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Health and Social Care

Volume 699: debated on Tuesday 13 July 2021

The Secretary of State was asked—

Social Care Reform

What recent discussions he has had with the Chancellor of the Exchequer on funding for a plan to reform social care for (a) older people and (b) people of working age. (902628)

I want people to be able to get the care they need when they need it and to have the choices they want. I want people to live their life in full and to live independently as part of a community for as long as possible without facing an astronomical care bill. We are committed to social care reform, and we will bring forward proposals this year.

I thank the Secretary of State for responding to my initial question. Eleven years into this Tory Government, 10 years on from Dilnot and almost 700 days since the Prime Minister promised

“to fix social care, once and for all”,

looking at it and studying the options is not enough for the four out of five people who say, “We need a solution now.” Is this just another of the Prime Minister’s promises that will not quite materialise?

We have already seen substantial increases in adult social care funding, but the Government have said that we want a long-term, sustainable solution, so we will bring forward proposals on that. The hon. Gentleman will know that later today we are debating the Health and Care Bill, which is also about structural reform, so I look forward to seeing him in the Aye Lobby.

May I just say to the Chancellor—the Secretary of State, rather—that when he brings forward the proposals, will he make sure that he addresses social care for working-age adults, which actually accounts for more than half of public spending? The debate is always focused on older people, and people of working age often get forgotten. The reason for my slip just now is that he will be aware, as a former Chancellor, that the tax burden was at a 50-year high before covid. When he brings forward the proposals, can we not just default to putting up taxes, however they are disguised, but look at overall Government spending, set some priorities and make some choices about what we think is important? Social care is important, but we need to make those choices about overall Government spending.

First, my right hon. Friend is right to bring to the House’s attention the way that the Government are also working on social care for working-age people. He is also right to point out—I was thinking about this the other day—that around 55% of total adult social care spending is for working-age adults, and it is important that we continue to provide that support. He will be pleased to know that I am working with the current Chancellor and other Cabinet colleagues on bringing forward a more sustainable long-term plan, and I hope he will support it when it comes forward.

I welcome what my right hon. Friend has said so far and the moves he is making to deal with the social care issue. One thing that elderly people particularly are worried about when they are in care or in hospital are the recent reports of “Do not attempt cardiopulmonary resuscitation” orders. Will my right hon. Friend give an assurance that they will only be put in place with the authority of the patient or their next of kin? Is he making inquiries into recent reports of their widespread use?

My hon. Friend will be interested to know that the Department commissioned the Care Quality Commission to review the DNACPR decisions that were being made during the first wave of the pandemic. That review was published in March, and the Department then established a new ministerial oversight group that will be responsible for delivery and the required changes that were recommended in the review. We want to ensure adherence to the guidance throughout the system whenever DNACPR orders are used. The first meeting of this new group will take place on 8 June.

I welcome the Secretary of State to his new position. I wondered whether he might be able to clarify something for me. Five days ago, he told the Local Government Association conference that for social care reform,

“we may not be able to announce the whole plan…with all the details there”,

but that he hoped to

“set out…the general sense of direction”.

The general sense of direction! It is two years since the Prime Minister made a clear promise to fix the crisis in social care “once and for all”. Since then, more than 40,000 care home residents have died from covid-19 and 2 million elderly and disabled people have applied for care but had their request turned down. Millions more families and staff have been pushed to breaking point, so may I ask the Secretary of State: what is the plan? When will we see the plan? Will it provide the full details that he and the Minister for Care, the hon. Member for Faversham and Mid Kent (Helen Whately) have promised, or does keeping your word mean nothing to anyone in government anymore?

I think the hon. Lady may well have misunderstood what I said at the conference; I am not sure she listened to the whole session. It is worth repeating that the Government are absolutely committed to coming forward with a sustainable plan for adult social care and to bringing forward that plan to make sure that every person when they reach old age in our country can have the dignity they deserve. We will bring forward full proposals—a full plan—this year.

Covid-19: Departmental Response

Since the start of the pandemic, we have acted swiftly to reduce the spread of the virus and to keep the public safe. As our vaccine programme progresses, links between cases and hospitalisations weaken, and that means that we are confident we can move forward with step 4, as I set out in the House yesterday.

I thank the Health Secretary for that answer. After the planned changes next week, the Health Secretary is predicting that covid cases will reach 100,000 a day. Research is suggesting that that could result in 3,000 hospital admissions and again put our health services under pressure. What is his response to Dr Mike Ryan of the World Health Organisation, who described the proposals to remove all covid measures and simply let people get infected as “epidemiological stupidity”?

The hon. Gentleman talks, understandably, about pressure on the NHS, and he will know that the restrictions we have necessarily had in place during the course of this pandemic so far have also led to considerable pressure on the NHS, especially when it comes to non-covid health problems. He may be aware, perhaps for his own constituents, that mental health problems are up, there are many undiagnosed cancer cases, domestic violence is up and child abuse is up. I hope he will agree with me that one of the things we can look forward to as we gradually start removing restrictions is helping people with their many non-covid health problems too.

