Public Health (Control of Disease) Act 1984 (Amendment) Bill
Nigel Evans Excerpts(1 day, 16 hours ago)
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Sir Christopher Chope (Christchurch) (Con)
I beg to move, That the Bill be now read a Second time.
This is the Bill’s first outing in debate, because although it was presented in the 2022 Session, unfortunately the House was unable to debate it. It relates directly to the beginning of the pandemic and the emergency measures that were taken by the Government and Parliament in implementing the Coronavirus Act 2020. At the time, a lot of concern was expressed about insufficient scope for parliamentary scrutiny under the Public Health (Control of Disease) Act 1984, and how the level of scrutiny available under that Act compared unfavourably to that available under the Civil Contingencies Act 2004. Since that time, a number of academic and other articles have been written, and speeches given, in which the concern has been expressed that the Government used the wrong tool to implement restrictions on individual liberty during that pandemic, resulting in this House having an insufficient role in scrutinising that important legislation.
This issue was raised, very ably, by my hon. Friend the Member for Windsor (Adam Afriyie) during the original debate on the Bill that became the Coronavirus Act 2020. He said:
“the whole purpose of the 30-day provision in the Civil Contingencies Act was for the Executive to be accountable to Parliament.”
The Leader of the House, however, responded to a point that he had made earlier by saying:
“we cannot use the Civil Contingencies Act…If we have time to bring forward legislation, it is proper that we do that, and anything we did under the powers of the 2004 Act would apply for only 30 days.”—[Official Report, 23 March 2023; Vol. 674, c. 132.]
Well, that is exactly what the Civil Contingencies Act 2004 is there to do. It was implemented to deal with emergencies even graver than that caused by the coronavirus pandemic.
The Civil Contingencies Act was the subject of detailed discussion before its enactment. Section 28 is entitled
“ Parliamentary scrutiny: prorogation and adjournment”,
while section 27 provides for “Parliamentary scrutiny” in other circumstances, stating that
“Where emergency regulations are made”
under the Act,
“a senior Minister of the Crown shall as soon as is reasonably practicable lay the regulations before Parliament, and…the regulations shall lapse at the end of the period of seven days beginning with the date of laying unless during that period each House of Parliament passes a resolution approving them… If each House of Parliament passes a resolution that emergency regulations shall cease to have effect, the regulations shall cease to have effect…at such time, after the passing of the resolutions, as may be specified in them, or…no time is specified in the resolutions, at the beginning of the day after that on which the resolutions are passed… If each House of Parliament passes a resolution that emergency regulations shall have effect with a specified amendment, the regulations shall have effect as amended”.
The Civil Contingencies Act therefore enables the regulations introduced under its provisions to be amended, unlike the Public Health (Control of Disease) Act 1984. The Government took advantage of that during the pandemic, and I am trying to put it right by including in my Bill provisions to ensure that there is scrutiny so that there will no longer be a perverse incentive for the Government, when faced with a pandemic or similar emergency, to resort to the use of the 1984 Act rather than the Civil Contingencies Act, on the basis that it would suit them to use the former rather than the latter because it would be subject to less scrutiny.
Clause 1 of my Bill provides that section 45D of the 1984 Act should be amended so that
“the appropriate Minister must lay before Parliament a statement that the restriction or requirement is proportionate under subsection (1)”,
and that
“In the case of English regulations, that proportionality must be demonstrated by a regulatory impact assessment that has been laid before Parliament.”
The importance of such a regulatory impact assessment cannot be overstated. We now look back on that period three years ago, and consider the consequences that flowed from the over-zealous restrictions that were introduced by the Government. Almost every day we hear of the adverse consequences for a whole cohort of young people who were excluded from school for extensive periods. As a result, not only has their education been damaged but their health, welfare and, particularly, their mental health. In my view, that is a direct consequence of this House not having had the opportunity to consider the costs and benefits of introducing such draconian restrictions on people’s ability to participate in their school education.
A similar point can be made about businesses being able to carry on what they were doing normally. I visited a garden centre a few weeks ago. In the height of the pandemic it was verboten that people could visit garden centres. For a time people were not even allowed to go to the refuse disposal points to get rid of their rubbish. They were not allowed to venture out and meet their loved ones, even in open spaces. As a result, a whole mass of people lost their loved ones without really being able to say goodbye to them, because they were incarcerated in care homes. We must never allow such a situation to be repeated in another health or other type of emergency without the proper scrutiny.
When one looks back over the course of this Parliament, it is possible to say that if we had been able to scrutinise the social distancing regulations to a greater extent, the Prime Minister in office at the time of the pandemic would still be in office today. The regulations and restrictions of which he fell foul would not have been in place, because somebody would have asked some sensible questions. The Government would have been persuaded that the workplace regulations should have enabled people working during the emergency to try to deliver benefits for the public to be allowed have a cup of tea or a bun together without falling foul of the law.
The use of the Public Health (Control of Disease) Act 1984 may well have had the direct consequence—unintentionally, obviously—of depriving the former Prime Minister of his post. When the history books come to be written, these restrictions may be seen as a much more significant decision by the Government, though as the head of the Government, the Prime Minister himself at that time decided to use the 1984 Act rather than the 2004 Act regulations.
