Long-term Medical Conditions

[Clive Efford in the Chair]

15:00:00

It is a pleasure to serve under your chairmanship, Mr Efford. Long-term conditions need a long-term plan. We were promised one of those, and it cannot come soon enough. The Chancellor’s statement yesterday, which committed to a 3% real-terms rise in NHS funding each year, gives me enormous hope for the future of our health service. Some 70% of that funding will likely go to the treatment of long-term conditions, so it is incredibly important that we consider how we should treat them. Most of us at some point will collect a few long-term conditions. Some of us are born with them; sometimes, they are serious disabilities. I am sure that we will hear some stories of those challenges. I reached out to the people of Bury St Edmunds and Stowmarket and heard many stories about their experiences of using our NHS. All too often, it is the same story: it is those with long-term conditions, not deadly diseases, who feel most let down now. The reality for many is that by the time they reach my age, they are fortunate if they have never had to visit a clinic or see a nurse about something that is no longer working quite as well as it should. The wheels begin to fall off all of us eventually. Living with a long-term condition has a profound impact on people. It can mean lost work days, missed opportunities and, for many, being pushed out of the workforce altogether. When people are unable to work because of poor health, they are cut off from society and their quality of life obviously declines. That also has a terrible effect on the economy. It is estimated that successfully addressing the crisis in long-term sickness would increase GDP by between £109 billion and £177 billion over the next five years, generating billions of pounds of additional tax revenue. This is a growing trend and as the population gets older it will simply become more pressing. I worry that we have not truly adapted our medical system to deal with this reality. When I was a medical student, a heart attack was managed with morphine and bed rest. Things have certainly changed, and yet the NHS has not changed enough. In 1948, it was created to deal with infectious diseases and acute hospital care, but the health needs of the population have changed completely. People now live long lives with conditions such as heart disease, diabetes and arthritis. We need to focus on keeping those people in the community rather than waiting until they become so unwell that they have to be brought to hospitals. The NHS should not just be a sickness service; it should help people to manage their conditions and live much better lives. During our debate on dementia a few days ago, I heard many moving stories about families challenged by that devastating illness. Dementia fills so many hospital beds, and the cost to society is quite staggering, but the real message of the debate was about the need for better community care and greater investment in technology and research. That is true for dementia, but it is also true for many long-term conditions. We have the time and the ideas; now, we must use them. There is much talk about moving care from hospitals to the community, which is not a slogan but an absolute necessity. I have seen it work in practice: before I came here, I was involved in a project that moved care for people with hearing loss out of hospitals and into the community. Patients benefited from easier and quicker access to specialist NHS audiology and nursing services. We now need to see such an approach rolled out across the country. The neighbourhood practice model advocated by my Suffolk GP colleagues must be part of the answer, with community health hubs open into the evening, resourced with nurses and mental health services and incorporating a pharmacy, with a GP who is known to the patient and to the family. Those hubs would be the place to call when sick—a better option than calling 111 or having a long wait in A&E. They would offer access to multi-disciplinary teams all in one place, a bit like the geriatric day hospitals that my dad, Professor Derek Prinsley, a pioneer of geriatric medicine, introduced into his practice in Teesside in the 1960s. The NHS must be a neighbourhood health service, not just a national health service. That is how we join up care so that patients no longer feel like they are being pushed from pillar to post. Instead of being rushed between different appointments in hospital corridors, people should be cared for in one place, bringing lifesaving continuity of care. It is time to end the fragmented system of the past, where people ended up in A&E simply because there was nowhere else to go, and where we had older people lying in trolleys in the early hours for long-term conditions that could have been managed in primary care. A&E should be for real accidents and emergencies. That is how we must start thinking about the long-term care of long-term conditions. At the centre of our thoughts must be the patient. Health services are all too often designed to deal with patients with a single disease, but for a growing number, that is no longer a suitable model. If I have high blood pressure and asthma, I have to visit the practice three times: once for the blood pressure check and once for the asthma check, and then another appointment to see the GP. I think we can do better than that. How can we truly put the patient at the centre of healthcare? As I have said before, one answer is to embrace the digital transition and change the medical record paradigm. Let the patient have the record. Give them agency over their healthcare. If people knew a bit more about their health, they might care for it a bit better. More than one in five patients with a long-term condition has said they do not have enough information to manage their condition. That is 5.5 million people across the country who are not confident that they can manage their condition, so let us have the doctor ask the patient for the record, not the other way round. That would be a revolutionary change. I would like to talk about medical research. Of course, our country has an incredible record of medical research: Jenner, who devised vaccination; Lister, who invented antisepsis; and Fleming, who discovered penicillin—British doctors who saved unimaginable numbers of lives. Then there is Dr John Snow, who removed the handle from the water pump in Broad Street, near to where we are sitting today, ending the cholera epidemic and founding the field of public health. It is on scientific advances like those that we mostly depend as we fight many long-term conditions. We will hear of artificial pancreas pumps to treat diabetes and genetic treatments to cure sickle cell disease and arthritis, but let us not take that progress for granted. We should support medical innovation and put the best technology into the hands of our doctors. I am proud that the Government are boosting investment in diagnostic machines in hospitals across the country, because I have been told by constituents about the struggle of misdiagnosis—months and years spent unsure what is wrong with them, with doctors unable to shed any light. We are rolling out artificial intelligence and improving diagnostics across the country, and the Government have promised to support that further. Improving researchers’ access to medical data will be part of the approach. Let us imagine the scientific advances we could make if researchers could conduct studies on sample sizes of 67 million people. Scientific and medical advances depend on our brilliant young people, who must be funded and supported as they embark on research careers. The number of clinical academics is in decline, which is a particular worry of mine. We should challenge that and reverse it. The NHS is easily the biggest employer in our country—perhaps one of the biggest employers in the whole world—but what are we doing to ensure that its people can best support us? A failure to tackle long-term conditions is significantly impacting the NHS’s own workforce. Musculoskeletal conditions, rheumatoid arthritis and osteoarthritis are leading causes of absenteeism among NHS staff, with ambulance and clinical support staff particularly affected, but we also hear many examples of terrible workforce planning. We learn of nurses and midwives graduating from colleges carrying large debts, after working for thousands of hours on placements for free, only to find a recruitment freeze in the very hospitals that desperately need their skills. Instead, hospitals are spending huge sums on agency staff. This is not a long-term plan; this is short-term thinking of the very worst kind. I am glad that agency spending fell last year. We must make sure that we spend wisely on newly qualified nurses and midwives, which will end up saving the NHS enormous sums. We also ought to do something about their student debt. Why not write it off if they commit to working for five years in our NHS, giving them security? Our health service needs their expertise. What about the young doctors, of whom I have spoken before? We need enough GPs, nurses and clinicians to help people to get well, but every year, thousands of UK doctors qualify with debts of up to £100,000. Many are then sent far from home, family and friends just as they begin their careers, and after two years they face intense competition for higher training against thousands of international doctors who fill up our hospital rotas and keep our services running. Some young doctors find themselves repeating their foundation years or going overseas, and others leave medicine altogether. This is certainly not a long-term plan. We must do better. I have seen for myself that our hospitals can run better with the resources they already have. At my West Suffolk hospital I saw the results: corridor care has been abolished and long-term waits in A&E are now a thing of the past. That has been done by taking a whole-hospital approach to improve the patient experience and ensure that the appropriate health professional is dealing with the patient at the earliest opportunity. That does not cost more, the staff are happier and the service is massively better. That is what happens when we put people first, work together across the disciplines and take real responsibility for change. Mr Blair once spoke of dealing with crime and the causes of crime; today I speak of dealing with diseases and the causes of diseases. Poverty, poor nutrition and poor housing are at the heart of so much of our country’s ill health. Those are not just background factors; they are the root cause of suffering and long-term conditions. If we are truly committed to a healthier society, those are the challenges we must address. The mission of our party and our Government is to lift millions out of poverty, tackle deep inequality and shape people’s health from cradle to grave. We will not accept the shocking housing conditions endured by so many of our fellow citizens. These are not simply political and economic problems; they are the underlying causes of much disease and misery, and many avoidable deaths. There is much for us to do, but I am convinced there is much that we can do to create easier access to NHS services, improve primary care and support those who want to conduct groundbreaking medical research. I hope the Government will look to tackle our long-term conditions crisis.

