Terminally Ill Adults (End of Life) Bill
Simon Hoare Excerpts(3 days, 2 hours ago)
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Kim Leadbeater
No, I am going to make some progress, if that is okay.
The substances that would be used would not be new substances. As we know, assisted dying is available in many other jurisdictions, and there are substances that have been used safely and, in some cases, for many years. Their safety and efficacy has been proven around the world, but they do need to be treated differently, which is the purpose of new clause 13.
Dr Sandher
I have spent a lot of time around data, but I am not sure that I understand the question.
Dr Sandher
I will make a bit more progress.
This has been a heated debate, and hon. Members on both sides of the House feel strongly about it. I am grateful to Members who came before me, who made my place here possible and who have spoken so powerfully and movingly in this debate, but I believe—and the evidence shows—that the colour of my skin does not belong in discussion of the Bill.
Rebecca Smith
I thank the hon. Member for his intervention and I completely agree with him. These are the sorts of safeguards that even the promoter of the Bill is saying should be there. I do not think that they are in the Bill and my amendment to new clause 15 would make them much stronger.
Simon Hoare
My hon. Friend is right in what she says. Those of us who are opposed to the death penalty, for example, are against it because we do not believe in the infallibility of the state. The state can get things wrong; professionals can get things wrong—and when they do, there should be a proven, clear path as to how that wrongdoing can be identified, to try to ensure that it does not occur again.
Rebecca Smith
I thank my hon. Friend. The statistics I quoted earlier are pretty clear on the point he makes. Let me make some progress.
The work undertaken by the coroner is not a box-ticking exercise or a bureaucratic hurdle. In the context of assisted dying, it is an extremely powerful deterrent against abuse and malpractice. Again, to quote Judge Thomas Teague KC, in a letter to The Times on 7 May this year, he said that the removal of
“any realistic prospect of an effective inquest...would magnify, rather than diminish, the obvious risks of deception and undue influence”.
Blair McDougall
I do not wish to exacerbate your bronchitis, Madam Deputy Speaker, so I will continue.
Amendment 15 touches on a fundamental point at the heart of the debate. Disabled people and the sick, in every aspect of their lives, have to fight every day for resources from a state, a market and a society that view them as a drain on finances. Do we honestly believe that at the moment when the most vulnerable are least able to argue for themselves, under the most intense societal and cultural pressure, and at their most expensive, those same public and private sector institutions will succeed in making choice real for them when they have failed to do so throughout the rest of their lives? Even if we stretch credulity and convince ourselves that that will be true in the state sector, can we say that it will be true in the market? I do not believe that the Bill should be passed, but if it is, let us not make it worse by allowing unscrutinised profit from the loss of human beings.
Simon Hoare
I rise to speak in support of amendments (a) and (b) to new clause 14, new clauses 1, 2 and 16, and amendment (a) to new clause 15.
I will make two observations at the outset. I do so as a Welshman representing an English constituency, as a former Chair of the Northern Ireland Affairs Committee, and as the current Chair of the Public Administration and Constitutional Affairs Committee. I remain to be convinced, despite the confidence expressed by the Bill’s promoter, that the Bill honours, in spirit and letter, the devolution settlement. Based on the expression on the face of the Chair of the Scottish Affairs Committee, the hon. Member for Glasgow West (Patricia Ferguson), I do not think she believes that it honours the devolution settlement as far as Scotland is concerned either.
I also make the point that we are here to make law that has to stand the test of time. She was not the only one to do so, but the hon. Member for North Herefordshire (Ellie Chowns) shared a heartfelt anecdote about a conversation with her mother as a result of her mother’s professional work. I know how easy it is to do, because it is a trap that I have fallen into, but, particularly on an issue as emotive and literally life-changing as this, we should not base our decision just on anecdote. We must base it on cold analysis of what is before us.
It is almost six months to the day since the Bill was introduced and still I think it is best described as skeletal. We have been told time and again by the hon. Member for Spen Valley (Kim Leadbeater) and the Minister how busy officials have been looking at the practicalities of the Bill and how to operationalise it and make it workable. Yet this House is kept in the dark on what Ministers intend. Indeed, the hon. and learned Member for Folkestone and Hythe (Tony Vaughan) said in his earlier contribution that his understanding was that the hon. Lady was still prepared to work with colleagues to perfect the Bill. But, Madam Deputy Speaker, we are on the second day of Report stage and we could easily fall to Third Reading today. The time for that evolutionary conversation is long past. The time for detailed clarification is now. The Bill remains skeletal.
Simon Hoare
I will not; I am very conscious of time.
Madam Deputy Speaker, given that so many right hon. and hon. Members have been constrained in the length of their contributions because of your persistent cough—I say that not as a criticism—and that next week we have a lot of one-line Whips and the following week we have exactly the same, more time really should be given to the Bill. I do wish the Government had taken it on, not as a Government Bill but by finding Government time for Report on the Floor of the House. This is too serious an issue to have as many gaps and lacunae as this Bill has.
The founding fathers of the United States worked on the basis that the vague generalities of the constitution would always be adhered to, and that men and women of goodwill would adhere to it. I am pretty certain that they are now beginning posthumously, with the current incarnation, to wonder whether that is true. We should not be legislating to leave it up to Ministers to define regulations and decide how they come forward. We have Bills that have page after page after page which, when people ask themselves, “What is this all about?”, actually amount to very little. The amendments that have been tabled, and which I support, have been tabled in good faith, but I am afraid to say that, in trying to improve the Bill, they are trying to make a silk purse out of a sow’s ear.
Catherine Fookes (Monmouthshire) (Lab)
I rise to support new clauses 20 and 21, and amendments 70, 71 and 92 to 95. They are all about the right people having the right powers at the right time, and they respect the devolution settlement for Wales. I am mindful of time, and therefore I am sorry but I will not take interventions. I am extremely grateful to my hon. Friend the Member for Spen Valley (Kim Leadbeater) for engaging so meaningfully and strongly with the Welsh Government, including going to Cardiff to speak with Welsh Health Ministers and officials, to ensure that they are continually consulted during this process.
