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Health and Social Care

Volume 718: debated on Tuesday 19 July 2022

The Secretary of State was asked—

Access to NHS Dentistry

During the pandemic, we took unprecedented action to protect NHS dentistry capacity, providing over £1.7 billion of income protection. We also ensured that those who needed it most could access the available care by establishing 700 urgent care centres nationwide. NHS dentists are now returning to 100% of their contracted activity.

I thank my right hon. Friend for his answer, but in West Dorset we are really struggling with dentist availability; at the moment there is no capacity for new patients, and the NHS appears to be incapable of solving the issue. Could my right hon. Friend tell me what he is doing to help restore dental services in West Dorset for those who need them?

My hon. Friend raises a very pertinent point. I recognise that there are significant challenges in NHS dentistry, including disparities across regions. Improving access for patients is a priority, and that is why just today the Government, together with NHS England, have announced a package of improvements to the NHS dental system, on which we have worked closely with the sector and the British Dental Association.

Having seen the former Minister for dentistry on numerous occasions, we were assured of today’s announcement to tackle the appalling lack of dentists in dental deserts such as my North Devon constituency. Can my right hon. Friend explain how the measures in today’s written ministerial statement will rapidly deliver extra dental appointments?

I am grateful for my hon. Friend’s campaigning on this issue; it is something she has highlighted on a number of occasions. The sorts of areas where the measures announced today will help include the management of NHS dental contracts, increasing the use of the skills mix in the dental workforce, and rewarding complex treatment to better reflect the complexity of that work.

There are 18,000 people on the NHS waiting list for dentistry in Plymouth; it is a real crisis. As a city, we have a cross-party plan for the new Cavell centre, a west end health hub as part of a health village in the city centre, with extra dental capacity with our brilliant dental school. However, we urgently need the Government to unlock the funding for it. Will the Secretary of State agree to meet a cross-party delegation from Plymouth to make the case for that, so that we can get on, get spades in the ground and get people’s teeth healed?

As part of the Government’s wider commitment to levelling up, we are very interesting in taking a place-based approach. Indeed, the essence of the integrated care boards is to help facilitate that. I am very happy to have discussions with colleagues across the House on how we best deliver that.

We all know that NHS dentistry was in crisis long before the pandemic. In my community, only a third of adults have seen an NHS dentist in the last two years, and fewer than half of children have seen a dentist in the last 12 months. It is obvious why: we have an ageing system—units of dental activity—based on a snapshot taken 15 years ago, which is completely unfit for purpose, as dentists and patients around the country are telling the Government. Will the Secretary of State listen to dentists and patients and reform the system urgently?

I hope the hon. Gentleman will look at today’s announcement, because it shows that the Department has listened. That is why, for example, it will facilitate better contract management, better reflect the floor price for units of dental activity and reward complex treatment, which was one of the key concerns. Equally, I hope that the hon. Gentleman recognises that this Government, through the £1.7 billion of income protection during the pandemic, have done much to facilitate dentistry’s ability to bounce back.

Net Zero

We are committed to supporting the NHS to achieve net zero by 2040 for direct emissions, with the Government already investing £280 million through the public sector decarbonisation scheme to support that ambition.

The NHS plays a key role in our national attempts to achieve net zero. I was therefore delighted to see the Airedale NHS Foundation Trust submit its plans for a new Airedale Hospital in my constituency. Those plans of course deal with the severe structural risk associated with aerated concrete, but they are also designed to create Europe’s first ever carbon neutral hospital. Does my hon. Friend agree that these are extremely exciting plans and that they are another reason why we should try to achieve a new Airedale Hospital in my constituency?

I thank my hon. Friend, who campaigns hard on this issue for Airedale Hospital. I absolutely understand the urgency around aerated concrete given the effect it is having, and of course I agree that the NHS has a vital role in supporting net zero. He will understand that I cannot commit to any one application. We are reviewing all applications and we aim to make a final decision later this year.

Can the Minister assure me, and the House, that the money used for the purpose of achieving a net zero NHS will have no impact on, for instance, those who are on waiting lists for cataract operations, who cannot even see the environment because they have been waiting for their operations for so many years? Net zero is very important, but what is more important is getting those operations done.

I think we can do both. We have already reduced emissions in the NHS by 30%, and there are a number of ways in which we can reduce them further, from changes in procurement—the NHS will no longer purchase from suppliers that are not aligned with net zero ambitions—to the delivery of estate change.

Breastmilk Substitutes: International Code of Marketing

3. If his Department will take steps to fully implement the international code of marketing of breastmilk substitutes. (901151)

The Government recognise that the code is intended to promote breastfeeding. Existing legislation in the UK implements its general principles, giving effect to its aim of covering marketing, accounting, information and the responsibilities of health authorities. As well as restricting advertising to scientific and specialist babycare publications, it sets requirements for labelling, presentation and advertising so as not to discourage breastfeeding. Guidance on working within the code is available to service commissioners, providers and practitioners.

As the World Health Organisation’s recent status report on implementation of the code gives the UK a mark of only 40 out of a possible 100, the UK could clearly be doing a great deal more to implement a code that was intended to protect breastfeeding, and to protect those who are bottle-feeding from marketing influence. Will the Minister meet me and the all-party parliamentary group on infant feeding and inequalities to discuss the issue further?

I commend the hon. Lady for the work that she does through her all-party parliamentary group. The Government recognise the importance of these issues, which is why we recently committed £50 million to improve breastfeeding support in 75 local authorities. I should be delighted to meet the hon. Lady and the APPG.

Mileage Expenses Reimbursement: NHS Community Care Staff

4. What assessment he has made of the adequacy of the rate of reimbursement for mileage expenses for NHS community care staff. (901152)

The reimbursement of travel costs for NHS staff is covered by the NHS terms and conditions, which are agreed jointly by employers and NHS trade unions. The terms and conditions set out the process for reviewing the rate, and that process includes reviewing fluctuations in fuel prices.

