Justin Madders
MP for Ellesmere Port and Bromborough · Labour · United Kingdom
“Friend the Member for Dunstable and Leighton Buzzard asked about, will consider the points raised in this debate and whether any of them can be put into future updates to guidance. As was mentioned, good passenger information is central to standards.”
“As the roads Minister, I of course recognise the importance of bus stops and the important effect they have on the streetscape. My hon. Friend the Member for Dunstable and Leighton Buzzard made clear that she is passionate and informed about the importance of bus journeys to everyone.”
“Where responsibility for highways or individual assets sits elsewhere, close and effective working between the relevant authorities is essential. We expect local plans to join up services, infrastructure and passenger information, rather than treating them as separate issues. That will no doubt be music to the ears of my hon.”
“Our guidance encourages authorities to take a strategic approach to stops and interchanges, including keeping an inventory of infrastructure, identifying priorities for investment and setting locally appropriate standards for facilities and maintenance.”
“She is absolutely right that the quality of a bus stop is about more than accessibility, although of course accessibility is vital. Passengers notice whether a stop is easy to find and use, whether it offers shelter or seating where appropriate, whether it is clean, whether the surroundings feel safe and well maintained and, as we have di…”
“That approach reflects a simple principle: local transport authorities know their areas and are best placed to plan improvements across the whole local bus network. That is why the Department’s vision for buses, within an integrated transport system, puts local transport authorities at the centre of delivery.”
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“Labour will support the amendment tabled by the Chair of the Health and Social Care Committee, which we hope will be pushed to a vote. I hope I have not been too effusive in my comments about him—I have a reputation to maintain after all—but I will refer to the excellent report done by his Committee on workforce burnout, which in many ways is the cornerstone of what we are debating. In its conclusion, the Committee said: “The emergency that workforce burnout has become will not be solved without a total overhaul of the way the NHS does workforce planning. After the pandemic, which revealed so many critical staff shortages, the least we can do for staff is to show there is a long term solution to those shortages, ultimately the biggest driver of burnout.”
“For the NHS, the long term is indeed a long time—for example, the time needed to develop and train GPs and consultants. More money is not the only answer; technology and reform of the way we work must all be part of the mix. However, the labour-intensive nature of care will not fundamentally change, so we must look at workforce numbers as the priority. It is often said that failing to plan is the same as planning to fail. Some colleagues believe that a failure to plan is exactly that—a route to ending the NHS as we know it by showing that it fails. However, the Bill suggests an acceptance that a plan is needed, and work is under way. Hopefully that work is not being handed out to more consultants, of whom we see enough already.”
“There is also whistleblowing, and aspects of how staff are nurtured and supported. At its very best, the NHS is very good, but unfortunately that is not the story across the board. It should be good in every part. On that theme, let me mention the continuing disgrace in the way that some members of the NHS workforce are treated. I find it unacceptable that cleaners, porters, catering and IT staff are still being outsourced by trusts that are trying to make tax savings or outsource services to the lowest bidder. Perhaps the Minister can look into the current dispute at South Warwickshire in that regard, as we do not think that is a template to follow. Workforce planning is not a problem that can be solved quickly, although increased funding in social care could help that.”
“I thank my hon. Friend for her intervention and I will later talk a little about outsourcing and the role it has to play. We believe that plans should be built from the bottom up, not from the top, and that implies the involvement of ICBs, NHS trusts and foundation trusts. ICBs and their strategic arms, integrated care providers, will not be functional for some time. That is a shame, but it does not mean we should not proceed with the amendment. The scale of the workforce challenge is well established: high rates of vacancy, inadequate levels of retention, and much more. It goes far deeper than numbers and structures, to issues of workforce terms and conditions, particularly in social care. It must also cover cultural issues, as there is a clear indication that all is not well in the NHS in terms of diversity.”
“New clause 1 seeks to put the protection of the public at the forefront by giving the Secretary of State power to bring into force a national licensing scheme for cosmetic procedures. Clearly, given that this is a departure from the wild west we face at the moment, we recognise that significant research and engagement with stakeholders will be needed to develop a scheme, as well as the provision of a practical and efficient system for people to become regulators and practitioners. If that does not make it on to the face of the Bill today, we hope this is an issue the Government will return to shortly.”