New clause 20 ensures that the Secretary of State, not the chief medical officer, is responsible for issuing guidance on the operation of the Bill. It enhances oversight and accountability by placing that responsibility with the Secretary of State, so that scrutiny and accountability regarding how the Bill will be implemented in practice is put in the right place. It is normal practice that officials whose roles and responsibilities may alter over time are not named in primary legislation. It is, however, important to note that the chief medical officer is not being cut out of the process, because the chief medical officers for England and Wales must be consulted. The new clause also allows persons with learning disabilities and other protected characteristics, as well as providers of palliative care services, to contribute to the process of provisioning guidance. It is a simple but important measure that ensures the right level of ministerial oversight, and I urge colleagues to support it.
As my hon. Friend the Member for Cardiff West (Mr Barros-Curtis) has explained, it is important to urge Members to support new clause 21, because it ensures that people in Wales are able to access the assisted dying process in the Welsh language if that is their preference. Almost 30% of the population in Wales speak Welsh, and it is so important that they can access this service in their language should they wish to do so. It is a small change, but it will make a huge difference to patients, families and clinicians in Wales.
Amendments 70 and 71 simply refine provisions around the use of interpreters, requiring the Secretary of State to publish a code of practice on the matter. Interpreters are essential to ensure fair and equal access to the assisted dying process for those whose first language is not English or Welsh.
Amendments 92 and 93 provide greater detail on the Welsh Government’s responsibilities in delivering assisted dying services in Wales. Some hon. Members seem confused about what is and is not devolved, but as a Welsh MP, I wholeheartedly support the amendments, which 100% respect devolution. They ensure that Welsh Ministers have all the powers they need regarding the devolved aspects of the Bill and the health provisions, while retaining the powers of UK Ministers over those aspects that are not devolved, such as criminal justice provisions and, crucially, changes to the Suicide Act 1961.
Amendments 94 and 95 clarify how and when provisions relating to voluntary assisted dying will come into force in Wales. They do not impinge on the devolution settlement, but simply provide clarity and legal certainty. All the amendments would help my constituent, Noah, a 19-year-old with a terminal brain tumour who knows what he wants if his pain becomes unbearable. The Bill is about giving people like Noah the choice, control and compassion that they deserve at the end of life. Who are we to deny that choice?
I pay tribute once again to my hon. Friend the Member for Spen Valley for working closely with officials in both Wales and this place to craft what could be the strongest and most safeguarded assisted dying legislation anywhere in the world. It is a Bill designed to protect everyone, including my constituents in Monmouthshire and people across Wales. Thanks to the careful, considered amendments, including the ones that I have spoken about today, the Bill not only respects the devolution settlement but ensures that the right people hold the right powers at the right time to deliver this law safely. I urge Members to join me in the Aye Lobby to legislate to protect the rights of the terminally ill in their final months—to legislate for compassion, for choice and for dignity.
Dementia Care
Simon Hoare Excerpts(1 week, 6 days ago)
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Sir Alec Shelbrooke (Wetherby and Easingwold) (Con)
It is a genuine pleasure to follow the hon. Member for Hartlepool (Mr Brash), who has hit the nail on the head when it comes to how terrible this disease is.
Forty years ago this August, my paternal grandfather was dying of lung cancer. My father went to the hospital with him. The day went on and on, and eventually, my grandfather said to my father, “Go and give your mother a call—let her know where we are at.” She answered the phone, and my dad said, “Just to let you know, mum, we’re delayed at the hospital. Dad and I are going to be late.” She said, “Oh, I’ve not seen your father in three weeks.” At that point, he said, his blood ran cold. Tragically, my grandfather died just two weeks later. The funeral came, and the funeral went. My grandmother constantly asked, “Where have all these flowers come from?”
Within four years, my grandmother had to go into a nursing home. Making the right decisions during those four years put a huge strain on my father. “Do we sell the house? How are we going to pay for the care?” My grandmother was walking the streets at 3 am. She was leaving the gas on. Neighbours were saying, “The whole street is going to be destroyed. Derek, you have got to do something.” Then she was put into the home. What I have found during my work on dementia is that that is often the pattern. The spouse, or the partner, protects his or her spouse or partner. They pick up the slack—and this is such a ratcheting disease, which comes so slowly, that they do not realise that they are under more and more pressure and taking on more and more work.
Tragically again, in 2019, my father-in-law died suddenly, and it soon became apparent that he had been hiding my mother-in-law’s dementia. My mother-in-law is doing very well: she has a carer, and on some days she is still pretty sparky. She was a formidable woman in her time. She is 87 years old now. She still remembers me, and there is an important point there: I will be the person she forgets next, because I was the last in. I say to my wife, “For as long as she remembers me, we are still in a roughly good place.” That is quite a sad statement, is it not? It is sad that we are moving down that road.
However, I was inspired by something I saw shortly after I was elected, in 2010 or 2011, at a dementia café down in Rothwell. I went there when it first opened, and I quickly became aware of the support that it was giving people, and of how much they appreciated it. That brings me back to what the hon. Member for Hartlepool said about how cruel this disease is. Because people are gradually supporting their loved ones more and more, they reach a point at which there is enormous pressure. They are not going to take a step back, go on to Google or try to get on to the local Facebook to try and work out what is going on locally. People do not know what is going on out there, and that was even more true 10 or so years ago.
A huge number of voluntary organisations take clients. Let me name just two in my constituency: Wetherby in Support of the Elderly—WISE—and the Easingwold Hub Club. They provide a huge amount of support for people with dementia, but dozens of other voluntary organisations supply an incredible service that helps to take the pressure off carers, who are also able to take their loved ones out, which in itself can be stimulating. That gave me an idea, and I created the Dementia Directory and one of the first dementia-friendly constituencies. The directory breaks up the constituency up into parts, and lists all the events that are going on. We are working on the new one now. It is a complex process; it is a bit of a spider’s web, because we find one event and then another is off, and then another is off. We try not to miss any, but inevitably we do.