I also welcome the Secretary of State to his new role. I hope he will soon see that the Department performs best when it follows the scientific advice. This morning, Professor Graham Medley, the chief modeller for the Scientific Advisory Group for Emergencies, said of mask wearing that

“if it’s not mandated it probably won’t do any good.”

That advice would explain why, last year, the Government moved from just guidance on mask wearing in May 2020 to making it compulsory on public transport in June and in shops in July. So if the advice is clear and the Government took that advice last year, why on earth are they moving away from it now?

The hon. Gentleman will know that the Government’s decisions are rightly informed by the best possible scientific advice there is and, as well as that, looking at the data and then taking all of that into account when reaching decisions. The hon. Gentleman asks about masks, and I have answered that question a number of times at the Dispatch Box. I am very happy to repeat that we are moving away from a system of regulation to guidance, but in that guidance, which was published yesterday, we have made it very clear that in certain situations masks will still make sense, and we believe that people will use their common sense and follow that guidance.

NHS Estate

In our manifesto, we committed to building 40 new hospitals by 2030 and to upgrading another 20 hospitals. We are delivering on this commitment, and we now have plans to build 48 new hospitals this decade. We are also delivering improvements across the country to hospital maintenance, eradicating mental health dormitories and improving A&E capacity. Finally, the Department has received a £9.4 billion capital settlement for 2021-22, including the first year of a £5.4 billion multi-year commitment until 2024-25 for new hospitals and hospital upgrades, and £4.2 billion for NHS trusts’ operational capital.

Some 83% of the Airedale hospital in my constituency is built from aerated concrete, with the building containing 50,000 aerated concrete panels in its construction, which is five times more than any other hospital in the UK. This building material is known for its structural deficiencies, so can my hon. Friend assure me that when his Department considers new infrastructure projects, schemes with the highest risk profile, such as the Airedale hospital, will be an absolute priority?

My hon. Friend is a doughty campaigner in this House on behalf of his local hospital at Airedale, going the extra mile, I gather from the Keighley News, by committing to run 100k in 10 weeks to raise funds for, among other things, the Friends of Airedale Hospital—I hope, if he has not finished that yet, it is going well.

To my hon. Friend’s substantive point, he raises an important issue. Airedale has been allocated capital investment in the millions for the 2021-22 financial year from a funding budget that is ring-fenced for RAAC—reinforced autoclaved aerated concrete—plank remediation, but I can reassure him that, as we look to set the criteria for the next eight hospitals, safety considerations are highly likely to be one of the key considerations.

The Minister will be aware that, in March 2018, Shrewsbury and Telford Hospital NHS Trust was allocated over £300 million to undertake a radical transformation of its acute hospitals at Shrewsbury and Telford. Since then, the trust’s management have been engaged in finalising the strategic business case, but as a consequence of changes to the Green Book and clinical standards the cost will have increased. Will the Minister commit to meet with Shropshire and Telford MPs once the business case is complete to help to ensure that the project can still be delivered?

NHS E&I and the Department of Health and Social Care wrote to the Shrewsbury and Telford Hospital NHS Trust on 19 November last year confirming we remain committed to supporting the scheme. This letter confirmed the allocation remains at £312 million at this time, and of course my right hon. Friend will recall that I committed to approving the request in principle for £6 million of early funding to continue to develop the scheme. It is an important scheme, we want to see it proceed and I am very happy to meet him and fellow Shropshire colleagues.

In my role as chair of the all-party group for axial spondyloarthritis I have heard from many about the importance of hydrotherapy pools in supporting those living with the condition, but there has been a concern that the reopening of these pools following the pandemic has been jeopardised by space within hospitals being allocated to other functions and a general low level of prioritisation. Does my hon. Friend agree that it is vital that we have robust plans in place to reopen as many hydrotherapy pools as possible, and will he consider meeting me to discuss this matter in further detail?

I pay tribute to my hon. Friend and the all-party group for their work. He raises an important point: the challenges posed by infection control and the impact of the pandemic on the operation of hospitals. That has had an impact in this space, but I entirely recognise the value and importance of hydrotherapy as a treatment for particular conditions and I will be delighted to meet him.

Of course the number of general and acute beds open across the estate impacts on a trust’s ability to get on top of the elective backlog, which now stands at 5.3 million—a record high—with 336,000 waiting over a year and 7,000 waiting over two years for treatment. On appointment, the Secretary of State promised trusts that they would get everything they need to get through the backlog. So how much will trusts get and when will they get it?

It is an important question. The Secretary of State has made it clear that tackling the elective backlog is one of his key priorities in his new role. The right hon. Gentleman will be aware that the Government have already committed £1 billion to helping to tackle the elective backlog. That, of course, comes on top of the record funding of £33.9 billion to ’23-24 for our NHS, but that commitment remains. We will do whatever is necessary to ensure that our NHS can tackle the elective backlog and get those waiting lists down.

