1. If he will make an estimate of the average waiting time for treatment for gender dysphoria; and if he will make a statement. (904600)

NHS England does not routinely collect or publish data on waiting times for treatment for gender dysphoria, but I can tell the right hon. Gentleman that as of February this year 28,290 adults were waiting for a first appointment in England.

Four years on average for an initial appointment, and seven years at the south-west clinic in Exeter. With healthcare for trans people in effect non-existent, the Government planning to remove trans human rights from the Equality Act 2010, breaking their promise to ban conversion therapy and to reform the gender recognition process, and now threatening to force schools to out trans students to their parents, can the Minister see why this tiny and particularly vulnerable minority feels under attack by the Government, and that some who can afford to are even leaving the country for a less hostile environment?

I can reassure the right hon. Gentleman that we are putting an additional £7.9 million into four new pilot gender identity clinics, because we want services to improve and waiting times to come down. The four new pilot services are now operating in Greater Manchester, Cheshire and Merseyside, East of England and London, and a new clinic will be opening in Sussex later this year. The four pilot studies have already removed 3,400 patients from the waiting list and I am hoping the fifth clinic will go further.

2. What steps his Department is taking to reduce health inequalities in deprived areas. (904601)

23. Whether he has made a recent assessment of the potential relationship between poverty and life expectancy. (904623)

The Government are committed to our levelling-up mission to narrow the gap in healthy life expectancy by 2030. That is why, in October, we committed an additional £50 million to 13 local authorities to tackle inequalities and why we are also setting out our plans through the major conditions strategy.

Even in areas that people consider to be affluent, such as Buckinghamshire, health inequalities can be a serious concern. Figures from Opportunity Bucks show there is an eight-year difference in life expectancy between residents of the Aylesbury North West ward and the Ridgeway East ward, both of which are in my constituency, yet the funding for those areas is essentially the same. Will my right hon. Friend explain the steps he is taking to ensure that deprived communities, wherever they are in the country, get the additional help and support—not necessarily purely financial—that they need to address their needs?

My hon. Friend is absolutely right to highlight the importance of targeting health inequalities. Let me give the House a practical example. For lung cancer, patients are 20 times more likely to survive five years if we catch it early rather than late. Before the pandemic, those in the most deprived communities had the worst diagnosis. However, as a result of the targeted action we took with lung cancer check vans, they now have the best early diagnosis, which obviously has a big read-across for the five-year survival rate.

The UK ranks 29th in global life expectancy. Professor Martin McKee from the London School of Hygiene and Tropical Medicine notes that one reason why the overall increase in life expectancy has been so sluggish in the UK is that it has fallen for poorer groups. The Scottish Government are doing everything they can within devolved competencies to fight poverty—the Scottish child payment and so on—but Westminster controls 85% of social security. What representations has the Secretary of State made to Cabinet colleagues and the Department for Work and Pensions about the damaging effects of their policies on life expectancy?

The hon. Gentleman raises a very important point. He can see the success of the representations I made to Cabinet colleagues from the Chancellor’s Budget statement, when he announced additional funding to tackle, in particular, health impediments to access to the labour market. He will also have seen the recent announcement of targeted action on, for example, smoking cessation, which is a particular driver of health inequalities. That includes our financial incentive scheme to pregnant mums, which obviously has a big impact on both their health and the health of their baby.

It is becoming clear that in Cornwall the only way to get dental care is to go to a private dentist. In a deprived area, of which there are many across Cornwall, that is just not an option for people on low incomes. What can the Secretary of State do to increase the accessibility of NHS dentistry?

This issue concerns Members across the House. We have already started to reform the dental contract. We have introduced the £23 minimum value for units of dental activity and created more UDA bands, reflecting the fair cost. We are seeing more patients nationally—to March, up nearly a fifth on the year. But I recognise that there is more to do, and the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien), is undertaking that work as we speak.

Women in my constituency have a healthy life expectancy of only 56 years. Could the Minister explain why the difference between West Yorkshire and North Yorkshire—where the Prime Minister has his constituency—is 10 years? Why should women have to put up with that kind of experience? What is his explanation of how that has happened?

The hon. Gentleman is right that we should narrow the health inequalities gap, and we are committed to doing that. That is why in the women’s health strategy, which I set out in the summer, we committed to having women’s health hubs as one-stop shops to tackle some of the gender inequality. It is also why, whether on obesity, smoking or lung cancer, we are targeting our screening and public health interventions to close the gap, which he is quite right to highlight.

I call the shadow Minister.

The Secretary of State is absolutely right: we should be narrowing the health inequalities in this country. It is just a shame that, on his watch, we are not. A baby born in Blackpool today will live eight years less than a baby born in Kensington. Under this Tory Government, health inequalities have widened in many parts of the country. They have scrapped their health disparities strategy and cut the number of health visitors by a third, and ordinary families are paying the price. Why does the Secretary of State not get a grip, adopt Labour’s plan to scrap the non-dom tax status and train 5,000 new health visitors, so that every child has a healthy start to life?

There is consensus in the House on our desire to close the health inequality gap—everyone agrees that is a key aim. The hon. Gentleman seems to have written the question before hearing my answer. I just gave a practical example of how we have transformed the early detection of lung cancer. He raised the public health grant, and I am happy to update the House that we are delivering 2.8% funding growth in the public health grant to help local authorities.

It is also about areas such as obesity and access to employment, which can have a big impact on mental health. The Chancellor announced specific funding—[Interruption.] The shadow Minister chunters away about children; I am conscious that one does not want too long an answer, but let me give the example of mental health. In the Budget we announced extra funding for a whole load of digital apps—[Interruption.] The shadow Minister keeps chuntering about children. Let me talk about the roll-out of our mental health support in schools, which is targeted at getting that early mental health intervention to school children.

3. What steps he is taking to tackle vaping by young people. (904602)

I recently announced new measures to tackle youth vaping, including an extra £3 million for a new enforcement squad to tackle underage sales and illicit vapes. We also launched a call for evidence to identify opportunities to reduce youth vaping, which covers everything from the appearance, marketing and price to the environmental impact of vapes.

