assist remote hearing users, and to enable them to access their hearing in the most appropriate fashion. Of course, the type of hearing held is always up to judicial discretion, and dependent on the circumstances.

On the point about the backlog, the hon. Member for Denton and Reddish said—I address this to the hon. Member for Chesterfield, too—that we want to forget about the pandemic, but also that the backlog is entirely the result of Government incompetence. Let us be clear: before we went into lockdown, the backlog was smaller than when Labour was last in power. When we went into lockdown, the courts closed. The Crown Court’s output collapsed. That should not be a surprise; we did not have jury trials because of social distancing.

My right hon. and learned Friend the Member for South Swindon (Sir Robert Buckland), then Lord Chancellor, who has just emerged into the Chamber—he is probably out of sight to most Members—put in an extraordinary shift, together with the Lord Chief Justice and others in our courts, to get courts reopened, and to get jury trials going again in this country, but there was a consequence: a huge bottleneck of cases. That is why we had this record backlog. The good news is that the number of cases in the backlog is falling; it has gone from a peak of around 61,000 last June to around 59,000. However, we recognise that we have to go further, which is why court recovery is a priority for this Government.

The measures that we propose extending through the statutory instrument that is before us are helping to ensure that courts and tribunals have the resources necessary to deal with these outstanding cases. To be clear, sections 53 to 55 of the Coronavirus Act 2020 enable thousands of hearings to be conducted online—currently around 11,000 per week—so that courts and tribunals can be reserved for hearings, such as trials, that must be heard in court. Without section 30, the backlogs in our coroners courts would have been larger, which would have further increased the demand on local authority-funded coroner services. These temporary measures are in fact so important to court recovery that we intend to make them permanent, but we cannot afford any gap in provision while we wait for that legislation to complete its passage through Parliament. If courts were unable to continue to use these provisions, even for a few months, there would be a significant impact on our court recovery programme. That would mean defendants waiting longer than necessary for trial, more victims waiting longer than necessary for justice, and the bereaved waiting longer than necessary for inquests.

I express my thanks to all those who work in our courts for the sterling work that they did to keep the courts running during the pandemic. I hope that Members agree with me that, by extending the four provisions of the Coronavirus Act 2020 that are under consideration for a maximum of six months, we can continue to build on the progress that we have made in managing the virus, and in ensuring that our courts and tribunals can recover as quickly as possible from the effects of the pandemic. I reassure the House—this is crucial—that the four provisions will be expired under the Act once new legislation comes into force.

As was noted by the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Erewash (Maggie Throup), who has responsibility for vaccines, statutory sick pay is a transferred matter, and the Government are simply facilitating an extension of the provision relating to it, following a formal request by the Department for Communities in Northern Ireland.

Question put and agreed to.

Resolved,

That the Coronavirus Act 2020 (Delay in Expiry: Inquests, Courts and Tribunals, and Statutory Sick Pay) (England and Wales and Northern Ireland) Regulations 2022 (SI, 2022, No. 362), dated 23 March 2022, a copy of which was laid before this House on 23 March, be approved.

Coronavirus Act 2020 (Review of Temporary Provisions) (No. 4)

Resolved,

That the temporary provisions of the Coronavirus Act 2020 should not yet expire.—(James Cartlidge.)

Dementia Research in the UK

Lyn Brown Excerpts

Thursday 10th February 2022 Commons Chamber

[Margaret Ferrier]

I thank the right hon. and gallant Member for that intervention and the hon. Member for Ochil and South Perthshire (John Nicolson) for his story about his lovely mother—a really sparkling lady, who I remember seeing pictures of. It is very sad when people give up the will to live.

One in five hospital admissions are for potentially preventable reasons, such as a fall, infection or psychiatric difficulties. It is not all bleak though. There have been developments and we understand the disease better now than we did just a few years ago. New research from University College London and the University of Paris, published in The BMJ in December, found that those with two or more chronic health problems in middle age are more than twice as likely to develop dementia. That research was based on a long-term clinical trial showing how progress can be made if the resources are available.

I would like to mention the Glasgow Brain Injury Research Group based in the Queen Elizabeth University Hospital. The group looks at traumatic brain injuries, or TBIs, and the impact that they have on patients exposed to varying levels of severity of injury. It is pursuing an interesting workstream on the link between repetitive mild TBIs, incurred through sport such as football and rugby, and the increased risk of dementia. We all know of many famous footballers who have died from dementia, such as the great Billy McNeill. This is a fantastic piece of work and one of the many different research areas that could really deepen our understanding of how dementia occurs and develops and of subsequent treatment methods.

The medical community remains hugely optimistic. A survey of researchers at the UK Dementia Research Institute found that 90% of them felt that new treatments would be found within the next decade, and 72% held the opinion that the pace at which breakthroughs are being made is increasing. Vitally, though, 100% pressed the need for additional funding to allow breakthroughs to be made. They are the experts and we should listen.

