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Health and Social Care

Volume 701: debated on Tuesday 19 October 2021

The Secretary of State was asked—

NHS Capacity

The NHS will receive an extra £5.4 billion for the second half of this financial year to support its response to covid-19. This includes an extra £1 billion to help to tackle the treatment backlog and £478 million to continue the enhanced hospital discharge programme, freeing up beds. This brings the total extra investment in health and care services so far this year, during the pandemic, to £34 billion.

My wonderful local charity York Against Cancer has been approached by York Hospital regarding the part funding of a da Vinci robotic cancer surgery system. This revolutionary machine allows for fewer and smaller incisions, meaning faster patient recovery, shorter hospital stays and, ultimately, better and faster cancer care. Will the Secretary of State assure me that he fully supports local collaboration, wherever needed, to introduce these machines and that he is doing everything he can to roll out this new technology across our health service?

I assure my hon. Friend that cancer care, whether provided through these machines, diagnostics or in any other way, remains an absolute priority for the Government. Colleagues will understand that some cancers were not diagnosed during the pandemic, and I join him in congratulating York Against Cancer on the work it is doing. I would like to learn more about this machine and to see how we can make it work throughout the NHS.

I thank my right hon. Friend for his answer and welcome the extra investment he outlined, but too often we talk about catch up in terms of physical health. What is he doing to catch up on mental health, particularly mental health beds?

My hon. Friend is right to highlight the importance of mental health. He will know that one of the unintended consequences of the lockdowns is that, sadly, there were more cases of mental ill health. The NHS long-term plan commits to increasing investment in mental health at least as fast as investment in physical health, with at least £2.3 billion of extra spending on mental health by 2023-24, which I hope he welcomes.

Local general practitioners report that they are working as hard as they ever have, with full lists of appointments, but constituents are still unhappy that they cannot get appointments quickly or in the format they would like. Is there more the Government could do to help local GPs across the country to give patients the service that they want and that GPs want to provide?

We are hugely grateful for the tireless efforts of GPs and their teams throughout the pandemic. In our comprehensive new plan, which we announced last week, we are including a £250 million winter access fund to support GPs and make it easier for them to see and speak to their patients. A record number of GPs began training in 2021, and we are committed to increasing the number to 4,000 each year.

I start by paying my respects to Sir David Amess and James Brokenshire, who were sadly taken from us far too soon.

I welcome the Minister for Care and Mental Health, the hon. Member for Chichester (Gillian Keegan), to her new brief. I look forward to working with her.

We are all too aware of the growing demand for support across the NHS, but all too often mental health treatment is forgotten. With up to 10 million more people thought to require treatment as a result of the pandemic, with waiting lists soaring and with beds being cut, we need more than just warm words from the Government. Labour will guarantee treatment, not just an assessment, starting within a month, and we will recruit 8,500 new staff so that 1 million additional people can receive the timely treatment they so deserve. That is what came out of our conference from our party leader. There was nothing of equal value from the Prime Minister, bar recycled old pledges and money spent four times over. Why?

Sorry, Mr Speaker. I did not realise the hon. Lady had finished. What she calls old pledges are hugely significant, and they continue to play a significant role. The NHS long-term plan, as I said a moment ago, has £2.3 billion extra each year by 2023-24. That extra investment will support 380,000 more adults and 345,000 more children.

The hon. Lady is, of course, right that the number of cases of mental ill health has sadly grown during the pandemic, which is one of the reasons we published a mental health recovery action plan with an additional £500 million this financial year.

NHS dentistry is facing a capacity crisis. There is a huge backlog of urgent care and treatment, which is leaving many dentists overwhelmed. Patients, including those in Pontefract and in towns across the country, are now unable to get routine check-ups, which is making the urgent care crisis worse and creating a vicious spiral. Will the Health Secretary ask his Ministers to meet dentist groups and patient groups in Yorkshire to hear about the urgent crisis they are facing and set out an urgent plan to deal with the huge capacity crisis in NHS dentistry?

The right hon. Lady is right to raise the issue of access to dentistry for her constituents and those across England. Dentists have done a fantastic job faced with the challenges of the pandemic. We all knew that those were very real for dentists, who, of course, could not see their patients in the normal way, and they have done everything they can to help on that. The measures that have recently been taken—the review by the United Kingdom Health Security Agency on infection prevention and control—will help. Reduced access has been a major cause of the backlog. We are also working with our colleagues in the NHS to see what more we can do.

All Devon’s hospitals are on red alert, partly because of capacity issues caused by ongoing covid cases. Why does the Secretary of State think the UK now has the highest covid infection, hospitalisation and death rates in western Europe?

First, may I take this opportunity to congratulate all the health and care workers across Devon on the fantastic work they are doing? The right hon. Gentleman will know that the Government have set out clearly their approach to dealing with the pandemic and that we are very much focused on vaccinations, which are working, building a wall of defence, treatments and testing.

Further to the last question on NHS dentistry from the right hon. Member for Normanton, Pontefract and Castleford (Yvette Cooper), we are in a difficult situation across North Yorkshire, where there is no NHS dentist availability across the whole of Thirsk and Malton. It will take the NHS two years to recommission the service in Helmsley—the closed practice in Helmsley—and the Thirsk practice has just closed its doors with its current list of patients. Will my right hon. Friend set out exactly what we can do to increase the availability of NHS dentistry?

Again, my hon. Friend is right to raise this issue. As we have just heard from other hon. Members, there is a real issue with dentistry across England, including in North Yorkshire, and we know how the pandemic has had an impact on that. Dentists have tried to do the best they can in those circumstances. The changes we are making to infection prevention and control will help. We are looking at further measures, and I understand that my hon. Friend will be meeting the Minister shortly to discuss his issues in North Yorkshire carefully.

