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Oral Answers to Questions

Volume 721: debated on Tuesday 1 November 2022

Health and Social Care

The Secretary of State was asked—

GPs: Continuity of Care

1. Whether he supports the continuity of care and long-term relationship between a GP and their patients. (901945)

The recent Health and Social Care Committee report rightly highlights the importance of continuity of care, recognising that there is sometimes a trade-off between speed of access and continuity of care.

I welcome my right hon. Friend back to the Front Bench in this position; it is great to see him there. Investigations in the United States and in Australia show that if there is a close relationship between a patient and one specific general practitioner, the outcomes are better in terms of both morbidity and visits to A&E. What can the Government do to encourage that practice, and what is the Government’s view of that practice?

My hon. Friend raises an important point. If one looks at the GP survey of patients, around two in five have a GP that they would like to have continuity of care with, and more than one third of those say that they see them a lot of the time or always. It is more pertinent with complex cases, where that continuity of care adds most value, as opposed to patients who want speed of access on an isolated incident.

We have seen a cut of almost 5,000 GPs and the closure of hundreds of practices in the past 10 years. My constituents are having a terrible time trying to get GP appointments and, when they do, the lack of continuity of care is impacting the effectiveness of that care; it is a strain to tell the same story again and again, particularly for older people and those with complex conditions. Can the Secretary of State outline what he is actually going to do about it?

In fact, around 80,000 more GP appointments a day are happening, so significantly more demand is being met. The Government have invested an extra £1.5 billion to create an additional 50 million general practice appointments by 2024, increasing and diversifying the staff available for those patients seeking care.

One way GPs can get better outcomes for their patients is to see them face to face if possible, particularly with prostate cancer in men. Men just do not present themselves to their GP as often as they should. Today is 1 November—Movember—so what is the Secretary of State going to do to promote men’s coming forward to see their GPs so that we can get this disease eradicated?

First, I pay tribute to the work my right hon. Friend is doing to raise awareness of this issue. It is important that those patients who want access to face-to-face appointments are able to get them, and campaigns such as Movember are a great way of raising that awareness.

In Cumbria we have lost one in six of our GPs in the past six years, most recently at the Central Lakes medical practice in Ambleside and Hawkshead. Will the Secretary of State pay special attention to the letting of that new contract to ensure that there is a GP service running out of the surgeries in Ambleside and Hawkshead? Will he also give thought to the fact that the Government’s removal of the minimum practice income guarantee has cost many rural surgeries their ability to be sustainable, and consider bringing back a sustainable small surgeries fund so that small rural surgeries can stay open?

As a rural MP and having worked in Kendal earlier in my career, I know the geography to which the hon. Gentleman refers. That is why we are investing in more GP training, increasing the number from 2,671 in 2014 to 4,000, but it is also why we introduced the payment of £20,000, to encourage GPs into those areas that are hard to recruit in.

The new Secretary of State—it is great to see him back—understands that there is a wealth of evidence that higher levels of continuity of care in general practice are good for patients and, indeed, for GPs themselves. I wonder if I could press him a little further. Is the new ministerial team open to limiting the list size of patients a GP has, as more GPs come online through the Government’s plans? Would he like to see personal lists reimplemented in the GP contract during his tenure?

Alongside the Government, no one wants to see better patient outcomes more than GPs themselves. By their training, they are evidence-led, so I look forward to discussing with the GP workforce how we can work together in a constructive spirit to deliver on whatever the evidence is showing. As I said, there is a body of evidence around continuity of care, but it is more weighted towards those with more complex needs, and not every patient prioritises that in terms of access to their GP.

The Health and Social Care Committee report showed that continuity of care was best for patient safety, which is so important, but in order to deliver that, there needs to be some headroom at practice level to bring about a reorientation of local services. How will the Secretary of State create that headroom, and will he adopt the report’s findings in full?

I know that the hon. Lady has a lot of expertise in this area, and she raises a valid and important point. That is why, through the GP contract framework for 2020-21, we announced a number of new national retention schemes and continued support for existing schemes to retain more GPs. It is also why, at the other end, we are boosting training numbers, to get more GPs into the pipeline.

The Secretary of State says they are investing in GPs, but this Conservative Government have cut 4,700 GPs in the last decade. Patients are finding it impossible to get a GP appointment in the manner in which they want one. Seeing the same doctor for each appointment means better care for patients, but under the Tories, that is becoming rarer and rarer, much like seeing the same Health Secretary at the Dispatch Box. Even his own Chancellor wishes he had done more on the issue of continuity of care, so why is this Secretary of State not matching Labour’s ambition to bring back the family doctor?

First, as I have touched on, the number of GPs in training is up. The number of GP appointments is significantly up, because there is more patient demand, so they are seeing more patients. There is often in this House a real focus on GP appointments, and that is important, but it is about the skills of the primary care workforce as a whole. If one looks, for example, at the women’s health strategy, women want to be able to go to specialist services, not always requiring the GP. It is about looking at the primary care workforce as a whole, alongside the appointment of GPs.

Workforce Shortages: Rural Areas

2. What recent discussions he has had with relevant stakeholders on tackling health and care workforce shortages in rural areas. (901946)

Ministers and officials regularly engage with a wide range of organisations to ensure that we are alert to the staffing issues facing the NHS and care sector across our country. We have increased training places for doctors, nurses and allied health professionals and increased access to clinical placements across a wide range of settings. We have also developed apprenticeships and blended learning opportunities to improve access to training that supports remote and rural communities.

In Devon, workforce shortages are acute. One in 10 nursing places remains unfilled, one in eight mental health roles across the south-west is vacant, and there are no dental practices taking on new NHS patients. That gap is too big to be bridged through current training and recruitment plans. Will the Minister create as a matter of urgency an innovative new career pathway, reducing the time to get new staff to the frontline?