My Bill would ensure that we not only have proper parliamentary scrutiny of the regulations under section 45D of the 1984 Act, but that under section 45Q we introduce a provision that
“before such regulations may be made, a draft of the statutory instrument containing them shall be laid before each House of Parliament for a period of not less than twenty days on which that House has sat, and, if either House before the expiration of that period presents an address to Her Majesty against the draft or any part thereof, no further proceedings shall be taken thereon (but without prejudice to the making of a new draft statutory instrument) and that part of the draft shall not have effect unless both Houses by resolution approve it, or, if any modifications in that part are agreed to by both Houses, except as so modified.”
The consequence of that would be that there would be no incentive for a Government to introduce restrictions on freedom under the 1984 Act; instead, they would use the Civil Contingencies Act, which was of course set up for that very purpose.
I referred earlier to the public commentary about this issue. Most significantly perhaps, the noble Lord Sumption gave a lecture in which he expressed doubt about the legal basis for the draconian measures and argued strongly that we need proper parliamentary scrutiny. Another commentator, Tom Hickman KC, made the case not for using the 2004 Act but for having bespoke legislation to deal with such situations in the future.
The public health regulations that came into effect on 26 March 2020 set out criminal laws that required each person or household to remain in their homes until further notice. There were very narrow grounds on which people were able to leave their homes. The guidance that the Government issued was, as we eventually discovered through the courts, often over-claimed and overused by the enforcement authorities. We also found that those regulations essentially set up a system of false imprisonment, completely in breach of all principles of English common law. There were tremendous restrictions on people’s ability to go out and earn a living, and the reasonable excuses available to them to avoid the lockdown requirements were strictly limited.
Let us not forget the consequences for individual liberty, and for a whole generation of young and old people, who were particularly affected by these draconian laws, brought in by the Government under the wrong piece of legislation and insufficiently scrutinised by this House. Let that never happen again. Let us hope that Baroness Hallett, when she looks at this issue in the public inquiry, reaches the conclusion that the Government did indeed go too far in locking down, restricting freedom and preventing people from accessing education or seeing their loved ones in care homes. That inquiry will reach a conclusion in perhaps five or 10 years’ time—who knows?—but I hope that, if the Government do not support my Bill today, a future Government will be persuaded by Baroness Hallett’s report to do exactly the same thing and ensure the Public Health (Control of Disease) Act 1984 contains proper scrutiny provisions as safeguards.
Mr Deputy Speaker (Mr Nigel Evans)
The shadow Minister has indicated that she would like to make a very short contribution.
Hospice Funding
Nigel Evans Excerpts(5 days, 16 hours ago)
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Martin Docherty-Hughes
I want to push the hon. Gentleman on the point I made to the hon. Member for Enfield, Southgate, because I have heard this notion of symbiosis with the NHS, but they are two very distinct approaches to care. From my perspective, the palliative care sector is at its best when it is run as a voluntary local body. Would he expand a wee bit more on what he means by that kind of convergence with the NHS? There is a fear among those in the voluntary hospice sector that what they are doing to push palliative care forward could be held back by more physical integration in the NHS.
Mr Deputy Speaker (Mr Nigel Evans)
Order. Before the hon. Member continues, I just remind everybody that there is quite a bit of interest in this debate. If we could ensure self-discipline in the length of speeches, that would be very helpful.
Peter Gibson
I am very grateful for the intervention, and the hon. Gentleman raises some really important points, which I am not sure I have time to go into in detail. If the Government are going to give the national health service enough money to increase the wages of everybody in the national health service and the integrated care boards are commissioning services from hospices around the country, the very least those hospices should expect is an equal minimum uplift so that they can maintain parity of wages. Our hospices are not seeking to be nationalised. They cherish their independence passionately, and it is because of their independence that they are so integrated into our community, but if we are going to rely on them to provide services, the least we can do as a society is to meet the costs of the services we are expecting them to provide.
Mr Deputy Speaker, mindful of your words, I will bring my remarks to a close in a moment. Philanthropy and charitable giving have been the foundations on which our wonderful hospice movement has been established. To my mind, hospices’ charitable status has enabled them to be flexible and to develop an holistic pattern of palliative care outside the NHS. However, in the 21st century it cannot be acceptable that funding is reliant on pensioners performing skydives and communities baking cakes to fund palliative care.
Much work has been done, and much work must be done by our ICBs and the Government to map the demands and needs for palliative care across the country. We must end this postcode-based patchwork of provision. It really is time that the Government established a rapid taskforce to collaborate with the entire hospice movement and our integrated care boards to ensure that we as a nation have the best provision in palliative care, and that everybody can have a good and peaceful death.
Mrs Hamilton
I absolutely agree with your sentiments and statement. As was said earlier, we need to move away from looking at individuals to look at population health and how we will support the local community. I will move on swiftly so that I can finish.
My constituency is the fifth poorest in the UK, and our communities are in some of the UK’s so-called left behind neighbourhoods. For places like mine, respite care is so important to ensure that carers get the break and support they need to keep them doing the incredible work that they do.