Cancer Diagnosis and Treatment: Backlogs

11. What recent estimate he has made of the size of backlogs in cancer diagnosis and treatment. (903659)

The number of people waiting longer than 62 days for treatment following an urgent referral for suspected cancer in England has come down considerably, from 35,000 people in May 2020 to about 19,000 people. The NHS is putting in place extra capacity to diagnose and treat cancer patients, with the aim of clearing the cancer backlog of patients waiting over 62 days from referral to first treatment by the end of March 2022.

To do that, we are going to need healthy NHS staff. I was alarmed to hear Cambridgeshire’s director of public health last week talking about the sheer scale of covid ripping through the school population and then into the parental cohort, many of whom, of course, will be working in the NHS. Peterborough currently has the highest number of cases it has had at any time during the pandemic. So what is the Government’s plan to keep NHS staff healthy, in order to allow them to tackle that alarming cancer backlog?

First, let me say that NHS staff have done a phenomenal job throughout the pandemic in helping patients with cancer or any other illness. A comprehensive plan of support has been in put in place, with this Department working with our NHS colleagues carefully to provide, for example, advice and help. Extra mental health support has been provided as well, and we are looking to see what more we can do.

My late constituent Anne began to suffer pain in April. She never had a GP visit. She had two visits to accident and emergency, which did not result in any treatment plan. Finally, after four months, she had a non-urgent visit to a urologist. Sadly, because at no point was she diagnosed with a terminal condition, she was not given access to hospice care and died in September. I put it to the Secretary of State that this is no way to treat an elderly lady and no way for her family to suffer. What is he going to do to guarantee that there will not be many more Annes in the months and years to come?

I thank the hon. Gentleman for raising that case. I am very sorry to hear about his constituent Anne and send my condolences to her family for what has happened.

The hon. Gentleman will understand that, during the pandemic, sadly, many people stayed away from the NHS, on which there was a huge amount of pressure. Despite everyone, especially those working in health and care, doing as much as they could, it just was not enough for some people. There is not only emergency spending to deal with the pandemic pressures—this year there is an additional £34 billion—but much more investment in equipment and diagnostic processes, such as the community diagnostic hubs that we announced last week, which will help to make a real difference.

Unsurprisingly, I have become more acutely aware of stories about backlogs in cancer diagnosis and treatment, the impact of which should not be underestimated, so I welcome the Secretary of State’s sensitive and sensible response. Will he join me in recognising the multidisciplinary teams throughout the country that are working non-stop to meet cancer pathway targets, including Maidstone and Tunbridge Wells NHS Trust, which continued to operate cancer services throughout the pandemic last year and has met the 62-day target for 26 months in a row? Will he consider a visit to the hospital that treated me and thousands of others, to hear how the team there continues to strive to achieve improvements in diagnostic services and outcomes for cancer patients in my constituency and others in Kent?

Yes. It is great to see my hon. Friend, who speaks with real knowledge on this issue. Not only would I be pleased to visit that hospital but I wish to join her in congratulating the multidisciplinary teams throughout the country—especially the Maidstone and Tunbridge Wells multidisciplinary trust—that have been doing fantastic work on cancer.

The proportion of people starting cancer treatment within one month has dropped to the lowest level on record. Some 30,000 fewer people are accessing cancer treatment than we would have expected pre-pandemic, and winter pressures have already caused chemotherapy to be paused in Nottingham. The Government’s plans simply are not working and the Secretary of State is denying reality. Will he make a commitment today that there are now sufficient resources for cancer services throughout the winter period that will protect staff from redistribution, so that they can continue to deliver the care and support that cancer patients need?

The hon. Gentleman may have heard me say a moment ago that, of course, cancer remains a huge priority for the NHS. Very sadly, there have been people who have waited longer than 62 days after urgent referral. The number has come down considerably in the past year, to 19,000 as of May 2021, but that is still 19,000 too many, which is why the NHS is rightly committed to clearing that completely by March 2022. That requires a lot more investment. There is the additional £34 billion this year, but it requires long-term, sustainable investment, which is why the plan we have announced for long-term funding over the next three years, with additional funding of at least £12 billion a year for health and care, will make a real difference.

People with Learning Disabilities and Autism

3. What steps the Government is taking to improve health outcomes for people with learning disabilities and autism. (903650)

I thank my hon. Friend for her work as the Minister for Care and particularly for starting the work on the Oliver McGowan mandatory training. We are currently trialling the training to improve awareness and understanding of learning disability and autism for all health and care staff. The improvement of health outcomes for people with learning disability was also championed by our dear friend Sir David Amess; I shall think of him every day in this role and try my very best to live up to his expectations.

I warmly welcome the Minister to her role, which I know she will do with great care. Will she expand a little on the roll-out of the mandatory training for all health and care professionals working in learning disability and autism, which is, as she knows, named in honour of Oliver McGowan? Will she say when it is likely to be rolled out nationwide and what sort of funding will be attached to it? Will she also say when the annual GP health checks for people with learning disability or autism are likely to be rolled out throughout the country on a face-to-face basis post covid?

We have started the trials and they are well under way. We are using three trial providers. Our final evaluation report is due in spring 2022 and I would be very happy to share that with my hon. Friend. The outcomes of this trial and the evaluation will inform the plans for the roll-out across the country. I am working closely with Paula and Tom, Oliver McGowan’s parents, who, incidentally, grew up in the same place that I did—in fact, two streets away. They are key stakeholders and, obviously, we will make sure that we set out the detailed plans for roll-out as soon as possible. I thank my hon. Friend and Paula and Tom for all the work that they have done in this area; it really is remarkable and will make a massive difference. On the annual health checks for people with learning disabilities, the NHS has already met its target two years ahead of time for 75% of people on the GP learning disability register to receive an annual health check. I would urge anybody to come forward to make sure that they take advantage of that very important step.

