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Oral Answers to Questions

Volume 712: debated on Tuesday 19 April 2022

Health and Social Care

The Secretary of State was asked—

Smoke-free 2030 Target

I know that my hon. Friend has long been a passionate advocate for a smoke-free England, and I read his recent Westminster Hall debate with interest. Some 64,000 deaths a year are attributed to smoking and it is one of the greatest drivers of health disparities in our country. I am personally determined that we should do everything we can to reach the Government’s ambition of a smoke-free 2030. That is why, in January, I asked Javed Khan to lead an independent review into tobacco control. Once that review is complete, the Government will set out their next steps.

To get to a smoke-free 2030, for every 100 people smoking today we need to reduce that figure by eight, because “smoke-free” actually means 5% or less of the adult population smoking. Can I ask the Secretary of State to ruthlessly target the barriers that stop people stubbing out their last cigarette? We need to get the numbers of smokers down; otherwise, 2030 will be an ambition that is not achieved.

My hon. Friend is absolutely right. The smoking rate is currently 13.5%, which is the lowest on record. However, smoking remains the largest driver of health disparities in our country. The new tobacco control plan, which will be informed by the new independent review, will be looking to do exactly what my hon. Friend says.

As one of the original campaigners for a ban on smoking in public places, I fully support what has just been suggested, but can I go further and beg the Secretary of State to come up very soon with a plan so that every child, every person and every family in this country can breathe clean, fresh air away from the pollution coming from diesel vehicles and other sources?

The hon. Gentleman has long been a campaigner on this issue and I commend him for that. He is right to continue pushing. I do not want to pre-empt the outcome of the independent review because it is just that, a review fully independent of Government. However, once it is complete—I hope to publish it in May—we can set out our plans.

Health and Care Integration

The past few years have shown that we are strongest when we work together. Earlier this year we published the integration White Paper, drawing on our experience of the pandemic to develop a plan that will bring together the NHS and local government to deliver jointly for local communities. We have also created integrated care partnerships, such as the programmes in mid-Nottinghamshire and Northamptonshire, through which we are already showing how we can bring together health and local social care services.

As covid regulations come to an end, I understand that the discharge fund is also set to end. This could leave local government vulnerable where there are no formal procedures locally to pass funding from the NHS to local government services and local authorities. Particularly as we seek to reduce hospital backlogs, it is vital that we get people out of hospital and into appropriate care settings. Will my right hon. Friend assure me that, where local authorities seek to tackle such backlogs, they will have access to appropriate funding?

I can give my hon. Friend that assurance. Of course, we are already putting in record funding for local authorities and the NHS to deal with backlogs. I believe the plan we set out earlier this month for the integration of NHS and local authority care services will make a real difference.

I thank the Secretary of State for referring to the work in Northamptonshire to integrate health and social care. Can he assure me that the central role of local government in ensuring that health and social care services work together to make the most efficient use of local resources will continue? And will he give me a clear guarantee that adult social care will not be taken over by the NHS?

I am pleased to give my hon. Friend the assurance he seeks. The integration White Paper signals our intention to go further and faster on health and care integration, building on the work already being done by the NHS, adult social care and local government to deliver services jointly. The plan will lead to better collaboration, and we want to make sure that overall responsibility is still shared between local authorities and the NHS.

The Secretary of State will know that Walsall Manor has been merged with the Royal Wolverhampton—they share a chief executive and chairman—without consultation with local people. How on earth can integration take place when Walsall Manor does not have a full-time chief executive to ensure that it happens? Will the Secretary of State please ensure that Walsall Manor gets its own chief executive?

I understand the right hon. Lady’s point, but it is about what works on the ground. My understanding is that what is happening in her area is about a shared management team that shares best practice and tries to address challenges together, rather than any kind of formal merger.

Across the country, tens of thousands of people sitting in hospital are medically fit to go home but cannot do so due to a lack of social care. The Health and Care Bill should have addressed that, but it does not. Rather than making us wait for more legislation, will the Secretary of State at least concede that local health leaders, be they in clinical commissioning groups or in integrated care systems in shadow form, should be driving this locally as a matter of urgency?

That is exactly what the new integrated care systems are all about. My understanding is that the hon. Gentleman sat on the Health and Care Public Bill Committee, which made it a reality.

Thank you, Mr Speaker. You have clearly had a happy Easter.

The fact is that the Government’s failure to fix the social care crisis is causing huge pressures on the NHS. As of last week, more than 20,000 patients were fit to leave hospital but could not be discharged because the care was not available, which means that 22,000 patients each month are waiting more than 12 hours in A&E and that heart attack and stroke victims have to wait more than an hour for an ambulance. We are used to hearing about winter crises, but is it not the case that, after more than a decade of underinvestment in the NHS, a failure to fix social care and the absence of a plan even to address the staffing challenge in the NHS and social care, we have not just a winter crisis but a permanent crisis in the NHS?<

That is not the case at all. The hon. Gentleman knows, although he pretends not to, that the NHS and social care are facing unprecedented pressure because of the pandemic. He will know that as a result of the pandemic, both in NHS settings and in adult social care there has been a necessity for infection and protection controls. He will know that, sadly, staff absences are higher than they have been in normal times. But the NHS is stepping forward, with its colleagues in adult social care, to provide whatever support it can bring, especially with the record funding the Government are providing, both to the NHS and to adult social care.