Developments are already under way, but the key now is maintaining and accelerating the existing momentum. We have heard of the Join dementia research resource, which is piloting actively writing to all people with dementia after their diagnosis to invite them to participate in research. That would hugely benefit dementia research. In March 2021, Public Health Scotland revealed that less than half the people estimated to have had a new dementia diagnosis in 2018-19 were referred to vital post-diagnostic support. That outreach is essential. How will the Government support the JDR pilot and its roll-out across the four nations?

The lack of timely and accurate diagnosis is making it hard for current clinical trials to identify suitable candidates. The condition is severely underdiagnosed and the current backlog has only slowed things down even further. Transforming the current diagnostic process is pivotal. If diagnosis comes too late, we risk patients not being able to access treatments that might have helped to slow down its development.

The Government talk a lot about levelling up the UK, and I wonder whether that same attention could be given here. As part of the dementia strategy, the Government should invest in the development of multiple dementia clinical trial sites to form a network across the UK. Such a project would be in keeping with a true levelling-up agenda and make the UK an attractive centre for international life science investment. Better understanding of the disease leads to better support medically and emotionally. It will lessen the burdens on our frontline services. Early detection of the disease is crucial to allow patients to continue living independently and with dignity. That is one step that can be taken now. We need a stronger understanding among the general public about what to look out for and how to get help.

I wish to highlight the essential support provided by a number of charities for those with dementia and their support networks. They have also provided a wealth of knowledge to Members to support this debate, for which I am very grateful. Age Scotland, whose remit reaches much further, provides excellent support for older people in Scotland, as do Alzheimer’s Research UK, the Alzheimer’s Society, and Alzheimer Scotland, among many others. Charitable funding has become harder to come by over the past two years, and the work of those organisations in the face of that is invaluable and impressive. Their working commitment is commendable. The UK is a leader in biomedical research. That is something to be proud of, and something we must harness. I look forward to the Minister setting out today how plans for dementia research will be included in a national dementia strategy.

[Ms Lyn Brown (West Ham) (Lab)]

One of my constituents, in asking me to attend today’s debate and talk about dementia, mentioned that they did not feel that dementia is a sexy enough subject to get the funding for research. It is almost as if it is expected that most of us, at the end of our lives, will not be as sharp tacks in the box as we once were, and may therefore find it hard to attract the funding. Does the hon. Lady agree with my constituent?

[Margaret Ferrier]

I do not agree that people with dementia have nothing else to give to society. As the hon. Member for Bexhill and Battle mentioned, they have some great memory recall, and it can be good to work along with young people from schools. It is essential that we have funding to continue that work and research into dementia because as I said earlier, more and more of us may succumb to that terrible illness. I look forward to the Minister setting out how plans for dementia research will be included in a national dementia strategy, and how the Government are supporting the development of essential new technologies in that space.

--- Later in debate ---

[Steven Bonnar (Coatbridge, Chryston and Bellshill) (SNP)]

I too commend the hon. Member for Oldham East and Saddleworth (Debbie Abrahams) for securing this debate and for her excellent contributions to it.

We have heard that dementia affects around 850,000 people in the United Kingdom—one in every 14 people over the age of 65, and one in every six over the age of 80. Dementia is one of the leading causes of death across the United Kingdom and currently, as we know, there is no cure. The most well-known impact of dementia on an individual is progressive memory loss, which affects both mental and physical abilities and makes it difficult to execute even the most basic of daily activities effectively and efficiently. When someone is diagnosed with dementia, it can be overwhelming, as they face several difficult challenges on the long road ahead.

We all know and have heard just how much dementia has affected many of our constituents and their loved ones during this awful pandemic. The House heard so lovingly from my hon. Friend the Member for Ochil and South Perthshire (John Nicolson) about his plight and the plight of his wonderful mother Marion. I have spoken to those who care for family members across my constituency of Coatbridge, Chryston and Bellshill, and they have expressed how much more difficult covid and the pandemic have made the experience, as the pandemic has presented its own new and unique challenges.

Not only does dementia cause harm and heartbreak to millions of families throughout the countries of the UK but it is completely unsustainable for our health and social care systems. The economic cost to the UK of caring for people with dementia is estimated to grow from the £24 billion it was in 2014 to £47 billion by 2050. Age is, of course, by far the biggest risk factor for a dementia diagnosis, and as our population ages the number of people diagnosed with dementia will increase. The number of people living with dementia in the UK is expected to exceed 1 million by 2025.

As we have heard, 90,000 people are currently living with dementia in homes all across Scotland. That is why the SNP Scottish Government published a dementia and covid-19 action plan in December 2020, to build on, continue and expand the national action taken since March 2020 to support people with dementia and their carers. The Scottish Government are working with partners such as Age Scotland to help dementia patients to get better support and have a bigger say in what works for them and in their individual care package.

