Helen Morgan MP: speeches

Speeches

• 27 Nov 2024 · World AIDS Day · Hansard source

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  It is a pleasure to see you in the Chair, Sir Mark, and indeed to represent the Liberal Democrats for World AIDS Day. I thank the hon. Member for Uxbridge and South Ruislip (Danny Beales) for his excellent introduction to this topic and for securing the debate. There have been so many brilliant contributions. I want to leave plenty of time for the other Front Benchers to speak, so I will not go through them all, but I am very impressed that in such a short time we have covered so much ground, and so eloquently. I particularly want to pick up on the speech by the hon. Member for Bournemouth East (Tom Hayes), who powerfully told us the story of John Eaddie, and thank him for that contribution. AIDS is one of the globe’s biggest killers, as we all know, despite being entirely preventable and treatable. In 2023, nearly 40 million people across the globe were living with HIV, 1.3 million of whom became newly infected within that year. Given that it is entirely preventable and treatable, we can aspire to bring that number right down to zero. In the United Kingdom the fight has been serious and ongoing since the 1980s, and yet since 2021 the numbers diagnosed have been increasing, while the numbers tested have been decreasing. We absolutely have to ensure that that is turned around rapidly. Testing is still 4% lower than pre-covid levels, and that has been driven by a drop among heterosexual men, where the testing rates are 22% lower than pre-covid. The most recent UK-wide estimates have about 5,000 people as undiagnosed and not aware that they are living with HIV. Again, that shows that the importance of testing—I entirely support the call for opt-out testing—is paramount to bring such people into the healthcare that they need and deserve, and to prevent the disease spreading. Internationally, good progress has been made, but the picture is still extremely concerning. I want to pick up on the inequality in that picture. Every week, globally, 4,000 adolescent girls—young women aged between 15 and 24 years—become infected with HIV; in 2023, 3,100 of those infections occurred in sub-Saharan Africa. Poverty and displacement drive those higher rates of infection, and there is a worrying link between conflict, sexual violence and HIV. That is something we need to address. I want to be brief, so to summarise the policy ask, the Liberal Democrats are keen to ensure universal access to HIV prevention, such as PrEP, and treatment. I have mentioned the importance of opt-out testing. We still need to work to eliminate the stigma and the discrimination linked to HIV, especially the racist element highlighted so carefully earlier. We press on the Government the importance of restoring the public health grant, which the Conservatives have cut by a fifth since 2015, to deliver better access to sexual health services. On helping globally, it is important that we restore, or at least set out the path to restoring, the 0.7% of gross domestic product for international aid, to enable issues such as AIDS to be prioritised in accordance with our requirements. With that, I will leave time for the other Front Benchers.

