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Health and Social Care

Volume 733: debated on Tuesday 6 June 2023

The Secretary of State was asked—

Urgent and Emergency Care: Growing Towns

1. What assessment his Department has made of the adequacy of urgent and emergency care provision in towns with significant population growth. (905207)

Our recovery plan for urgent and emergency care provides £1 billion of additional funding for NHS capacity, alongside £250 million for capital improvement schemes up and down the country. Local integrated care boards are now responsible for working with their partners to decide how best to use that funding to improve services to meet the health needs of their changing populations, and all integrated care boards will shortly set out their plans for the next five years through a joint forward plan process.

Rugby is the largest urban area within Coventry and Warwickshire that does not have its own A&E provision. In the wider region, Kettering, Shrewsbury, Redditch and Burton upon Trent all have similar or smaller populations, each with their own A&E services. Rugby is growing fast, with 12,500 homes being delivered between 2016 and 2031, when the population will exceed 135,000. Will the Minister say at what population level it will be appropriate for local health commissioners to upgrade the A&E provision at the Hospital of St Cross in Rugby?

As my hon. Friend knows, the provision of services, including accident and emergency, are a matter for local NHS commissioners and providers. I know that he regularly meets local NHS leaders about this matter and will continue to do so. I am very happy to meet him and, of course, visit. Funding for Coventry and Warwickshire Integrated Care Board has increased to over £1.6 billion this year. My hon. Friend is a huge champion for his constituents; I would be happy to meet and visit.

The population of my constituency is due to grow rapidly over the next 10 years and beyond. On that basis, can the Minister give a completion date for the new Whipps Cross Hospital, which was announced last week?

And obviously we want 24-hour provision in Chorley, which has the fastest-growing population, but let us move on.

Complex Mental Health Needs: Young People

2. What assessment he has made of the adequacy of the treatment and care available for young people with complex mental health needs. (905208)

We have recruited an extra 4,500 NHS children’s mental health specialists, which is a 40% increase on 2019. That is part of our additional £2.3 billion of investment into mental health services, compared to four years ago.

Earlier this year, I was contacted by a mother who told me how her daughter, who has been both autistic and anorexic, has been receiving treatment since she was 13. Sadly, her condition has significantly deteriorated in that time, and it is her firm belief that closer integration of the different services she was accessing would have resulted in much better outcomes for her daughter. Will the Secretary of State consider a review of mental health services for children and young people, to look at how to better integrate services and ensure continuity of care?

I am sure the whole House is sorry to hear that her constituent’s condition has deteriorated. The hon. Lady raises a very important point about integration, which is exactly the right approach. The 2022 reforms were about integrating health and social care and empowering commissioners to take a more integrated place-based approach. I am sure her local commissioners will take note of the valid point that she raises.

A 14-year old climbing out of hospital windows; a child absconding to a local railway station; a teenager with complex needs brought to A&E, requiring four police officers to spend an entire shift watching them, only for them to abscond the next day. There is a pattern here. At almost every step of the way, children needing mental health services face a perfect storm of delay and treatment in inappropriate settings, fuelled by an under-resourced service with over-stretched staff. In light of the Met’s announcement that they will stop attending emergency mental health calls, is it not time for the Government to get their act together, or simply do the right thing and step aside?

One can see the way the Government are responding constructively to these issues by looking at the pilots we have been rolling out in Humberside, where police are released within one hour in 80% of section 136 detentions. We intend to roll out that pilot nationally.

The hon. Lady is right on the first part of her challenge, as demand for mental health services is increasing. In fact, there was a 41% increase in new referrals to mental health services in 2021 compared to the previous year. Where she is wrong is on the resourcing. She missed my previous answer that set out how we are committing an extra £2.3 billion of investment into mental health services, compared to four years ago.

Notices of Decision for Care Homes: Change of Ownership

3. Whether he is taking steps to ensure that notices of decision for care homes do not lapse upon a change of ownership unless standards improve. (905209)

When a care home is taken over, the Care Quality Commission assesses and re-rates it under its new ownership. Previous notices of decision cannot legally be passed to a new provider, but they do inform the CQC’s approach to an assessment and how soon it takes place. During the time between the takeover and the CQC’s carrying out a new assessment, the legacy rating is shown on the CQC website.

My constituents Brenda, Gary and Trina lost their parents after they were placed in Melbourne House care home, which the CQC later deemed to be “inadequate”. However, because the notice of decision lapsed on its transfer to the original owner’s family, the home, now known as Earlsdon Lodge, is able to operate as if nothing had happened. Will the Minister meet my constituents and me to explain exactly why that was allowed to happen, and what is being done to prevent it from happening to other families?

I shall be happy to meet the hon. Member to look into that case, because I feel strongly about the importance of ensuring that everyone has access to good, if not outstanding, care in care homes.

Sun Protection Products: Affordability

4. If he will make an assessment with Cabinet colleagues of the potential impact of increasing the affordability of sun protection products on levels of skin cancer. (905210)

Last month was melanoma month and skin cancer month, and people are increasingly aware of the risks of excessive sun exposure without protection. Through the energy price guarantee and our direct support for vulnerable households, we have provided cost of living help worth, on average, £3,300 per household.

Since the early 1990s cases of skin cancer have doubled, with nearly 16,000 new cases diagnosed each year leading to 2,300 avoidable deaths annually. If some products were more affordable, more of our constituents might be able to use them and bring those numbers down. Will the ministerial team make representations to their Treasury colleagues about the Sun Protection Products (Value Added Tax) Bill, a private Member’s Bill promoted by my hon. Friend the Member for East Dunbartonshire (Amy Callaghan) which would remove VAT from some sun protection products, so that we can start to make an impact on those appalling figures?