Motorists across the country have seen the cost of fuel increase by as much as 60p per litre since this time last year. Fuel costs are penalising the many NHS staff who treat patients in the community for simply doing their job. The current reimbursement rate of 56p per mile drops to 20p after staff have travelled 3,500 miles, and that has not been adjusted since 2014. Does the Secretary of State agree that if the rate of reimbursement does not rise in line with prices at the pump, those staff can easily obtain jobs in the acute sector, where they will not face the extra fuel costs? Given that we want more people to be treated in the community, that would surely be a catastrophe both for staff and for patients at home.

This is an important issue, and it affects different parts of the workforce in different ways. The 56p is higher than the rate approved by Her Majesty’s Revenue and Customs, and, as the hon. Lady said, it drops to 20p after 3,500 miles have been travelled. Of course, the Government are taking other measures more widely in their fiscal response to the cost of living, such as cutting fuel duty, but there is a review mechanism in respect of the NHS specifically, which involves looking at these issues in the round.

Covid-19 Vaccine Uptake

Vaccines continue to be the best line of defence against covid-19, and about 94% of those aged over 12 in England have come forward for their first dose. We are continuing to make vaccinations as accessible and convenient as possible, with thousands of sites operational, including targeted mobile vaccination clinics. Throughout the roll-out, we have monitored data and shared it with local NHS systems to support tailored interventions and outreach. That includes providing bespoke messages from the trusted community and faith leaders who know their communities best.

As the Public Accounts Committee reported last week, there are still 3 million people who have not been vaccinated, and we hope that the Government will give as much support as they can to increase the take-up among that group. However, I am particularly concerned about people with black, black British and Pakistani backgrounds, who are far less likely to have had their first booster. There is a real inequality issue here. Can the Minister give us any further indication of how she will ensure that, on her watch, we do not see that inequality embed itself?

I have read the hon. Lady’s Committee’s report with interest and I recognise the points she has raised. We know that vaccine hesitancy among ethnic minority groups has reduced over the course of the covid-19 vaccination programme, but we will not rest on our laurels. We continue to work closely with our valued communities and community leaders to provide advice and information at every opportunity, and we have materials translated into 28 different languages. There have been many ways in which we have reached out to those communities. For example, we have had vaccination sites in mosques—I visited one in Small Heath in Birmingham—and the Bangladeshi community have come together and encouraged people to get a “jab with your jalfrezi”. We are looking at every different way of reaching out to ensure that we reach all those communities.

Vaccination remains one of the most important ways to protect ourselves and others against covid-19, so I welcome the Secretary of State’s announcement that he has accepted the independent advice from the Joint Committee on Vaccination and Immunisation on the autumn covid-19 booster programme, but what additional steps does the Minister feel need to be taken to encourage vaccine uptake among those with a hesitancy for the additional boosters?

The hon. Gentleman is right and, as I said to the hon. Member for Hackney South and Shoreditch (Dame Meg Hillier), we know that there is more work to be done and we cannot rest on our laurels. We know that covid-19 vaccinations are our best line of defence and that the more people who come forward and take up their first jab, the more people are protected. That evergreen offer is still there, so if anyone has not had their first jab or has not come forward for their second or their booster, I encourage them to come forward now. It is never too late.

Access to GPs

We know that general practices are still under significant pressure and demand for their services is high. We are investing at least £1.5 billion to create an additional 50 million appointments a year by 2024, and of course not all appointments are, or should be, with GPs.

Last week, hospital clinicians raised with me their serious concerns that they are seeing incoming case notes of vulnerable and frail patients marked with

“telephone consultation during covid-19 pandemic”,

but those consultations were just in the last few weeks. This is clearly unacceptable and is leaving many of my constituents with the very real possibility of either a missed diagnosis or a misdiagnosis. What action is the Secretary of State taking to guarantee face-to-face appointments that are easily available for the elderly and vulnerable patients who need them?

The number of face-to-face appointments is increasing and in May 2022, excluding covid-19 vaccines, 64% of appointments were face-to-face, up from 55%. But the hon. Lady is right to say that patients should have the choice, and that is why the NHS access improvement programme has been supporting practices experiencing greater access challenges. Indeed, one of the first visits I did in my new role was to a GP practice to look at the practical measures it was putting in place to facilitate greater access for its patients.

The inverse training law is depriving communities in Blackburn of access to primary care. Blackburn already has one of the lowest ratios of GPs to patients in the country, and it struggles to attract and retain GPs. The Government have committed to provide 6,000 new GPs by 2024, but according to the British Medical Association there are actually 1,737 fewer GPs as of this month. What is the Secretary of State’s Department doing to level up primary care and deliver the incentives for GPs to train and practise in communities such as Blackburn?

I know this is an issue of concern that the hon. Lady wrote to my predecessor about, and indeed she raised its impact on her constituency in the House last month. There are specific programmes such as the targeted enhanced recruitment scheme that was launched in 2016, and the one-off financial incentives to attract GPs to the more deprived areas. We are also looking at how we can have the right skills mix to boost not just the number of GPs but wider access to appointments.

I welcome my right hon. Friend to his place. I offer a solution. Will he commit himself to sorting out the transfer of electronic prescriptions between hospital consultants and GPs, which would stop people trying to get appointments for prescriptions written in hospital. That would simplify things enormously, and my GPs would really welcome it. We could also do rural dispensing doctors while we are at it.

I always welcome solutions from colleagues on both sides of the House. From memory, Tim Ferris, who leads on tech within the NHS, is looking at a tech solution—I think it is in beta testing, although I would have to check. Appointments made shortly after a person has been discharged from hospital are often quite complex cases and create additional pressure on GPs.

Another issue I am keen to explore is GP appointments that can be done through either better use of technology or the wider skills mix so that we can better focus GPs’ time on more complex cases where their expertise delivers the best patient outcomes.