The Scottish Government have pledged a further £1 million to help to tackle dementia in Scotland. Brian Sloan, the chief exec of Age Scotland, said:

“This funding will help address some of these challenges by shaping communities that work for those who have lived experience of dementia.”

That is a clear indication of the effectiveness of Scotland’s response. The Scottish Government have seen how the coronavirus pandemic has had a disproportionate impact on people with dementia. Through partnerships, they will help to grow the community support that has been considered critical to people and their families. I am of the belief that Scotland is also seeing positive results through our policy of integrated health and social care among health boards and local authorities. The Westminster Government should follow that lead.

Of course, Scotland is currently the only country in the United Kingdom with free personal care, which is extremely important support for people under the financial strains that dementia and living with dementia can place on families. People who are not in Scotland may wonder what that looks like: a dementia sufferer can receive up to four visits per day in their own home, where care is administered and the carer spends some time with them because, as the right hon. and gallant Member for Beckenham (Bob Stewart) pointed out, loneliness can be one of the biggest indicators that mean people simply give up. We must do everything we can to make sure that people live a fulfilling and wonderful life.

[Ms Lyn Brown]

Hear, hear!

[Steven Bonnar]

Thank you.

In 2017, the UK Government declared that the UK would be the most dementia- friendly country in the world by 2020. [Interruption.] The Minister nods his head, but unfortunately we know that that is not true: just look at the hundreds of dementia care homes in England that were discovered to be providing substandard care to their dementia patients.

A Care Quality Commission report found that one in every five homes specialising in dementia were rated as “inadequate” or “requiring improvement”. Some posed such a serious risk to people with dementia—because of filthy living conditions, poor infection control and poorly trained staff—that inspectors had to order them to be put into special measures. In total, 1,636 care homes are failing patients, according to findings described as “appalling” by charities and campaigners. They stated that immediate action was required to address the “unacceptable” state of dementia care across the country.

If we are to position the UK as the world leader in dementia—something we all want to see—we should not start by cutting the much-needed funding that was promised by the Government for dementia research. As we have heard, the 2019 Conservative party manifesto committed to address dementia by pledging to double funding for dementia research to more than £160 million per year. However, two years later and another broken promise later, we find ourselves in the same situation, with no plans from the Government to deliver on their manifesto pledge. The funding for dementia research for 2020 was £75.7 million—a decrease from £82.5 million in 2019 and from the high of £98.1 million in 2016.

What else do we need to say to persuade the Government to recognise the importance of funding dementia research in trials? Currently we have over 150 clinical trials worldwide examining potential dementia treatments. It is more pressing than ever that we can transform dementia diagnosis. We need early diagnosis of the diseases that cause dementia and we need to diagnose them more accurately; otherwise it will be too late for patients to benefit from potential new treatments. The Government should invest now in infrastructure, resources and the clinical workforce to build diagnostic capacity and support innovative ways of organising NHS services such as brain health clinics to offer new diagnostic pathways. I look forward to the Minister outlining how the Government intend to achieve that.

The Scottish Government have proven our commitment to dementia research with a one-off £75 million increase in funding for our universities to ensure that they can protect world-leading research programmes against the financial impacts of covid-19. That is exactly how we protect those we care about and those who care for us. The current prevalence rate of dementia among older people in the UK is about 7.1%, and of the four countries Scotland has the lowest prevalence rate, with England having the highest overall prevalence rate. With the growing trend and threat of dementia to our citizens, it is now time for this Government to act and to outline a proper plan to help combat the threat of dementia across these nations, with the goal of preventing people from developing the onset of dementia.

The UK Government can follow in the footsteps of Scotland and become the world leader in dementia research they told us they would be, but to do so they must deliver on their manifesto commitments to double the funding for dementia research, speed up progress in clinical trials, and ultimately—maybe only by the grace of God—help us to find the cure. We cannot allow any more time or opportunities to pass by as we seek to support those living with and at risk of dementia.

Government Contracts: Randox Laboratories

Lyn Brown Excerpts

Thursday 10th February 2022 Commons Chamber

[Maggie Throup]

There is a lot of detail in that question. If I may, I will write to the hon. Lady with answers.

[Ms Lyn Brown (West Ham) (Lab)]

I am finding this really rather difficult, for the same reasons as my right hon. Friend the Member for Kingston upon Hull North (Dame Diana Johnson). Has the Minister actually read what has been laid in the Library? If she has, will she enlighten us as to what it says about the meeting in the Lobby?

[Maggie Throup]

I reassure the House that I did read the documents before they were laid in the Library.