• 26 Nov 2024 · Tobacco and Vapes Bill · Hansard source

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  I can confirm that it has been a very long time since anyone has asked me for ID to make a purchase—a moment that is even further into the past than the last time I bought a packet of cigarettes. That experience will inform some of my comments today. I support this legislation, but it will be a free vote for my Liberal Democrat colleagues, and I will use my speech to explain why. First of all, the Bill is split into two sets of measures: one to deal with smoking and one to deal with vaping. We are 100% supportive of the set of measures dealing with vaping, which is in line with our party policy that was passed at our 2023 conference. I think everyone in this House is united in agreeing that the targeting of nicotine products at young people and children through bright colours and attractive flavours is a shameful practice. Measures need to be taken to prevent that. I am the mum of a teenager—lucky me—and he reports that some of his friends are unable to concentrate through a 40-minute lesson, because they have been exposed to such high levels of nicotine in the vaping products that they use that they are even more addicted to nicotine than someone who might have taken up smoking many years ago when I was young. We welcome the changes to prevent the targeting of vaping at children, and the recent ban on disposable vapes. We also acknowledge that vaping is an important part of smoking cessation, and legal vaping needs to continue into the future. The introduction of a phased smoking ban is problematic, and not because Liberal Democrats want to see people smoke themselves into an early grave—far from it—but because it raises issues of practicality and civil liberties, which I will run through on behalf of my colleagues. The first question is, practically, how will this work? My son was born in January 2009. He will be one of the first people to benefit from a smokefree generation, and I sincerely hope that he never takes up smoking, but if his friends who are just a few weeks older choose to take up smoking, they will be able to continue to do that for the rest of their lives. Under this Bill, those future adults will be able to buy tobacco products for themselves but it will be illegal for them to pass them on to others a few weeks younger, such as my son. Problematic enforcement causes some concern and leads us to question why there was not an alternative way, perhaps by setting a very high minimum age to buy cigarettes, so that most people get through the flourish of rebellious youth and do not take up smoking in the first place. The concerns about practicality are legitimate. The Bill also raises the spectre of an ID card, because those people who choose to start smoking will potentially be forced to carry an ID card or some other form of ID with them for the rest of their lives. That is a concern for the Liberal Democrats, who are strongly opposed to requiring people to carry ID around with them, for various issues of privacy and personal liberty. There is also an ideological point about discriminating between two people because of their age. We are generally opposed to that as a society, but the Bill does that. The concerns about retailers suffering abuse are also legitimate. They are already suffering from a wave of shoplifting and antisocial behaviour. Some of the abuse directed at them comes from the enforcement of age legislation for things such as alcohol and existing tobacco legislation. We need to be cognisant of the decimation of community policing under the previous Government. We need to be sure that those retailers are fully protected. The Bill creates an extra risk for them. Finally on the risks, there is a concern for the licensing authorities, which presumably will be local councils, although we do not have the detail on that yet. Lots of local councils are unable to carry out much more than their statutory duties currently, so I would appreciate confirmation that licensing will be fully funded for them, so that they are not put in charge of enforcing something that will be impossible. I want to touch on what for me is quite an important area: the creation of a black market. Criminal gangs exploit young people in North Shropshire by getting them hooked on cannabis. It is an extremely difficult problem. Young people get into debt to those criminal gangs and are hooked into criminality for life. They see things people should never see and are extremely damaged by that exploitation. I share the concern that progressively banning tobacco products will increase the scope for the black market and the risk to children. For all those reasons, as some Members may be aware, I abstained on the vote last time the legislation was brought through the House. It would be a legitimate question to ask me why I have changed my mind. I met somebody called Linda Chambers, a Liberal Democrat councillor in Hull, who came along to an event organised by Action on Smoking and Health to encourage Members to support the Bill. Linda was devastated when she lost her husband of 50 years to cardiovascular disease. As with a number of other speakers at the event who also spoke very powerfully about their experiences, her loved one had tried on several occasions to give up smoking but had been unsuccessful. The speakers at the event explained that the nicotine addiction had taken away the personal choice of their loved ones to live the lives they wanted to live. They were not exercising their personal choice any more. For a liberal, that is a very powerful argument. Personal choice is so important, and addiction really does take that away. As the asthmatic daughter of two smokers who have repeatedly tried and struggled to give up over the years, Members might perhaps have expected me to understand that argument a little bit earlier. Typically, as the daughter of two smokers, I took up smoking myself. I did not smoke very much and did not smoke for very long, but I still occasionally have the odd craving for reasons I cannot explain, especially when I am in a traffic jam. But it is not funny, is it? Tobacco is uniquely harmful and uniquely addictive, and that is why I support the measures we are taking to address that. Another really important, persuasive and powerful argument I heard in the previous Parliament was when Dame Andrea Leadsom, the responsible Minister at the time, and Chris Whitty took the time to provide a briefing to the Liberal Democrats. One point they highlighted was health inequality. A point that struck me—at the time, I was the co-chair of the all-party parliamentary group on baby loss—was that 21.1% of pregnant women in the most deprived areas of the country are likely to smoke while pregnant, whereas in the least deprived parts of the country only 5.6% are likely to be a smoker. That huge difference correlates to a horrifying differential in the rate of stillbirth. Women who smoke while pregnant are more likely to have a stillbirth, and stillbirth rates in the most deprived areas of the country are 50% higher than in the least deprived areas. If we are serious about tackling health inequality rather than just paying it lip service, we have to take additional measures to tackle those inequalities. For all the reasons I have outlined, I will support the Bill. However, I retain a few concerns, and I would be grateful if the Minister could address them in his wind up. The powers in the Bill effectively allow the Secretary of State to make any public place or workplace a no-smoking area. That is very far reaching. I would prefer to introduce measures in Committee that would require him to come back to Parliament before extending the areas affected. That would protect the hospitality industry, which, as hon. Members have pointed out, is struggling, particularly in rural areas. I will also point out the obvious, which is that anybody who is currently over 16 could potentially be a smoker for life. There are many, many people who took up smoking and who want to give up but are unable to. We must reverse the cuts to the public health budget and the smoking cessation budget to enable those people to benefit from stopping smoking. The Conservatives have slashed the public health budget since 2015. We would like the Secretary of State to use the money provided for health in the Budget to address that problem. A quarter of cancer deaths are caused by smoking and 75,000 GP appointments every month are for smoking-related illness. Many women who smoke during pregnancy will continue to smoke for up to another decade. Despite my concerns, I will support the Bill to ensure that people like Linda do not have to lose their loved ones to an addiction they were unable to end. I urge the Secretary of State to look at measures to deal with the practical considerations we have outlined and to support the current generation of smokers to quit if they want to.

• 25 Nov 2024 · Storm Bert · Hansard source

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  I remind Members that I am chair of the all-party parliamentary group on flooding and flooded communities. Large areas of North Shropshire are often under water, either from river flooding or from prolonged rainfall. This weekend has been no exception, with villagers cut off for long periods of time and vast swathes of farmland flooded. This year, there are farmers who have been unable to plant crops in the current harvest, which has just been collected, and who will not be able to do so next year—they are in a desperate state. When the Secretary of State reviews the flooding formula and the funding, will he consider how farmers will be compensated for storing vast quantities of water upstream, regardless of whether they like it or not?

• 20 Nov 2024 · Engagements · Hansard source

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  Q14. Last week I was contacted by a constituent whose husband has stage 4 bowel cancer. He had a routine scan in June but did not receive the results until early November, and unfortunately during that period he received unsuitable chemotherapy and his cancer has progressed. Given that Shropshire has the worst record in the country for CT and MRI scan results, may I ask the Deputy Prime Minister the same question that my constituent has asked me? When will the Government address this problem?

• 19 Nov 2024 · Topical Questions · Hansard source

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  The Conservatives’ disastrous legacy on dentistry means that more than 4.4 million children have not seen a dentist in the past year. In Shropshire, dentists continue to hand back their contracts, including one in Wem in recent weeks. Will the Minister outline his plan to reverse that terrible decline and ensure that the issue is addressed in rural areas where there are dental deserts?

• 19 Nov 2024 · Health and Care Staffing Costs: Employer NI Contributions · Hansard source

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  Hospices provide essential care for people at the most difficult point of their life, and they are usually only partially funded by the NHS. Hospice UK says that real-terms funding has fallen by £47 million since 2022, and hospices are struggling with this hike in national insurance contributions. Hope House children’s hospice in North Shropshire estimates that it will cost £178,000. Will the Secretary of State commit to either exempting hospices from the NICs increase or ensure that they are funded to cover those additional costs?

• 18 Nov 2024 · Bus Funding · Hansard source

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  Shropshire is one of the worst-served counties in England for public transport, having lost 63% of its bus miles since 2015, compared with a national average of about 19%. A person in Market Drayton who wants to get to the closest hospital in Telford, which is a 20-minute car journey, is looking at a five-hour round trip on the bus. We have only one service operating between Oswestry and Chester on Sundays. I am afraid that I was therefore quite disappointed by Shropshire’s £2.5 million revenue allocation in this round of funding. Will the Secretary of State meet me to learn about the huge transport challenges we face in Shropshire, and to see if we can do better?