We would all encourage people to vape instead of smoke, but we do not know the long-term health impact of vaping at all. Reports suggest that one in seven young people are taking up vaping directly and therefore becoming addicted to nicotine, the most addictive drug known to humankind. What measures will my hon. Friend take to make sure that young people understand the risks of vaping?

I pay tribute to my hon. Friend’s work as chair of the all-party parliamentary group for vaping. He is right; as well as the measures I mentioned, we have updated the guidance on Talk to FRANK, to illustrate for young people the dangers of consuming lots of nicotine.

In 2021, the Government rejected my amendment to the Health and Care Bill to tackle smoking and youth vaping. England is now set to miss the Smokefree 2030 target by at least seven years, and countless children are now addicted to vapes. I welcome the U-turn, but what steps has the Minister taken to make up that lost time?

We are taking action across the board on smoking. I think we are in agreement on what has to be done. That is why we recently announced that we are giving vaping kits to a million smokers to help them swap to stop. We are also bringing in new health incentives for all pregnant women so that we can help them stop—that is based on good local evidence. We are taking preventative action, and I think the hon. Lady and I both want the same thing.

4. What assessment his Department has made of the impact of funding allocations for adult social care on charitable and not-for-profit providers. (904603)

This Government back social care, which is why we are giving social care a record funding boost of up to £7.5 billion over the next two years. That extra funding will help local authorities increase the rates they pay to care providers, helping those providers in turn meet extra costs and increase staff pay.

Frontline charities, such as United Response and Age UK, have responded that the Government’s plan falls far short of what is needed, including holding back the promised £250 million in social care workforce funding. Can the Minister promise that will be revisited with urgency, given that one in five over-80s have some unmet care needs and we are facing the highest social care vacancy rates on record?

I can assure the hon. Member that not a penny of funding is being cut from adult social care. We are driving forward our reforms to the adult social care system, which have the workforce at their heart. We are introducing a new career path for the social care workforce, new care qualifications and new training, boosting the adult social care workforce and making sure people in that workforce get the recognition and rewards they deserve.

I call the shadow Minister.

The Minister says this Government back social care—I would love to see what the reality would be if they were against it. We already know that the Conservatives have completely failed to deliver their flagship policy of a cap on care costs, and over Easter we learned that they have broken the rest of their promises on social care too. The £500 million promised for the care workforce has been cut in half; the £300 million promised for housing in care has been slashed by two thirds; and as for the £600 million of other promises, your guess is as good as mine, Mr Speaker. They have not had the courage to announce this to Parliament or the nous to grasp that if people are not kept in their own homes, they end up stuck in hospital, with all the knock-on consequences for NHS waiting times and emergency care. Will the Minister tell us where all that money has gone? Why on earth should older and disabled people and their families ever believe the Conservatives on social care again?

Out of that, I can pick one thing we agree on: the importance of helping people to live independently at home for longer and social care as a part of that. I say to the hon. Lady, as I said a moment ago, that we have not cut a penny of funding from our commitments to adult social care, both on adult social reform and on the historic £7.5 billion of adult social care funding announced in the autumn statement. We are forging ahead with our reforms, with the workforce at their heart, because the workforce is crucial, hand in hand with the digitisation of social care, improving data, joining up health and social care, and supporting unpaid carers.

5. What steps his Department is taking to encourage people to stop smoking. (904604)

We have the lowest smoking rate on record in England, down from 21% in 2010 to 13% now, partly because we have introduced minimum excise tax on cheap cigarettes and double duty on cigarettes, but we know we have to go further. That is why we recently announced significant new funding to help a million smokers quit, through swap to stop, and introduced a new financial incentive for pregnant women. We are also consulting on new pack inserts, similar to those in Canada.

As someone who was able to quit smoking using nicotine patches, following the advice at last year’s Emley show, I welcome the measures announced by the Minister earlier this month to help us achieve our Smokefree 2030 target. Does the Minister agree that, in order to help even more people quit, we should continue to pursue harm reduction strategies such as swap to stop? That will ensure that we maintain our position as a world leader in public health.

I absolutely agree with my hon. Friend and congratulate him on quitting. The swap to stop scheme that we are rolling out nationally, which is the first of its kind in the world, is based on strong local evidence. We know it works from local pilots, which is why we are rolling it out at scale.

Smoking remains the biggest preventable cause of cancer and we know that smoking cessation services are vital to kicking the habit, but smokers in England face a postcode lottery when trying to access them. What is the Minister doing to ensure that everybody who needs those services is able to access them?

Absolutely. In total, public health grants will go up by 5% in real terms over the next two years. We want to reduce the postcode variation, because these are important services. I am keen to speak to anyone who wants to work with us at a local level.

I call the SNP spokesperson.

Welcome as the UK Government’s recent announcement is to help more people in England to quit smoking, the Khan review’s key recommendation to increase investment in smokefree policies, making the polluter pay by raising tobacco duty, was not mentioned. Product duty, as we all know, is a wholly reserved matter, so what representations have been made with Cabinet colleagues about implementing that recommendation to improve public health outcomes across all four of our nations?

I recently had a very productive meeting with my Scottish Government counterpart. As I mentioned, we have already doubled the duty on cigarettes since 2010 and have brought in a minimum tax for the cheaper cigarettes. Of course, tax is a matter for the Treasury, but we will always be interested in things that can drive down smoking.

6. What steps his Department is taking to improve access to maternity care in the south-west. (904605)

Accessibility and choice remain high in the south-west. All but one trust in the region have a minimum of three birth options.

In my local council area, birthing units were closed in 2020. My constituents were promised a new midwife-led unit at the Royal United Hospital in Bath, but three years on it is still not up and running. The Minister will say that it is a funding decision for the local area, but it is an NHS England funding decision and the Government are the paymaster, so when will Bath get its midwifery unit at the RUH?