A much-needed new medical centre at Calne in my constituency was approved by the NHS in 2021, but there have since been a number of blockages to do with covid and the contractors. Will the Secretary of State look into those problems to find out what the blockages are—I think they are largely bureaucratic—and clear them out of the way to give the people of Calne their much-needed new medical centre?

I am very happy to look into that specific issue, which I know my hon. Friend has raised with the Department. I am happy to have further conversations with him.

The GP survey out last week shows that the proportion of people reporting their overall GP experience as very poor or fairly poor doubled between 2021 and 2022. Instead of picking a fight or blaming someone else, will the Secretary of State tell us what he will do to ensure that people in places like Wakefield can see their GP when they need to?

Far from blaming anyone else—notwithstanding the fact I have been in post for less than two weeks—I have set out a range of things we need to do, because this is a shared challenge that affects all our constituents, and it is within the context of increased demand. The May figures show a significant increase in appointments—1.31 million appointments per working day this year compared with 1.24 million last year. There is increasing demand, and we need to harness GP time, the skills mix and better use of technology.

We need more GPs and junior doctors in Worcestershire, and there is strong support from our local GPs, our acute trust and neighbouring trusts for the Three Counties Medical School in Worcester. Will my right hon. Friend meet me to discuss the case for providing funded places as swiftly as possible?

My hon. Friend will be aware that, through this Government’s funding, we have opened five new medical schools and, from memory, 1,500 additional undergraduate places. That is thanks to the work of the former Secretary of State, my right hon. Friend the Member for South West Surrey (Jeremy Hunt), who championed this specific initiative to address workforce pressure.

More widely, I am always happy to meet my hon. Friend the Member for Worcester (Mr Walker) to discuss issues in Worcester.

Does the Secretary of State agree that one way we can take some of the pressure off overstretched GP services is to ensure that pharmacists can continue to play their vital role in looking after the health and wellbeing of patients? Pharmacies across the country are closing because of financial pressures, so will he urgently look into extra support for them to recruit and retain staff?

The hon. Lady raises a valid and important point about getting the right service to patients, which can often best be delivered by a pharmacist. That is why, as I signalled earlier, we need better use of tech to support patients in understanding where they can best access the advice they need.

Access to GPs is a huge problem across my constituency of Burton and Uttoxeter, as it is in other constituencies. A walk-in centre in Burton would significantly ease some of the load on our GPs and hospital services. Will my right hon. Friend meet me to discuss this possibility?

I have had quite a few meeting requests this morning, and I am always keen to meet colleagues. My hon. Friend will be well aware that part of the reason for having integrated care boards within the place-based approach is that commissioners can determine the best mix of services in the locality, including in Burton.

Emergency Care: Average Waiting Time

NHS Digital publishes information on average waiting times, and the data for May shows that the median average total time spent in A&E for all patients was three hours and six minutes.

Across the west midlands, 38 people died waiting for ambulances between March and May 2022. In the same period in 2021, two people died; before 2019, in the corresponding period, there were no deaths. A week ago Sunday, 80 people were waiting in accident and emergency in my constituency. What are the causes of these problems?

The west midlands is more affected than many regions of the ambulance service. There are a number of causes, the first of which is that we are living with covid, which has not disappeared. If we look at the in-patient rates, we see that they have increased significantly; last month, they were 17.9 per 100,000 and they are now up to 24.4 per 100,000 in the west midlands, which is experiencing significantly higher rates than other parts of the country. [Interruption.] If the shadow Secretary of State wants to hear this, I can tell him that we also have a significant number of staff sicknesses from covid; this time last year, it was about 4% of staff but when I spoke to some trusts this weekend I heard that it was up to 6%. That has a knock-on effect on acute and emergency services and ambulance services being able to respond.

Derek Taylor came to my surgery as his late wife Lynda had tragically passed away in Moses Gate country park while they were out walking together. The ambulance was unable to access the park due to barriers impeding entry, and he will never know whether Lynda’s life could have been saved. What steps can the Minister take to ensure that all public parks are accessible to ambulances in cases of emergency?

I am very sad to hear of the experience of my hon. Friend’s constituent and he is right to say that emergency services need to be able to access public areas. I am happy to talk to him about that afterwards to see what more can be done.

“24 hours in A&E” was a reality TV programme but now it appears to be the reality for far too many people. The zero tolerance standards on 12-hour A&E waits and 30-minute ambulance handover delays are being systematically and seriously breached. So when do the Government plan to achieve those standards, which were set and delivered by the Labour Government?

Let me place on record my thanks to all the ambulance staff up and down the country who have gone above and beyond in the past 24 to 48 hours to be able to respond to extreme pressures that are only really seen in winter times. Let me give a scale of the pressures they are under. Compared with the situation in May last year, there have been over 100,000 more calls to the ambulance service, and there were 2.1 million attendances at A&E departments in June, which is 3.6% higher than the figure for June 2019. So they are under incredible pressure, and I pay tribute to all of them doing their best.

One issue affecting waiting times in many acute hospitals is the fact that so many people could be in community hospitals instead. In my constituency, I have a bid in to replace Shotley Bridge Community Hospital, doubling the capacity to 16 beds from the current eight. However, this is not under way just yet, as a few more hoops need to be jumped through. Will the Minister or Secretary of State come on a visit with me to North West Durham to see what more we can do to speed through the replacement hospital for Shotley Bridge as quickly as possible, to help ease some of the issues in our acute hospitals?

My hon. Friend is right; the delayed discharges and being able to free up those beds has a knock-on effect on A&E, which in turn has a knock-on effect on ambulances being able to unload. We have the £2 billion better care fund, which is supposed to be addressing just that, to help integrated care boards deliver and help patients get out of hospital. I have a meeting with all the integrated care boards tomorrow, so his is a timely question, but I am happy to meet him as well.