The Government have not responded to the report of the Health and Social Care Committee on the treatment of autistic people and people with learning disabilities and that response is now well overdue. Sadly, there is continued evidence of ongoing abuse of people with learning disabilities and autistic people. I point the Minister to the deaths reported at Cawston Park. There was a terrible report on that recently. This needs immediate and assertive action. Autistic people and people with learning disabilities are often trapped in inappropriate units for six years on average. By delaying their response, the Government are demonstrating apathy with regard to the terrible treatment in places such as Cawston Park and other units. When will the Government respond and act?

I share the hon. Lady’s concerns; it simply is not good enough. The events at Cawston Park—my first response as a Minister to an Adjournment debate was on that subject—were unbelievable and deeply traumatic. My deepest condolences are with the families of Ben, Joanna and Jon. I have committed to meeting with the families at the earliest opportunity so that I can understand their experiences directly. This is currently being arranged by officials and the Norfolk Safeguarding Adults Board. The Department continues to work at pace through the delivery board of cross-Government and cross-system partners to drive progress on implementing the Building the Right Support national plan, which is ultimately the answer to have much better support in the community. We will publish an action plan, outlining all of the plans that we have, how we will improve outcomes and how we will enable people to live well in our communities.

First, let me welcome my hon. Friend to her position. As chair of the all-party group on learning disability, I look forward to working with her.

On the point that the hon. Member for Worsley and Eccles South (Barbara Keeley) raised, the Government have a plan to reduce the number of people in in-patient units—the assessment and treatment units—like the one at Winterbourne View, which delivered completely inappropriate treatment. When will that delivery plan be published? Her predecessor committed to doing it four months ago; she said that there was work to be done. Can my hon. Friend set out when it will be published so that we can press the Government on delivering those ambitious goals?

I look forward to working with my right hon. Friend. I have been along to the first board, although I have not yet chaired it. But we will be developing that action plan. I cannot commit to the date but I will let him know as soon as I can when we will publish the plan. We will be publishing a winter plan for the NHS, which will include lots of different support, in the next couple of weeks.

I thank the Minister for her response. Given recent statistics that show that one in 20 schoolchildren in Northern Ireland has an autism diagnosis, may I ask her what steps have been taken here on the mainland to ensure that children with learning disabilities or autism have guidance in their health journey and are never left overwhelmed without specialised support at those very necessary appointments?

I thank the hon. Gentleman for his question. He is right to identify this concern. Compared with the general population, people with learning disabilities are three times more likely to die from an avoidable medical cause of death. That is why these annual health checks to ensure that we get early diagnoses for these people are so important. That is why I am delighted that many people are coming forward and that the NHS is two years ahead of its plan here in England. Hopefully, others will follow that lead.

New Hospital in Doncaster

We have now received applications from trusts to be one of the next eight hospitals in our new hospital programme, which will be the biggest hospital building programme in a generation. I understand that an expression of interest has been submitted, proposing developments at the Doncaster Royal Infirmary site. Although I cannot comment on this particular application at this stage, I can tell my hon. Friend that we aim to make our final decision in spring next year.

It appears that every time that I am fortunate enough to ask a question relating to health and social care, another disaster has happened at Doncaster Royal Infirmary. This time, it is a second water leak in the women’s hospital. Given that there is a maintenance backlog of £514 million and the newest part of Doncaster Royal Infirmary is older than the town of Milton Keynes, does my hon. Friend agree that a new hospital is not a “nice to have”, but an absolute necessity for the people of Doncaster? Will he please also visit Doncaster Royal Infirmary, although, with ceiling collapses and water leaks, he may need to bring a hard hat and some wellies?

I cannot comment on the selection process while it is under way, but my hon. Friend is a strong and powerful advocate for his constituents and for a new hospital in Doncaster. He has met me a number of times and continues to raise this matter in the House. I should perhaps have taken him up on his offer of a visit in the summer, when it was sunny, but I am still certainly happy to take him up on that offer.

If I may briefly be indulged, Mr Speaker—we do not often have the opportunity to do this from the Front Bench—let me say that I am grateful to the hon. Member for Tooting (Dr Allin-Khan) for her kind words about our late colleagues, James Brokenshire and Sir David Amess. The last time I saw David was a few weeks ago, when he posed for a photo that he wanted with me and then tried to impress on me the question of whether I would come to the wonderful town of Southend.

Hang on, sir! I was about to say that I would be delighted to visit what is now the city of Southend. My only deep sadness is that our friend will not be there to meet me when I do so. He and his family are very much in our thoughts.

Walley’s Quarry: Odorous Emissions

5. What discussions he has had with the Secretary of State for Environment, Food and Rural Affairs on the (a) short-term and (b) long-term impact on public health of the ongoing odorous emissions from Walley’s Quarry in Newcastle-under-Lyme. (903652)

I commend my hon. Friend for his tenacity on the issue of Walley’s Quarry and for continuing to stand up for his constituents. As part of the multi-agency response, the UK Health Security Agency provides expertise and support to the Environment Agency and the Department for Environment, Food and Rural Affairs. On 4 May, the Secretary of State took appropriate action, writing to the Environment Agency, which regulates the landfill operation, and urging it to use its regulatory and enforcement powers over Walley’s Quarry Ltd to resolve the problems at the site. It has been strongly recommended that the Environment Agency takes appropriate measures as early as possible to reduce offsite odours from the landfill site and to reduce the concentrations in local areas to levels below the health-based guidance values used to assess long-term exposure.