As the hon. Gentleman knows, tax matters are for the Treasury, but we are absolutely committed to providing cost of living support. By the end of June the Government will have covered nearly half a typical household’s energy bill since October, so we are providing one of the most generous packages in Europe.

The last time I asked Ministers whether they would support that Bill I was told that the issue of VAT and skin cancer was a matter for the Treasury, and we have just heard a similar answer. Surely this is a matter for joined-up government. What are Ministers doing—instead of imposing more pressure and costs on the NHS—to persuade their Treasury colleagues to consider more cost-effective cost preventive measures such as making skin protection products more affordable?

The hon. Gentleman is campaigning for a reduction in the VAT on suncream, but let me put this into perspective. As I have said, our cost of living support is worth, on average, £3,300 per household. That is help on a huge scale. On cancer we are taking more action across the piece, and more people are being given life-saving checks, referrals and treatment than before.

Cancer Waiting Times and Outcomes

We are diagnosing and treating patients faster. In March, nearly three in four people were diagnosed or given the all-clear within two weeks—ahead of the 28-day target—and nine in 10 patients start treatment within a month.

In May last year I wrote to the then Health Secretary and the Prime Minister about the case of a young man in my constituency, Elliott Simpson, who was misdiagnosed with a water wart in a telephone consultation with a GP. When Elliott was finally able to see someone face-to-face, he found that he had late-stage skin cancer. He passed away on 28 April, aged just 27.

Between January and March this year, both the two-week wait target and the 62-day target were missed at East Lancashire Hospitals NHS Trust. Does the Secretary of State accept that delays are costing lives?

The whole House will be hugely saddened to learn of the passing of Elliott, especially at such a tender age.[Official Report, 20 July 2023, Vol. 736, c. 16MC.]

The hon. Lady is right to highlight the importance of speedy diagnosis, and I was pleased that we met the faster diagnosis standard in February for the first time and again in March, with three in four patients receiving their diagnosis within two weeks and nine in 10 starting treatment within a month. She is also right to point out that there is still variation between trusts, and we are focusing on that in particular, but it is good that nationally we are hitting the faster diagnosis standard.

When I was diagnosed with multiple myeloma six years ago, my GP gave me two pieces of advice: keep positive and keep active. The other day, I visited the wellbeing centre in my constituency, which is run by Sheffield Hallam University, the Sheffield Teaching Hospitals NHS Foundation Trust and Yorkshire Cancer Research. It is putting on a programme called Active Together to which people who are diagnosed with cancer can be referred by their consultant and have a bespoke programme of treatment involving physical activity, nutrition and psychological support to prepare them for surgery, and a programme after surgery to help them recover. Would the Secretary of State like to come to my constituency to visit this novel and innovative programme to see how it could be rolled out across the country and treat more cancers well in this way?

The hon. Gentleman raises an interesting and important point. How we better equip patients pre-surgery and post-surgery, how we look at their wellbeing—the keep positive bit and the social prescribing—and how we think about being active are all are hugely important. I would be keen to learn more about the programme that he highlights and for either me or one of the ministerial team to follow up on his offer.

In March, the all-party parliamentary group on brain tumours published its report into research funding, which found that only about £15 million of the £40 million pledged has made its way into the hands of the researchers. Can the Secretary of State set out what we can do to fix these challenges in the funding system so that we can get that money into the hands of the researchers and improve those outcomes?

I welcome the fact that my hon. Friend has raised this point, because the £40 million of funding is available. That money is there, ready to allocate to quality bids. All the bids that have met the National Institute for Health and Care Research standard have been funded, but she is right to say that there is more money available and we stand ready to work with researchers to get that money allocated as soon as those quality bids come in.

Analysis by Cancer Research UK projects that, by 2040, cancer cases will rise to over half a million new cases a year. Will the Secretary of State confirm when the NHS long-term workforce plan will be published, that it will set out transparent projections for workforce need for the next five, 10 and 15 years, and that it will be fully funded to ensure that there are enough staff to deliver timely diagnosis and treatment for cancer patients?

The hon. Lady is correct to say that demand for cancer services is increasing. We have seen demand up a fifth recently. That is why, alongside the long-term workforce plan, to which we are committed—the Chancellor set out that commitment in the autumn statement—we are also putting over £5 billion of investment into diagnostic centres, surgical hubs and equipment in order to better provide, alongside the workforce, the skills and equipment we need to treat cancer.

What assurance can the Secretary of State give that both the letter and the spirit of section 5 of the Health and Care Act 2022 will be embraced to encourage the NHS to improve early diagnosis and therefore cancer survival rates by focusing on outcome measures such as the one-year survival rate, so that we can start catching up with international averages when it comes to survival?

I pay tribute to my hon. Friend, who has long championed this issue. Indeed, he secured an amendment to the Health and Care Act as part of that campaign. We will be fulfilling our obligation by including an objective on cancer outcomes when we publish the next mandate to NHS England, and I hope he will see that as a welcome step.

To improve cancer waiting times and outcomes, and learning from the success of the covid vaccine roll-out where hard-to-reach cohorts were vaccinated in everyday settings such as shopping centres and football stadiums, will my right hon. Friend look at locating more community diagnostic centres away from formal clinical settings in hospitals and taking them out into the community?

This is an innovative and exciting development, thinking about how we offer services in different ways and bring those services to patients much more locally. The community diagnostic centres are a huge step forward in that, but we should also be looking at our engagement with employers, at how we use more tests at home and at the successes we have had, for example, with some of the screening programmes in order to offer more services closer to patients.

The figures on diagnosing people with cancer are certainly improving, but what is getting worse, and has got significantly worse in the last three months, is the starting of treatment for people who definitely have cancer. The figures are now the worst on record, with 19,000 people waiting for treatment, and all the evidence suggests that waiting another week adds 10% to the likelihood of death. Can I please urge the Minister not always to give the rosy, good statistics but to face up to the fact that there are real dangers in the statistics, too?