I am a nurse, and it breaks my heart that the NHS is in the worst state it has ever been in. Throughout the 14 years of this Tory Government, I have seen doctors striking, nurses striking, technicians striking, people queuing around the block for a GP appointment, people pulling out their own teeth, the highest waiting times in history, and complete disdain for the service that quite literally serves us from birth to death. We must have a national care service and we must properly invest in our NHS. It is no longer acceptable for hospices to rely on charitable donations to try to survive. Now more than ever, our hospices and our NHS need a Labour Government.
Mr Deputy Speaker (Mr Nigel Evans)
I gently remind the House that when people use the word “you”, they are referring to me, so please try to resist that.
Several hon. Members rose—
Mr Deputy Speaker (Mr Nigel Evans)
Order. I thank Members for shortening their speeches. We still have another 15 people who wish to contribute.
Several hon. Members rose—
Mr Deputy Speaker (Mr Nigel Evans)
Order. I am going to try to protect everybody so that they can get in, so it is a seven-minute limit forthwith.
Tobacco and Vapes Bill
Nigel Evans ExcerptsTuesday 16th April 2024
(1 week, 4 days ago)
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Victoria Atkins
I am going to conclude. In fairness, I have been generous with my time.
We want to build a brighter future for our children and grandchildren, which means moving from the tossing sea of cause and theory to the firm ground of result and fact. The result of this legislation will be to free future generations from the tyranny of addiction and ill health. The facts include that parents worry about youth vaping and want us to take on the tobacco and vaping industries. The result and facts of this change will save hundreds of thousands of lives, reduce pressure on our NHS and increase millions of young people’s chances in life. The decisions we make today will stand the test of time. For those many reasons, I commend the Bill to the House.
Mr Deputy Speaker (Mr Nigel Evans)
I will try not to impose a strict time limit. If I were wishing to speak, I would start to think about taking seven minutes for my contribution. That does not apply to the shadow Secretary of State.
Several hon. Members rose—
Mr Deputy Speaker (Mr Nigel Evans)
Order. I remind everyone that there is a lot of interest in this debate, particularly among Government Members, so I ask speakers not to stray too much beyond seven minutes. I call Liz Truss.
Wes Streeting
On a point of order, Mr Deputy Speaker. Is it in order for Members of this House to attack individual officers, such as the chief medical officer, or the civil service more generally, when they cannot answer back? Ultimately, advisers advise and Ministers decide. If people do not like Government policy or its consequences, they should take responsibility as Ministers and not attack officials who cannot answer back.
Several hon. Members rose—
Mr Deputy Speaker (Mr Nigel Evans)
Order. Let me just remind Members of the seven-minute guidance.
Young Adults with Spinal Injuries
Nigel Evans Excerpts(1 month, 4 weeks ago)
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The Minister for Social Care (Helen Whately)
I thank the hon. Member for Dulwich and West Norwood (Helen Hayes) for securing this debate and for her powerful speech telling us about Tom Lazarides’s experience, his tragic accident and his injury. I welcome his family, who the hon. Lady said are here in Parliament today. I offer them my sincere condolences on the loss of Tom, who sadly died in November 2023.
I listened carefully to the hon. Lady’s speech, although I did not have advance sight of her comments, and I will do my best to respond. I assure her that I am happy to write to her with further details about the points she has raised this afternoon. I am responding as the Minister with oversight of continuing healthcare and discharge, so I will be able to say more on those points. Particularly in her summing up, she talked more generally about care for people with spinal injury, which can have such a devastating impact and can mean that a person needs a great deal of care from multidisciplinary NHS teams.
I could go into the way NHS England commissions services for spinal cord injuries—there is a national specification and a range of support—but I think I could make better use of the time today by picking up on the question of continuing healthcare and the discharge situation, which the hon. Lady outlined. She described how Tom’s family feel that the system failed him and his clearly complex health needs as a result of his injuries. She described the long time he spent in hospital and the long-term rehabilitation he needed, which meant he needed significant ongoing clinical care. She described how he was considered for continuing healthcare and the experience of the eligibility assessment, and how Tom and his family felt it did not take into account his injuries and health conditions, and did not take full account of his medical records. She described how he and the family were then told that he was not eligible. They subsequently and rightly appealed, and I heard how difficult the hon. Lady said that process clearly was for the family and for Tom, with the lack of transparency, the uncertainty, and the feeling that meetings happened without them and their involvement. I heard how Tom felt under pressure to move into a care home, when he really wanted to live well at home. All of us can completely understand that. Anyone, whether a young person such as Tom or someone of old age, wants to live as independently as possible, whatever their health needs at home. I also heard about the experience with discharge to assess.
Clearly, a process is in place for accessing NHS continuing healthcare. The intention of the process is to consider the individual’s clinical needs, the combination of those needs and how they come together, and therefore to assess whether somebody is eligible. The intention is to design a package of care around the individual to support them where they wish to live, be it at home or in a care home. First, a checklist is used, which leads to someone having an eligibility assessment. If I understood it correctly, Tom experienced and went through the eligibility assessment, but, as the hon. Lady mentioned, the initial decision was that he was not eligible. I am happy to make some inquiries. As a Minister, I cannot make a call on any particular decision that is made on an individual, but clearly I want always to be assured that the right process has been followed. It is probably helpful if, with the help of officials, I try to seek some further information outside the Chamber from the hon. Lady to see what I can do to understand fully what happened and to be assured as to whether there is anything we need to do to make the process work better, particularly in the circumstance that she has described, where somebody such as Tom has clearly had some severe injuries. I am also happy to meet her and Tom’s family to understand this process better.