I welcome the Minister to her place. This ongoing public health emergency in Newcastle-under-Lyme has been a real trial for my constituents. Does she agree that in future the Environment Agency will need to take into account the effects on public health—both physical and mental health—of odorous emissions and the gases that escape from landfills, so that no other town has to go through what we have in the last year?

I assure my hon. Friend that the Environment Agency takes the situation very seriously and is working with the operators of the site to address it as quickly and effectively as possible. I am sure that he will be pleased to learn that the Environment Agency has re-evaluated its regulatory approach following the outcome of the judicial review, and on 14 October published its plan to reduce the levels of hydrogen sulphide emissions at the site.

Dandy-Walker Syndrome

6. What estimate his Department has made of the number of people with Dandy-Walker syndrome in the UK. (903653)

I thank my hon. Friend for raising a question on this rare but important condition. Public Health England’s national disease registration service contributed data to a European Dandy-Walker syndrome epidemiology study back in 2019. The results identified that the condition occurs in about 2.7 live births per 100,000. More work is currently being done to report on the number of people living with the condition in the United Kingdom.

I thank my hon. Friend for doing the research on this question. One of my constituents, Steven Forster, came to see me during a surgery last summer. His granddaughter, Mia, is suffering with Dandy-Walker syndrome. As there is not the knowledge in the NHS about how best to treat the condition, like many families, when they do eventually find a doctor who has that knowledge, they have to travel a long way to see them and there is a huge cost attached to that. With that in mind, will my hon. Friend agree to meet some of the families across the UK who are trying to get together a support group on the issue, and consider putting together an NHS centre of excellence so that parents and carers know where to go for help?

I thank my hon. Friend for raising his constituent’s granddaughter Mia’s case. With over 7,000 rare conditions, awareness among healthcare professionals can be difficult. That is why in January this year the Government set up the UK Rare Diseases Framework whereby officials are working with partners including Health Education England to raise awareness of rare conditions such as Dandy-Walker so that we provide training for staff and target education for healthcare professionals. I would be happy to meet him and his constituent to talk about this and listen to some of their concerns and experiences.

Social Care

Last month the Prime Minister announced an unprecedented investment in social care to support our own futures and those of our loved ones and our growing ageing population. This investment of £5.4 billion will support the wellbeing of the 1.5 million-strong workforce, offer professionalisation and provide hundreds of thousands of training places. It will also fund supported housing, better advice and capped care costs at £86,000, removing the fear of spiralling care bills.

I am grateful for my hon. Friend’s answer, but she will acknowledge that even the promised better integration of health and social care, although very welcome, will not be enough. We need a long-term plan covering workforce issues, the use of technology, and provision whereby people can live in their own home for longer if we are to achieve ultimate success. If we do not solve all those issues, then I am afraid we will not have fixed social care.

I agree with my right hon. Friend. The forthcoming White Paper on adult social care reform, which we will publish before the end of the year, will set out our vision for the sector. It will cover issues that affect care users, including housing and innovation within our housing models, access to information and advice, and funding for the workforce. I am very happy to be meeting him on 4 November in his role as chair of the all-party parliamentary group on adult social care to ensure that his insight and all the work that he and the APPG have done in this area are carefully considered.

I welcome the hon. Lady to her post. I listened carefully to what she said about the Government’s recent announcement. However, is not the reality, as the Association of Directors of Adult Social Services says, that all the additional money announced is going to the NHS in the first three years and little, if any, will ever make it to social care; there is nothing to deal with the overwhelming workforce pressures and increased levels of need we are experiencing right here, right now; and we will not see a single extra minute of care and support or an improved quality of life for older and disabled people or family carers? On top of this, at £86,000 the cap on care costs will not even stop people having to sell their homes to pay for care, and the vast majority of people will be dead before they ever reach the cap because it does not cover the costs of accommodation or food. How is this a long-term solution to social care, and is the Chancellor finally going to fill these gaping omissions in his Budget and spending review next week?

I am sure the hon. Lady is in fact delighted that finally a Government have come forward with a plan for social care. In addition to that, this Government have spent an extra £34 billion this year in the NHS and we have raised the levy, which, as she says, will fund both the electives and the catch-up from the pandemic—we all know that many of our constituents need this—but there is also the £5.4 billion that is the biggest investment we have had in social care in this country. As things stand, one in seven adults over 65 face care costs of over £100,000 in their lifetime. Nobody will be forced to sell their home, as people will now have a very clear cap of £86,000 that will give families peace of mind that their assets will not be wiped out, and people can already take a deferred payment agreement so that their payments can be deducted from their estate after they die. Most people I have spoken to truly welcome this announcement and are absolutely convinced that this Government will introduce it.

We all know that when the care sector is struggling, the NHS feels the pressure, and that is certainly the case in Gloucestershire at the moment. The demand for adult social care is increasing for us locally by 4% year on year, which is higher than the average, and the huge number of requests for new care packages means that there are now delays for domiciliary care, as the market cannot respond to demand. Will the Minister, who I welcome to her new post, tell the House and the Gloucestershire care sector that the Government are working to support us? Will she meet the six Gloucestershire MPs and the leader of the council to discuss this matter?

This is absolutely vital. The recent announcement of £500 million over three years to fund social care professionalisation is very warmly welcomed by the sector. It is a sector that employs 1.54 million people. It is larger than the NHS, construction, transport or food and drink. I am of course happy to meet my hon. Friend and other Gloucestershire MPs. I know this issue is a challenge. We have some short-term actions, and it is a key pillar of our long-term reform.

With the Government introducing a health and social care levy, will the Minister ensure that social care is not at the back of the queue for spending? Can she provide clarity about every penny of Barnett consequentials that will be given to the devolved nations?