I thank my hon. Friend for her question. She is a passionate campaigner on this issue. I recently responded to a debate on this issue led by her. She also chairs the all-party parliamentary group on rural health and social care. She is right, and we have developed an apprenticeship route for almost all professions in our NHS, allowing people to join the health and care sector immediately on an earn-as-you-learn basis. We continue to work hard to develop pathways into health and care professions, including via our groundbreaking blended online learning programmes.

In terms of district nursing and community midwifery, is the Minister aware that there are real security concerns about entering homes alone, and that that plays into resignations in many rural areas? Will he address that by providing security devices so that rural, isolated nurses and staff know that they are not alone and are safe?

The hon. Gentleman raises an interesting point. It is not something that has come across my desk in the two days I have had this portfolio, but I will of course meet local integrated care system leaders, and if it is something that they are calling for, I will look to see what we can do to assist.

Worcestershire and Herefordshire are rural areas that suffer from a shortage of doctors at both primary and secondary levels. My hon. Friend is an excellent Minister: will he meet me to discuss the strong case for funding places at the Three Counties Medical School in Worcester—a ready-made solution to the problem—which has already seen 851 applications from home students?

I thank my hon. Friend for his compliment. He raises an important issue. I know that my predecessor not only agreed to meet him, but undertook to visit Worcester. I would be happy to make the same commitment.

Wirral and Cheshire have many rural areas, with all the same problems that have been described. When I met healthcare professionals on Friday, they were clear that the problem is not just recruitment, it is also retention. Which of the changes that have happened over the past 12 years to make working life for NHS staff less good than it needs to be will he reverse?

Of course retention is as important as recruitment. Since September, we have had the non-repayable training grant, which is a minimum of £5,000 per academic year, additional funding for certain courses, and extra funding worth up to £3,000 for eligible students to cover childcare costs. That is, of course, on recruitment. On retention, we are looking at more access to mental health support and high-quality support while in training and clinical placement, but of course there is more to do.

Mental Health Services

The NHS long-term plan commits to investing at least an additional £2.3 billion a year by the next financial year to expand and transform mental health services in England. That will be supported by an additional 27,000 mental health professionals in the workforce to deliver that transformation.

I thank my hon. Friend for that answer. I recently met the child and adolescent mental health services team in Harrogate, and they confirmed that there are long waiting lists for attention deficit hyperactivity disorder and autism diagnosis. Will the Minister consider the criteria to help those who need the service most to get the support they need?

I thank my hon. Friend, who raises a good point. He does a huge amount of campaigning in Harrogate and Knaresborough on this issue. We recognise there can be long waits for diagnosis both for ADHD and autism, and that is why we refreshed our national autism strategy last year, backed by more than £74 million to help to reduce diagnosis waiting times. NHS England is now setting out the process of how children, young people and adults might receive a diagnostic assessment much more quickly.

Delayed discharge from mental health beds is preventing people from getting the treatment that they need. In fact, in Humber NHS trust 42% of learning disability beds are taken by people with delayed discharge, 5.5% of secure beds have patients in waiting for adult social care, as do 70% of adult mental health beds, 22% of CAMHS beds and 27% of community beds. To deal with the problem in mental health, we need to deal with the problem of lack of adult social care placements. When will the Government be able to fix that?

The Government actually started working on the plans around delayed discharges this summer, because of course they affect mental health services. They also affect a range of acute beds. With the winter coming, we know that there will be additional pressure on those beds, and that is why we are working with local government social care services and integrated care boards which have responsibility for that in their local areas.

In the last four weeks, there have been three investigations on abuse in in-patient mental health settings. The Government should be on top of the situation, not relying on undercover reports from Sky, The Independent, or “Panorama” that show patients languishing in seclusion, excessive use of restraints, bullying and dehumanisation, and falsification of medical records. Patients and their families rightly expect to be safe. Tory chaos has meant that the Government have not engaged with abuse allegations. For weeks there has been no functioning mental health Minister. Will the Minister conduct a rapid review of mental health services, respond to our concerns about in-patient services and apologise to patients and their families now?

Of course we apologise for the cases that we have seen; anyone who watched some of those programmes will have seen the distressing and unacceptable care. I am the Minister with responsibility not just for mental health but for patient safety, so I will be looking at the cases in “Panorama” and other programmes, and at cases across the board, because I want to ensure that in-patient mental health services are as safe as possible. We know that these are some of the most vulnerable patients who often cannot speak out when there are problems. We are looking at the staffing, training and reporting mechanisms. On the case that was highlighted in “Panorama”, the Government are working closely with NHS England, the Care Quality Commission and the individual trusts.


Gynaecological conditions, including endometriosis, are a priority in the women’s health strategy, which we published in the summer. We are committed to improving care for women with endometriosis and are particularly looking at the patient experience and journey from first seeing their GP through to diagnosis.

Last week, the all-party parliamentary group on endometriosis heard from many different women about their shocking experiences of getting diagnosed and treated. Despite the very good women’s health strategy, they are not seeing that on the frontline. Long waiting times, poor care and disbelief from medical professionals are all still too prevalent for women with endometriosis. Commitments in the women’s health strategy are long overdue and women are not fully feeling those benefits. When can we expect to see real progress to back that up and end this national scandal once and for all?

I thank the hon. Lady for her question. The Government introduced the first women’s health strategy to make issues such as endometriosis a high priority. Of course it will take time—we published the strategy only in the summer—but work is happening already. The women’s health ambassador is working to better inform young women about the signs and symptoms of endometriosis, so that they cannot be fobbed off with advice such as, “This is just a normal period.” Better and mandatory training for healthcare professionals in women’s health is being introduced and we are working with the royal colleges to streamline the referral process.