“There would undoubtedly be a saving to the NHS in reduced visits to accident and emergency and GPs to correct mistakes made by poorly trained and unregulated practitioners. We therefore think the new clause has value. Some of the impacts on the NHS from the lack of regulation include outbreaks of infection at a skin piercing premises, resulting in individuals being hospitalised; disfiguration and partial removal of an ear; second and third-degree burns from lasers and sunbeds; allergic reactions due to failures to carry out patch tests or medical assessments, which led to hospitalisation; and blindness in one eye caused by the incorrect administration of dermal filler.”
“Finally, on new clause 1, I pay tribute to the all-party parliamentary group on beauty, aesthetics and wellbeing, whose work in this area has been influential in producing it. Many of the group’s members have put their name to it. As we know, cosmetic treatments can include a wide range of procedures aimed at enhancing or altering appearance. Many of those procedures are becoming increasingly popular and new clause 1 speaks to the well-articulated concern that non-medically and medically trained practitioners are performing treatments without being able to provide evidence of appropriate training, and without required standards of oversight and supervision. I hope the Members moving new clause 1 will have the opportunity to speak to it, as there are far too many stories of people suffering horrific, life-changing injuries.”
“60.] We also support the amendments put forward by the spokesperson for the Scottish National party, the hon. Member for Central Ayrshire (Dr Whitford), which are important in preserving the principle and status of protected spaces. We feel it is important that they cannot be nibbled away at, as the Bill currently allows. The purpose of amendment 57, which we also tabled in Committee, is simply to delete clause 127, which deals with the role of the Secretary of State in professional regulation. So far, we have had no convincing explanation of why the Secretary of State needs these powers. If there are no professions that he wishes to remove, we do not need the clause. If there are, he should say so, so we can have a debate now on whether it is appropriate to hand over those powers to him.”
“Under subsection (2), the Secretary of State can direct the HSSIB in whatever manner he determines, which I would have said is about as far away from independence as we can get—until we get to subsection (4), which means the Secretary of State can also effectively step into the HSSIB’s shoes and undertake the duties himself. I can do no better than refer to the evidence Keith Conradi gave to the Public Bill Committee, when he said: “Ultimately, we end up making recommendations to the Department of Health and Social Care, and in the future I would like to ensure that we have that complete freedom to be able to make recommendations wherever we think that they most fit.” –– [ Official Report, Health and Care Public Bill Committee, 7 September 2021; c.”
“Our major reservation is, yet again, with the involvement of the Secretary of State. Our amendment 74 would have the effect of leaving out clause 115, which is another clause that gives the Secretary of State extra powers to interfere. Our general observation would be that there is far too much extra power going to the Secretary of State in the Bill anyway, but we are particularly concerned at the powers set out in clause 115, which give him what we consider to be wholly unnecessary powers to direct. It is pretty much a blank cheque to enable him to step in and interfere any time he likes as long as he considers that there has been a significant failure.”
“However, I wonder whether the Minister can give us an assurance that, should those recommendations turn out to be as we would expect, he will be able to act on them quickly and get something down in statute as soon as possible so that we do not miss the boat. Turning to the amendments on the health services safety investigations body, much of the proposed legislation is the same as that proposed in the other place, and there were extensive debates on this matter in Committee. There are, however, issues that remain, which are covered by amendments we will be debating today. I can imagine the other place having quite a lot to say about some of these issues. In general, we support the move to the new body, but over time attention must be applied to some aspects of the way it will function in practice.”
“I thank the hon. Member for his intervention. I think he is being very modest, but he is absolutely right that these things do not happen by accident. It is often the hard work, over many years, of campaigners and campaign groups who being these issues to the fore and do the diligence and the hard work behind the scenes that leads us to the sort of outcome that we will hopefully get today—an end to this abhorrent practice. On the hon. Member’s other amendment, new clause 22, we also want to see hymenoplasty ended. It has no medical benefit whatsoever. As the Minister said, there is currently an expert panel looking at the issue, and he is waiting on its recommendations. I think the outcome is in little doubt, to be frank.”