• 13 Nov 2024 · Future of the Post Office · Hansard source

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  Oswestry in my constituency is the second largest town in Shropshire and serves a vast rural area stretching into mid-Wales and across north Shropshire. It is digitally excluded because it often does not have adequate mobile signal or broadband services, so the full range of Crown post office services are absolutely essential there. Will the Minister assure me that the full range of Crown post office services will remain in Oswestry, and that the Post Office will take into account the importance of retaining vital services in rural areas, which are being deserted by commercial organisations such as banks?

• 13 Nov 2024 · Disabled People: Discrimination · Hansard source

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  Nowhere are disabled people more discriminated against than on Britain’s railways. The previous Government had an Access for All scheme that would allow disabled people to get to platforms that were otherwise inaccessible. This has been put on hold by the new Government. Can the Minister tell me what discussions he has had with his colleagues in the Department for Transport and when we might see stations such as Whitchurch made accessible to people who cannot manage steps?

• 12 Nov 2024 · Topical Questions · Hansard source

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  Many homes in my constituency are off grid, which means that their owners have to fill up the tank at the beginning of winter to keep warm. The pensioners who have lost the winter fuel payment are struggling with that up-front amount. Will the Minister review the level at which the winter fuel payment is removed, because the most vulnerable are struggling?

• 11 Nov 2024 · Rural Affairs · Hansard source

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  I congratulate the hon. Members who made their maiden speeches earlier. I thought they were all excellent, although I obviously take issue with anyone who does not think that North Shropshire is the best place to be an MP. North Shropshire is very rural and is inhabited by some of the best people you will ever meet. I like to spend my Saturdays and Friday afternoons knocking on their doors and asking them what they think. What they think is that they were taken for granted by the previous Government for many, many years, but I fear they are concerned the new Government are about to repeat that trick. I strongly urge them not to. Farming is the backbone of the economy in places like North Shropshire. Whether farming arable land or dairy herds, people have had an incredibly challenging time, not just because of the phasing out of the basic payment scheme and the botched transition to the sustainable farming incentive, but because farmers with breeding herds trying to export to Europe have been badly let down by the botched Brexit deal. There is no timetable on the horizon for a phytosanitary agreement to resolve that issue; I urge the Government to act at pace to resolve it for farmers who need to export abroad. The changes to the inheritance tax threshold have been very badly communicated to farmers. According to the Government’s figures, 288 farms in North Shropshire will be affected. Many of the farmers have been in touch with me, and they are extremely concerned, because they need more support not higher tax. If those farmers are wrong, I think the Government need to accept that their communication with them needs to be a great deal better, because at present they are very concerned. I urge the Government not to adopt a high-handed tone but to listen to and engage with them. Farmers are also concerned because of flooding. They have had an extremely challenging time, with 18 months of continuous wet weather. Many in my constituency who lost a whole field or a larger area last year are still unable to re-till following an appalling October, but in Shropshire we have not been eligible for either the farming recovery fund or the frequently flooded allowance, although many of my constituents are underwater, reliably, every single year. I therefore urge the Government, when they look at flood defence spending, to consider those who are being clobbered by the weather year in, year out but have so far been ineligible to receive the support that they need to recover. I also urge the Government to think about how the sustainable farming incentive might be used to encourage farmers to hold water upstream. An hon. Member—I apologise for forgetting which one—mentioned reservoirs; I urge the Government to consider building that issue into their plans, so that water can be managed effectively for the farmers who have had such an appalling time over the last 18 months. Healthcare is problematic in rural areas. Because ours are not big university hospitals, it is difficult to attract staff to come and work in them—they are not necessarily looking at a glittering career investigating all sorts of exciting conditions—which means our health services are much worse than those elsewhere in the country. When I was elected, the problem of ambulance waiting times was the top issue that people raised on the doorstep, and it remains awful. October was the third worst month on record for handover delays at West Midlands ambulance service. Last week one of my constituents had to wait 24 hours in pain on a plastic chair before being diagnosed with heart difficulties. Every month over 2,000 patients spend more than 12 hours in the A&E departments of Shrewsbury and Telford Hospital NHS Trust. We must address the important issue of the recruitment and retention of health staff in rural areas. Obviously, the Budget has raised the question of how healthcare providers will handle the increased NICs. That is probably an issue for a separate debate, but I urge those in the Department for Environment, Food and Rural Affairs to liaise with their colleagues in the Department of Health and Social Care and discuss how we can get staff into rural areas and ensure that people have the same outcomes as those in the rest of the country, because at present they are being poorly served. People need to have access to healthcare, as well as education and work opportunities, but transport is a huge problem, and that is killing off the high street. According to the jobcentre in Oswestry, the single biggest issue is the inability of workers to get back into work because public transport is so poor that they cannot access a place of work. Shropshire has lost 63% of its bus miles since 2015, while the national average is 19%. That will give Members some idea of how difficult it is for us. In the Budget, the Government did not mention public transport investment in rural areas. I strongly urge the Minister to address that with his colleagues and, in particular, to consider really good schemes such as the Oswestry-Gobowen railway line, and the desperate public transport desert that is Market Drayton. I have very little time, so I will just say this. The Government must make sure that the shared rural network is delivered and is effective, but if it is not, they must ensure that people can roam between networks. Local councils must be fairly funded so that the cost of delivering services over a vast area is reflected in the funding settlements that they receive. When it comes to healthcare, transport and digital services, rural areas are struggling, and we must have—