Thank you, Mr Speaker. A&E waiting times are through the roof, and we have people waiting without a bed—not even a trolley. This is removing the dignity that every patient deserves, but, sadly, it is not a one-off; this is commonplace up and down the country. It is not the Health Secretary who is on the receiving end of it, but staff, who are running from patient to patient trying to ease pain, diagnose illness and save lives—most importantly, it is of course the most vulnerable themselves. When the Minister hears reports such as this, does she not feel ashamed of the decisions her Government have made over the past 12 years?

I say gently to the hon. Lady, who does amazing work on the frontline in A&E, that I have worked in A&E under the last Labour Government—I am showing my age now—and there were trolley waits and ambulance queues then as well, just as there are in Wales, where Labour is running the NHS, and in Scotland and in Northern Ireland. This is unprecedented pressure, because we are trying to live with covid and deal with a backlog of procedures and rising cases. The shadow Secretary of State was not here yesterday, so he may have missed some of the support that we are putting in. We are putting £150 million of extra funding into the ambulance service, £50 million into 111 to increase capacity, and £30 million into an auxiliary ambulance service to increase support. We are supporting the service, but we must recognise that it is facing unprecedented pressures.

With respect, I will take no lectures from the Minister about working in A&E under a Labour Government and a Conservative Government. I have worked in the NHS under a Labour Government, when NHS waiting times hit record lows, and I have worked under a Tory Government, when NHS waiting lists hit record highs.

The Minister can use the pandemic, the heatwave, or even winter as justification. I have seen that emergencies do increase demand for services, but there is no excuse for not hitting the four-hour A&E waiting target for seven years. There is no defence for stroke and heart-attack victims waiting almost an hour for an ambulance. Undoubtedly, lives will be lost that could have been saved. Will the Minister apologise for those failings?

The hon. Lady says there is no excuse for missing those waiting times, but perhaps she can explain why the Labour Government in Wales are also missing those times.

Cancer Outcomes

Thank you, Mr Speaker. The Government are focused on improving the early diagnosis of cancer in England to aid cancer outcome rates. That was set out in the NHS Long Term Plan, setting an ambition of seeing 75% of people diagnosed within stages one and two by 2028. Progress has continued on delivering the Long Term Plan. That includes increased investment and public awareness campaigns, rolling out targeted lung health checks, and introducing non-specific symptom pathways to speed up diagnosis.

Very sadly, in April this year I lost my mum to a sudden diagnosis of secondary breast cancer in the liver, and so like many, I understand that cancer outcomes are not just statistics. In my constituency of West Bromwich East our outcomes are significantly poorer than the national average, and I know what that means for families. When will my hon. Friend publish the 10-year cancer plan, and confirm the levels of investment going into that?

I am sure I speak for the whole House in expressing condolences to my hon. Friend for the loss of her mother. I know she is a doughty champion for addressing health inequalities in her constituency. While the publication of the 10-year cancer plan is under review, we remain committed to tackling inequalities and levelling up outcomes, experience and access. That is a key focus of the NHS Long Term Plan and 2022-23 planning guidance, and it remains a priority for the Government and the NHS cancer programme. Approaches to support that are embedded throughout the programme —for example, increased accessibility for the cancer quality of life survey, to help increase representation results and, as I mentioned, the targeted lung health check programme is focused on areas with high lung cancer mortality, where typically there are also high levels of deprivation.

Weston Park Cancer Centre provides outstanding cancer care for patients, not just in South Yorkshire but around the country. I met two previous Secretaries of State, and the outgoing Minister, to press the case for investment in the site, given that it is now 50 years old. Will the Minister please look at the case for investment in Weston Park, so that it can continue to provide outstanding care for patients around the country?

I am very happy to meet the hon. Gentleman. We are investing further money—£350 million in diagnostics—and making efforts to address the backlog caused by the covid-19 pandemic.

Brain tumours kill more children than any other cancer. My constituent’s five-year-old granddaughter has a brain tumour. She, and many children like her, are being given chemotherapy drugs that were originally developed in the 1960s for adults, and we need more research into this. What can the Minister and the Government do to help accelerate research into paediatric brain tumours to save children such as my constituent’s granddaughter, and will the Minister meet me to discuss the case I have mentioned?

That sounds like a very distressing constituency case. Obviously we are investing lots of money in research across the whole cancer spectrum, and I would be happy to meet my hon. Friend to discuss the issue he raises.

Unprotected exposure to the sun can leave someone vulnerable to skin cancer, but as my constituent Tina, who suffers with melanoma, knows, the sun is not the only risk factor for skin cancer—sunbeds continue to be used all year round at very high risk. Does the Minister agree that it is time we took the dangers of sunbeds seriously? Does he support Melanoma UK’s campaign to ban the use of sunbeds, and if not, why not?

Obviously, given the weather that we are experiencing at the moment, issues to do with melanoma are particularly high on the priority list. I am happy to meet the hon. Lady to discuss the specific issues that she has raised in relation to sunbeds.

Eye Health

We are supporting the prevention of sight loss throughout the NHS sight testing service and diabetic retinopathy screening programmes. Work to reduce smoking and obesity tackles risk factors for sight loss. We are also supporting ophthalmic services to recover from the pandemic and to transform services so that we can meet future demand, including exploring the provision of delivering more services out of hospital, closer to patients where they need them.

Fifty per cent. of all sight loss is avoidable, but currently there is no overarching strategy in England to govern eye care that would help to reduce sight loss. A strategy for England would improve the quality of life for people who are blind or partially sighted, address health inequalities, and link up patient pathways for overall improved health outcomes. Does the Minister therefore agree that England needs its own national eye care strategy, which would include targets for the reduction of avoidable sight loss, and will he agree to meet me to discuss this further?