Early diagnosis in endometriosis and many other conditions is important, so I welcome the news that a community diagnostic centre was approved in Hinckley last week. That will bring MRI, ultrasound and CT scans to the heart of my community, but we are looking for more. For the likes of endometriosis, people sometimes need to have a day case procedure. Will the Minister meet me to discuss having a day case unit in Hinckley? A bid is going through that I am keen to see ensured, so that we can get the diagnosis of things such as endometriosis in the heart of my community.

My hon. Friend campaigned hard for the CDC in Hinckley and I am glad that he has been successful. Community diagnostic centres will provide a range of tests to speed up the diagnosis process. I am happy to meet him, because they are just the start of a huge opportunity, particularly for conditions such as endometriosis, to get diagnoses as soon as possible.

Cold Weather: Long-term Health Effects

5. What recent assessment he has made of the potential long-term effects of cold weather over the winter on the health of (a) children and (b) pensioners. (901949)

Pensioners and children are particularly vulnerable to cold weather, which is why we are spending £37 billion on our energy support package. A typical household will save a third—£700—of what they would have paid this winter. The 8 million most-vulnerable households will get £1,200 in support this year to help with the cost of living. The record block grant agreed at the spending review will enable devolved Administrations to provide further services to support those in need.

It is a fact that growing up and living in poor and cold housing leads directly to bad health outcomes. The director of University College London’s Institute of Health Equity, Sir Michael Marmot, stated that the Government must act now, because

“we are facing a significant humanitarian crisis with thousands losing their lives and millions of children’s development blighted”.

That was before the Chancellor’s U-turn on the energy price guarantee, which will mean that average household bills are £4,000-plus a year, or more if they are off-gas grid. Does the Minister think that is acceptable, or will he urge his colleagues to do much more?

I actually agree with the first part of the hon. Gentleman’s point. That is why, as well as the huge direct support to households, we are investing £12 billion in Help to Heat schemes to help make people’s homes warmer and cheaper to heat, another £1.1 billion in the home upgrade grant, and £500 million in the sustainable warmth competition. We take this issue very seriously, and colleagues at the Department for Levelling Up, Housing and Communities are taking further actions to clamp down on squalid housing.

Access to GP appointments is particularly important to help to deal with winter pressures, so can the Minister update the House on progress in implementing the improvements promised in October last year to help GPs to expand to meet demand over the winter?

My right hon. Friend is so right, and she has been a powerful champion on this issue. We have invested £1.5 billion to get an extra 50 million GP appointments per year. The number of appointments in September was up 7% compared with the same month in 2019. We now have an extra 2,300 doctors working in primary care compared with 2019, and an extra 19,300 primary care professionals, on the way to the goal of 26,000 extra primary care professionals. This is hugely important, we are investing in it, and my right hon. Friend is right to campaign on it.

We know that, if poorer communities cannot afford to heat their homes, health inequalities will worsen significantly over the winter months and beyond. Despite the seriousness of this issue, the previous Health Secretary—that is the right hon. Member for Suffolk Coastal (Dr Coffey), in case Members are struggling to keep track—planned to ditch the Government’s long-promised health disparities White Paper. Does the current Minister intend to do the same? If he does, how will he seriously address the dreadful health inequalities that have widened after 12 Tory years?

The hon. Gentleman implies that I disagree with him about this. In fact, the Government are working hard to clamp down on squalid housing. That is exactly what we were doing in my previous Department, DLUHC, and I have just mentioned some of the things that we are doing: the £37 billion we are spending to help people to meet the cost of living, the £15 billion of that that is targeted on the very poorest households, and the £12 billion that we are investing in making people’s houses easier to heat. We will continue to tackle health disparities across the board.

The NHS Confederation wrote to the former Chancellor raising its concerns about rising energy costs and the knock-on effects on health and on NHS services. We all know that this winter we will see people making the choice between heating and eating. Both routes will inevitably lead to more illness and worse health outcomes, so what action are Ministers taking, with their colleagues in Cabinet, to avoid this public health catastrophe?

We are taking the action that I have just been describing in terms of direct support for households. Of course, because health is devolved, we are also helping the devolved Administrations. The Scottish Government, for example, receive £126 per person for every £100 per person of equivalent UK Government spending in England and Wales. That enables the Scottish Government to provide extra help for those in need. It is another example, on top of furlough and the energy support scheme, of how this country is strongest when we all work together constructively.

Mental Health Treatment Waiting Times

Waiting time targets for adult talking therapies were exceeded in 2021-22, with 91.1% accessing those services within six weeks and 98.6% within 18 weeks.

Young people in the north-east potentially have to wait up to three years for mental health treatment. Local Metro Radio launched Charley’s campaign to get young people more timely health support. The campaign is in memory of 12-year-old Charley Patterson, who took her own life waiting for treatment. Labour has a fully costed plan to guarantee mental health treatment within a month of referral for patients who need it. Will the Minister commit to adopting that target now?

I thank the hon. Lady for her campaign on this issue. I am very sorry to hear of the tragic case of Charley Patterson. We recognise that, particularly with the pandemic, there has been a significant rise in mental health conditions for young people and children. We are expanding services so that an additional 345,000 children and young people can access NHS mental health support, and we are providing more support in colleges too. I am very happy to meet the hon. Lady to discuss her campaign further.

When I recently visited Sheffield College, students told me about the difficulty they face in accessing mental health services, and it is the same every time I visit a school to talk to students about the priorities for this place and for the Government. According to Mind, one in six young people have a mental health problem. We know that referrals for children and adolescents hit record numbers this summer. Early intervention is crucial but is simply not available. Young people are waiting months and months for their first appointment with child and adolescent mental health services after referral. There is a deepening crisis and, frankly, what the Minister just described will not address it, so what more will she do to ensure proper funding of mental health services for young people?