My hon. Friend the Member for Hyndburn (Sara Britcliffe) and I have been working with east Lancashire local authorities and our GP services to see whether we can increase the number of face-to-face GP appointments. Will the Secretary of State say what action he and the Government are taking to ensure that people in east Lancashire can see their general practitioner face to face?

My right hon. Friend is absolutely right to raise this issue. We have heard time and time again in this Chamber about the pressures our constituents are facing in order to get that kind of face-to-face access to their GPs. We all know why the situation was particularly bad at the height of the pandemic, but we expect it to improve rapidly. The percentage of people being seen face to face is increasing substantially, in large part because of the measures the Government have taken, including the £250 million access fund that was announced a few months ago.

Thank you, Mr Speaker.

Integration and service improvement cannot be delivered without sufficient staff, and the only way to attract people to a career in social care is by valuing them. In Scotland, they are already paid better than those in England and Wales, and through the national care service the Scottish Government will improve terms and conditions for care workers, through the introduction of national pay bargaining. Have the UK Government considered following the Scottish Government’s approach and commitments?

Integration between the NHS and social care requires the right level and quality of workforce, both in the NHS and in adult social care. In the NHS in England, we have more doctors and nurses—more people working than ever before. In adult social care, we are recruiting at high levels, not least because of the huge recruitment campaign we ran with the sector, and some of the other changes we made, including the £400 million- plus of retention funding over the winter period. In addition, the support for the workforce more generally is making a real difference.

In north Northamptonshire, integration is getting on very well, with Councillor Helen Harrison heading the adult social services. However, going back to what my hon. Friend the Member for Northampton South (Andrew Lewer) said, there is the worry that because the NHS is so big it will overwhelm local government. I have told the Secretary of State that they do not want to mess with Helen Harrison, but can he ensure that there is a mechanism for reviewing that?

I know that my hon. Friend knows Helen Harrison extremely well, but he is right to talk about the importance of the NHS and the adult social care sector and local authorities working together. We must make sure that it is a true partnership, where one does not overwhelm the other and they work together towards their shared interests.

One key cause of the urgent care crisis in Shropshire, in the Shrewsbury and Telford Hospital NHS Trust, is the inability to discharge patients who are medically fit to go home into social care in the community. Shropshire Council’s resource challenges in that area are well known. Will the Secretary of State commit to putting extra resource into social care in Shropshire so that the medically fit can be discharged into the community when they are ready?

The hon. Lady is absolutely right to raise this issue, and the whole House heard just before the recess the results of the independent work done by Donna Ockenden. The hon. Lady is right to talk about that and the pressure that has been faced locally. I understand that she has already reached out to my hon. Friend the Minister for Health and that he will be meeting her to discuss just that.

NHS Dentistry Backlog

The dental activity threshold has recently been raised to 95% of usual activity. That is another quarter-on-quarter increase to get us towards 100% of pre-pandemic activity. I fully recognise, though, that access to NHS dentistry before the pandemic was patchy and that the crux of the problem is the current NHS dental contract, so work is under way to reform that contract. As negotiations have started, I am limited in what further I can say, but I will update the House as soon as possible.

A number of my constituents are finding it impossible to access NHS dental care. They include Alison, one of my constituents who worked as a midwife in Ipswich Hospital for 40 years. Some of them have contacted 40 different practices and have not got anywhere. My understanding is that there has been a 30% drop in the number of dentists taking on NHS work in Suffolk. Will the Minister explain what local work is going on between the Department and the local NHS bodies to try to ensure that this issue is addressed?

My hon. Friend is quite right in his question and is campaigning hard to increase dental activity in his constituency. One of the key pieces of work is being done through Health Education England, which set out a range of recommendations in its “Advancing Dental Care” review. That will do a number of things, such as increase the skill mix and scope of practitioners across dental teams, and we may well require legislation to bring some of that work forward. Health Education England is also introducing more flexible routes into dental training and doing some workforce modelling to identify the parts of the country with the biggest gaps in provision, so that we can establish centres of dental development in those areas. I will look at Ipswich in particular.

My constituent contacted me to tell me that when she broke her canine and went to contact her NHS dentist, she found she had been kicked off the list and was facing a bill of £4,000, which she simply does not have, to have the work done privately. Will the Minister speak to some of the dental practices about the possibility of relaxing their rules on kicking people off their dental lists, especially as covid has meant that patients might have had legitimate reasons for missing appointments?

I am sorry to hear about the hon. Lady’s constituent’s experience. There is not actually a list system for dentists as there is for GPs, so patients can see any dentist when they have a dental issue. With that said, we have asked dental practices to update their availability for NHS patients on the website. This morning, I looked at the website to see what availability there was throughout the country and saw that many dentists still have not updated their availability, so I will ask officials—particularly in her constituency—to update the lists so that patients can access NHS dentistry more easily.

I join the Minister in thanking dentists and their associates for getting so much of the service back. Does she agree that in places such as the Arun parts of my constituency, where people cannot find a dentist and have not been able to for two or three years, there must be a way for people to get on a dentist’s list and get treated, and for dentists to be properly rewarded? Dentists and patients would be grateful for a change in the contract.

The Father of the House is quite right that the crux of the problem is that there is a shortage throughout the country not of dentists but of dentists taking on NHS work. The contract is the nub of the problem, which is why work is under way to reform it. We will shortly announce some short-term changes and some longer-term reforms, which will hopefully help my hon. Friend’s constituents.

