House of Commons
Tuesday 23 November 2021
The House met at half-past Twelve o’clock
[Mr Speaker in the Chair]
Oral Answers to Questions
Health and Social Care
The Secretary of State was asked—
Integrated Health and Care Services
We are committed to the delivery of world-leading health and social care across the UK. The Health and Care Bill will ensure that every part of England is covered by our integrated care boards and integrated care partnerships. This will remove the silos within the NHS while supporting the NHS, local authorities and the wider system of partners to join up healthcare, social care and public health services to achieve the long-held ambition of more integrated care.
Will the Secretary of State come with me to visit Townlands Community Hospital in my constituency, where we have built into the process of keeping the hospital going a real potential for the integration of NHS and social care services? It would be very good if I were able to share that with him.
I would be pleased to visit the hospital with my hon. Friend. I know that the site to which he refers is multi-disciplinary and provides rehabilitation and palliative care together and is doing well at it. I know also that it is an excellent example of good integration at work.
I apologise for once again returning to the subject of integrated care boards. One important question remains unanswered following yesterday’s debate. If we are to have truly integrated health and social care, all voices need a seat at the table: public health; social care; mental health; the workforce; and, of course, patients and carers. As matters currently stands, there is nothing guaranteeing each of those groups a seat at the table. I am sure that the Secretary of State will agree that none of them should be missed out, so what will he do, for example, if an ICB decides to exclude the patient’s voice?
That is an important point, which is why the Government have listened to it. The hon. Gentleman will know that a lot of consultation was done before the Bill that he refers to was presented. In terms of voices around the table in the ICB, we have deliberately set up a permissive system that allows those local voices to be catered for, and for local decisions to be made. While there are minimum requirements, there are no maximum requirements.
Humphrey Perkins School in my constituency had carried out all the necessary preparations ahead of its anticipated roll-out of the vaccine prior to the autumn half-term. However, the day before, the school was informed that the roll-out would be postponed until 30 November. Please can my right hon. Friend set out the reasons for this delay, and will he confirm that this date will not be pushed back again, as that could have an impact on transmission between local adults, among which cases have increased recently?
When it comes to the integration of health and care services, it is very important that we have early diagnosis. The covid-19 pandemic has shown that there are some 200,000 potential type 2 and type 1 diabetics. What can be done to address the issue of diabetes, speaking as one who is a diabetic?
The hon. Gentleman is absolutely right to raise that as one of the unintended impacts of the pandemic. The reassurance that I can offer him is that there is close co-operation across the devolved Administrations when it comes to working on those impacts. NHS England is working with the health service in Northern Ireland to see what more can be done.
I am very happy to do so. My hon. Friend will know that the system that we set out back in September for social care will mean that no one loses out. In fact, when it comes to receiving social care in the future, the vast, vast majority of people across the country will be better off, including his constituents.
While the Scottish Government are taking action to establish a national care service in Scotland, the UK Government’s plans allocate the bulk of the money raised over the first three years of the national insurance rise to the NHS backlog. Does the Secretary of State agree that A&E functioning is greatly impacted by the lack of beds due to delayed discharges to social care? Will his Department provide urgent funding for the critical support for social care?
The Government have provided urgent funding, especially because of the impact of the pandemic. We have put more than £34 billion extra into health and social care, with the relevant Barnett consequentials, from which Scotland will of course have benefited. The issue of delayed discharges is an important one to continue working on and addressing, which is exactly why NHS England has a delayed discharge fund of almost £500 million for this winter.
Covid-19 Booster Doses: Shipley
There are more clinics in England delivering covid-19 vaccines than there were at any point during the covid-19 vaccination programme. A lot of planning has gone into ensuring that sites are distributed according to demand. I can tell my hon. Friend that there are three vaccination sites in Shipley itself—at Lynfield Mount Hospital, Shipley health centre and Windhill Green’s emerald suite—and eight walk-in centres within 10 miles of Shipley. These sites are available to all those who are eligible and need to book.
Lynfield Mount is not in my constituency. Many of my constituents want to have the booster vaccine, but are unable to access it locally and are instead being told to go to Bradford, which many are unable or unwilling to do. If the Government want a bigger take-up of the booster vaccine, may I urge my right hon. Friend to ensure that there are more places available in the Shipley constituency where my constituents can have their booster?
My hon. Friend, as always, make an important point. I thank his constituents for their excellent response to the national roll-out of the vaccination programme, and for playing their part in that. I have heard what he has said very clearly. We want to make access to vaccination as easy and convenient as possible. I will speak to the NHS to see what more can be done.
The vaccination programme has lost momentum over the summer and autumn. To ensure that everyone who is eligible gets their booster jab by Christmas, we need to be vaccinating half a million people a day, but we are currently not near that figure. We need to reboot the national effort in Shipley and beyond—[Interruption.] Always just for you, Mr Speaker. We need to be mobilising retired medics, and using pop-up clinics and of course our nation’s pharmacies, which are crying out to help. Will the Secretary of State commit to that, and confirm by which day the 500,000 person target will be met?
I know that the hon. Gentleman sees it as his job always to be negative about the Government, although on the vaccination programme he and his colleagues have so far been very co-operative across the House. We should not talk down our world-successful vaccination programme, because we have delivered more than 15 million booster vaccines across the UK to 26% of the population over the age of 12—the most successful booster vaccination programme in the whole of Europe.
We recognise that carers perform a difficult role and often find it challenging to access support. The Care Act 2014 secured important rights for carers, including a responsibility for local authorities to assess and support their specific needs where eligible. We will work with unpaid carers and stakeholders to co-develop further detail in a White Paper for reform later this year.
The Minister will know that among those unpaid carers are 800,000 young carers, who play an extraordinary role—some from as young as seven or eight years old—in looking after parents with long-term conditions. Too many are unidentified, and as a consequence struggle without the support that they deserve. Does the Minister agree that integrated care boards could require GPs, who are uniquely placed to do this, to identify young carers and signpost them to support services? Will she also work with ministerial colleagues to require schools to create a young carers lead, as with special educational needs co-ordinators, to co-ordinate the identification of and support for young carers?
We will certainly be looking at all those points within guidance. Local authorities have a duty to assess the needs of young carers under the Children and Families Act 2014, and that duty has remained in place throughout the pandemic. Authorities must ensure that young carers are identified and referred to appropriate support if needed, and that the young carer is not taking on excessive or inappropriate care and support responsibilities. We have also announced an additional £1 billion of new recovery premium funding, which schools can use to support young carers’ mental health and wellbeing, alongside their academic recovery.
The carers action plan published in 2018 was a two-year cross-Government attempt to try to change the way we identify and support the millions of unpaid carers across our country. They save our health and care system a fortune, but for their loved ones they are literally the world. What plans are there to publish a progress report and set out the next steps for how the Government intend to keep focused on this really important issue?
I pay tribute to my hon. Friend for her work in this role and also to all unpaid carers. There are 5.4 million unpaid carers in England and they do a fantastic job. In the forthcoming Bill that we are co-producing with unpaid carers, we will make sure that we continue to make progress in this area. I look forward to sharing that with her before the end of this year.
Carers UK recently called for an additional payment across the UK for unpaid carers after its survey found that more than one in five unpaid carers are worried that they may not cope financially over the next 12 months. In Scotland we already have a carer’s allowance supplement, and the Scottish Government will once again make a double payment this December, recognising the impact that the pandemic has had on our carers. Will the Minister now urge her colleagues in the Department for Work and Pensions to make a commitment to match the Scottish Government’s offer?
There is a carer’s allowance in the UK as well, but in most cases financial incentives are not the main driver for those providing unpaid care. However, we may see a shift towards less intensive caring activities or a reduction in the hours spent caring as people become more eligible for state support and we push through some of the reforms. Charging reforms bring an end to the unpredictability of care costs for care users and will do the same for those who provide unpaid care for them, allowing them to make informed choices. We need to do more to support them in providing respite and day services.
What action have the Government taken to support the charities and community groups that provide help to unpaid carers, because many of these charities found it very hard to operate and raise funding during the covid shutdown?
My right hon. Friend is absolutely right: charities are also a vital part of the network of support for our unpaid carers, and some of them did have to close during the pandemic, so we have been encouraging them to open up now that we can all open up. Additional financial support was provided for the charitable sector to make sure that it could continue its vital services during the pandemic when fundraising activities were very difficult.
Many families are pushed to breaking point because they cannot get the help they need to look after the person they love. Will the Minister now confirm that somebody who is trying to hold down a job and care for their elderly mum whose house is worth £100,000 will face a tax rise that will not improve their mum’s care or give them a break from caring, and will not even stop them from having to sell their mum’s home, because under the plans Tory MPs voted through last night, she will never hit the cap on care costs? Will the Minister further confirm that this tax rise on working people will be used to protect 90% of a home worth £1 million? If she disputes these figures, why does she not publish the impact assessment before MPs are asked to vote on the Health and Social Care Bill tonight?
From October 2023, the Government will introduce, for the first time in our history, a new £86,000 cap on the amount any adult in England will need to spend on their social care. That will protect them from unpredictable and unlimited costs. But as well as that there is a more—[Interruption.] The hon. Lady may like to listen to the answer. As well as that, there is a more generous—[Interruption.] Please listen. On top of that, a more generous means test for adult social care will come into effect, allowing more people to benefit from the means-tested support. Under the current system, about half of all older adults in care receive some state support. This rises to roughly two thirds under the recently announced charging reforms, which will help many adults, including unpaid carers. Everybody will benefit from this system.
Young People’s Mental Health Services
We are committed to ensuring that children and young people get the mental health support that they need. That is why we are expanding mental health services through the NHS long-term plan so that 345,000 more children and young people a year have access to services by 2023-24. This year the Government and the NHS, under NHS England, have provided an additional £109 million on top of long-term planned funding. This additional funding will allow 22,500 more children and young people to access community health services this year, earlier than planned, and that will accelerate the roll-out of mental health support teams in schools and colleges.
In West Berkshire, a family seeking a child and adolescent mental health services diagnosis of autism spectrum disorder or attention deficit hyperactivity disorder can face a waiting time of up to two years. The Berkshire West clinical commissioning group has recently made £1.6 million available to recruit extra staff, but when I spoke to it, I was struck by the absence of any hard targets to reduce waiting lists and any consequences if it fails to deliver. These waiting times are causing misery to my affected constituents, so can my hon. Friend say what steps can be taken to ensure accountability in the provision of this service, and will she meet me to discuss waiting times in West Berkshire?
I share my hon. Friend’s concern that waits for autism assessments and diagnosis are often way too long, and that is why we are investing an additional £13 million of funding this year. That funding will allow local systems to test different diagnostic pathways—including working on a multi-disciplinary basis, which will shorten the diagnosis time—and to find new solutions for addressing long waits. The precise allocation of funding for diagnostic pathways are decisions made at the local level, and those should be compliant with National Institute for Health and Care Excellence guidance. NHS England is working with local systems to evaluate what works well. Since November 2019, we have been reporting on waiting times between referral and first assessment, and that is important, because we use that to drive up local performance. I would be very happy to meet my hon. Friend to discuss this further.
When the Government talk about waiting times, they refer to how long it takes simply to get an assessment, and not to when treatment may start. Most children face an incredibly long wait after that first step, or even have their referral closed. The real truth is revealed when we look at how long it takes for children to complete treatment. In Yorkshire and the Humber, it took one child more than 13 years to complete treatment for their anxiety. In the north-west, some children took three years to complete treatment for eating disorders. In the midlands, it is not uncommon for treatment completion to take five years. Will the Minister commit, as we have, to the provision of a counsellor in every school, a mental health access hub in every single community and regular mental health assessments for children in all key stages?
We know that the prevalence of children and young people with a mental health condition has increased—in some cases, it has increased massively. That is why we remain committed to increasing investment through the long-term plan. Also, we have consulted on the potential to introduce five new waiting times standards, including for children and young people and their families and carers presenting to community-based mental health services. In addition, NHS England and NHS Improvement have announced an additional £40 million to address the impact of covid on children and young people’s mental health, including for eating disorders. Since 2014, extra funding has been going into children and young people’s community eating disorder services every year, but we know that we have more to do. This extra funding will enhance the development of more than 70 new and improved community eating disorder teams, but there is no doubt that there is much to catch up on. We are also introducing services into schools for young people.
When the chief inspector of hospitals placed St George’s in Tooting into special measures, he warned that the
“emergency department was not large enough for the number of patients that passed through it and privacy and dignity were compromised.”
Given the report by the British Red Cross in this morning’s edition of The Times highlighting the causal link between A&E attendance and deprivation, does the Minister understand the further huge impact that moving acute services from St Helier to wealthy, healthy Belmont will have on A&E attendances at St George’s?
St Helier and St George’s Hospitals
I am grateful to the hon. Lady. To answer the tabled question, no recent assessment has been made of the changes associated with the Epsom and St Helier reconfiguration, including proposed changes to some services outside the new Sutton site. The hon. Lady will know that these proposals have been through consultation, judicial review and the independent reconfiguration panel, which all supported the plans as being in the local population’s interest. The Secretary of State agreed with their advice.
Turning to the hon. Lady’s supplementary question, I am grateful to her and I know how strongly she feels about the issue, but I take her back to the point I have just made, which is that these proposals have all been through extensive consultation and extensive legal process and been looked at by the independent reconfiguration panel. Those processes all concluded that what is proposed is in the best health interest of the population.
The community pharmacy contractual framework outlines a transformational programme of work to integrate community pharmacies into the NHS, delivering more clinical services and making them the first port of call for many minor illnesses. The framework commits £2.5 billion annually to the sector to support that ambition.
That is a welcome response from the Minister, and shows that she and the Department now seem to recognise our pharmacies for their magnificent efforts during the pandemic, providing frontline primary care and delivering and encouraging vaccination. Will she further recognise their expertise and dedication, and push rapidly forward with integrating pharmacies into the delivery of primary care—thus also, of course, easing pressure on GPs and hospitals?