I remind Members that they must bob if they want to take part in the debate.

15:12:00

It is a real pleasure to serve under your chairship, Mr Efford. I thank the hon. Member for Bury St Edmunds and Stowmarket (Peter Prinsley) for his learned and absolutely excellent speech. I will focus on my profession as an NHS optometrist and discuss the impact of sight loss from long-term conditions. Let us imagine a young mother-to-be sitting in my consulting room glowing with excitement, whose joy turns to fear as I gently explain to her that her sight is deteriorating—all of a sudden it becomes a race against time; she may never be able to see her baby clearly. Or let us imagine the teenage boy with dreams of a rugby career who leaves my room with the life-changing knowledge that he is losing his vision. Unfortunately, those are not extraordinary cases; they are everyday tragedies in my workplace. These long-term conditions are often framed in terms of physical health, but as someone working with patients losing their sight, I see—as the hon. Member already eloquently articulated—the more profound, layered consequences everyday: the emotional trauma, isolation and loss of independence, and the inevitability of declining mental health, which I want to concentrate on. For example, macular degeneration is the leading cause of blindness in the UK. It does not just take away people’s central vision; it also affects their ability to read, recognise faces and drive. That means grandparents may never be able to see the faces of their grandchildren; tears are a natural result of such a devastating awareness. There is also a condition called glaucoma—generally diagnosed later in life—known as a thief of sight, because it creeps up on someone silently, often unnoticed, until irreversible damage has been done. It steals more than vision; it robs people of confidence, safety and the ability to live independently. For many, the diagnosis comes too late, and with it comes a slow loss of identity. Sight loss is not just a health issue but a social one, and its impact is profound. More than 4 million people in England with a long-term physical health condition also live with mental health problems. Those individuals experience significantly poorer outcomes and shorter life expectancies, and economically the toll is massive: between £8 billion and £13 billion a year, or at least £1 in every £8 spent on long-term conditions, is linked directly to poor mental health and wellbeing. One extremely overlooked condition—I suspect many people have not heard of it—is a consequence of vision loss called Charles Bonnet syndrome, which causes people to see vivid hallucinations as the brain attempts to fill in the gaps left by the reduced sight. The images can be repetitive patterns, but more often and distressingly they can be realistic visions of people, sometimes long deceased, or landscapes. Let us imagine that a person who is elderly, fragile and possibly alone is diagnosed with sight loss, and all they can see is their long-lost childhood pet—it is beyond frightening. It is not a mental disorder, yet many patients suffer in silence, afraid to talk about the hallucinations for fear of being misunderstood and misdiagnosed. Research suggests that at least one in five adults with sight loss will experience Charles Bonnet syndrome—more than 1 million people in the UK—but the figure is probably even higher. Children are affected too, but we are only beginning to understand their experiences. People living with long-term conditions such as macular degeneration, glaucoma and diabetic retinopathy face a constant battle not just with their illness, but with a system that is not designed to meet the complex, long-term nature of their needs. We need a change in the Government’s upcoming 10-year healthcare plan, and I have some suggestions for that. We should recognise sight loss and associated conditions such as Charles Bonnet syndrome as part of the national long-term conditions framework. We need routine mental health screening and support for people with chronic vision impairment—in fact, for all long-term conditions. We need training for all healthcare professionals, as the hon. Member for Bury St Edmunds and Stowmarket said, in integrated work, so that optometrists, GPs and nurses identify patients and support them with the psychological impact of the illness. NHS funding models and care pathways should be redesigned to reward integrated care and cross-speciality collaboration, especially where physical and mental health intersect. We need investment in early detection and care pathways. Long-term conditions shorten lives not only through the body but through the burden they place on the mind. If we do not act, we will be complicit in that erosion. But if we do act—if we integrate care, listen to patients, fund innovations and remove stigma—we can change what it means to live with long-term conditions in this country. Let us ensure that people living with long-term health conditions, whether heart failure, arthritis, diabetes or sight loss, are not left to fall through the cracks. Sight is not a luxury, independence is not optional and suffering in silence must never be acceptable.

15:17:00

It is a pleasure to serve under your chairmanship, Mr Efford. I thank my hon. Friend the Member for Bury St Edmunds and Stowmarket (Peter Prinsley) for securing this extremely important debate. He speaks from a position of great experience. He rightly points to a holistic approach, putting the patient at the centre of their treatment. By 2035, two thirds of the UK population aged over 65 are expected to be living with two or more long-term conditions, whether chronic obstructive pulmonary disease, Parkinson’s, diabetes or epilepsy. Living with an LTC can significantly reduce a person’s quality of life. I rise to speak on behalf of those living with a condition that affects approximately 1.5 million women in the UK: endometriosis. This chronic condition, whereby tissue similar to the lining of the womb grows outside the uterus, causes debilitating pain, fatigue and often infertility, yet despite its prevalence it remains under-recognised and undertreated, like so many conditions that affect women. The average time to diagnose in the UK is more than eight years. Many women visit their GPs multiple times before receiving a referral, and some are forced to turn to private healthcare due to the lengthy NHS waiting times. That delay not only exacerbates the condition’s physical symptoms but impacts mental health and quality of life. Endometriosis is not merely a health issue for women; it is a public health issue that costs the UK economy. Over half of those affected have taken time off work due to endometriosis, and many fear job loss or reduced income. My constituent, Angela Tiernan, has thoracic endo-metriosis, a rare form of the condition where tissue similar to the uterine lining grows in the chest cavity, commonly affecting the diaphragm and lungs. Angela recently found out that planned surgery to confirm her diagnosis and reformulate a treatment plan would no longer be going ahead as the specialist Oxford University Hospitals has stopped commissioning the surgery, as have other specialist centres in London and Bristol. Angela has told me that patients are being advised to go private to access required treatments and surgeries that were previously available through the NHS, but have since been cancelled by the hospital. My constituent Angela and other women are now left in a position with no diagnosis and no access to investigation, care or treatment unless they can afford to go private. Endometriosis is a long-term condition that requires a long-term solution. I ask the Minister for reassurance that endometriosis is addressed in our 10-year-plan.