Bearing in mind that dentists are now determined to turn their practices wholly private as they cannot make ends meet with NHS prices, will the Minister pledge to review NHS payments to stop the haemorrhaging of NHS dentistry provision?

The hon. Gentleman is correct that the units of dental activity payments are a perverse disincentive. Sometimes, when someone needs more extensive work, their dentist is paid the same as they would be for, say, one or two simple fillings. That is the nub of the problem and we are currently in negotiations on the matter.

My hon. Friend the Minister is right to talk about the contracts with dentists, but should she not also look at how dentistry is structured and the regional nature of the contracting? It sits outside our clinical commissioning groups, which reduces co-ordination and accountability in respect of something that is central to our health. Should this not change?

My right hon. Friend is right. Health Education England is addressing the overall system of where dentists are training and where the gaps in provision are filled in its “Advancing Dental Care” review. It is also working with commissioners at a local level to develop more opportunities in those places that we term dental deserts, where there is currently a lack of provision.

NHS dentistry is in crisis. Patients are stuck with either a never-ending wait for an NHS appointment or footing the bill for going private, which is simply not an option for most families suffering rising bills and taxes. With a third of the population experiencing untreated tooth decay, when will this Government, who have had 12 years to do so, finally come up with some practical solutions that put patients’ needs first, rather than the half-baked, unworkable ideas we have heard to date?

I am sorry to the hear that tone from the hon. Lady. We are working under Labour’s 2006 dental contract, and she may have missed that dentists were unable to offer any routine care during the pandemic over the last two years, which we have slowly worked up to 95% of usual activity. She may want to play politics with this issue, but perhaps she should speak to her Labour colleagues who run the NHS in Wales, where 6% of dental posts were lost last year. She should get her own side in order before lecturing this side of the House.

With the exception of the previous question, I do not think that anybody on either side of the House who has raised this issue is playing politics, because a pattern is emerging of a backlog and problems in accessing NHS dentistry. An increasing number of constituents are contacting me having gone to their NHS dentist with an acute dental problem only to be told either that NHS patients are no longer being seen or that they have fallen off the list, as the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) mentioned. How can Ministers help in the short term? I know the long-term answer is around the contract—I used to give that answer when I was in her seat—but will the Minister please meet me over a cup of tea so that we can try, as a starter for 10, get to the bottom of this?

I thank my hon. Friend for his question. We have had many cross-party meetings with colleagues about dentistry, with many raising constituency issues that we have followed up. He could speak to his local commissioners, because there can sometimes be local problems with the commissioning of dental services. However, now that we are moving towards 95% of usual activity—a significant change compared with last year— I hope that his constituents will be able to access services more easily.

NHS Ear Irrigation and Microsuction

4. What recent assessment he has made of the adequacy of access to NHS ear irrigation and microsuction treatments. (906512)

Ear wax services are the responsibility of local commissioners, who are responsible for meeting local healthcare needs. Depending on a local area’s arrangements, services should be undertaken either at local primary care practices or through referrals to appropriate local NHS services.

Well, I obviously want to thank the Minister for that answer, but I was recently contacted by a constituent who complained that she was told by her GP surgery that such services were no longer available on the NHS and that she should consider obtaining them privately. This is happening despite recent studies that link the effect of impacted cerumen with cognitive decline and dementia. Will the Minister consider writing to clinical commissioning groups to remind them of their obligations and patient entitlements?

I thank the hon. Gentleman for his question. There has been no national removal of ear wax services, which can still be commissioned locally. NICE guidance is clear on the types of services that should be commissioned. Traditional methods of manual ear syringing are no longer offered for safety reasons, but electronic irrigation and microsuction should be being offered. If his local CCG is not commissioning such services, I am happy to meet him and them to discuss why not.

GPs provided the service for decades. We all understand why the NICE guidance means that they no longer offer syringing, but there is a gap in that many clinical commissioning groups are not offering alternative services. We are talking about people with dementia or receiving end-of-life care who literally cannot hear and are going deaf. The Minister must be direct with CCGs on this issue.

My hon. Friend is right that there must be consistency across the country in how those procedures are commissioned. After today’s questions I will take this up with officials to see why that is not happening consistently across the country.

Regional Health Inequalities

I am determined to tackle unfair disparities in health outcomes. That is why I launched the Office for Health Improvement and Disparities. OHID’s regional directors of public health will work with local government and the wider health system to empower local partners with the tools they need to respond to disparities in their regional and local areas. We will also publish a health disparities White Paper later this year, with a strong focus on prevention, to improve health for the whole population.

I thank the Secretary of State for his answer, but a decade of under-investment and mismanagement have left 4.5 million people on waiting lists and staff shortages of more than 100,000 people even before we entered the pandemic, which exacerbated health inequalities. I welcome the work his Department is doing, but the reality is that people who live in a constituency such as mine are twice as likely to end up on a waiting list for treatment for more than a year as those in better-off areas. While I welcome what he has announced today, may I ask that he puts in appropriate investment to go along with tackling those appalling health inequalities?

The hon. Lady is right to talk about the importance of tackling health inequalities; on that we absolutely agree, and I hope she will contribute to the health disparities White Paper that I mentioned a moment ago. However, it is wrong of her to suggest that some of the current challenges we face are because of under-investment or because of a smaller workforce than otherwise. We have the largest investment ever going into the NHS. Its budget this year is bigger than the GDP of Greece. It is the highest amount ever, rising by billions each year. We also have more going to social care than ever before, and the highest level of workforce that the NHS has ever seen in its history.