I am very happy to contact the hon. Lady’s local commissioners to find out the answer for her. However, I highlight the fact that the £7.6 million health and wellbeing fund is funding 19 projects across England to reduce health disparities in new mothers and babies. Two of those projects are in the south-west: the Trelya in Cornwall, a community-centred whole-family provision that takes a holistic approach to working with children and their families; and the Splitz Support Service in Wiltshire, which aims to improve community knowledge, access to and engagement with pre-conception and perinatal care. We are investing in the hon. Lady’s region, but if she has a local funding issue I am very happy to speak to her local commissioning group on her behalf.

I am very glad that the maternity unit at the Royal United Hospital in Bath is rated as outstanding—we actually have very good choices in our local area. Does the Minister agree that choice is an important thing in maternity services? I am very glad that we have a first-class birthing centre in Chippenham and another in Malmesbury. One of the most important things is allowing women the choice to have the birth at home. That requires first-class midwifery support thereafter, which we also have in our area.

Absolutely; choice is important. Only last month we published the single delivery plan for maternity and neonatal services, which I am sure Members across the House will already have read. It puts women at the heart of decision making and learns from the Ockenden and East Kent inquiries, to ensure that women have better choice when giving birth.

7. What progress his Department has made on the delivery plan for recovering urgent and emergency care services. (904606)

9. What progress his Department has made on the delivery plan for recovering urgent and emergency care services. (904608)

The urgent and emergency care recovery plan sets out how we will invest more than £1 billion in increasing capacity, including 800 new ambulances, an additional 5,000 core beds and a further 3,000 virtual wards, to provide more than 10,000 out-of-hospital care settings.

A key component of delivering better urgent care services will be expanding the network of urgent treatment centres across the country. Can my right hon. Friend assure me that a UTC in the major population centre of Northampton will be a high priority for the Department?

My hon. Friend is right to highlight the importance of UTCs. Nationally, they are above the national standard: 95.5% of patients are seen within four hours. He is a highly effective campaigner on health issues—he helped to secure the £2.8 million of investment for a new paediatric emergency department in his local area—and I know that he will be making a similar case to his local commissioners.

Ultimately, the best way to improve urgent and emergency care services is through new build, purpose-built hospitals. Can the Secretary of State confirm where we are with the Royal Berkshire Hospital and Frimley Park?

As the House knows, I am extremely committed to modern methods of construction and modular building capacity. We are using that as a central component of our new 40 hospitals programme. My hon. Friend will know that the RAAC—reinforced autoclaved aerated concrete—hospitals are very much part of that discussion, not just at Frimley but at King’s Lynn, at Hinchingbrooke and in a whole range of other settings. He will also know that we are in a purdah period, so we are constrained in what we can say, but we will have more to say on this very shortly.

We have had 13 years of Conservative government. There are record numbers of patients on waiting lists, record numbers of vacancies in the NHS, and a crisis of vacancies in social care. As for emergency care, the Government cannot meet their 18-minute target for category 2 ambulance responses. If the Conservatives were really concerned about the NHS, would we not be in a better position than this after 13 years?

The hon. Gentleman talks of 13 years. People are nearly twice as likely to be waiting for treatment in the Labour-run Welsh NHS as people seeking treatment in England, and, indeed, waits are longer in Wales: we have virtually eliminated two-year waits in England, whereas more than 41,000 people in Labour-run Wales are waiting more than two years.

I recently conducted a major surgery—[Laughter]—I mean a major survey of Rotherham residents to learn about their experiences of the NHS. A staggering 73% of respondents who had called ambulances needing a category 1 response had waited longer than the seven-minute target time. Given that minutes can mean the difference between life and death, what are the Government doing to ensure that my constituents receive the life-saving support that they need, when they need it?

I know we have clinicians in the House who do second jobs, but I did not know that the hon. Lady had expanded that definition to such an extent! She is right to highlight, through her survey, the importance of timely care. There is currently a range of initiatives, such as the development of the NHS app, the review of the 111 service, and the examination of innovations such as artificial intelligence. We are looking into how we can manage demand in the case of, in particular, frail elderly people by noting changes in behaviour patterns, which will allow us to ensure that, for example, someone who has a fall at home receives care much earlier before arriving in the accident and emergency department, because we know that once frail elderly people have been admitted they will often be in hospital for about 14 days. The hon. Lady has raised an extremely important issue through her survey, and one on which we are focusing in our urgent and emergency recovery plan.

I call the Chair of the Select Committee.

That urgent and emergency care plan, which was announced in January, was received with acclaim by me and, indeed, with wide acclaim. It was described as a two-year plan to stabilise services by, for instance, returning to the A&E target that the Secretary of State has mentioned. What assessment has he made of the impact of the ongoing industrial dispute among the Agenda for Change cohort, and, of course, the junior doctors, on the delivery of the plan?

As a result of the fantastic work of Sir Jim Mackey and Professor Tim Briggs through the Getting It Right First Time programme, we have been making significant progress in respect of elective procedures. When it comes to urgent and emergency care, there are lessons coming out of the various strikes which we are keen to adopt, but this situation is also clearly having an impact on patients and the number of cancellations. As my hon. Friend well knows, we publish the figures.

We have been working constructively with the NHS Staff Council. Unison voted by a majority of 74% to support the deal, there will be further votes this week from other key trade unions, and there will be a decision from the staff council on 2 May. Obviously, that will be extremely important when it comes to addressing the concern highlighted by my hon. Friend.

According to figures that I obtained recently from the House of Commons Library, in January 2023 54.4% of patients who were treated after an urgent referral received their first treatment within 62 days of that referral. The target is 85%. The figure for performance in January 2020, before covid, was 73.6%. Why has there been such a deterioration?

To be honest, I think the position is mixed. In certain areas we have seen significant improvements in performance: the faster diagnosis standard, for example, was hit for the first time this month. Purdah prevents me from going into the details of the 78-week wait, but I expect to be able to update the House very soon on the progress that has been made. As the hon. Gentleman says, there are still challenges as a consequence of the pandemic, but we are seeing much more progress than the NHS in Wales, and it is also worth reminding the House that, through Barnett consequentials, the Welsh NHS receives more funding that the NHS in England.