• 5 Nov 2024 · Income Tax (Charge) · Hansard source

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  Fair funding for rural authorities, and indeed all local authorities, is something I have talked about many times in this House, and I absolutely agree with the hon. Gentleman on that. We saw £600 million allocated to social care in the Budget and an increase in the national living wage, both of which are obviously welcome, but the huge pressure on private providers as a result of the national insurance contributions increase will be really problematic, unless councils are funded to pay those additional costs. It is not clear that the funding announced in the Budget will even touch the sides of the crisis in local government funding or in social care. We all know that this is a thorny problem, and that funding social care is extremely expensive and difficult; that is why cross-party talks are so urgent. I urge the Secretary of State to instigate those as soon as possible, so that we can work towards a permanent fix for social care. Liberal Democrats believe that free personal care on the Scotland model would be the best way of achieving that, and the Institute for Public Policy Research says that we could save £3.3 billion by 2031 by implementing that model. That would be a good investment, because it would save taxpayer money and it would keep people in their homes—where they want to be—with dignity. The debate today covers other public services, and I want to touch on a couple; education is an important one, and we welcome the investment in it, but I want to talk a bit about SEND budgets and local authorities. Schools are under enormous pressure to provide SEND measures for the children they look after, and local authorities are under huge pressure to provide transport and specialist places. The £1 billion for local government will be insufficient to deal with social care, the SEND crisis and SEND transport. As the hon. Member for South Shropshire (Stuart Anderson) mentioned, Shropshire council is spending about 80% of its budget on social care, so without adequate measures for social care, it seems unlikely that this Budget will address all the problems that local authorities need to deal with. We are therefore concerned about the decision to put VAT on private school fees. Schools such as Oswestry school in my constituency take a relatively large number of pupils who have failed to thrive in a larger setting. They have special educational needs but no education, health and care plan, and they might even have refused school altogether. There is a risk that those children, whose parents are saving hard to put them into that alternative place, will end up back in the state sector, where their needs are not met. They might refuse to go to school, and the school would struggle to cope with those additional children. The capital expenditure is welcome, and I hope that the demountable buildings at the Corbet school in Baschurch will benefit from that announcement, but I urge the Government to reconsider some of those measures. On transport, it was disappointing to see the bus fare cap increased, although in Shropshire it will not make any difference, because it is almost impossible to catch a bus anywhere. We would really like to see some of the detail behind the public transport plans announced by the Chancellor, particularly the bus service improvement plan that Shropshire council has put forward, and railway schemes such as the Oswestry to Berwyn line. Finally—it may be stretching it to call this a point about public services—I believe that farmers provide an essential public service in feeding us, looking after the countryside and protecting the rural environment, and it is disappointing to see that there is confusion between the Department for Environment, Food and Rural Affairs and the Treasury about how many farms will be affected. My sense from talking to local farmers in Shropshire is that the DEFRA numbers are more accurate.

• 5 Nov 2024 · Income Tax (Charge) · Hansard source

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  I declare an interest as a vice-president of the Local Government Association. I welcome the shadow Secretary of State to his place. He responded to my first Adjournment debate on a Thursday before Easter, and I was very grateful, but he will be disappointed to hear that we have not seen the improvements in ambulance response times that we would have liked to see in Shropshire. Last week’s Budget brought £22 billion of investment for the NHS. By anybody’s standards, that is a big number, so the Liberal Democrats welcome the investment. The NHS was left in a dire state by the Conservatives, and it is clear that something radical must be done. What is the Conservatives’ legacy? Well, we all know: crumbling hospitals, 7 million people on NHS waiting lists for secondary operations, our constituents struggling to access a GP when they need one, dental deserts such as the one in North Shropshire, appalling ambulance waiting times with horrifying outcomes, and a tsunami of a mental health crisis waiting to overwhelm us. It is clear that investment is needed, which is why the Liberal Democrats put the NHS at the front of our election manifesto and our campaigning since. It is very important that the £22 billion is spent wisely to keep people healthy and to save money in the future, so I look forward to hearing how the Budget will affect the public health grant and mental health services in particular. Those are two really important areas where we can invest to save taxpayers’ money, and to get better health outcomes for people and avoid their suffering in the future. It is also really important that the £22 billion of investment is not undermined by a decision made by the same Government on the very same day. It is hard to believe that the decision to increase employer’s national insurance contributions and to lower the threshold—at a cost of £566 per person—was properly thought through before the Budget was delivered last Wednesday. That decision is going to hit GP practices, hospices, social care providers and the charities that provide so much additional care outside the formal NHS structure. A local GP got in touch with me over the weekend to say that the decision will “serve to directly undermine access and patient care at a time when practices are already under strain due to years of neglect.” Another said it will “kill the family doctor”. Why will it kill the family doctor? Because GP practices are not eligible for employment allowance. They cannot put up their prices, and their only option is to cut staff and services, which would be a disaster. The Conservative Government proved that if we cut the number of GPs, we end up with a really big problem in the NHS—one that we are fighting now. Labour’s plan to increase the number of GPs, which is welcome, is surely in jeopardy because of the increase to employer’s NICs. The Liberal Democrats are calling on the Government to exempt GPs from the NIC hike or ensure that they are funded to cover it. Otherwise, no one is going to see their GP within seven days—a right that the Liberal Democrats think people should have. I want to touch on social care, which feels a bit like the elephant in the room and is likely to be significantly affected by the change in thresholds and rates of employer’s national insurance contributions. We all know that the sector is in crisis, and the Budget took note of this but did not really go far enough to address it. I think we can all agree that we cannot fix the NHS without fixing social care. We know that there are thousands of patients in hospital who are medically fit to be discharged and who would recover better in their own bed at home, but who are stuck in a hospital because the social care packages are not available to allow them to return home. That bed blocking, which is a horrible term, causes patients to be unable to flow through a hospital when they are admitted. It causes the queues of 12, 13 or 14 ambulances that we see outside hospitals in Shropshire on a regular basis, and it means that those ambulances do not arrive when somebody is in a life-threatening position in their community. Social care is so important in dealing with this urgent problem.