Given the size of England and the diversity of the health needs of different communities, we believe that commissioning should be locally led, so there are no current plans for a national eye health strategy. However, I am delighted that NHS England has appointed the first-ever national clinical director for eye care, Louisa Wickham, who will want to set priorities in this area. It is also worth mentioning that we continue to be committed to the national eye care recovery and transformation programme, which is looking to transform secondary care ophthalmology services in order to use existing funding to improve service quality and patient outcomes. That remains a top priority for us.

Treatment and Care Innovation: NHS Patients

The NHS has made significant progress in recent years in embracing innovations, from the NHS app where patients can now access their medical records, to the expansion of electronic patient records making it easier for healthcare professionals to share information for better, safer care for patients.

I recently visited Coventry and Warwickshire Partnership NHS Trust’s wound healing service and saw the ground-breaking work being undertaken there, which is changing the lives of people who were thought to be living with unhealable wounds. By adopting innovative methods of healing, the service has not only healed the unhealable, giving patients back the quality of life they deserve, but reduced the average cost of healing at the trust. Will the Minister look at how this approach could be adopted more broadly to improve patient care, save money, and reduce on-costs incurred through unhealed wounds?

I thank the hon. Lady, because it is the first I have heard of that and it sounds very exciting. I know how difficult it is with chronic wound management to get wounds to heal. Often these are patients with multiple co-morbidities such as diabetes that make the wounds very difficult to treat. I am keen to visit her constituency and her trust to learn more about it.

Care Setting Transfers: Waiting Lists

I assure the hon. Lady and everybody in the House that this is a key focus for the Department as we know that delayed hospital discharges put pressure on the health and care systems and, most importantly, impact our patients. To address delays, we have established a national hospital discharge taskforce, which is running a 100-day discharge challenge, and integrated care systems can now become discharge front-runners to share good practice and ambitious ideas.

I thank the Minister for her answer, but Miriam Deakin of NHS Providers has said:

“There is huge pressure on beds…and a lack of social care capacity means that hospital patients can’t be discharged as soon as they could be to recover closer to home”.

The Royal College of Emergency Medicine has estimated that 57% who longer meet the criteria are stuck in hospital. That is putting huge pressure on hospitals such as the Royal London in my constituency, which is doing amazing work. However, it cannot get the job done if the Government do not step up and back local authorities with the resources they need to provide care for those who can be discharged. That is what is needed. Is it not time that the Minister, with the new Health Secretary, got to grips with this problem, which has built up over a decade because of the decimation of social care? That is what is needed. There is a fix; the Government need to get on with it.

Between March 2020 and March 2022, we made nearly £3.3 billion available to support discharge, recognising the pressures faced by the health and social care sectors, as they manage the demands of covid-19. Under section 75 of the National Health Service Act 2006, funding can be pooled across health and social care to ensure the effective use of available resources. That allows funds such as the better care fund to be used to support discharges, and I know that many integrated care systems are focused on doing that and pooling more resources.

I do appreciate that it has only been two weeks, but the Secretary of State will be familiar with the use of root cause analysis to solve problems; however, yesterday he spoke for almost eight minutes on ambulance delays with scant reference to social care. Had he been badly briefed?

The Secretary of State did mention social care, and of course, very recently, on 1 July, we established the integrated care systems. They are specifically focused on making sure that local authorities work with their local health services to really focus on the patient and improve outcomes for the patient. We recognise that these systems all have to work together around the patient.

We understand what the proposals are, but the Secretary of State said earlier that he welcomed solutions. We have heard today from the Association of Directors of Adult Social Services. Seven in 10 say that care providers have closed, handed back contracts or ceased trading. We have all seen this in our constituencies. It is mainly due to the now imminent workforce crisis. Will the Minister ensure that the Secretary of State heeds those warnings and responds adequately to the workforce crisis?

This is absolutely key, which is why we are implementing a comprehensive reform programme of adult social care. In September 2021, we committed to investing an additional £5.4 billion over three years, and in December we published “People at the Heart of Care”, which set out our 10-year vision for reforming adult social care and our priorities for investment. This absolutely has to be done—it is a key part of the system—but we have to put the foundations in place. Our 10-year plan will put those foundations in place.

Unusable PPE

12. If he will make an estimate with Cabinet colleagues of the amount of unusable PPE procured by the Government since the outbreak of covid-19. (901160)

22. If he will make an estimate with Cabinet colleagues of the amount of unusable PPE procured by Government since the outbreak of covid-19. (901171)

Around 3% of PPE that the Department purchased was unusable. We are working to dispose of this unusable stock in the most environmentally friendly way.

I am grateful for that response. From the onset of the covid-19 pandemic, the Scottish Government have worked with the NHS and Scottish suppliers, as well as on a four-nation basis, to ensure that Scotland has adequate stocks of PPE. In Scotland, 88% of PPE is produced locally, and the overall cost of pandemic procurement was a third less than for the UK. The Scottish Government have committed to retaining powerful safeguards on the use of public money in healthcare through strong procurement rules. Will the UK Government follow suit and replicate this ethical model?

I am very interested to hear from the hon. Lady, because according to The Herald on Sunday recently, half a billion pounds-worth of procurement in Scotland during the pandemic did not go through the usual scrutiny process. I would be very interested to hear her update on that.

The Public Accounts Committee found that there is £4 billion-worth of unusable, substandard PPE in storage, which is due to be incinerated, which is hardly environmentally friendly. While cronies and donors were fast-tracked, this substandard PPE put frontline workers’ lives at risk by preventing them from accessing the right equipment. How much of that £4 billion will be recovered, and what other actions are being pursued against these so-called suppliers?

To put this in context, I make no apologies for all the efforts that were made to secure PPE for frontline staff. We delivered more than 21.5 billion items of PPE to keep frontline staff safe during a time when we had a dangerous virus that no one knew anything about, we had no vaccine and there was a global push on the market resources. Those products that we procured that did not meet the standards for health and social care were used in other avenues. For example, we donated masks to transport operators and to schools, so that we could reopen the economy and to help them to keep safe.