I know the hon. Gentleman takes a very close interest in this, and we can all see that there is a shared desire to meet the increasing demand. He recognises the progress on diagnostics. Nine in 10 patients are starting treatment within a month, and the all cancer survival index for England is steadily increasing, but I agree that there is much more still to do, which is why we are investing in diagnostic centres, surgical hubs and the long-term workforce plan. I am very happy to continue working with him and other colleagues as we meet this ongoing challenge.

Does the Minister agree that one of the ways we can improve cancer care and outcomes is by supporting brilliant charities such as Chemocare Bags? Emma Hart and her team do an outstanding job of putting together bags, which include fluffy socks, puzzle books, colouring books, mints and lip salve, for those starting chemotherapy at Ysbyty Gwynedd in Bangor.

I am very happy to join my hon. Friend in paying tribute to all those who support Chemocare Bags for the fantastic work they do. That sort of support makes a real difference to patients, and the NHS benefits hugely from the work of volunteers, including those at Chemocare Bags.

As my hon. Friend the Member for Rhondda (Sir Chris Bryant) pointed out, the brutal truth is that the Tories have consistently missed England’s cancer treatment target since 2013. Last year, 66,000 cancer patients waited more than two months for their first treatment following an urgent GP referral, and the UK now has the worst cancer survival rate in the G7. Labour will give the NHS the staff, the technology and the reform it needs, and we make no apologies for expecting cancer waiting times and diagnosis targets to be met once again. That is our mission. Why is theirs so unambitious?

We are making significant progress. The hon. Gentleman specifically mentions GP referrals, and there were more than 11,000 urgent GP referrals for suspected cancer per working day in March 2023, compared with just under 9,500 in March 2019, so we are seeing more patients.

Let me give an indication of how we are innovating on cancer. We have doubled the number of community lung trucks, which means the detection of lung cancer at stages 1 and 2 is up by a third in areas with the highest smoking rates. In the most deprived areas, we are detecting cancer much sooner, and survival rates are, in turn, showing a marked improvement.

Healthcare for Women

This is the first Government to produce a women’s health strategy in England. We are making huge progress on the eight priorities in our first year, from introducing the hormone replacement therapy pre-payment certificate, which is reducing the cost of HRT for women, to the £25 million roll-out of women’s health hubs across the country. We will be announcing our second-year priorities in due course.

Half of all women over 50 will experience bone fractures due to osteoporosis, and many of these will be serious hip fractures. As many women will die from these fractures as from lung cancer or diabetes. Can the Minister explain why not even one of the 63 key performance indicators set by NHS England for integrated care boards sets a target for fracture prevention?

I thank the hon. Lady for her work in this space. She is campaigning hard on this issue. I reassure her that osteoporosis is in the women’s health strategy and is a priority area for us. We are already working to make sure that women’s vitamin D status is known, and to make sure that we fill gaps. NHS England is expanding fracture services for high-risk women with osteoporosis, and it is working to prevent falls. The women’s health ambassador is raising the profile of osteoporosis so that women who are at higher risk can take action to prevent fractures and falls in the first place.

Women too often struggle with needless pain through standard but invasive procedures, such as hysteroscopies and intrauterine device fittings, offered without any pain relief. Our pain is being misunderstood and ignored. How much unnecessary pain must Ministers see women endure before the Government finally deliver on the pain management promised in the women’s health strategy? And why is this a 10-year ambition instead of a more immediate one?

I thank the hon. Lady for her question, and let me also pay tribute to the hon. Member for West Ham (Ms Brown), who has campaigned hard in this space. I met a group of women to discuss painful hysteroscopies just a few weeks ago. This is a priority in the women’s health strategy, as the hon. Member for Luton North (Sarah Owen) said. We are working with the royal college to update its guidelines, because a lot of these issues are associated with women’s consent, the provision of information before these procedures, and women knowing that they can have them under a local or general anaesthetic and can also ask for pain control. This is not working in practice, which is why it is a priority in the women’s health strategy.

Women living with HIV of course have the right to healthcare on the same terms as anyone else, except that now they do not when it comes to starting a family. Many people living with HIV are currently excluded from accessing fertility treatment, both by law and by the Government’s microbiological safety guidelines. So will the Government now follow the scientific evidence, particularly on undetectable viral load, and remove what are surely discriminatory restrictions on the basis of HIV status?

I thank the Chair of the Health and Social Care Committee for his question, as he raises an important point. Last year, we asked the Advisory Committee on the Safety of Blood, Tissues and Organs to reconsider this specific issue. It set up a working group in June last year to look at it and we expect its recommendations this month. We will take them seriously and address them swiftly once we have its advice.

So many women’s health issues begin with birth and pregnancy, as health is often dependent on the care and aftercare that women receive. Will my hon. Friend give the House an update on the recruitment of midwives and maternity teams, as Gloucestershire NHS is working so hard on that, in order to fully reopen Stroud Maternity Hospital?

I thank my hon. Friend, who does a huge amount of work supporting her local midwives in Stroud. I can give her encouraging news: not only have we spent £190 million on midwifery services, but we are seeing an increased number of midwives coming through midwifery training. Excitingly, we have a nurse conversion course, which takes 18 months, with NHS England paying the tuition fees for nurses to convert to being midwives. We have had 300 in training this year and we are expanding that to 500 in the next academic year. We have encouraging retention rates too, which show that midwives are not only joining the profession, but staying in it.

There is a particular group of women whose health needs should be highlighted during Carers Week: women who look after an older or disabled relative. The majority of unpaid carers in their 50s and 60s are women. Eight million unpaid carers have seen their own health suffer, with those providing high levels of care twice as likely to have poor health as people without caring responsibilities. So will the Minister finally commit to a cross-Government national carers strategy, including health issues in it, as the last Labour Government did? That is a key demand during this year’s Carers Week.