I am grateful to the Minister for his answer, but if it is a priority of the new Secretary of State why on Friday were trusts told that the threshold for accessing that elective recovery funding was increasing, effectively making it harder for a trust to access funding at just the time when hospital admissions for covid are increasing and we have trusts, such as in Leeds and Birmingham, cancelling cancer surgery? Surely we should be giving trusts more resources now, not restricting access to the elective recovery fund.

In terms of the elective recovery fund, we have worked with the NHS to determine the right thresholds and the right premiums for payment for elective activity over and above what we would be expecting in the circumstances. The NHS is doing an amazing job in difficult circumstances, as the right hon. Gentleman will appreciate, with the impact that infection prevention control restrictions have had on the ability of trusts to see the number of people that they normally would. Trusts are taking huge strides to restore services and the ERF is there to help to ensure that they are funded for that activity level so that they can get provision up and above where it needs to be in order to get the waiting lists down.

NHS: Trade Deals

We have been clear that the NHS, the price it pays for medicines and the services it provides are off the table in our trade negotiations. No trade agreement has ever affected our ability to keep public services public, nor forced us to pay for more medicines. My Department works closely with the Department for International Trade to ensure that this is reflected in the negotiations of new trade deals.

Last week we proudly celebrated the wonderful creation of the NHS—the most cherished of all national institutions—yet grave fears remain about its ultimate privatisation under this Government. If the Government are determined to sign up to the provisions in the trans-Pacific partnership for investor-state dispute settlement, can the Minister at least do one thing today to limit that damage? Will he guarantee that the NHS will be totally exempt from the scope of those ISDS lawsuits and ensure that that exemption is written into the terms of the UK’s accession?

The Government have been clear in our published approach to negotiations, both on the comprehensive and progressive agreement for trans-Pacific partnership and any US trade deal, that protecting the NHS is a fundamental principle of our trade policy. The UK will ensure that the terms we sign up to in any trade negotiation uphold the Government’s manifesto commitment that the NHS, its services and the cost of medicines are not on the table, and that we hold true to our principles underpinning the NHS—of a service available to all at the point of need, free.

Childhood Obesity

We are committed to halving childhood obesity in England by 2030, and the 2020 strategy takes decisive action to help everybody to achieve and maintain that healthier weight. We have five trailblazer sites working to create a healthy environment for our children. We have laid regulations for out-of-home calorie labelling. We have put £100 million into funding for adult and child weight management, and announced the introduction of some of the toughest advertising restrictions—both on TV and online—regarding children’s exposure to high fat, salt and sugar products. This is about the cumulative effect of several policies.

I am grateful to my hon. Friend for mentioning that wide range of measures. May I also encourage her to work closely with colleagues at the Department for Education and the Department for Digital, Culture, Media and Sport on an expanded children’s sports and activity plan, both in and out of school, to try to make 60 minutes a day as much a norm as five-a-day fruit and vegetables by bringing in the power of sports clubs and the governing bodies, and finally getting more school facilities available for out-of-hours use?

My right hon. Friend’s question is music to my ears. He will be pleased to hear that, last week, along with Ministers from DCMS and the DFE, I was in front of the Lords National Plan for Sport and Recreation Committee talking about doing just that—about how we can build on the DFE’s £10.1 million contribution, so that we can unlock the 40% of facilities that lie on school estates and help to get children active for 60 minutes a day. We will be publishing our cross-departmental update to the school sport and activity action plan later this year.

Ultra-processed food is basically high in fat, high in salt and high in sugar, and it is highly addictive. I believe that it plays a significant part in the growing crisis that is obesity. I genuinely believe that it is not food in itself, when one considers all the flavourings and artificial colourings that have to go into it to make it taste like food in the first instance. Does my hon. Friend agree that the food industry needs to play its part in tackling the obesity crisis, and not contribute to it?

I do. This is about helping people and caring for people. We know the detrimental effect obesity has on all stages of our lives. It costs personally, in productivity terms, as well as the NHS, being the precursor to diabetes, heart disease, cancer, musculoskeletal conditions and so on. We cannot afford for the country not to tackle this issue. I am encouraged, but want to see business go faster in the reformulation ambition to reduce the salt, sugar and fat in these products.

General Practice Data for Planning and Research

What progress he has made on consultations on the General Practice Data for Planning and Research roll-out. (902631)

We are committed to being transparent about the collection and use of data. We paused the implementation of GP data for planning and research services, and we have had productive discussions with the Royal College of General Practitioners, the British Medical Association, health charities and others. We have listened to the concerns and we will respond to them. We will continue to listen and we will take our time. We will show patients and clinicians why they can have full trust and confidence in the programme, where data will only be accessed through a secure environment with the oversight of the Information Commissioner’s Office and the National Data Guardian.

The Government’s plan to give pharmaceutical firms access to pseudo-anonymised data from GP practices in England is creating public concern and distrust, just like the failed project of 2013. Most patients would be happy to see better communication and information sharing within the NHS, as well as for public health and academic research, but are concerned about commercial access to their data. Will the Minister halt the process to allow time for genuine debate and public consultation?