I am sure that the Chancellor will be setting out what will happen with the Barnett consequentials. Yes, this issue is important. The most important thing to say is that this is the start—we have £5.4 billion over the next three years for us to embed some of the changes we need in the system, but this levy will continue, and social care will be a big part of and a big beneficiary from that levy in the future.

Will the Minister recommend what North Northamptonshire Council has just done, which is to pay its social care workers as a minimum the real living wage and to backdate that to April this year? That would be a small step in helping with this situation.

Yes, I completely agree. Some 95% of the jobs are with private providers, so it is important that they take care of their workforce. There is a lot of competition for labour and a lot of skills shortages in our country. Most workers are on just above the national living wage, but it worries me that a third are on zero-hours contracts, so there is a lot we can do to improve the terms and conditions of the social care workforce. My hon. Friend raises a good leadership example.

Free Prescriptions for People Aged Over 60

The Department’s consultation on aligning the age for free prescriptions with the state pension age closed on 3 September. The responses to the consultation are being reviewed, and we will outline the next steps in due course.

We know that low incomes are associated with worse healthcare outcomes and also that average prescription use is higher among those in more deprived areas. Will the Minister accept that increasing healthcare costs for those on low incomes will mean that health inequalities will widen, increasing the pressure on low-income families and the NHS this winter?

I thank the hon. Lady for her question. I reassure her that around 90% of prescription items in the community are provided free of charge. Those who are vulnerable and on low incomes, such as those on universal credit, income support and jobseeker’s allowance, already qualify for free prescriptions. It is really important that those over the threshold can also apply for the prescription prepayment certificate, where all their items will cost just about £2 a week. We are making sure that costs are low for those on low incomes.

Record levels of funding by the Scottish Government for primary care will protect free eye examinations and free prescriptions for people in Scotland and will also enable the abolition of all NHS dentistry charges. Will the Minister follow Scotland’s lead and commit to a similar policy for England?

I thank the hon. Gentleman for his question. Although the Scottish Government provide free prescriptions, the money comes out of existing budgets, which means it is taken from elsewhere in the health service. That may be why, at the moment, three health boards in Scotland need the armed forces’ support to deal with their winter crisis.

Elective Procedure Backlogs

We have committed an additional £1 billion this year to increase elective activity and tackle the backlog, doubling the £1 billion already provided through the elective recovery fund. Over the next three years, we plan to spend more than £8 billion to fund the biggest catch-up programme in NHS history, which comes atop, of course, the record £33.9 billion increase in funding and the health and social care levy.

Before asking my question, may I make a declaration of personal interest, namely, my age? People of my generation and older are finding more and more delays in elective procedures, but the response of the Government, as we just heard, appears to be to just pump more taxpayers’ money into the bottomless pit of the NHS, resulting in ever more waste and lower productivity. Why do the Government—this Conservative Government—not use innovative private sector solutions to relieve some of the pressure on the NHS? Why do they not do what the Major Government did—hardly right-wing extremists—and give tax relief for private health insurance?

I have known my right hon. Friend for a long time and he is eternally youthful. As my right hon. Friend the Secretary of State set out, the record investment that we are putting into our NHS, particularly to address the elective procedure backlogs, goes hand in hand with innovation and reform.

To the specific point of my right hon. Friend the Member for Gainsborough (Sir Edward Leigh), the NHS is utilising the independent and private sector to carry out procedures for NHS patients. As he would expect me to say, however, tax breaks or similar are matters for the Chancellor, not me.

The thresholds of the elective recovery fund have a perverse impact, so hospitals with the least capacity are more unlikely to have the money to build their capacity. What steps will the Minister take to ensure that my constituents in York have funding from the Government to help build that capacity and have the elective surgery they need?

In respect of the elective recovery fund and the thresholds, the hon. Lady recognised that they are an additionality alongside the record extra investment that we are putting into our NHS. We are putting more resources in, alongside reform and innovation, to deliver that increased capacity. The elective recovery fund is also designed to stimulate activity and to reward additional costs over and above that activity. We believe it is the right approach to generate that increased activity.

The elective procedure backlog requires appropriate capacity for recovery and rehabilitation, much of which is provided by community hospitals, especially in rural areas. Is the Minister aware that on Friday, NHS Shropshire announced the imminent closure of Bishop’s Castle Community Hospital for patient safety reasons due to a lack of qualified nursing staff? Will he work with me to put pressure on the local NHS to develop a plan to recruit suitably qualified nurses and reopen the hospital as soon as possible?

In the context of elective surgery recovery, my right hon. Friend makes an important point about the role that community hospitals play in helping to drive down waiting lists. I am grateful to him for drawing that to my attention and I will look into the specific situation he raised. It is important that, alongside providing a service, it is a safe service. I am happy to work with him to see what can be done in that situation.

Delays in procedures are causing increased pressure on our adult social care system. In September, East Riding of Yorkshire Council told my constituent that there was not a single carer to be had for her mum in the whole of the East Riding, and that the family’s options were to put their mum into residential care or to deal with it themselves. I spoke to those on the Conservative-led council to check whether that was true, and they said yes. They are facing a huge shortage of carers and they asked for my support in lobbying their Government for increased funding for social care. Will the Government give East Riding of Yorkshire Council the extra funding it needs to raise the wages of carers and try to attract some of them back to the profession?

The hon. Lady is right to highlight that, essentially, social care and the NHS go hand in hand; they are two sides of the same coin. That is why we have made ambitious proposals, and will bring forward further proposals, for furthering the integration of those two sides.

The hon. Lady raised a specific case to illustrate her point. I, or perhaps more appropriately the Minister for Care and Mental Health, my hon. Friend the Member for Chichester (Gillian Keegan), would be happy to meet her to discuss the details of that situation.