Surely one of the cruellest health inequalities is in fertility treatment. Of the 106 CCGs in the country, only six limit the age at which women can have in vitro fertilisation treatment to 35, and two of those are in Hampshire. Will the Secretary of State meet me to discuss how we can end that most devastating of postcode lotteries?

My hon. Friend is right, and of course I will be happy to meet her and discuss this further, but I can also tell her that that is one of the key things we will be covering in our upcoming women’s health strategy.

Warm words from the Secretary of State, but people in the most deprived parts of England are almost three times as likely to lose their lives from an avoidable cause as those in the least deprived areas. With the cost of living soaring and the Resolution Foundation estimating that 1.3 million people will be pushed into poverty as a result of the Chancellor’s spring statement, those inequalities will worsen. Why will the Secretary of State not just admit that his Government have failed the poorest communities, and start doing something about it?

The hon. Gentleman acts as though health inequalities are something that has just emerged under this Government. There have been long-running health inequalities in this country over decades under successive Governments, and this Government are putting in record investment and coming up with the ideas to deal with them. As ever, the Labour party has no idea how to deal with the challenges this country faces.

Mental health is a serious challenge of our time. It is totally unacceptable that waiting times, average number of sessions and minimum number of sessions differ according to which part of the country someone lives in. Sadly, recent statistics show that in Stoke-on-Trent people are taking their own lives at double the national average. That is why I am proud to support the cross-party “No Time to Wait” campaign, led by James Starkie with the backing of The Daily Telegraph and the Royal College of Nursing, for the provision of mental health nurses in GP surgeries, which could make a real difference to those who bravely come forward asking for help. Will my right hon. Friend meet me, hon. Members of this House who are supportive, and James to discuss how we can make that possible?

Yes, of course; I would be delighted to meet my hon. Friend and others to discuss the campaign. He speaks with passion and I know this is something he has long campaigned on. I have had time to look at some of the content of the campaign, but I would certainly be happy to discuss it further.

NHS Waiting Lists: Southampton

Reducing waiting lists and waiting times, exacerbated of course by the impact of the pandemic, is a key priority for this Government. Southampton, like the rest of the country, will benefit from the detailed actions set out in the elective recovery plan published by my right hon. Friend the Secretary of State a few months ago. In addition, as part of Solent Acute Alliance hospital upgrade programme, University Hospital Southampton NHS Foundation Trust has received £12.1 million to increase capacity at Southampton General Hospital.

The hospital trust in Southampton, which is an excellent provider, is desperate to get back to elective surgery and non-life-threatening procedures, but finds that it cannot because it cannot integrate covid treatment into general ward activities, and has a continuing high level of staff sickness, which means that procedures are often undertaken very inefficiently in terms of resources. What assistance can the Minister provide for the trust to enable it to get on the front foot as regards elective procedures and non-life-threatening treatments in the near future?

The hon. Gentleman rightly pays tribute to the staff at his hospital trust, and I join him in doing so. The number of those in his area waiting for an elective procedure or routine operation has reduced slightly. There is more to do, but the trust is making inroads, as he says, and I know that it wants to do more. As we set out in the elective recovery plan, some innovations, such as surgical hubs, allow a greater separation between covid areas, or areas where covid may be present, and elective activity is a key part of that. If it is helpful, I am always happy to meet him to discuss the specifics of his local hospital.

Poor Housing Conditions: Health Outcomes

7. What steps he is taking with Cabinet colleagues to tackle the effect of poor housing conditions on health outcomes. (906515)

The Government are committed to tackling poor-quality housing. In the social housing White Paper, we committed to a review of the decent homes standard to test whether it is up to date and reflects current needs and expectations. The levelling-up White Paper sets out a commitment to halve levels of non-decency in all rented homes by 2030, with the biggest improvements in the poorest-performing areas. These reforms will have a positive impact on health, and we will work closely with the Department for Levelling Up, Housing and Communities to support their implementation.

The NHS spends a staggering £2.5 billion-plus annually on treating people with illnesses directly linked to living in cold, damp and dangerous conditions. As a consequence, severe respiratory diseases such as asthma, mesothelioma and other asbestos-related diseases are on the increase, mainly in the most deprived areas. Sadly, more and more people are dying. How does the Government’s levelling-up policy plan to tackle this increasingly urgent health issue?

The hon. Gentleman raises a really important issue that we are determined to tackle. Housing is one of the key determinants of health. A decent home can promote good health and protect from illness and harm. As he said, poor housing conditions have severe consequences for mental and physical health. That is why we are determined, not just through the levelling-up White Paper but through the health disparities White Paper that will be published later this year, to set out a bold ambition to reduce the gap in health outcomes and the actions that the Government will be taking to address the wider determinants of health, including the impact of poor housing on health.

In North Devon it is not just the quality of housing that is causing health issues but the lack of availability of affordable housing and a complete collapse of the private rental sector, which is creating mental health issues among my constituents and also means that my much-loved North Devon District Hospital is struggling to recruit adequate local medical services. What steps is the Department taking to try to address these concerns?