I thank the shadow Minister for her question. My colleague the Minister for Social Care is hosting an event today for carers, and £300 million for carers in the better care fund has also been released. I am a carer for my dad, who thankfully is well and spritely, so I understand the pressures of this. Recently, I met carers from Kinship; often they are grandparents, and older aunts and uncles, who look after young children. Work is going on between us and the Department for Education on how we can better support kinship carers, who do fantastic work in looking after young children. We fully recognise the issue, and the Social Care Minister is not just providing funding, but meeting those carers to see how we can better support them.

Arthritis: Treatment Waiting Times

NHS England has drawn on the work of Versus Arthritis, including its joint replacement support package, in the resources it provides to support people waiting for hip and knee replacements. Alongside that, we know that what people really want is faster treatment. That is why we are working so hard to cut waiting lists, which is one of the Prime Minister’s five key priorities.

I am glad that the Minister referenced Versus Arthritis, because it does great work, but it has significant concerns about the waits for treatment for people living with arthritis. While recognising the efforts of hard-working NHS staff, there are more than 800,000 people in England waiting for trauma and orthopaedic treatment, including more than 5,500 Southwark constituents waiting for treatment at Guy’s and St Tommy’s hospitals. Will the Minister meet staff from Versus Arthritis specifically to discuss how to better support people waiting for those treatments?

As the hon. Member said, Versus Arthritis is doing really important work not only supporting people with arthritis while they wait for treatment, but better preparing them for surgery. What is really important, as I said a moment ago, is reducing those waits and the work that we are doing on that. We have already virtually eliminated two-year waits, and 18-month waits have been reduced by more than 90%, which is quite a contrast, we know, to the performance of the Labour-run NHS in Wales. I encourage Versus Arthritis to contribute to our call for evidence on the major conditions strategy where we are looking at what more we can do to support people with, among other things, muscular skeletal conditions.

Primary Health Care Facility: East Sefton

The Government are providing record levels of capital to the NHS, with more than £24 billion allocated between 2022-23 and 2024-25, over £12 billion of which is allocated to integrated care boards themselves to invest in local priorities, including primary care facilities, of which just under £700 million has been allocated to NHS Cheshire and Merseyside integrated care board.

The Minister has just reminded us that the allocations are made by Government to integrated care boards. The problem is that, with a board the size of Cheshire and Merseyside, there are very many competing priorities. Sefton Council has secured more than £1 million from developers for a new health centre in East Sefton. The Health Secretary’s recent predecessors, of which there have been many, have agreed with me that a new health centre there is a priority. Will he and his colleagues match the priority accorded to this by their predecessors, match the ambition of my constituents and support the commitment by Sefton Council and award that additional funding, so that my constituents can get that much-needed health centre in East Sefton?

The hon. Member has been campaigning doggedly for this for several years, and I am sure that his local ICB will be strongly seized of that and the strong arguments for it. He raised the issue of developer contributions. One thing that we have done in the most recent primary care recovery plan is set further steps to increase investment from developer contributions so that we match new housing with the much-needed infrastructure, such as primary care facilities.

GP Appointments

We are taking action to increase the workforce in general practice. We have managed to hit our target of recruiting 26,000 extra clinicians a year earlier. In fact, we have 29,000 extra clinicians in GP surgeries as well as nearly 2,000 more doctors. Of course, we will go further: as well as increasing the training of GPs to a record level—up from about 2,600 to 4,000 a year—we are also taking action to improve technology to take the burden of bureaucracy off GPs through our primary care recovery plan.

Although I appreciate the Minister’s response, Sittingbourne and Sheppey still has one of the highest patient to GP ratios in the country. Without more GPs, no initiative to increase appointments will succeed. Our local integrated care board is doing its best to bring more doctors to our area. What help can my hon. Friend give to the ICBs so that they can provide my constituents with the GPs they need?

My hon. Friend is quite right that we absolutely need to go further. That is why, through the primary care recovery plan, we are taking some of the pressure off general practice, investing £645 million in the new Pharmacy First service, which will free up about 10 million GP appointments a year. That is why we are investing about £60,000 per practice in new IT and modern online systems. None the less, he is totally right: we need those doctors in general practice. We have about 2,000 more now than we did in 2019, but we will go further. We have already increased GP training and we are looking at building on that further.

Can the Minister clarify when Oldham will receive its share of the 6,000 additional GPs that were promised in the Conservative 2019 general election manifesto? Today we are running with fewer GPs, and that is not helpful to anyone.

I have already noted that we have increased the number of doctors in general practice by nearly 2,000 since 2019 alone. The number of direct patient-facing staff in general practice is 50% higher in total than in 2019, and that is up right across the country. However, of course we will go further and grow the number of clinicians in general practice, building on what we have already done.

The primary care recovery plan includes excellent measures to extend visas for international medical graduates, but can my hon. Friend say whether that extension will be automatic, answering the concerns of the Royal College of General Practitioners, and whether it will be in place for the 1,000 or so graduates coming this June and August?

My hon. Friend modestly does not mention his role in advocating for that important reform, which will help to increase the number of highly qualified GPs coming from other countries to work in the NHS. We will ensure that that extension is automatic, so that people have extra time to make sure they get the right placement in general practice.

There was a net loss of 577 full-time equivalent GPs last year. A contributing factor in rural communities was the Government’s decision a few years ago to remove the minimum practice income guarantee, making it unsustainable for small surgeries—and many rural surgeries are necessarily small—to survive. Will the Minister consider whether it is time to reintroduce a strategic small surgeries fund, to allow smaller rural surgeries in communities such as mine to survive and thrive?