It is because the last directory had such a huge and positive impact that we are preparing this one for the new constituency, following the boundary change. All that we need now is the sponsorship that will enable it to be printed and posted. It will make a difference, because, as the hon. Member for Hartlepool said, this is a terribly cruel disease. There is a statement that upsets and annoys me greatly: “It is not such a bad disease, because the person who has it does not know they have it.” That is an awful thing to say. I can never hold back a tear when I see the advertisement in which a chap sitting on the end of the bed says to his wife, “I want to go home.” How many of us, as children, became homesick? I was homesick when I went to university. It is a terrifying thought that as you get older you will not know your partner, and you will be constantly homesick.
For Members who may not know this, I have a tip, because I have done dementia training. When I went to a care home, there was an elderly lady of about 90, who said, “I don’t like it here. They never let me see my parents. I just wish they’d let me see my father.” I had been told to get into a memory of the person and mention somewhere their relative may be, so I said, “Well, your father’s down at the allotment.” She said, “Oh, yes, that’s right,” and she calmed down. Do not argue with those people, because that will just make them more upset, but try to take them back to a memory.
As well the directory being used to notice events, it highlights things that may help, such as hydration. One of the things that happens with elderly people is that they do not want to keep going to the toilet and they get worried about doing so, so they are often quite sparky in the morning when they have had a cup of tea, but by 3 o’clock they are getting memory lapses because they have not drunk enough. That is also something we have to tell people.
How many Members in this Chamber, when they said they were going to speak in this debate—they do not have to put their hands up—had somebody say, “Oh, don’t forget to go there”? Everybody seems to know what dementia is, but nobody really knows what it is. It is a real paradox. Everybody makes that comment, “Don’t forget,” but do they really understand the depth and impact of this disease? Dementia includes Alzheimer’s disease. I recently read a book about Ronald Reagan, which at the end said that he did not open his eyes for the last four years of his life. Just think about that, and what this terrible disease does to people and all the impact it has.
This debate is about dementia care, and several contributions have been made about things the Government can do. I raised this issue back in 2012-13, and the then Prime Minister, David Cameron, did put funding into research for dementia. The trouble is that we have learned how to preserve all the organs of our body with medical research and medical advances, but we have never bothered with the brain. The blunt truth is that, before this disease had the prevalence it now has, most people were dead before they got it. However, there is something we can do all do as Members of Parliament in our constituencies, and that is to draw together all the voluntary organisations that give such relief to families and help to stimulate the sufferer along the way.
Simon Hoare (North Dorset) (Con)
My right hon. Friend is making a characteristically powerful and informed speech. He mentioned the importance of the role of volunteers, which I think the whole House will recognise. Does he, however, share my concern that, with an ageing population, we seem to be seeing a smaller cohort of people prepared to step up to volunteer? Across the Government and across this place, a noble endeavour to embark upon would be to champion and encourage more people to get involved with volunteering outside the usual catchment or cohort, because otherwise, in the not-too-distant future, these vital organisations will be so short of volunteers that they will not be able to do the jobs they need to do.
Sir Alec Shelbrooke
I am most grateful to my hon. Friend, who does indeed make an important comment. My constituency of Wetherby and Easingwold has an older demographic, and that will become more acute over time. He is right to say that there is a dedicated band of volunteers, but most of the people who do the voluntary work during daytime are of an age to be retired. There are people who I think do an incredible job in supporting people—they really do—and they deserve nothing but our gratitude and thanks.
As I have said, there is something positive that we really can do as Members of Parliament, so I urge everyone when they are back in their constituencies to look at what goes on and see what they can do to promote it. I promise them that it will make a transformational difference not just to the lives of the people affected, but to their lives as Members of Parliament in doing what they can do for their local community, which is why we are all here in the first place.
Tobacco and Vapes Bill
Simon Hoare ExcerptsTuesday 26th November 2024
(6 months, 3 weeks ago)
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Wes Streeting
I can not only imagine it, but I recently experienced a similar situation. There I was in Barkingside Sainsbury’s one evening, only weeks ago, buying a bottle of wine to have with dinner and, to my surprise, I was asked for my ID. I am afraid it is just a burden that those of us with youthful vim and vigour in our early 40s have to bear, and it is a price I am willing to pay—for good moisturiser. However, there is a serious point. Along with many others that I am sure we will encounter during the passage of the Bill, this is one of the cynical arguments being deployed by the mendacious smoking lobby, which would have us believe that, decades hence, there will be people who are at the margins—one aged 41 and one aged 40, for example—being asked for ID on the sale of cigarettes. The point is that the Bill will create a smokefree generation. Young people growing up in our country today will not be smokers, because we will have stopped the start. We will do everything we can to support adults who are currently smoking, because the vast majority want to break the habit but struggle to do so.
Simon Hoare (North Dorset) (Con)
If only proof of age was still asked of me.
The Secretary of State knows that I support the Bill and will vote for it this evening, but he will know that rural pubs are increasingly marginal in their operations. He has referred to further powers, post consultation, that may stop smoking outside in particular places once the Bill is on the statute book. Will he put the minds of rural MPs, from across the House, at rest by saying that he does not envisage at any point, either now or post-Royal Assent, the inclusion of a ban on smoking outside rural pubs? That would be a further nail in their business model at a time when we need them.
Wes Streeting
I was going to address that point later in my speech, but let me address it now. It is not often that a Government comment on leaks or welcome the events following a leak; I do not want to encourage future leaks, either. However, it is well known and a matter of accurate reporting, in this case, that we were considering an extension of the ban on outdoor smoking to include outdoor hospitality, including pubs, as the hon. Gentleman mentioned. Because of that leak, representations were heard from Members from across the House, including the hon. Gentleman, my hon. Friend the Member for Great Grimsby and Cleethorpes (Melanie Onn) and others. We took those representations very seriously because we know the hospitality industry has been through a torrid time, and not just in rural communities. I accept that rural pubs face a big challenge, but even high street pubs in towns and cities are struggling.
Our approach to public health always has to weigh up the upside benefits to public health against the downside consequences elsewhere. It is not in the national interest to see our high streets further suffer, so I reassure the hon. Member for North Dorset (Simon Hoare) and the hospitality industry—although I think it feels reassured on this already—that we will not be consulting on extending the powers to outdoor hospitality spaces. I hope that reassures people, as we embark on consultation on the measures that I am outlining today, that the Government listen, engage and consult seriously. Consultation is genuine with this Government.