NHS Hysteroscopy Treatment

Lyn Brown Excerpts

Monday 31st January 2022 Commons Chamber

[Ms Lyn Brown (West Ham) (Lab)]

I am, frankly, very disappointed to have to be raising this issue again in this House. This is the ninth time I have spoken about this, and it is more than eight years since my first speech on this topic. However, the problem of pain and trauma caused during hysteroscopies has not gone away. I want to pay tribute to the Campaign Against Painful Hysteroscopy, who do so much to let women know that they are not alone, that their experience has not been singular, that they were not making it up and they were not hysterical; they were experiencing great pain and discomfort. That campaign offers comfort and a productive outlet for their utterly justifiable anger. My hope is that this Minister will not only take this issue away, but will commit today to getting action at a national level, because it is a true scandal that these horrific abuses are still taking place. Let me be really clear with people. Every time I speak, I have new stories, because women hear my speech as they reel from fresh abuses and they get in touch. So all these stories that I am going to recount today have happened since my last speech on this issue.

I will start with the story of Jane, who had a hysteroscopy late last year. Jane had been warned by her excellent GP that the specialist might attempt to talk her into a hysteroscopy without anaesthetic, and that she had the right to insist on proper pain relief. After all, she has several well-recognised risk factors for pain during hysteroscopy, including endometriosis, a tilted uterus, and never having had children. Fully aware of that, Jane received a letter for an appointment about the results of an ultrasound scan she had had. The letter said nothing about a hysteroscopy, and nothing about her risks or her right to anaesthetic, so she went along expecting simply to have a discussion with a consultant about the results of the scan. But when she got there, she was informed that the consultant wanted to do a hysteroscopy there and then. She said immediately she wanted a general anaesthetic, and explained that she had had terrible pain from similar procedures in the past. Shamefully, the consultant’s response was to laugh in her face and say

“if we gave a general anaesthetic to every woman who had a hysteroscopy the queue would be a mile long”.

To laugh at a woman in distress in that position, I find abhorrent.

Jane was scared. She shook but she felt she had no choice but to comply. She told the doctor and nurse what she had heard about the pain, but they told her not to believe everything she read. She told me that

“as soon as the speculum went in I felt immense pain that was absolutely unbearable...the doctor was having difficulty finding the opening to my cervix so twisted the speculum and dug around, which caused indescribable pain, I felt I might pass out, I had tunnel vision”—

and she was “shaking and hyperventilating.”

At that point, thank heavens, the procedure was stopped but, unbelievably, the doctor said that he simply did not understand why Jane was in so much pain and causing such a fuss, which only worried her more, because it increased her concern that she had cancer. Even after all that, the doctor was still unwilling to consider a proper anaesthetic. Instead, he prescribed a hormonal pessary and suggested that she come back for another go in a fortnight.

Jane was in a fog. She does not remember anything other than getting home and curling up on the sofa, shaking with shock. She has relived the experience over and over, unable to move on because of the threat that she would have to go through it all again without pain relief. She has had trouble sleeping and has had to take time off work because she cannot concentrate. Understandably, Jane believes that she has post-traumatic stress disorder. She told me that she was actually more afraid of having another brutal experience than she was of dealing with possible cancer. How much will the late detection of cancers resulting from this fear cost our NHS and our families? I emphasise to the Minister that this is not major surgery; it could be essentially painless if only proper anaesthetics were offered.

The last I heard, Jane will now have a hysteroscopy with a general anaesthetic. I am praying that she does not have cancer, because if she does, the months-long delay caused by her mistreatment and the callous attitude of that doctor could be deadly to her. What estimate have the Government made of the added cost of failed hysteroscopies that must then be repeated with anaesthetic? Jane is not alone in her experience and in having understandable distrust of the NHS and doctors as a result of her trauma.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady on her speech. I was there the last time that she brought this issue to the House, as I am tonight, because my wife has been through the experience that the hon. Lady referred to. As a result, I think it is important that I am here to support her not just for my wife, but for every other lady across the United Kingdom. Pain relief is a way of providing much needed reassurance for women who are having hysteroscopies. This is a potentially life-changing treatment and women must be enabled to be as comfortable as possible—I see how important that is. Some 35% of the women who undergo anaesthesia-free hysteroscopies reported severe pain. Does the hon. Lady agree that the pain medications and anaesthesia must be readily available for those who need it? No one should have to live in this day and age with severe pain that cannot be taken care of.

[Ms Brown]

I agree with the hon. Gentleman and I am grateful for his intervention. I know he has been in these debates with me, and he makes the same point: no woman should have to go through this. No woman should be held down while procedures happen because they are screaming with pain and they want the pain to stop.

Another woman who contacted me about a hysteroscopy that took place last year told me that she had never experienced so much pain—not from a hip operation, nor from having her spleen removed. As a result of her traumatic experience, she now has anxiety and has been prescribed tablets by her GP just to help her function with the day-to-day. Like Jane, she is losing sleep and no doubt her broader health has been harmed by this. She does not know whether she has cancer, but she told me that she is now too scared to go to the hospital for anything.