While the Tories flogged off PPE contracts to party donors and friends of Ministers through their unlawful VIP PPE lane, the Scottish Government’s processes ensured value for money, as we have heard; their PPE costs were less than a third of the UK Government’s. Will the UK Government follow Scotland’s example in future, and refuse to engage in cronyism and corruption?

I outlined in my answer to the hon. Member for East Renfrewshire (Kirsten Oswald) that around half a billion-worth of pounds of procurement in Scotland did not go through the usual channels. All offers that were identified, regardless of route, underwent rigorous financial, commercial, legal and policy assessment, led by officials, and the final decision on whether to enter a contract sat with the appropriate accounting officer at the Department.

Topical Questions

I am honoured to have taken on the role of Secretary of State for Health and Social Care, and to have responsibility for incredibly important services that touch all our lives. I pay tribute to my predecessor, my right hon. Friend the Member for Bromsgrove (Sajid Javid), for everything he achieved in this role, and for the dedication he showed. I also welcome my new ministerial team.

Since my appointment, I have been relentlessly focused on the urgent pressures facing health and care, including this week’s extreme weather. Yesterday I updated the House on the strong support we are giving, including extra ambulance capacity and more call handlers, and we will stay vigilant so that we can make sure our health and care system is there for those who need it.

Today marks one year since we lifted covid restrictions. While the virus has not gone away, we are able to enjoy our freedoms, thanks to the incredible vaccine roll-out. I have accepted the Joint Committee on Vaccination and Immunisation’s advice for a covid and flu autumn and winter booster campaign, in which we will roll out that vaccine further.

I have been contacted by many constituents working in the NHS who are struggling to cope with financial pressures, exhaustion and stress. I recently spoke to a district nurse using our food pantry in West Derby, and it was a heartbreaking example of how the cost of living crisis is impacting people across our communities. That nurse was going to lose their home and was struggling to feed their children. How does the Secretary of State plan to address the dire situation that the very people he applauded as heroes during the pandemic now face? Maybe a start would be giving NHS workers an inflation-proof rise.

On NHS pay, I expect to announce a response to the integrated pay review bodies shortly. We are putting more funding into the NHS, as I signalled in my statement yesterday.

T2. Making a diagnosis of dementia is important to allow appropriate treatment, support and time to plan for the future. Pre-pandemic, the diagnosis rate for dementia in England was meeting the two thirds target, but today it is 61.9%. In Wales, data capture and quality is poor, but the equivalent rate is thought to be just 50%. Will my right hon. Friend outline what steps he is taking to improve the situation? (901174)

My hon. Friend will be aware that the matter is devolved to the Welsh NHS, but I can say that in the last financial year, the Government allocated £70 million to NHS England to specifically address dementia waiting lists and increase the number of diagnoses. To further support recovery of the dementia diagnosis rate and access to post-diagnostic support, NHS England is funding two trusts in each region to pilot the diagnosing advanced dementia mandate tool, which will improve access to diagnosis.

I welcome the Secretary of State to his first oral questions and, as this is likely to be his last oral questions, also wish him the best for the future. I associate myself with his remarks about his predecessor, who of course resigned from the Government on a point of principle as others chose to remain loyal; on that note, I also pay tribute to the former Minister, the hon. Member for Charnwood (Edward Argar), for the diligent approach he took to his work and the spirit in which he engaged with the Opposition. One of the contenders for the Conservative leadership says that public services are in a state of disrepair. Another describes the NHS backlog as frightening. A third called ambulance waiting times appalling, and of course the Secretary of State for Culture, Media and Sport said that the former Health Secretary’s preparation for a pandemic was “found wanting and inadequate”. They are right, aren’t they?

The Government are committed to putting increased funding into our NHS. I set out yesterday the position on the resource departmental expenditure limit. Just to remind the House of the capital departmental expenditure limit, capital investment in the spending review was £32.2 billion between this year and 2024-25. The Government are committed to putting record funding into our NHS. We are also committed to funding 40 new hospitals and have allocated £3.7 billion to that programme.

I cannot believe that the Government are still talking about 40 new hospitals with a straight face. Nobody believes that it is true. As for capital investment, we have the lowest in the OECD and we lag significantly behind.

We have the longest waiting lists in NHS history and record waits for ambulances. People are finding it impossible to book a GP appointment. There are 400,000 delayed discharges each month because the social care support is not there. The Government are finally acknowledging that covid is still a challenge, and that the hot weather is a challenge, but they do not want to talk about their record, which is, I am afraid, at the heart of the challenge. Does the Secretary of State really believe that it is reasonable to expect NHS employers to meet the pay rise for NHS staff from existing budgets?

We will respond shortly to the independent pay review body, which, as part of its recommendations, weighs up the pressures on the cost of living and the other factors within its remit. The Government are delivering more doctors, more nurses, more appointments and more treatments, investing in our estate and planning for the future. That includes investment in research and development, and in future technology through our life sciences. That not only delivered the vaccine that allowed us to lift the covid restrictions that the Opposition wanted to retain, but will unlock the technologies of the future.

May I recommend some scintillating summer reading to the Secretary of State: the study of 4.5 million patients that showed that people who see the same GP over a long period are 30% less likely to go to hospital and 25% less likely to die? Will he, after reading that, consider changing the GP contract to get rid of the micromanagement, and replace it with what doctors and patients want, which is the ability to have a long-term relationship?

I think my right hon. Friend knows me well enough to know that I will have a close interest in reading anything over the summer that is data driven. He highlights an extremely important issue. Just yesterday, I met with Andrea and Simon Brady, whose daughter tragically died of cancer at the age of 27. One of the key concerns that they raised with me was the lack of consistency when it came to the GP that Jessica went to see, and the fact that she kept seeing different people, and there was not continuity of care. Specific cases that I am looking into speak to this issue, and I am happy to look at the data that my right hon. Friend can share.

