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Oral Answers to Questions

Volume 704: debated on Tuesday 23 November 2021

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?

Unfortunately, that question is not relevant to Question 1. We will come back to it as a substantive question later.

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.

Can the Secretary of State outline the ways in which yesterday’s votes on integrated care systems and the increased social care cap will benefit my constituents in Redcar and Cleveland?

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

2. What assessment he has made of the adequacy of the number of locations providing booster doses of the covid-19 vaccination in Shipley constituency. (904296)

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.

Unpaid Carers

4. What steps his Department is taking to help ensure that unpaid carers can access support when caring for family members. (904298)

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

5. What steps he is taking to reduce waiting lists for (a) children and adolescent mental health services and (b) other mental health services for young people. (904299)

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?

I can answer the hon. Lady’s supplementary question, but would it be in order for me to answer her tabled question and then the supplementary?

St Helier and St George’s Hospitals

6. What recent assessment he has made of the impact of the proposed downgrade of services at St Helier hospital on the delivery of acute services at St George's hospital. (904300)

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.

Community Pharmacies

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

8. What steps his Department is taking to roll out the covid-19 vaccination to 12 to 15-year-olds. (904305)

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

9. What steps his Department is taking to increase the number of carers in the adult social care sector. (904307)

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

11. What steps he is taking to ensure booster doses of the covid-19 vaccine are available to all eligible people in West Dorset. (904309)

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

12. What assessment he has made of the effectiveness of the roll-out of booster doses of the covid-19 vaccine. (904310)

19. What assessment he has made of the effectiveness of the roll-out of booster doses of the covid-19 vaccine. (904317)

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 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

13. What recent steps he has taken to help ensure that everyone in Sittingbourne and Sheppey constituency has access to a GP. (904311)

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.

Topical Questions

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.

T2. Hundreds of local people have responded to my High Peak GP surgery survey, and I look forward to presenting Ministers with the results shortly. One of the top concerns is about how we can improve access to primary care. One way would be finally to build a major new health centre for Buxton. The local NHS already owns a suitable town centre location with outline planning permission; all it requires is the capital funding. Derbyshire Community Health Service NHS Trust has submitted a strong bid, which I support, so will the Secretary of State meet me to discuss how we can deliver the proposal and improve healthcare for Buxton and the whole High Peak? (904321)

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.

T4. Now that the cap on care costs has unravelled, many of my constituents feel misled and betrayed, especially those with modest capital in the value of their home. How can it be that those with the most will contribute the least and that those with the least will contribute the most? Where is the equity, where is the fairness, and where is the justice in any of that? (904323)

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—

Order. Questions and answers are meant to be short and punchy. We cannot get into a full-blown debate.

T5. My constituents benefit from the excellent healthcare provided at Hillingdon Hospital, but it is long overdue a rebuild. Can my right hon. Friend give me an update on when we might expect to see progress on those plans? (904324)

It is a vital project, and the trust project team are working well with NHS England and with my Department. The scheme, as I understand it, remains on track; like my hon. Friend, I look forward to its completion.

T7. New research from the Disabled Children’s Partnership shows that nearly three quarters of disabled children and young people have seen their conditions regress in the pandemic because of a lack of adequate support. Therapies, short breaks and health services have all been massively reduced, and there are huge backlogs. Will the Secretary of State outline how the Government plan to rapidly sort that out? (904326)

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.

T6. The capital transformation of acute hospitals in Shrewsbury and Telford has been eight years in the making. Will the Secretary of State confirm what is now needed to start delivering the £312 million of capital committed by the Conservative Government to improve Shropshire’s healthcare facilities? Will he also confirm that it does not make sense to head down the rabbit hole of a new hospital and start this whole process all over again? (904325)

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.

T8. As ear syringing is no longer being undertaken in local surgeries, and as self-care does not work for many people, will the Government make sure that microsuction is at least available in every primary care network area? Otherwise, we are leaving people to go deaf. (904327)

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.

T9. In the next week or so, the Secretary of State will receive the Goldacre report on maximising the use of data in the national health service for both research and operational reasons. The Department has failed dramatically, a couple of times in the past decade, to maximise the use of this enormously important resource. Will he undertake to read the report, consider carefully the policies in it with a view to implementing them quickly, and publish it before the end of January? (904328)

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 am sorry to hear about the hon. Lady’s constituent, and of course a Minister will meet her.

T10. I refer to my interest as chair of the all-party parliamentary group on stroke and as the husband of a stroke survivor.Mechanical thrombectomy can be a game-changer for sufferers of strokes, greatly reducing the levels of disability they are left with. NHS England committed itself to a full roll-out of mechanical thrombectomy availability by 2022, but we are lagging seriously behind. Where are the plan and the investment to bring the programme back up to date and on track? (904329)

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.