There are so many stories that I could have told today. I am sent so many of them, despite the fact that the issue does not get a huge amount of press. Women who experience this are seeking out me and the charity I work with to tell us about it. If there were more publicity, more women would come forward. I really hope that the Minister understands that this is an issue of patient safety, but also an issue of common decency. It is an issue of confidence in the medical professions and the NHS, and it will be costing us all, both in money and in lives, because problems simply are not being caught early enough.

[Liz Twist (Blaydon) (Lab)]

I have the privilege of co-chairing the all-party parliamentary group on women’s health. We held a meeting at the end of last year to talk about women and the health service, and I must admit that the meeting lit up when one of the medical people spoke about women’s experiences and, in particular, hysteroscopy. I could not believe what happened on my Twitter feed immediately afterwards. So many women were sharing their experiences, listening and saying, “We are entitled to have our experiences of pain validated, and to not have to go through that pain.” Does my hon. Friend agree that the women’s health strategy, which we will be talking about increasingly often, must involve accepting those experiences and seeking to listen more to women, validate their experiences and ensure that the right anaesthetic and treatments are provided?

[Ms Brown]

I entirely agree with my hon. Friend, and that will indeed be an ask I have of the Minister at the conclusion of my contribution. My hon. Friend is right: women are not listened to. When they tell a doctor, “This hurts. I am in pain and I can’t bear it,” their experiences are not considered valid. They are told that they are being hysterical or overreacting and that they need to be as strong as the other woman he saw last night, last week or whenever, and to not be such a baby in demanding that the procedure be stopped.

Another case from last year is that of Sandy. When Sandy was referred for a hysteroscopy, she was told that pain was a risk, but the information that followed about local pain relief gave her false reassurance. She assumed that it meant some kind of anaesthetic. When she met the clinician, he told her that it would be like period cramps. When she asked about pain relief, he just repeated, “No more than just period cramps, if there’s any pain at all.”

Sandy was well acquainted with period pains. She had had coils inserted and had given vaginal birth twice, one with no pain relief, so she knew she was tough and she thought she would be fine. But when the hysteroscope reached Sandy’s uterus, she felt

“the most incredible, searing, tearing pain I have ever experienced. I found the arms of the bed to grab onto and could hear myself shouting no no no stop stop stop.”

Madam Deputy Speaker, you will be glad to hear that on this occasion the clinician did actually stop, but I would say that by that point the damage had already been done. Sandy has no memory of any questions asked or what the clinicians said to her afterwards. She just remembers the pain, the shaking and the shock. She was completely and utterly dazed, but scant minutes after enduring this, Sandy was ushered out the door. She was given no time to rest and recover, and she was so confused because she had been made to feel that she had made a terrible fuss about nothing. Sandy then had to drive herself home. She told me that she has gone from being fearless and confident to being terrified of going back at all.

Finally, I want to mention Penny. She told me what happened after her “brutally painful failed hysteroscopy”. She strongly, and understandably, believes that she was misled about the risk of pain, because if she had known, there is no way she would have consented to having the procedure with just painkillers. Immediately after Penny went through the same agony that I have just described, she had an assessment with a nurse. The nurse told Penny how she had seen many women like her traumatised and in tears after hysteroscopies. The nurse said that she would never, ever go without a full anaesthetic herself, and that to do the procedure on women with no anaesthetic was barbaric. Penny was deeply and rightly angry to hear this, and the nurse was very clear that women were going through this without being fully informed of the risks.

Let us be really clear: the women I have spoken of today are the tip of a massive iceberg. That nurse is right, the GP I mentioned earlier in the debate is right, and there are many others within the NHS who recognise that this is simply unacceptable. So what needs to change? Frankly, there is still a massive problem with the attitude that many doctors take towards women patients. Our words and our wishes are ignored, and when our words are ignored, our rights are ignored. That has got to end, and I believe that that takes a culture of change. I do not accept that there are just a few badly trained, uncaring or even sadistic doctors. There is a broader problem that the Government and the NHS must address.

The Government have talked previously about a women’s health agenda, and before that there was the women’s health taskforce. Now, there is going to be a women’s health strategy. Believe me, the word “strategy” is music to my ears, but I want a guarantee from the Minister today that tackling painful hysteroscopy will be a core issue. That is my first ask. The patient groups that have been raising this issue so forcefully over many years must have a seat at the table in discussing and monitoring that strategy. These issues are common and the structure of the NHS is complex and obscure; it is failing to listen. So we need to find ways to ensure that patient outcomes for hysteroscopies are measured and monitored alongside the strategy.

My second ask is for all NHS trusts to offer patients who need a hysteroscopy a full range of anaesthetics and to inform them accurately about the risk factors for serious pain, so that all women can make an informed decision. That will require more anaesthetists and theatre capacity for hysteroscopy patients. My third ask is that the Government ensure that this investment is made, and that the commissioning decisions required are being made by NHS trusts. In my view, this is something that the women’s health strategy should be measuring and monitoring, alongside robust evidence on women’s experiences of NHS hysteroscopy, over the coming years.