15:21:00

It is a delight to speak under your chairship, Mr Efford. I thank the hon. Member for Bury St Edmunds and Stowmarket (Peter Prinsley) for securing this important debate. Many of those living with long-term conditions are people who live happy and enriched lives. They are supported not only by wonders in medical advancements, but by the communities of people—friends, family or incredible NHS and care staff—who support them week in, week out, day in, day out. But for some, the consequences when those support networks fail can be catastrophic. I would like to use this opportunity to raise awareness of the plight of my constituent, Andy. Andy has been living with a benign brain tumour and functional neurological disorder for nearly a decade. In that time he has been treated in various medical settings. By 2022, he had been transferred from the care of London hospitals to medical facilities closer to home in my constituency of Eastbourne. Following an initial appointment there in April 2022, he was told that there would be a follow-up six months later. Outrageously, due to human error, the follow-up was not held until November 2024, a staggering two and a half years after his initial appointment. I hear of cases like that again and again, disproportionately from patients experiencing long-term health conditions. It seems there is no parity of esteem between people suffering from these kinds of conditions and people suffering from shorter-term, more emergency-based conditions. If that was not bad enough, Andy was subsequently informed that the services and expertise needed to treat his condition, which he had been referred to Eastbourne for, were not available locally, so one has to ask why that transfer happened in the first place. But the wider question, which goes to the point made by the hon. Member for Bury St Edmunds and Stowmarket, is why towns like Eastbourne are denied such important services locally. It cannot be right that people living with long-term conditions sometimes have to travel dozens or in some cases hundreds of miles to access the care that they deserve and rightly expect. We have seen in the likes of my town and across the country, following years of underfunding by the last Government, centres like the Eastbourne district general hospital losing core services to other towns and cities nearby, forcing residents to trek even further to get the treatment they need. The life of my constituent, Andy, has been hugely impacted by this woeful state of affairs—a broken system and broken administration within it. Both his personal and professional lives have been significantly compromised. He can, of course, take his case to the ombudsman, which he plans to do, but that process can take months if not years to conclude, and he needs answers now. I ask the Government: what steps are being taken to address and rectify the issues, not only with the funding but with the administration of our NHS, caused by some of these things that create such grief and hardship for residents like Andy? What steps are the Government taking to ensure that local hospitals like mine are equipped to treat a broad range of long-term conditions? Most importantly, for Andy, can I get a categoric reassurance from the Government that his case will be looked into and resolved as a matter of urgency, so that neither he nor anyone else in his position has to experience this gross injustice on top of the hardship of living with a long-term condition?

15:26:00

It is an honour to serve under your chairmanship, Mr Efford. I thank my hon. Friend the Member for Bury St Edmunds and Stowmarket (Peter Prinsley) for securing this debate. This is also an appropriate time to acknowledge his more than four decades of service as a surgeon in the NHS. I want to use my time to talk about strokes, because I, like millions of people across the country, have a personal account of dealing with this life-altering medical condition. At 11 am on 13 August 2013, I received a message from a relative saying, “I think your dad has been in a crash. The car is all smashed up and the doors are wide open outside the house.” I was at work in Cambridge that morning, and my parents’ house was back in Norfolk. Not being able to reach my dad, I managed to get a message to my sister to go round. She found my dad in bed. Unbeknown to any of us, including my dad, he had been having a stroke all morning. Getting ready for work, he struggled to put on his coat. He forgot to pick up his car keys and initially left the house without locking the door. My mother did not think too much of it. He then somehow managed to drive her to work and drove himself to his engineering factory just a bit further down the road. When he got to work, they sent him home. They thought he was drunk. On the way home, my dad crashed into a parked lorry. Dazed and confused, and in the midst of his stroke, he drove home and took himself to bed, thinking he had a cold. If he had not left the car abandoned outside the house, and if that relative had not raised the alarm, he would have been in bed for the rest of the day alone and he likely would not have survived. As it turned out, we were able to get him to hospital and we managed to have a further 10 years with him. My dad was 55 when he had his stroke. He was fit and healthy. He worked full time. He showed no warning signs, and then—wham. He had a full-on, major stroke from nowhere. As a family, we did not know much about strokes at all. I had no idea that they came in all shapes and sizes, with varying levels of severity. The recovery, too, is variable. Strokes directly affect 100,000 people each and every year. Approximately one in four men and one in five women aged 45 can expect to have a stroke if they live to 85. Stroke is the fourth leading cause of death in the UK, and a leading cause of disability. Tragically, nine out of 10 strokes are preventable through early detection and management of conditions such as high blood pressure. Last month was Stroke Awareness Month, which is an important opportunity to highlight how to spot a stroke. I urge Members to look at F-A-S-T—face, arms, speech, time—the method to recognise symptoms. Is the face drooping? Does one side of the face feel numb? Is the arm weak? Can the person raise both arms? Is speech difficult? Ask the person to repeat a simple phrase. Check to see whether speech is slurred or strange. If these symptoms are observed, it is time to call 999—F-A-S-T. I welcome the Government’s commitment to a 25% reduction in deaths from cardiovascular disease and stroke by 2035, but without urgent action on stroke, that goal will not be met. A plan is needed to tackle three key factors: early detection, treatment and prevention. There are almost 3,000 stroke survivors in my South West Norfolk constituency alone, and they are all working to rebuild their lives. The prevalence of stroke in my constituency is 473; given that one is the lowest prevalence and 543 is the highest, it is clearly a significant problem in my community. While I have the opportunity to do so, I also want to note the Stroke Association’s incredible work to support stroke survivors across the country.

15:30:00

It is a pleasure to serve under your chairship, Mr Efford. I thank the hon. Member for Bury St Edmunds and Stowmarket (Peter Prinsley) for securing the debate and, like the hon. Member for South West Norfolk (Terry Jermy), I thank him for his service. I did not know he was a surgeon —I thought he was a GP—but whatever it was, I thank him. We are all indebted to him for his contribution. It is great to speak in this debate as the Democratic Unionist party health spokesperson, and as an MP who has many constituents suffering from long-term health conditions. I frequently meet them to discuss the issues they face and, more often than not, the issue is benefits and help to fill in their benefit forms—I have a staff member who does nothing else but that. We are, then, face to face with those with complex and chronic long-term conditions. It is important to come here and make the case for them. I declare an interest as a type 2 diabetic. Believe it or not, this thin young man—he is not young no more, by the way—used to be 17 stone. He is now down to just over 13 stone. Whenever I was told I was diabetic, the doctor was very clear that I really had to do something. A sweet trolley was going by the table—I remember that well; it has stuck in my mind all these years—and he phoned up to tell me. I went to see him because I thought there was something wrong, and there was something wrong, but thank goodness it was not what I thought it was at the time. He said, “You’re diabetic. The one good thing is that you’ve got a heart like an ox.” That was perhaps the one good thing out of it all. I lost weight and was able to control my diabetes for four years or thereabouts, but then it got worse. I am now surviving with nine tablets in the morning and five at night. That keeps the condition subtle and manageable. This is not about me, but I wanted to tell that story because many people who are diabetic do not know they are. We always talk about early diagnosis, as the hon. Member for Bury St Edmunds and Stowmarket and others will know.

It is an honour to intervene on the hon. Gentleman. I am the chair of the all-party parliamentary group for diabetes and I want to emphasise the point about early detection. A family recently got in touch with me who tragically lost their daughter because she had not been identified as a type 1 diabetic and ended up in diabetic ketoacidosis. Does the hon. Gentleman agree that we need to do more to identify people and screen them for chronic, lifelong conditions?