My hon. Friend raises an important issue specific to her area, and other areas that attract people who go there for their holidays and are perhaps not there on a permanent basis. We are determined through our White Papers to address every health inequality, whether caused by a moving population or a static population, in the sorts of areas that the hon. Member for Wansbeck (Ian Lavery) talked about.

Cancer Treatment Backlogs: Derbyshire and England

8. What recent assessment he has made of the scale of the backlog in cancer treatments in (a) Derbyshire and (b) England. (906516)

Cancer treatment and diagnosis remained a top priority throughout the pandemic, with 4.4 million urgent referrals during the period and over 1 million people receiving cancer treatment. Thanks to the brilliant work of our NHS staff, first treatments for cancer have been maintained at above 94% of usual levels over the course of the pandemic. However, we know that fewer people came forward, so we are now seeing record numbers of people coming through the system, with November last year having the highest number of 11,000 cancer referrals per working day.

I asked specifically about Derbyshire, but I did not get an answer. Derbyshire clinical commissioning group has failed to reach any of the cancer referral targets for the most recent 12 months. Although this is a national failure, the shortages are particularly acute in Derbyshire. These failures have tragic consequences. My constituent Paul Bryan is just 58. He has been attending his surgery for two years; he kept getting dismissed and was not tested, and now the prostate cancer that was undiagnosed for all that time has spread to his ribs, spine and bones, and his diagnosis is terminal. His family are urging the Government to show more urgency to improve outcomes, so that other families do not have to experience such needless heartbreak. Will the Minister explain to the Bryans why the Government rejected the workforce planning amendment to the Health and Care Bill that could have helped our NHS get the cancer specialists it needs and prevented heartbreak like the Bryans in other families?

I am sorry to hear about the case of the Bryan family, but I reassure the hon. Gentleman that, in Derby and Derbyshire, 92% of treatments start within 30 days, despite record numbers of patients coming forward. To tackle the issue of getting people diagnosed earlier, which is key to getting more successful treatment, we are rolling out rapid diagnostic centres across the country so that people can access screening and testing much more quickly and easily. We have 159 of those live right now, with more to follow.

Personalised Healthcare

Personalised healthcare is a key priority in my reform agenda. I recently set out a new ambition: that as many as 4 million people benefit from personalised care by 2024, covering everything from social prescribing to personalised support plans. We are also on track to deliver 200,000 personal health budgets and integrated personal budgets by 2023-24.

I welcome the Secretary of State’s answer. My constituents are still telling me that they are experiencing some delays beyond the NHS guidelines on diagnosis for special treatment. What plans does my right hon. Friend have to address the lack of capacity and need for capacity in specialty-trained doctors and specialist diagnostic equipment, to make personalised care a reality?

My hon. Friend is absolutely right to mention the importance of the workforce and medical equipment. He will be reassured to know that the NHS has more doctors and nurses working for it than ever before, with more in training than ever before. We are investing record amounts of capital for new medical equipment, including investment in some 160 new community diagnostic centres, which will all include the latest, state- of-the-art diagnostic equipment.

Mental Health Support for Veterans and Military Charities

10. What recent discussions he has had with Cabinet colleagues on the adequacy of mental health support for veterans and military charities. (906519)

NHS England has several bespoke services for veterans, including Op Courage, the veterans’ mental health and wellbeing service, which provides a complete mental health care pathway for veterans. Veterans can benefit from personalised care plans, ensuring that they can access support and treatment both in and out of hours. As part of the care and support available to veterans, Op Courage works with military charities and local organisations to provide healthcare and address wider health and wellbeing needs, including for drug and alcohol addiction.

My constituency of Airdrie and Shotts has a long military history, with many people having previously served in the armed forces. When I meet veterans from my constituency, we often discuss the mental health of veterans. The war in Ukraine will undoubtedly have an immediate and lasting impact on the mental health of veterans, as they may be reminded of their experiences of war. To help support our veterans, will the Department come forward with a package of emergency funding for armed forces mental health charities?

The hon. Lady raises a very good question. Last year, we committed an additional £2.7 million to further expand Op Courage following the recent events in Afghanistan, and NHS England has put in place several bespoke services and initiatives to meet the needs of our armed forces community. In addition to Op Courage, there is the veterans trauma network, the veterans prosthetic panel and the veteran-friendly GP accreditation scheme, but given ongoing events in Ukraine, we will of course keep everything under review. I am very happy to meet the hon. Lady to discuss further what may be required.

Our veterans have risked their lives for our country and deserve excellent mental health support. We must go even further: from the military frontline to frontline workers who have kept us safe, everyone deserves proper mental health provision. People have stepped up to protect our country and save lives during the pandemic, so is it any wonder that teachers and NHS staff are so furious with the comments made by the hon. Member for Lichfield (Michael Fabricant), about how they would go back to the staffroom and have a “quiet drink”, in an attempt to justify the indefensible actions of the Prime Minister? What does this say about the effect of mental health on our frontline staff? Will the Minister please condemn those comments and apologise for the hurt caused by those remarks?

I am very happy to say that we of course thank very much all the staff who have been on the frontline, whether veterans or teachers, and involved in everything that kept us going throughout the pandemic. We are of course very much aware of the impact of those stresses and strains on mental health. There is additional support for mental health, and there will continue to be additional support for young people’s mental health and for adult mental health. That is one reason why I launched a call for evidence last week to inform a new 10-year cross-departmental mental health vision, and I urge everybody to input into that process before it closes on 5 July.