New Hospitals

I am grateful to my hon. Friend for his question. In October 2020 the Prime Minister announced details of 40 schemes that we will be taking forward in line with our manifesto commitment to deliver 40 new hospitals by 2030, supported by an initial £3.7 billion investment for them.

This seems to be the crumbling hospital corner of the House, as we have already heard from my hon. Friend the Member for Don Valley (Nick Fletcher) about his concerns. In Norfolk, we have the Queen Elizabeth Hospital, which is physically crumbling, and the ceilings and roofs are held up by wooden staves and acrow props. Although it is not in my constituency—it is in the constituency of my hon. Friend the Member for North West Norfolk (James Wild)—it serves the entire county, and eight Members of Parliament have written in support of the bid. Could I invite the Minister to visit the Queen Elizabeth Hospital to see for himself the state of its structure?

I am very grateful to my hon. Friend, who quite rightly recognises and highlights the work that my hon. Friend the Member for North West Norfolk (James Wild) has put into championing the cause of this hospital. I understand that it has put in an application to be one of the next eight hospitals, which will of course be considered very carefully. I am very happy to visit Norfolk as well, but I would also highlight that one of the key issues at this particular hospital is the existence of RAAC—reinforced autoclaved aerated concrete—planks, for which we have already provided £20 million for remedial works this year.

As well as building new hospitals, the Government appear to be downgrading existing ones. Will the Minister meet me to discuss the downgrading of Walsall Manor, so that I can explain it to constituents and whistleblowers?

I am always happy to meet the right hon. Lady. However, I would say to her that decisions such as that are NHS-made, clinical decisions. That is the framework through which they should be viewed, but I am always happy to meet her.

Will the Minister agree to meet me in Hyndburn to discuss plans for Accrington Victoria Hospital, making sure we are utilising our fantastic and historic building to its full potential?

The short answer is that it looks as though I may be going on tour in the coming months, and I am delighted to accept my hon. Friend’s kind invitation.

With a £9 billion maintenance backlog, examples of which we have heard this morning, it is truly mind-boggling that the Department’s priority has been to try to change the definition of what a new hospital is, so let us cut out the spin on 48 new hospitals. Can the Minister tell us, of those 48—if we take out all the projects under way before the announcement was made, and those that are new wings, extensions or refurbishments of existing buildings—exactly how many new hospitals will be built by 2030? It is not 48, is it?

I am grateful, I think, to the shadow Minister. We have a very clear definition of a new hospital, which I believe is shared by the public. It also leans on VAT notice 708 and its definition of what constitutes a new build or a refurbishment. To his specific question, we are committed to our manifesto commitment of 40 new hospitals by 2030—we build, the Opposition complain.

Topical Questions

If I may, I would like to take this opportunity to remember my friend and colleague James Brokenshire, who shall be sorely missed, and I would like to dedicate this statement to my colleague Sir David Amess.

Sir David was a friend, and I had the privilege of knowing his kindness, his compassion and his selflessness at first hand. For those who did not, Sir David’s record tells them everything they need to know. His first concern was never his own rank or status, but the cause of the underdog, the vulnerable, the marginalised and the forgotten. As well as on fuel poverty and in standing up for animal welfare, Sir David left his mark on my own brief in campaigning to tackle obesity, chairing the Conservative Back-Bench health committee and launching the all-party parliamentary group on endometriosis. That disease would never affect him personally, but it was raised by one of his constituents in his surgery—exactly like the one he was taking when he was killed. His legacy is the many lives that he touched, and I know that, like me, Members across the House will miss him terribly.

Of course I agree with every word of that very fine tribute to our two lost colleagues.

I represent an area of high housing growth so general practice provision needs to increase as the houses go up, but my clinical commissioning group tells me that NHS capital often appears at incredibly short notice and then disappears just as quickly. Can we try to get the provision of new general practices on a planned basis as the new houses go up?

My hon. Friend is right to raise this. Capital is allocated by two CCGs on a regional basis that is weighted by population, and, as he says, if that population changes, the weighting also changes. Additional funding can sometimes be allocated from section 106 or community infrastructure levy funding as well, but I am more than happy, if my hon. Friend would like, to meet him to discuss this further.

If I may, Mr Speaker, I will, with your indulgence, take a moment to express my deep sadness at the loss of James and David and my utter shock at what we saw this weekend, but also to remember David as someone who was always smiling, who always encouraged me, particularly as a rookie MP when my office was just down the corridor from his, who always asked after my children and who always gave me tips. I sometimes get in a bit of trouble for being friends with Tories, but I will hugely miss David and James and send my condolences and sympathies to their friends and families.

I also welcome the new Ministers to the Treasury Bench. In recent weeks we have seen a patient at Preston wait over 40 hours for a bed, we have seen a child with mental health problems wait nearly 48 hours for a bed at Ipswich A&E, we have seen ambulances backed up outside hospitals—in Norfolk a patient died of a heart attack waiting in the back of an ambulance—and we have seen ever more patients, who cannot bear the wait for surgery, paying for operations. This is an NHS not just under pressure, but under water. What is the Secretary of State personally going to do to avert a winter crisis of misery for patients?

I agree with every word the right hon. Gentleman said about our friends and colleagues, James and David, but I hope his friendship with me will not get him into trouble—I hope I have not given that away. He is right to ask about the huge pressure the NHS is facing, and all our constituents are seeing that wherever they live. It is picking up over the winter. Winters can usually be tough for the NHS but this winter will be particularly tough and the Government have set out the reasons why: the pandemic is still ongoing; and this flu season will, I think, be particularly tough, which is why we are having the largest flu vaccination programme alongside the covid programme this year. We are doing a lot alongside the vaccination programmes, especially in terms of resources. We have put an extra £34 billion into the NHS and care for this year, including much more funding for diagnostics such as the community diagnostics hubs that I announced a couple of weeks ago, in which we invested 350 million. We will very shortly set out with the NHS a detailed programme for the winter and how we can better deal with the pressures.