The hon. Member and I are both passionate about the use of data to enhance patient care, as she outlined. That is the prize here. We are listening. We are taking our time. The data will only be used for health and care planning and research purposes by organisations that have a legal basis and a legitimate need to use the data. NHS Digital will publish all the details of the data we have shared on our data release register. We want to build confidence. We want to build trust. We are listening, but this is an important agenda that we need to get right to deliver better care for patients.

The problem is that the plan to allow commercial access is going to undermine the public trust in improving digitisation within the NHS, and the Minister will be aware of that. The current plans apply only to the NHS in England, but can she guarantee that the United Kingdom Internal Market Act 2020 will not be used to force commercial access to patient data from Scotland’s NHS? If so, can she explain why the Department for International Trade is advertising access to the health data of 65 million people, which is the population of the whole UK?

I go back to the answer I gave: we do not allow data to be used for commercial purposes. NHS Digital will not approve requests for data where the purpose is for marketing and so on and so forth. The hon. Member would not expect me to respond on behalf of another Department, but I reiterate that we are communicating and building trust. There will be a public information campaign. We will be working across the professions and across research to make sure that access is appropriate and proportionate. In the Health and Care Bill, we will be redoubling our efforts to make sure people have that confidence.

At the previous health questions, we secured a commitment from the Minister to delay the implementation date for this data grab in order to properly communicate with the public. However, rather than a significant delay so there could be the public information campaign the Minister says she is so keen to have, on the basis set out by the BMA and the Royal College of GPs, what we have instead is a short pause. The Minister says she wants to listen and to build trust, so why on earth is this being snuck out during the summer recess? The reality is that the Government simply have not passed the test for informed consent. Will the Minister take this moment today to stop this process and commit to a proper engagement campaign, rather than running off during recess?

I really respect the hon. Gentleman, but nothing is being snuck out. We are not doing a data grab. I refer him to the answer I gave a few moments ago. It is important that we get this right. We have heard the concerns and will respond to them. We will take the appropriate amount of time—even if that means going beyond 1 September—to ensure that we have engaged properly.

Covid-19 Roadmap

What evidence he plans to use to inform the Government’s decision on whether to proceed with step 4 of the covid-19 road map on 19 July 2021. (902632)

What evidence he plans to use to inform the Government’s decision on whether to proceed with step 4 of the covid-19 road map on 19 July 2021. (902653)

The Government have committed to taking a cautious approach to easing restrictions, guided by the data and not by dates. As I set out in my statement to Parliament yesterday, the decision to lift the remaining measures on 19 July and proceed to step 4 is based on an assessment of the four tests that were set out in the road map.

I thank my right hon. Friend for his answer and welcome him to his new post.

For me and most of my constituents, 19 July cannot come early enough. It is refreshing to see the Secretary of State’s new approach to the wider issues of health provision, and the huge success of our vaccine roll-out has surely ensured that there should and will not be any more lockdowns or restrictions on our civil liberties. Will he assure me that no matter what vested interests have held sway in his Department and across Government in the past 18 months, he is clear that lockdowns and state intervention in the lives of our constituents have gone far enough and need to be curbed?

First, I am pleased that my hon. Friend agrees with the decision we have made to proceed with step 4. It sounds like he agrees with the central decision to move from a system of regulation to one of guidance. As he knows, the pandemic is not over, so we are rightly moving forward in a measured way. I am pleased that he agrees with the approach.

I also welcome yesterday’s step 4 announcement. Does the Secretary of State agree that his Department should embrace a bit more risk by working with the Department for Transport to open up the international travel sector fully? Will he also ensure that GPs return to fully physical appointments and that we open up the full range of dental services?

I am pleased to tell my hon. Friend that, now that we have begun the process of opening up, more work is being done between my Department and the Department for Transport on international travel. The announcements made by my right hon. Friend the Transport Secretary last week will certainly help and be welcomed by the sector and travellers. On GP access, now that we have started to open up, working together with GPs we can see better direct access, and especially face-to-face access.

Pharmacies: Primary Care

We are committed to the five-year community pharmacy contract and to enabling community pharmacy to deliver more clinical services as well as being the first port of call for minor illnesses. Pharmacists are highly skilled members of the primary care team. We are making good progress with referrals from NHS 111 and general practice, with discharge medicines services from hospitals, and with 96% of pharmacies providing lateral flow tests as well as delivering vaccines. We know that community pharmacies are keen to deliver more, and we should be thinking pharmacy first.

I am sure the Minister agrees that pharmacies have gone above and beyond to deliver vital medicines and health advice to patients in their communities during the covid-19 pandemic and that their response underlines the huge potential to grow their already massive contribution to our nation’s health. Pharmacies have proven themselves to be a valuable member of the NHS family, so will she prioritise looking at the potential for pharmacies to provide even better primary care? Will she bring forward a plan to unleash their potential post pandemic?