The funding formula already takes account of rurality. I hear the hon. Gentleman’s argument, but it is worth noting that our GPs are doing more than ever before. In the year to April there were nearly 10% more appointments than before the pandemic, or 20 more appointments in every GP practice per working day. GPs are working incredibly hard, as well as putting in extra staff, and I pay tribute to them for the sheer amount of work they are doing.

The Minister recently joined me at the Thistlemoor medical centre at the heart of my constituency. Led by the inspirational Modha family, the team prioritise making face-to-face appointments available for patients by having amazing admin and support staff who speak a variety of languages. That means that, by the time the patient sees the GP, all the relevant checks have been done and the GP has all the relevant information. How can we better use admin and support staff at GP surgeries so that doctors can maximise their time and operate at the very top of their licences?

It was an absolute pleasure to meet the Modha family and see the inspirational work happening in my hon. Friend’s constituency. In our primary care recovery plan we are learning some lessons from that work, particularly about focusing GPs’ time on the jobs only they can do—hence the investment in the extra 29,000 additional roles reimbursement scheme staff, the detailed plan in the primary care recovery plan to improve communication between hospitals and GPs, the cutting back of unnecessary bureaucracy, and the freeing up of resources by simplifying the investment and impact fund and the quality and outcomes framework. It is brilliant to learn from the inspirational work happening in his constituency.

Recent research from the Nuffield Trust shows that Brexit—a Brexit supported by both the Government and the Labour party, it has to be said—has worsened the shortage of NHS staff across the UK. Indeed, it has led to more than 4,000 European doctors choosing not to work in the national health services across the UK, due to higher costs, increased bureaucracy and uncertainty over visas. Can the Minister tell me whether that is one of the success stories of Brexit that we keep hearing about?

International recruitment is up. In fact, we have 38,000 more doctors and 54,000 more nurses in the NHS than in 2010. In England at least, we are taking every step we can to draw on that international talent and we are using it to grow staffing in the NHS.

From Sittingbourne via Bristol and Oldham, people are fed up with not being able to speak with a GP when they need to. GPs are warning that rising demand and increased costs may lead to workforce cuts or even closures. They are fed up with the bamboozling of numbers—more of which we have heard this morning—whether on GPs, full-time trainees, locums and now appointments. Whatever the metric, can the Secretary of State or the Minister tell us how many more GPs or GP appointments they think are necessary for people to access the care that they need?

We committed in our manifesto to increasing the number and availability of appointments by 50 million. We are well on our way to meeting that target, as I have mentioned—we had 10% more appointments in the year to April than in the year before the pandemic. That is the result of the additional staffing that we are putting in: the extra 29,000 other clinicians and the nearly 2,000 more doctors in general practice. We have made that investment, but the reason why GPs are doing more appointments is not just that we have provided a fifth more funding since 2017 up to 2021; it is also that GP teams are working incredibly hard, and I pay tribute to them for all they are doing.

New Hospitals and Health Centres: Funding

We are investing record sums in the NHS estate, with more than £20 billion in the largest hospital building programme and, in addition, a further £1 billion to put an extra 5,000 bed capacity into NHS trusts, and more than £5 billion as part of our elective recovery plan, including for diagnostic centres and new surgical hubs.

The Secretary of State is aware of the £30 million bid that we have submitted to redevelop Thornbury health centre. That new facility would provide GP appointments, more out-patient services, more mental health support and a proactive frailty hub to keep elderly residents in their homes for longer with the support that they need. Thornbury is a growing town and it desperately needs the new facility. Can the Secretary of State update me on the timescales for the outcome of our bid, and will he meet me to discuss it in more detail?

I know that is an extremely important scheme. My hon. Friend will know that the costs have risen considerably from when it was first proposed, and it is therefore right that we look at embracing modern methods of construction and at whether a rebuild option is the way forward. I am very happy to meet him to discuss it.

The Government have failed to support the East London NHS Foundation Trust’s bid for a new hospital, despite the fact that it has the capital to build the much-needed Bedford health village. We have a mental ill-health epidemic among adults and children. Does the Minister agree that it is reckless to expect my constituents to wait many months and to travel miles to access in-patient mental health services?

The hon. Gentleman might have missed in the announcement we made a couple of weeks ago that we are building three new mental health hospitals as part of the hospital building programme. That is also a part of our wider support for mental health, including the extra £2.3 billion of funding compared with four years ago.

May I thank my right hon. Friend for the rapid progress he is making on the hospital building programme? Can he confirm that he will shortly be announcing a full and final programme of funding so that we can deliver a superb new state-of-the-art hospital in Hillingdon, where, I am proud to say, enabling works are already under way?

I am delighted to hear that the enabling works are under way. I know that my right hon. Friend has championed both Hillingdon and the new hospital building programme. I am sure that he will welcome the investment of more than £20 billion. I can confirm that Hillingdon will be fully funded. In addition to the enabling works, we are working closely with the trust to incorporate the Hospital 2.0 design into Hillingdon, as we will at Whipps Cross, as part of taking that programme forward.

Chorley is extremely important, Mr Speaker—I am very sighted on that.

Our commitment is that that is part of the new hospital building programme. We said that it is part of the rolling programme, so it will not be completed by 2030 but we are keen to get work started on it, and that is exactly what we will be discussing with Members of Parliament in the weeks ahead.

Dental Recovery Plan

Our dental plan will be out shortly. We are already taking steps to reform the contract. We have created more bands for units of dental activity, to better reflect the fair cost of work and to incentivise NHS work. We have introduced a minimum UDA value to sustain practice where it is low, allowing dentists to deliver 110% of their UDAs. As a result, the amount of dental activity being delivered is up by about a fifth on a year ago, but we know that we must go further.