Simon Hoare (North Dorset) (Con)
I welcome this Bill, and I think the country should welcome it and salute the Government for effectively taking on the Bill—they have polished and finessed some elements—that was introduced by my right hon. Friend the Member for Louth and Horncastle (Victoria Atkins) under the previous Government. The gracious remarks of the Secretary of State in his opening speech will have resonated on the Conservative Benches and been appreciated.
A lot has happened in our country’s relationship with tobacco. I am pretty certain that had we known in the past what we know now about the harms of tobacco for so many thousands of our citizens, both societally and in terms of health, Queen Elizabeth would have probably said to the merchant adventurers, “Thank you very much for bringing it over, but please take it back.” It would not have taken root, but it has done. We have moved through a time when medics were paid by the industry to tell us of the beneficial effects of tobacco—for example, the idea that menthol was good for clearing people’s lungs. As we know, the medical profession has very much changed its tune. Rather like the hon. Member for Bury St Edmunds and Stowmarket (Peter Prinsley), my late father-in-law was an ENT surgeon, and I well remember talking to him about the devastating impacts that he saw on people’s health and the cost that such terrible and avoidable conditions can have, both to the economy and to the health service.
As I mentioned to the Secretary of State, I am no longer asked for proof of ID when I go into shops to buy anything. However, I can well remember that as a young schoolboy —this just goes to show how this country’s relationship with tobacco has changed—the headmaster at my local primary school seemed to be addicted to Piccadilly cigarettes. I do not know whether they are still made, but it was my job every morning—I obviously had a trustworthy face—to trot up Wyndham Crescent, go round the corner into Severn Road, go into Tony’s, the newsagent, and pick up either 20 or 40. I knew it was going to be a bad day if my headmaster needed two packets of 20. It is amazing that a nine-year-old schoolboy could be given cigarettes, but so trusting was Tony, the newsagent, that we did not have to pay. We did that on Fridays, and there was always 10p left over, which would allow me to have a comic, two packets of crisps or a bag of Chewits. When I say this to my children, who are either in or approaching their teenage years, they look at me with glee but also as though I am talking about a different age, which of course I am. What on earth can we buy for 10p these days?
As I said in my intervention on the Secretary of State, I welcome the Bill. I was grateful to him and to the Under-Secretary of State for Health and Social Care, the hon. Member for Gorton and Denton (Andrew Gwynne), for a brief conversation we had today about the Government’s intention not to include within the scope of this Bill—or, indeed, in any future consultation—a prohibition on smoking outside a hospitality venue. I entirely take the Secretary of State’s point that it is not just the rural hospitality sector that would be affected, but a number of publicans in my constituency have said to me that it really would be the death knell for their business if smokers were not allowed to have a cigarette and a pint outside the pub, in the designated smoking area. Their businesses are very marginal, as the Minister knows and as the Secretary of State recognises, so I am grateful to them for that.
The licences that the Bill envisages will be useful for providing a record of who is doing what, where, for the benefit of officialdom in its many guises, but I urge the Government—and local government, if this gets passported down to it—not to see those licences as a cash cow. They should not be a profit centre, and the requirements to secure a licence should not be onerous. The constraints of the Bill are clear. Hon. Members have asked why, if smoking is so bad, we do not just stop sales completely. The Government are not going down that route, so those who are going about a legal business should not be made to feel like criminals or societal pariahs for selling what is still a legal product to those who are legally entitled to purchase it.
I disagree almost fundamentally with the assessment of vaping from the hon. Member for Newcastle upon Tyne East and Wallsend (Mary Glindon). I have three kids at our local high school, and too many of their cohort have got entrapped into vaping, brought in by the colours, the flavours, the smells, the packaging and the novelty factor. I understand entirely the intention for vaping to be a passport away from tobacco, but for too many, it seems to be an entry to smoking, and then moves them on to tobacco. That is entirely not what was envisaged, so I support fundamentally the robust approach that the Bill takes to the vaping sector.
I would be interested to hear the Minister’s response to the concerns raised about smuggling. One can make something illegal, prohibit it or narrow access to it, but that does not necessarily, in the first instance, choke off market demand, and people will seek it. There will clearly have to be some robust empowering of His Majesty’s Revenue and Customs agents and others to ensure that we do not see a burgeoning black market in tobacco products.
On the hon. Member for Newcastle upon Tyne East and Wallsend’s point, I remember hearing a presentation from British American Tobacco, and a point that resonated with me was that there are legal vapes, the ingredients of which we know and are listed, and then there is a huge black market for vapes, principally from China, and nobody knows what the hell is in them. I think an awful lot of parents think that those vapes are just producing steam, and have no idea about their dangerous chemical composition. I think too many teachers and headteachers also thought that, and the learning curve has been steep.
James McMurdock (South Basildon and East Thurrock) (Reform)
I have an interesting thought on the supply and demand issue, and the challenges it will pose from a control perspective. The hon. Gentleman paints a nice image of a day gone by when one of the kids could be sent down to the shop to pick up something for an adult, and I ask Members to consider what kind of world and country we want to live in. Do we want to live in a country where we could send one of the kids down to the shop to pick up something for us, or do we want to live in a country where we are forced to police each other’s behaviour in parks? We should think very carefully about the Government’s remit.
Simon Hoare
The hon. Gentleman takes me neatly to my closing point. If I understand him correctly, he is making an argument about civil liberties and freedoms. One does not have to be a libertarian to cherish freedom and liberty, as I hope we all do in this House. Libertarianism is the extreme form. It is the difference between liberty regulated and controlled—parametered, if one will—and liberty laissez-faire. It strikes me as rather incongruous for a libertarian to wish to become a lawmaker, because most laws are there to control, prohibit and regulate. It seems masochistic: “I am a free market libertarian, yet I have decided to put myself in the shackles of lawmaking in order to restrict the liberties that I cherish.” The hon. Gentleman makes a serious point, but we have to deal with society as it is, rather than as we might like it to be. Things have changed.
The ultra-libertarian would ask why we force people to wear seatbelts, as people should be free to hurl themselves through their windscreen at speed. Why do we have speed limits? The libertarian would say that we should be absolutely free to drive at whatever speed, irrespective of the conditions. I remember, back at university, hearing an eccentric American—that can sometimes be a tautology—questioning, from the extreme wing of libertarianism, the merits or otherwise of ages of sexual consent.