“Thank you, Madam Deputy Speaker— [ Interruption. ] It has been a long day, Mr Deputy Speaker, but we will get there. I will speak to the amendments tabled in my name and those of my right hon. and hon. Friends. As the Minister said, this group of amendments covers a large range of important areas, so I will be brief. New clause 27 flags up the issues around waiting times. Passing any amendment requiring a report is, of course, not a total solution, but it might be a source of focus. As Labour has said many times since 2010, winter pressures, waiting times and the flight into private healthcare to get earlier treatment have exacerbated the issues.”
“An assessment should include carers with special attention if a child carer is involved, and there is a concern that unpaid carers will not be identified and consulted at the point of discharge. The system for step-down care outside acute hospitals must be adequate, and there must be sufficient high-quality and funded places in care settings of all kinds. We are literally a whole generation away from having that kind of system, even if the funding started to become available today. On a related point, new clause 63 from the hon. Member for St Albans (Daisy Cooper) also deserves support. I will leave my comments there, as I know many hon. Members want to speak.”
“We are led to believe, and have some confirmation, that this development is working well for some acute settings, helping ease the perennial and disruptive issues around delayed transfers of care, but in other places we hear voices calling for much greater caution and for tougher safeguards or even, as amendment 60 requests, to stop it altogether. While we have sympathy with amendment 60, it would only pose more problems for the NHS if it was passed, so we have opted in our amendment 73 just to tighten up on safeguards. Of course the real solutions are far more complex and would require higher investment both in the NHS and in social care. It should be mandatory that all aspects of ongoing care have been properly discussed and agreed with the patient and carers prior to discharge.”
“The well-articulated fear is that it will be used to block necessary but unpopular changes and that expediency will rule. Such decisions should be left to the clinicians or maybe the health economists but not politicians. Labour opposes this new power and would gently say to the Minister, “Be careful what you wish for.” Finally, the issues around discharge to assess are complex. As we worked our way through in Committee, we heard evidence from many stakeholders, and it is fair to say that views on the matter were polarised.”
“Perhaps he will give us his insight into that later on. It is the absolute antithesis of the Lansley view that politicians should be distanced from NHS operational issues and makes a mockery of the overall thrust of this Bill, which is about encouraging local decision making. It is no exaggeration to say that, taken literally, clause 39 and its accompanying schedule 6 require the Secretary of State to be told if there are, or even if there might be, proposals to vary service—even moving a clinic from one location to another nearby. As has been pointed out by wise heads, the power is not one that many Secretaries of State should want to get involved in. A Secretary of State who used it could be accused of favouring certain areas or decisions for political purposes.”
“Nevertheless, we live in a country where significant inequalities remain, and narrowing those gaps should be a national priority. Research from the IPPR last month highlighted the 10-year gap in life expectancy between a person living in the poorest community and a person in the best off. That gap doubles when we talk about healthy life expectancy. Tackling that disparity must be a priority in the Bill. The Secretary of State for Health and Social Care said in his first speech that said he wanted to tackle the “disease of disparity”, so why is that missing? Turning to clause 39—one of my favourites—why it remains in the Bill is a mystery given that the previous Secretary of State, the right hon. Member for West Suffolk (Matt Hancock), who requested these powers, is no longer in the role.”
“My hon. Friend is right that one of the criticisms we have levelled against the Bill is that it does not address the issues and challenges facing the NHS. I will take no further interventions, because I am conscious that many Members have contributions to make. I will move swiftly on to our two amendments dealing with inequality and to new clause 64 in the name of my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams). To show that this is an NHS and social care Bill, not just an NHS Bill, local authorities need to be more involved and more emphasis must be placed on wellbeing and better outcomes. We support the NHS triple aim—improving health, quality of care and cost control are, of course, important functions.”
“Whether that damage was worse than the damage done by a decade of austerity remains to be seen, but repairing the damage done by austerity is not for today, as there is little in the Bill to address the ongoing consequences of a decade of underfunding, particularly the wholly appalling waiting times that we now see across the board.”