I know that the hon. Lady speaks from experience, having been a clinical pharmacist before she came to this place. That potential needs unleashing. We are working across the profession to make sure that pharmacies are enabled to play a fuller part in the primary care family. We should think pharmacy first when we have minor ailments, and pharmacies should be enabled to do everything they can.

Health and Social Care: Collaboration

We can no longer just think of a health system; we have to think about the health and social care system. We want people’s experiences of care to be seamless, which is why we have introduced the Health and Care Bill and will debate its Second Reading today.

In order to better integrate and support local services in Nottinghamshire, we would benefit greatly from working with a single integrated care footprint for a simpler and fairer service. A boundary congruous with our county boundary would allow us to offer more equitable care across the whole area. I understand that the decision on the integrated care system boundaries is imminent, so will my right hon. Friend meet me to discuss the potential benefits?

I am aware that several factors are helpful in fostering stronger partnerships between the NHS and local authorities, including alignment of boundaries. My hon. Friend will know that the former Secretary of State, my right hon. Friend the Member for West Suffolk (Matt Hancock), asked NHS England to conduct a boundary review for integrated care systems. That review, which is just being completed, will certainly look at and give advice on the best ICS footprint for alignment. No final decision has yet been made, but it is a priority for me. I would be happy to arrange a meeting for my hon. Friend with Ministers to discuss the matter further.

Covid-19: Child Health Services

What steps he plans to take in response to the findings of the Royal College of Paediatrics and Child Health on the effect of covid-19 on child health services, published on 14 June 2021. (902636)

My apologies, Mr Speaker; I have lost my voice slightly. I was at Wembley on Sunday night and I have to say that those young lions outperformed. We are so proud of them, and I am certain that in 15 months’ time the nation will get behind them in Qatar and they will outperform again.

I thank the hon. Member for raising this really important question. We are committed to protecting vulnerable children and ensuring that every child receives the best start in life.

Children’s and young people’s health has been severely impacted by the pandemic, but it is the mental health impact of lockdown and school closures that is perhaps most concerning. Some 12% of in-patient paediatric beds are now occupied by those admitted because of severe mental health problems. That is double what it was in 2019. Does the Minister agree that children and young people have suffered greatly as a result of lockdown and that their health should now be prioritised in our recovery? If so, what steps will he take to put children at the heart of all policies and implement an overarching child health strategy?

I am grateful for the hon. Member’s question. Our mental health recovery action plan will allow us to deliver additional support for 22,500 more children to have access to community health services—I know that the Minister for Patient Safety, Suicide Prevention and Mental Health would say that community access is incredibly effective—and for 2,000 more children to access eating disorder services. It will also help to increase the coverage of mental health support teams in schools and colleges from 29 to 400 by April 2023. That makes it all the more important, as the Secretary of State has outlined, that we get to step 4: it is critical to delivering the recovery action plan.

Patient Transport: VAT

What recent discussions he has had with the Chancellor of the Exchequer on the effect on patients of the VAT treatment of patient transport service providers. (902637)

While the Department of Health and Social Care takes a keen interest in any tax situation that may affect patients, any discussions surrounding the VAT treatment of patient transport services would need to be conducted with relevant officials in Her Majesty’s Revenue and Customs. Services for the transportation of the sick and injured are exempt from VAT.

Non-emergency patient transport services provide vital support to those who have no other way of reaching hospital and medical appointments, in addition to those who require specialist transport. An inconsistency in the VAT treatment of providers currently means that some can claim VAT relief while others cannot, despite providing the same services in the same type of vehicles. Would the Minister consider meeting representatives of the sector to better understand the impact and, hopefully, find a way forward?

I am very happy for myself and the Under-Secretary of State, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), to meet with others about that. Of course, I cannot comment on specific cases, and I would recommend that the services in question take up their concerns with Her Majesty’s Revenue and Customs as well.

Quarantine-free Travel

What discussions he has had with his (a) European and (b) US counterparts on progressing (i) mutual quarantine-free travel for people who are fully vaccinated against covid-19 and (ii) international covid-19 vaccine pass recognition. (902638)

I thank the hon. Lady for her question. We are working with the United States authorities, with the EU and with other international partners to ensure a safe return to international travel while managing public health risks. We support a global consistent minimum technical standard for covid status notification. Of course, the NHS app with the NHS covid pass is now accepted in 33 countries around the world.

The continued lack of recognition of vaccination status between the UK and the EU is putting the UK at a competitive disadvantage, according to the Association of British Travel Agents, especially when compared with the steps taken by the EU and the US. Both the US and the EU now have standardised digital ways to prove vaccination status, so will the Minister clarify why there is an ongoing delay in resolving this matter?

The European Medicines Agency and our regulator, the Medicines and Healthcare Products Regulatory Agency, work incredibly closely together, and the EMA has authorised the vaccines that are approved by the MHRA. All vaccines that are authorised and deployed in the UK have been subjected to rigorous checks, including individual batch testing and site inspection. Our two regulators work incredibly closely together and I am confident that we will continue to do so and ensure that any issues are resolved as quickly as possible, working with the manufacturers as well.