I suggest that all we do, and our inspiration for doing it, is benign and kindly. Too often, it is interpreted as being paternalistic and patronising, but I like what the Secretary of State said about this approach to lawmaking being in the proud one nation tradition of the Conservative party, because Tories like order, not disorder.
Simon Hoare
Here is a man who adores order nearly as much as he adores Margaret Thatcher.
Andrew Rosindell
One of my reasons for getting involved in politics is that I believe in a free society, and I believe that people should make choices about their own life. I do not believe that the state should govern how people live their life, but that does not mean I am an extreme libertarian. It just means that I believe in freedom with responsibility.
As my hon. Friend has said, attitudes to tobacco have evolved over the years. People have naturally decided not to smoke and, speaking as a Conservative, surely it is better to educate and let people make their own choices than to impose decisions on them.
Simon Hoare
My hon. Friend makes an important point, and I readily accept that it has a huge intellectual underpinning, but we have had public health campaigns for years on the dangers of smoking tobacco. In some instances, it has worked. We have also used taxation and the pricing mechanism. My late father told my mother that he would give up when cigarettes reached 10 shillings a packet. He eventually gave up when smoking was banned in public buildings and the like. The question that remains is: do we allow unfettered freedom if it harms only the individual who is exercising it, and step in when the exercise of that unfettered freedom has negative impacts on society?
The Secretary of State and others have dilated, perfectly correctly, on the impact on demand and supply in the national health service. A disproportionate amount of resource goes to dealing with smoking-related diseases, illnesses and conditions. We can do something about that. We know full well the negative impact of passive smoking on other people’s health, so the impact of the exercise of that liberty is not limited to the individual. I suggest respectfully that my hon. Friend the Member for Romford (Andrew Rosindell) would have a stronger point if it was limited to the individual. Then we could say, “Provide the information and let the individual take the decision.” However, that decision impacts many other people. It affects the productivity of the nation and the national health service, and the health of family and society.
I suggest to my hon. Friend that it is an entirely Conservative instinct to say, when all the levers have been pulled and buttons pushed—when there has been public information, education and some forms of prohibition—“It has worked up to a point, but not enough and not at the right speed. We will have to do something else.” I accept that not everybody who describes themselves as a Conservative, as my hon. Friend and I both do, will make the same analysis and arrive at the same position as me. I voted for the Bill in its last iteration, and I will vote for it again today, because I think it is the next lever that we need to pull and the next button that we have to push.
Dr Danny Chambers (Winchester) (LD)
Does the hon. Gentleman agree that we have an NHS and a Government who are expected to provide and pay for treatment when people are ill, so there is a duty and an onus on the Government to try to keep people healthy, and to provide information about well-known dangers to people’s health? This is not about having a nanny state, but about nudging people to make the right choices, because it costs money to treat people, and we want to save money as well.
Simon Hoare
The hon. Gentleman makes a valid point. One can nudge, prod, push and exhort as much as one can, but the Bill is probably the final stepping stone in quite a long line of stepping stones to try to wean people off their dependency on tobacco.
The House has been generous with its time, as have you with your patience, Madam Deputy Speaker. In closing, I echo and endorse the point made by the Secretary of State and other contributors from the Government Benches: people who have an addiction are not free. They are trapped by their addiction, and that affects many areas of their life. If someone is terribly well off, they can afford the addiction to tobacco, and it will make not a jot or tittle of difference to the household budget or income, or to their standard of life—
Simon Hoare
I will not, I am afraid, because I want to conclude. The disproportionate hammer blow is felt by families who would describe themselves as poor, on low or fixed incomes. When the choice between feeding the addiction and feeding the children comes into play, then feeding the addiction seems to have the trump hand. The Government are right to have picked up the ball and taken the Bill forward. It is an entirely Conservative measure. This is not a restriction of liberty in the abstract. The Bill is about public health. It is about taking the data, extrapolating the facts and recognising the harms, and, as responsible legislators, responding to that to make a difference to all our communities up and down the country.
Oral Answers to Questions
Simon Hoare Excerpts(8 months ago)
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Andrew Gwynne
I pay tribute to my hon. Friend for her work in this area and for setting out eloquently her own personal experiences. Of course this Government will do more to raise awareness and enable more women to access breast screening services.
Simon Hoare (North Dorset) (Con)
A significant impediment to improving adult social care is the split of budget and responsibility and policy between the Secretary of State’s Department and the Ministry of Housing, Communities and Local Government. Will he and colleagues work to remove that hurdle, to have better outcomes more cost-effectively delivered to improve the lives of all our constituents?
Wes Streeting
The hon. Gentleman is right to raise that risk. I assure him and the House that I and the Deputy Prime Minister, herself a former care worker, are working in lockstep to align strategy, policy and delivery.
Oral Answers to Questions
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The Minister for Care (Stephen Kinnock)
I thank my hon. Friend for that question and welcome him to his place. This issue is personal for me, and I am sure it is for many others across this House. A number of potential new disease-modifying drugs for Alzheimer’s are in the pipeline, including lecanemab and donanemab. We are committed to ensuring that clinically effective and cost-effective medicines reach patients in a timely and safe way. The National Institute for Health and Care Excellence is appraising lecanemab and donanemab to determine whether they will be made available in the NHS.
Simon Hoare (North Dorset) (Con)
Nearly 10 children a month die from brain tumours, and I know that the public health Minister takes this issue seriously. He was familiar with the work of the Brain Tumour Charity’s HeadSmart campaign. Will he agree to meet me and my fierce campaigner constituent Sacha Langton-Gilks, who lost her son to a brain tumour, to discuss how NHS England could be persuaded to do more to inform and educate parents to identify the symptoms, so that collectively we can reduce the number of deaths?
The Parliamentary Under-Secretary of State for Health and Social Care (Andrew Gwynne)
I am grateful to the hon. Gentleman for that question. He knows that I met his constituents when I was a shadow public health Minister, and I can confirm that I am more than happy to meet him and his constituents now that I have dropped the “shadow”.