I call the shadow Minister.

This may surprise you, Mr Speaker, but I have found evidence that the Health Secretary has got something right. He recently hailed the power of local news outlets, and he was spot on. I have here a story from his local paper, exposing the shocking length of waits in A&E for those in a mental health crisis: 5.4 million hours across England in just one year. He is very welcome to have a look if he would like to. Given his admiration for local journalism, does he feel embarrassed for his Government’s failings and will he apologise to all the people across the country who are stuck waiting in A&E?

There are two separate issues there: what we are doing for mental health in-patients and the point we just touched on about A&E. On mental health, it is good of the hon. Lady to give me the opportunity to remind the House of the significant increase in funding we are making to mental health. In the long-term plan, the former Prime Minister, my right hon. Friend the Member for Maidenhead (Mrs May), made a major strategic choice to invest more in mental health—an extra £2.3 billion per year. The hon. Lady is right to highlight the need for more capacity for mental health in-patients—[Interruption.] She asked a question on what we are doing on mental health. I am able to tell her that we are spending far more and investing far more in it, but it seems that she does not want to hear that answer.

8. What steps his Department is taking to tackle health inequalities experienced by people with learning disabilities and autistic people. (904607)

Annual health checks for people with a learning disability are important in addressing the causes of avoidable deaths and avoidable morbidity and in improving health.

It is eight years since the Transforming Care programme started, with a target of halving the number of people with a learning disability and autistic people in in-patient mental health settings by 2024, yet according to the Challenging Behaviour Foundation, the number of children in those settings has nearly doubled since then, the average length of stay is 5.4 years and, 12 years on from the Winterbourne View scandal, reports of appalling standards of care are still too frequent. Does the Minister agree that people with learning disabilities and autistic people deserve so much better?

I thank my hon. Friend for her work in this place. Our priority is always to ensure that children and adults with a learning disability and autistic people receive high-quality care. More than 2,000 people—children and adults—are still waiting to be discharged from in-patient facilities but that is a reduction of 30% and we are making progress. I am meeting individual integrated care boards—[Interruption.] Perhaps the shadow Minister would like to listen to this. I am meeting individual ICBs to go through their patients who are waiting to be discharged to see what more support we can give to make that happen as quickly as possible.

Last year the Scottish Government announced £2 million-worth of funding and help for health boards to deliver health checks for all people with learning disabilities so that any health issues could be identified and treated as quickly as possible. What plans do the UK Government have to do similar across England?

We also ensure that those eligible for safe and wellbeing reviews get one. Last year about 87% of those who were eligible did so.

10. What recent assessment he has made of the adequacy of the availability of NHS dental services. (904610)

22. What progress his Department has made on improving access to NHS dentist appointments. (904622)

There are 6% more dentists doing NHS work than in 2010, and activity levels are going up. In March the number of patients seen over the past year was up by nearly a fifth on the year before. The initials reforms we have made to make NHS work more attractive are having positive effects but there is much more to do and we will be publishing a plan to improve access to dentistry.

In York alone, practices are closing, turning private and handing back contracts. Units of dental activity are down 126,130 compared with four years ago and it can take five years to see a dentist. This is an unacceptable crisis after 13 years of complete failure. Will the Minister enable integrated care boards to have full flexibility to establish an under-18s NHS dental service in schools, along with a full elderly service and one for the most disadvantaged?

We will look at all those things. We have introduced additional flexibilities, as the hon. Lady knows, and we are allowing dentists to do more to deliver 110% of their UDAs and bringing in minimum UDA values, but we are also interested in prevention and I would be happy to look particularly at what we can do for younger people.

Tooth care, like any other form of healthcare, should be universally accessible, but we know that we are facing a crisis across the UK, with one in five adults who could not get an appointment in the past 12 months carrying out dental work on themselves, or getting someone else to do it, which is quite horrifying. The problem is not confined to one part of the UK. In Scotland, 80% of dentists are no longer accepting new adult or child patients. We have a crisis across the UK, so will the Minister commit to introducing a national programme and to speaking to the Scottish and Welsh Governments to address the shortage of NHS dentists for all of us?

I am happy to work with the Scottish and Welsh Governments. We are, as I said, driving up levels of delivery, and we will be publishing a plan to take that further.

Like other colleagues, I have been approached by constituents who are struggling to find an NHS dentist because their previous dentist has either retired or converted to private practice. When the Minister presents his new dental plan, will it include a target to ensure registrations are available, as well as to increase the number of appointments?

My hon. Friend is right, and I am particularly seized of the issue of access for new patients.

My constituents in Dalton-in-Furness were dismayed to find out that their dentist has closed. This follows the closure of Bupa in Barrow and in Millom, and Avondale in Grange-over-Sands has handed back its NHS contracts. What was a bad situation has got very bad indeed. I am meeting the ICB next week to talk about what it might be able to do, but will the Minister agree to meet me to discuss what levers he can pull to improve dental access in Barrow and Furness?

I am very happy to meet my hon. Friend, and we have already talked to some extent. The minimum UDA value that we introduced particularly helps rural and coastal areas of the kind he represents, and I am happy to talk further, and to go further, on all these things.

As in the NHS, workforce is the biggest single issue. The Nuffield Trust has identified that, post-Brexit, dentists are among the key staff we are losing. On top of that, while Scotland and Wales have childhood dental health programmes, England does not. When will England have a national childhood dental health programme, and when will the contract in England be reformed to reward preventive work, rather than just dealing with emergencies?

We passed legislation last month to make it easier for international dentists to come to the UK by reforming the General Dental Council to speed up the flow from abroad. The hon. Lady mentions an additional service that is available in Scotland. Of course, Scotland has 25% more funding per head than the rest of the UK, which is just one benefit of being in the UK, and it is one reason why people in Scotland voted to remain in the UK.