NHS Workforce Planning

11. What recent progress his Department has made on NHS (a) short-term and (b) long-term workforce planning. (906520)

The workforce are the heart of our NHS, and I join the Minister for Care and Mental Health, my hon. Friend the Member for Chichester (Gillian Keegan), and Opposition Members in paying tribute and putting on record our thanks to those who work in the NHS. In the short term, the NHS has well-established processes to ensure that the health service has the right number of staff with the right skills, and that is alongside our investment in workforce expansion, including delivering 50,000 more nurses over the course of this Parliament. For the longer term, we have commissioned Health Education England to set out the key drivers of workforce supply and demand. It is due to report this spring. Building on that, my right hon. Friend the Secretary of State has commissioned NHS England to develop a long-term workforce framework. We will share the conclusions in due course.

The anti-immigration, “hostile environment” rhetoric and actions of this Government are having a significant impact on our NHS workforce, both by not encouraging people to come here to work in our NHS and by discouraging current staff from staying here. The Health and Social Care Committee recommended the introduction of a national policy framework on migration to support national and local workforce planning. When will the Government implement that recommendation?

I am very grateful to the hon. Lady for her question. We are clear, and always have been clear, about how much we value the huge contribution that overseas workers in our NHS make towards keeping our health service up and running, and delivering first-class care every day. There are three strands to our approach to building and increasing our workforce. The first is increasing the numbers of people training in this country and the second is increasing retention. The third focuses on the workforce who come from overseas and who are incredibly welcome here. Indeed, the number of people coming from countries outside the EU into our NHS workforce has increased.

The Minister will be aware that I have highlighted the challenge for rural areas in developing a workforce plan on a number of occasions. Indeed, the last report from the all-party parliamentary group on rural health and social care made 10 recommendations, including for how we might address workforce planning in rural areas. Will the Minister advise me of what steps he has taken to put in place any of those recommendations to improve the plight of those living in rural areas?

I am grateful to my hon. Friend, who takes a close interest in this issue, which she and I have discussed on a number of occasions. She is right to highlight the challenges that some more remote or rural communities can face in securing the workforce they need to meet their communities’ needs. The HEE work and the subsequent workforce framework will be looking at that across the whole range of different geographies and the challenges they face.

The Scottish Government have recently bought Carrick Glen, a private healthcare hospital, in order for it to become part of the national network of treatment centres, which once fully operational will have capacity for over 40,000 additional surgeries and procedures each year. In contrast, the UK Government have taken the path of further privatisation of the NHS, so what recent assessment has the Minister made of the impact on the workforce of further privatisation of NHS England?

I am grateful to the hon. Gentleman, and had we been going further down the route of privatisation, his question might have had a little more resonance. What we are doing in the NHS in England is investing in our workforce and investing in our national health service, while of course working closely with the independent sector to maximise the use of its capacity in parallel to make sure we bring down waiting lists and waiting times.

Topical Questions

Our healthcare system is standing at a crossroads, and sooner or later we will have to make a choice between endlessly going back to the taxpayer to ask for more money and reforming the way in which we do healthcare in our country. Last month, I unveiled an ambitious new programme of reform, setting out how we are going to prioritise prevention, offer more personalised care, deliver improvements in performance and back the people making the difference in the NHS. The objective of this agenda is simple: to bring about the biggest transfer of power and funding in decades from our ever-expanding state to individuals, their families and their communities.

In Gloucestershire Hospitals NHS Foundation Trust, 30% of patients do not medically need to be in hospital; they are waiting for discharge. That figure is twice the national average. Will one of the Ministers contact the relevant people in the health service in Gloucestershire to ask them for ways in which the Government could help them to reduce that figure, because as it stands lives are being put at risk?

My hon. Friend is right to raise this. We are already in contact with the acute trust in Gloucestershire and some of the other trusts that are finding delayed discharge a particular challenge. My hon. Friend will know that, because of the pandemic, what has been a long-term challenge has become much more acute, not least because of the lost beds due to infection protection control and staff absences both in healthcare and in social care. Our delayed discharge taskforce is making a difference—the numbers are coming down overall—but we will be working with Gloucestershire.

Why does the Health Secretary think he has any licence to lecture the British people on their moral duty to pay taxes when he spent so many years avoiding his own?

I am very happy to answer if you will allow me, Mr Speaker. The hon. Gentleman could have asked me a question on anything to do with health and care—anything he wanted—but instead he chooses to talk about my personal affairs before public life. That was his choice. He could have asked me about the covid backlogs that he pretends he cares so much about. He could perhaps have given me suggestions—

Order. Secretary of State, I have got it. These are questions about your responsibilities. Now we can have another try—Wes Streeting.

Thank you, Mr Speaker. I would just say to the Secretary of State that he should be careful what he wishes for. I hope he will at least reply to the letter I sent him last Thursday—I will place a copy in the Library of the House. He has been stonewalling journalists’ questions, but since he says he wants to talk about the Government’s record, let me ask him about that instead. We went into the pandemic with NHS waiting lists already at 4.5 million. We went into the pandemic with NHS staff shortages of 100,000. We went into the pandemic with social care staffing vacancies of 112,000. So it is not just the case that the Tories did not fix the roof while the sun was shining; they dismantled the roof, removed the floorboards and now they have no plan to fix it. Where is the Secretary of State’s plan to fix the NHS crisis?