How many hospital trusts are actually following the guidance to offer anaesthetics up front to all hysteroscopy patients? How many offer a range of effective anaesthetics and have trained staff to discuss women’s risk factors so that they are given an informed choice? How many women are forced to endure a traumatic failed hysteroscopy without pain relief, with public money wasted as a result, only to have another procedure under anaesthetic?

How many patients do not even know they are going to be asked to have a hysteroscopy until they attend an appointment, with all the pressure that that involves? Can Members imagine going to a doctor in a hospital because of a fear that they have cancer and that doctor telling them they are going to do a hysteroscopy right now? Can Members imagine how much pressure there is on a woman to accept that procedure there and then because of the fear of what might be there and how long they might have to wait? They do not want to upset the doctor, do they? They might have something really awful that needs to be attended to immediately.

Any women’s health strategy worth its name would make sure that the answers to the questions I have asked are known and that we are moving in the right direction on all those issues. I am delighted to say that the best practice tariff on hysteroscopy, which financially incentivised the mistreatment of women, is now gone. We had a system under which our hospitals were paid more for hysteroscopies done without anaesthetic than they were paid for those done with anaesthetic. I am thankful that that incentivised mistreatment of women has now gone. That is a massive achievement for the campaign.

Several previous Ministers have engaged with me on this issue—the hon. Member for Thurrock (Jackie Doyle-Price) was very good on it when we spoke—and I thank them for hearing me. One benefit is that trusts are now paid the same amount for out-patient and day-case hysteroscopies. That is far better than it was, but it can still cause problems, because day-case procedures with anaesthetic cost more. If a trust will not be compensated for the difference, it might still decide to try to limit access to pain relief, because it will know that if anaesthetic is given, it will not receive a benefit in kind to pay for that procedure. We need to know that individual trusts are actually changing their behaviour and attitude in response to the progress that has been made. If they are not, we might need further action to ensure that no trust will lose money by doing the right thing and providing the pain relief that a woman needs.

I am sure the Minister will be slightly alarmed by an increase in demand for anaesthetists and theatres, and we all understand the massive covid backlog that the Government and the NHS face. I reassure the Minister that both regional or spinal anaesthetic and intravenous sedation with anaesthesia may be good options for many hysteroscopy patients, depending on their needs and risk factors. The NHS has got to offer a real choice in the range of anaesthetics, not a false choice between a general anaesthetic and no effective pain relief at all. It is simply wrong that if a man needs a colonoscopy, the chances are that he will be offered an effective anaesthetic without question, whereas if a woman needs a hysteroscopy, they may be forced to endure such terrible trauma that it shakes them to the very core ,and then made to feel pathetic when they cry out in pain.

I am not going to stop raising this issue, and the courageous women I have been working with will not stop either. I want to work with the Minister on this issue, as I have with other Ministers in the past, and I hope the Government engage fully, because we need to end this scandal and ensure that women are treated like human beings in every single part of our NHS.

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

I congratulate the hon. Member for West Ham (Ms Brown) on securing this debate. I thank her for all her hard work. I am very sorry that she has been speaking about this issue for nine years and is still having to share some of the stories and experiences of women who have contacted her, whether that is Jane, who was unaware of the potential for pain when having such a procedure—women being investigated for endometriosis often wait eight to 10 years to get a diagnosis, so if there is an offer of a procedure to find the cause of their problems, of course they will grab it and not necessarily ask questions about what is involved; or Sandy, who got no information on pain relief at all, or Penny. Penny was warned by the nurse—often nurses are attuned to these things—and was worried about what the outcomes were, but went ahead with the procedure. These are shocking tales that should not be happening in this day and age. I appreciate everything that the hon. Lady says, and I offer that I will be happy to work with her on this issue.

As Members will be aware, hysteroscopy is an essential tool to get to the bottom of many complaints. Whether that is cancer, endometriosis, vaginal bleeding or pelvic pain, it is a necessary test. While other tests can be used, they do not necessarily get to the level of clinical detail that a hysteroscopy can provide for clinicians. It is therefore important that the test is available for women, but in a way that does not create the problems we have heard about this evening.

Many women can have the procedure as out-patients in 10 to 15 minutes and it can be relatively painless, but many women, as we have heard today, experience great pain, which puts them off from coming back if they need further procedures, as the hon. Lady has said. If they share that story with other women they know, it can put them off from coming forward, too.

Unfortunately the NHS does not collect data on the number of women who experience pain during a hysteroscopy or the women who fail to have the hysteroscopy and then need to have either a general anaesthetic or further anaesthetic later on. I am aware that the Campaign Against Painful Hysteroscopy estimates that between 5% and 25% of women are affected and have reported severe pain, and frankly that is not good enough. I welcome that NHS England will be meeting the campaign group on 4 February. I look forward to hearing the outcome of that meeting, and I will be following up any recommendations after that.