I welcome the Minister’s response and his comments in a recent Westminster Hall debate. It is clear that there is still a problem, and many of us are still asking for the recovery plan to come forward. I am afraid that “soon” is not good enough. Nearly every single one of the NHS dentists in my constituency is either not taking on new patients or leaving the area. “Soon” needs a date. Can we have this plan either immediately or sooner?

I was seized by the thoughtful comments that my hon. Friend made in that Westminster Hall debate. We are working on all those ideas, and the plan will be out very shortly.

I thank the Minister for his response. Would he consider encouraging more students to go into dental work by writing off student loans for those who go into NHS dental work for a five-year period—in other words, we get something back if we invest in them?

At every stage, we are taking action to get more dentists doing NHS work. There are 6.5% more dentists doing NHS work than in 2010. The hon. Gentleman has an important idea. We are doing other things to retain NHS dentists, such as the important reforms that we made to pensions, which have helped both GPs and NHS dentists.

Improving Hospital Facilities

The Government are providing record investment in NHS hospital facilities to improve staff and patient experiences and provide extra capacity to cut waiting lists, including the more than £20 billion that we announced just under two weeks ago.

I thank the Secretary of State for his serious investment in Leicestershire, with £14 million for the diagnostic centre in Hinckley and now part of that £20 billion going to Leicester Royal Infirmary, Leicester General Hospital and Glenfield Hospital, including for upgrading the car park. But there is one final part. In 2018 we had £7 million allocated to Hinckley for improvements, but due to covid and the community diagnostic centre investment, the business plan has changed to a day case unit. The money is there. Will he remove the red tape and look on this kindly and swiftly?

My hon. Friend is right to highlight the series of investments that we have made in his local area. On the specific case he raises, he will know that the business case needs regional approval, and that is currently with NHS colleagues, but I am happy to commit to him that once that is received, we will look at it very keenly.

How much of the reduced £20 billion for the 2030 new hospital programme, if any, is secured for Imperial College Healthcare NHS Trust hospitals, and what are the new completion dates for building works to Charing Cross, Hammersmith and St Mary’s hospitals, now that they have been removed from the list of projects to be completed by 2030?

As I set out in my statement, there are three schemes within the trust proposal. That is part of the rolling new hospital programme. We are keen to get the enabling works started as soon as possible. That includes a decant at Charing Cross to enable floor-by-floor refurbishment to proceed. We also need to discuss with the trust potential sites for St Mary’s. There is a considerable amount of work to be done, but we are keen to get that enabling work done as soon as possible.

I warmly welcome the works beginning on the new £26 million A&E facility in Swindon, hot on the heels of the £23 million urgent care and radiotherapy centres. Will the Secretary of State confirm that this is the single largest investment in Swindon healthcare facilities?

I am very happy to confirm that it is the largest investment in Swindon facilities. My hon. Friend is right to draw the House’s attention to the £26 million investment in A&E and the £23 million investment in radiotherapy. It is a tribute to his championing of the need for those facilities in Swindon that the NHS has responded and this capital funding has been provided.

I have seen the wide smiles in the pictures of the Prime Minister, former Health Secretary and other MPs who have been happy to visit North Tees hospital in my constituency, where health inequalities are some of the worst in the country. They know that it is not fit for purpose, so why on earth have the Prime Minister and his Health Secretary turned their backs on the dedicated staff there and rejected their bid to replace our rundown hospital?

The hon. Gentleman seems to have missed the £12 billion record investment in capital across the NHS, the investment in the NHS app, the investment in tech—

No, the technology programmes are national programmes that cover everyone, including North Tees. It is slightly odd to suggest that one place alone in the country would be exempt from a national programme; that is simply not the case. We are making record investment, including over £20 billion in the new hospital programme and 160 diagnostic centres and 43 new surgical hubs this year.

Topical Questions

As Health Secretary, I have been clear that deploying the latest technology and innovation is essential in order to deliver our priorities: to cut waiting lists, improve access to GPs and improve A&E performance. The NHS app is at the heart of this, including the enhancement of patient choice set out in our recent announcement, which is not available to patients in Wales. The Patients Association estimates that by enabling people to select a different hospital in the same region on the app, we can cut their waiting times by as much as three months.

We have been making major improvements behind the scenes, which are already paying off. Today, I can tell the House that between March 2022 and March of this year, there have been 6 million new registrations for the app; repeat prescriptions via the app have increased from 1.6 million a month to 2.5 million a month; and primary care appointments made on the app have increased from 30,000 a month to 250,000, and secondary care appointment from 30,000 a month to 360,000. We continue to work to increase the app’s functionality, including opening more records and test results and enabling more appointments, as part of our commitment to technology.

Brain tumours are the biggest killer for people under 40, but we are still waiting for the full £40 million that the Government promised to fund brain tumour research. In March, I raised in the House the heartbreaking experience of my constituents Yasmin and Khuram, whose daughter Amani died from a brain tumour just before her 23rd birthday. Once again, I ask whether the Minister for Health and Secondary Care or the Secretary of State will meet with me and my constituents to hear their calls for the full funding allocation to be given to researchers. That funding would be transformational for the treatment of brain tumours.

The Minister of State has met with campaigners, and I know he stands ready to have further such meetings. As we touched on earlier, the £40 million is available; obviously, that needs to be allocated to research bids of the necessary quality, and the remaining money is open to researchers to bid for. I hope they will do so.

T3. I thank my right hon. Friend for reconfirming the investment into North Devon District Hospital. Will he meet with me, the hospital trust and my local housing association to ensure that the housing committed to on the Barnstaple site can rapidly commence? (905249)

I am very keen to meet with my hon. Friend. I know this is an extremely important scheme for her constituency, particularly the key worker accommodation, and I look forward to having that discussion with her and the leadership of her trust.