• 5 Nov 2024 · Income Tax (Charge) · Hansard source

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  I thank the hon. Gentleman for his intervention. The point that we are trying to make is that some of the Budget measures will cost extra money. If we look at the detail on the national insurance contributions hike, for example, we see that changes in behaviour and exemptions for the NHS will reduce the amount of money raised to about £10 billion. We have absolutely put forward alternative measures to raise £10 billion. Whether by reversing the Tories’ cuts to the banking taxes or by putting taxes on online media giants, we would find alternative ways to raise those funds. The point about private school fees is the same. If we overburden the state sector with children who have special educational needs, difficulties and disabilities, those children will not have their needs met, and that will cost us more in the future. This is all about making sensible choices to save taxpayer money in the future and, most importantly, delivering public services to the people who need them most, whether they are trying to access NHS care or whether they need help to get through their school career in order to thrive and achieve their potential.

• 5 Nov 2024 · Income Tax (Charge) · Hansard source

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  I am just about to conclude, so I will carry on. I was about to talk about farmers and the concerning differences between DEFRA and the Treasury on the number of farms that will be affected. My sense from talking to farmers locally is that the DEFRA numbers are more likely to be accurate, and I therefore think there may have been a serious misstep in the plan to raise what will be a relatively small amount of money. Liberal Democrats welcome investment in the NHS. We welcome the ambition to undo the damage wrought on this vital service by the previous Government, but we are concerned that, in social care in particular, we are in danger of kicking a thorny problem down the road. We urge the Government to consider immediate cross-party talks on funding social care and providing a long-term solution. We are also really worried about the impact of increased national insurance contributions on key providers outside hospitals. We cannot have GPS going out of business because of a Government measure that was intended to improve and expand their services. My constituents were fed up with being taken for granted by the Conservatives and they voted emphatically to change that situation, but I am sure that they are very worried that they are about to be ignored by Labour. I urge the Government to rethink their damaging policies on national insurance contributions and the care sector, to have another look at the impact of the Budget on family farms, which I think may have been underestimated, and to back the infrastructure that rural areas need.

• 4 Nov 2024 · Budget: Implications for Farming Communities · Hansard source

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  One of many emails I have received in the past week is from a farmer who has an archetypal family farm of 330 acres of mixed dairy and arable that they are planning on passing on to their son, even though they are struggling to make ends meet. He is typical of farmers in my constituency, and he is very concerned. We have not seen any investment in public transport or any of the other sweeteners that the Minister mentioned earlier. Can he explain what investment will go into rural transport, and why he has set the threshold for APR so low?