I have highlighted that there are additional pressures—more children and young people are coming forward with mental health conditions—but I assure the hon. Gentleman that we are putting early intervention directly into schools. Mental health support teams now cover 26% of pupils, with the aim of going up to 35% of pupils by April, and we intend to increase that further. So we are getting in as early as possible. Over 420,000 children and young people were treated through NHS-commissioned services in the last financial year. There is more to be done, but we have made a good start.

There is a real danger that prioritisation of mental health services is not what it was a few years ago. Does the Minister agree that we need to take urgent action on workforce development and other measures to increase capacity for mental health services, so we do not let down the hundreds of thousands of young people who are on the waiting lists? We need to take action now.

I agree and we are taking action now. Our aim is to expand the mental health workforce by an additional 27,000 healthcare professionals by 2023-24. We have already seen an increase—almost 6,900 more full-time equivalent staff. The workforce are the key to that, which is why are investing in them so heavily.

Waiting times to access mental health specialists in my area are unacceptably high, and I am constantly told there is simply an inability to recruit mental health specialists. I know the Minister works very hard on this subject and she just mentioned what we are doing over the next couple of years. What practical steps can the Government take to ensure that, this year, 2022, there are more mental health specialists available to serve my constituents in Plymouth and south-west Devon?

My hon. Friend makes a good point. We have introduced standards to measure waiting times because the situation is very diverse across the country. NHS England is consulting on introducing five new standards so we can keep track of where the gaps are. Patients can also refer themselves to talking and psychological therapies: over 1 million people have self-referred through the NHS website without having to go and see their GP, so they can get direct access and support when they need it.

Local Dental Provision

During the pandemic, we provided £1.7 billion to protect dental services. Now, through the improvements announced in the summer and our recent plan for patients, we will pay dentists more fairly and improve access for patients. We are enabling practices to deliver more activity than they are contracted to deliver—up to 110%—practices will have to keep their NHS website details updated, making them easier to find, and we are enabling dentists and their wider teams to work to their full scope of practice, improving access. The number of dentists doing NHS work increased by over 530 last year, but there is much more to do.

The Minister is aware that recent Local Government Association analysis showed that Bolsover has some of the worst dentist provision in the UK. That is highlighted by constituents to me daily. Whether it is getting access to treatment or even registering for an NHS practice, my constituents are struggling. Will the Minister take a look at that and meet me so we can discuss what more we can do for dentistry in Bolsover?

Absolutely. My hon. Friend has been a formidable campaigner on this issue. I know he met the Secretary of State to talk about it in the summer. It is a pleasure to have talked to him already and I am happy to meet with him further. Seven Derbyshire dental providers have been commissioned to deliver extra weekend activity to improve access this winter and, nationally, we are exploring how to incentivise dentists to work in areas where getting an NHS dentist is proving challenging.

Effective dental provision is essential not only for quality of life but for nutrition and confidence. Indeed, not being able to access it at important points in life is storing up more trouble for later, yet nine out of 10 dentists are not accepting NHS patients and, with the soaring cost of living, my constituents cannot afford dental treatment. What will the Minister say to them and do to address the millions who cannot get the dental treatment that they need?

The hon. Lady asks a powerful question. As well as the reforms that we started this summer and I announced in our plan for patients, as we start to think about the next dental contract, we are thinking about all the different things we can do to incentivise dentists to work in particularly poorer areas where there is difficulty accessing services. We are also working with the General Dental Council to review the processes that overseas dentists have to complete before they start to provide NHS care, which are sometimes more arduous than those for doctors. We are also thinking about the internal market of the UK and making it easier for dentists in Scotland to practise in England as well.

I welcome the shift in responsibility for NHS dental services in my area to my local Hampshire integrated care board. That will bring a real improvement by focusing on local priorities, rather than the previous regional approach. Will my hon. Friend join me in encouraging ICBs to ensure that they adequately fund dental services, especially for elderly people and children? Dental health is as much of a priority as any other aspect of our health.

My right hon. Friend is absolutely right. The shift to ICBs is right and it is an opportunity to integrate services in a way that has not been done before. She is right to stress the important preventive role that dentistry can play, which also reduces demand on other services, including accident and emergency.

A constituent of mine recently rang the national health contact centre about the possibility of an NHS dentist in Southampton and was told not only that no dentists in Southampton were taking on patients but that no one within 25 miles of Southampton was taking on patients either. What does the Minister have to say to my constituent, who has no prospect of a dentist now and no prospect of a dentist remotely in the future?

That is extremely concerning. This year, in NHS Hampshire and Isle of Wight ICB, there were 1,255 active dentists, compared with 1,248 the previous year. However, there is clearly an issue, which the hon. Gentleman was right to raise in the House. I am happy to talk to him more about that offline to ensure that we can solve that important problem.

Nursing Workforce: Recruitment and Retention

8. What recent representations he has received on recruitment and retention of the nursing workforce. (901953)

We are on target to meet the 50,000 nurses manifesto commitment, with nursing numbers more than 29,000 higher in August this year than they were in September 2019 and more than 9,100 higher than in August last year. We are working across a range of delivery partners to invest in and diversify our training pipeline, conduct ethical international recruitment, improve retention and support return to practice.

Cancer services are buckling both sides of the border and workforce challenges remain the biggest barrier to reducing waiting lists and meeting need. Will the Minister ensure that the long-term workforce plan being developed by NHS England gives consideration to the plans being prepared by NHS Scotland to minimise duplication and try to ensure the best possible patient outcomes in both countries?