The lack of NHS dentists is a major concern in north Staffordshire. Does the Minister agree that we should set up a dental school at Keele University, which already has one of the best medical schools in the country?

We are looking at the dentist, hygienist and therapist workforces as part of the long-term NHS workforce plan. I can reveal that this is not the first time my hon. Friend has lobbied me on this idea, and I am sure he will continue to do so.

11. What progress his Department has made on improving access to NHS appointments. (904611)

We are investing at least £1.5 billion to create an additional 50 million GP appointments by 2024. To improve access to hospital appointments we are giving patients choice about their care and offering alternative providers, with shorter waiting times, to long-waiters. We are also investing £2.3 billion in community diagnostic services, which will improve access to tests, checks and scans. One hundred community diagnostic centres are already open, and they have delivered more than 3.6 million additional tests.

If we have a power cut in north Scotland, people get a text message from SSE saying that engineers are coming out and that they will have power by, say, 3 o’clock. Missed NHS appointments are a waste of resources. I understand that some dental practices in England offer some sort of reminder service, but would it not be helpful if a leaf could be taken out of SSE’s book so that everyone with an NHS appointment receives a text to remind them, “You have a test at 10 o’clock tomorrow,” or possibly, “There is a big queue and there are delays, so your appointment has been changed to 4 o’clock”?

The hon. Gentleman is right to raise this issue. Better communication with patients was one of the five principles at the heart of our elective recovery plan, which was published in February. We recommend that all providers use appointment reminders, often through text messages. As he suggests, in some cases that has been shown to reduce “did not attends” by up to 80%. Providers have told us that they see better results when communication is two-way, for example, where patients can reply to cancel their own appointments. Alongside that, we also launched the My Planned Care website, so that patients can access information ahead of their planned appointment, and of course we are doing a lot more with the NHS app. This is just one of the ways in which we are putting patients in control of their own care.

I am the father to two beautiful daughters, Becky and Eris, one of whom was conceived through in vitro fertilisation. Being a father is one of the best things that has ever happened to me, and I was very proud to see IVF services reinstated in Peterborough and Cambridgeshire, following a campaign that I supported and helped to lead. What plans does the Minister have to ensure that IVF services and appointments are routinely offered across the NHS, in line with National Institute for Health and Care Excellence guidance?

I, too, have two daughters, so I recognise much of what my hon. Friend said—

I do, too.

You do, too. Mine were not through IVF, but as a Back Bencher I also campaigned on IVF issues, because there was a postcode lottery on that around the country. That still exists to some extent and I would be happy to work with my hon. Friend to make sure that wherever people are in this country they can get IVF services.

I call the shadow Secretary of State.

The Conservatives have cut 2,000 GPs since 2015 and now too many patients cannot get an appointment when they need one: 3,000 patients are waiting a month to see a GP in Dover; 3,500 are doing so in Mansfield; 3,500 are doing so in North Lincolnshire; and 5,000 are waiting a month in Swindon. So why will the Government not adopt Labour’s plan to double the number of medical school places, paid for by abolishing the non-dom tax status, so that patients have the doctors they need to get treated on time?

I recognise the pressures on the system, but Labour has spent the non-dom money 10 times over. We are taking real action on this issue: real-terms spending on general practice is up by more than a fifth since 2016; as I said, we are investing £1.5 billion to create an additional 50 million GP appointments; we have recruited more than 25,000 additional primary care staff; and there are 2,167 more doctors in general practice; and we have the highest number ever in training.

12. What steps he is taking to reduce the waiting time from receiving a cancer diagnosis to first treatment. (904612)

In February, the faster diagnosis standard was met for the first time. In addition, we are investing in additional screening, testing and tech in order to detect cancer much earlier.

Recent data for the Buckinghamshire, Oxfordshire and Berkshire West ICB shows that 42.6% of cancer patients are waiting more than 62 days for treatment. That will only get worse without a significant programme of upgrading radiotherapy equipment and ensuring that there is a skilled workforce of radiographers. So what steps is my right hon. Friend taking to ensure that new, cutting-edge radiotherapy equipment is making it to the frontline, coupled with a fully staffed workforce to operate it and save those lives?

My hon. Friend is right to highlight the interaction of workforce and capacity in equipment. That is why we have 810 more consultant training places over three years, and we have grants to enable more than 1,000 nurses to train, for example, in chemotherapy and 1,400 new recruits to the cancer diagnostic workforce. Obviously, that sits alongside the expansion in capacity, including both in our surgical hubs and our expanded diagnostic centres.

My constituent had emergency surgery for a brain tumour, but this was after six months of going to the doctor repeatedly with problem headaches. Brain cancer causes 9% of cancer deaths but accounts for only 1% of cases. Sadly, my constituent is terminally ill, but he is in a position to explain his experiences. He has asked me to raise with the Secretary of State the issue of what work is being undertaken on genome sequencing, which could have a major impact on better treatment for brain cancers. It would be helpful if the Secretary of State not only answered this today but wrote to me in more detail on it.

The whole House will send their best wishes to the hon. Lady’s constituent. She raises an important point about genomics, which is why we have invested in Genomics England and 100,000 babies are being screened—that is a key programme of work. The Minister for Health and Secondary Care, my hon. Friend the Member for Colchester (Will Quince) recently hosted a roundtable with key stakeholders on that, but I am happy to write to her with more detail, because the prevention and capability that is offered through screening is a great way of getting early treatment to people.

13. What progress his Department has made on increasing the number of GP appointments. (904613)

I think the question is about GPs and workforce capability, and that is why we are investing in more doctors. We have recruited over 5,000 more doctors, including an additional 2,000 doctors in primary care.

An increasing number of my constituents are having difficulties obtaining appointments in GP surgeries. However, I was pleased to learn that the GP workforce in my constituency of Bexleyheath and Crayford has increased by an estimated 75% since September 2019. Will my right hon. Friend confirm what further steps he is taking to continue growing the workforce in general practice, which is so crucial to increasing the number of appointments available?