• 30 Oct 2024 · NHS Winter Readiness · Hansard source

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  I beg to move, That this House has considered NHS readiness for winter 2024-25. It is a pleasure to serve with you in the Chair, Sir Roger, and I am grateful to have secured a debate on the crucial topic of preparing the NHS for winter. This is particularly timely on a day when the Government have delivered the Budget and outlined their priorities for the coming year, and indeed, the years after that. We all know that due to the Conservative failure to protect the NHS, winter is a time when pressure on the NHS peaks. Every year, we suffer what we describe as a winter crisis. But for the millions of people stuck on waiting lists, the thousands of people treated in corridors and the legions of staff battling to keep people safe, it must feel like the winter pressure never ends. I am sure we would all agree that the health and care crisis requires long-term action—improving public health, focusing on primary care, training and retaining more doctors, dentists and nurses, fixing the crumbling NHS estate, and fundamentally, finally addressing the crisis in social care. But while we wait for that action, winter is now looming. The clocks have gone back and time to prepare for winter has run out. I am here to find out what the Government are doing both to get the NHS through the upcoming winter and, following the Budget statement, to get the NHS ready for the winters to come. I am aware that the Chancellor has just announced a £22 billion cash injection into the NHS, although further detail on that was scant, so we will put forward our ideas in this debate and hope that they come to fruition over the next few weeks. For the sake of staff and patients, it is crucial that winter crises become a thing of the past. We have reached the point where winter pressure is normal all year around. We should be striving for the reverse, where pressure is relieved and the forecasted crisis does not happen. I am pleased to hear some of the measures that the Government have outlined today, but I remain worried that fundamental issues are still being ignored—most crucially, the crisis in social care. Until that is resolved, we will not be able to fix the NHS. So what is the state of play? Dr John Dean, the clinical vice-president of the Royal College of Physicians, warned that the latest NHS statistics show the health service “is in an extremely concerning position as we head into winter.” He is not alone in holding such concerns, for it has already been a really busy year for the NHS. In fact, it has been the busiest ever summer for A&E departments in England, with NHS staff managing 6.8 million attendances in just the past three months, according to a briefing by NHS England on readiness for winter. Last month, emergency departments had 2.2 million attendances—the highest such number for a September on record—with more than 38,000 people waiting longer than 12 hours after the decision to admit them. Meanwhile, the weekly average of extra bed days for patients remaining in hospital beyond seven days due to delays in discharge was the highest since December 2022. A look at my local hospital trust in Shropshire illustrates the situation well. In Shropshire, at the Shrewsbury and Telford hospital NHS trust, our bed occupancy rate is constantly around the 95% mark. That is not unusual; it has become the norm at acute hospital trusts up and down the country, and not just in winter, but all year around. Hospital staff constantly have to juggle resources to try to secure people the care they need. As the wards fill up, A&E becomes crowded and care moves on to corridors. Every month, I am contacted by constituents who are shocked by what they have encountered in the hospital: being forced to wait for hours in pain on plastic chairs, or having their dignity taken away as they occupy a trolley in a corridor, in agony and in full view of the public. Many people remain unaware of how common that is until they find themselves with a loved one in that situation. The “Dispatches” documentary filmed at Shrewsbury and Telford hospital trust earlier this year brought the reality home to the nation. The issues with hygiene and infection control were startling enough on their own—I am pleased that the trust is addressing those directly—but most stark was the human impact on the patients. Scenes included that of the elderly man who was forced to urinate while on a trolley in a corridor, in full view of staff, or the woman who cried out in agony for hours, with staff being left in despair at the terrible situation they were trying to deal with. That was not in the depths of winter; it was in April and May. Corridor care takes a toll on patients and a huge toll on the staff who are forced to attempt to cope. However, the full scale and the impact of corridor care are unknown, because there is only patchy reporting on the level of care in temporary environments. As we seek to better understand and prepare for pressure in the winter, and all year round, will the Government consider mandating the recording and publishing of the number of patients receiving care in temporary environments, such as corridors? Honesty and transparency are key if we are to properly prepare for the winters to come. Every month, more than 2,000 patients spend more than 12 hours in the A&E department at Shrewsbury and Telford, and one in every three of the many ambulances arriving outside have to wait more than an hour to hand over their patient—not in winter, but in every month of the year. Since April, ambulances have lost around 15,000 hours through waiting outside the two hospitals in Shropshire, and one poor patient was stuck in an ambulance in Shrewsbury for 15 and a half hours. As we have discussed many times, that keeps ambulances off the road, and has a knock-on effect on how long people who may be in life-or-death situations have to wait for help. This leads to situations such as the one in my constituency in April this year, where a carer was left alone performing CPR for 23 minutes while being told by the 999 call operator that no ambulance was available. Tragically, the victim died, and the carer who tried so hard to save her has been left traumatised—as, I would imagine, has the 999 call operator. As I mentioned in the Chamber a couple of weeks ago, an 11-year-old in my constituency, Charlotte, has an adrenal deficiency that leads to her needing an urgent injection of hydrocortisone if she has some kind of trauma. When that happens, she is logged as needing an automatic category 1 ambulance response. Recently, a car crash happened involving Charlotte and her mother, and when an ambulance was called for, they were told that none was available, and the family had to make their own way to hospital. That is not good enough. It is endangering lives. The target for a category 1 response time is an average of seven minutes. So far this year in Shropshire, the average has been 11 minutes and 57 seconds. For a category 3 response, which still means that the person urgently needs an ambulance, the average wait is more than two hours, which is more than double the target time. That is not new, but it is very wrong, and it demonstrates the pressure already facing the health service as we head into winter. Perhaps more worryingly, the situation in many areas this summer has been getting worse, rather than better. West Midlands Ambulance Service, which serves my constituency, described a “significant, rapid deterioration of delays at hospital in September which has continued further in October.” The service has been operating with the highest level of risk score for the past year. October is forecast to be the second worst month on record for lost handover hours, with the equivalent of 130 out of 600 ambulance crews in the west midlands being lost to delays every single day—and it is only October. That takes a huge toll on the mental health of the hard-working staff involved at every level. It also undermines staff retention, which will be crucial for any NHS plan, such as the 10-year plan or any winter plan to come. We must retain these experienced professionals; we cannot rely on recruitment alone to solve the staffing crisis in our NHS. These wonderful staff have been stretched to breaking point by years of neglect and mismanagement by the Conservatives. Labour must do better, yet patients and staff are understandably fearful as we approach winter. According to a recent poll commissioned by the Liberal Democrats, one in four people in Britain have avoided calling an ambulance because they were frightened that it would take too long to arrive. Of course, many pensioners are particularly fearful this year. Winter is a perilous time for older people, given the additional diseases that they might catch, and many will be more at risk after being denied the winter fuel payment for the first time. This will be the first winter without the payment being universal, and the annual uprating of the state pension will not make up the shortfall until next spring, which will be too late for people to pay their electricity or gas bill—and if someone in my constituency has to top up their oil tank now, it is too late for that, too. There is a danger, as happened when fuel costs increased two years ago, that people will reduce or turn off their heating entirely, with possible consequences for their health and a knock-on effect on the NHS. So what are the solutions? First, we need to stop throwing money at the fire and instead prepare properly. As we all know, the most cost-effective cure is prevention in the first place. Over the past seven years, the Conservative Government announced an average of £376 million of emergency funding each year to tackle the winter crisis, much of which arrived too late to make any meaningful difference. The Liberal Democrats want to create a winter taskforce armed with a ringfenced fund of £1.5 billion for the next four years. That would be used to build resilience in hospitals, A&E departments, ambulance services and the discharge of patients, and allow integrated care boards and NHS trusts that are struggling to balance their books to plan their budget more effectively in advance to cope with the winter crisis. The taskforce would bring together senior leaders from the NHS and the Government, along with staff representatives, to ensure better co-ordination and preparation for winter. It would be empowered to deliver rapid changes in day-to-day operations to ensure a co-ordinated response—for example, by deploying more beds to certain hospitals or boosting social care capacity where it is most needed. Tackling the issue of patient flow is the most fundamental aspect of steering our health system through this winter and the years ahead. If patients are to be treated on time, they need an ambulance to arrive on time, and that ambulance must be able to hand over its patient to A&E as soon as it gets there. If A&E is to have more capacity, we need to reduce the amount of people there in the first place through prevention and investment in primary care. We must make hospital beds available so that patients can be moved out of the A&E department and into the medical or surgical part of the hospital, as appropriate. If we are to move patients on when they are ready to go home, when they would be better served in their own home with the proper therapy, we must invest in social care and deal with its capacity issue, which is at the heart of so many of these problems. Half a million people in England are waiting for care, stranded in hospital beds that are so important to free up over winter, and those in power have continually ignored social care for many years. I am extremely worried that the Government have not said an awful lot about social care in the Budget today. The additional money announced for local councils, £600 million of which is for social care, will presumably be gobbled up largely by the increase in national insurance contributions and the minimum wage. It is really concerning that those councils will not be able to meet their social care commitments in the future. We urgently need cross-party talks so that, between us, we can commit to a long-term solution to the crisis in social care. Liberal Democrats believe that we should introduce free personal care along the lines of the model in Scotland. That would help people to stay in their own homes and out of hospital and ease the pressure on the NHS. We should pay for a fairer deal for unpaid carers and a higher carers’ minimum wage, which of course, we saw some movement towards in today’s Budget. We welcome that and look forward to the review of the cliff edge in the unpaid carers’ allowance. Critically, a higher carers’ minimum wage must be fully funded, because councils will be pushed over the edge if they are not given the money to support that, as will many small care providers, which provide the vast majority of paid social care in this country. We need to ensure that people can see a GP when they need one, so that they do not end up adding to the overwhelming pressure on A&E departments. I recently spoke to someone in my constituency who waited seven weeks for a telephone consultation. We must ensure that we focus on the outcome for the patient, which is why we would give everyone the right to see a GP within seven days, or within 24 hours if the need was urgent, and we need to increase the GP workforce by at least 8,000 to deliver that. As I said, it is crucial that that is done through retention as well as recruitment and more training. We also need to reform the NHS dental contract and guarantee access to an NHS dentist for anyone needing urgent or emergency dental care, ending the dental deserts that exist in my North Shropshire constituency and the rest of the country. The biggest reason for a child to go into hospital is to have a tooth extracted, because their teeth are in such a poor state. That is scandalous, and I look forward to hearing what the Government will do to address that issue. We also need to support community pharmacists, who are critical to the preparedness of the NHS, by making sure that everyone has access to the healthcare advice and medicines that they need. Pharmacy First is an excellent idea and helps to relieve the pressure on the NHS, but community pharmacists are closing at an alarming rate, and we risk that good idea going to waste. Are enough people being vaccinated against the “tripledemic” of flu, covid and respiratory syncytial virus, including staff? Analysis by the Health Service Journal showed that 283,000 fewer staff received a flu jab last winter than at the end of 2019, despite the number of frontline staff growing. If staff are not protected, fewer patients will be protected when they get seriously ill, and staff will not be able to go to work to treat ill people. Increasing the awareness of what is on offer at pharmacies and reversing the cuts to the public health grant to increase the health and fitness of people up and down the country are both integral to relieving pressure on hospitals and preparing the NHS for winters to come. Stories and statistics from up and down the country show that the NHS was already under extremely severe pressure this summer. That has been the case throughout this year and last year. It is autumn now, so it is critical that the Government outline their plans to deal with the added pressure of the winter to come. More fundamentally, we need bold, long-term action so that winter crises become a thing of the past. We need to train, recruit and retain staff, and make them proud and happy, instead of tired and stressed, with them then leaving the system. We need to fix our crumbling hospitals so that money can be spent on care instead of fighting fires and draining floods. We need to invest in all aspects of primary care, including dentists, doctors, pharmacists and optometrists, as I reminded Members in the Chamber last week. Most crucially, we must confront the crisis in social care. Earlier this week, the Secretary of State said that the Budget will arrest the decline in the NHS, but I am afraid that that is not good enough. The annual winter crisis costs lives, jobs and patient dignity. It also costs the taxpayer more than we can afford. We must invest now; we cannot afford not to do it. We must invest to save so that we have an NHS fit for the future.