The hon. Lady raised a point about discharge to assess and how it did not work for someone with a catastrophic injury. Again, we should pick that up in a conversation outside the Chamber. In general, the purpose of discharge to assess is a good one: to avoid people having long and unnecessary stays in hospital, where we know that frail and elderly people, in particular, are likely to decondition and live less independently as a result. She knows that well from the work that she does on social care. Once somebody has been discharged home, they are often able to live with more independence and regain mobility in a way that was not clear when they were assessed in hospital. Sometimes assessment in hospital will lead to delays and a longer stay in hospital, and to what is called over-prescription, with somebody ending up living longer in a care home when they might have continued at home. In general, discharge to assess is a good thing but, as I say, I am happy to look into the specific question of whether there might be circumstances, such as when somebody has had a very serious injury, when the process works differently. I will take that away.
The hon. Lady made a point about the involvement of patients in decisions about their care. It is fundamental that patients should be involved in decisions about their care, as should families and carers. In many circumstances, the patient and those around them will be the experts on what they will need. They need to be involved in the ramifications of whatever decisions are made. That should take place, but let us investigate further outside the Chamber whether that is working as it should be, together with the points she made about transparency and trying to ensure that people are involved when continuing healthcare is being assessed and considered.
I receive a significant amount of correspondence about continuing healthcare. The NHS has a challenging job to ensure that the decisions go the right way. I know the process can be long and hard for those involved in it. I want to ensure it works as well as it possibly can, so that those who should be eligible receive such care. I understand in Tom’s case that, after the appeal, the decision was made that he should be receiving continuing healthcare. How sad that that came after his death and after all the suffering that he and those close to him must have gone through.
I thank the hon. Lady for bringing Tom and his family’s situation to my attention. I commend her for her powerful speech and how clearly she put across the concerns. I look forward to speaking about this further outside the Chamber.
Mr Deputy Speaker (Mr Nigel Evans)
I pass on the deepest condolences of everybody here at the House of Commons to Tom’s family, friends and all who mourn his passing. It was a very moving speech.
Question put and agreed to.
NHS Dentistry
Nigel Evans Excerpts(3 months, 2 weeks ago)
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Mr Deputy Speaker (Mr Nigel Evans)
I am afraid that I have to reduce the time limit to five minutes for the last four speakers, so that we get the Division as close to half-past 4 as possible.
Alex Sobel (Leeds North West) (Lab/Co-op)
Access to dental care in West Yorkshire is a problem that cannot be ignored. Dental care is a fundamental right and its absence has far-reaching consequences for the health of our whole community. Currently, no dentists are accepting new NHS patients in the whole of Leeds, with waiting lists lasting years. Only recently, a dentist in my constituency, in the rural market town of Otley, withdrew from the NHS scheme citing a “chronic lack of investment”; Manor Square has been a reliable provider of NHS dentistry to the local community for many years—intergenerational communities and families have been receiving NHS care at that practice for many decades—but now they cannot receive it there.
The practice’s withdrawal from the scheme has affected 15,000 patients and raises serious questions about the future availability of affordable dental care in the whole area. One constituent was paying around £45 for two annual check-ups at the practice, with their children receiving free dental care. Under the practice’s new private dental plan, the cost will be £640, which is clearly unaffordable for many families in Otley. Such costs are set against rising costs for families across the board.
The decision appears to be yet another symptom of the chronic underfunding and neglect faced by the NHS. Oral health is an integral part of our overall wellbeing and neglecting it can lead to serious health issues down the line. The withdrawal of NHS dental care not only affects individuals, but has a broader impact on the health infrastructure of our communities. The consequences are felt not just by those who currently need dental services, but by all of us who value a robust and comprehensive healthcare system.
We need an urgent reform of dental care. We need to recognise its critical role in maintaining overall health. Our communities deserve access to quality and affordable dental services. The Government have no clear plan, but Labour does. Labour plans to provide 700,000 additional appointments and education on basic life skills in areas where children’s dental health is most affected, through supervised toothbrushing, and to reform the dental contract, which the Government have failed to do over the last 14 years. As many colleagues have said, there are major issues facing the workforce as many NHS dentists have left to practise privately, or have left the UK for countries where dentistry is more highly valued than it is by our Government.
To conclude, the lack of dental care in West Yorkshire is a serious concern that demands immediate attention. It is not just a matter of oral health but a reflection of broader challenges across the NHS. That is why we should support the motion.
Mr Deputy Speaker (Mr Nigel Evans)
Members who have taken part in the debate should make their way to the Chamber now, as the wind-ups will begin after Mr Western finishes his speech.
NHS Winter Update
Nigel Evans Excerpts(3 months, 2 weeks ago)
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Victoria Atkins
I thank my hon. Friend. We know the figures for previous strike actions, but sadly we will hear the true extent and impact of the strike action over the last six days later this week, and I suspect we will have even more missed and cancelled appointments to add to the list she rightly sets out.