Now that I have found the right page in my notes I can be precise in telling my right hon. Friend that it is a 75.7% increase in his constituency, so he is absolutely right about that. Nationally, we have recruited an additional 25,262 full-time equivalent primary care professionals, so that is expanding the workforce capability in primary care. As my hon. Friend the Minister for Health and Secondary Care said a moment ago, it is part of our £1.5 billion investment in the workforce in primary care.

As the House will know, this week is MS Awareness Week. Early diagnosis and treatment of MS are vital to delay disability progression and help those with the condition to manage it, yet, currently, 13,000 people have been waiting more than a year for a neurology appointment after GP referral. A recent study suggested that the UK comes a shameful 44th out of 45 European countries for neurologists per head of population. When will the Government bring forward a strategy to attract, recruit and retain the neurology workforce?

The hon. Lady raises an important issue related to MS. I am happy to write to her with a more detailed answer about the capability and the plan. There is always a tendency within government to lurch to a strategy rather than to look at what is needed for immediate delivery. I will happily set out what steps we are taking now as part of our pandemic recovery in order to target the workforce within the constraints that she raises.

14. What steps he is taking to improve access to in-home health and social care services. (904614)

24. What steps he is taking to improve access to in-home health and social care services. (904624)

I want people to live independently in their own homes for longer with the care that they need. We are investing half a billion pounds annually through the disabled facilities grant to pay for housing adaptations, and supporting the home care workforce through our record social care funding increase and workforce reforms. Our new and expanded NHS virtual wards give people hospital-level care in their own homes.

My constituent, Ewan, recently lost his grandfather. His grandfather would have liked to have spent more time at home in his last few days, but he could not because of resources—the people were not there. What are the Government doing about that? There is a real recruitment and retention crisis in the social care workforce.

The hon. Member makes an important point about people spending their last days of life where they would like to spend them, which, more often than not, means at home. That comes down to supporting end-of-life care—hospices play a really important role in providing that care in people’s homes—and supporting the adult social care workforce. We are investing up to £7.5 billion in social care over the next two years and taking forward important reforms to support the adult social care workforce. As I mentioned a moment ago, we are increasing the amount of hospital-level care that people can get at home by expanding our virtual wards, which, by next winter, will mean that up to 50,000 people a month can be cared for to that level at home.

Despite ministerial complacency, Age UK has pointed out that, nationally, there are currently 165,000 vacancies in social care, which is a 50% increase on last year. In the Wirral, vacancies run at 16%, which is despite the Wirral paying the real living wage. That means that only 26% of hospital patients are currently being discharged from Wirral University Teaching Hospital when they are actually ready to go. Does the Minister agree that the neglect and underfunding of social care by this Government is costing more money through wasted provision in hospitals, when social care, if it were properly provided, could give a much better experience for people who are ready to leave hospital?

I thank the hon. Lady for giving me another opportunity to talk about what we are doing to support adult social care: an extra £7.5 billion was announced at the autumn statement to support adult social, an extra £700 million was spent on supporting discharges into social care over this winter, and we have already announced £600 million to support discharges to people’s homes with the provision of social care over the coming year, because we recognise how important it is for people to get the care they need at home. The workforce are crucial to that, which is why we are taking forward our reforms to the adult social care workforce as announced a couple of weeks ago.

T1. If he will make a statement on his departmental responsibilities. (904625)

The Government support the right to take industrial action within the law, but equally the law is there to protect patients and NHS staff alike. Following legal advice, NHS Employers and my Department are confident that the proposed strike action by the Royal College of Nursing goes beyond the mandate it secured from its members, which expires on 1 May at midnight. While NHS Employers has sought to resolve the issue through dialogue, the RCN’s failure to amend its planned action has led NHS Employers to request my intervention. Even as we work to resolve those issues through dialogue, I can tell the House that I have regretfully provided notice of my intent to pursue legal action. None the less, I am hopeful that discussions can still be productive, especially those between the RCN and NHS England on patient safety, and that they will continue to be guided by the imperative to keep people who use the NHS safe.

The right to choose sounds attractive, but when diabetic eye disease and glaucoma seriously threaten the sight of millions, the fact that any qualified provider can and does cherry-pick reversible cataract work leaves the NHS with astronomical bills and all the complex cases. Will the Secretary of State praise award-winning clinicians Christiana and Evie at Central Middlesex Hospital and visit to see for himself how effectively writing a blank cheque for private treatment is destabilising NHS budgets and jeopardising the NHS’s ability to do award-winning research and to train junior doctors, who need routine work?

I am always happy to praise the brilliant work of clinicians up and down the NHS, who do a formidable job. Given the huge scale of the backlogs we face as a consequence of the pandemic, it is important that we not only use the full capacity available within the NHS, empowering patients through patient choice and technologies such as the NHS app to better enable that, but maximise the capacity in the independent sector.

T7. Following the excellent television campaign on bowel cancer, which by the way got me to take a test, can I now ask that we have a similar campaign to talk about the importance of pharmacists? If people consult pharmacists rather than their GPs on occasion, it will take the pressure off general practices. (904631)

My hon. Friend makes a brilliant point, and that is something that we are committed to doing. There is a huge amount of expertise within the pharmacy network, which is why we are looking, through technology such as the NHS app, at how we can better enable people to get the right care from the right place at the right time. Quite often, that is not by seeing the GP, but it might be by seeing those in additional roles in primary care or going to a pharmacist who can offer the right services.

I call the shadow Secretary of State.

A 13-year-old girl who has already waited more than a year for spinal surgery has seen her operation cancelled twice because of the Government’s failure to negotiate an end to the junior doctors’ strike. Why on earth is the Secretary of State still refusing to sit down and negotiate with junior doctors?