The right hon. Gentleman will find no greater supporters of community pharmacists than this Government. That is why we launched the community pharmacist consultation service, where GPs and NHS 111 can refer patients directly to pharmacy services. We now see pharmacies dealing with minor ailments such as sore throats, coughs and colds, providing the new medicines service and providing public health services such as weight management and stop smoking services. We place on record our thanks to all in community pharmacies.
Community pharmacies in my constituency have played a crucial role during the pandemic, not least in providing vaccines, as at Hughenden Valley. Will my hon. Friend join me in thanking them, as well as the pharmacists working in GP surgeries such as Meadowcroft surgery in Aylesbury, which I visited last week? Their growing role in primary care is an important part of our efforts to improve the health service and ensure that patients get the best possible care.
My hon. Friend makes some excellent points, and I put on record again our thanks to community pharmacists and all community pharmacy teams. During the pandemic, more than 1,500 community pharmacy-led covid vaccination sites have been set up, delivering 15 million covid vaccinations so far, and this winter more than 3.8 million flu vaccines have been delivered through community pharmacies, which shows that they are leading the way in primary care.
The role of community pharmacies across Angus and Scotland during the pandemic cannot be underestimated. The way they were able to alleviate pressure on clinical services and the wider NHS must be noted. That is why the Scottish Government have introduced their NHS Pharmacy First Scotland service, backed by £7.5 million last year and going up to £10 million. Can the Minister assure me that the lessons we have learned in Scotland are accepted by Whitehall, and would she like to come to see the lessons we have learned in Scotland? I would be happy to accompany her.
As I have said, this Government are leading the way in England in the way community pharmacies are transforming services in primary care. That is why we have the new medicines service, where patients with conditions such as asthma and high blood pressure or who are on blood-thinning medication are able to go and see their pharmacist as a first port of call in managing their medication. We will be expanding those services and are in discussion with community pharmacists about how we take that forward.
Covid-19 Vaccination: 12 to 15-year-olds
We have vaccinated more than 1.1 million 12 to 15-year-olds since roll-out began. Vaccine clinics have been held at around 3,500 schools, with 800 more to be visited next week, and there are more than 240 out-of-school vaccine sites in operation. To bolster the roll-out, since 22 October vaccination bookings for any 12 to 15-year-old in England can be made through the national booking service to attend a vaccination site outside school hours. I take this opportunity to thank everybody involved in making this programme so successful.
Humphrey Perkins School in my constituency had carried out all the necessary preparations ahead of its anticipated roll-out of the vaccine prior to the autumn half-term, but on the day before, it was informed that the roll-out would be postponed until 30 November. Please could my hon. Friend set out the reasons for this delay, and can she confirm that this date will not be pushed back again as this could have an impact on transmission between local adults, among whom cases have increased recently?
In late September, the Leicestershire Partnership NHS Trust school age immunisation service devised an updated schedule for covid-19 and flu vaccinations comprising the remaining schools to be visited. This was to address some operational challenges, reduce the need to postpone sessions at short notice and offer the best experience to the young people receiving vaccinations. All affected schools were notified as soon as possible. As my hon. Friend said, the service will be attending Humphrey Perkins on 30 November, when eligible students with consent will be offered both the flu and the covid-19 vaccines. West Leicestershire clinical commissioning group has confirmed to me that this date will not be moved.
Wales has now joined Scotland in having vaccinated more than half of all 12 to 15-year-olds, Scotland’s figure being 57.7% in comparison with England’s 36.3% of eligible pupils. Given that 10 to 19-year-olds have maintained the highest rate of infections in recent months, what steps are the UK Government going to take to follow Scotland’s lead and improve vaccination further in this age group?
As I said earlier, we have already vaccinated over 1.1 million 12 to 15-year-olds since the roll-out began, which to me is a huge success. We have opened up the national booking service, and provided more opportunities for youngsters to come forward whether within the school environment or outside the school environment. We always look at every opportunity to ensure complete accessibility for people to get their vaccine.
Social Care: Staff Numbers and Vacancy Rates
We recognise the considerable challenges the adult social care sector faces in recruiting and retaining staff. We have put in place a range of measures to support local authorities and care providers to address workforce capacity pressures. These include a new £162.5 million workforce recruitment and retention fund, and the latest phase of our national recruitment campaign, launched on 3 November, which highlights adult social care as a rewarding and stimulating place to work.
I thank my hon. Friend for her reply. The latest figure I have for the vacancy rate for carers in August was significantly worse than those from before the pandemic, and it is likely to worsen still further due to the requirement for compulsory vaccination. When does my hon. Friend believe the vacancy rate will return to pre-pandemic levels?
The first thing to say is that obviously the vaccine saves lives, and it is our responsibility to do everything we can to reduce the risk for vulnerable people. As of 14 November, 92.5% of care home staff have had their second dose. We have put in place measures, as I said earlier, to support workforce capacity, which have only just gone to local authorities. The Department continues to closely monitor workforce capacity, bringing together the available data, including the vacancy rate, with local intelligence. Longer term, we have committed at least £500 million to support and develop the workforce, and that will go some way to addressing the barriers to people taking up work in adult social care, which has been an issue for a number of years.
There are 105,000 vacancies across all social care workforce grades, but employers are unable to recruit across those grades. The Government have accepted the need to add senior care workers to the shortage occupation list—they did that in April—but the Migration Advisory Committee is not due to report until next April on the need to recruit social care workers. It is no good the Minister saying employers need to pay more money to recruit UK workers, because this Government are the ones underfunding the employers, who cannot then compete with the likes of Amazon. When will the Government admit that they need to add all grades of social care workers to the shortage occupation list if they are to have any hope of addressing this shortfall and providing the care that is needed to address the care crisis?
As I mentioned earlier, we have sent out £162.5 million, which has not yet been put into effect. For example, Sefton received £1,032,474. That money has only just gone into the bank account, and has not yet been utilised to retain staff, or to recruit agency or other staff. As the hon. Gentleman says, adult social care providers can recruit key adult social carers from overseas from the shortage occupation list. That provides lower fees and a reduced salary threshold of £20,480 for someone to be eligible for the skilled worker visa.
The adult social care sector faces the worst staff shortages in living memory. A recent survey by the National Care Forum found that one third of managers of registered care homes are limiting or stopping admissions from hospital, due to staff shortages, with direct consequences for both the NHS and for vulnerable people who cannot access the care they need. The care sector needs action now, not warm words and job adverts. Will the Minister commit to paying a retention bonus to frontline care staff, to help stem the tide of those exiting the care sector this winter? Will she commit to a fully funded, permanent pay increase, to bring the minimum level of pay for care workers up to £10 an hour—the minimum rate at which Amazon is recruiting in many areas where the care shortage is at its most acute?
We have committed to bring forth new measures in the White Paper, and to spend at least £500 million on recruiting that workforce. To address the emergency now, as I mentioned, there is £162 million. In addition, we have put around £500 million particularly to address discharge processes, and to ensure a discharge to assess process, which means it can be much quicker. We must ensure that those teams work together to shorten the discharge process. There is no doubt that our NHS and our whole system is under extreme pressure this winter, and we thank it for all the work it is doing.
There is a particular challenge in a county such as Surrey that has a rapidly ageing demographic, high housing costs, and where the cost of living is high generally. Could I urge the Minister and the Secretary of State to ensure that they consider all possible avenues to assist with what is becoming an acute shortage of key staff? We cannot end up in a position where the elderly do not receive the care they need, and we need maximum flexibility to ensure they get that care.
There is no doubt that the sector is facing extreme pressure. It always faces pressure as the demographic need grows by 1% to 2% every year, but we have set out money to help with the short-term impact of that. Surrey will receive £2,704,702, so just over £2.7 million. We recently started the biggest national recruitment campaign we have ever done, Made with Care, to thank our care workers and to show what a fantastic and rewarding career it would be. We will continue to work with local authorities to help as much as we can.
In the context of what the Minister has announced about increased money for staff terms and conditions, what does she make of the Alternative Futures Group, which operates in the north-west? It refuses to take up the real living wage, even when councils offer to fund it, and is in a process that is seeing the terms and conditions of its workforce deteriorate? Is there a need to look at that group, and to have a collective agreement for the whole sector?
Yes, and I would be grateful if the hon. Gentleman would write with the details. We have a skills shortage in many areas across our economy. Because of the success of the Plan for Jobs, and our bounce back from the pandemic, anybody who does not treat their staff well will find that their skills shortages become very acute indeed.
Covid-19 Booster Doses: West Dorset
We have delivered more than 15.3 million booster doses in the UK, and we know there is a strong demand for boosters in Dorset. The NHS has worked hard to deliver boosters and third doses at all 18 primary care networks in Dorset, providing them across a number of sites. Additional provisions are also in place for those who are housebound, elderly, or in care, to ensure that they get their booster.
I thank my hon. Friend for her answer. Almost a third of constituents in West Dorset are over the age of 65. While I welcome very much the Secretary of State’s announcement this week that he is rolling out the booster to those over the age of 40, I am afraid that, in the county town of Dorchester and the second town of Bridport particularly, it is still very difficult for the elderly to receive their vaccine boosters. Will my hon. Friend help urgently with sorting this issue by arranging walk-in centres so that we might address it rapidly?
The Department of Health and Social Care and the NHS keep the covid-19 vaccine programme under constant review in order to ensure that there is sufficient capacity across the country. There are more vaccination sites than ever before in England, including hundreds of walk-in centres. A lot of planning goes into ensuring that those sites are distributed to meet the level of demand, and there are measures in place to ensure that boosters are accessible for all in West Dorset, but I will look into this matter further on behalf of my hon. Friend.
Covid-19: Booster Vaccinations
The UK’s covid-19 vaccination programme has been a recognised success story. It is the largest vaccination programme ever undertaken by the NHS. We are working at speed to get people their covid-19 booster vaccines. Our vaccination programme is making great progress, with over 15.3 million people across the UK already having taken their covid-19 booster or third jab.
It is great to hear about the uptake of the booster vaccine nationally. I have seen some data to suggest that in Milton Keynes, uptake is slightly below the national average. We have some great advertising campaigns—MKFM, for example, has been really good on this—but what more can we do to encourage people who need to take the booster to protect themselves and protect the NHS over the winter?
I think my hon. Friend might be wearing a booster badge, because I understand that he has taken his own boost this morning. What more encouragement would the people of Milton Keynes want than their very own Member of Parliament getting boosted? I can tell him that the Bedfordshire, Luton and Milton Keynes clinical commissioning group is in regular dialogue with Healthwatch and the local authority to see what more it can do to encourage local people to take up their booster jabs, and the national “Boost your immunity” campaign is helping to encourage more and more people to come forward, not just for their booster jab but for their vital flu jab.
I thank my right hon. Friend for his answer and for the speed of the booster roll-out. In fact, it is so speedy that the criteria for getting a booster are changing all the time, and many constituents have contacted me confused about exactly what the criteria are. I have spoken to my CCGs to try to get them to improve the public engagement that they are doing, but will my right hon. Friend lay out what the criteria are for getting a booster at the moment, and what support he is giving to CCGs so that they can get the message out to people and get them into walk-in centres or booking their appointment for a booster?
My hon. Friend will understand that there is often good reason to change the criteria. They might be changed, for example, on the latest advice from the Joint Committee on Vaccination and Immunisation; the Government must of course consider that advice and take it seriously. As was mentioned earlier, we are extending the booster jab to 40 to 49-year-olds. NHS England has issued guidance to CCGs on the covid-19 vaccination programme, which includes guidance on eligibility for booster vaccines and how to manage those appointments. We encourage everyone to visit the NHS website on gov.uk for the very latest information on the programme.
A disabled member of my community needs the booster and is very keen to have it. However, he is housebound and unable to go the 1.2 miles to where the booster is being offered. What can the Secretary of State do to ensure that people who are housebound and unable to leave their homes can get the booster that they desperately need?
The hon. Lady makes a very important point. Hundreds of thousands of people have received their booster jabs directly from primary care—from their GPs—in most of the type of cases that she describes. If anyone is housebound or, for example, in a care home, they will receive a visit from their GP. That has happened up and down the country. If the hon. Lady is aware of any individual that has not received such contact, I ask her please to contact me, and I will do everything I can to assist.
Take-up of the booster jab in Northern Ireland has been somewhat behind, although it is now beginning to catch up. Does the Secretary of State agree that the roll-out is best done as a voluntary roll-out, so that we can persuade people that it is a good thing, and that it protects both them and their family and friends, to take up the booster jab?
I very much agree with the hon. Gentleman. The general vaccination programme for covid-19, or any other vaccine for that matter, should be voluntary. It should be a positive decision that people take to protect themselves and those around them. The only exception to that in England, as the hon. Gentleman will know, is those who work with vulnerable people in the NHS or in social care. Otherwise, it absolutely should be a positive decision that people are encouraged to take.
GPs: Sittingbourne and Sheppey
The Kent and Medway clinical commissioning group has informed us that all practices in the area have open lists and are accepting new patients. It has also informed us that practices in Sittingbourne and Sheppey are being prioritised for support to help them manage the high levels of demand they are currently facing.
I think the Minister has been misled by my local CCG. I can tell her that all the GPs in my area are oversubscribed and people are finding it very difficult to get an appointment with their GP, even including a virtual appointment. Indeed, some patients struggle even to speak to a receptionist, because the phones are engaged for hours on end. I understand that the NHS is planning to give GPs an upgrade of their telephone systems, but such upgrades will be of no use whatever unless doctors have the resources needed to recruit and train additional receptionists to answer the phones. What assurances can my hon. Friend give me that GPs will get those resources?
We recognise the difficulty that patients have had in particular with telephone access and GPs have fed in that phone lines have been busier than ever. That is why the Secretary of State, through the winter access fund, has addressed the issue in two ways: the availability of the cloud-based telephone system that GPs and primary care networks can be a part of, which will help to build their telephone capacity; and the £250 million winter access fund, which GPs can use to either recruit more telephone receptionists and train up existing telephone receptionists or build up more resources. I am very happy to discuss that further with my hon. Friend.