First, I congratulate the Health Secretary on his recent write-up as the next Leader of the Opposition. According to the i newspaper, his supporters are calling him “Mr Consistent”. Is that because of the consistent rise in waiting lists since he became Health Secretary, the consistently longer waiting times that patients are facing, or the consistent delay to the NHS workforce plan?

The point of consistency is that we gave a manifesto commitment to have 26,000 additional roles in primary care, and we have delivered that. We made a commitment to the largest ever hospital building programme, and we have announced over £20 billion of investment in it. The Government are standing by their manifesto commitments—that is what we are delivering.

I am sure that will do it.

I want to turn to the most recent reports about the NHS workforce plan, because apparently not only is that plan delayed, but we now read in the media that it is unfunded. Labour will pay for our workforce plan by abolishing the non-dom tax status. [Interruption.] Conservative Members do not like it, Mr Speaker, but it is the only tax they have been unwilling to put up. We have a plan, and we have said how we will pay for it. How will the Health Secretary fund his plan when it eventually arrives? Will it be cuts to the NHS, more borrowing, or even more broken promises?

The hon. Gentleman is recycling this question almost as often as he recycles the non-dom funding. As I said at the last Health and Social Care Question Time, it is like the 1p on income tax that the Lib Dems used to promise, which was applied to every scheme going.

We touched on this issue at the last Question Time, and indeed at the one before: we have a commitment to a long-term workforce plan. The Chancellor made that commitment in the autumn statement, but it is a complex piece of work that NHS England is working on. It is important that we get the reforms in that plan right, and that is what we are committed to doing.

T4. Just a couple of weeks ago, the Obesity Health Alliance launched its manifesto to tackle the high levels of diet-related ill health and the impact that has on our economy and society. Can my hon. Friend update the House on the progress being made on implementing the measures in section 172 of and schedule 18 to the Health and Care Act 2022 on the advertising of less healthy food and drink? (905250)

We are still committed to reducing the advertising of unhealthy food, including the junk food watershed that will be implemented in 2025. Ahead of that, we are taking action on obesity across the board, including the sugar tax, which has cut the average sugar content of affected drinks by 46%, the calorie labelling that we have on out-of-home food in cafés and restaurants, and the location restrictions on less healthy food that are coming in from October.

Kidney Research UK has published a report on the health economics of kidney disease, predicting a terrifying rise over the next 10 years. As we know, uncontrolled diabetes is the biggest cause, with Diabetes UK noting that those disproportionately most at risk are those from poverty and from south Asian and black ethnic backgrounds. Reducing health inequalities is therefore key, and it is a key ambition for the Scottish Government. It means tackling poverty in our society. What steps is the Minister’s Department—

I had a useful conversation with the Scottish public health Minister where we discussed many of these issues. We are providing huge cost of living support—some of the most generous in Europe, worth £3,300 a household—and taking action across the piece. Whether it is smoking or obesity, we are tackling the underlying causes of the health inequalities that the hon. Gentleman mentions.

T8. Under the Human Rights Act, do the Government not have a duty of care to deal with the housing of illegal migrants? How can the Government ensure the health of 2,000 migrants cooped up in the former RAF Scampton? In particular, how will they ensure their health given the fact that the site is riddled with asbestos and contamination from 100 years of RAF usage? I see a case coming to the European Court of Human Rights. (905255)

Clearly, an increase in population in a specific area will have an impact on the health needs there. I recognise the concern that my right hon. Friend raises, and I will ask the Minister for Primary Care and Public Health to follow up with him on this important point. While the NHS is well equipped to deal with short-term pressures, this issue highlights the importance of the Prime Minister’s commitment to stop the boats and the Government’s overall strategy on illegal migration.

T5. As chair of the all-party parliamentary health group, I have been hearing so much about the importance of artificial intelligence innovation in mental health, and I was pleased to launch the AVATAR2 clinical trials in three universities across the UK. Will the Secretary of State commend this progress being made in digital innovation? It deserves scrutiny, but can make much progress. (905251)

I very much welcome it. I am delighted to hear that constructive approach to AI from the hon. Lady. The importance of AI is why we have been funding more than 80 AI lab schemes with more than £130 million. AI has huge potential to help patients. We are seeing that, for example, in stroke patients getting care much quicker. She is right that there are also some regulatory and other issues that we need to address, but we should not miss the opportunities of AI, and she is right to highlight them.

T9. Last week, not a single dentist across the city of Southend said that they were taking on new NHS patients, which is concerning for my constituents. Can my hon. Friend confirm again what steps he is taking to make sure that my constituents get the NHS dental treatment that they deserve? (905256)

This is absolutely the top priority I am working on at the moment. I am totally seized of the challenge that my hon. Friend mentions. I have mentioned some of the reforms we are already making, which have increased dental activity by about a fifth in the year to March, but we know that we have to go further and we will do so shortly.

T6. More than one in 10 social care roles are vacant, and the biggest culprit in this recruitment and retention crisis is low pay. According to recent TUC analysis, a £15 an hour minimum wage for care workers would not only tackle staff shortages, but level up places such as the east midlands, introducing an £800 million economic boost. Will the Government introduce that? (905252)

I want to see the care workforce recognised and rewarded for the work that they do. That is one reason why we gave adult social care a record uplift to its funding of up to £7.5 billion in the autumn statement, for local authorities to fund care providers to pay their workforce in turn. That goes hand in hand with our workforce reforms to develop the skills and career opportunities for the care workforce.

Has my right hon. Friend the Secretary of State read the report “Safe and Effective?” produced in April by a group of senior clinicians, which is very critical of the work of the Medicines and Healthcare products Regulatory Agency? If he has not yet read it, will he do so, please?