• 30 Oct 2024 · NHS Winter Readiness · Hansard source

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  I thank you, Sir Roger, the Minister, the shadow Minister, all my Liberal Democrat colleagues and the hon. Member for Strangford (Jim Shannon) for coming to this debate on a very busy day. I am grateful for all their contributions, which were positive and constructive, as always. I thank the Minister in particular for her comprehensive response. It is reassuring to hear that she has considerable expertise in this area. We welcome the investment that was announced in the Budget, including significant investment in day-to-day NHS spending, capital investment and investment to deal with the repairs backlog, which needs urgent attention. We called for the Government to address the backlog in our general election campaign, because we recognise its importance. However, the very nature of the Budget statement means that we have been a bit light on detail today, and that is why we want to provide constructive opposition and ideas to move this forward. I reiterate my concerns about social care. Little was said about it today, but many social care providers are small businesses that will be heavily impacted not only by the increase in the minimum wage, which is welcome for carers, but by the increase in employer national insurance contributions. We risk a real crisis in those companies and in local government budgets, which are perilously stretched, if we do not have a plan to fund those carers and their wages. I leave the Minister with that thought, and thank everybody for attending. Question put and agreed to. Resolved, That this House has considered NHS readiness for winter 2024-25.

• 30 Oct 2024 · Engagements · Hansard source

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  Q14. The Robert Jones and Agnes Hunt hospital in Oswestry, in my constituency, is home to the veterans’ orthopaedic service, which is by far the largest provider of veterans’ hospital care in the country. It is a fine example of what can be built when the national health service and local authorities work together. It cost no extra public money to set it up but, because of NHS changes in how integrated care boards charge each other, it has been left with a funding shortfall. Will the Prime Minister come to visit this fantastic facility in beautiful North Shropshire to see for himself why it is so important that we keep it going?

• 23 Oct 2024 · Engagements · Hansard source

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  Q11. Shropshire’s farmers have been suffering from flooding following 18 months of incredibly wet weather, topped off last Wednesday by a month’s worth of rain in 24 hours. They were not eligible for the farming recovery fund, and a freedom of information request by Farmers Weekly found that only £2.1 million of that £50 million has been handed out to farmers. Will the Government consider extending the eligibility of that scheme so that we can keep farmers going when they are deluged by floodwater?

• 16 Oct 2024 · Access to Primary Healthcare · Hansard source

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  That is a really important point. A lot of people in my constituency have contacted me for help with drugs—for example, to deal with ADHD. People need to be able to access important medication readily. We must not forget the dentistry element of primary care. A generation of children are at risk of poor oral health because of the mess in which dentistry has been left by the previous Government. Tooth decay is the biggest cause of children being admitted to hospital, with over 100,000 admitted since 2018. That is totally unacceptable. Some 4.4. million children have not been seen by an NHS dentist in the last year, according to the House of Commons Library. Dentistry is really important for children—they have to keep their teeth for the rest of their lives—but this issue affects adults too. My constituent Ron Kelly, who is 62, is disabled and lives in Market Drayton. Members who have been around a while might know that it is not easy to catch a bus to anywhere from Market Drayton. He has not been able to find a dentist since 2019, and my caseworkers have rung every NHS dentist in our constituency. None of them is taking on new patients, so even if he was able to use the bus, he would not be able to find an NHS dentist in North Shropshire at the moment. Office for National Statistics data released last week shows that, in the midlands, 99% of people who do not have an NHS dentist, and who are trying to find an appointment, cannot access one—99%! It is just unbelievable in a modern country in the 21st century.