It is a critical time for our country, and we are taking vital steps across health and care. First, on covid, we have now given over 112 million doses of the vaccine in total across the UK. Yesterday, our booster programme was opened up to all people over the age of 40 and we extended our offer of a second dose to all people aged between 16 and 17.
Secondly, on recovery, we are delivering the biggest catch-up plan in the history of the NHS, including the £5.9 billion capital investment we announced last month. Lastly, on reform, yesterday we announced our intention to put a policy of education and training for the health workforce and digital transformation at the very heart of the NHS, so we can plan more effectively as one for the long term, with clear accountability for delivery.
A young constituent of mine, Chris, has had to have part of his skull removed following a stroke. Although he is prone to falling, his brain has been largely unprotected for nearly two years. This is because his surgeon feels that the necessary surgery is primarily cosmetic. Several other of my constituents have been refused surgery on those grounds, despite procedures being available elsewhere. What steps is my right hon. Friend taking to level up such health disparities and make health inequality a thing of the past?
First, I am sorry to hear about my hon. Friend’s constituent Chris and wish him all the very best. She will know that clinical commissioning groups are responsible for commissioning local healthcare services. If the aim of a cosmetic procedure is health rated, such as the need to repair or reconstruct missing or damaged tissue or skin that might come through illness, birth defect or accident, it will be commissioned and seen to by commissioners. She refers to a particular case. If she would like to provide me with more details, I would be happy to take a look.
At the weekend, the Secretary of State effectively ditched his promise to deliver 6,000 extra GPs. Last week, the Infrastructure and Projects Authority said his promise to deliver 40 new hospitals is “unachievable”. Last night, he whipped a vote that sees poorer pensioners lose their homes to pay for care, while the homes of the richer are protected. Can he tell us which promise is he going to break next?
I have to say that the right hon. Gentleman is wrong on all three counts. The Government are absolutely committed to hiring more GPs, with over 1,800 full-time equivalent GPs entering primary care in the two years to September 2021. We are seeing success after success in the hospital building programme, with the biggest capital investment programme in hospitals that this country has ever seen. As for our social care programme, this Government are the first in decades to have the guts to deliver, and that is exactly what we are getting on with.
The Secretary of State’s social care programme is not levelling up when the promise in his manifesto that no one should have to lose their home to pay for care is broken and in tatters after last night.
The Secretary of State’s next promise was to give the NHS “everything” to get through the backlog. With waiting lists growing at pace, ambulances backed up outside hospitals, and cancer operations getting cancelled, what will he do to recruit the staff we need? He is apparently not going to support the cross-party amendment in the name of the former Health Secretary, the right hon. Member for South West Surrey (Jeremy Hunt), tonight, and he failed to win the funding needed for recruitment and training in the Budget, so how will he deliver on his promise to give the NHS “everything” when it does not have the staff to deliver the care to bring waiting lists down?
Once again, the right hon. Gentleman proves he still does not understand the social care programme that this Government have set out. I think that is deliberate; he chooses not to understand it. For the first time, catastrophic costs are being capped for everyone in the country, regardless of where they live, and the generous means-testing system will ensure that the vast majority of people will benefit and that no one will lose out.
The right hon. Gentleman asks me what I am doing about the workforce. We are making the biggest investment in the workforce that this country has ever seen. Yesterday I announced the merger of Health Education England into the NHS, so that we can have a better joined-up strategy, and we have already set out a 15-year framework to consider the long-term needs of the workforce.
Yes, I will. I looked at the previous bid and have been trying to understand why it was not taken forward. However, I would like to look carefully at the revised bid. I reassure my hon. Friend that more funding is available for such capital projects, and I would be happy to discuss that with him.
I thank the hon. Gentleman for his question. We are trying to solve something that has not been solved for decades, and the Labour party does exactly what it always does when it comes to this point: it picks one specific part without looking at the package as a whole and misleads the whole country. I want a better system not only for our grans and grandads, but for our mums and dads and all of us. If this system had been in place for my grandmother when she had dementia before dying in 2018, she would have been a lot better off. While we sit here doing nothing, the reality is that everybody loses—
I thank the hon. Lady for her very important question. There is nothing more important than our children. Sadly, some of the actions that were taken at the height of the pandemic, for understandable reasons, have had unintended consequences. That is exactly why we are putting in a record amount of funding, with the biggest catch-up programme for elective procedures in the history of the NHS. I know that that will help.
I am grateful to my right hon. Friend, who has taken a long-term and consistent interest in the matter. The strategic outline case for transforming the Royal Shrewsbury Hospital and Princess Royal Hospital Telford was received at the end of October 2021. It has been reviewed by the NHS and detailed feedback has been given; I look forward to it coming forward to me early next year. We remain committed to delivering the investment and improvement that Shropshire’s hospitals need and that he and his colleagues have helped to secure.
Women across the country have lost jobs and life savings as a result of chronic pain and disability caused by complications after the use of medical mesh. Many, including one of my constituents, have had to pay for corrective surgery overseas. The Government have so far refused to set up agencies to provide financial redress, as was recommended in the Cumberlege report. Will the Secretary of State revisit the Cumberlege report, and in particular the need for financial redress?
Women who have suffered are being helped and supported through the difficult choices that they are having to make. The Government have set up eight specialist mesh centres across the country to provide them with the specialist treatment that they need. Our priority is patient safety, preventing anything like this from happening again, and supporting women who have been affected. There is no evidence that a redress system would improve patient safety or improve the outcome for those women.
Local commissioners are responsible for meeting the health needs of their local population and should continue to ensure appropriate access to ear wax services. However, should a CCG not routinely commission ear wax removal or the suction method that my hon. Friend refers to, a patient can request an individual funding request. I am happy to help my hon. Friend if that is not happening locally.
Cancer targets are not being met. This September had the worst figures on record for both the 31-day and the 62-day targets; the 62-day target has not been met since 2015. Extra funding is welcome, but where is the detailed implementation plan that was promised to follow?
I reassure the hon. Gentleman that cancer has remained an absolute priority for the NHS during the pandemic, as it will continue to be. The funding that has been awarded to deal with long-term electives includes funding for cancer referrals. Some amazing work is being done by our cancer alliances, which are looking to deal with the urgent backlog that has developed during the pandemic.
My right hon. Friend has raised this issue with me before, but he is right to raise it again, because proper use of data is important to the future of the NHS. He may have noted our announcement yesterday that we are merging NHS Digital and NHSX with NHS England, which will enable us to do a much better job with data. I will of course look carefully at that report, and I should be happy to meet him to discuss it further.
Poppy is just eight. She has severe epilepsy, with ever more frequent and enduring episodes. Her specialist consultant has said that surgery is her only hope, but Sheffield and Leeds have refused to assess her for capacity and administration reasons, not clinical reasons. Will the Minister work with me to ensure that Poppy receives the treatment that she needs?
I know that my hon. Friend has a personal interest in improving stroke services. I can reassure him that the national stroke service model was published by NHS England and NHS Improvement in May this year, and that as of 1 April there are 20 operational integrated stroke delivery networks, bringing together key stakeholders to improve the diagnosis, treatment and rehabilitation of those who have suffered a stroke.
Ambulance response times are at their highest since records began. A month ago, on 22 October, I tabled a parliamentary question asking the Secretary of State how many ambulance trusts had moved into level 4—the level at which potential failures creep into the service. I am still awaiting an answer. Will the Minister answer that question today, please?
If the hon. Lady supplies the number of the question, I will ensure that it is dealt with today. As for her broader point, yes, ambulance services across the country are under significant pressure this winter, which is one of the reasons why we have already invested an additional £55 million in helping them to cope with that pressure.
Thank you, Mr Speaker.
The Secretary of State knows that some in Government are worried about the extra cost of training additional doctors, but does he agree that every additional doctor we train means one fewer locums that the NHS has to hire, which is cheaper for the NHS and better for patients?
I agree that we want more and more full-time doctors, which will mean that there is less demand for locums and is, of course, very good for the NHS. I also agree that there should be more focus on the workforce, and I hope that my right hon. Friend welcomes the measure that I took yesterday of merging Health Education England with the NHS, so that we can have a much more joined-up workforce plan.
Andrew Dilnot, whose commission undertook the inquiry into social care nearly 10 years ago, says that the impact of the Government’s social care plans on working-age disabled people will be “catastrophic”. What is the Government’s assessment of the impact?
The hon. Lady is right to raise the importance of doing everything we can to look after working-age people who need social care. As she will know, the total funding of social care from the state now constitutes most of the funding, and it is right that all needs are met through those funds. As for the new plan, everyone will benefit—no one will lose out from this versus the current system—so the vast majority of people will be better off, including working-age adults.
The Minister has heard from my right hon. Friend and neighbour the Member for Ludlow (Philip Dunne) how essential it is that the £320 million we have secured for the Future Fit programme be released, so that construction can start. We are beginning to see a definite negative impact on A&E services because of the seven or eight years of delays. Please will the Minister do everything possible to ensure that the money is finally released and construction can start?
I am grateful to my hon. Friend, and likewise to my right hon. Friend the Member for Ludlow (Philip Dunne), who has campaigned vigorously this issue. We now have the outline business case from the trust, and we are reviewing it at pace to ensure that we can deliver the investment in both of Shropshire’s hospitals that they need to continue to serve my hon. Friend’s and colleagues’ constituents.
My 90-year-old constituent, Jimmy, fell in his garden recently and broke his hip. When his family rang 999, they were told that it would be up to 14 hours before an ambulance could attend. The family got the fire brigade out after two and a half hours to sort him out. When the Government going to get a grip on the crisis in our ambulance services?
The hon. Gentleman might have done this already, but if he wishes to, I would be grateful if he wrote to me about that case, not only to see whether there is anything I can do, but because it is always interesting and useful to hear from individual Members about specific incidents. To his broader point, as I set out to the hon. Member for St Albans (Daisy Cooper), we have invested £55 million this year ahead of the winter to support our ambulance services, but it is entirely true to say that they are under considerable pressure this winter across the country.
Point of Order
On a point of order, Mr Speaker. On 18 November, the same day as the statement was made in this House on the integrated rail plan, Transport for the North was written to by the Department for Transport setting out changes in relation to its future operation. In essence, the already limited powers of TfN are to be further reduced and its budget cut again. This comes after TfN’s recommendations on the integrated rail plan were largely rejected, with the scaling back of previously promised investment plans for northern England’s rail network.
As you know, Mr Speaker, rail infrastructure investment is a central part of the levelling-up agenda, which in turn is meant to be a central part the Government’s strategy to increase overall UK economic growth. These changes to TfN represent a significant policy development, with consequences for the levelling-up agenda, and as such they should be discussed in this House. With no Transport questions scheduled until 16 December, Mr Speaker, have you been told whether Ministers intend to make a statement in this House on TfN’s future? If not, could you advise on how we might best summon Ministers to the House to answer questions on this matter?
First, I am grateful to the right hon. Member for giving me notice of her point of order. The short answer is that I have not had any notice from the Government that they wish to make a statement on the important subject that she has raised. She might wish to speak to the Clerks in the Table Office about other ways to pursue this subject. She has also put her point on the record and those on the Treasury Bench will have heard it; and there are always other ways, such as an urgent question.
Motion for leave to bring in a Bill (Standing Order No. 23)
I beg to move,
That leave be given to bring in a Bill to require matters relating to climate change and sustainability to be integrated throughout the curriculum in primary and secondary schools and included in vocational training courses; and for connected purposes.
Madam Deputy Speaker, 2050 is the year that the world needs to reach net zero. This will require fundamental changes to every sector of our economy unprecedented in their overall scale. For some, 2050 might feel like it is a long way away. In the next 30 years, Governments will come and go and many Members of this House will retire, but for my generation and for those who are still in school—young people who have their whole future ahead of them—2050 will be the middle of their working lives. A child who started primary school this September will not even be 35. The world and the economy that they inherit will feel very different from those of today.
If our education system is not preparing young people to mitigate and deal with the impacts of climate change, it is failing them. If it is not teaching them the knowledge and skills they need to thrive in a net zero society, it is failing them. If young people are not being taught to understand the impact of human interaction with the natural world and the need to maintain biodiversity and cut our carbon emissions, it is failing them and our planet. This Bill aims to put that right and to prepare young people for the future, and this Bill is what young people are demanding. In 2018, one survey found that 42% of pupils felt that they had learned a little, hardly anything or nothing about the environment at school, and 68% said that they would like to know more.
This Bill exists only because of the hard work of young people. School students from Teach the Future, who have joined us today in the Public Gallery, have spent the past two years campaigning relentlessly to be taught the truth about the climate crisis and to be equipped with the skills to tackle it. Their campaign has put this issue on the agenda; it now falls to us to put it into law.
The Bill comes in the same month that the UK hosted the COP26. If we want to know whether something was a success, we need to start by asking the people who have the most to lose—people such as 15-year-old Safia Hasan, a climate activist from Chad, who said:
“I’m hugely disappointed and hugely let down by COP. Coming from Chad, millions of my people are suffering but nobody is listening to our cries, our tears. It’s our planet, and it’s time to stop messing about with our future.”
Notwithstanding the disappointing outcomes on climate finance, decarbonising of the energy sector and just transition initiatives, however, I welcome the Government announcement at COP26 that they will take action to promote greater teaching of climate change in the curriculum. That is a key first step and a vital recognition of the importance of climate education, but a voluntary scheme such as the one announced can achieve only so much, and unfortunately the fine print of the announcement was such that it amounts to little more than teachers being sent PowerPoint presentations.
While teaching about the climate remains voluntary, many young people will continue to miss out. Teachers must also be supported to deliver climate education, given that 70% of teachers feel that they have not received adequate training to educate young people about climate change. This Climate Education Bill would make climate education mandatory, embedding it across the national curriculum and ensuring that all teachers receive training. It would be intertwined with every subject, a golden thread that runs through a young person’s schooling, just as the climate crisis and our actions to tackle it run through every aspect of our lives.