If I could ask for one thing in this debate, it would be that—it is important. I should have welcomed the hon. Member for Wellingborough and Rushden (Gen Kitchen) to her position; apologies for not doing that at the beginning of my speech. It is a real joy to see her there. It is better than whipping, I am sure she knows. This is two debates in two days running in which we have had Parliamentary Private Secretaries and, in this case, a Whip in the place of Ministers. I wish her well in her role today. Many of the people I meet every day have diabetes, dementia, Alzheimer’s, multiple sclerosis, Parkinson’s, osteoporosis or chronic obstructive pulmonary disease. COPD has been more prevalent this last while than it has been in the past. It is an accumulative disease, of course—it comes at the end of a person’s life, unfortunately —and it catches up with people, in many cases. It is not just about the long-term physical conditions; it is the depression, the anxiety and the mental health effects, as well as the pressure of life. The physical pressures are part of it, but the mental pressures come off the back that. Many of the people I speak to have complex needs, and might have one, two or perhaps three of those conditions, which adds to the issue. Ahead of the debate I met representatives from the Cystic Fibrosis Trust and spoke to them about the effect of cystic fibrosis on people. This week, I celebrate the people, like the trust, who have responded to cystic fibrosis by trying to find a cure. CF is a chronic, life-limiting genetic condition without a cure. It affects more than 11,000 people across the UK, with approximately 500 of those diagnosed back in Northern Ireland. I meet some of them regularly in my constituency. For those living with the condition, medication and general health must be considered when planning the simplest of projects or activities—even getting out of bed, for goodness’ sake, or going down the stairs or making breakfast. Going shopping is a no-no for most of them, and interaction with family is another issue. Being unwell can interfere with work and education every day. Research has highlighted the intense financial costs of the condition, which causes an average loss in income of nearly £6,800 a year. This is not a direct attack on the Minister, but I have to make a point about the potential changes to the guidance on welfare and personal independent payments. I have raised before how the changes will impact people with certain health conditions who are on benefits such as PIP. I know that the Government are trying to get people who want to work back into work. Some people with these conditions cannot work, of course, but for people with other conditions there are days that they feel good, and days that they do not. They cannot regulate themselves and say, “I’m going to work Monday, Tuesday and Wednesday of next week,” because the fact is that they do not know how they will feel next week. They may not be able to get out of bed. The Government need to look at flexibility in the PIP process. That probably means that a person cannot do every job that they would like to do, and is restricted. It might be that they have to do some of their work from home. When they look at changes, the Government need to consider that. The Government must commit—this is my absolute red line in the sand—to scrap the four-point rule for personal independence payments, which disproportionately harms people with conditions such as Parkinson’s and CF by failing to account for conditions that tend to fluctuate. That is the very issue I am trying to put forward. As I said, the cost of some of these conditions is financially challenging for many. Aside from the loss of PIP payments, it is also important that a safety net is provided by increasing the age of transition for young people who are currently eligible for disability living allowance but transferring to PIP. These are not issues that the acting Minister will understand, or respond to positively, in a focused way, but it is important to feed these issues into the process so that when Labour comes up with a way forward, it understands the issues. I wish to speak briefly about the Government’s national cancer plan, which is extremely important for people living with cancer and the care they receive. The plan states that more care will be shifted from hospitals to local communities. Earlier today, the hon. Member for Wokingham (Clive Jones) asked the Minister for Secondary Care a question on the health and social care statement, and expressed disappointment at not hearing anything about cancer in the statement. The Government need to focus on cancer, including the early diagnosis of the disease and how quickly the process can move forward to ensure that people get treatment. Back home in Northern Ireland, general practitioners are referring people for cancer treatment, and only 35% of those people have been seen. What a disappointment. That is not the Minister’s fault—it is a devolved matter, so it is the responsibility of the Minister back home—but if 65% of people who are diagnosed with cancer are not getting treatment, my goodness me! That comes to the point that the hon. Member for Eastbourne (Josh Babarinde) made about his constituent who had to wait two and a half years—how long are people waiting to get treated? Sometimes the delay in treatment means that the person does not survive and passes away. What a tragedy that they did not get the response they needed at the time that they needed it. We need to be ever mindful that the care of people who require long-term cancer care is tailored to them and structured in a way that suits them and makes them as comfortable as possible. It is wonderful how the NHS has advanced, and how the cures for cancer have advanced. Although 50% of the people in this room will get cancer, 70% of us will hopefully survive. Is it not marvellous how the NHS has progressed and how the research into finding the cure for diseases has marched on? One in two people with a serious disability or other long-term condition, such as diabetes or heart disease, say that it is now harder than ever to get a diagnosis, and some people may have the complex issues I referred to earlier as well as cancer. Too many opportunities to support people are being missed. I look to the Minister for a response, and for her to say that the Government will do what they can, through the legislature, to provide support for people with long-term health conditions. So many people across this nation are suffering and we must do more to ensure that their lives are made as easy as possible. I look to the Minister for a very positive answer. I hope that I have not given her a difficult time; that was not my intention. I try to do things in a respectful way, and hope my questions have not been too hard to answer. They are straight from the heart, and from the heart of us all, because we are here to work on behalf of our constituents. The stories that I bring to this Chamber are those of my constituents, and the hon. Member for Eastbourne brings the stories of his constituents. The hon. Member for Leicester South (Shockat Adam) told us three or four different stories about vision, which is not something we hear about often, but those are the true, everyday experiences of his constituents. We need something in response to that. When it comes to the answers, perhaps we could have a better working relationship with the devolved Administrations. I am ever mindful that health is devolved in all three of them, but there could be concerted plans. Whenever I first came to this place, we had a United Kingdom of Great Britain and Northern Ireland diabetes plan that was agreed by this Parliament and by all the regions and all the Administrations. Sometimes, we need to do things collectively. I always put forward the advantages, and this great nation—this United Kingdom of Great Britain and Northern Ireland—is great because of all the people who make up the component parts: the Scots, the Welsh, the Northern Irish and, of course, the English.