Government PPE Contracts
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Will Quince
The hon. Member for Kingston upon Hull East (Karl Turner) will know that civil servants had to take decisions about speed, pace and quantity. They were looking at contracts that would get the most amount of PPE for the best value for money as quickly as possible.
Simon Hoare (North Dorset) (Con)
Was everything that was done, done perfectly? No, and no doubt all the lessons will be learned but, as the Minister says, we would all be well advised to remember, because it was a long time ago now, the absolute panic and fear. The whole world was trying to buy any of this stuff they could get hold of at any price. If we neglect to remember the doctors, nurses and care home operators in our constituencies who were knocking on our doors asking for emergency help, we cannot have a proper debate about this issue.
Will Quince
My hon. Friend is absolutely right. Under those circumstances, in those conditions, we had to be quick and decisive to protect colleagues on the frontline so that they could continue providing life-saving care. With lives on the line, of course we had to change our approach to procurement and adjust our appetite for risk. I do not believe the British people would have forgiven us if we had stuck to the same old processes. We had to balance the risk of contracts not performing and supplies being sold at a premium against the real risk of harm to the health of frontline workers, the NHS and the public if we failed.
Public Health
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Wes Streeting
My hon. Friend is absolutely right.
We have heard the arguments in outline: this is about protecting staff and patients; it is not a new precedent; and there is a professional obligation, which makes it slightly different from the experience in the social care workforce. I will come on to talk about what the Government need to do. Those are broadly the arguments—
Wes Streeting
If the hon. Gentleman just lets me make this point, I will certainly give way.
Those are broadly the arguments, but I would ask Members on both sides of the House to think about those NHS staff who go to work every day feeling unsafe because their colleagues are not vaccinated. If that is not persuasive enough, I ask them to think about how they would feel if a loved one were treated in a clinical setting or care home by an unvaccinated member of staff through whom they contracted covid and, with it, serious illness or worse. If I lost a loved one through serious illness in those circumstances, I am not sure that I would be very forgiving about the decisions made by Members of this House.
Wes Streeting
I will say more about that in a just a moment, because the hon. Member for North Dorset (Simon Hoare), at the back, has been very patient.
Simon Hoare
I am grateful to the shadow Secretary of State for giving way. May I endorse and welcome what he said at the start of his speech with regard to comments about the Nazis? I called that out yesterday and he was right to do so at the Dispatch Box. I was looking through my inbox from the start of the pandemic and lockdown, and almost every person working in the care sector or the NHS in my constituency was saying, perfectly legitimately, “When the vaccine is available, we must be at the front of the queue, because we are dealing with the vulnerable and it is our duty to get vaccinated.” I do not think that has changed, and I think he is absolutely right, as is the Secretary of State, to say that those caring for the most vulnerable in society should, to try to reduce the risk that they face, be vaccinated.
Wes Streeting
I agree with the hon. Gentleman. We have a big effort to boost the booster this month and we have to boost the workforce as well, and make sure that people are supported.
Public Health
Simon Hoare Excerpts(3 years, 6 months ago)
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Daisy Cooper
Something appears to have been lost in translation here. I am not entirely sure whether the right hon. Member is referring to students or to the academics who teach them. I am talking about encouraging people to work from home where they can. There are of course examples where people will need to go into work, and they can change the ways in which they work, but working from home has been proven to reduce levels of transmission.
I am concerned that we are talking solely about the new variant, and that the mantra around putting in place restrictions to protect the NHS appears to have stopped. I worry that the Government appear to have lost their tongue. Ambulance services across the whole of England are at their highest alert level: level 4, or code black. That means that there are people in the back of ambulances who cannot get into hospitals. The NHS 111 line has had more than 1 million calls abandoned after 30 seconds this year, when they should be answered within 20 seconds. We have GPs who are reducing their hours or resigning because of the workload and the abuse. Some of them are really worried and saying that they will not to take on the contracts to deliver the booster jabs because of the expectation that they will still have to do the same amount of work seeing their patients and that if they are required to do the booster jabs as well, that will mean longer waits for other appointments. They are not getting the support they need in that regard, and I hope that the Minister will respond to this point. We have record backlogs—
Simon Hoare (North Dorset) (Con)
I very much agree with the hon. Lady’s comments, and I wish that she had amplified them more in regard to the ambulance service. I represent a large rural constituency, as many colleagues do, and if people are waiting for ambulances because people are queueing at the acute sector because others cannot be discharged, that is going to lead to huge problems during the winter months. Does she agree that that is something we should all keep at the forefront of our minds?
Daisy Cooper
I am incredibly grateful to the hon. Gentleman for raising that point. I have tried to raise that issue as often as I can through various means, and that is probably all I can say on the matter. Back in October, I tabled a written question to the Government to ask how many ambulance services were at level 4, and it took a couple of attempts at chasing that up before I got a response. I believe that hon. Members would benefit from having time to debate the issue in this House. In my own constituency of St Albans, there have been some incredibly tragic cases. A woman lost her baby because she was stuck in the back of an ambulance for many hours without being able to get into the local hospital. Another constituent lost their partner because they were stuck in the back of an ambulance for 12 hours and then died a week later because they had not been able to get that emergency treatment—
Autism and Neurodiversity Research Funding
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Robert Buckland
I am grateful to my hon. Friend. In 2020, he and I visited his local prison in Winchester, a prison with many challenges and, there is no doubt about it, a share of the population with a brain condition, sometimes undiagnosed and often an acquired brain injury. Many people who are in for offences of violence have themselves been the subject of violence. Those issues are frankly endemic within the criminal justice system.
That is why, when I was Lord Chancellor, in last year’s sentencing White Paper, I announced a call for evidence on neurodiversity in the system. I was hugely grateful to Charlie Taylor, Her Majesty’s Chief Inspector of Prisons, and Justin Russell, Her Majesty’s Chief Inspector of Probation, for leading that independent call for evidence. Charlie Taylor was a public servant who came from the education sector, specifically the special needs sector, had real frontline knowledge and experience of autism and brain conditions and previously ran the Youth Justice Board for England and Wales.