Whether those young people grow up to be a builder or a banker, a carer or a caterer, the climate crisis will affect everyone. We need to train the next generation of plumbers to install low-carbon heat pumps, and teach the next generation of chefs about sustainable diets and sustainable food production. This Bill would ensure that climate change is given the emphasis in our education system that it deserves.
The climate and ecological crisis impacts everything around us. Pandemics, such as the one that has turned our world upside-down for the past two years, will become more frequent as loss of habitat forces animals to migrate and come into contact with other animals or people. Climate education will help young people to understand the world around them and provide access to nature and opportunities for children to engage with our natural world. Some 57% of child and adolescent psychiatrists in England see patients who are distressed about the climate crisis and the state of the environment. The Bill would provide support for students to deal with eco and climate anxiety, which climate education will also mitigate, as it will empower students to understand what actions they can take to help tackle climate change and the role that they will play in the future.
I hope that the Government will recognise the Bill as a natural continuation of their announcement at COP26. I hope it will encourage them to go further—to legislate to make climate change part of the core content of all subjects, to support teachers to deliver climate education and to decarbonise the education sector much faster. Not only young people but our entire economy stands to benefit. Our green jobs and recovery plans lag far behind those of most G7 countries. The availability of the right skills and a keen interest in sustainability will pave the way to a productive green transformation and decent job creation.
I am delighted and grateful that the Bill includes among its sponsors the Chairs of the Environmental Audit Committee, the Select Committee on Education, and the Business, Energy and Industrial Strategy Committee. I pay particular thanks to the right hon. Member for Ludlow (Philip Dunne) for his continued leadership on skills and training as part of a just transition to a greener economy, as well as for his personal kindness and support for this campaign.
It is important to be honest about the climate and ecological emergency, but it is also important to remember how much we still have to fight for. Every ray of hope and every inch of progress at COP26 was won through relentless pressure from activists and campaigners, especially those on the frontlines of the crisis. Change has always happened this way, and always will. The next generation are calling on us to take these steps, to secure their future. I want us to listen to them and act for them. Some of us may not be around to see the full results of our actions, but our legacy will live on. We must decide: do we want to be remembered for what we did or for what we failed to do? Young people’s futures depend on us. We must not let them down.
Question put and agreed to.
That Nadia Whittome, Philip Dunne, Robert Halfon, Caroline Lucas, Layla Moran, Mhairi Black, Yvette Cooper, Rebecca Long Bailey, Zarah Sultana, Darren Jones, Clive Lewis and Jeremy Corbyn present the Bill.
Nadia Whittome accordingly presented the Bill.
Bill read the First time; to be read a Second time on Friday 28 January 2022, and to be printed (Bill 197).
Health and Care Bill
2nd Allocated Day
Further consideration of Bill, as amended in the Public Bill Committee
[Relevant documents: First Report of the Health and Social Care Committee, The Government’s White Paper proposals for the reform of Health and Social Care, Session 2021-22, HC 20; Fifteenth report of the Joint Committee on Human Rights, Care homes: Visiting restrictions during the covid-19 pandemic, Joint Committee on Human Rights, Session 2019-21, HC 1375 / HL 278; Second Special Report of the Joint Committee on Human Rights, Care homes: Visiting restrictions during the covid-19 pandemic: Government Response to the Committee’s Fifteenth report of session 2019-21, Session 2021-22, HC 553; Letter from the Care Quality Commission regarding the Committee’s report on Care homes: Visiting restrictions during the covid-19 pandemic, dated 18 May 2021; Report of the Joint Committee on the Draft Health Service Safety Investigations Bill, Draft Health Service Safety Investigations Bill: A new capability for investigating patient safety incidents, Session 2017-19, HC 180 / HL 1064, and Government Response, Cm 9737.]
New Clause 36
Offence of virginity testing: England and Wales
“(1) It is an offence under the law of England and Wales for a person to carry out virginity testing.
(2) ‘Virginity testing’ means the examination of female genitalia, with or without consent, for the purpose (or purported purpose) of determining virginity.
(3) An offence is committed under subsection (1) only if the person—
(a) is in England and Wales, or
(b) is outside the United Kingdom, and is a United Kingdom national or habitually resident in England and Wales.
(4) ‘United Kingdom national’ means an individual who is—
(a) a British citizen, a British overseas territories citizen, a British National (Overseas) or a British Overseas citizen,
(b) a person who under the British Nationality Act 1981 is a British subject, or
(c) a British protected person within the meaning of that Act.
(5) In subsection (2), ‘female genitalia’ means a vagina or vulva.”—(Edward Argar.)
This new clause creates an offence under the law of England and Wales of virginity testing.
Brought up, and read the First time.
With this it will be convenient to discuss the following:
Government new clause 37—Offence of offering to carry out virginity testing: England and Wales.
Government new clause 38—Offence of aiding or abetting etc a person to carry out virginity testing: England and Wales.
Government new clause 39—Virginity testing offences in England and Wales: penalties.
Government new clause 40—Offence of virginity testing: Scotland.
Government new clause 41—Offence of offering to carry out virginity testing: Scotland.
Government new clause 42—Offence of aiding or abetting etc a person to carry out virginity testing: Scotland.
Government new clause 43—Virginity testing offences in Scotland: penalties and supplementary.
Government new clause 44—Offence of virginity testing: Northern Ireland.
Government new clause 45—Offence of offering to carry out virginity testing: Northern Ireland.
Government new clause 46—Offence of aiding or abetting etc a person to carry out virginity testing: Northern Ireland.
Government new clause 47—Virginity testing offences in Northern Ireland: penalties.
Government new clause 48—Virginity testing: consequential amendments.
New clause 1—Licensing of aesthetic non-surgical cosmetic procedures—
“(1) No person may carry on an activity to which this subsection applies—
(a) except under the authority of a licence for the purposes of this section, and
(b) other than in accordance with specified training.
(2) Subsection (1) applies to an activity relating to the provision of aesthetic non-surgical procedures which is specified for the purposes of the subsection by regulations made by the Secretary of State.
(3) A person commits an offence if that person contravenes subsection (1).
(4) The Secretary of State may by regulations make provision about licences and conditions for the purposes of this section.
(5) Before making regulations under this section, the Secretary of State must consult the representatives of any interests concerned which the Secretary of State considers appropriate.
(6) Regulations may, in particular—
(a) require a licensing authority not to grant a licence unless satisfied as to a matter specified in the regulations; and
(b) require a licensing authority to have regard, in deciding whether to grant a licence, to a matter specified in the regulations.”
This new clause gives the Secretary of State the power to introduce a licensing regime for aesthetic non-surgical cosmetic procedures and makes it an offence for someone to practise without a licence. The list of treatments, detailed conditions and training requirements would be set out in regulations after consultation with relevant stakeholders.
New clause 12—Protection of the title of “nurse”—
“(1) A person may not practise or carry on business under any name, style or title containing the word ‘nurse’ unless that person is registered with the Nursing and Midwifery Council and entered in sub part 1 or 2 of the register as a Registered Nurse or in the specialist community public health nursing part of the register.
(2) Subsection (1) does not prevent any use of the designation ‘veterinary nurse’, ‘dental nurse’ (for which see section 36K of the Dentists Act 1984) or ‘nursery nurse’.
(3) A person who contravenes subsection (1) is guilty of an offence and liable on summary conviction to a fine not exceeding level four on the standard scale.”
New clause 21—Prohibition of virginity testing—
“(1) A person is guilty of an offence if they attempt to establish that another person is a virgin by making physical contact with their genitalia.
(2) A person is guilty of an offence if they provide another person with a product intended for the purpose, or purported purpose, of establishing whether another person is a virgin.
(3) A person is guilty of an offence if they aid, abet, counsel or procure a person to establish that another person is a virgin by making physical contact with their genitalia.
(4) No offence is committed by an approved person who performs—
(a) a surgical operation on a person which is necessary for their physical or mental health; or
(b) a surgical operation on a female who is in any stage of labour, or has just given birth, for purposes connected with the labour or birth.
(5) The following are approved persons—
(a) in relation to an operation falling within subsection (4)(a), a registered medical practitioner; and
(b) in relation to an operation falling within subsection (5)(b), a registered medical practitioner, a registered midwife or a person undergoing a course of training with a view to becoming such a practitioner or midwife.
(6) There is also no offence committed by a person who—
(a) performs a surgical operation falling within subsection (4)(a) or (b) outside the United Kingdom; and
(b) in relation to such an operation exercises functions corresponding to those of an approved person.
(7) For the purpose of determining whether an operation is necessary for the mental health of a girl it is immaterial whether she or any other person believes that the operation is required as a matter of custom or ritual.
(8) This section applies to any act done outside the United Kingdom by a United Kingdom national or resident.
(9) A person who is guilty of an offence under this section is liable, on summary conviction, to imprisonment for a term not exceeding 12 months, to a fine, or to both.
(10) The court must refer the case of any person guilty of an offence under this section who is subject to statutory professional regulation for investigation by the relevant regulator.”
New clause 22—Prohibition of hymenoplasty—
2(1) A person is guilty of an offence if they undertake a surgical procedure for the purpose of re-attaching membrane tissue, creating scar tissue or otherwise attempting to re-create the hymen in the vagina of a patient.
(2) A person is guilty of an offence if they advertise the service of hymenoplasty or any service that purports to ‘re-virginise’ or otherwise re-create or re-attach the hymen of a patient by way of surgical procedure.
(3) A person is guilty of an offence if they aid, abet, counsel or procure a person to undertake a surgical procedure for the purpose of re-attaching membrane tissue, creating scar tissue or otherwise attempting to or re-creating the hymen in the vagina of a patient.
(4) This section applies to any act done outside the United Kingdom by a United Kingdom national or resident.
(5) A person who is guilty of an offence under this section is liable, on conviction, to imprisonment for a term not exceeding 5 years.
(6) The court must refer the case of any person guilty of an offence under this section who is subject to statutory professional regulation for investigation by the relevant regulator.”
New clause 28—Secretary of State’s duty to report on long term workforce planning—
“(1) The Secretary of State must prepare and publish a report each year on projected workforce shortages and future staffing requirements for health, public health and social care sectors in the following five, ten and twenty years.
(2) The report must report projections of both headcount and full-time equivalent for the total health, public health and care workforce in England and for each region, covering all regulated professions and including those working for voluntary and private providers of health and social care as well as the NHS.
(3) The projections must be independently verified and based on projected health and care needs of the population for the following 5, 10 and 20 years, consistent with the Office for Budget Responsibility long-term fiscal projections.
(4) All relevant NHS bodies, arm’s-length bodies, expert bodies, trade unions and the Social Partnership forum must be consulted in the preparation of the report.
(5) The assumptions underpinning the projections must be published at the same time as the report and must meet the relevant standards set out in the National Statistics Authority’s Code of Practice for Statistics.
(6) The Secretary of State must update Parliament each year on the Government’s strategy to deliver and fund the long-term workforce projections.”
New clause 29—Duty on the Secretary of State to report on workforce planning and safe staffing—
“(1) At least every five years the Secretary of State must lay before Parliament a health and care workforce strategy for workforce planning and safe staffing supply.
(2) This strategy must include—
(a) actions to ensure the health and care workforce meets the numbers and skill-mix required to meet workforce requirements,
(b) equality impact assessments for planned action for both workforce and population,
(c) application of lessons learnt from formal reviews and commissions concerning safety incidents,
(d) measures to promote retention, recruitment, remuneration and supply of the workforce, and
(e) due regard for and the promotion of workplace health and safety, including provision of safety equipment and clear mechanisms for staff to raise concerns.”
Amendment 10, in clause 34, page 42, line 12, leave out from beginning to the end of line 17 and insert—
“(1) The Secretary of State must, at least once every two years, lay a report before Parliament describing the system in place for assessing and meeting the workforce needs of the health, social care and public health services in England.
(2) This report must include—
(a) an independently verified assessment of health, social care and public health workforce numbers, current at the time of publication, and the projected workforce supply for the following five, ten and 20 years; and
(b) an independently verified assessment of future health, social care and public health workforce numbers based on the projected health and care needs of the population for the following five, ten and 20 years, consistent with the Office for Budget Responsibility long-term fiscal projections.
(3) NHS England and Health Education England must assist in the preparation of a report under this section.
(4) The organisations listed in subsection (3) must consult health and care employers, providers, trade unions, Royal Colleges, universities and any other persons deemed necessary for the preparation of this report, taking full account of workforce intelligence, evidence and plans provided by local organisations and partners of integrated care boards.”
This amendment would require the Government to publish independently verified assessments every two years of current and future workforce numbers required to deliver care to the population in England, based on the economic projections made by the Office for Budget Responsibility, projected demographic changes, the prevalence of different health conditions and the likely impact of technology.
Amendment 40, in clause 108, page 96, line 9, leave out subsection (2) and insert—
“(2) In this Part ‘protected material’ means—
(a) all statements taken from persons by the HSSIB during a safety investigation or in the course of deciding whether an incident is going to be subject to an HSSIB investigation,
(b) records revealing the identity of persons who have given evidence in the context of the safety investigation,
(c) information that has been collected by the HSSIB which is of a particularly sensitive and personal nature, such as (but not limited to) copies taken by the HSSIB of health records, care records, clinical notes, or personnel records,
(d) material subsequently produced during the course of an HSSIB investigation such as (but not limited to) notes, drafts and opinions written by the investigators, or opinions expressed in the analysis of information obtained through the investigation,
(e) drafts of preliminary or final reports or interim reports, and
(f) information that would be subject to legally enforceable commercial privileges.”
This amendment would define more closely the materials covered by the “safe space” protection provided for by the Bill.
Amendment 41, page 96, line 32, leave out
“information, document, equipment or other item held by that individual”
and insert “protected material”.
This amendment is consequential on Amendment 40.
Amendment 43, in clause 109, page 96, line 43, leave out from “Part” to end of line 24 on page 97.
This amendment would remove the ability of the Secretary of State to make regulations authorising disclosure of protected material beyond that provided for in the Bill.