New Hospitals: Funding Bids

What progress his Department has made on selecting the eight new hospital programme schemes invited to bid for funding announced in the spending review 2020. (902639)

On 2 October last year, we announced 40 new hospitals to be built by 2030 and committed to an open process to confirm a further eight new schemes. Taken together, those 48 schemes should represent the biggest hospital building programme in a generation. As my hon. Friend would expect, my right hon. Friend the new Secretary of State is taking a close interest in the detail of this process, and I hope to be able to offer a further update on the selection process for the next eight hospitals very soon.

Spending hundreds of millions of pounds patching up buildings long past their planned lifespan—such as the Queen Elizabeth Hospital in King’s Lynn, which currently has 200 safety props holding up the concrete roof—does not represent value for money. What reassurance can my hon. Friend give to the thousands of my constituents who in recent days have signed a petition for a new hospital to replace the QEH that the Government are looking seriously at the urgent and compelling case for a new fit-for-purpose hospital for staff, patients and visitors?

My hon. Friend’s constituents will know that, in him, they have a doughty champion of their cause and a strong advocate for his hospital. He and I have spoken on many occasions, and I recognise the challenges facing the Queen Elizabeth Hospital, which he has been very clear about. The spending review 2020 included £4.2 billion this financial year for NHS operational capital investment to allow hospitals to maintain and refurbish their infrastructure, including a ring-fenced £110 million allocation for the most serious and immediate risk posed by reinforced autoclaved aerated concrete. My hon. Friend’s hospital has received just over £20 million of that funding to help to mitigate the most urgent RAAC risk, but he will also have heard me say, without prejudging any announcement my right hon. Friend will make about the criteria for the future eight, that safety will be one of the considerations.


What steps his Department is taking to ensure that unpaid carers can access the support they need to provide care to family members. (902647)

We recognise how much carers do and the huge demands that caring places on them. We have made carers a priority group for covid-19 testing and vaccination, funded carers’ organisations and asked local authorities to meet their duties to identify and support carers. We have also provided guidance and funding through the £1.5 billion infection control fund to support the reopening of day services.

I have been contacted by a Megan, a young carer in my constituency, and I have been in correspondence with the Minister about the lack of guidance for young carers on the website. We got the Government to remove an outdated linked to a Barnardo’s service that had closed at the end of March, but they have not replaced it with anything, which has left a vacuum in where young carers can look for advice and support. Can the Minister ensure that there is adequate, up-to-date information on the website and that young carers have somewhere to turn to when they need help and support?

I thank the hon. Lady for her question and her correspondence on this. She makes a very important point and I will make sure of that.

When the Select Committee on Housing, Communities and Local Government went to Germany about four years ago to look at its social care system, we saw that people entitled to public funding for social care could either pay the public authorities or care agencies to deliver it. Alternatively, for a slightly reduced amount of money, they could pay their family members, which meant that the person receiving care got the care they wanted, family members got paid for their efforts and the public purse actually saved some money. In reforming the social care system, would the Minister look at introducing elements of the German system into our system in this country?

The Secretary of State has already said that we are working on our plans for social care reform, and we will be bringing them forward later this year. Of course, as part of those plans we are considering unpaid carers.

Topical Questions

It is an honour to be here for my first oral questions as the Secretary of State for Health and Social Care, and I thank the Prime Minister for bringing me back from furlough. I accepted this role because I love my country and the NHS. I know that I join this Department at a pivotal time, and I have three pressing priorities for these critical few months. The first is getting us on the path out of this pandemic. The second is busting the backlog of non-covid services. The third is putting social care on a sustainable footing for the future. I want to draw on what I have learnt during this time of adversity and what we have all learnt together. I want to make this great nation a healthier and fairer place, and I am looking forward to working with all hon. Members in this House.

East Sussex Healthcare NHS Trust has the potential to get hundreds of millions in investment as part of the Government’s NHS estate infrastructure improvement plan. Will funding be allocated on a two to three-year basis, so that the NHS can better plan its funding and estates plans? Where funding has been indicated for a longer term, what plans are there to ensure that providers have sufficient resource in the shorter term to address immediate issues, or to support covid or recovery?

We have put more and more capital into the NHS. There are always representations from hon. Members, including you, Mr Speaker, for even more capital. My hon. Friend is right to raise the issue of the importance of local healthcare systems, which will need more capital funding as we progress. She will know that we set out our capital plans for this financial year, 2021-22, but she is right to say that multi-year funding will mean that trusts can plan better, and that is a priority; we want the spending review to have more sight and better planning for capital.

Let us consider these words about mental health services:

“prior to 2017, no government invested in or prioritised MH services.”

Those are not my words but the words of the Minister for Patient Safety, Suicide Prevention and Mental Health, the hon. Member for Mid Bedfordshire (Ms Dorries). Indeed, the new Secretary of State was the architect of these cuts, during his time as a Treasury Minister. The unparalleled devastation he left behind has been simply staggering, so does he agree with his Minister? Can he explain to us why 140,000 children were turned away from mental health services last year? Can he explain why a quarter of mental health beds have been cut since 2010? Is he ashamed of his track record?