“We know that the genesis of this Bill has been the realisation that increasingly large parts of the NHS were ignoring the 2012 Lansley Act. Along with changes to procurement and pricing, this grouping deals with the main elements of reversing parts of that Act. We could spend all our time referring to what we said 10 years ago, and how the Health and Social Care Act 2012 has proved to be the disaster that we said it would be, but we will spare the Government the “We told you so” lectures, because even those on the Government Benches are now aware that the 2012 Act has been among the worst policy mistakes in the history of the NHS.”
“Our discussions on these matters in Committee showed that our disagreements tended to centre around an intention by Government to limit what is in statute and to leave maximum flexibility at local level, as opposed to our desire to ensure that safeguards and protections were in place for those matters we felt were too important to be left out. It is wholly ironic, therefore, that the Bill proclaims, on the one hand, local freedoms and flexibilities, yet on the other proposes sweeping top-down powers for NHS England and the Secretary of State. Our view remains that some flexibility is fine to allow shaping to local needs, but that some key principles need to be put into the Bill to ensure that there are no misunderstandings or unintended consequences.”
“Sadly, we have insufficient time to go over the same ground again, particularly given the rapid shifting of the goalposts we have seen in the past week. I turn first to integrated care boards, or ICBs, and, more widely, the issue of governance. The question of governance and accountability remains an important matter to us and needs greater clarity than currently appears in the Bill. For Members who may not be familiar with the detail, the Bill proposes yet another reorganisation of the NHS, creating 42 new integrated care systems where decisions on how NHS and care spending will be made. The decision-making bodies within these systems are the ICBs, replacing the CCGs, which fall away into the annals of history alongside the primary care groups, the primary care trusts and all the other permutations that we have seen.”
“A wide range of issues that are part of this group of amendments demonstrate the cold reality of this Bill. It is a jumble sale of bits and pieces. Of course a Bill can be wide-ranging, but having breadth is not the same as having coherence, or indeed clarity. Such are the issues within scope in this grouping that I will not comment directly on every new clause and amendment but hope to have time to say at least a few words on those emanating from the Opposition Front-Bench team, as well as on any Government new clauses or amendments that we oppose. Some amendments refer to matters that have been dealt with in Committee where we have expressed our views and put forward amendments that failed to persuade the Government.”
“It is a wholly regressive measure, to say the least, to give support through means-testing, but then to penalise people later for receiving it in the first place. We will vote against this iniquity, and I hope many Conservative Members will vote with us. They should be used to the Prime Minister’s broken promises by now; this is their chance to make the point that he should stand by what he says.”
“In fact, in 22 Committee sittings spanning some 50 hours, we never once heard mention of this amendment coming forward or discussion on the care cap. Indeed, when this Chamber was busy debating the social care levy, we were beavering away in Committee on the Bill, oblivious to the fact this measure was coming down the track. If the Government cannot even get their decision-making processes integrated, what hope is there for integrating health and social care? As we know, the aim of the new clause is to remove means-tested benefits from the costs that count towards the care cap. As has been pointed out far and wide by Members from all parts of the House, that change adversely impacts some more than others.”
“We need to be able to challenge NHS bodies that do not comply, as well as Ministers who try to flout the rules. I will now deal with new clause 49, saving the best—or more accurately, the worst—until last. Because of how Report stage works, it has fallen to me to express our opposition to this measure, rather than my expert colleague, my hon. Friend the Member for Leicester West (Liz Kendall), who shares my dismay at what has been produced and how it has been presented to us. Starting with the process, it is wholly wrong to bring such a fundamental change forward as a last-minute addition to this Bill. That means it cannot be debated properly today. There is no impact assessment and, as we have already heard, this change was not discussed in Committee at all.”
“We hope that extra transparency and extra rigour would mean we avoid buying stuff that is unsuitable and sits in container mountains, stuff that does not meet specifications, and stuff made by companies that have no experience, but are owned by friends and family. In short, we would stop the covid crony gravy train. The use of private sector capacity in the covid emergency turned out to be a farcical failure. It became very clear, very quickly that it was not there to support the NHS; it was there just to make profits. Use of private providers through dodgy deals during the PPE scandal has highlighted the need for greater transparency and greater capacity in the NHS. We can never allow a repeat of what we have seen there. We need the rigour set out in the amendment to be put into legislation, rather than left to guidance.”