Amendment 74, page 101, line 1, leave out clause 115.
Government amendments 24 and 127.
Amendment 57, page 110, line 11, leave out clause 127.
This amendment seeks to ensure that a profession currently regulated cannot be removed from statutory regulation and that regulatory bodies cannot be abolished.
Government amendments 86 and 87.
Government new schedule 1—Virginity testing: consequential amendments.
Government amendment 88.
Amendment 42, in schedule 14, page 218, line 30, leave out paragraph 6.
This amendment would remove the provision allowing coroners to require the disclosure of protected material.
This broad group of amendments concern improving patient safety and the quality of health and care services, both of which are a priority for this Government. For that reason, this Bill will put the Health Services Safety Investigations Body on a statutory footing. The HSSIB will be one of the first independent healthcare bodies of its kind, leading the way in investigating for the purpose of learning, not blaming. For the HSSIB to be able to perform this “no-blame” role, the integrity of safe space is paramount. I look forward to contributions from right hon. and hon. Members from both sides of the House, recognising the depth of expertise, particularly that residing in the hon. Member for Central Ayrshire (Dr Whitford), on how best to make safe space work. As we discussed extensively in Committee, we recognise that ultimately this comes down to: what is the appropriate balance to be struck? Different views are likely to be aired again today.
Within this group, I will also address amendments brought forward by colleagues, including my right hon. Friend the Member for South West Surrey (Jeremy Hunt), on the health and social care workforce. Ensuring we have the workforce this country needs will, in the short-term, tackle the elective backlog. Crucially, in the long-term, as we build back better, it will help to reduce damaging health inequalities. For those reasons, I will later speak in more detail about this Government’s plans on the workforce, some of which of course are already in motion. I hope I can reassure the House that the provisions already made in this Bill, alongside the Government amendments I am about to discuss, do go sufficiently far to address these important issues.
I will begin by addressing new clauses 36 to 48, new schedule 1 and amendments 86 and 87, which comprise the package of Government amendments to prohibit virginity testing in the UK. I offer my deepest thanks to my hon. Friend the Member for North West Durham (Mr Holden) for his tireless efforts in proposing these amendments originally and in supporting the Government in proposing our variations on them, which we believe achieve the right balance—I will turn to that in a moment—as we bring forward this ban.
I should also put on the record my gratitude to the Opposition Front-Bench team for their constructive engagement on this issue, which does not divide us on party political lines but is about doing the right thing. I am grateful to the shadow Ministers on the Opposition Front Bench: the hon. Members for Ellesmere Port and Neston (Justin Madders) and for Nottingham North (Alex Norris).
In July, the Government promised in our violence against women and girls strategy that virginity testing will not be tolerated in the UK and will be banned at the earliest opportunity, so I am delighted that we are introducing amendments that demonstrate the strength of our commitment to the removal of all forms of abuse against women and girls. Our amendments will create three offences: conducting a virginity test; offering virginity testing; and aiding or abetting another person to conduct a virginity test in the UK or on UK nationals overseas. Each offence will carry a maximum penalty of five years’ imprisonment and/or an unlimited fine. This sentencing reflects the long-term physical and psychological damage that this repressive practice can cause.
The offences begin to tackle the harmful misconceptions that surround a woman’s sexuality. This House’s commitment to legislate is a profoundly important step forward in helping to tackle the damaging myths concerning the so-called purity of women’s sexuality. In response to concerns that, once the offence is banned in the UK, vulnerable women and girls will be taken abroad and subjected to virginity testing there, the offences will carry extraterritorial jurisdiction.
The proposals have been discussed by Health Ministers throughout the UK, including in the devolved Administrations, and I am working with them to ensure that the whole of the UK together tackles this abhorrent practice. I put on record my gratitude to the devolved Administrations for the constructive manner in which they have engaged on the issue. I hope that the House will pass the amendments today and allow us to take another step forward in our shared endeavour and important work on safeguarding and improving the lives of women and girls throughout the United Kingdom.
Let me turn briefly to new clause 21, tabled by my hon. Friend the Member for North West Durham—I thank him again for doing so. I hope that what I have said will reassure him and the rest of the House that the package of Government amendments that I have just discussed go further to protect women and girls from this form of abuse and are the most effective vehicle by which we can achieve what we seek to do. Our package of amendments set out that the conducting, offering or aiding of a virginity test is simply indefensible. The amendments ensure that victims are protected on our shores and abroad and that the sentencing of those convicted reflects the detrimental physical and psychological impacts of the practice. I therefore hope that my hon. Friend will feel able not to press his new clause to a vote and instead to support our amendments. I am incredibly grateful to him—as, I am sure, is the House—for his campaigning vigour on this issue.
My hon. Friend also tabled new clause 22, which seeks to ban the practice of hymenoplasty. The Government remain concerned that hymenoplasty is also driven by a repressive approach to female sexuality and is closely related to virginity testing, which we have made clear today is not an acceptable practice in the United Kingdom or elsewhere. We announced in the violence against women and girls strategy that we would set up an independent expert panel to explore the complex clinical, legal and ethical aspects of the procedure in more detail. The panel, which includes key stakeholders with ethical and clinical expertise, has already met and will shortly make its recommendations to Ministers, before Christmas. It is crucial that, having asked the panel to contribute, we carefully consider its views before we make a firm decision to ban hymenoplasty. However, I assure the House that although we cannot accept the new clause today because we await the recommendations of the review panel, we will of course fully reassess our position as soon as the panel makes its recommendations.
If we are to ensure patient safety and quality of care, it is vital that we have the workforce in place to deliver it. That is a priority for the Government and I reassure the House that we are taking the necessary steps to secure the workforce of the health and social care sector. Members throughout the House would all agree that although investment in technology, in new hospitals and buildings, in therapeutics and in kit are all phenomenally important, the golden thread that makes that investment valuable is the workforce—the people who always go above and beyond, particularly in the past 18 months, to make that equipment more than just a shiny piece of kit but something that actually saves lives. They are absolutely the heart of what we are doing.
I am particularly concerned about the workforce situation in primary care. In my constituency, the practices are reporting back not only on an acute shortage of locums, but on their ability to recruit new GPs. One reason is that, 10,15, 20 years ago, there was inadequate planning for the future and we did not train enough doctors. That is one reason why I have signed amendment 10 tabled by my right hon. Friend the Member for South West Surrey (Jeremy Hunt). May I urge the Government to go beyond where they have been and to look for any way available to deal with this issue now, and particularly to plan for the future so that this does not happen again?
My right hon. Friend is perspicacious in his prediction of where I was about to go. I was about to turn to amendment 10 tabled by my right hon. Friend the Member for South West Surrey and new clause 28 tabled by the shadow Minister, which go to the heart of what my right hon. Friend is talking about.
I hope the shadow Minister will agree that amendment 10 and new clause 28 are, essentially, broadly unified in their intention and therefore I hope that he will allow me to take them both together. They require the Government to publish independently verified assessments of current and future workforce numbers for the needs of the health, social care and public health services in England.
There has rightly been much discussion on workforce planning for the NHS and adult social care. That reflects the deep debt of gratitude that the country owes the staff and also, as I said, their absolute indispensability in delivering on all our aspirations for healthcare and social care in this country and for our constituents’ care.
As part of our commitment to improving workforce planning, my Department is already doing substantial work to ensure that we recover from the pandemic and support care. We have already committed to publishing, in the coming weeks, a plan for elective recovery and to introducing further reforms to improve recruitment and support for our social care workforce, with further detail set out in an upcoming social care White Paper. We are also developing a comprehensive national plan for supporting and enabling integration between health, social care and other services, which support people’s health and wellbeing.
Let me turn to that framework, to which my right hon. Friend the Member for Epsom and Ewell (Chris Grayling) was alluding, for a longer-term perspective. The Department has already commissioned Health Education England to work with partners to develop a robust, long-term 15-year strategic framework for the health and social care workforce, which, for the first time, will include regulated professionals in adult social care. That work was commissioned in July by my hon. Friend the Member for Faversham and Mid Kent (Helen Whately) when she was in post in the Department. That work will look at the key drivers of workforce demand and supply over the longer term and will set out how they impact on the required shape and numbers of the future workforce to help identify those main strategic choices, and we anticipate publication in spring of next year.
It is vital that the workforce planning is closely integrated to the wider planning across health and social care and, as such, Health Education England, which has established relationships with the health and care system at a local, regional and national level, is best placed to develop such a strategy. Crucially, following the announcement yesterday of HEE merging with NHS England in improvement, we will, for the first time, bring together those responsible for planning services, for delivering services on the ground, and for delivering on the workforce needs of those services so that we can have a more integrated approach to delivering on that framework.
I am grateful to the Minister for giving way. There is much to commend in the amendment of my right hon. Friend the Member for South West Surrey (Jeremy Hunt) and in what the Minister is saying. One thing that is not obvious in either, though, is the focus on labour costs and productivity. For example, how is technology going to reduce labour costs in the delivery of the same quality or higher quality of service? What is the possibility of creating new care pathways, which require less qualified staff to deliver as good or better service? What is going on in terms of reducing the proportion of non-clinical staff by the adoption of technology and other means in healthcare? Perhaps the Minister could address that. I am sure that my right hon. Friend will be doing so later, too.
My hon. Friend is absolutely right. We see huge opportunities, almost every day, from new technology and new ways of using that technology to deliver more efficient and shorter turnaround times—for tests and diagnostics, for example. He is also right to talk about the need constantly to examine care pathways, and, where opportunities exist, to use highly qualified healthcare professionals but to look carefully at the most appropriate level at which a treatment or test can be carried out; historically, we may have used healthcare professionals for particular tasks for which they were almost over-qualified. It is right that care pathways are informed by clinical and scientific expertise and judgment, but that we continue to review how new technology, new ways of working and new care pathways can improve the productivity of our amazing workforce.
As part of the Minister’s workforce review, will he look at the Carr-Hill formula, which local GPs tell me incentivises GPs to go to areas with longer life expectancy—therefore, wealthier areas—at the expense of areas such as Hull? It feels like the funding mechanism for GPs is not fair.
The Carr-Hill formula has been through many “almost reviews” over the years and has been looked at by different Governments. Various GP practices in my constituency—as I am sure is the case in the hon. Lady’s—understandably raise opinions about how the formula might be improved. The point does not necessarily goes to the entire heart of what we are discussing, but she has managed deftly to make it within scope, in the context of GPs and so forth.
Finally, the report in clause 34 will increase transparency and accountability of the workforce planning process. It is for those reasons that I encourage—perhaps unsuccessfully—my right hon. Friend the Member for South West Surrey and the shadow Minister, the hon. Member for Ellesmere Port and Neston, to consider not pressing their amendments to a Division.
Fifteen years is a long time in workforce planning. The make-up of the workforce could change significantly over that time, not least as we are trying to address some real workforce crises now. Will the Minister put in place a road map to fill those vacancies over that time, and interim reports so that we can review progress?
I set out the commissioning of the 15-year framework to look at need. Within that, the House will be regularly updated, as happens now—not least in oral questions, as we saw in the session preceding this debate—with plenty of opportunities for Members to challenge the Government and to see updates. There is also the regular publication of figures and workforce statistics, which will continue. Once we have that 15-year framework back and see what HEE says, we will be able to look at how best that might be interrogated by Members of the House and the wider public. I am hopeful that it will report back in the spring, and I suspect that that may well occasion a debate in this House. If not, I suspect that it may well occasion an urgent question from the hon. Lady or the hon. Member for Ellesmere Port and Neston.
Let me turn to new clause 29, which also addresses the issue of workforce planning. This new clause would place a duty on the Secretary of State to report on workforce planning and safe staffing. I have just elaborated at some length on the substantial work that my Department is doing to improve workforce planning. It remains the responsibility of local clinical and other leaders to ensure safe staffing, supported by guidance and regulated by the Care Quality Commission. The ultimate outcome of good-quality care is influenced by a far greater range of issues than how many of each particular staff group are on any particular shift at any one time, even though that is clearly important, which is why the Government are committed to growing the health workforce. It is also important that local clinical leads can make decisions based on the circumstances in their own particular clinical setting, utilising their expertise and knowledge.
The amendment would also require the report to contain a review of lessons learnt. In the last decade, the Government have introduced significant measures to support the NHS to learn from things that go wrong, reduce patient harm and improve the response to harmed patients, such as: a regulated duty of candour that requires trusts to tell patients if their safety has been compromised and apologise; protections for whistleblowers when they raise safety concerns; the Healthcare Safety Investigation Branch, which we are building on and establishing as a separate statutory body through the Bill; and the first-ever NHS patient safety strategy, with substantial programmes planned and under way to create a safety and learning culture in the NHS.
I hope I have given the House some reassurance that we are doing substantive work to improve safe staffing and workforce planning. Again, I encourage the shadow Minister—perhaps it will be unsuccessful, but it is always worth trying—to consider withdrawing his amendment.
New clause 29(2)(d) has merits, as I am sure the Minister will accept, in that we need to incentivise people to join health and care, and, crucially, to be retained with the system. Will he give some consideration to this, particularly given that, for example, somebody working in the care system can work for years and years and still be in the same place when it comes to applying for a training place in a profession allied to medicine as somebody who simply has a couple of A-levels? That seems to be wrong. Does he agree that we need to complete the structure so that there is some prospect of progression with health and care and to try to break down the barriers between the two?
As ever, my right hon. Friend—my friend—makes his point well, and, as ever, I will commit to taking it away and reflecting on it very carefully. He is always very considered in the points he makes in this House, so I am happy to look at it.