Order. Once again, I remind Members that topicals are short and punchy questions, not lengthy statements. A lot of Back Benchers on both sides deserve to get in to raise constituency matters, so please let us give them time. I do not want a lengthy fall-out, and these are Health questions.

Mr Speaker, you have been very generous to the hon. Gentleman: you gave him another try, but that was another failure to ask a question. Again, the hon. Gentleman is not asking about the serious issues, which again shows that he will play petty party politics and that Labour has no plan for the challenges this country faces.

May I just reassure the Secretary of State for Health that I was not being generous? The shadow Secretary of State had two questions, so I have not been generous in any shape, way or form.

T2. We have all seen the disturbing scenes in Shanghai recently. Does my right hon. Friend agree that this shows how dangerous a zero covid strategy is and that we were right to open up this country and to rely on our vaccines as the safest way out of the covid situation? (906500)

Like many across the House I have been deeply disturbed by the reports we have all seen from Shanghai and my thoughts are with the people affected. It shows what a dangerous fallacy this whole idea of zero covid was, and it also shows that we are the most open country in Europe and that we have got the big decisions right. We did not listen to the Opposition when they said we should not open up in the summer, and we did not listen to them when they again called for restrictions in the winter. We are showing the world how to live with covid.

T3. My constituents have been forced on to private and unaffordable dental plans or they have to wait up to five years to see an NHS dentist. The situation is getting worse and worse, so I met with the groundbreaking Hull York Medical School to see if it can assist in training a future generation of dentists and it is keen to help; what is the Minister doing to work with medical schools? (906501)

I thank the hon. Lady for her question, and we have met to discuss this previously. I am happy to discuss with Health Education England whether one of its centres for dentist development could be suitable for her constituency.

T6. In 2019 Kettering General Hospital, which serves my constituency, was promised £46 million for a major upgrade. Three years later the hospital still has not got the money. Secretary of State, will you go out and buy a very big pair of scissors, cut through the red tape and get it sorted? (906504)

No one, with the possible exception of my hon. Friend the Member for Kettering (Mr Hollobone), is more passionate than my hon. Friend the Member for Wellingborough (Mr Bone) about seeing improvements delivered in their local hospital, and I had the pleasure of visiting. As my hon. Friend will know, the £46 million was allocated originally for an urgent treatment centre; the hospital asked that that be changed and it folded in with the overall programme. It has yet to submit a business case for the enabling works; when it does, I will make sure that it is expedited.

T4. The gap in life expectancy between people living in the richest and poorest areas is once again growing. That affects my constituents directly. I have heard nothing to date that tells me what the Secretary of State is going to do to narrow the gap; Secretary of State, what will you do to protect my constituents? (906502)

As the hon. Gentleman is aware, I know his constituency well; it is my birthplace. He might also know that just a couple of months ago I visited his constituency and met members of the local community at the Deeplish community centre to talk about exactly what he has rightly raised today: the importance of tackling inequalities in Rochdale and beyond. We will set out our plans in our upcoming health disparities White Paper.

T9. The Cass review interim report found that to date there is a profound lack of evidence on the best approach to treat gender dysphoria in children. Does my right hon. Friend share my concern that in spite of this the NHS insists on making a child’s expressed gender identity the start-point for treatment, and my surprise that the NHS has chosen so far not to track patient outcomes, particularly for under-18s? (906507)

I share my hon. Friend’s concerns, which is why the NHS commissioned this review from one of our top paediatricians. It is already clear to me from her interim findings and the other evidence I have seen that NHS services in this area are too narrow; they are overly affirmative and in fact are bordering on ideological. That is why in this emerging area, of course we need to be absolutely sensitive, but we also need to make sure that holistic care is provided, that there is not a one-way street and that all medical interventions are based on the best clinical evidence.

T5. Since February 2020 my local borough of Lambeth has seen a 14% drop in dementia diagnosis. That means people are not getting the support that comes from diagnosis. We also know that so far none of the announced £8 billion backlog funding has been dedicated to addressing the stagnation of diagnosis rates. Can the Secretary of State explain what exactly he is going to do to make sure that people get diagnosed on time? (906503)

The hon. Lady raises a very important question. We want a society in which every person with dementia and their families and carers receive high-quality, compassionate care from diagnosis through to end of life. We have provided £17 million this financial year to NHS England and NHS Improvement to increase the number of diagnoses. That funding was spent in a range of ways, including investing in the workforce to increase capacity in memory assessment services.

The Secretary of State will have read the scandal exposed in The Sunday Times this weekend that six babies are born every month after being exposed to sodium valproate, which has been known for many years to cause disabilities. Last year the Government consulted on putting warning labels on valproate. Is it not time to go much further and ban the prescription of sodium valproate to epileptic pregnant mothers?

My right hon. Friend is right to raise this, and many of us will have seen the recent reports, especially from the families affected. It is right that we reconsider this and make sure that sodium valproate, and any other medicine, is given only in the clinically appropriate setting.

T7. The Secretary of State is right that we all want to get to the bottom of many important health matters, and we do not want what he described as personal affairs to get in the way of that. In order to ensure that the House concentrates entirely on those matters, will he welcome HMRC investigating whether he was claiming non-dom status on a solely— (906505)

Thank you, Mr Speaker. I will try not to make this one a waste. I was grateful to the Minister for meeting me to discuss my ongoing campaign to restore the A&E to Bishop Auckland Hospital. Many of my constituents face a long drive to get to Darlington or Durham, and given that swift treatment can be a significant factor in outcomes for conditions such as strokes and heart attacks, does he agree that having A&E services spread geographically rather than just in strong population centres is an essential part of keeping our community safe?