The good news is that, thanks to the published results of the call for evidence, the Government committed—I am pleased to say I committed—to training for frontline staff and the upskilling of those staff right across the criminal and youth justice system, as part of a new custody and detention apprenticeship that is being offered and that will be completed by all prison officers. Her Majesty’s Prison and Probation Service is developing a revised policy framework and guidance all about those issues, but in particular about children in custody with those conditions. This work is carrying on. I will develop those points a little further. I know people are anxious to come in.
Robert Buckland
I will let my hon. Friend the Member for North Dorset (Simon Hoare) in first before my hon. Friend the Member for Bromley and Chislehurst (Sir Robert Neill).
Simon Hoare
I echo what our hon. Friend the Member for Winchester (Steve Brine) said in that it is a travesty that my right hon. and learned Friend is not speaking still from the Front Bench, but it is a delight to hear him speak this evening.
To go back to the point made by the hon. Member for Strangford (Jim Shannon), what is my right hon. and learned Friend’s assessment of the impact of covid on diagnosis, assessment, the provision of support and the crucial need to link up the Ministry of Justice, the Department of Health and Social Care, the Department for Education and the Department for Work and Pensions?
Robert Buckland
I am very grateful to my hon. Friend. There is no doubt that covid has had an impact on backlogs in all parts of the health system, including diagnosis. Having said that, there are significant advantages in the use of remote technology for people with autism and brain conditions. For them, very often the journey to a clinic, hospital or health centre is in itself traumatic and anxiety forming. I see remote technology as a real liberator for many people with autism, so the potential there is immense.
Sadly, the point my hon. Friend makes about the impact of covid is one that, without increased capacity and increased staffing, we will have to wrestle with for a number of years. On the point he makes about joined-up Government, I well remember saying on many occasions to anybody in Government who wished to listen that Justice could not do this on its own. As a downstream Department, it needed Education, Health, the DWP, the Ministry of Housing, Communities and Local Government and, frankly, all arms of Government to work together to identify some of these problems at the root to prevent them from becoming part of criminal justice, but I will speak more about that in a while.
Robert Buckland
I could not have put it better myself. Levelling up is about people and communities, not things. Things are important and they deliver us levelling up, but levelling up is about people. That is why the Government have to show seriousness of purpose. I am with the Government on these things—I helped to author a lot of the documents on which they will be held to account. This matters, but if we do not focus on people, we are not going to level up. That is the point that my hon. Friend made so well.
I commend the Autistica report to hon. Members, but if I may crave the indulgence of the House for a little longer, I want to outline what Autistica suggests the key stages of support should be that will make a real difference. First, the report made the important point that support for autistic families around and shortly after the time that they receive a diagnosis has to be improved, because it is big news for families. It is a big moment when they get that diagnosis. I remember now the mixture between relief that the system is listening and deep sadness, grief and anger, and all the emotions that someone goes through as a result. These are big moments for families. It sounds axiomatic, but this does not happen, because we do not empower all families of people with autism to understand the diagnosis and to come to terms with what it means for them. This is a moment when services have an opportunity to get to know these families better and to ensure that their personal profile, which should be done, is really understood.
Simon Hoare
Does my right hon. and learned Friend share my concern that, very often, as with so many of these things, the children of the—let me use this phrase—“sharp-elbowed middle classes” seem to get a disproportionate amount of attention, care and support and those who are often least comfortable with officialdom and challenging professionals and asking questions usually get the smaller section of the pie? Quite a lot of work needs to be done on that to ensure that we have that uniformity of levelling up.
Robert Buckland
Again, that is a really important point. I do not make any criticism of the sharp-elbowed middle classes; these people are doing what they think is right for their children. I have been there and I make no apology for it, but among all those dedicated, wonderful, loving parents and carers, there are many families who do not have that wherewithal, and they often come to our surgeries and offices for help. We are the last port of call and, very often, we can make a difference. Looking back on the plethora of cases that I have dealt with, I am probably most proud—I know that hon. Members will share this feeling—of bumping into families years later and being told, “You helped our son. He has just finished his education and is going to go off and pursue a skill. If you hadn’t intervened six years ago, I don’t know where we’d be.” That is wonderful, but it should not be necessary: that is the big message that I want to convey today.
Rather than just stand here and make a general cri de coeur, my aim is to look at the bigger picture. Individual cases such as the one that the hon. Member for Croydon Central mentioned are symptoms of the problem, but it is all about dealing with the challenge itself. Documents such as the Autistica plan really help to tie the threads together and give us a blueprint that the Government, working with the private and charitable sectors, can run with.
I mentioned support around diagnosis. The document has some very interesting proposals for pilots and initiatives relating to how we can improve what is referred to as the diagnostic pathway. At the moment, there is a lot of ambiguity about precisely what is offered and what works, but the time of diagnosis is not a time for ambiguity. It is no good making educated guesses at that point; we want to know with certainty what pathways work. Families embarking on this new journey need that certainty, so I strongly commend to the Minister the document’s recommendations, particularly in relation to the work of the National Institute for Health Research.
As stage one, we need a framework that can be applied nationally, rather than relying on purely local initiative. Stage two, as the document describes it, is preparing for the future: after diagnosis, what systems do we have to match the needs of people with autism and brain conditions with the right therapies and services? We need to make those connections better; we need to connect people to safe practical advice, particularly from people who have been through the system. Peer-to-peer support works in so many contexts, and particularly in this one.
What we and Autistica are asking for is not a finger in the air, but evidence-led systems. It is no good just saying that the needs of autistic people are diverse. They are diverse, believe me: when you have met one person with autism, you have met one person with autism. They are all wonderfully unique, in my experience, but that should not be an excuse to say, “We’ll let a million flowers bloom and see complete diversity.” We need less of an unguided mêlée and much more of a framework—a mechanism by which, with evidence, we can ensure better support for people as they prepare for life and work out the pathway.
Finally, the third element of the report is meeting in a realistic and feasible way—we are not trying to create something totally out of this world—the evolving, ever-changing needs of people with autism. That is particularly important at the transitions, be they from primary to secondary, from secondary to tertiary, or from tertiary out of education. Age 25 is a big time for people who have an education and healthcare plan, because it is the moment when it stops—and what’s next? All such transitions can feed anxieties that if left unchecked can develop into a co-morbid mental health problem, with the concomitant waste that I spoke about at the beginning of my speech.