The hon. Lady is right that for many procedures a man would undertake, anaesthetic is probably routinely provided or offered. We need to ensure that the same applies to those procedures that women have to go through.

There are guidelines in place, and I spoke only last week to the president of the Royal College of Obstetricians and Gynaecologists, because I knew this debate was coming up. Those guidelines were published back in 2011, and they need updating. The guidelines focus on minimising pain and optimising the woman’s experience, as well as making specific recommendations on how to reduce pain, but as the hon. Lady said, we do not have the information to know who is and is not following those guidelines. We are therefore not in a position to say whether, if those guidelines were followed, many women would not experience pain, and that is the difficulty we have. The data is therefore crucial.

In the last debate that the hon. Lady secured on this issue, which I think was in September 2020, my predecessor, the right hon. Member for Mid Bedfordshire (Ms Dorries), informed the House that to ensure the recommendations were robust and up to date, the royal college would be producing a second edition, in which it will assess whether the current guidelines are effective and are being used. The second edition is being jointly developed with the British Society for Gynaecological Endoscopy, and I am assured that patients’ voices will be at the heart of its development. The royal college has informed me that good progress is being made, and that it will have the updated guidelines by next year.

[Ms Brown]

Can I ask specifically that we involve the campaign, because that would be one way of assuring me that the voices of patients are being heard?

[Maria Caulfield]

I said to the president that I would follow up after the debate, so I can certainly make that request.

The royal college has also said that it is producing a good practice paper specifically on pain relief and how informed decisions should be made, particularly in out-patient hysteroscopy procedures. It is going through the peer review process next month and will be published shortly afterwards. Once it is published, I would be very keen to hear from campaign representatives about whether they feel that those guidelines would make a difference to them in a practical session.

It is crucial that women who are offered a hysteroscopy are given the information they need to make an informed decision, given that they have sometimes waited a long time for the appointment and that serious clinical conditions can be diagnosed from it. That should include information about potential pain, options for pain management and alternative procedures that could be used.

The Department and NHS England recommend that, as part of good practice, the royal college’s patient information leaflet, which was published in 2018, should be provided to patients to aid decision making. I think that should be provided in advance of the appointment, because it is often hard for someone to take in all that information in the midst of a consultation. Again, I would be interested to hear from the campaign whether that is happening in practice.

The House will also be interested to learn that the British Society for Gynaecological Endoscopy recently published a statement to clarify that from the outset women should be offered

“the choice of having the procedure performed as a day case…under general or regional anaesthetic”.

It further asserts that the procedure should be stopped immediately if a woman experiences pain.

I encourage any woman offered a hysteroscopy to read those valuable resources along with any additional resources provided by their clinician. I agree with the hon. Lady that women often do not understand what a hysteroscopy is or what is involved, and debates such as this highlight how important the procedure is, the options around pain relief and the different anaesthetics available.

The hon. Lady touched on the tariff. Previously, there was a different rate of payment for hysteroscopies carried out in an out-patient setting compared with in-patient procedures. I recognise that that is a concern for many hon. Members on both sides of the House because of how it affects patient choice and the choices that are offered to them. In the last debate on the topic, my predecessor announced a statutory consultation. I am pleased to say that as of 1 April, hysteroscopy out-patient procedures will no longer attract a higher tariff than elective procedures as an in-patient day case. That will hopefully make a difference to the choices offered to women.

[Ms Brown]

That is absolutely true and we are delighted about that; I welcomed it in my speech. The problem that we now have is that if a hospital offers an anaesthetic, it does not get compensated for the resource that it has used. We need to go one step further to ensure that there are no incentives for not offering women proper anaesthetic.

[Maria Caulfield]

I completely agree with the hon. Lady. She made a point about having the data to see how many hysteroscopies fail and whether that money could be better spent on offering an anaesthetic up front to many women. I do not have an answer to that, but it would be interesting to look at that information.

Alongside clinical guidelines and access to high-quality patient information, I stress the importance of the voices of patients, which are critical at every stage of the treatment pathway. Decisions should always be discussed and shared between clinician and patient. The Government are committed to ensuring that the voices of women in particular are more central in the healthcare system.

The women’s health strategy has been touched on several times. We have also taken key learnings from reports such as the Cumberlege review, where women were talking for a long time about the issues that they faced before anyone truly listened. We need to improve that so we are not learning from such incidents after nine years of raising them on the Floor of the House. The women’s health strategy will include gynae issues such as endometriosis and polycystic ovary disease, which are conditions that do need a hysteroscopy, so I am pretty confident that we will cover that in the strategy. We will also have a women’s health ambassador—they will be appointed in the coming weeks; applications are almost closed—with whom I will meet. I want them to lead on these issues, where they can be a real voice for patients, do a deep dive into what is happening at the coalface and speak up for women if it is not working. We have guidelines, but we do not know whether they are being used in clinical practice. From what the hon. Lady says, it sounds like there are clearly issues that need to be addressed.