I did indeed have a positive and constructive meeting with my hon. Friend. It is right that we have access geographically spread to A&E services, but the decisions are rightly taken by clinical commissioners on the basis of clinical evidence. I know that she will continue fighting the corner for the reopening of her local A&E with tenacity and passion.

T8. The 10-year cancer plan that the Secretary of State has announced is a key opportunity to ensure that future services are designed with the patient at their core, especially for those living with cancer. What steps is his Department taking to engage with under-represented groups in the development of the 10-year cancer plan, and will he agree to meet with Macmillan Cancer Support to discuss how it can provide support in this key area? (906506)

I would be pleased to have the meeting that the hon. Lady has suggested. She should know that we just closed the consultation on the 10-year cancer plan. There has been a fantastic response. She may also have seen the announcement that we made today about lung cancer health checks. With improvements like that, we intend to do a lot more.

One of the best ways to maximise NHS capacity is to increase people’s access to GP appointments and treatments such as mental health services and physiotherapy in their own communities. Will the Minister join me in backing our bid for a new health centre in East Leake and in calling on Nottinghamshire’s clinical commissioning group to prioritise funds for this vital service?

I thank my hon. Friend for her question. I had an excellent visit to the surgery in East Leake, and I look forward to the submission of the business case so that we can look at it further. She is right that investing in primary care does a huge amount to support the health of the local community.

T10. A survey by the charity stem4 has found that 95% of GPs believe that children and adolescent mental health services are in crisis, with children and young people waiting up to two years for treatment after referral. Will the Secretary of State stop treating children as an afterthought and act to provide open access mental health hubs for young people in every community, to put an end to these agonising waits? (906508)

The hon. Lady raises a very important point. I know that children’s mental health services are treating more young people than ever. However, the demand has quadrupled since the pandemic and that is why we have invested £79 million in these services. By 2023-24, an extra 345,000 more young people will be accessing support. I mentioned the call for evidence. It is important that we work through our vision for our 10-year plan. We are also introducing mental health support teams in schools, which will help, plus access to community and mental health hubs, and more young people will have access to eating disorder services, but there is a lot of work ongoing.

I know from discussions with constituents that needle phobias are a real thing. Will my right hon. Friend therefore tell the House what support the Government are giving to intranasal vaccine delivery systems to ensure that the maximum number of people take up the vaccine?

The Department of Health and Social Care commissioned research through the National Institute for Health and Care Research, co-funded with UK Research and Innovation, for an Imperial College London study, worth £580,000, looking specifically at the safety and effectiveness of two covid-19 vaccines administered by respiratory tract. The study is ongoing, but it is in the later stages of the phase one clinical trial, and the results will be made public in due course, following peer review.

Those providing social care often work long hours and are a real lifeline for the most vulnerable. Will the Minister act to ensure that those in social care are paid properly with a real living wage, as Citizens UK is campaigning for?

Actually, according to Skills for Care data from 2020-21, the majority of care workers were paid above the national living wage in that year. Most care workers are employed by private sector providers who set their terms and conditions. However, we have committed £1.36 billion to the market sustainability and fair cost fund, which will support local authorities to move towards paying providers a fair cost of care. We hope that will lead to better sustainability and better staff.

At Prime Minister’s questions, I raised a local campaign for a specialist menopause clinic in Devon. I am pleased the Minister agreed to meet me. Will my hon. Friend encourage local NHS leaders to fund specialist menopause centres?

The Government recognise that menopause services need to improve, which is why menopause is a priority area in our women’s health strategy. We recognise such services are often best provided in primary care, but that some women need specialist services. We are looking at that in our women’s health strategy and the menopause taskforce.

In December last year, the Department of Health and Social Care promised three urgent actions to tackle the gender health gap: the appointment of a women’s health ambassador; legislation to ban hymenoplasty; and the publication of the women’s health strategy for England in spring 2022. Can I ask the Minister when those vital actions are actually going to happen?

I can let the hon. Lady know that interviews have taken place for a women’s health ambassador. We are expecting an announcement on the appointment any day now. We will be publishing the women’s health strategy in the coming weeks.

I welcome all that my right hon. Friend is doing to address health inequalities. However, could I ask him to look carefully at public health funding for my borough of Bexley, as we are seriously underfunded compared with similar boroughs in London?

I would be very pleased to meet my right hon. Friend to discuss that further. I am sure he will welcome the publication of the upcoming health disparities White Paper.

In a recent survey by Carers UK, almost half of unpaid carers said that they are currently unable to manage their monthly energy bills and expenses, and that any further increases would negatively affect their own physical and mental health, or that of the person they care for. What steps are being taken, along with the Secretary of State for Work and Pensions, to support those hard-working exhausted unpaid carers with the cost of living?

I thank the hon. Lady for her question and of course we have a great deal of gratitude for every unpaid carer. Around 360,000 carer households on universal credit can receive an additional £2,000 a year through the carer element. The weekly rate of carer’s allowance increased to £69.70 in April 2022. Also, real-terms expenditure on carer’s allowance is forecast to increase by around £1.3 billion. In addition, there is a big focus, in our reforms and in the White Paper, on what more we need to do to support unpaid carers.