The truth is that the needs of people with autism and their families fluctuate and change. Instead of inviting crisis, let us plan for it and avert it. The support that the report envisages is all about services that will be there if things start to get a bit heavy, but that can be light-touch in other circumstances. The suggestions about nurturing expertise in the NHS and social care with hubs of expertise to deliver specialised services seem the most sensible way of developing those service models.
This is going to take investment, but, as I have said, I do not believe that it should begin and end with Government, which, hopefully, is good news for my hon. Friend the Minister. If she has had a chance to see the report that I mentioned—it was published only today, but I know that her officials will be familiar with it, because Autistica works very well with the Department, and I commend those officials for working with it so constructively—she will know that it sets out a costed programme, in which Autistica itself declares it will invest, or partner, to the tune of nearly £16 million. That is money from the third sector, but we ask the Government to step up, because the total cost of the projects that Autistica envisages in its list is just over £65 million. All those projects are designed to improve the evidence base and hence to improve the way in which we can deal with each of those three stages, and I warmly commend them to my hon. Friend.
What, finally, is the context in which we should work? I have talked—at the risk of stating the bleeding obvious—about the need for Government Departments to come together: the Department for Work and Pensions on employment, the Department for Education on exclusions, the Minister’s own Department on diagnostics and care, and my former Department on criminal justice. As I have said, however, this will require an effort from all sections of society, and the private sector must step up as well.
It is in businesses’ interest to get this right, if they are to unleash the talent of autistic people not just because it is good, but because it is damn sensible. It is to that sort of enlightened self-interest in the wider community that I want, through the House, to appeal tonight. I think that the offer of finance from Autistica is significant, although I want to see it scaled up. I think that the work we need to do outside this place to harness philanthropy and the support of the private sector could start to bring us much closer to the levels of research investment that we see in, for example, the United States, which, although it does not enjoy the wonderful national health service that we have in our country, is very far ahead of what we are doing here in terms of research investment.
If we are to succeed, that partnership between the third sector, the private sector and the public sector will be essential. The quid pro quo for Government is that our wonderful officials must remember that they do not have a monopoly on wisdom. I have sat in the Minister’s seat and worked with officials and worked well with them, but sometimes there is an institutional reluctance to go outside the tent because of fears about control, whatever form it may take, and, inevitably, about accountability. We must overcome that, because Government alone will not be able to crack this.
The last two years have, in many ways, opened our eyes to the potential that Government can offer. Government-led support and declarations of Government funding meant that we were able to create a vaccine manufacturing capacity virtually from scratch. I am about to see 250 jobs come to Swindon—jobs that would not have existed a few years ago, without the terrible crisis that we have all had to live through. The Government rose to the challenge, and I was proud to see them do so, underwriting, in effect, many of these initiatives.
We heard words such as “moonshot”, did we not? We heard about the Government’s big ambition to deal with the threat posed by the pandemic, and rightly so. Let us remember that. Let us bottle it and use it here. Let us have our autism moonshot; let us have our neurodiversity moonshot. Let use the power of Government—its convening power—to kick-start this research, and to lead our society in the improvement of research. Through the gathering of that evidence and Autistica’s work, we can reach some of Autistica’s 2030 goals. Its realisable ambitions for 2030 include: halving the employment gap for people with autism; services truly centred around the person with autism; proven support from day one; public spaces being more accessible for neurodivergent people; tailored health checks for people with neurodivergence; and, yes, screening at an early age, whether in the health system or the education system. That is a wider application of the principle that I wanted to see in our criminal justice system.
This could be a decade of achievement. It is up to all of us and the Government to make it happen.
Coronavirus Act 2020 (Review of Temporary Provisions) (No. 3)
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The Parliamentary Under-Secretary of State for Health and Social Care (Maggie Throup)
It is a pleasure to be closing this debate, and I thank hon. Members from all across the House for their contributions today. It is clear from the speeches we have heard—and, indeed, from the fact that the House can meet at full capacity once again—that we have made so much progress in our fight against covid-19. This is thanks to the perseverance and resolve of the British people, and also to our vaccination programme, which has now given first doses to over 85.9% of the population of the UK over the age of 12. It is this life-saving work that has disrupted the once inevitable link between cases, hospitalisations and deaths, and that has allowed us to start carefully reopening our society and our economy once again.
This battle forced us to take unprecedented steps in pursuit of a lethal virus, and the Coronavirus Act has been a vital weapon in our armoury, but we have said throughout our response that we did not want to keep these powers in place for any longer than we have to and that the House performs an essential role in scrutinising the measures every six months.
In 2020, and shortly after the one-year review, we came before Parliament to remove provisions from the Act that were no longer needed. So far 13 of the non-devolved temporary provisions have already been expired and, as pledged in our autumn and winter plan, we are looking to expire even more of these provisions and will lay regulations very soon to make this happen so that we can continue down the path to normal life.
Simon Hoare (North Dorset) (Con)
May I invite my hon. Friend to remind the House and the country that the instincts of the Government sitting behind this Act were benign and in support of public health, not malign and vindictive and trying to erode liberties? These were unprecedented times that required emergency action. Those actions have paid dividends; they were difficult but right. The intention was benign not malign, contrary to what some of our colleagues seem to suggest.
Maggie Throup
I thank my hon. Friend for that intervention. The Government were acting in very difficult times and had to take unprecedented measures, as he rightly said.
The Secretary of State explained the provisions in detail in his opening statement, so I will not repeat those that we will be expiring but they include some of the most stringent measures in the Act such as directing the temporary closure of educational institutions, the detention of potentially infectious people, and enabling Ministers to restrict or prohibit gatherings or events. Meanwhile the powers in the Act that we are retaining are those that are critical to our response to the pandemic; after all, as the Opposition spokesman rightly said, this virus has not gone away. We are facing a difficult winter, a time when we have seen from experience that the virus poses a particular threat, so we are keeping in place provisions that are fundamental to our response, for example to make sure the NHS is properly resourced and to support statutory sick pay for those who are self-isolating.