I thank the hon. Gentleman for his question. We remain absolutely committed to growing and supporting our vital NHS workforce. In addition to the work already in place to continue growing the workforce, we have, as he mentioned, commissioned NHS England to develop a long-term plan for the workforce, looking at the next 15 years. It is important that we do that in tandem and I will have conversations—I think later this week—with my counterpart in the Scottish Government.

Workforce does matter enormously to backlogs and cancer backlogs in particular. I have come here straight from a mammogram two years after being diagnosed with breast cancer. Luckily, I am in rude health. [Hon. Members: “Hear, hear.”] However, for my constituents, the Norfolk and Norwich University Hospitals NHS Foundation Trust has met cancer referral targets only once in the last three years. Staff are working extremely hard, including by running more clinics and scaling up services. Will the Minister support the trust to reduce waiting times for my constituents for tests, results and treatment?

I thank my right hon. Friend for her question and I look forward to visiting Norfolk and Norwich University Hospital as soon as possible. She rightly raises cancer referrals. Cancer referrals from GPs are now at 127% of pre-pandemic levels. Cancer treatment levels are at over 107% of pre-pandemic levels, with nine out of 10 people starting treatment within a month. However, as she rightly points out, there is variance across the country and, where trusts have more challenging statistics, we need to address them.

Moving Patients into Social Care

9. What steps he is taking to help move patients who no longer need acute care from hospitals into social care settings. (901954)

When a patient no longer needs acute hospital care, they are usually better off outside hospital and that frees up their bed for somebody else. Delayed discharges are nothing new, but they have been getting worse in part because of the shortage of social care. That is why the Government have announced £500 million to speed up discharges from hospital into social care this winter.

Warrington is at least 90 beds short in terms of step-down care. A local hospital has too many long-term patients who simply cannot be discharged because there is nowhere for them to go. I am told there is capital funding available. We have two local NHS trusts, a local authority and the integrated care board, which is no longer in Warrington but now in Liverpool, but no action is being taken. Will the Minister come to Warrington to meet local NHS leaders and me, so we can secure access for patients who are spending too long in acute hospital care?

My hon. Friend is absolutely right about patients spending too long in acute care in his own hospital. We know this is affecting other people around the country. I am very happy to meet him and I would very much like to visit his hospital and speak to his NHS, the local authority and other stakeholders to ensure we can improve the situation.

Tony Hickmott is an autistic man who was detained in an in-patient unit for 22 years, often in near total seclusion, against his wishes and those of his parents, Pam and Roy. Tony now has his own home in the community, but the NHS spent £11 million on his detention in the last nine years after doctors considered him fit for discharge. Can the Minister comment on the wasted years Tony and his family spent fighting to get him free? What will she do to release the 2,000 other autistic people and people with learning disabilities detained in in-patient settings who would receive far more effective care in the community?

The hon. Member raises Tony’s individual case, which is very hard to hear about. She and I know there are too many others in this situation. She will know, too, that I listened to this when I was formerly a Health Minister. It is a difficult problem to solve, but we should absolutely continue to work with the NHS, the Care Quality Commission and local authorities to ensure people who are not benefiting from being in in-patient settings are able to get the care and support they need in the community.

The previous Health Secretary promised £500 million social care discharge funding for this winter, but it is 1 November and not a single penny of that money has been seen. I am afraid that the political chaos and incompetence over the last few weeks means that local services cannot properly plan and thousands more elderly people are trapped in hospitals when they do not need to be, with all the knock-on consequences for the rest of the NHS. Will the Minister now tell us: is this money still available? When will it be released? Can she guarantee that it will be genuinely new funding, not found from cuts made elsewhere?

I am sure the hon. Member heard the answer I gave a moment ago to a similar question. I absolutely acknowledge the challenge of discharges. The challenge is nothing new, but it has indeed worsened, in part due to the availability of social care. That is one reason why the Government have announced the £500 million discharge fund. I am just a few days into this job—[Interruption.] I am looking at the proposals on how this will—[Interruption.] If she will listen, I am looking to make sure that we allocate that money effectively, because we know that money is tight and we must absolutely make sure that every penny of the funding is well spent on improving the discharge from hospital to people’s homes.


10. When he plans to respond to the all-party parliamentary group on menopause’s report on the impact of menopause. (901957)

I am very grateful to the hon. Lady for all her work on issues around the menopause and to all those on the all-party group on menopause for their work. I have read her report and the 13 recommendations. The Government are already working on many of those, from the cost of hormone replacement therapy through to supporting women in the workplace.

The lack of information about symptoms is a recognised barrier to diagnosis. As a result, only 14% of the 13 million menopausal women in the UK have a diagnosis and are accessing treatment. More resource, training and awareness are urgently needed. Will the Government listen to the APPG’s recommendations and commit to a menopause-specific health check for all women?

The hon. Lady is right about the lack of awareness. Awareness is increasing through her campaign and the campaigns of many others. That is why we are seeing a significant rise in the number of women being prescribed HRT, but there is more work to be done. I am looking through the 13 recommendations from her report, and I am very happy, when we meet regularly, to discuss that further.

GP Recruitment

We are making progress on increasing numbers. The number of doctors in general practice has increased over the past three years, from 34,729 in September 2019 to more than 37,000 in September this year.

I am grateful for that answer. I recently met representatives of the local GP network in my constituency who described to me their difficulties in employing GPs. What can the Secretary of State do to ensure that people choose to go into general practice and to make the job much more attractive, so that he hits his target of recruiting 6,000 more GPs, which he is woefully way off doing?

I touched on that exact point in an earlier answer. There are parts of the country where it is more difficult to recruit GPs; that is why we have a targeted fund to attract people into those areas, with grants of up to £20,000. Alongside the appointment of GPs, we are also looking at using the wider primary care skills workforce, so that people can get to the appointment that they need.