“Since its inception, the NHS has always relied on some non-NHS providers, with the model developed for GPs being an obvious example. However, in recent decades there has been an increase in the use of private providers of acute care, most notably in diagnostics and surgery. To be clear, we on the Opposition Benches believe that the NHS should be the default provider of clinical services. If it is not the only provider, it should be the predominant provider in geographical and services terms. Where a service cannot be provided by a public body because the capability or capacity is not there, there is still the option to go beyond the NHS itself, but that should be a last resort and never a permanent solution. Amendment 72 therefore sets out a clear framework for how we could achieve that.”
“The public, patients, staff, social care, public health and mental health—which of those can be safely ignored and which has no part to play? As I have already mentioned, there is a major area of uncertainty because of the complete absence of anything that sets out how the much-vaunted place-based commissioning will work. Who will sit at the place-based table is, I am afraid, still completely opaque. The next major area covered in the Bill is a further deconstruction of Lansley with the removal of compulsory competitive tendering for clinical services. We have seen the NHS proposals for a provider selection regime to replace the regulations under section 75 of the 2012 Act. That is to be regarded as a work in progress, so our amendment 72 covers the issue and would reintroduce some safeguards into how our money is spent.”
“We have already had some discussion of who goes on the ICB. Apparently, the answer is not the most appropriate people chosen by an independent external process or individuals directly accountable to the public; the answer is left to guidance that leaves open the risk that voices we think need to be heard will slip through the net. Our amendment 76 deals with that by setting out the requirements for ICB membership. Allocating scarce NHS resources should be robustly debated and will always be political. Tough choices have to be made, so we need people on the ICB who will be there to cover all the necessary interests for the wider good. If Members look at what amendment 76 suggests, I hope nobody would argue that those interests do not have to have some voice.”
“He identified the concern perfectly: “We forget at our peril the added value, the accountability, the loyalty and the good will that the NHS provides. We really do…I am saying that it does matter. Your local acute trust is not there on a 10-year contract, willing to walk away after two years. It is there for your population; it cannot walk away.” –– [ Official Report, Health and Care Public Bill Committee, 9 September 2021; c. 90, Q113.] Those final words sum it up perfectly. Put a company on the board, and its interest lasts as long as the contract, and those interests will of course not be the same as the NHS’s anyway. A company’s primary concern is the shareholders, not the patients. With that clear and unanswerable concern about conflicts of interest, we invite the Government to withdraw their amendment and support ours.”
“At the moment, ICBs are not a legal entity, so they do not own anything. When the Bill comes into force, they will effectively take over mainly administrative buildings from the CCGs, and the trust will hold ownership of most of the assets. We hope that there will not be the risks that my hon. Friend outlines, although it is not impossible for ICBs to set up their own trusts at some point in the future. We do not believe that the question of private providers sitting on the place-based boards can be left open in this way, because this is really about who runs the NHS. There is a complete and utter incompatibility between the aims of private companies and what we say should be the aims of the NHS and the ICBs. I can do no better than refer to the evidence of Dr Chaand Nagpaul from the Bill Committee.”
“Again, my hon. Friend must have read my speech because I will make that point later. The proposal shows that the Bill is not a plan to fix social care but a very thin attempt to change parts of the system. There are many other elements that clearly need dealing with. In case Conservative Members need reminding, in the Prime Minister’s first speech on taking office, he promised to, “fix the crisis in social care once and for all, with a clear plan that we have prepared”. We are still to see that plan. What we have is a new tax and a broken promise.”
“It is not what was promised, but hon. Members do not have to take my word for it. Let us listen to the experts. Age UK says: “The change the Government has announced makes the overall scheme a lot less helpful to older people with modest assets than anyone had expected. It waters down Sir Andrew Dilnot’s original proposal to save the Government some money, but at the cost of protecting the finances of older home owners…This feels like completely the wrong policy choice and we are extremely disappointed that the Government has made it”. The King’s Fund says of people with more modest assets that, “the Prime Minister’s promise that no one need sell their house to pay for care…doesn’t seem to apply to them.” Instead, it will only “benefit wealthier people”.”