I turn to Government amendment 127, which I bring forward with support of the Welsh Government. Clause 127 on professional regulation provides additional powers that will widen the scope of section 60 of the Health Act 1999 and enable the Privy Council to make additional changes through secondary legislation. One of the powers within this clause is to enable the regulation of groups of workers concerned with physical and mental health, whether or not they are generally regarded as a profession. This element of the clause falls within the legislative competence of the Senedd. When the section 60 powers are used, they are subject to the existing statutory requirements in schedule 3 of the Health Act 1999— namely, consultation and the affirmative parliamentary procedure. When legislation made using section 60 powers also falls within areas of devolved competence, it will be developed in collaboration with the devolved Administrations. Orders may require the approval of the Scottish Parliament where they concern professions brought into regulation after the Scotland Act 1998, or of the Welsh Assembly where the order concerns social care workers. In Northern Ireland, where the regulation of healthcare professions is a transferred matter, the UK Government will continue to seek the agreement of the Northern Ireland Executive when legislating on matters that effect regulation in its territory.
The amendment introduces a requirement to obtain the consent of Welsh Ministers before an Order in Council can be made under section 60 of the Health Act 1999 when it contains a provision that would be within the legislative competence of the Senedd. It would apply if we were seeking to bring into regulation in Wales a group of workers who are concerned with physical or mental health of individuals but who are not generally regarded as a profession. The UK Government recognise the competence of the Welsh Government regarding this provision and are respecting the relevant devolution settlement in making this amendment. For these reasons, I ask hon. Members to support the amendment.
Finally, I turn to the amendments related to part 4 of the Bill on the health services safety investigations body. These are the most significant set of provisions found within this Bill to enhance patient safety. The establishment of an independent healthcare body focused on learning from mistakes to improve safety and quality is a world first. For the health service safety investigations body to be able to perform this “no-blame” role, the integrity of safe space is paramount. Without it, health and care staff will not have confidence to come forward, and potential learning will be lost. This principle runs throughout the drafting of these clauses. We have made a small number of exceptions in the Bill—for example, to ensure that coroners can continue to perform their vital functions as judicial office holders and effectively as part of the judiciary. We have also provided for a regulation-making power to ensure that safe space can evolve in line with innovation in technology or medical practice. However, nothing in the Bill can or will undermine the imperative that the HSSIB is an independent organisation or the fundamental importance of safe space to the effective working of that organisation.
The Minister does not need to be anxious, because he has already heard it all in Committee. Does he not recognise that there is nothing in HSSIB that takes away from coroners’ investigations that they carry out at the moment, and that HSSIB should not be seen as replacing that work by another health body? Adding coroners to it has already created a campaign relating to the ombudsman and freedom of information, and there is a real danger that it weakens the safe space.
I am grateful for the manner in which the hon. Lady puts her points. She is right; we have debated this previously. We have been publicly clear that we do not believe that the exemption or exception should be extended to the ombudsman. She is right that there are campaigns saying we should have no exceptions or that we should widen the exceptions. We believe we have struck the right balance with this measure, while respecting the fact that a coroner is a judicial office holder and has a very specific function to perform, as set out in legislation in—this is where my memory may fail me—the Coroners and Justice Act 2009, which recognises their particular and special status. I suspect that she and I may have to agree to disagree on whether the appropriate balance is struck, but that sets out why we have done what we have done.
How best to achieve an effective safe space is complex and the current drafting has been arrived at through years of detailed policy work, including pre-legislative scrutiny before the Health Service Safety Investigations Bill was introduced in the other place in autumn 2019. The issue was also debated at length in Committee, and I look forward to hearing contributions from Members on that, particularly the hon. Member for Central Ayrshire.
Turning to the two minor and technical Government amendments to the health service safety investigations body provisions, amendment 24 is a technical amendment to clarify the definition of “investigation” that applies to part 4 of the Bill. Investigations carried out by HSSIB by agreement under clause 114, which relate to Wales and Northern Ireland, were never intended to be part of the main investigation function of HSSIB and therefore will not be covered by the safe space or other investigatory power provisions provided for in the Bill. The amendment ensures that the drafting of the Bill fully reflects that original policy position. I hope that hon. Members on both sides of the Chamber will be content to pass this technical amendment.
Finally, I turn to Government amendment 88 to schedule 13. Schedule 13 contains a regulation-making power which allows the Treasury to vary the way any relevant tax has effect in relation to associated transfer schemes. Regulations made under this power will be used to ensure that no unintended tax consequences arise. The amendment ensures that value added tax is included in the taxes which the Treasury can, by regulations, vary when considering the transfer schemes in this Bill. Without this amendment, it is possible that complications with VAT bills may arise when transfer schemes are made and transactions take place. It is for those reasons that I ask hon. Members to support this amendment.
I am conscious that other hon. and right hon. Members may wish to speak to their amendments. I look forward to addressing those that I have not directly addressed thus far when I wind up debate on this group of amendments. With that, I conclude.
I thank the Minister for his introduction. It seems like only yesterday that we were having a similar exchange across the Dispatch Box.
I will begin with our new clauses 28 and 29 and amendment 10. This discussion about workforce could well be the most important of all today. Just this weekend, Chris Hopson from NHS Providers was trying to get the Government to acknowledge the seriousness of the problem when he tweeted:
“93k NHS staff vacancies. £6bn spend on temporary staff to fill gaps. 55% of staff working unpaid extra hours each week. 44% saying they’ve felt ill with work related stress. NHS desperately needs long term workforce planning. Govt must make this happen this week.”
Everything comes back to workforce and the failure to invest in it consistently over a sustained period. Today we have a chance to correct that.
While we favour our new clause 29, it is obvious that amendment 10 has captured the attention of many and may well be put to a vote. In many ways, as the Minister said, it closely mirrors what we have put forward, so I will be making my general points on both the new clauses and the amendment. In supporting amendment 10, I pay tribute to the right hon. Member for South West Surrey (Jeremy Hunt), the Chair of the Health and Social Care Committee. Given his previous role, he is well placed to have an informed view on what needs to be done, and he has done that with this amendment without undue hype or drama. The support he has obtained more widely from stakeholders outside the House is impressive; indeed, the way he has united just about the entire sector shows not only his powers of persuasion, but the importance of the issue. He has come close to uniting the entire sector in the past, but that was usually in opposition to something he was proposing, rather than in support. There may be many other areas where we have disagreed in the past, but that does not diminish our support for his call.
Let us just say that the more I hear of the right hon. Gentleman, the more I like what he has to say—I will leave it there.
We all accept the urgent need to address the workforce crisis, but I cannot find anyone who thinks that what the Government have put forward in clause 34 is the solution.
A doctor in my constituency, Dr Tom James, told me that he and his colleagues in the hospital were demoralised, exhausted and at the end of their tether, particularly after the covid crisis, in a building that was falling apart around them. He said there was no more goodwill, and the Government needed to grab hold of this crisis and resolve it. Are new clause 29 and amendment 10 not a minimum, rather than a maximum, for what we should be looking to achieve?
New clause 29 and amendment 10 are the starting point, not the whole answer. They are a framework for getting this right in the future and offering the workforce, which, as the Minister said, has given so much in recent times, some hope that there will be better times along the way. I will refer later to the report by the Health and Social Care Committee on workforce burnout, which brought home just how demoralised the workforce have become and why they need to be given some positive news today.
Anyone who on Sunday was on the March with Midwives will understand the real crisis now facing that profession—a particularly acute once since it is also about women’s health. Is there not a need to ensure that plans are not just on paper, but expedited, so that we are sure of seeing real delivery of those much-needed staff?
Like just about every profession and sector in the NHS, midwives are under tremendous pressure and are understaffed. We need a clear plan, and a plan that is delivered. Of course, having a plan is not the whole answer, which is why it is important that we hear regular reports back from the Secretary of State on progress. That is why we hope amendment 10 will be supported.
One reason I want to emphasise the importance of new clause 28 is that we are anticipating a greater demand for mental health services, and therefore a greater demand for mental health professionals working in the NHS. Only by having regular reviews will we be able to anticipate what that demand will be and prepare accordingly.
My hon. Friend is correct; we could not have anticipated what has happened in the past 12 to 18 months, but we can see what it means moving forward. Regular reviews of demand are critical, and we know that training these highly qualified and skilled staff takes time, which is why a longer-term view and approach are required.
I want to pick up on the increasing demand for mental health services. Does the hon. Gentleman accept that in general, it is utterly impossible to meet the expectation of increasing demand for health services without vast improvements in the efficiency with which people working in the health and care sector deliver that service? Is it not a shortcoming of both the Government and the Opposition that there is not an intense focus on solving that problem of labour cost productivity? Without that, we will not be able to meet current needs and we certainly will not meet future needs.
The hon. Member for North East Bedfordshire (Richard Fuller) talks about efficiency, but the figures show that in 2019-20, some £6.2 billion was spent on bank and agency staff. If we are talking about efficiency and using all the extra money the Government are saying they will put in to catch-up, we need to provide value for money for the taxpayer. Therefore, long-term planning to recruit the right skills is critical.
I thank the hon. Member for her intervention. The point about agencies and locum spend is not a new one. It will be interesting to see the figures for the last 12 to 18 months when the Minister has finally ratified them, because I suspect they will be even higher than those we have heard recently.
Having spent over three decades in the NHS, I know that this is not just about senior staff and what are called frontline staff. It is said, “We’ll protect frontline staff, but we’ll cut administrative staff or backroom staff.” However, if I am not in a clinic with the right results with the right patient at the right time, I am a waste of space. In actual fact, we need to look at the whole team. There is a sweet spot where I am working flat out but I have a team who are helping me. If we cut any of those, then we lose efficiency, and as the hon. Member for Twickenham (Munira Wilson) said, costs are going up, so we are becoming not more productive, but less productive.
I thank the hon. Member for her intervention. Indeed, this actually covers some of the debate we had in Committee. There has been a rhetoric coming out of Government in recent months that managers are somehow a cost burden and that administrative staff do not actually help deliver the services. Of course, as the hon. Member has just pointed out, they are a vital source of support for those on the frontline.
The hon. Member is being generous in giving way. Would he avoid the temptation to suggest that productivity is in some way simply a demand for hard-pressed people in health and social care to work harder? It is not that at all. It is just doing what they want to do, which is to work smarter and thus get more out of the system, which I think is what the hon. Member for Central Ayrshire (Dr Whitford) has just said.
I accept what the right hon. Member has said. There has been a gap in investment in IT and other things that make people’s jobs easier and more efficient, and that has been a characteristic of NHS spending over the last decade.
With your permission, Madam Deputy Speaker, I will try to make some progress, but it is important, as we have talked about the staff, that we pay tribute to all those who make the NHS what it is today. On Nursing Support Worker Day, I pay tribute to all those who work in wards, clinics and community settings to support our nurses and provide that essential hands-on care to patients.
Our care system does indeed face a crisis—over waiting times, over recovery—but as with all other crises, the root cause is inadequate funding. The most visible and significant symptom is an inadequate workforce, plus the scandal of social care provision. There is no plan at the moment; it is just a plan for a plan. When we talk about a workforce crisis, that cannot be in any way a reflection on the huge value and contribution of the workforce we have now.
There are particular positive aspects to amendment 10 to which I would like to draw attention. Explicit recognition of the need to consult with the workforce through trade unions is very welcome. The planning covers health and social care, which is also absolutely essential. Given the scope of the review, the timescale is about right—every two years is demanding, but not too onerous—but a regular update each year might be preferable. However, the main point, which I have made already, is to compel a regular report and review of demand. The central role is that the Secretary of State has a duty to get planning done, and we hope that will be a crucial lever for the change we need to see.
If the amendment has a weakness, it is probably the one we have touched on already, which is that it does not ensure that the plan is feasible or delivered. A plan that shows the gap is not a plan unless it has a credible funding solution alongside it. Even if that is not explicit in the amendment, we assume that funding would follow any such assessment and plan that is set out. Our suggestion would be that any such financial projections in a plan are subject to the same level of independent expert verification as we see with the Office for Budget Responsibility. Since all the various think-tanks are going to do an assessment anyway, we may as well have a built-in process for verification.
Does my hon. Friend agree with me that many of the recruitment challenges often sit in outsourced services in the private sector, and as a result it is really difficult to find the complement of staff required because people want to work in the NHS? That needs to be taken into consideration in any workplace plan.
I thank my hon. Friend for her intervention and I will later talk a little about outsourcing and the role it has to play. We believe that plans should be built from the bottom up, not from the top, and that implies the involvement of ICBs, NHS trusts and foundation trusts. ICBs and their strategic arms, integrated care providers, will not be functional for some time. That is a shame, but it does not mean we should not proceed with the amendment.
The scale of the workforce challenge is well established: high rates of vacancy, inadequate levels of retention, and much more. It goes far deeper than numbers and structures, to issues of workforce terms and conditions, particularly in social care. It must also cover cultural issues, as there is a clear indication that all is not well in the NHS in terms of diversity. There is also whistleblowing, and aspects of how staff are nurtured and supported. At its very best, the NHS is very good, but unfortunately that is not the story across the board. It should be good in every part.
On that theme, let me mention the continuing disgrace in the way that some members of the NHS workforce are treated. I find it unacceptable that cleaners, porters, catering and IT staff are still being outsourced by trusts that are trying to make tax savings or outsource services to the lowest bidder. Perhaps the Minister can look into the current dispute at South Warwickshire in that regard, as we do not think that is a template to follow. Workforce planning is not a problem that can be solved quickly, although increased funding in social care could help that. For the NHS, the long term is indeed a long time—for example, the time needed to develop and train GPs and consultants. More money is not the only answer; technology and reform of the way we work must all be part of the mix. However, the labour-intensive nature of care will not fundamentally change, so we must look at workforce numbers as the priority. It is often said that failing to plan is the same as planning to fail. Some colleagues believe that a failure to plan is exactly that—a route to ending the NHS as we know it by showing that it fails. However, the Bill suggests an acceptance that a plan is needed, and work is under way. Hopefully that work is not being handed out to more consultants, of whom we see enough already.
Labour will support the amendment tabled by the Chair of the Health and Social Care Committee, which we hope will be pushed to a vote. I hope I have not been too effusive in my comments about him—I have a reputation to maintain after all—but I will refer to the excellent report done by his Committee on workforce burnout, which in many ways is the cornerstone of what we are debating. In its conclusion, the Committee said:
“The emergency that workforce burnout has become will not be solved without a total overhaul of the way the NHS does workforce planning. After the pandemic, which revealed so many critical staff shortages, the least we can do for staff is to show there is a long term solution to those shortages, ultimately the biggest driver of burnout. We may not be able to solve the issues around burnout overnight but we can at least give staff confidence that a long term solution is in place.