On the point about pay, the basic pay of a foundation year one doctor has risen by 10.3%. Once one takes into account factors such as overtime and unsocial hours payments, that means the average salary is £40,800, a figure that I hope begins to reflect the importance we put on doctors and their role in the NHS. As doctors progress with their careers, there is a good package of development and progress, culminating in the pay settlement, currently out to ballot with the BMA, that I hope consultants, who are at the end of their career and do so much to help train younger doctors, will vote for. There is much work to be done, but progress has already been made on pay. That is why the decision by the BMA junior doctors committee to call strikes of such length at this time of year was so disappointing.
Mr Deputy Speaker (Sir Roger Gale)
I thank the Secretary of State for her statement and for responding to questions, and my thanks also go to those on the Opposition Front Bench.
Building an NHS Fit for the Future
Nigel Evans Excerpts(5 months, 2 weeks ago)
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Amy Callaghan
I thank the hon. Member for her contribution, but I would say that there are definitely structural funding issues because of being tied to this financial Union, which is the point I was just about to make. I hope she recognises that, and will maybe reflect on the fact that being part of this Union does have dire consequences.
Mr Deputy Speaker (Mr Nigel Evans)
Order. I remind the hon. Lady that she has to face forward.
Amy Callaghan
The First Minister’s pledge of £300 million to cut NHS wait times is an example of the fantastic work that the SNP Scottish Government are doing. There will be 100,000 fewer patients on our NHS wait lists come 2026, because of that incredible investment.
Despite the year-on-year reduction in Barnett consequentials for health, NHS Scotland staff remain the best paid across these isles. What does that look like in practice? A band 2 porter in Scotland earns £2,980 more a year than their counterpart in England, and a band 5 nurse in Scotland earns £3,080 more a year than their counterpart in England. This is all despite the increased privatisation in NHS England. Under the SNP, the Scottish NHS fares much better than its counterparts across these isles, but under the current funding structures only the UK Government can deliver the funding necessary to get the NHS back on its feet. Down here, the Treasury gives money to private companies to provide a service for NHS England. That means less capital investment into NHS England, which means less money for the Scottish Government to spend on NHS Scotland.
I have always found the monarch’s speech quite baffling, but particularly so over the past few years, with so many broken promises and so many shallow, unfulfilled commitments. I think of promises to ban conversion therapy, commitments to reach net zero and pledges for a mental health Bill. The Government think my party does not respect this place, yet it is them who make a mockery of it by not fulfilling the policy agenda that they set for themselves. Perhaps this threadbare King’s Speech is perfect for them: less to fail on.
Several hon. Members rose—
Mr Deputy Speaker (Mr Nigel Evans)
Order. As you can see, there is a lot of interest in the debate. We will try to proceed without a time limit, but I will give an indicative amount. If Members do not go wildly over eight minutes, we should get everybody in. Let us give that a go to begin with.
Under-age Vaping
Nigel Evans Excerpts(9 months, 2 weeks ago)
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Kirsten Oswald
I would be equally outraged. I know how much work the hon. Lady does in this regard. I am unsurprised to find that we are both enraged by the same thing. This is really unacceptable. If we are serious about dealing with the harms to children and young people, we really should expect sports clubs to be somewhere that they can see positive imagery and have positive influences. I recently visited a vaping shop near to where I live. I know they are sold in other outlets too, in corner shops and supermarkets, on Amazon and eBay, and we have heard about them being sold in a barbershop as well. They are not difficult to find, and they are so inviting. When I went into the shop, it looked lovely: the display was beautiful, with nice colours and names and all kinds of fancy shapes that looked like highlighters or lipsticks. I have seen some online that look like brightly coloured fidget spinners. These things are quite enticing, are they not? They are very attractive, and that is obviously deliberate.
I was interested to hear about the King’s College study on plain packaging, because anything that makes vapes less attractive to young people is obviously worth considering. I say that for many reasons, one being that I heard recently about young people purchasing disposable vapes to match their outfits. I must say that that had never occurred to me before, but why not? If they are purchasing them, they might want them to match their outfits, just as they might think about what flavour they would like, such as bubblegum or grape soda. The hon. Member for Denton and Reddish talked about them looking like an old-fashioned sweet shop, and he was right about that.
Disposable vapes are designed to be enticing, to draw young people in. They are throwaway and they are affordable. The right hon. Member for Romsey and Southampton North (Caroline Nokes) was absolutely right to describe them as pocket-money purchases. Parents will not always know what their children are purchasing with pocket money; presumably children throw disposable vapes away, as I have said, before the parents find them. As parents, we have no idea whether our children are using them. I hope mine are not, but none of us can know that, because they are so easy to find and so easy to throw away that we must be alive to the fact that we might not have the full picture.
Presumably we cannot all have the full picture, because, if we look at the statistics, in a recent YouGov/ASH survey the proportion of children aged between 11 and 17 who vape has gone up from 4% in 2020 to 7% in 2022, and the proportion of children who have tried vaping overall is now sitting at 16%. We have heard significantly higher figures than that cited in this debate.