“I thank my hon. Friend and neighbour—I am getting all my neighbours in tonight. She makes a brilliant point: the proposal exacerbates regional inequalities through an unfair tax and is certainly not a plan to fix social care. Hon. Members should look at what my hon. Friend the Member for Leicester West has said about what needs to be done to tackle the social care crisis in this country; it is an awful lot more than putting in place a cap that benefits only some people in certain parts of the country. Not only will the proposal not stop people having to sell their home to pay for their costs, but it will bake in unfairness for a generation. It does nothing for working adults with long-term care needs, who seem to have been completely missed out, as my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) said.”
“According to the Health Foundation, assuming care costs of about £500 a week, those with assets of £150,000 will take a year and a half longer to reach the cap than they would have under the Dilnot proposals, those with assets of £125,000 will take four and a half years longer, and those with assets of under £106,000 will never reach the care cap. Contrary to what the Minister has said, people with assets of £106,000 or less will not benefit from the proposal at all.”
“I thank my hon. Friend for his intervention—I think. What I can say here and what I might say outside are not the same, and I do have to finish my speech, so I will leave it there. I am sure that the public will make up their own minds about the veracity or otherwise of comments made by the Prime Minister. Sir Andrew Dilnot said that the proposals will create a north-south divide, that those with assets of £106,000 will be hardest hit and that anyone with assets under £186,000 will be worse off than under his proposals.”
“Almost a year on, I hope the Minister will be able to update us on what progress has been made on that plan.”
“Members have picked up on all these things today, so we know that the crisis we are in is not simply the result of covid. We know that NHS waiting lists are now at a record high, with 5.8 million people waiting for treatment. Hospital leaders have warned in recent days that our services are at breaking point, and we know that the coming winter weeks are going to be some of the most challenging in the history of the NHS. We need to see a plan to get the NHS through the winter without compromising patient care. We need a realistic plan to tackle the backlog in non-covid care and a dedicated plan to tackle the huge backlog in respiratory care. In a written answer in January this year, the Government said they were working with partners to develop and implement policy on the provision of pulmonary rehabilitation services in England.”
“The NHS long-term plan includes commitments related to respiratory disease, including to detect and diagnose respiratory problems earlier and increase access to pulmonary rehabilitation. Will the Minister update us on what progress has been made towards meeting those commitments? It is important to note that the plan was written before covid-19 struck. As my hon. Friend the Member for Weaver Vale said, this plan is very good for sitting on the shelf, but what happens on the ground and how it is delivered are what really matter. The Minister will know that services were already severely strained before covid-19. We went into the pandemic with the NHS already on its knees, with 17,000 fewer beds, 100,000 full-time NHS staff vacancies, hospitals crumbling, public health services cut and GP numbers down.”
“The report also finds that those who received the basic standards of COPD care had fewer exacerbations, were able to manage their condition, and better understood what to do when their symptoms worsened than those who did not, so it simply is not good enough that that group only received the right care eventually, leaving them vulnerable to a deterioration in their health as a result. We already know that an estimated 420,000 people in the UK may have had their working lives cut short by COPD, and more than half who responded to the BLF survey said their mental health had worsened since suffering a COPD diagnosis. Clearly, we need to do better than this. As Members have said, it is absolutely vital that the right support and treatment are put in place at the right time.”
“It is not acceptable that current levels of care mean that, even when a patient has a confirmed COPD diagnosis, they are likely to struggle to access the care they need, resulting in people needlessly ending up in hospital. When national guidelines are in place, it should not be the case that over three-quarters of those who responded to the BLF survey said they were missing out on some aspect of this care. Those with a recent diagnosis were the most likely to receive the lowest levels of care and there was a clear relationship between the length of time since diagnosis and receiving the five fundamentals of COPD care, so we can see that the situation is deteriorating. The BLF report suggests that this may be because people with COPD have to learn how to navigate the NHS to get the care they need.”