T3. As the chair of the all-party parliamentary group on sickle cell and thalassaemia, I and the chief executive officer of the Sickle Cell Society were due to meet the Secretary of State’s predecessor to discuss the experiences of and health failings for people living with sickle cell and, indeed, sickle cell patients. Will the Secretary of State meet me—if he is still in post in September—or urge his predecessor to meet me and the CEO of the Sickle Cell Society? (901175)

I am not sure that I will urge my predecessor to do so, but if indeed there is a successor, I will be happy to share that with them. The hon. Lady raises an important point, and I am happy to look into it.

We are becoming more aware of how poor lifestyles, including with respect to diet, physical activity and stress, can contribute to an increase in the risk of cancer. Research is also highlighting that exercise, particularly moderate-intensity aerobic training, reduces side effects from treatment, anxiety, depression and recurrence rates. With that in mind, will the Secretary of State ensure that alongside diagnostics and treatment, exercise forms a fundamental part of the forthcoming 10-year cancer strategy, not only for preventing cancer but for reducing its recurrence?

My hon. Friend makes an important point. As part of our public health messaging and so on, exercise as a preventive mechanism against cancer is extremely important. We have had a call for evidence; we will consider the evidence that has been provided when we look at the 10-year plan, of which exercise will be an important component.

T4. Despite repeated questions from me and other hon. Members, immunocompromised people still do not have access to the prophylactic drug Evusheld. It appears that some heads might need knocking together, so will the Secretary of State convene an urgent meeting with AstraZeneca and the UK Health Security Agency to ensure that test results can be released? If the results are positive, will he get on with ordering supplies and rolling them out, so that immunocompromised people can finally get on with living their lives? (901176)

The hon. Lady continues to be a loud voice for those who are immunosuppressed, and I commend her for that. As she is aware, Evusheld was awarded conditional marketing authorisation by the Medicines and Healthcare products Regulatory Agency, which outlined some remaining questions, including about the amount of protection and the dose needed. My Department has been conducting an assessment of Evusheld, looking at the data available and the options for the NHS. We have asked clinicians to look at what we can do for future patient cohorts; we are considering their advice and will update the House shortly.

One of the great privileges of the three years that I spent at the Department of Health and Social Care was seeing at first hand the amazing work of our NHS workforce; I put on record once again my gratitude to them. Growing that workforce is vital to meeting the future health needs of our population, so will my right hon. Friend the Secretary of State, whom I welcome to his post, reconfirm the Government’s commitment to the target of 50,000 more nurses, and update the House on progress towards that target?

May I take the opportunity to thank my hon. Friend for his service as Minister of State? I think he was one of the longest-serving Ministers in that role; in fact, I think he took over from me, or shortly after me. He carried out the role with great distinction, as I am sure the whole House recognises.

I am very happy to reconfirm our commitment. I think the number is at about a third of a million, and great progress is being made. That enlarged measure is down to my hon. Friend’s work as Minister of State.

T5. I wrote to the Secretary of State’s immediate predecessor on 16 May and followed that letter with one to the Prime Minister about the case of a young man in my constituency, Elliott Simpson. Sadly, I have not had a response. Elliott was misdiagnosed with a water wart in a telephone consultation with a GP. When Elliott finally got to see someone face to face, he had late-stage skin cancer. National Institute for Health and Care Excellence guidelines do not currently allow him to receive the necessary life-saving treatment. Will the Secretary of State meet me and Elliott’s family to discuss what can be done to get this young man the treatment that he desperately needs? (901177)

I am very sorry, as I am sure the whole House is, to hear of the circumstances that the hon. Lady sets out. I am happy to look at the case, as I said to her ahead of this sitting, when I discovered that she had written to my predecessor. As I also flagged earlier, the number of face-to-face appointments is increasing. Telephone consultations are not a new thing; they have been around for a long time and are an important part of the mix—indeed, some patients prefer the flexibility that they offer. But of course I am happy to meet the hon. Lady in due course.

Long Crendon Parish Council in my constituency has an exciting proposal for an innovative new health and wellbeing centre, including GP services. It has the land from planning gain, and it has an agreement to put Unity Health in as the GP partnership, but we are stretched for funds to build it. I am grateful to my hon. Friend the Member for Charnwood (Edward Argar) for his engagement over the past year. Will my right hon. Friend the Secretary of State meet me over the summer to discuss how we can move the project forward?

Again, as I am sure my hon. Friend will appreciate, these decisions should not be run from Whitehall and the centre. We should take a place-based approach, letting local decision-makers and commissioners make the decisions to shape the best services through their integrated care boards. My hon. Friend the Minister of State or I will engage with him to ensure that his representations are very much at the heart of any decisions that are taken.

T6. An estimated 117,000 people are reported to have died while on NHS waiting lists. A record 6.6 million people are waiting on the NHS for treatment, and they are in pain and suffering and, in many cases, fearful for their lives. This is a direct consequence of more than a decade of mismanagement and incompetence. What will the new Health Secretary do to give the British people the guarantees that they need to make sure that more do not die while waiting for treatment on the NHS? (901178)

That is why we have launched a range of initiatives, such as surgery hubs and diagnostic centres, to address the very real backlog resulting from the pandemic. Indeed, the NHS has published its delivery plan for tackling the covid-19 backlog of elective care, and that is focused on four areas: increasing health service capacity, prioritising diagnosis and treatment, transforming the way that NHS provides elective care, and providing better information and support to patients.