I thank my hon. Friend for his question. I feel that we had a very productive meeting yesterday with the all-party parliamentary group on covid-19 vaccine damage about the vaccines for covid and the issue of the MHRA. He raised a number of important points during that meeting, including that on the MHRA, and I will be responding to him shortly.

T7. One of my constituents with complex health needs has struggled to get GP appointments for years now. On one occasion when they could not get an appointment, they had to resort to taking out-of-date medicine. Last week, they phoned every morning at 8 am, before finally getting just a telephone appointment. When will the Government finally fix the crisis in primary care and make sure that everyone gets access to a GP appointment? (905253)

As the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough, said earlier, through the primary care recovery plan we have specific measures to tackle things such as the pressure at 8 am, particularly on a Monday morning. There is the investment in digital telephony, with call-back features, and online booking, as well as the channel shift to enable pharmacists to do more and to prescribe more, the use of the NHS app and the review of 111. There is a range of initiatives that we are taking to address the increased demand. Ultimately, GPs are seeing more patients—up to 10% more patients—but there is more demand, and that is how we are meeting it.

Kettering General Hospital is aiming to submit its final business case for its £34 million net zero energy centre in December, but has been told that when it does so, it can expect at least a 13-week wait for approval. The Secretary of State has been good enough to see for himself the urgent need for this new power plant. Is there anything he can do to speed up this process?

I share my hon. Friend’s desire for us to move at pace on the scheme. As he says, I have seen at first hand the importance of the scheme at Kettering, and I stand ready to work constructively with him to expedite that case, because I do not think anyone is in any doubt of the importance of the work at Kettering. It is a huge tribute to him and the way he has championed the case for Kettering that it was such a central part of the new hospital programme announcement.

In Wakefield, I am pleased to say that our campaign to save our city centre walk-in service has been successful, but every day people are still struggling to get a GP appointment. The latest NHS statistics show that, in April, 12,586 people waited more than 28 days. Quite simply, there are not enough fully qualified GPs. Labour has a workforce plan that is ambitious and costed. Where is the Government’s delayed and fully funded workforce plan?

I have already mentioned that we have nearly 2,000 more doctors in primary care than we did in 2019, as well as the early delivery of the 26,000 extra clinicians we have brought into primary care. [Interruption.] The Opposition may not want to hear it, but the truth is that we have increased funding for general practice by about a fifth in real terms. We have more doctors and other clinicians, and GPs are doing 10% more appointments every month. We want to continue to build on that, which is why we have the primary care recovery plan and why we have invested a further £645 million in enabling people to get treatment from their pharmacists, freeing up 10 million more GP appointments. We know we must go further, but we are making progress.

I know the Minister is very keen to see the numbers of elective waits fall, and they have been falling. My constituents in Newcastle-under-Lyme share that aim. So will he welcome the local hospital trust opening not only a new modular theatre for specialised hand surgery, but a central treatment suite for day patients at the County Hospital in Stafford funded by NHS England’s elective recovery plan, which will help cut waits for planned procedures?

I thank my hon. Friend for his question. He has articulately and eloquently set out the improvements being made at Stafford County Hospital, and he has been a strong champion for those works. This is real, visible, positive change that will benefit both residents and patients in Newcastle-under-Lyme and the surrounding areas.

My constituent Brian Murray lost his wife Roberta six years ago, following years of chronic health conditions after an infected blood transfusion. He wants to know: when will the Government enact all of the recommendations regarding compensation from the second report by Sir Brian Langstaff?

I thank the hon. Gentleman for his question. We take this issue very seriously, and we have already made interim payments to those infected. The Minister for the Cabinet Office came to the Dispatch Box in April when Brian Langstaff’s review was published, and we are working night and day to respond to those recommendations and get that plan out as soon as possible. We recognise the impact on families, and on those infected and affected.

I refer Members to my entry in the Register of Members’ Financial Interests. Today Dr Mike McKean, a respiratory consultant and vice-president of the Royal College of Paediatrics and Child Health, said that vaping is “fast becoming an epidemic” among children. The Royal College of Paediatrics and Child Health said that we should ban disposable cigarettes—e-cigarettes—“without a doubt”. Will the Minister do all he can to prevent children from starting vaping, and will he back my ten-minute rule Bill, which was first introduced in this place in February, to ban disposable e-cigarettes?

I pay tribute to my hon. Friend and her leadership on this issue. Many of the ideas that she has been putting forward are already in the plan that we set out to tackle youth vaping, including the creation of the “flying squad”, the ongoing call for evidence on youth vaping, and all the different things we could do to continue to drive it down.

The non-surgical breast cancer service in South Yorkshire is facing a critical shortage of oncologists. The shortage is so severe that patients are being told to expect months between referral and appointment. What immediate steps are the Government taking to ensure that patients, no matter their postcode, see a specialist as soon as they need to do so?

As reflected in the fact that we met the faster diagnosis standard in February and March for the first time, we are investing more in our cancer services to meet the recognised increase in demand. That is why more patients are being treated sooner and survival rates are improving. I am happy to look at any variation at a local level because of workforce pressure, but the diagnostic centres and surgical hubs are all part of our response to the increase in cancer demand.

A number of dentists across north Staffordshire are stopping NHS treatment, which is extremely concerning. Some of my constituents have reported that they are being told they will have to pay either £120 a year or £14 a month to stay on the books. Will my hon. Friend look into those serious concerns and meet me to discuss the matter further?

I recently learned that my local integrated care board is not allowed to spend the money it wants to spend on securing the best location for a new GP practice and health centre. The reason is that Treasury rules, which are used by the District Valuer Services, are not keeping up with market rents. Will the Secretary of State speak to his colleagues in the Treasury to fix that, before we face an epidemic of health centres and GPs leaving town and city centres, and moving to ring-road locations away from the populations they serve?