Will my right hon. Friend tell me how patients in the Witham constituency will benefit from the really important investment in more GPs and more GP training? And if he cannot tell me today, will he write to me about the progress being made on the Witham health hub, through which more health workers and GPs need to come together to serve the local community?

I am grateful for that question. The plan for patients, which was set out by my predecessor, my right hon. Friend the Member for Suffolk Coastal (Dr Coffey), addressed the issue that my right hon. Friend the Member for Witham (Priti Patel) raises on behalf of her constituents. That includes how people make an informed choice about which practice is best for them, how we make it easier for them to book an appointment and how we harness technology better—in particular, the very significant number of patients, including in Witham, who will have downloaded the NHS app and will be able to access services through it from this month.

Topical Questions

It is an honour to return to the Department of Health and Social Care to continue its important work, especially ahead of the challenges this winter. I pay tribute to my predecessor, my right hon. Friend the Member for Suffolk Coastal (Dr Coffey), for everything that she has done to get the system ready for the challenges ahead. I welcome my experienced ministerial team to their posts and thank Ministers from the summer. I am also looking forward to robust, I am sure, but—based on our previous experience—very constructive engagement with Opposition Front Benchers.

I am pleased that all GP practices will soon be able to automatically provide patients aged 16 and over with access to the latest information and their health records through the NHS app. We are switching on that ability from today in a process that we expect to be completed by the end of the month. That is an important milestone for patient empowerment and is part of a process that sees patients play an even more active role in managing their health and care. I hope that Members across the House will welcome that on behalf of patients.

I congratulate the Secretary of State on his reappointment. Will he reiterate the importance of getting ambulance waiting times down? Would he endorse the use of minor injuries units in community hospitals, such as those in Malvern and Tenbury, as a very effective way to open up access through other routes for our constituents?

My hon. Friend raises an important point, particularly for category 3 and 4 ambulance journeys. As she highlights, there are numerous aspects to the challenge of ambulance delays: the blockage in the flow from social care and delayed discharge, which we have debated many times in the House; issues in accident and emergency with pre-cohorting, post-cohorting and triaging nurses; conveyance rates, which often vary significantly between ambulance trusts; call handling, which we have put additional money into; and the work of the auxiliary service. My hon. Friend is quite right that within the portfolio of options, minor injuries units are an area that can help to relieve pressure on busy A&Es.

I welcome the Secretary of State back and welcome his team, but I have had boxes of cereal with a longer shelf-life than Conservative Secretaries of State. As a consequence of the turnover and chaos, the truth is that the NHS is not prepared for this winter—it cannot even get allocated funds out of the door.

Let us turn to the future. Over the summer, the Prime Minister promised to establish a “vaccines-style taskforce” to tackle the Conservatives’ NHS backlog on “day one” and to have overall waiting list numbers falling by next year. May I ask the Secretary of State who is on that taskforce, how many times it has met and what its programme of work is?

I am grateful that the hon. Gentleman raises the issue of vaccines; in fact, I raised it in Cabinet today. The UK is the first country in the world to have introduced bivalent vaccines targeted both at omicron and at the original strain of covid-19. We have now made the covid vaccine and the flu vaccine available to all over-50s; I hope that Members across the House will promote that. I think the UK can be very proud of its work to roll out vaccines against both covid and flu, which are a key part of preventing some of the pressure on our A&Es.

I can forgive the Secretary of State for mishearing the question, but what I find unbelievable is that it seems as if this is the first time he has heard about the Prime Minister’s own proposed taskforce to deal with the Conservatives’ NHS backlog. That is what the Prime Minister promised, and that is what I asked the Secretary of State about. This is obviously another case of the Conservatives over-promising and under-delivering.

If the Secretary of State cannot stand by the Prime Minister’s pledges, what about the views of the man next door? When we announced our policy to train a new generation of doctors and nurses, paid for by abolishing non-doms, it was welcomed by the Chancellor as—and I quote—“something I very much hope the government also adopts on the basis that smart governments always nick the best ideas of their opponents.” In the spirit of constructive opposition that the Secretary of State asks for, Labour has a plan to tackle the staffing crisis. The Conservatives do not. It is fully costed and paid for, so will he nick it?

The hon. Gentleman skirts over the fact that it is this Government who have opened five new medical schools, who have significantly boosted medical undergraduate training, who are investing more in our NHS as per the long-term plan, who have invested a further £36 billion as part of our covid response, and who are investing in technology and the skills of the workforce as a whole. We are boosting the number of medical trainees and—I touched on this question earlier—we are also boosting the number of doctors in training to be GPs.

T2. At a face-to-face surgery this weekend, a constituent mentioned the difficulties that a relative of hers, who has subsequently died, had had in getting a face-to-face GP appointment at a surgery run by an American company called Centene, which now covers 600,000 patients. Will the Government insist that we are fully committed to the traditional approach of a committed and caring family doctor seeing patients face to face, and that we will not allow GP surgeries to be fully commercialised? (901971)

My right hon. Friend raises an important point about face-to-face care, which matters to many constituents, but I gently remind him that in the Lincolnshire integrated care system, 71.9% of appointments were face to face in September 2022. It is not the case that every patient wants a face-to-face appointment; there can be instances in which an online service is better. For patients facing domestic violence, for example, it can often provide a much more convenient service.

Order. I know we are bedding back in, but Front Benchers have to think about Back Benchers. These are their questions as well, so please let us make sure that I can call as many of them as possible.