I welcome both the Secretary of State and the new Minister to their places and warn them that the one statistic that they will hear me say time and again is that cancer is the biggest cause of death of children under the age of 14. Both of their predecessors met my constituent Charlotte Fairall, who lost her daughter, Sophie, to a very aggressive form of rhabdomyosarcoma. Their story inspired the speech that the former Secretary of State, my right hon. Friend the Member for Bromsgrove (Sajid Javid), gave when he launched the 10-year cancer strategy. With that in mind, I would really appreciate it if the new Secretary of State restated his commitment to that strategy and to including a childhood cancer mission at its very heart.

The House recognises how my right hon. Friend has championed this issue over many years. There can be few more emotive issues than the one she draws to our attention. Of course, in keeping with my predecessors, I would be very happy to engage with her on this important issue.

T7. [R] I refer hon. Members to my entry in the Register of Members’ Financial Interests. I am asking specifically about intractable epilepsy. Three NHS prescriptions have been written for the appropriate medicine, so we have proven that that can be done and that the medicine can be provided free on the NHS. When can families and friends, who scramble every month to raise thousands of pounds to pay for private prescriptions, reasonably expect to receive this medicine on the NHS? (901179)

I thank the hon. Gentleman for his question, and I deeply sympathise with patients and families who are dealing so courageously with the difficult conditions that he describes. The Government are taking an evidence-based approach to unlicensed cannabis-based products to ensure that treatments are safe and effective before they can be considered for routine funding within the NHS. Whether to prescribe cannabis for medicinal use must remain a clinical decision, and public funding arrangements apply, as they do for all other medicines. The Government remain committed to research and catalysing the generation of evidence to support the use of these products. The National Institute for Health and Care Research remains open—

The National Institute for Health and Care Research remains open to receiving research proposals in this area as a priority.

Order. Minister, when I stand up, please do stop. You are the one who is dragging this out, so you tell these people why they cannot get in.

I welcome the confirmation of the cohorts to be vaccinated against covid-19 and flu this autumn. Will my hon. Friend advise the House and my constituents whether the two vaccines will be co-administered?

My hon. Friend asks a really important question. The Joint Committee on Vaccination and Immunisation has advised that covid and flu vaccines can be given at the same time where that is operationally possible, and we will seek to maximise opportunities to co-promote and co-administer the flu and covid vaccines where it is possible and clinically advised, especially where this improves patient experience and vaccine uptake. Regardless of whether co-administration is offered, it is important that eligible people come forward as soon as they are called by the NHS for their jab, whether for flu or covid.

T8. Today, the Office for National Statistics reports that real pay is dropping at the fastest rate since records began in 2001. However, it is reported that the Government are going to punish our hard-working NHS staff even further by forcing through a real pay cut of between 5% and 6%. Will the Minister please dispel that by confirming that NHS staff will be awarded an inflation-proof pay rise? (901180)

The Government have committed to giving NHS workers a pay rise this year, on top of last year’s 3% rise when pay was frozen in the wider public sector. The independent pay review bodies base their recommendations on a number of factors, which include but are not limited to the cost of living and inflation, as well as the economic context and issues such as recruitment and retention. The Government are considering carefully the content of the pay review body’s report and will respond shortly.

I want to raise the case of 10-year-old Lucas from my constituency, who has a rare form of cancer called DIPG—diffuse intrinsic pontine glioma. The only drug that would prolong his life has to come from Germany. The family have raised the funds to pay for the drug, but they are now being charged £530 per shipment in import duty. Will my right hon. Friend please help me to lobby the Treasury for an exemption, because it should not be making money off the back of this poor boy’s lasting difficulties?

As my hon. Friend recognises in her question, that is a decision for Her Majesty’s Treasury, but I am very happy to highlight with the Chancellor the case that she brings to the attention of the House.

T9. Many people in the Chamber will know of my passion for addressing alcohol harm and addiction. However, 2022 marks a decade since the last alcohol strategy was introduced, and a decade of Government inaction. With deaths reaching the highest level in 20 years and the number of those drinking at high risk rising steadily, what plans do Ministers have to introduce a new comprehensive alcohol strategy to reduce the number of lives lost to alcohol harm and save the vast cost that alcohol imposes on our society? (901181)

I have heard the hon. Gentleman speak passionately about the impact alcohol has had on his family, and I commend him for his continued campaigning on the matter. It is not just about plans; it is about action. Through the drugs strategy, we are making the largest ever single increase in drug treatment and recovery funding, with £532 million being invested to rebuild local authority-commissioned treatment services. That will benefit people seeking support for alcohol addiction, as alcohol and drugs services are often commissioned together. In addition, £27 million has been invested in an ambitious programme to establish alcohol care teams in the 25% of hospitals that are most affected by alcohol dependency.

Last week, I chaired a joint meeting of the all-party parliamentary groups on maternity and on baby loss, where we heard from bereaved parents, maternity staff, and the fabulous and dedicated Donna Ockenden. Given that the women’s health strategy is about to be published, can the Minister or the Secretary of State reassure everybody in the sector that it will address maternity safety and the maternity staff numbers we so badly need?

I thank my hon. Friend for all her hard work campaigning on pregnancy and baby loss. We will publish the women’s health strategy shortly. Baby loss featured heavily in the call for evidence, and we committed to provide more than £200 million of funding to improve maternity staffing after the Ockenden review.

On a point of order, Mr Speaker. Today’s Order Paper states that the Secretary of State for Health and Social Care has released three statements. Two have been released—those on dental system improvement and the health update on the Down Syndrome Act 2022—but there is no sign of the Department of Health and Social Care update. We have just had the last oral questions to the Department of Health and Social Care for three months, so will you advise me what we can do to ensure that statements are released in time to be referred to in ministerial Question Time?

I thank the hon. Lady for notice of her point of order. The Government’s guidance states:

“Written statements should be issued at 9.30am where possible…If the statement cannot be issued by 12.30pm, the department should endeavour to notify the Chair of the relevant select committee and/or any other member with an interest.”

It states that that should include “Opposition front bench spokespersons”. Hopefully, the Chief Whip has heard the message and will want to deal with it.