The way that the NHS does workforce planning is at best opaque and at worst responsible for the unacceptable pressure on the current workforce which existed even before the pandemic.
It is clear that workforce planning has been led by the funding envelope available to health and social care rather than by demand and the capacity required to service that demand. Furthermore, there is no accurate, public projection of what health and social care require in the workforce for the next five to ten years in each specialism. Without that level of detail, the shortages in the health and care workforce will endure, to the detriment of both the service provision and the staff who currently work in the sector. Annual, independent workforce projections would provide the NHS, social care and Government with the clarity required for long-term workforce planning.”
That conclusion shows what we are trying to achieve today. That is the nub of it: if not now, when? When will the Government finally accept the obvious that has been staring them in the face for years?
New clause 29 would require the Secretary of State to lay before Parliament a fully funded health and care workforce strategy to ensure that the numbers, skill and mix of healthcare staff are sufficient for the safe and effective delivery of services. It builds on other amendments, and seeks further assurances by putting patient safety and safe staffing levels at the heart of workforce planning, by setting out how the Government will be required to act to assess and rectify shortages. It seeks to ensure that the workforce will be on a sustainable footing in future. Patient safety should be our primary concern. We have the evidence base: when there are not enough registered nurses, mortality rates change and health outcomes are worse. I accept that the level of detail in the new clause is significant, but we consider that necessary to underscore the importance of setting out how this will be delivered.
New clause 12, which deals with the use of the title “nurse”, follows one that we tabled in Committee, on which we got sympathy and agreement from the Minister but were told that it was not quite good enough. Nevertheless, we will continue to support new clause 12, for the reasons we have already set out. Even if it does not get approval today, we hope that the Government will look into the issue and involve all those who need to be involved in trying to reach a satisfactory conclusion.
Currently, the title “registered nurse” is protected but “nurse” alone is not, meaning that anyone can legally call themselves a nurse. Under current legislation, someone could operate under the title “nurse” even if they have no nursing qualifications or experience, or indeed if they have previously been struck off. To protect the public, the title “nurse” should be limited to those who are registered with professional regulators, such as registered nurses and dental nurses, as is the case with titles such as “paramedic” and “physiotherapist”, which are limited to those on professional registers. The issue of the title “nurse” not being protected in law has long caused concern in the profession. There have been many examples where the use of the title appears to have been abused, and it is about time we put an end to that.
I turn to the issues covered by Government new clauses 36 to 48, which appear to respond to new clauses 21 and 22. New clause 21, in the name of the hon. Member for North West Durham (Mr Holden), would prohibit virginity testing. This horrendous so-called procedure has absolutely no basis in science; instead, it is based entirely in misogyny. The Royal College of Midwives states:
“We are clear that virginity testing is a violation of women’s and girls’ human rights. In addition to being wholly indefensible and offensive, there is no medical benefit to virginity testing, and it is in any event not possible to conclude through an examination of the hymen whether or not a woman or girl is a virgin (even if such an examination was justifiable),”
which, clearly, it is not. Similarly, the World Health Organisation has said that this is a practice of abuse.
The hon. Member for North West Durham has done a superb job in advocating for the end of this gross practice and, as with the new clause he tabled in Committee, he has assembled a strong cross-party coalition of support for new clause 21. We are therefore pleased to see that Government new clauses 36 to 48 seek to consign this practice to history.
I thank the hon. Member for giving way, and I apologise to the Minister for not being here at the very start; I was on a train back from a ministerial visit in my constituency. I would just like to pay tribute to some of the campaigners who are in the Public Gallery at the moment, particularly those from Karma Nirvana, the Iranian and Kurdish Women’s Rights Organisation, the Middle Eastern Women and Society Organisation, and the Royal College of Obstetricians and Gynaecologists. Does the hon. Member agree that it is those campaigners and charities who have worked on this issue for a very long time who have really brought it to the fore—they have just been supported by some Members of this House—and that it is they who deserve the credit?
I thank the hon. Member for his intervention. I think he is being very modest, but he is absolutely right that these things do not happen by accident. It is often the hard work, over many years, of campaigners and campaign groups who being these issues to the fore and do the diligence and the hard work behind the scenes that leads us to the sort of outcome that we will hopefully get today—an end to this abhorrent practice.
On the hon. Member’s other amendment, new clause 22, we also want to see hymenoplasty ended. It has no medical benefit whatsoever. As the Minister said, there is currently an expert panel looking at the issue, and he is waiting on its recommendations. I think the outcome is in little doubt, to be frank. However, I wonder whether the Minister can give us an assurance that, should those recommendations turn out to be as we would expect, he will be able to act on them quickly and get something down in statute as soon as possible so that we do not miss the boat.
Turning to the amendments on the health services safety investigations body, much of the proposed legislation is the same as that proposed in the other place, and there were extensive debates on this matter in Committee. There are, however, issues that remain, which are covered by amendments we will be debating today. I can imagine the other place having quite a lot to say about some of these issues. In general, we support the move to the new body, but over time attention must be applied to some aspects of the way it will function in practice. Our major reservation is, yet again, with the involvement of the Secretary of State. Our amendment 74 would have the effect of leaving out clause 115, which is another clause that gives the Secretary of State extra powers to interfere.
Our general observation would be that there is far too much extra power going to the Secretary of State in the Bill anyway, but we are particularly concerned at the powers set out in clause 115, which give him what we consider to be wholly unnecessary powers to direct. It is pretty much a blank cheque to enable him to step in and interfere any time he likes as long as he considers that there has been a significant failure. Under subsection (2), the Secretary of State can direct the HSSIB in whatever manner he determines, which I would have said is about as far away from independence as we can get—until we get to subsection (4), which means the Secretary of State can also effectively step into the HSSIB’s shoes and undertake the duties himself. I can do no better than refer to the evidence Keith Conradi gave to the Public Bill Committee, when he said:
“Ultimately, we end up making recommendations to the Department of Health and Social Care, and in the future I would like to ensure that we have that complete freedom to be able to make recommendations wherever we think that they most fit.”––[Official Report, Health and Care Public Bill Committee, 7 September 2021; c. 60.]
We also support the amendments put forward by the spokesperson for the Scottish National party, the hon. Member for Central Ayrshire (Dr Whitford), which are important in preserving the principle and status of protected spaces. We feel it is important that they cannot be nibbled away at, as the Bill currently allows.
The purpose of amendment 57, which we also tabled in Committee, is simply to delete clause 127, which deals with the role of the Secretary of State in professional regulation. So far, we have had no convincing explanation of why the Secretary of State needs these powers. If there are no professions that he wishes to remove, we do not need the clause. If there are, he should say so, so we can have a debate now on whether it is appropriate to hand over those powers to him.
Finally, on new clause 1, I pay tribute to the all-party parliamentary group on beauty, aesthetics and wellbeing, whose work in this area has been influential in producing it. Many of the group’s members have put their name to it. As we know, cosmetic treatments can include a wide range of procedures aimed at enhancing or altering appearance. Many of those procedures are becoming increasingly popular and new clause 1 speaks to the well-articulated concern that non-medically and medically trained practitioners are performing treatments without being able to provide evidence of appropriate training, and without required standards of oversight and supervision.
I hope the Members moving new clause 1 will have the opportunity to speak to it, as there are far too many stories of people suffering horrific, life-changing injuries. There would undoubtedly be a saving to the NHS in reduced visits to accident and emergency and GPs to correct mistakes made by poorly trained and unregulated practitioners. We therefore think the new clause has value. Some of the impacts on the NHS from the lack of regulation include outbreaks of infection at a skin piercing premises, resulting in individuals being hospitalised; disfiguration and partial removal of an ear; second and third-degree burns from lasers and sunbeds; allergic reactions due to failures to carry out patch tests or medical assessments, which led to hospitalisation; and blindness in one eye caused by the incorrect administration of dermal filler.
New clause 1 seeks to put the protection of the public at the forefront by giving the Secretary of State power to bring into force a national licensing scheme for cosmetic procedures. Clearly, given that this is a departure from the wild west we face at the moment, we recognise that significant research and engagement with stakeholders will be needed to develop a scheme, as well as the provision of a practical and efficient system for people to become regulators and practitioners. If that does not make it on to the face of the Bill today, we hope this is an issue the Government will return to shortly.
I rise to speak in support of amendment 10 but, before I do, I also want to express strong support for amendments 40 to 43, tabled by the hon. Member for Central Ayrshire (Dr Whitford), which will make a big difference in making the new health services safety investigation body a success. I strongly encourage the Minister to listen to what she says later not just with the deference due to an experienced surgeon, but with the enthusiasm to follow a doctor’s advice, because what she says is extremely important.
I also thank the hon. Member for Ellesmere Port and Neston (Justin Madders) for his generous comments about me. Having sat opposite him at the Dispatch Box on many an occasion, I realise how difficult they must have been for him to say. He must have wrestled with those thoughts for a long time, and I am delighted that he has been able to unburden himself today.
The hon. Gentleman was absolutely right to focus on burnout in the NHS workforce. All of us would agree that NHS and care staff have done a magnificent job looking after us and our families in the pandemic, but right now they are exhausted and daunted. They can see that A&E departments and GP surgeries are seeing record attendances. They can see nearly 6 million on waiting lists, which is more than one in 10 of the population. They also have the vaccine programme and covid patients.
I commend the right hon. Gentleman for amendment 10. With 2,700 vacant nursing posts in Northern Ireland, and 40,000 in the NHS as a whole, will the amendment offer more nursing bursaries, train nurses up to relieve the pressure, and provide a decent working environment?
I believe it will. I am grateful to the hon. Gentleman for raising that issue, because medical training is relevant to the whole United Kingdom, not just one part of it. I hope the amendment will be beneficial to Northern Ireland as well.
If we put ourselves in the shoes of any frontline doctor, nurse or care worker, we would see that they are all completely realistic that this is not a problem that can be solved by next Monday. It takes a long time to train a doctor or nurse. All they have is one simple request: that they can be confident that we are training enough of them for the future, so that even if no immediate solution is in place, there is a long-term solution. That is the purpose of amendment 10. It simply requires the Government to publish every two years independently verified estimates of the number of people we should be training across health and care.
The Government have recognised the pressures on the NHS by giving generous amounts of extra funding. I commend the Government for doing that, but extra money without extra workforce will not solve the problems that we want to solve. At the moment, the NHS just cannot find the staff.
I congratulate the right hon. Gentleman on amendment 10 and on how he has built such a coalition of support. Many of the challenges facing those with mental health concerns are because, as he says, there simply is not the workforce—it has hardly grown over the past decade. There are over 16,600 full-time equivalent vacancies and a waiting list of 1.5 million. His amendment, which would require a report every two years, is so important for ministerial accountability because the targets in the five year forward view have not been met, so we have no chance with the 15-year projection.
The hon. Lady gives a good example, because mental health is an area that we have all recently come to realise can be immensely beneficial to ourselves, our families and our constituents. However, while there has been explosive growth in demand, we have not had growth in the supply of people able to look after those with mental health issues. We can only do that with the kind of long-term planning that amendment 10 will make possible.
The royal colleges say that, as of today, there are shortages of 500 obstetricians, 1,400 anaesthetists, 1,900 radiologists, 2,00 A&E consultants, 2,000 GPs, 39,000 nurses and thousands of other allied health professionals. That is why this problem has become so acute.
The Minister has engaged thoughtfully with me on the issue on a number of occasions. He and I both know that there is some concern in the Government about the cost of training additional doctors and nurses. I want to take that concern head on. Yes, the amendment would lead to more doctors, nurses and professionals being trained. Yes, that would cost extra money. Yes, it would save the NHS even more money, because every additional doctor we train is an additional locum we do not need to employ. Locums are not only more expensive for the NHS, but less good for patients. Patients prefer to see the same doctor on every visit if they possibly can, which is much harder with a high number of temporary workers.
It is not just that patients prefer to see a doctor long term. There are safety issues when locums in acute specialties move from hospital to hospital, particularly if they are dealing with an acute case. They do not know where things are or who to phone; passwords and phone numbers change. There is a real safety issue with having too many locum staff in the very exposed acute services.
I absolutely agree with the hon. Lady, who knows about acute services. I also point to recent evidence from Norway that shows the same for general practice: patients who see the same GP over and over again go to A&E departments less than patients who see different GPs.
The hon. Member for Central Ayrshire (Dr Whitford) is absolutely right about acute safety; I speak from personal experience. My right hon. Friend is right about general practice, but the issues are different. In general practice, the issue is chronic long-term care: patients need to know that practitioners have a view of their condition that spans a long period—sometimes generations. The issues are very different in acute and primary care, but they come to the same thing.
Does my right hon. Friend agree that part of the problem with the workforce is not recruitment, but retention, particularly the retention of senior doctors in their mid-50s? It pains me to say it in this consensual debate, but the root cause is the GP contract and the consultant contract brought in by the last Labour Government. Those contracts incentivise people—in my demographic, as it happens—to leave, potentially leaving the service short of 10% of their entire career.
My right hon. Friend is right that there are problems with the GP contract. I do not want to get into too many discussions about doctors’ contracts in this very consensual debate, but Conservative Members have to take responsibility for not having remedied the pensions anomaly, which gives people an incentive to retire much earlier than we would want. We have to address that issue.
Lots of people might reasonably ask whether I did enough to address the issues in the nearly six years that I was Health Secretary. The answer is that I set up five new medical schools and increased by 25% the number of doctors, nurses and midwives we train. However, that decision was taken five years ago and it takes seven years to train a doctor, so not a single extra doctor has yet joined the workforce as a result.
That is the nub of the problem: the number of doctors, nurses and other professionals we train depends on the priorities of the current Secretary of State and Chancellor. As a result, we have ended up with a very haphazard system that means that although we spend about the average in western Europe on health, as a proportion of GDP, we have one of the lowest numbers of doctors per head—lower than any European country except Sweden.