I think it is reasonable to look for disposable vapes to be removed from sale. That is certainly what I would like to see. I am pleased to hear calls for retailers to ban single-use vapes in Scotland, where environmental and health charities have joined forces to call for an end to the sale of disposable vapes. Groups such as Keep Scotland Beautiful, ASH Scotland and the Marine Conservation Society are urging retailers to follow the good example of Waitrose, who I take my hat off to here, in banning the sale of those single-use products.
Waitrose did that because of reports suggesting that their popularity was soaring among people who had not previously smoked, as we have heard already, including the younger generation. It is really important that we examine the subject. I am pleased about the Scottish Government’s action in that regard and I echo Barry Fisher, the chief executive of Keep Scotland Beautiful, who also talks about a “litter emergency” and emphasises that the time to act is now.
The time to act is now also on the illicit vapes we have heard about already—the dodgy vapes and the chemicals within them. Lab research shows that they have up to twice the daily safe amount of lead and nine times the daily safe amount of nickel. There is also chromium in there. We do not want our children to be ingesting those substances, and those studies are based only on some vapes confiscated from a school in England, so we do not know what else is out there; we just know it should not be. Dodgy vapes have deeply concerning health impacts. In Scotland, there have been reports of illegal vapes confiscated from a school that left children coughing up blood. Which of us wants that for our children? We need to act.
It is deeply concerning—and that is before we even get into the notion of young people who have never previously smoked using disposable vapes and then graduating on to smoking cigarettes. We know that is an issue. The producers of vapes would have us believe they were intended to rectify and remedy that very problem, but it turns out to be the opposite that happens. The World Health Organisation has expressed significant concern about that, stating that children who use such products are three times more likely to use tobacco products in the future. If the Minister is looking for evidence, that is the kind of statistic he ought to bear in mind.
Huge profits are being made on the back of all those sales of vapes to children. Big business is being done here, but it is not always being done by the rules. The most popular brand for children is Elfbar, but in July an Observer investigation found that Elfbar had flouted the rules to promote its products to young people in the UK. Advertising videos and promotions on TikTok, for instance, were felt to be of concern. Some of those videos attracted hundreds of thousands of views, on a platform that is used by three quarters of 16 and 17-year-olds.
We have already heard about children’s doctors calling for a complete ban on disposable vapes. The hon. Member for Sleaford and North Hykeham (Dr Johnson), who is herself a children’s doctor, has spoken out about that. If we will not listen to the views of children’s doctors about the impact of vapes on children’s health, who will we listen to?
I am heartened that Humza Yousaf, our First Minister, says that a ban on disposable vapes is under consideration, and by the incredible hard work being done by the campaign group ASH, which absolutely deserves our thanks. I also thank the organisers of the TRNSMT festival, which took place in Glasgow last weekend, because they did not permit disposable vapes there, and I absolutely applaud them for that.
Less positively, however, I cannot thank the administration of East Renfrewshire Council, which is where I live. The motion, which I think is a good one, includes a passage about working with councils, and that is absolutely right. Of the 32 councils in Scotland, 28 supported motions calling for a ban on disposable vapes. Regrettably, East Renfrewshire Council was not one of them. It did not support the ban, seemingly because a ban was supported by the SNP. I am really unimpressed by that. It is a poor show from that Labour Administration and their Conservative enablers that they could not bring themselves in step with the whole of the rest of the country and, I suspect, with the Members who are present in the debate. That seems somewhat ironic given the motion that is before the House. I hope that they will reflect on that and change their mind, and that we will get a full set of councils to support the ban—although the numbers so far are pretty impressive.
I hope that the Scottish Government come to the conclusion that these things are too dangerous and damaging, although I am grateful for their sterling work so far. I hope that the UK Government will listen to what is being said to them. Like my hon. Friend the Member for Angus (Dave Doogan), I was not entirely convinced that a huge degree of listening was going on, but I hope that I am wrong about that and that we will hear about a very serious focus on the matter. The industry will not take the steps that are needed; politicians need to do that. Disposable vapes are a danger to the environment and to our young people. It is high time that we took them off the shelf.
Mr Deputy Speaker (Mr Nigel Evans)
I call the Chair of the Health and Social Care Committee.
New Hospitals
Nigel Evans Excerpts(11 months, 1 week ago)
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Steve Barclay
It is always a pleasure to see my hon. Friend whatever the issue, but he is right that he has assiduously raised the case for Milton Keynes, as has his neighbour, my hon. Friend the Member for Milton Keynes South (Iain Stewart)—they worked very effectively as a team to make that case. I look forward to having further discussions with him as we take the plans forward.
Nick Fletcher (Don Valley) (Con)
Thank you, Mr Deputy Speaker—he who is first will be last, and he who is last will one day be first.
I thank the Secretary of State for his statement, and I congratulate all Members who have been successful with their bids for new hospitals. Sadly, there is one name missing from the announcement: Doncaster. Although I understand that the RAAC hospital replacements are desperately needed, and I know that many of my constituents will benefit from the new A&E department in Bassetlaw, that does not remove the need for Doncaster to have a new hospital. There is a brownfield site right in the centre of Doncaster that is shovel-ready and ready to go, so will the Secretary of State—as well as maybe the Chancellor and the Secretary of State for Levelling Up—meet me to see what we can do to get Doncaster a new hospital? It would not just be a new hospital: it would revitalise the city of Doncaster, and we really need this.