The hon. Lady will know that the NHS long-term plan that has been set out by this Government is committed to a transformation in mental health services and mental health spending; some £2.3 billion extra is being invested by 2023-24. In addition, she will be aware of the mental healthcare White Paper and the mental health recovery action plan. I hope these are all initiatives she will support.

May I welcome the Secretary of State to his place? I am sure he will do an excellent job. As he thinks about a 24-hour A&E for Chorley, I hope he will also think about the urgent need for a cancer institute at the Royal Surrey County Hospital as only second on his list.

The Secretary of State will know that this morning the Health and Social Care Committee published a worrying report about the inhumane treatment given to 2,000 people with learning disabilities and autism in in-patient units, often because no community provision was available. When he brings forward his plans for social care, will he make sure that there is adequate funding for local authorities to give care to such people? Will he also make sure that care workers are always paid the minimum wage, including for the time taken to travel between appointments?

I welcome my right hon. Friend’s comments and the work that he and other Members do through the Select Committee to scrutinise the work of the Department. He just referred to some of that work, especially in his comments about learning disability and autism, which will remain a huge priority for the Government and certainly for my Department.

My right hon. Friend also rightly raised the issue of care workers and the minimum wage; it is worth pointing out that the Care Act 2014 requires local authorities, when they provide funding, not just to support the minimum wage but to take account of the costs that care workers might incur, such as travelling costs. I look forward to working with my right hon. Friend and the members of his Select Committee.

I congratulate the Secretary of State on his new role.There are 1.5 million older people, disabled people and carers with unmet needs who are desperately waiting for care reform. What is the Secretary of State’s estimated start date for the implementation of the care package that the Government claimed was ready in their manifesto more than 20 months ago? (902596)

As the Government have said, we want to make sure that every person in this country has the dignity that they deserve in old age. We have recognised that the current system needs substantial reform. The process of reform has already begun in, for example, the Health and Care Bill that will have its Second Reading tomorrow, but we do need a new, sustainable way to fund care and we will come forward with the plans later this year.

I know that many of my constituents will be pleased to hear that from 16 August we will end the requirement for people to self-isolate after possible exposure to the virus if they are fully vaccinated. I am sure we all agree that it is right to change the rules as the information changes; however, will my right hon. Friend explain to the House the rationale for making this change on 16 August rather than next Monday? (902600)

I agree with my hon. Friend that it is good news that we can move away from restrictions and towards guidance. On the rationale for the decision he referred to, it is about vaccine effectiveness: we know that for those with both doses, vaccination is estimated to be 78% to 80% effective against symptomatic covid-19. The introduction on 16 August of the changes to which my hon. Friend referred will mean that more people will have been vaccinated and will help to reduce severe illness.

Macmillan Cancer Support calculates that since March 2020, 37,000 fewer people than expected have started their first cancer treatment, including an estimated 66 people in my constituency of Jarrow who have not started their first treatment. Given that Macmillan estimates that the cancer system will need to work at 110% of capacity for the next 14 months to address the backlog, will the Secretary of State confirm whether the NHS is on schedule to tackle the backlog of cancer diagnosis, care and treatment by the current March 2022 deadline? (902597)

I want to reassure the hon. Lady—because this is such an important question for so many people across the country—that cancer remains a huge priority for this Government. She is right to refer to the work that Macmillan has done on this issue because, sadly, during the restrictions thousands of people have not come forward in the usual way and their cancer sadly remains undiagnosed. We urge anyone who feels that this is an issue for them: please, go to your GP—please come forward. That is one reason why we have launched the “Help Us, Help You” campaign. We have also provided additional funding for rapid diagnostic centres.

Good afternoon from West Dorset, Mr Speaker. Constituents of mine have been in touch to say that they are struggling to get GP appointments either because there are not any, or because they are struggling with online booking and telephone consultations. That is resulting in people going to A&E, putting more pressures on their hospitals. What is my right hon. Friend doing to ensure that constituents, especially older constituents, can access a GP face to face if they need to? (902601)

I think we would all agree in this House that GP practices have done a magnificent job in responding to the pandemic, and I want to take this opportunity to thank all GPs and their staff for the work that they have done and that they continue to do. My hon. Friend is right to raise the issue of face-to-face access. We can all understand why it changed during the pandemic, but as we open up, we can start to provide more of this, particularly for older people. Over the coming weeks and months, that will be a priority for my Department.

Cancer Research UK estimates that, compared with pre-pandemic levels, nearly 45,000 fewer patients started cancer treatment in the UK in April 2020 to March 2021. It believes that this stems from there being less diagnosis during the pandemic. In England alone, 10,500 of those missing cases were breast cancer cases. What steps are the Government taking to reach out to those at risk of cancer who have not been diagnosed due to limited NHS access over the past 18 months? (902598)

As I said in response to an earlier question, this is a huge priority for the Government and, again, I am pleased that the hon. Lady has raised the issue. It is an issue for her constituents and for constituents throughout the country. She referred to the research by Cancer Research UK. I am afraid that it is right: there are thousands of people who did not come forward. We can understand why, so let me say this again as it is so important: for anyone concerned, please do come forward. We have provided additional funding—more than £1 billion—for more diagnostics and we will continue to provide additional support.