• 16 Oct 2024 · Access to Primary Healthcare · Hansard source

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  I beg to move, That this House regrets that the NHS has been plunged into crisis by years of neglect by the previous Government, leaving far too many people waiting weeks to see a GP or unable to find an NHS dentist, and children and adults waiting months or even years to receive the mental health care they need; believes that everyone should be able to access high-quality primary care services when they need them and where they need them; condemns the previous Government for presiding over a fall in the number of full-time equivalent fully qualified GPs and NHS dentists in the last Parliament; further regrets that the Government has not yet set out a plan to invest in primary care at the level needed to meet demand; calls on the Government to boost access to GPs, NHS dentists and community pharmacists; and further calls on the Government to give everyone the right to see a GP within seven days or within 24 hours if they urgently need to and to guarantee access to an NHS dentist for everyone needing urgent and emergency care. It is a real honour to open this debate on the Liberal Democrats’ first Opposition day for 15 years. Primary care is the front door to the health service, but for too many people at the moment, that door is closed. Whether they are waking up and dealing with the 8 am calling frenzy to get a GP appointment, frantically ringing every dental practice in their area for an NHS dentist, or turning up at their local pharmacy to pick up a prescription for their loved one or themselves and finding it unexpectedly closed or the medicine out of stock, primary care is in terrible trouble and it needs fixing urgently. That is not only to make lives better for the people who are suffering because they cannot access the primary care they need, but to allow the NHS to function more efficiently. Accident and emergency is not a decent substitute door to the NHS. I am an asthmatic and as a young person I had quite serious asthma. I can remember when primary care was absolutely there for me in the middle of the night. On lots of occasions when I needed help, my dad did not have to take me to the hospital in an ambulance. Somebody came to me with a nebuliser and got me sorted out within a couple of hours, and then we all went back to bed. Now, that is not an option for a lot of people. The NHS is in a crisis, and that is causing pain and suffering unnecessarily. The crisis is also costing far more than we can afford. It is costly because early intervention and dealing with people in their community or at their home is so much more efficient than taking somebody to hospital, even if that is in a private car. And it is costly because it causes people genuine pain: the BBC reported that in Oswestry in my constituency this year, a man removed his molar with a pair of pliers because he could not find an NHS dentist. But it is also costly because people are unable to access work, and that is costing the economy. Polling commissioned by the Liberal Democrats showed that one in four people had been unable to go to work while waiting for a primary care appointment. That is not good for an economy that urgently needs to grow. We need urgent investment in primary care—in doctors, dentists and community pharmacists—to save people from having to go to hospital.

• 16 Oct 2024 · Access to Primary Healthcare · Hansard source

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  My hon. Friend is entirely right. I believe that the Government are taking steps to address that, but he has made an important point about the need for flexible GP funding. A general practice may have money to spend on professionals and need more fully qualified doctors to deal with its patient list, but can only spend that money on another pharmacist or another nurse. That is a ridiculous situation, and I am pleased that the Government are dealing with it.

• 16 Oct 2024 · Access to Primary Healthcare · Hansard source

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  That is an important point. In my constituency, carers who go to pick up prescription medicines are finding that the pharmacists are not there because they are relying on locums. The pharmacy funding problem needs to be addressed as a matter of urgency, and I will say more about that later. Growing the economy is so important that we need to get people off the waiting and referral lists and back into work. Liberal Democrats believe that people should be in control of their own lives, not “chained up” at home, unable to get out of bed, because they have no access to healthcare. They should be able to get the help that they need, when they need it, in their own homes and communities. Let us start with GPs. The Liberal Democrat manifesto—it was well received, which is why there are so many Members sitting behind me on these Benches—called for the right to see a GP within seven days or 24 hours if the situation is urgent, and for those aged over 70 or with a chronic health condition to have access to a named GP. Those rights are extremely important. People who go to the same GP for more than 15 years have a 25% lower chance of dying than those who have seen a new GP in the last year. Primary care networks tell me that their inability to deliver continuity of care because of the shortage of GPs is one of the problems that worry them most.

• 16 Oct 2024 · Access to Primary Healthcare · Hansard source

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  I will make some progress now, if that is okay, because I am conscious that lots of people want to get in and make full speeches. We have called for a guarantee for urgent and emergency dental care. Check-ups for those people who are already eligible and those needing check-ups before things such as chemotherapy and surgery were also in our manifesto. It is only going to be possible to offer those guarantees if we deal with the issues in the dental contract and the flexibility of commissioning. Primary care is the front door to the NHS, as I mentioned at the beginning, and Lord Darzi pointed out in his report that that is where we should be investing. At the moment, money is flowing to secondary care—to hospitals—yet most people’s experience of the NHS is with their doctor or dentist. We must ensure that that first point of call is a good point of call, and reduce the numbers of people going to A&E. That is so much more cost-effective, but it is also so much better for those people who could manage their health condition without a crisis and without ever having to go near a hospital. We should also think of the knock-on impacts on those hospitals. We all have horror stories of ambulances queued up outside hospitals because so many people are in A&E and so few people can flow through the hospital. The issues around that are complex, and they link in to social care as well, but the reality is that if we can treat people in the community, we will save the lives of people who need emergency care. This is absolutely fundamental: we need investment in our GPs and in dental and pharmacy contracts because we cannot afford not to do it.