15:41:00

It is a pleasure to serve under your chairmanship, Mr Efford. I was a bit anxious, because I do not think I have ever followed the hon. Member for Strangford (Jim Shannon) before, and people are normally leaving as he sits down. But there we are. I congratulate my hon. Friend the Member for Bury St Edmunds and Stowmarket (Peter Prinsley) on securing such an important debate. He clearly demonstrated why he was the best person to bring this issue forward, given his years of experience. I declare an interest: I was a physiotherapist for 32 years. I was also used to dealing with long-term neurological conditions such as stroke, MS and Parkinson’s, and respiratory conditions such as asthma and COPD. They are all really important. Of course, I also dealt with long-term musculoskeletal conditions such as arthritis. For the sake of balance, I should say that my daughter is a resident doctor. I had to mention her, otherwise she would tell me off. As people can imagine, we have a very balanced debate about whether a doctor does better than a physiotherapist. We have a lot of interesting debate about that. I must thank Versus Arthritis, representatives of which I met earlier this week to talk about various conditions and the economic impact of arthritis. They reminded me about this debate. I was late asking to speak because it had completely passed me by. It is really important that we acknowledge the fact that, as other hon. Members have said, there are many people in this country living with long-term conditions and living very successful lives. We must make sure that we enable them to carry on in that way. Arthritis impacts over 20 million people in this country, which is a lot of people. Whether it is osteoarthritis or rheumatoid arthritis, nearly one in six of us is living with arthritis. Arthritis affects all ages, not just the elderly, as we tend to assume, and effects children, too. Juvenile chronic arthritis is well known, and at least 10,000 children are currently living with that condition. The issue is not only diseases and the way they affect people’s mental health, or other factors, but the economic impact, as we have heard clearly from other hon. Members. Some 2.8 million people may be economically inactive due to long-term conditions. After mental health issues, musculoskeletal issues are the second biggest reason why people are economically inactive. That means a tremendous loss of revenue to the Treasury. There is also a feeling of worthlessness, and people’s mental health going down and down. One of my ladies had MS. She said: “What really creases me is my children have to help me, instead of me helping them.” That really affected her mental health. Reliance on others is one of the biggest issues. There are lots of aids, gadgets and gizmos that can help people to live independently, but they need to know about them. There can be long waits for assessment, treatment or surgery, during which time people’s long-term conditions can deteriorate. We need to ensure that we educate people with these conditions; knowing what their condition is makes it is all the more easy to manage. Knowledge is power here. We need individual, tailored help. It is not enough to say, “You have osteoarthritis of the hip—you do this.” We have to tailor the programmes to ensure that the individual is very much a part of them, as my hon. Friend the Member for Bury St Edmunds and Stowmarket said. It is all about putting the person at the centre of the care plan. They are the most important person. Obviously, I am going to say that exercise and management of the physical condition is key—I am a physio, so I would, wouldn’t I?—but it is important that people do not just curl up in a ball in the corner and think, “That’s it; my life is over.” They can still go on to have worthwhile lives with a long-term condition. Osteoarthritis happens to the best of us. I look at people’s hands and I can see that they are a bit arthritic-y; I look at the way people walk and can see that, yes, they have a hip or knee problem. Having the disease does not make it inevitable that our function goes down. It is important that we manage the outcome and ensure that people can exercise and maintain their physical fitness. The Minister will be pleased to know that, as a Welsh MP, I am not going to be making asks of her—I do welcome her to her place and congratulate her—but I hope that she listens to the asks made by my English colleagues and talks to her colleagues in the Department. As the hon. Member for Strangford mentioned, the PIP changes are coming, and we are hearing about welfare reforms. Those are important, and I understand the need for reform, but at the same time we must take account of the variability of people’s conditions, and the assessment process must be done correctly first time. We save an awful lot of time and money on appeals if we can get it right first time, and that is what everybody wants. Finally, long-term conditions are here, but they can be managed, in partnership between the individual and the services all around. Bring it on.

15:47:00

It is a pleasure to serve under your chairship, Mr Efford. I follow other hon. Members in congratulating the hon. Member for Bury St Edmunds and Stowmarket (Peter Prinsley) on bringing this vital topic to the House and sharing his insight from his many decades of medical practice as well as the tribute that he paid to his father’s—he clearly comes from a family of strong medical pedigree. He talked about the potential for a boost of more than £109 billion for the economy. He also spoke about the wheels starting to come off, but I say to him that there is no sign of that happening in his case: I have heard him make valuable contributions using his medical experience in many debates in the House. This topic is important. Analysis from the Office for National Statistics conducted during 2019 and 2020 highlighted that almost half of the UK population reported having a long-standing health problem, with the four most common chronic conditions in the UK for men and women being allergy, high blood pressure, low back disorder and depression. The Health Foundation has found that more than 9 million people in England are projected to be living with a major illness by 2040—an increase of 2.5 million compared with 2019. A third of those surveyed in 2024 did not feel supported to manage their long-term health condition. Hon. Members have brought out some important themes in the debate. They have talked about the mental health and economic impact, and the importance of social, community and volunteer care, as well as care in hospitals and health facilities. They have talked about the importance of integrating care and ensuring that appointments are co-ordinated to avoid people being pushed from pillar to post in our excellent but sometimes complicated national health service. They have also all highlighted the critical importance of prevention, screening and early diagnosis and detection, as well as the need to reduce waiting times to increase survival chances. A number of hon. Members also highlighted concerns about the benefit system and personal independence payments, and I am sure we all very much look forward to hearing from the Minister on that point. The hon. Member for Leicester South (Shockat Adam) shared some very powerful stories from his time as an optometrist, including the impact of sight loss on people’s physical and mental health. He highlighted the potential to save between £8 billion and £13 billion by tackling mental health and wellbeing impacts. The hon. Member for Scarborough and Whitby (Alison Hume) spoke powerfully about endometriosis—I have a friend called Emma who is also dealing with that condition—and highlighted that two thirds of people expect to live with long-term conditions. My hon. Friend the Member for Eastbourne (Josh Babarinde) spoke powerfully about his constituent Andy, who has a benign tumour and functional neurological disorder. My hon. Friend laid out how the NHS and the care system have not always been able to meet Andy’s needs locally, despite their good intentions. The hon. Member for South West Norfolk (Terry Jermy) spoke emotionally and powerfully about how his father’s stroke was detected as a result of a car crash, which paradoxically saved his life, and he also told us how strokes are the fourth most common cause of death and a common cause of disability. The hon. Member for Strangford (Jim Shannon) talked about the importance of access to benefits. I pay tribute to his ox-like heart. He mentioned a number of long-term conditions, including type 2 diabetes, COPD, cystic fibrosis and cancer. The hon. Member for Newport West and Islwyn (Ruth Jones) talked about her physiotherapy background. It is so good to have so many Members who bring their past health and medical background to this House. She highlighted that one in six people are affected by arthritis and she quite rightly reminded us that long-term conditions are experienced not only by older people but by people of all ages. My constituent, Terry, has a range of long-term health issues, some spanning more than 20 years. There is little to no co-ordination of his care. He has had doctors from multiple hospitals and specialist centres working on medical care, with no one named person in charge and in control. Therefore, there is sometimes difficulty resolving conflicting medical priorities. This week is national Diabetes Week. Retinopathy is a serious diabetic complication that can cause blindness, and until recently it was the leading cause of blindness in the working population. Regular eye screening is key to detect this condition. My constituent, Carolyn, has written to me to express how difficult it is to access this essential service in Oxfordshire. A new service has been contracted by NHS England—for as long as it is here—to do that work with far fewer centres. Making screening more difficult to access will meant that there will be people who find it too difficult to access that important service. My constituent, Jess, has been struggling with endometriosis for 14 years because of misdiagnosis. As a result, her condition has progressed and worsened, which could have been avoided with better informed doctors and greater awareness. In the UK, diagnosis for the condition takes an average of nearly nine years, and one in six women who have endometriosis have to leave the workplace because of it. As Members have said, the personal independence payment scoring system is not fit for purpose. My constituent, Sally, has progressive MS. She scored 12 points and was rejected, but someone with a different disability scored eight points and was approved. That is because of the proposed “four points in one activity” rule, which can punish people with complex whole-body conditions just because their needs are spread across multiple areas. My constituent was unable to work for a number of months, but did not qualify for PIP. That highlights the importance of making sure that our disability benefits system is fit for purpose. It must recognise real human needs and not just view people as numbers in a system. The UK should be one of the healthiest countries in the world with our long history of grassroots sports, high-quality food production and world-leading medical research, but under the previous Government, the UK only became sicker, and it now lags far behind its international peers. That is why the Liberal Democrats want the new Government to take urgent action to support people to live healthier lives. They should start by reversing Conservative cuts to public health funding and investing in community services, so that everyone can see a GP within seven days. We must also end the crisis in social care, which is a disaster for people with long-term conditions and for our NHS. I repeat our call for the current review into social care to be concluded this year, not in three years. We have had many reviews into social care. We do not need further reviews; we need action. We are pressing for better social care for disabled people, including free personal care and more support for family carers, such as through more respite breaks and paid carer’s leave. We would also give everyone a new right to flexible working, and every disabled person the right to work from home if they want to unless there are significant business reasons why that is not possible. We would make it easier for people with long-term conditions and disabled people to access public life—including the world of work—by, for example, adopting new accessibility standards for public spaces, improving the legislative framework for blue badges and incorporating the UN convention on the rights of persons with disabilities into UK law. There is much work to be done to raise employers’ awareness of the Access to Work scheme, simplifying and speeding up the application process, introducing adjustment passports to record the adjustments, modifications and equipment that a disabled person has received and ensuring that Access to Work support and equipment stays with the person if they change jobs. As I mentioned, social care is critical to ensuring that people with long-term health conditions are properly cared for, recognising that hundreds of thousands of people are stranded in hospital beds because they are waiting for capacity in the care system. To that end, this is Carers Week, and the Liberal Democrats are campaigning to empower care users and to support care workers and the millions of unpaid carers looking after loved ones, some of whom we have heard about this afternoon. We would create a social care workforce plan, establish a royal college of care workers to improve recognition and career progression, and introduce a higher minimum wage for carers. Boosting public health and helping people to recover from mental ill health will be critical to achieving progress, as will tackling chronic fatigue and ME. A number of hon. Members highlighted the importance of the better use of data and technology to understand health trends and improve care. I very much look forward to hearing what the Minister has to say on those topics and others covered by hon. Members.