The Scottish Government introduced new national guidelines to make it easier for retiring NHS staff to return to support the NHS, while drawing their pensions. However, there is a substantive issue of pension tax rules pushing senior clinicians to reduce their commitments or retire early. As we know, pension taxation is a wholly reserved matter, so will the Minister address this issue with Cabinet colleagues in order to find a permanent solution that will allow us to help the NHS retain senior staff?

T4. More than 13,000 people who are in hospital today would be out of hospital if the care system had the necessary capacity, and most of them could go back to their own homes if we had enough domiciliary care workers. Can the Secretary of State assure me, and the House, that he will produce a proper workforce plan for the care sector as a matter of urgency? (901973)

Very much so. The hon. Member for Ilford North (Wes Streeting) asked about a taskforce. With our colleagues in NHS England, we launched a “delayed discharge” taskforce with a “100-day challenge” over the summer; we have also set up an international recruitment taskforce within the Department to prioritise the establishment of a “clearing house for care”. I will not add further to my answer, other than to say that this is a key area of focus.

T3.   I recently visited a local GP surgery which is short of a third of the staff that it needs. Surgeries are finding it increasingly difficult to retain staff owing to stress and burnout. Do the Government recognise that it is stress and burnout that make it so difficult for us to retain GPs in their profession, and for them to retain their staff? If so, what on earth are they going to do about it? (901972)

The wellbeing of staff—especially in the NHS, and especially after the pressure of the pandemic—is a crucial issue, and one on which I have focused in particular since returning to the Department. I look forward to having discussions about it with the hon. Lady.

T6.   Last year I raised with the Department worrying data from the Alzheimer's Society about the number of care home residents with dementia who were being prescribed anti-psychotic drugs when they did not have a psychosis diagnosis. Can my hon. Friend provide an update on the current levels of prescribing? (901975)

I have shared my hon. Friend’s concern about this issue in the past, and I know he has taken a long-term interest in it. We must ensure that people living with dementia are prescribed anti-psychotic medication only when it is clinically appropriate., and NHS England is actively monitoring the position. I have already asked for the latest data, and I will be keeping a close eye on it.

T5. The Secretary of State says that he is boosting GP trainee numbers, but according to the Royal College of General Practitioners, 49% of the more than 40% of GP trainees who are international graduates have reported visa processing problems and 17% are considering leaving the UK altogether, taking their desperately needed skills elsewhere. Why are the UK Government hamstringing the NHS with red tape, and what is the Secretary of State doing to sort this out with ministerial colleagues? (901974)

Across the clinical workforce—whether we are talking about dentistry, nursing, social care or doctors—we are seeking to boost recruitment, including international recruitment, and to remove red tape. Within the GP population, however, we are looking at retention, recruitment and boosting the number of trainees.

T7. The Government have given Epsom and St Helier University Hospitals NHS Trust the green light to get on with improving St Helier and building a new hospital in Sutton. We know that the pandemic has had an effect on timetables, so will my hon. Friend facilitate a meeting between his Department, the Treasury and the trust to ensure that we can get a planning application in by the end of the year? (901977)

We are fully committed to delivering a new hospital in Sutton, one of the 40 new hospitals to be built by 2030. Officials from the Department and the NHS are working closely with the trust at every step in the process, and I look forward to working with my hon. Friend to deliver this much-needed hospital improvement.

T8. In rural areas such as the west country, NHS dentistry is more of a distant memory than a vital service. Does the Minister agree that more must be done to boost NHS dental services in rural areas, and will he commit himself to reforming the NHS dental services contract to ensure that it meets patient need and properly incentivises dentists to take on NHS patients? (901978)

In the hon. Gentleman’s local NHS this year there were 758 active NHS dentists, up from 736 in the previous year. I have already mentioned some of the steps we are taking to tackle the problem of dental deserts and ensure that everyone in the country can see the dentists—and the GPs—whom they need to see.

Members of the Kent and Medway integrated care board are doing their best to recruit more GPs, but they are finding it difficult to attract them to our area. One reason is their close proximity to London, where newly qualified GPs can earn thousands of pounds more than they can if they practise in Kent. Will my right hon. Friend consider extending the NHS London weighting allowance to Kent and Medway?

Part of the reason for having the targeted funding is so that ICSs can look at those areas under particular pressure for recruitment and do that on a place-based basis. It would be interesting to look at the evidence, but I know that the fund has been used by my hon. Friend’s local ICS.

T9. Care workers were already struggling to get by on wages that hardly pay the bills, and now, with an escalating cost of living crisis, care workers in Nottingham and beyond are being pushed deeper into poverty. Does the Secretary of State back trade union calls for a £15 an hour minimum wage for care workers, and what steps is he taking to make this a reality? (901979)

Care workers should be properly paid for what they do, the skills they bring and the compassion they bring to their work. That includes being paid at least the national living wage, which was increased by 6.6% in April. I am also increasing the Care Quality Commission’s oversight of local authority commissioning, and we have created a £1.36 billion market sustainability and fair cost of care fund, which will ensure that local authorities always pay a fair cost of care.

Early access to scans and testing can prevent more serious illness, improve health outcomes, reduce health inequalities and reduce pressure on the acute sector. Will my right hon. Friend prioritise increasing the number of diagnostic centres across the United Kingdom and support my campaign for the establishment of one in Wimbledon town centre?

My hon. Friend is right to say that we are supporting the NHS to deliver up to 160 community diagnostic centres by March 2025, 89 of which are already operational, as part of £2.3 billion of capital funding, delivering around 2 million additional scans so far. Community diagnostic centres are closer to people’s homes in the hearts of communities, and they will help us not just to reduce and bust the covid backlogs but to tackle health inequalities.

As we get older, many of us—individually or our close family and their immediate family—will be touched by cancer. Can the Minister confirm when the 10-year cancer plan will be published in full, and will the Minister agree to meet me and a small delegation from the all-party parliamentary group on radiotherapy to hear more from the experts on the frontline about how we can use this technology to improve cancer outcomes?