The Secretary of State mentioned the pandemic, but he must surely be concerned that yesterday we recorded close to 50,000 infections, and on every single day of the last three weeks 10,000 children have been diagnosed with covid. The booster programme is stalling with charities describing it as a “chaotic failure”, and only about 13% of children have been vaccinated. His wall of defence is falling down at just the point that vaccination is waning, so may I suggest that he ditches the complacency and fixes the vaccination programme now?

Our vaccination programme has been one of the most successful in the world, and the right hon. Gentleman may know that it has prevented 24 million infections, has prevented some 230,000 people from being hospitalised and saved 130,000 lives. I do not call that a failure; I call it a success.

T2. Last week, a whistleblower told the American Congress that Facebook had repeatedly misled the public about the impact of its platform on children’s health. Does my right hon. Friend agree that it is time for Facebook to be transparent about the impact of its platform, and to share with the public what it knows about the impact on children’s health? (903672)

I absolutely agree with my hon. Friend, and I thank her for raising this issue. I share those concerns. Over the past year, the number of young people being urgently referred for eating disorders has doubled. In the light of that, I was astonished to learn that one of Facebook’s own internal studies, which was brought to light by Ms Haugen, found that 17% of teen girls said that their eating disorders got worse after using Instagram. Facebook did not think it was appropriate to inform parents, healthcare professionals and legislators. I do think it is time for Facebook to do the right thing and publish what it knows.

T3. As a former Chancellor, the Health Secretary will know that air pollution kills 64,000 people a year at a cost of £20 billion a year, according to the Royal College of Physicians, and twice that according to the World Health Organisation. Will he urge the Government to ensure that there are legally binding WHO limits in the Environment Bill, which we will consider tomorrow, to save tens of thousands of lives and tens of billions of pounds, and to send a message to the world on combating the 8.7 million deaths a year from air pollution? (903673)

The Government have a proud record on combating air pollution. The hon. Gentleman is right to raise the ongoing challenges of that, and I know that the Government, including the current Chancellor and the Environment Secretary, take it very seriously.

T4. Will the Secretary of State please confirm whether the additional £250 million investment in primary care will be spent on additional capacity to be delivered by NHS doctors, providing a distinct break from the bureaucracy of the last Labour Government and the legacy of Tony Blair? (903674)

First, let me say that our GPs have done a phenomenal job during the pandemic. The nation really cannot thank them enough for what they did during the pandemic and what they continue to do. The GP access programme that I announced last week is about providing extra support for GPs to do what they love doing best, which is seeing their patients. The extra £250 million over the next five months will be ringfenced—it will be protected—and it will be there to expand general practice.

T5. I thank the Secretary of State for his earlier response about my former constituent, Anne, but I did not detect that he mentioned the shortage of oncologists and radiologists in the health service. There is a 33% shortage of radiologists, and a 17% shortage—and growing—of oncologists. What is the commitment, not simply for this year but on an ongoing basis, to make sure that we train, train, train and have the staff who can deliver the cancer detection that is so fundamental? (903675)

The hon. Gentleman is right to raise this issue. Whether it is for treatment for cancer or other illnesses, we do need more clinicians in the NHS. On meeting the ongoing demand, I was pleased to see that this year we had the highest number of students ever entering medical schools for general practice, for example, and across the board. He may be interested to know that, for the year to date, to June 2021, the NHS has 2,700 more doctors and 8,900 more nurses. There is more to do, and I am pleased that he raised this issue.

T7. [R] My right hon. Friend will be aware of the potential emerging treatment of the most difficult mental health conditions, including depression, trauma and addiction, if psychotherapy were reinforced by pharmacology with appropriate use of the psychedelic class of drugs, including psilocybin. That could benefit millions of our fellow citizens, including more than 2,000 of our veterans wrestling with untreated trauma from their service in Iraq and Afghanistan. Today, it is very difficult to conduct research in the UK due to the scheduling of those drugs in the most restrictive category of all, with absolutely no evidence of risk to support that immense burden placed on science and medical research. Every day we delay this science, scores of our fellow citizens will die unnecessarily, and millions will suffer unnecessarily. Will my right hon. Friend urgently examine this issue so that British people receive British scientific research and British pharmaceutical— (903678)

Order. Come on, Secretary of State or Minister—whoever is answering. We have to get through these questions or it is unfair to others.

My hon. Friend is right to raise the importance of mental health and suicide. This is important, and I listened carefully to what he said. He knows that pharmacology already plays an important role in helping people with their mental health challenges, but he raises an interesting potential emerging treatment. He will know that scheduling is an issue for the Home Office, but I will be happy to meet him myself to discuss it further.

T6. As the Secretary of State knows, the NHS is facing extreme pressure because of rising covid infection rates and hundreds of people still dying every week, and that is in the context of 5.6 million people on NHS waiting lists. Is it not time for the Health Secretary to revert to making mask wearing mandatory and to commit to suspending the reckless decision to charge for lateral flow tests in the coming months? (903677)

We have a plan for both the pandemic and other challenges over the winter, which we set out in detail. I remind the hon. Lady that we do not charge for lateral flow tests.