“Later diagnosis is also linked to higher levels of COPD exacerbations, which can result in lung damage and longer hospital stays. In fact, COPD is currently the second largest cause of emergency hospital emissions, which have risen three times faster than general admissions, putting enormous strain on our NHS, at an estimated cost of £1.9 billion every year. As we have heard from other Members today, not only late diagnosis impacts hospital admissions; the BLF survey found that those patients who reported receiving the basic standard care—the five fundamentals of COPD care—had fewer flare-ups and better understood what to do when their symptoms worsened.”
“Worryingly, the Government’s own figures show that diagnosis rates, which I think we accept were too low to start with, have plummeted—understandably—during covid, and so far show little sign of recovery. This month, the British Lung Foundation reports that diagnostic tests such as spirometry have not yet resumed, which many Members touched on. My hon. Friend the Member for Halton mentioned that there was a 51% reduction in COPD diagnosis in 2020 compared with the previous year, meaning that around 46,000 people in England alone missed out on a diagnosis. Over two years, that is around 92,000 people missing out on a diagnosis. As we know, receiving a diagnosis late means the disease has progressed, which means there is a greater risk of early mortality, never mind the impact on quality of life.”
“In 2016, the National Institute for Health and Care Excellence estimated that 3 million people in the UK had COPD, of whom around 2 million remain undiagnosed. As we heard, numbers are higher in the north of England and in areas of deprivation. It is estimated that prevalence in the most deprived 10% of areas is almost double that in the least deprived 10%. My hon. Friend the Member for Blaydon referred to the British Lung Foundation’s survey of 8,000 people with COPD between December last year and May this year. It found that, before the pandemic, around 70% of people diagnosed with COPD said they faced barriers in getting their diagnosis, 14% experienced an initial misdiagnosis, and others had symptoms mistaken for a chest infection or cough or were sent away by their GP after raising COPD symptoms.”
“COPD is the name for a group of lung conditions, including emphysema and chronic bronchitis, that cause breathing difficulties and a permanent narrowing of the airways. Symptoms include shortness of breath when doing simple, everyday things such as going for a walk or housework; a cough that lasts longer than a week; wheezing, particularly in cold weather; and producing more sputum, or phlegm, than usual. My hon. Friend the Member for Weaver Vale highlighted the case study of Chris, which highlights how we sometimes take good respiratory health for granted; only when we lose it do we realise how critical it is. As we heard, a significant number of people in the UK—more than 1.3 million—have a COPD diagnosis. As many Members said, at least a similar number are estimated to have the condition but are currently undiagnosed.”
“Friend the Member for Halton (Derek Twigg), who talked about the prevalence of COPD in his constituency and the various factors that have led to that. He rightly mentioned how the condition leads to many more unplanned emergency admissions; as we know, pressure on A&E at the moment is immense, and that is before we even get into the depths of winter. He also spoke about the excellent work of the community rapid response teams, which can help reduce that pressure on A&E, which will ultimately deliver better patient outcomes. He was right to highlight the additional demands on GPs and the additional numbers of patients they now see, which of course contributes to the difficulty of getting those early diagnoses that all Members referred to.”
“She also raised a whole series of other statistics that set out the scale of the challenge that we face in improving air quality. My hon. Friend the Member for Blaydon (Liz Twist) spoke about her region and how the staggering levels of health inequality in this country mean that the north-east has much higher rates of COPD than many other areas. She rightly highlighted the importance of helping people to stop smoking as part of this battle. As Members referred to, a decade of cuts to public health grants has led directly to a reduction in smoking cessation services. She also raised the importance of spirometry testing and how this needs to be conducted in primary care; otherwise, issues related to a failure to diagnose conditions early, which we have talked about, will continue. It was a pleasure, as always, to hear from my hon.”
“He wanted to focus on public health issues, to avoid our constituents contracting COPD in the first place; improving diagnosis rates, to ensure that it is caught at an earlier stage; transforming treatment, to help patients manage their condition; and investing more in research, so that we can develop groundbreaking diagnostics and treatments. I think we all agree that those are worthy aims that we ought to cover in the debate. We also heard from my hon. Friend the Member for Newport West (Ruth Jones). She rightly raised the link between lung conditions and air pollution, and she provided some shocking statistics about the number of maternity units that exceed WHO air quality guidelines, particularly after recently updated guidelines were issued.”