15:56:00

It is a pleasure to serve under your chairmanship, Mr Efford. I congratulate the hon. Member for Bury St Edmunds and Stowmarket (Peter Prinsley) on securing this important debate. I declare an interest as an NHS consultant paediatrician. In my clinical work, I have seen at first hand the impact that chronic conditions can have not just on the health of individuals but on their families, their carers and their wider communities. These are conditions that can shape daily life in profound and enduring ways. In some respects, the increased prevalence of long-term conditions is a success story for the medical fraternity, because some conditions that previously would have led to a patient’s death can now be managed effectively for a longer period of time, and people can continue to live happy, healthy and fulfilling lives. There is no silver bullet for tackling such conditions, but effective interventions and systems can improve quality of life, enable independence —we have heard about the importance of that—and reduce avoidable healthcare costs. Such interventions require a co-ordinated, whole-system approach, bringing together local authorities, NHS trusts, public health, education, social care and the voluntary sector. I am glad that the Government are talking about a move away from reactive and acute-based care towards prevention, rehabilitation and supported self-management in the long term. I note that the hon. Member talked about care on Teesside some years ago. As someone who grew up on Teesside, I remember the Carter Bequest hospital—I do not know whether his father had anything to do with that—which was the local community hospital providing community care for many local residents. We increasingly see patients living with not just one long-term illness but multiple long-term illnesses, known as multi-morbidity. That provides challenges, because sometimes the medication that one would ideally provide a patient for condition A is complicated because they also have condition B, for which they are taking something else that would interact with that medication. A patient might also need an operation but not be able to have it because another condition makes the anaesthetic risk too high, so the management of the second condition might have to be suboptimal as a result of the first condition. Some people have more than two conditions. One of the challenges that people with long-term conditions will face is staffing and workforce. I notice that the Government have decided to cancel, or at least significantly reduce the availability of, level 7 apprenticeships, which train our specialist nurses in advanced clinical practice, our district nurses and our community nurses. Will the Minister talk to her colleagues in the Department for Education about how there can be a move towards community care and prevention if they are going to make it more difficult to train the people who would provide that care? The hon. Member for Eastbourne (Josh Babarinde) talked about the delay in follow-up appointments. I have seen that myself. One of the challenges is that when one is under pressure to meet the 18-week pathway and there is no similar pressure on follow-up appointment timings, the consultant’s clinic inevitably ends up with more new patients and fewer follow-ups. The follow-ups get pushed back, often for many months. How will the Minister’s team ensure that the pressure to meet the 18-week pathway does not cause chronic illness to be covered less well than it is now? I was also interested in what the hon. Member for Newport West and Islwyn (Ruth Jones) had to say about exercise and lifestyle. I see a lot of children with varying conditions in my clinics as a paediatrician, and I have been amazed by how fresh air and exercise, diet and hydration, sleep, and not spending hours on computers, particularly in the evening and through the night, can make a whole range of medical conditions better. We know that the same is true of adult care in some cases. While it is not the cure for all conditions—of course it is not—in some cases it can help people to live better with the conditions that they have. I am interested that in some cases people are allowed only a few physio appointments before they get referred back to their GP. Perhaps longer courses of physio treatment could help people a little more. Multimorbidity was recognised as a priority in the previous Government’s health and care White Paper in 2022. Community diagnostic centres opened in order to play a vital role in providing quicker access to essential tests, dealing with the backlog left by the covid pandemic. There are two centres near my constituency, in Grantham and Lincoln. I visited the one in Lincoln recently, which has had very good feedback from constituents and is providing a great service. Can the Minister confirm that community diagnostic centres will continue to be well funded following the spending review? The previous Government launched a major conditions strategy in 2023, aiming to address six key areas—cancer, heart disease, musculoskeletal disorders, mental ill health, dementia and respiratory disease—but the current Government have paused work on this strategy. They came to power saying that they had a plan. They stopped the plan that we had, because they wanted to think of their own, which is fair enough. But we are now three weeks out from the first anniversary of their election, and still this magic plan has not appeared. I say to the Minister that this is too long to wait for people who are unwell. Can she, at the very least, commit that the 10-year plan will be published before we have lost one year in which the Government could have started delivering it? Musculoskeletal conditions are particularly common long-term conditions, affecting around 20 million people in the UK—that is a third of women and about 30% of men. They are the second most common cause of economic inactivity after mental health, and take a considerable toll. I thank advocacy organisations such as Versus Arthritis for their tireless campaigning on this issue. They have highlighted how these conditions disproportionately affect women and those living in deprived communities. The recent cuts to the personal independence payments proposed by the Government have disproportionately affected people with MSK conditions. Have the Government conducted an impact assessment? My concern with the PIP changes is that they were announced to meet an economic target, rather than being properly thought through. Can the Minister confirm whether they have been properly thought through? Has an impact assessment been conducted, and if so, will she ensure that it is published so that we can all study it in some detail? Mental health should be treated as a core component of long-term care. People with long-term conditions are two to three times more likely to experience mental ill health. Research shows that people who are confident in managing their long-term conditions have not just fewer A&E visits and hospital admissions but better mental health. What concrete steps are the Government taking to improve mental health provisions specifically for those with long-term conditions? Rehabilitation can be just as important to health outcomes as medicine and surgery. As was mentioned earlier in the context of strokes, some people have very good stroke rehab care, but for others that is less of the case. Rehabilitation, particularly early rehabilitation, is very important. Providing timely rehab and self-management advice would significantly reduce the number of people diagnosed with health conditions in their 40s and 50s, for example, being pushed out of the workforce, which drives both income and health inequality. Is improved access to community rehabilitation for people with long-term conditions part of the Government’s plan to shift from hospital to community care, keeping people out of hospital and in work for longer? I know that the plan is not published yet, but perhaps the Minister knows. Long-term conditions will define the health and social care agenda of the next decade. That requires a joined-up strategy across healthcare, the Department of Work and Pensions, and social care, and for the Government to support the most vulnerable and maximise the quality of life for all our constituents who suffer from long-term conditions.