In vitro fertilisation treatment is a lifeline for many people desperate to conceive. My constituent Sarah Barker dreams of being a mother, but sadly suffers from an infertility problem. Sarah is being refused IVF treatment on the grounds that her partner already has a daughter from a previous relationship. Her petition to stop denying women fertility treatment for this reason has already reached almost 13,000 signatures. Does my hon. Friend agree that treatment for infertility should be available based on the medical needs of the women involved, and not affected by the partner that she has fallen in love with having a child from a previous relationship? (902602)

I thank my hon. Friend for raising this question and the situation of her constituent. What I can say is that we expect clinical commissioning groups to commission fertility services in line with National Institute for Health and Care Excellence guidelines, so that there is equitable access across England. We are aware of some variations in access, and we are looking at how we can address that. Very specifically, CCGs should not be using criteria outside that NICE fertility guidance.

Many of my constituents who are extremely clinically vulnerable due to conditions such as blood cancer are terrified that, from 19 July, the Government are effectively abdicating responsibility for keeping them safe in public. There is evidence that more than two thirds of people do not understand that vaccines are not always effective for people who are immuno-compromised or the importance of wearing a mask to protect others and to alleviate anxiety. Can the Secretary of State not see why it would send a much clearer message to keep masks on public transport mandatory, rather than leaving the safety of clinically vulnerable residents to chance? (902599)

The hon. Lady is right to raise this issue. As she has rightly explained, there will be a number of people who, understandably, will be concerned about the move away from regulations to guidance. None the less, there must come a point when we start to remove the restrictions slowly, in a measured way, as we are doing—not least because we want to be able to start dealing much more with all the non-covid health problems that have been created as well. We have provided very clear guidance on masks and it was published yesterday. I hope that the hon. Lady can share that with people who are concerned.

We know that there have been hidden costs to the restrictions that are in place to protect us, including worsening mental health and the risk of domestic violence. Will my right hon. Friend confirm that the need to balance those risks with the reduced threat posed by the virus is a key part of the Government’s decision to lift restrictions? (902603)

Yes, I can confirm that. Removing restrictions is not without risk—I accept that—but keeping restrictions is not without cost. As my hon. Friend points out, the restrictions have led to increased domestic violence, child abuse, mental health issues and undiagnosed cancer, which we have heard about today, to name but a few. As we start lifting restrictions, that means that we can better deal with all these major non-covid health problems.

I have been contacted by a number of my Colne Valley constituents who have had operations and medical procedures cancelled or postponed at short notice. With coronavirus cases still on the rise, what is the strategy to tackle the backlog in operations and medical procedures? (902606)

My hon. Friend rightly raises an issue that I know will be a concern for constituents of all Members of this House. The backlog of treatment—the waiting list—is over 5 million. However, we are making rapid progress with that, and so is the NHS. We are looking at a variety of ways to do that—not just providing the funding needed to do it, but through innovation, accelerator hubs and diagnostic hubs, all designed to get the waiting list down and to get people the treatment they need when they need it. I would be very happy to discuss the specifics of my hon. Friend’s local situation with him outside this place.

Thank you very much, Mr Speaker. When I return to my constituency of North East Fife, I will cross into Scotland, where the mandating of face masks is likely to continue. Is it the Government’s expectation that passengers will wear a mask only when they cross into Scotland—or, indeed, Wales? What consultation has happened with the Home Office in relation to guidance to the British Transport police? Do the Government accept that a lack of a four-nations approach to such measures is not helpful? (902604)

Throughout the pandemic, my predecessor and other Ministers have rightly been working with the devolved Administrations, and of course that work continues; it will remain a priority. I myself have already started weekly meetings with all my counterparts in the devolved Administrations. We discuss a number of issues and keep each other informed, but we also respect that in certain areas, in dealing with this pandemic, we may take a different course.

I congratulate the Secretary of State on his appointment. Cases of covid rose by 30% last week compared with the previous week, and on 10 July we saw over 35,000 new cases, the highest since 22 January. By mid-August we could see 1,000 people a day being hospitalised, and up to 200 people a day could die, despite the excellent vaccination programmes. Given that the Secretary of State now considers it irresponsible not to wear masks, is it not equally irresponsible for the Government not to require people to continue to wear masks rather than leaving it as an option? (902605)

The hon. Lady understandably talks about the link between case numbers and hospitalisation. She will know that the last time we saw cases at 30,000 and above on a daily basis, we saw a lot more hospitalisations. The reason for the difference now is the vaccine wall of defence. Masks do have an important role to play, but we think that that role can be played by moving from regulation to guidance.

I am suspending the House for three minutes to enable the necessary arrangements to be made for the next business.

Sitting suspended.