T8. My right hon. Friend will have seen last week’s Care Quality Commission report expressing continuing concern about maternity services in East Kent Hospitals University NHS Foundation Trust hospitals, including the William Harvey Hospital in my constituency. Can Ministers offer some reassurance to mothers-to-be in east Kent that giving birth in those hospitals will be safe? (903679)

I thank my right hon. Friend and I share his concerns completely. Just to reassure him, NHS England provided £1.6 million to East Kent Hospitals University NHS Foundation Trust to fund an additional 38 midwives, with 26 already in post. I would be happy to keep updated with him to see what the clinical experience is on the ground.

T9. A constituent of mine, David Brydon, suffered an horrendous accident at home, falling down the stairs and severing his spinal cord. His family were really encouraged to learn that a pioneering treatment—the ARC treatment, as it is known—is being trialled at Queen Elizabeth Hospital in Glasgow. However, they were severely disappointed to learn that because he lives in England, he does not have the opportunity to access the treatment. Will the Minister meet me to see if we can come to some sort of a resolution for Mr Brydon, please? (903680)

I am very grateful to the hon. Gentleman. This is what this House does best: raising and highlighting particular cases. I am very happy to meet him to discuss this very challenging case.

I would like to ask the Secretary of State about pressures in emergency care and comments that the new chief executive of NHS England made to the Health Committee this morning that we have shortages of 999 call handlers. Is he concerned about the time it is taking to answer some 999 calls? Do we have those shortages? What are his plans to address them if we do?

My right hon. Friend speaks with real experience, especially on tough winters for the NHS, and he highlights shortages across the NHS. He mentions 999 callers. There is a huge pressure at the moment on 111 calls as well, and emergency care generally, including ambulance services. A significant amount of support has been put in, especially over the past few months, with additional funding. We will set out a detailed plan with the NHS, coming shortly in the next couple of weeks, on exactly what more we will be doing.

Given the high covid infection rates and the risk of new variants of concern emerging that may be vaccine-resistant, what discussion has the Health Secretary had with the Chancellor on extending the contain outbreak management fund and on increasing public health budgets, which are 24% lower than they were in 2015?

The hon. Lady will know that in terms of the pandemic we are very focused on vaccinations, treatments and testing. She is right to raise the importance of testing and surveillance for possible new variants. That remains a priority for the Government and it is getting the support it needs from the Treasury.

With covid case rates across my area of Kirklees still above the national average, what extra support can be given to Kirklees to help to keep deaths and hospitalisations low and to boost the booster programme in Kirklees?

My hon. Friend is right to raise the extra pressures that Kirklees is seeing. Public health officials and local council members are doing everything they can. Extra support is available—something we keep under review—but he is right to raise the importance of the booster programme. The more people who get boosted and the sooner they do so when they are eligible, the better it will be for not just them but the whole community.

Across the continent of Europe, mask wearing, ventilation in buildings and the use of green passes for events are commonplace. They also have much lower infection rates, hospitalisations and deaths, so while the Secretary of State addresses the backlog in the roll-out of vaccinations for children and of boosters, will he consider implementing the very good practice that can be seen in other countries?

In terms of the challenges of the pandemic and the challenges more generally over winter, the Government have set out a detailed plan. It depends very much on vaccinations, treatments, testing and surveillance, but we keep it constantly under review and, should we need to do more, there are contingencies.

May I add weight to what my hon. Friend the Member for Newcastle-under-Lyme (Aaron Bell) said earlier? I have a similar situation in my constituency at the Chalk Pit in Epsom. It is really important that we strengthen the public heath duties of the Environment Agency. Will the Secretary of State make that a priority of his discussions with his ministerial colleague?

I do not know how to respond to that, Mr Speaker, but I will carry on. In declaring an interest, I welcome the Government’s decision to give a third jab to people with compromised immune systems. There has, however, been confusion in the NHS about the difference between a booster jab and a third jab. May I therefore ask the Secretary of State where is the responsibility in the NHS for advising people and arranging the third jab, and what will be the time gap between getting a third jab and a booster, as opposed to the second jab and a booster?

The hon. Gentleman will know that the gaps between vaccinations, especially for different people in different groups, is a decision that the Government would be advised on by the Joint Committee on Vaccination and Immunisation, and as soon as we get that advice, we will always publish it and act on it. It is important that everyone comes forward who is invited for their third jab if they are immunocompromised or for their third jab as a booster jab. As he will know, not everyone who is immunocompromised can benefit from the vaccine, but he might be interested to know that we are working on procuring new treatments that will help significantly.

Thanks for the warning, Mr Speaker. I congratulate the Secretary of State and the new vaccines Minister—the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Erewash (Maggie Throup)—on the roll-out of booster jabs. Over 3 million have been administered so far. May I attempt to strengthen their hands by asking for some of the pop-up vaccination centres, such as the Brent mosque, to get going with these booster jabs so that we can make sure that people in all communities have access to these much needed boosters?

One of the reasons that our country has one of the most successful vaccination programmes in the world has been the efforts of my right hon. Friend, and I want to take this opportunity to thank him for that. He is right to point to the importance of access to vaccines, and making that more mobile is exactly what we are doing.

Teenage vaccination rates in this country are lagging behind other countries. The latest data shows that the equivalent of 8,000 classrooms were empty over the past two weeks due to pupil absence, and schools such as Hampton High in my constituency had 11 teachers missing yesterday yet have been advised against reintroducing masks and have been told to teach 700-plus pupils outdoors. Does the Secretary of State think that that is sensible advice and will he ramp up the vaccination of teenagers, particularly over half-term next week?

We are ramping it up. I can tell the hon. Lady that to make the most of half-term next week, we will be opening up the national booking service to all 12 and 15-year-olds to have their covid vaccinations in existing national vaccination centres, which will offer families more flexibility. It is important that anyone who is invited as they are eligible for a vaccination—including young people—comes forward and takes up that offer.