Sadly, cancer takes far too many people before their time, and the Government are determined to improve cancer outcomes in the short term and the long term. I am very happy to meet the hon. Gentleman to discuss this further.

What steps is the Minister taking to improve health outcomes and early diagnosis for people with aortic dissections?

I know that my hon. Friend has a real understanding of this particular challenge. In March 2022, NHS England launched an aortic dissection toolkit to support the implementation of robust clinical pathways to identify and manage type A and type B aortic dissection, and English regions are working with the cardiac pathways improvement programme to improve diagnosis and treatment.

Tens of thousands of NHS workers are entirely dependent on the use of their car to do their vital job, but while petrol prices have rocketed, NHS mileage rates have remained frozen since 2011. Will the Secretary of State look at what can be done to increase NHS mileage rates?

That fits within the wider issue of how we work with and support our NHS workforce and what packages we can look at in discussion with Treasury colleagues. Of course, the approach to the NHS is also in line with other Government Departments, but the hon. Gentleman raises an important point and it is obviously one that Ministers discuss.

With flu cases on the rise, what action is my right hon. Friend taking to ensure that all parents are aware that they can access the free nasal vaccine at their GP surgery for all pre-school children?

My hon. Friend’s question gives me an opportunity to thank her for her fantastic work on vaccinations and our world-leading roll-out of vaccines across the country. She has also provided an opportunity to remind everyone of the opportunity to get those life-saving vaccines this winter and to get boosted.

This month a care provider in my constituency is closing, citing the workforce crisis. I have listened carefully to the Ministers’ answers, and the current Chancellor spent the last year telling us about the critical need for a workforce strategy. The door is open. Has the Secretary of State had a conversation with the new Chancellor to ask for a workforce plan on which we can all rely?

Forty per cent. of GP appointments are now related to mental health. That is why James Starkie and I launched the cross-party “No Time to Wait” campaign, which had the support of the Prime Minister when he was Chancellor. We have a fully costed plan with the Royal College of Nursing to pilot such a scheme. Is the Secretary of State willing to meet James and me?

I thank my hon. Friend for his suggestion. We are committed to boosting the mental health workforce, and I am happy to meet him to discuss his suggestions.

My constituent Wilma Ord and her daughter Kirsteen are victims of the Primodos hormone pregnancy drug. Will the Minister update me on where the Government are in getting justice and compensation for the affected families? Many people have died. Will she meet me and other families and representatives from the campaign group to get justice for these families? They have waited far too long.

As the hon. Lady knows, there is an ongoing legal case about Primodos, but I am very happy to meet her and the campaigners because I am keen to hear their experience. Unfortunately, I cannot comment further while there is an ongoing legal case.

I refer to my entry in the Register of Members’ Financial Interests. Last Saturday was World Stroke Day. Will my right hon. Friend the Secretary of State commend the work of the Stroke Association and its “saving brains” campaign? And will he meet members of the all-party parliamentary group on stroke to discuss how we can increase the provision of life-saving thrombectomy services across England and Wales?

I am very happy to commend the work of the Stroke Association, and I would be delighted to meet my hon. Friend to discuss this further.

A respected woman pharmacist in my constituency, with a lifetime of NHS experience, went solo with her own practice in the hope and expectation of an NHS licence, which she has been denied. Will the Secretary of State look into the opaque decision-making process? Our increasing population otherwise means increasing demand, and my constituent cannot survive on private alone.

Suicide is the biggest killer of under-35s in the UK, with more than 200 school-aged children taking their own life every year, including two, very sadly, in my constituency in recent months. We have heard about the pressures on mental health services, so will the Secretary of State look at alternative ways of supporting mental health by meeting the 3 Dads team and his counterpart in the Department for Education to discuss how we can embed age-appropriate suicide awareness and prevention in schools?

Part of the reason why we are putting an extra £2.3 billion into mental health is to recognise the sensitivity and the importance of this issue. I am very happy to look at all practical suggestions. The tragedy for constituents is something that unites the House. In particular, I will look at what technology can do to support people.

The New Statesman has reported that the spend on Healthy Start has fallen by two thirds in the last decade, and this afternoon I will be presenting a Bill that would help to increase take-up. Will the Secretary of State or one of his team meet me to discuss the details of what campaigners and I are proposing so that we can make this helpful benefit reach more of the families it is intended to benefit?

I am very happy to ensure that the ministerial team engages with the hon. Lady. I take this opportunity to commend my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom), who has done a huge amount of work on early years, which dovetails with this important issue.

Following a recent unannounced inspection by the Care Quality Commission, some services at Tees, Esk and Wear Valleys mental health trust have improved, but the trust’s overall rating remains “requires improvement.” Can my right hon. Friend assure me and my constituents in Darlington that his Department will keep a laser-like focus on the trust and that he will do everything in his power to ensure the trust carries out the improvements that are so desperately needed?

I thank my hon. Friend for raising this important issue. I understand he recently wrote to the Secretary of State, and we will respond shortly. NHS England and the North East and North Cumbria integrated care board have commissioned an intensive support team review of the trust, and I will keep him updated. He is right to make sure that we keep this high on the agenda.

Children who are born premature or sick are often discharged from neonatal care with energy-intensive equipment, such as oxygen machines, which has an impact in terms of the cost of living crisis. Is the Secretary of State willing to meet Bliss and myself to look at the costs faced by families who come out of neonatal care and how we can support them better?

The Bliss charity is recognised across the House for the extremely important work it does, and I know that the ministerial team will be happy to engage with the hon. Gentleman on how we can work on the matter he raises.