Steve Barclay
My hon. Friend is right to champion the case of Doncaster. As he knows, while it is not in his constituency, the investment we are making in Bassetlaw is for patient care that, in a number of instances, will directly serve his constituents in Doncaster. That is why it is right that we look at capital investment on a system-wide basis, and I am very happy to have further discussions with him in conjunction with his local integrated care system as to that ICS’s future plans regarding its capital investment.
Mr Deputy Speaker (Mr Nigel Evans)
I thank the Secretary of State for his statement, and for responding to questions for exactly one hour. Iain Stewart mentioned the passing of Karen Lumley as well; she was a personal friend of mine. She was a wonderful person and a great Member of Parliament, and my deepest condolences go to Richard and the entire family. We will miss her.
Reforms to NHS Dentistry
Nigel Evans Excerpts(1 year ago)
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Several hon. Members rose—
Mr Deputy Speaker (Mr Nigel Evans)
As more people want to speak, and we have the wind-ups to come, it is sensible to continue with this debate. We will try to reposition the debate that should have followed.
Jerome Mayhew (Broadland) (Con)
We have had a full debate today. This is the third Backbench Business debate on the subject, but not the third debate on dentistry; I have had an Adjournment debate on dentistry, for example. The subject is well rehearsed. The reason why so many people are keen to speak today is that the issue affects areas right across the country. We all know that there is a problem with NHS dentistry, that the Government are focusing on it, and that they are coming up with a dental plan. We anxiously look forward to its publication in the next two to three months. In the few minutes available to me, I will not focus on the national problem so much as recognise that within the national difficulties, there are regional crises. In rural areas such as North Devon, but also in the east of England and Norfolk in particular, we can see that what is already a challenging picture nationally is exacerbated. To identify the issue, we have only to follow the money. I will look at funding for the east of England, then I will talk about recruitment and retention.
I know that funding has been impacted by covid, and the ability to undertake units of dental activity was restricted because of the covid pandemic and the aerosol activity of much of dentistry. I also know that funding has subsequently been increased because of the catch-up bid, so the numbers for the year 2018-19 give a more accurate reflection of the level of investment by the Government in dentistry in the region. The national average gross spending per mouth in England was £66 in that period. The best performing region was the midlands, which received £78 of expenditure per mouth. The figure for the east of England was £39 per mouth. That is exactly half the amount of money spent on dentistry per head of the population in the midlands. Now, there are many unconfirmed rumours about the number of fingers and toes that we have in Norfolk, but we do not have half as many teeth as those in the midlands—not yet, anyway.
My request to the Minister is to follow the numbers, to look at where the expenditure has been taking place and, more importantly, to look at the places where the expenditure has not taken place, and then to ask the question of his officials, “Why is that?” Why is it that even though in many parts of the east of England we have the worst dental health, the expenditure by the Government is fully half what it is in the midlands, and £20 less than the national average per person?
Looking to recruitment and retention, a potential answer to my first question is that there are physically not enough dentists in the east of England to carry out the work. The national average number of dentists per 100,000 of the population is 43. In the east of England, we have just 39. That compares to Devon, where there is a dental training school, which has 49. Why is it that people do not want to be dentists in Norfolk? The answer is because it is rural, and for those who grow up there, the nearest place they can train is Birmingham.
People cannot train to be a dental technician or a dentist anywhere in the east of England. It is the only region of the country, other than the south-east, which is next door to London, that has no dental school at all. People can go either to London or Birmingham. Is it surprising, then, that we do not have an indigenous population of would-be dentists growing up, training to be dentists in Norfolk and then staying there for their working life? We are reliant entirely on people relocating to the east, and to Norfolk in particular, to supply our dental needs.
When people qualify as a dentist in their mid-20s, the overwhelming majority do not wish to move to a rural location. Even though it is without question the best place in the country in which to live, to grow up, to learn and to bring up a family, it is not immediately attractive. A policy that relies on importing foreign-qualified dentists does not satisfy the need in rural locations either, because overwhelmingly the data tells us that when we import, say, South African or Australian dentists, they relocate to the cities. They set up their new life where there are already expat communities. They do not move to Fakenham, and the problem is very real in Fakenham. I persuaded the NHS to write a wholly new NHS dental contract for Fakenham. That contract went out, and not a single organisation bid for it. The money is there, but there is physically no supply of NHS dentists.
The issue goes further than that, because the lack of dentistry spreads out into the private sector as well. There are many examples right across the county of where private dental practices, whether in my constituency or in those of my hon. Friends the Members for North Norfolk (Duncan Baker) and for North West Norfolk (James Wild), have been advertising for years—in one case I am familiar with, for a decade—and are yet to fill the place. While the short-term answer to the national issue may well be to improve access to international dentists, the medium and longer-term solution for the east of England, and Norfolk in particular, surely is to establish dental training in the county. There are two ways to do that.
There are two ways to do that. In the short term—the very short term, I hope—there is a bid by the University of East Anglia to create a centre for dental development: a postgraduate training establishment that would help to draw in newly qualified dentists from other parts of the country. The hope is that if they do their postgraduate training in the east, a percentage of them will remain. There is also what I hope is not a competing but a complementary application from the University of Suffolk in Ipswich. Those bids should not be in competition; they should be working together to improve access in both Suffolk and Norfolk.