Like others in the House, my heart goes out to any 13- year-old girl in that situation. As the parent of a 12-year-old girl, I can only imagine how distressing it is to the family concerned to see that operation cancelled. That is why it is important that we have dialogue. The hon. Gentleman has said that the demands of the British Medical Association are unaffordable and unrealistic at 35%, as has the Leader of the Opposition. We have been clear on that, but the House saw that in our negotiation with the Agenda for Change staff unions we had meaningful, constructive engagement; that was how we reached an agreement with the NHS Staff Council, and we stand ready to have similar discussions with the junior doctors.

So why is the Secretary of State not sat down with them today? He says that he cannot negotiate because the BMA will not budge on 35%, but that is not true, is it? He says that the junior doctors have to drop their preconditions; they do not have any, do they? And he says that strike action will have to be called off before he can sit down; there are no strike days planned, are there? So is it not the case that he is quite happy to see hundreds of thousands of operations cancelled so that he can blame the junior doctors for the NHS waiting lists rather than 13 years of staggering Conservative incompetence?

It is slightly odd that the hon. Gentleman talks about 13 years when we are actually talking about a current industrial dispute. We have shown, through our negotiation with the NHS Staff Council, our willingness to engage and to reach a settlement. Indeed, the general secretary of the RCN recommended the deal from the AfC unions to her members. Unison—the union of which the hon. Gentleman is a member—voted for the deal by a margin of 74%. We stand ready to have engagement with the junior doctors, but 35% is not reasonable. He himself has said—[Interruption.]

Order. I do not need the Minister for Social Care, the hon. Member for Faversham and Mid Kent (Helen Whately), shouting from the end of the Treasury Bench. Okay? I call Henry Smith.

T9.   What assessment has the Department made of antimicrobial resistance to superbugs originating in industrial farming? (904633)

Successfully containing antimicrobial resistance requires co-ordinated action across all sectors. That is why the UK takes a “one health” national approach to AMR across humans, animals, food and the environment. Since 2014, the UK has reduced sales of veterinary antibiotics by 55% and has seen a decrease in antimicrobial resistance as a result.

I call the SNP spokesperson.

The British Medical Journal has warned that the comprehensive and progressive agreement for trans-Pacific partnership trade deal will make it harder for the UK to regulate tobacco and alcohol or banned products such as those containing harmful pesticides. Given that no health impact assessment has been carried out, The BMJ recommends that one should be performed now. Will the Secretary of State commit to assessing the deal’s threat to public health?

We do not plan to debate any of our existing standards. We have some of the strongest standards for control anywhere in the world. We have no plans to get rid of any of those things.

Notwithstanding the work that the Government have done, the feedback that I am receiving from Suffolk-based NHS dentists is that there is still a very long waiting list for overseas dentists waiting to take the overseas registration examination, with more than 3,000 applicants and only 150 exams taking place each month. I urge my hon. Friend to leave no stone unturned in working with the General Dental Council to eliminate the waiting list as quickly as possible.

We are leaving no stone unturned. Last month, we passed legislation enabling the GDC to increase the capacity of the ORE. We have also made it easier for overseas dentists to start working in the NHS: as of 1 April, no dentist will need to pay an application fee. We also want to radically reduce the time that dentists spend in performers list validation by experience, and we will set out further steps in our dentistry plan.

T2. What is the Secretary of State doing to tackle the severe national shortage of desperately needed psychiatric intensive care beds, which means that people, including some of my constituents, have to travel hundreds of miles to see their loved ones? (904626)

We are spending an additional £2.3 billion a year on mental health services, and we have recently announced £150 million for crisis community support, because we are trying to reduce the number of people being admitted in the first place by treating them at an earlier point in their mental health illness. That will free up beds, but it will take time. Community crisis intervention is the way in which we want to make progress.

Investors need certainty and the British people need access to more medicines. The growth cap in the voluntary pricing agreement for branded medicines between the pharmaceutical industry and Government makes the size of the medicines rebate unpredictable. Will the Minister remove the growth gap from the 2024 voluntary scheme for branded medicines pricing and access, to supercharge investment that is currently leaking to Germany and Ireland?

I can certainly ensure the House that we are seeking a mutually beneficial voluntary scheme that supports patient outcomes, a strong life sciences industry and a financially sustainable NHS. We have been working directly with industry to understand the impact of changes to VPAS on investments into the UK life sciences sector, and we remain firmly committed to VPAS, which, it is important to say, has saved the NHS billions of pounds and saved millions of lives by supporting patients with life-threatening conditions and giving them rapid access to new medicines.

T3. I was very grateful to get fantastic treatment for a detached retina at the brilliant Manchester Royal Eye Hospital, but 551 patients have lost their sight as a result of delayed eye doctor appointments since 2019, and the backlog for ophthalmology appointments is, at 630,000, the second largest in the country. The treatments are there, but what will the Government do to sort that problem out? (904627)

First, I very much welcome the good care that the hon. Gentleman received, and it is great to see him back in the Chamber. On the wider issue, that is why we have an elective recovery plan, in which we have applied a boost in capacity, particularly through the surgical hubs. We are looking at how we build greater resilience, especially in winter, when elective beds are often under pressure. We are also investing in areas such as eye treatment, and we are rolling out through Getting It Right First Time a programme of improvement in a range of areas, including that one.

Provision for special educational needs and child and adolescent mental health services is one of the biggest issues in my inbox in Leicestershire, particularly in respect of delays in assessment and diagnosis. One of the Government’s plans was to introduce school mental health support teams. The Health and Social Care Committee heard that the aim was that 35% of pupils should be covered by 2023. May we have an update on progress and on when we are likely to reach 100%?

My hon. Friend makes an important point, and I am happy to update the House, as we have already achieved 35% coverage. By the end of the month, we expect to have 399 operational mental health support teams, covering 3 million children and young people. We plan to go further, with over 500 such teams by spring 2024.

T4. Last week, I visited Leftwich Community Primary School in my constituency. The joint head teachers raised the desperate attempts that are made to secure NHS dentists for children and families in the community. Aside from publishing a plan, will Ministers intervene and make sure that that happens in Cheshire and Merseyside, and throughout the country? (904628)

Absolutely. We have already taken action to increase the provision of dentistry, and that has begun to have an effect. Activity—the number of people seen—is up by a fifth over the past year as a result of the reforms that we have begun to make by reforming the old contract, but we must go further.