I reassure the hon. Lady that I am happy to work with her on this issue. Improving the tariffs is one thing, but there are still women who are not getting the information that they need to make informed decisions about pain relief and anaesthetic that could be available. I welcome the new information from the Royal College of Obstetricians and Gynaecologists on pain relief specifically for this procedure, which will be out next month, and I will feed back to it on updating the guidelines to ensure that patients are involved in the process.

I thank the hon. Lady for raising this important matter. I hope that we have raised its profile and that women are more aware of their options. When they go to that clinic appointment, they can ask for pain relief, they can have it as an in-patient, and they do not need to have it right there, right then. I look forward to continuing to work with her and all Members across the House to ensure that women are offered a hysteroscopy and can access the information they need and the care they deserve.

Eye Health and Macular Disease

Lyn Brown Excerpts

Tuesday 11th January 2022 Westminster Hall

[Ms Lyn Brown (West Ham) (Lab)]

It is a genuine pleasure to serve under your chairmanship, Ms Nokes. I wish you, and everybody here, a happy new year.

I thank the hon. Member for Strangford (Jim Shannon) for securing the debate on this neglected topic. Not for the first time, my comments will echo those of my right hon. Friend the Member for Hayes and Harlington (John McDonnell), because today I will focus on the damage that refractive eye surgeries can do to health. In particular, I would like to talk about my constituent, Darren Clixby.

Like many of us, Darren had lived much of his life needing glasses or contact lenses for short sight. As many people have, he heard the messages about laser eye surgery, and its promise to make life easier and better. He also heard the statistics that are bandied about regarding the rarity of serious complications, so he paid his money and went for it in January 2009, but I am sorry to say that the damage immediately after the surgery was awful.

Darren was in tremendous pain. He could not open his eyes at all until the following day and, when he did, his vision was unrecognisable. It was filled with sunbursts coming from light sources, with halos arounds them, with images that overlapped and with many floaters, which are small objects that persistently stay in the vision no matter where someone looks; I have loads of them in my eyes.

Having such damaged vision was distracting, disorientating and very distressing. Darren could not function. He had been told that this was merely a temporary effect and that it would go away after surgery, so he took sick leave and he persevered in that hope. The weeks passed, then the months, and the problems with his vision simply did not go away. Understandably, Darren became increasingly distraught, anxious and depressed. At check-ups, he was told time and again that it was temporary. He was fobbed off with steroid eye drops, which did nothing.

He was then offered another procedure with the same company, using an alternative refractive surgery technique, then another, via a private referral to Moorfields Eye Hospital, and then another. Darren has now had five separate refractive eye surgeries, four of which were to correct the damage of the first. None of these operations have helped. In fact, Darren believes they have just made things worse.

All of this time, Darren’s mental health was deteriorating. He found his work as a solicitor increasingly impossible because of the psychological damage that resulted in a diagnosis of severe depression and anxiety, which remains 13 years on. He resigned from his job and endured 18 months out of work. Even now, after getting a new legal role, he has found it difficult to continue and he had to resign 18 months after starting that job. Eventually, in 2012, Darren had to stop the process of repeated surgeries, and disengage to protect what was left of his mental health. It has taken him many years to come to terms with what has been done.

[Jim Shannon]

I thank the hon. Lady for sharing what surgery can be like. I have a diabetic constituent who asked a consultant if laser surgery would be appropriate. Unfortunately, as a result of that surgery he lost his eyesight in its entirety. Today, he has no sight in either eye. When it comes to surgery, the hon. Lady is absolutely right and I thank her for the reminder that it does not always work. People need to be careful and aware of that.

[Ms Lyn Brown]

Darren now believes that there is nothing that can be done significantly to repair the damage to his sight. He has uncomfortable, dry eyes every day of his life, which become far worse after reading or concentrating for long periods. He cannot see clearly in low-light conditions or drive after dark. Even crossing the road can be dangerous because it is hard to judge the distance between cars.

Darren believes that he was not fully informed about the risks before his surgery. He has no trust in what little regulation or self-regulation exists via the General Optical Council and the General Medical Council. This was a private, elective procedure that Darren paid for. Surely to heavens, the company that performed the surgery should be responsible for the best possible aftercare, and for making it right. In 2017, Darren again contacted the company responsible for the original surgery. It was made absolutely clear that it would offer him nothing. Effectively, it told him to go away, to stop being a nuisance and to stop getting in the way, frankly, of it making more money.

As always, the NHS has been left to pick up the pieces after poorly regulated private medicine has failed. I ask the Minister how much is this costing the NHS across the country? It would be good to know. Does she have any information to hand on that? We need to create a system where patients are genuinely informed about the real risks; a system where there is proper recourse to a regulator when things go wrong, and where private companies are held responsible for their failings and the cost.