I call the Minister.

16:04:00

It is a pleasure to serve under your chairmanship, Mr Efford. It is my first time speaking from the Front Bench, so please bear with me if I get my papers mixed up. I thank my hon. Friend the Member for Bury St Edmunds and Stowmarket (Peter Prinsley) for securing this debate, and for speaking so passionately on the subject, using his decades of experience of caring for patients in the NHS. I also thank all the other Members for their insightful contributions, and the Backbench Business Committee for granting this debate, especially because it is taking place during Diabetes Week. We have had more than 10 meaningful contributions, and I wish to respond to them individually. I have noted them all down, and if I do not get to them all, I will ask the relevant Minister to respond. My hon. Friend the Member for Bury St Edmunds and Stowmarket is concerned about economic inactivity, hospital-to-community care, the digital transition for patients, and research and development. I have, in my pack, full answers for my hon. Friend. The hon. Member for Leicester South (Shockat Adam) spoke passionately about sight loss and his time as an optometrist, as well as about macular degeneration and Charles Bonnet syndrome.

My office is supporting a vulnerable, elderly constituent, who has multiple sclerosis and suffers nervous breakdowns, having also battled hip cancer and undergone a hip replacement. Does the Minister agree that the failure to provide people with social care and early-intervention support can often expose individuals to a cascade of further suffering, and of course increases the strain on our health services?

I agree, and I will come to comorbidities and some of the strategies in the 10-year plan later in my speech. My hon. Friend the Member for Scarborough and Whitby (Alison Hume) spoke about endometriosis. I was very sorry and dismayed to hear about her constituent Angela Tiernan, who has endometriosis in her chest cavity. I assure my hon. Friend that urgent action to tackle gynaecological care is taking place through the elective reform plan, and we are having significant successes in that area. I thank the hon. Member for Eastbourne (Josh Babarinde). I was also dismayed to hear about his constituent Andy’s benign brain tumour. I was particularly dismayed to hear about his treatment, and the transfer of services to the community. The hon. Member rightly asked about the administration from care to community. I assure him that further work on the national neighbourhood health implementation programme will come after the 10-year health plan. I see that issue all the time in Wellingborough and Rushden, as he does in his constituency. As a semi-rural community, we have very little in the way of community healthcare, so I am also pushing that forward. I will ask the relevant Minister to respond directly to him about Andy’s case. My hon. Friend the Member for South West Norfolk (Terry Jermy) gave an impassioned and personal speech about his father’s stroke. I am grateful to him for highlighting and raising awareness of the F-A-S-T action that people can take if they think that someone is having a stroke. I reassure him that the NHS is actively working to provide access to 24/7 thrombectomy services across England and Wales. I thank the hon. Member for Strangford (Jim Shannon) for his speech. As he said, health in Northern Ireland is a matter for the Northern Ireland Assembly, but I assure him that the Secretary of State is regularly engaging with his counterpart across the sea on all the issues that the hon. Member outlined, which were many. He told his personal story of diabetes, and spoke about COPD, cancer, cystic fibrosis and many other conditions. I share the sentiment that it is marvellous that so many people will now survive cancer. As he may know, my father is currently undergoing treatment for his terminal diagnosis. I reassure the hon. Member—and it gives me some hope—that the national cancer plan is coming. We had a lovely intervention from the hon. Member for Harrogate and Knaresborough (Tom Gordon), who is also the chair of the all-party parliamentary group for diabetes. I thank him for his work on diabetes awareness. I thank my hon. Friend the Member for Newport West and Islwyn (Ruth Jones) for her many years of service as a physiotherapist, and I thank her daughter for her many years of service as a doctor. My hon. Friend rightly raised arthritis and all the great work that she did as a physiotherapist. I am sure that she is aware of the great work that the National Institute for Health and Care Research is doing with Versus Arthritis in funding dedicated UK MSK translational research. She will also be aware that the National Institute for Health and Care Excellence has published expert guidance on early diagnosis to speed up that process. She will know that the Department of Health and Social Care and the Department for Work and Pensions are committed to supporting disabled people and people with long-term health conditions. A range of support is available already, including some that joins up the health and employment support systems. I agree that we need to get it right first time, because a system that has an over 90% appeal approval rating is not getting it right first time. The hon. Member for Didcot and Wantage (Olly Glover) and I spent a lot of time together on the Planning and Infrastructure Bill Committee; I am glad to be able to finally respond to him on things. I was very sorry to hear about his friend Emma and his constituents Terry and Jess, who have a range of health conditions. I was particularly dismayed to hear that Terry had no one named person in his multidisciplinary team. That should not be happening. The hon. Member for Sleaford and North Hykeham (Dr Johnson) asked many questions, which I have noted down. If she does not get the answers in my speech, I will press the relevant Minister to write to her. She asked about training and apprenticeships. To reassure her, a new workforce plan will be coming after the 10-year plan, and the 10-year plan will be coming in the summer. I would love a community diagnostic centre as well; in a semi-rural constituency, it is very hard to get care. I will press a Minister to write to her, following the spending review. I pass on apologies from my hon. Friend the Member for West Lancashire (Ashley Dalton), the Minister for public health and prevention, who is passionate about improving care and support for people with long-term conditions, and had really looked forward to responding to this debate. Unfortunately, due to the medical emergency of a family member with a long-term condition, she is unable to be in Westminster this week, but she hopes to return to Westminster as soon as possible to write the letters that I have promised on her behalf. This is a busy afternoon in the House for the Health Department, with my hon. Friend the Minister for Secondary Care currently representing the Government in a general debate on the fifth anniversary of the covid pandemic in the main Chamber, and my hon. Friend the Minister for Care currently serving on the Mental Health Bill Committee. I am pleased to be here to respond on their behalf to such an important debate, and I hope that my remarks demonstrate that improving support for those with long-term conditions is a priority for this Government. Over 15 million people in England have long-term health conditions, and many people live with two or more. Every one of us has a constituent living with a long-term condition; even some of my colleagues in this place who have shared their stories today have long- term conditions. Given that the prevalence of long-term conditions generally increases with age, the number of people with such conditions in our society will only get bigger, as new treatments and technologies keep us alive for longer. Let me be clear: that is to be celebrated. It is a wonderful and amazing thing to happen, but it is critical that we have the health architecture in place to manage those changes. That is why building a health service and care system fit for the future is central to this Government’s mission. Yesterday, my right hon. Friend the Chancellor of the Exchequer set out the multi-year spending review, which prioritises health, with a record investment in the health and social care system that will improve treatment, support and outcomes, and help those living with long-term conditions. The Government are providing £29 billion more in day-to-day funding in real terms than in 2023-24, and the largest-ever health capital budget, with a £2.3 billion real-terms increase in spending over the spending review period. The spending review puts the NHS on a sustainable footing by cutting the waiting lists so that by the end of the Parliament 92% of patients will start consultant-led treatment for non-urgent health conditions within 18 weeks of referral, delivering on the Prime Minister’s plan for change and commitment to prioritising people’s health. The settlement also supports the shift from analogue to digital, with a total investment of up to £10 billion in NHS technology and transformation between 2026-27 and 2028-29—an almost 50% increase from 2025-26. Colleagues will know that we have undertaken the biggest ever conversation about the NHS since its creation. We have received more than 270,000 contributions and had almost 2 million visits to our online portal, a significant number of which were from people with long-term conditions. We will ensure that their voices are heard in the 10-year plan. The plan will deliver three big shifts to ensure the NHS is fit for the future: from hospital to community, which we have spoken about a lot this afternoon; from analogue to digital, which was also mentioned a couple of times; and from sickness to prevention. All three are relevant to improving the diagnosis, care and management of long-term conditions in all parts of the country. We will see more tests and scans in the community, in high street settings, to reduce the need for people to take multiple trips to hospital to get diagnosed—a particular issue in Wellingborough and Rushden, because we do not have a hospital or a bus service. We will see better joint working in neighbourhoods between primary care, pharmacies, community healthcare, such as district nurses, and social care to help people to manage multiple long- term conditions at home. That will help them access the right self-care professional support so that they are not passed from service to service, and will reduce the need for emergency hospital admissions. Again, that is brilliant for Wellingborough and Rushden, as I am sure it is for all hon. Members’ constituencies. We will see better access to technology that helps people to manage their health conditions in their own home, such as apps and wearable technologies, to reduce the need to go to hospital or other healthcare settings. We will have better, joined-up access to healthcare records, as my hon. Friend the Member for Bury St Edmunds and Stowmarket suggested, to ensure that those working in health and care are better able to support patients in planned and emergency care, and that patients feel confident that the clinicians who are treating them know about their conditions. There have been many mentions in the debate of the changes to welfare and economic activity. We recognise that people with long-term conditions face multiple challenges in trying to remain in work. Long-term sickness continues to be the most common reason for economic inactivity among the working-age population.