All Governments in the UK are expanding medical school places and trying to train more students, but that has led to a shortage of foundation places. In the first two years after a doctor graduates, they are not allowed to practise outwith a foundation job, and they can never practise if they do not go through a foundation job. In the summer, about 400 young graduates were still struggling to find a place. It took 19 years from my entering medical school to my becoming a consultant surgeon. We need to think not just about medical school, but about the whole pathway.
The hon. Lady is absolutely right. Medical school, the foundation years and, as my right hon. Friend the Member for South West Wiltshire (Dr Murrison) said, the retention of staff—all those things need to be built into long-term planning and baked into the system.
That long-term planning strikes a contrast, if I may say so, with some of the short-termism that we have seen recently. Even in the recent Budget and spending review, the budget for Health Education England, which funds the training of doctors in this country, was not settled. Although I think that the proposed merger with NHS England is probably the right thing to do, I fear it will mean that the budget is not settled for many more months, at precisely the moment when the workforce crisis is the biggest concern for the majority of people in the NHS.
My right hon. Friend is making an excellent speech, and I strongly support his amendment. Will he add to the list of factors that need to be considered in the future the requirement for many research scientists in medical sciences to be trained in medical schools first? If we want to expand and build on the excellence that we have there, it is not just a question of meeting the needs of the NHS workforce; we need to have extra people who can become the brilliant researchers and discoverers of new medicines in the future.
My right hon. Friend speaks about these issues with a great deal of knowledge, given his former ministerial and Select Committee roles, and he is absolutely right. I think that the big lesson from the pandemic, and indeed an issue that emerged in the report that our Committees jointly produced, is the way in which science can add value to clinical practice and clinical practice can add value to science.
One of the key workforces is, of course, in public health, where the aim is to shift the balance by increasing prevention so that we do not need all the doctors and nurses and other health professionals further down the road. The health visitor delivery programme led to a heavy stream of new health visitors, but it had other consequences. That is another reason why the right hon. Gentleman’s amendment is so important: we see rapid changes in the workforce which could have other consequences.
I thank the hon. Lady, who before entering this place spent her time campaigning to support NHS and care staff. She speaks with great experience, and I think that the fundamental point she makes is very important. Unless there is long-term strategic planning, when we have a priority such as the one we have at the moment of tackling the backlog, we will often make progress on that priority by sucking in staff from other areas, which then suffer. That is an unintended consequence which happened when I was Health Secretary, and I fear that it will happen again without a long-term strategic framework.
Amendment 10 has wide support. It is supported by 50 NHS organisations, including every royal college and the British Medical Association—an organisation which, to be honest, is not famous for supporting initiatives from me—and by six Select Committee Chairs and all the main political parties in this place. I am sure that the Government will ultimately accept it, because it is the right thing to do, but if they are intending to vote it down today, I would say to them that every month in which we delay putting this structure in place is a month when we are failing to give hope to NHS staff on the front line.
Let me end by quoting the Israeli politician Abba Eban, who said that
“men and nations behave wisely when they have exhausted all other alternatives.”
Let us prove him wrong today by supporting amendment 10.
I am delighted to follow the Chair of the Health and Social Care Committee, and, in this rather unnerving outbreak of consensus and good humour, to mirror his speech and add my support to his amendment on workforce planning.
It is important to remember that healthcare is not delivered by hospital buildings or fancy machines; it is delivered by people to people, which is why the most important asset in any health service is its workforce. As I pointed out in an earlier exchange with the right hon. Gentleman, we need a long-term view, because it takes a long time to train senor specialists. As I said to him, it took 19 years from my entering medical school to my becoming a consultant breast cancer surgeon. We will struggle to work out what specialties we might need in 20 years’ time, because medicine is evolving, but many aspects and many sectors of staff do not change. If we do not get even those right, we are constantly in a position of drought and thirst, and it is not possible for staff to evolve—to pick up new rules, to use new techniques and to develop new services.
Although this workforce strategy would apply only in England, I would encourage consultation with the Health Secretaries and the workforce bodies in the devolved nations, because junior doctors in particular tend to move around during their training. During the junior doctors’ strike, which the right hon. Member for South West Surrey (Jeremy Hunt) might remember rather painfully, I talked to students on the picket lines whom I had trained. People move around, and it is important that such a strategy does not end up just sucking staff out of the three devolved health services. Also, many aspects of medical training are controlled on a UK basis. Foundation places for new graduates are decided on a UK basis, for example, so it is important to take that wider view.
The workforce shortage is the biggest single challenge facing all four national health services across the UK. It has been exacerbated by the loss of EU staff after Brexit, with an almost 90% drop in EU nurses registering to come and work in the UK. Early retirements are being taken due to the Government’s pension tax changes, which, as has been highlighted, have not been sorted out and are resulting in senior doctors paying to go to work. There is only so long that they will continue to do that. Finally, there is the exhaustion of dealing with a pandemic for the past 18 months. This is why it is really important, when we talk about NHS recovery, to have a greater focus on staff wellbeing and on their recovery. There can be no recovery of the NHS without them. I am really disappointed to see how the clapping of last spring has turned to severe criticism and attacks directly from members of the public, from sectors of the media, and even from some Members in this place and members of the Government.
I shall now speak to my own amendments 40 to 43, which seek to tightly define the materials covered by the safe space protections as part of Health Service Safety Investigations Body investigations. The idea behind HSSIB was to learn from air accident investigations and to provide a confidential and secure safe space in which healthcare staff could be open and candid in discussing any patient safety incidents. I was on the pre-legislative scrutiny Committee, which was chaired by the hon. Member for Harwich and North Essex (Sir Bernard Jenkin), and the recommendations of that cross-party—and indeed cross-House—Committee were very clear: evidence gathered under the safe space protocols should be protected and disclosed to third parties only in the most pressing situations, such as an ongoing risk to patient safety or criminality. Despite that, there are aspects of this Bill that could undermine the principle of the safe space, and that is what I am seeking to amend.
Amendment 40 would define he safe space materials much more tightly, because it seemed as though anything that HSSIB was using would be covered by the safe space protocol and that exemptions would then be made, whereas it makes much more sense to be very clear about the materials that are defined as protected materials. Therefore, all the original clinical information—medical notes, etc—would still be available to all the other bodies to enable them to carry out their investigations as they do now.
Amendment 43 would remove the ability of the Secretary of State to use regulation at a later date to authorise the wider disclosure of protected materials beyond the provision that is finally passed in this Bill. Amendment 42 would remove the provision allowing coroners to require disclosure of protected materials, as this has already led to calls for access by other health bodies and even freedom of information requests, as I highlighted in my earlier intervention. If a coroner uses safe space materials in their report, that report is public. The question is: how are they going to handle that so that the safe space materials are not further disclosed? It is critical to defend this. It is important to stress that HSSIB does not limit anyone else’s access to original materials, but nor should HSSIB be seen as an easy way for other bodies to avoid doing the legwork and carrying out their own investigations.
HSSIB will not apply in Scotland, where the Scottish patient safety programme is focused more on preventing patient safety issues in the first place. My interest is purely personal, as a surgeon. I experienced the impact of the Scottish patient safety programme when it was introduced to operating theatres in 2007. It cut post-operative deaths by 37% within two years. It has subsequently been rolled out to maternity, psychiatry, primary care and all the main sectors. It has not just reduced hospital mortality, but prevented morbidity—such as pressure sores, leg thrombosis or sepsis, which all in their own way cost the NHS a huge fortune.
I recognise the innovative approach and the potential impact of HSIB, but I fear that if NHS staff do not trust the confidentiality of the supposed safe space, they will not be candid in giving their opinions. Most patient safety incidents are caused either by wider issues such as staffing levels or communications, or by the failure to develop a system that stops an individual error resulting in patient harm. It is relatively rare for the person left holding the baby to be the person entirely to blame. That is the whole argument for shifting from blaming to learning.
Therefore, it is vital to ensure that the staff have that confidence. We will be asking them to talk about their part in an incident—what role did they play in something going wrong—if we are to understand how it could have been prevented. The principal aim is to ensure that shift from blaming to learning, to turn the NHS in England into a learning organisation. The end result of that would be greater patient safety. That is surely what all of us are trying to achieve.
I will speak mainly to new clause 1, but I cannot start without paying tribute to my hon. Friend the Member for North West Durham (Mr Holden) for his work to ban virginity testing. It is an abhorrent practice and high time it was made illegal.
I speak to new clause 1 in the names of my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) and the right hon. Member for North Durham (Mr Jones), among others. The existing situation, absurdly, is that someone may walk into a clinic and easily and legally get a treatment that could blind them, and there is absolutely no regulation whatever. For some time, we have talked about fixing the issue, and my private Member’s Bill—now the Botulinum Toxin and Cosmetic Fillers (Children) Act 2021—which was passed with the support of many Members of the House, has been able to bring some regulation to this space. Under-18s are now able to get only non-cosmetic interventions, and that by legal practitioners alone.
For those over the age of 18, however, there is no protection. Save Face, a campaigning organisation, last year received 2,000 complaints from people. Those are complaints not about the clinics people were in being dirty, but practitioners being uninsured or unable to fix the problems created when patients were given injections or fillers. People had necrotic or rotting tissue, which individuals would have to pay for themselves to get fixed. It is unacceptable that we are in a situation where that can take place with no regulation by Government.
I am afraid that is a pattern over time, across many Governments, of issues that primarily affect women not having the attention that they deserve. I am hopeful that we make some progress today. I pay tribute to my right hon. Friend the Member for Romsey and Southampton North on tabling her amendment.
The Health and Care Bill allows for
“a profession currently regulated to be removed from statutory regulation when the profession no longer requires regulation for the purpose of the protection of the public.”
Labour voted against the relevant clause in Committee, but we were defeated by the Government. I therefore tabled amendment 57, which would remove clause 127 from the Bill and ensure that a profession currently regulated cannot be removed from statutory regulation, and that statutory regulatory bodies cannot be abolished. I am grateful that the amendment received cross-party support.
The removal of a profession from regulation is deeply concerning because, once a profession is deregulated, we can expect the level of expertise in that field to decline over time, and along with that the status and pay of those carrying out those important roles. It also brings with it serious long-term implications for the health and safety of patients. In the White Paper that preceded the Bill, the Government stated:
“This is not about deregulation—we expect the vast majority of professionals such as doctors, nurses, dentists and paramedics will always be subject to statutory regulation. But this recognises that over time and with changing technology the risk profile of a given profession may change and while regulation may be necessary now to protect the public, this may not be the case in the future.”
It is notable that the Government only “expect” that the vast majority of professionals will be subject to statutory regulation, but they give no guarantee. The fact is, if the Bill passes, Ministers will be able change their mind at any point and make changes through secondary legislation.
The Government appear to be arguing that technological advances may change roles to such a degree that the high level of professional expertise that currently serves the NHS will no longer be needed. I will make two points about that. First, if the work of an NHS profession has changed to such a degree that regulation is no longer needed, I would argue that it is a different profession and needs a new job title. Secondly, when deploying new technology, there is always a need for professional staff with a high level of expertise and understanding of not only the functionality of that new technology, but its shortcomings. Technology has the power to improve productivity, but it should not be used as an excuse to deregulate professions.
It is important to consider where the impetus for that proposal may be coming from. The recent lobbying scandal certainly gives us a clue when we consider the number of MPs on the Government Benches with private interests in medical technology—I do not want to elaborate on that today, but to make the point. Certainly, big business is keen on deregulation, because it allows them to pay lower salaries to staff.
During a seminar on wellbeing, development, retention, and delivering the NHS people plan and a workforce fit for the future, a representative of Virgin Care said:
“We should have flexible working for all. We should consider what that means. We should embrace what that means. Both of those things really push what has been quite a traditional work model across the NHS. We need to be more modern. We need to have a think about how we rip up the old rule book. But change in an area that is very risk averse because the nature of the work we do is really tricky, so we need our leaders and our workforce to embrace trying things”.
That was an alarming statement for her to make. I think we would all agree that healthcare professionals’ understanding of risk and the importance of mitigating risk is incredibly important. It is always a matter of concern when business says that it wants to “rip up” the rule book on employment rights and pay.
Yesterday, in the Minister’s summing up, he said that
“the Bill does not privatise the NHS.”—[Official Report, 22 November 2021; Vol. 704, c. 151.]
I have to say, however, that I disagree. ICBs—integrated care boards—will be able to delegate functions, including commissioning functions, down to provider collaboratives, and provider collaboratives can be made up of private companies. I do not understand what it is that the Minister does not understand about that.
Add to that the fact that the abolition of the national tariff will open up the opportunity for big business to undercut the NHS, this is a potent situation indeed, and one that will be exploited by big business if the Bill goes through. The late Kailash Chand, former honorary vice-president of the British Medical Association said:
“The core thrust of the new reforms is to deprofessionalise and down skill the practice of medicine in this country, so as to make staff more interchangeable, easier to fire, and services more biddable, and, above all, cheaper”.
The removal of professions from regulation is a part of that scenario he described.
I turn now to workforce planning. There is a workforce crisis in the NHS. In fact, that is probably an understatement. Earlier this year, I met members of the Royal College of Nursing in the north-west, who told me of the sheer exhaustion that they are experiencing because of staff shortages. I was struck by how, even at this point when they were describing how they are on their knees with exhaustion, their primary concern was patient safety. We owe it to them to address the matter. The British Medical Association highlighted:
“Burnout has led to significant numbers of medical professionals considering leaving the profession or reducing their working commitments”.
According to the latest figures, there are well over 90,000 full-time equivalent vacancies in England’s NHS providers. The best the Government can come up with is in this Bill is to require the Secretary of State to publish a report, at least once every five years, describing the system in place for assessing and meeting the workforce needs of the health service in England. That is woefully inadequate. The Royal College of Physicians says that this duty on the Secretary of State
“falls short of what is needed given the scale of the challenge facing the health and care system”.