However, the real solution in the medium term is to unite with the University of East Anglia and its existing medical school to create a dental school at UEA, which already has the Quadram Institute—the world’s leading centre for the study of the gut biome, which of course begins with the mouth. The Norfolk and Norwich University Hospital is right next door. We would then have the ability to bring people in and train them in the city of Norwich; as evidence from the medical school demonstrates, a percentage of them would remain thereafter to develop their careers.
The hybrid nature of the UEA bid would mean that even in the first year of the five-year training period, people would be spending at least a day a week working in practices, helping work through the dentistry backlog, and developing community relationships that will make them more sticky to the region once they qualify. All that will go towards the long-term solution to the dental desert in Norfolk.
I very much look forward to the publication of the dental plan in the next few months, but it would be the most monumental wasted opportunity if that plan did not include training for dentistry in Norfolk.
Mr Deputy Speaker (Mr Nigel Evans)
Last but not least from the Back Benches, I call Robbie Moore.
Robbie Moore (Keighley) (Con)
I am pleased that this Backbench Business debate has been allowed time; I thank the hon. Member for Bradford South (Judith Cummins) and my hon. Friend the Member for Waveney (Peter Aldous) for securing it. I almost feel that I am about to sum up all the issues that have been discussed, but I want to pick out some of the challenges that I have faced as a constituency MP.
I am sure that all in the House agree that toothache and tooth-related issues can be extremely painful—for our constituents, unfortunately, getting to see an NHS dentist can itself feel like pulling teeth. I am pleased that one of the Government’s immediate priorities is to deal with the backlog, but I cannot stress enough how important it is that we pick up the pace and go even faster. Like many in the House, I was pleased to welcome last year’s announcement that the Government would provide £50 million for up to 350 additional dentist appointments in England. I am also pleased that they are continuing to have talks with the British Dental Association and other stakeholders to reform dental contracts, increase the incentives for dental practices to take on more NHS work, and help get on top of the backlog in dental treatment.
As my hon. Friends the Members for Waveney and for Hartlepool (Jill Mortimer) identified, the contract originally established back in 2006 is the real nub of the issue that all our constituents are facing today: simply not enough NHS dental work is being carried out. That is a huge issue in my constituency.
Over the past year, there has been a significant increase in the number of constituents writing to me in frustration because they cannot secure an NHS dentist appointment. Only last week, one constituent had to make an appointment 50 miles away in Sheffield, as she could not get a local NHS appointment and could not afford a private one. Another constituent kindly contacted me, dismayed at the fact that they had been contacting local dentists listed on the NHS website as available and taking patients—it turned out that they were not. My constituent tried to contact another dentist, which was only accepting children. My constituent ended up having to pay up to £80 up front for them and their three-year-old to see a local dentist. That is not acceptable. I checked it out for myself. The NHS England website said that the dentist was accepting patients, but when I clicked on the link and followed it, it said that
“this dentist surgery has not given an update on whether they’re still taking NHS patients. Please contact them directly to ask.”
That is simply not acceptable, because it instilled a false sense of hope in my constituent who has dental pain and needs to see a dentist as soon as possible.
As we all do, I recently held a surgery. A lady came and explained that she had been an NHS patient all her life with a particular practice in Keighley, as had her partner and her children, only to receive a letter to say that it would now only accept private appointments for her family. Again, that is not acceptable.
The Government are well aware of the issues and the scenarios that we have put forward today, but I urge them to look at some key points. Demand is there, but we are not recruiting enough dentists and we are not allowing those dentists enough space to support the demand. As my hon. Friend the Member for North Devon (Selaine Saxby) said, it is important to focus on early prevention work, particularly for younger people. As my hon. Friend the Member for Broadland (Jerome Mayhew) said, recruitment, retention and training in the early years are incredibly important. I want to pick up on the point that all integrated care boards must have dentistry represented on them, to ensure on a geographical basis that contracts are awarded for NHS providers and can be delivered on the ground.
The big issue is the contract reform that must take place. As we have all identified, units of dental activity are not keeping up to speed with demand. That is my constituents’ No. 1 priority. I hope that the Minister will ensure that appropriate action is taken to alleviate the pressures on NHS dentists and the dental pain that my constituents are suffering.
Neil O’Brien
I have mentioned some things that are already changing—some of the first reforms to the contract since 2006 that we have started to bring in. We are working on the plan at pace. There is no date for its publication yet, but we are working on it at pace because we are conscious of the urgency.
I thank the hon. Member for Bradford South and my hon. Friend the Member for Waveney for securing this important debate. I hope they have been assured that we have started to reform dentistry, that we are seized of the importance of the issue, and that we recognise that we can and must go further to further strengthen NHS dentistry.
Mr Deputy Speaker (Mr Nigel Evans)
We were going to come to the debate on reducing plastic pollution in the oceans. I said that it would be repositioned, but that is clearly not the right word, because it will still be here. “Rescheduled” is what I was grasping for, and I have now finally found the word. We hope that it will be rescheduled in the not-too-distant future, because it is a very important debate, and it was right not to truncate it in the way that was going to happen.