I congratulate my hon. Friend on her turn speaking from the Front Bench. DWP analysis suggests that people with long-term conditions such as arthritis are more likely than most to be affected by the changes to PIP. Does she acknowledge that taking away PIP from people with long-term conditions such as arthritis, which can fluctuate and vary, could be devastating?

I acknowledge that those with long-term health conditions such as arthritis will rightly be very worried about what is happening, considering that only a Green Paper, rather than a Bill, has been published. I assure my hon. Friend that the Department of Health and Social Care and the DWP are committed to supporting disabled people and those with long-term health conditions. There is already a range of support that is online and working, but we want those who are in work and can stay there to do so, and we want people to get back to work. Those measures include joining up the health and employment support around the individual through employment advisers, NHS talking therapies, individual placements, support in primary care and WorkWell, as well as work coaches and disability employment advisers at the jobcentre. That will get people back to work if they can, and keep working people in work. We have a range of specialist initiatives to support individuals. Things currently online include WorkWell, and Connect to Work is coming online as we speak. We are also mobilising eight place-based trailblazers to reduce economic inactivity in places where we can see that it is really key. On elective care, our plan for change is clear that our immediate priority on health is to reduce elective waiting lists to meet the NHS constitutional standard that 92% should wait no longer than 18 weeks from referral to treatment. We have hit that pledge already—more than 2 million more elective care appointments have happened early—and we have now exceeded it by delivering over 3.5 million more appointments.

Hear, hear!

Thank you. In fact, the waiting list has been cut by over 200,000 since we came into office. Another topic touched on a lot was social care, its effective use and access to it. Effective and accessible social care is crucial for people with long-term conditions.

There is a question that I have been wondering about. Baroness Casey is doing a report for the Government on social care, but she is also doing a report on child abuse. We were told initially that those reports would run consecutively, but they appear now to be running concurrently. I do not necessarily expect the Minister to be able to answer the question now, because she is standing in for somebody else, but it would be helpful if she could get us a written answer on what proportion of Baroness Casey’s time is currently devoted to the Home Office, and what proportion to healthcare.

I was coming on to Baroness Louise Casey’s report to the Prime Minister. I will try to get an answer from the Departments she is working with. Hon. Members will be aware that we have launched the independent commission into adult social care as part of our critical first steps to delivering a national care service. It is chaired by Baroness Louise Casey and reporting to the Prime Minister. The commission will make clear recommendations for how to rebuild social care systems to meet the current and future needs of the population, but I will make sure that Ministers write to the hon. Lady on her specific question. We also had a small discussion on unpaid carers and how crucial they are for individuals with long-term conditions. These unpaid carers, often family members or spouses, do vital and essential work that helps people to manage their long-term conditions and also helps the health service. Lord Darzi’s independent review of the national health service highlighted the need for a fresh approach to supporting and involving unpaid carers, to improve outcomes across the board for carers and those they care for. Those findings are being carefully considered as part of our 10-year plan to reform and modernise the NHS. We continue to shape our plans to reform adult social care, including through the national care service. We cannot underestimate the toll of living with one or more long-term health conditions. The hon. Member for Tiverton and Minehead (Rachel Gilmour) made an intervention about the mental health support that is needed for long-term conditions. Living with one or more long-term conditions can put significant stress on an individual’s mental wellbeing and can lead to stress, worry and depression—all of which come to our constituency doors a lot. Two thirds of people with a common mental health problem also have a long-term physical condition. That is why the NHS is prioritising the development of NHS talking therapies to include a focus on people with long-term conditions. These services bring together mental and physical health providers to work in a co-ordinated way to achieve the best outcomes for all. I feel that I have been speaking a rather long time, so, to conclude, I once again thank my hon. Friend the Member for Bury St Edmunds and Stowmarket, for securing the debate, and all those who have spoken. The debate has been extremely wide ranging and covered conditions from across the spectrum, many of which I cannot pronounce. I hope that Ministers will be able to write back to hon. Members and reassure them on some of the questions they have raised today. It is understandable that we have covered so many topics, given the sheer number and breadth of long-term conditions and the multitude of challenges they pose for individuals, their families, their communities and the healthcare system. For that reason, as I said, I have not been able to cover in full the well-informed points that were made throughout the course of the debate. However, my hon. Friend the Minister for public health and prevention has committed to writing to all hon. Members who have raised specific concerns today.

16:24:00

I thank all who have contributed to this interesting discussion. I particularly thank my hon. Friend the Member for Wellingborough and Rushden (Gen Kitchen), who has acquitted herself extraordinarily well and should be congratulated. It is quite obvious that many of our fellow citizens are depending on us. It is also obvious to me that the politics of healthcare really do matter. We have an opportunity to do something about this, and we must seize that opportunity, because I believe that is one of our great missions. I thank everyone very much for coming to the debate this afternoon.

My congratulations to the hon. Member for Wellingborough and Rushden for filling in ably for the Minister. Question put and agreed to. Resolved, That this House has considered long-term conditions.

16:25:00