One of my constituents, Bethany Whitehead, suffers from functional neurological disorder, which often presents with a number of debilitating symptoms. Bethany has often been left waiting two to three years before seeing a consultant. Will the Minister meet me to discuss this further?

My hon. Friend makes a really important point. I can say to her here and now that functional neurological disorder was previously regarded through a diagnosis of exclusion. It now has a rule-in diagnosis with available treatments, which is a major step forward in destigmatising the disorder. I am very happy to meet her to discuss this further.

T5. As chair of the all-party parliamentary health group, I have heard from UK patients who struggle to access GP appointments from chain GP practices. Many of those practices have very low ratios of GPs to patients, including, in one case, only two GPs registered for 30,000 patients. Will the Department meet the APPG to address these grave concerns? (904629)

We have increased real-terms spending on general practice by over a fifth since 2016, and as a result there are now 10% more appointments happening every month. We are grateful to GPs for that. We have more doctors and clinicians, but we want to keep going, and I am happy to discuss this with anyone who has useful ideas to keep us powering forward.

Yesterday, when the Prime Minister met business, the huge value of the NHS database was highlighted. Unfortunately, the previous occasions on which the NHS has tried to open its database have been unmitigated disasters. Will the Secretary of State give an undertaking to stick closely to the recommendations of the Goldacre report so that we can deliver the database while protecting the privacy of patients?

It is a huge opportunity. My right hon. Friend and I have discussed this matter outside the Chamber, and I met Ben Goldacre in the summer to discuss his fantastic work in the context of covid. It is absolutely right that, given the potential of artificial intelligence, there are huge opportunities in relation to health inequalities and allowing us to better target provision. I think my right hon. Friend would agree that we should do that through the prism of patient consent. One thing that we are trying to build into the NHS app is the ability to better empower the patient to decide what they wish to sign up to and what they would like their data shared with.

T6.   By 2040, cancer rates in the UK are expected to rise by a third. That is half a million new cases each year, so hundreds of thousands of lives literally depend on the Government implementing a long-term, fully funded, comprehensive plan for cancer. Will the Secretary of State recommit to a 10-year cancer plan? (904630)

We are committed to a major conditions paper, not least because many people with cancer have multiple conditions; that is why it is important that we look at these issues in the round. With the Minister for Social Care, I had a very useful roundtable with key stakeholders, including the cancer charities. The key issue is that as part of our work on cancer checks, over 320,000 more people are receiving treatment for cancer compared with last year—that is around fifth higher—and we are expanding our capacity through the diagnostic centres, the surgical hubs and the expansion of the workforce. All of that fits within the strategy we have through the major conditions paper.

St Rocco’s Hospice in Warrington provides invaluable palliative and end-of-life care for families. However, the charities that run hospices around the UK are finding it incredibly difficult to raise funds. Will the Minister give us an assurance that she is working very closely with the sector to ensure that those services continue to be provided?

My hon. Friend makes a really important point about the very important work that hospices do in our communities, and I fully support hospices as a sector. The funding for hospices generally comes through the NHS and the local integrated care boards that commission the services they provide, as well as, of course, from their own fundraising efforts. I am speaking to NHS England about the support it provides to hospices, because I am very keen to make sure that they get the support that they need.

T8. I have in my hands the draft business case for a satellite radiotherapy unit at the Westmorland General Hospital in Kendal. If it is approved and commissioned, residents in my community who have cancer will no longer have to travel two, three or four-hour round trips every day to get lifesaving treatment; they will be able to get it closer to home. Will Ministers meet me and the clinical specialists who helped draft the business case, so that we can make it come to fruition? (904632)

Yes, I am very happy to meet the hon. Member.

Building on the novel approach to clinical trials that was so successful for the covid-19 vaccines, what more is the Department doing to capture that success and the willingness of volunteers to come forward, as well as to streamline processes across participating bodies for clinical trials of future medicines?

My hon. Friend is right to raise this issue. Over 12,000 more participants a month are recruited into clinical trials than before the pandemic, but we recognise that there is much more to do in order to be internationally competitive, including around regulation and speed of approval. I am pleased to say that in the coming weeks, Lord O’Shaughnessy will publish his independent review into UK clinical trials, and I very much look forward to receiving his recommendations.

T10.   When we had a shortage of doctors, the last Labour Government established the Hull York Medical School. We now have a shortage of dentists, so it is time for a Hull York dental school. This proposal has cross-party support in the Humber, so I wonder whether a delegation of MPs could meet the Minister to discuss taking the initiative forward. (904634)

I am very happy to meet the right hon. Lady as we work towards the workforce plan and the dental plan.

I call Mark Fletcher to ask the final question.

The Minister is aware that BUPA recently closed the dental practice in Bolsover, leaving a severe shortage of NHS dentistry in the constituency. I met the ICB yesterday to discuss the various options for the constituency, but will the Minister commit to meeting me and the ICB to talk through those options and see what we can do to maintain NHS dentistry in Bolsover?

I have already met my hon. Friend, but I am very happy to meet him and his ICB to make sure that we commission the services that are so needed locally.

Bill Presented

Digital Markets, Competition and Consumers Bill

Presentation and First Reading (Standing Order No. 57)

Secretary Kemi Badenoch, supported by the Prime Minister, the Chancellor of the Exchequer, Secretary Michelle Donelan, Secretary Lucy Frazer, Kevin Hollinrake, Paul Scully and Julia Lopez, presented a Bill to provide for the regulation of competition in digital markets; to amend the Competition Act 1998 and the Enterprise Act 2002 and to make other provision about competition law; to make provision relating to the protection of consumer rights and to confer further such rights; and for connected purposes.

Bill read the First time; to be read a Second time tomorrow, and to be printed (Bill 294) with explanatory notes (Bill 294-EN).