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Oral Answers to Questions

Volume 736: debated on Tuesday 11 July 2023

Health and Social Care

The Secretary of State was asked—

NHS Dentists: North Shropshire

1. What progress his Department has made on improving access to NHS dentists in North Shropshire constituency. (905889)

Last year, we announced a number of reforms to the NHS dental system, making the NHS more attractive and helping patients to access care. Treatments and dental care delivered in England went up by a fifth between 2021 and 2022.

In North Shropshire, the number of adults seen by a dentist between 2019 and 2022 fell by more than 10%, from 47.5% to 35.4%, and the number of children seen by a dentist in that time has fallen by just about 10%, from 59% to 49.8%. Constituents report not being able to access a dentist, and are being turned away from their NHS dentists as they seek to take on only private work. Can the Secretary of State reassure me that he is taking steps to ensure that dentists in rural areas will continue to provide NHS services, because this healthcare problem will continue into the future?

We recognise that we need to do more. That is why we are making NHS dentistry more attractive by creating more bands of units of dental activity, having a minimum UDA value, and increasing to 110% the amount of activity that dentists can do. Indeed, Shropshire, Telford and Wrekin NHS trust, for example, was above the national average in the 24 months until June 2022. We are putting reforms in place to build more capacity.

Elective Care Waiting Times

15. What recent progress he has made on reducing the number of patients waiting more than 18 months for elective care. (905904)

The elective recovery plan sets out clear steps to eliminate long waits, and that is supported by £8 billion of revenue funding and £5.9 billion in capital over three years.

The waiting list for elective care has risen to more than 7 million people, including one constituent who is unable to work while waiting months for an orthopaedic assessment, and another who has been waiting three years for a prostate operation. Both have had to seek emergency care while they wait for an agonisingly long time. Is it not true that the longer the Conservatives stay in power, the longer patients will wait?

On the last bit of the question, the average waits in Wales are 20.4 weeks as of April, and in England they are 13.8 weeks, which is the exact opposite of the point the hon. Lady raises. We are taking action. We are boosting diagnostic capacity; 111 community diagnostic centres are now open. We are increasing treatment capacity through our surgical hubs programme. We are giving patients choice, which is not available in Wales under the Labour Administration—we are giving them more choice. We are also making better use of the independent sector, which some on the Labour Front Bench support but others do not.

One of my constituents has now been waiting 14 months for a hysterectomy, while another waited years to receive a much-needed hip replacement. That is way over the 18-week standard set out by the NHS Constitution. Can the Secretary of State tell the House what is being done to get wait times down to that 18-week mark?

We recognise the challenges from the pandemic, and that is why we are boosting capacity, particularly through our community diagnostic centres. The additional capacity has already delivered more than 4 million extra tests and scans. We are rolling that programme out with the target of 160, and 111 are already in place.

Cancer Outcome Targets

In accordance with section 5 of the Health and Care Act 2022, the Secretary of State’s mandate to NHS England for this year set out ambitious objectives to improve outcomes for cancer patients, including the specific aims of improving one-year and five-year survival of all cancers.

Many on the Conservative Benches are pleased that section 5 is finally being implemented, but we would urge the Government to ensure, when consulting on the NHS mandate, that the focus is on outcomes such as the one-year survival rate to encourage earlier diagnosis, and is not watered down in favour of softer objectives such as patient experience surveys, because patients may not be aware of how badly the NHS compares on international survival rates, as recent research from the King’s Fund has shown.

I congratulate my hon. Friend on his commitment to ensuring that we are focused on cancer outcomes and on his successful campaign for that to be included in the NHS mandate, which it has been, as I just mentioned. The best way to improve outcomes for cancers is by catching cancer early. That is one reason why we have a range of metrics, including process metrics, which measure early diagnosis and therefore help us to achieve our ambitions on outcomes. Other metrics such as patient experience are important as well.

I agree with the hon. Member for Basildon and Billericay (Mr Baron). One of the problems is the time it takes from the GP’s referral to the consultant at the hospital and the treatment then starting; there are still concerns about delays in that. What is the Minister doing to speed up the process from not just the GP’s referral to the consultant but from the consultant to treatment starting?

The hon. Member is right that the duration is very important. One reason why we are focused so much on increasing early diagnosis is because we know that the sooner we diagnose people, the more likely they are to have a successful outcome from cancer treatment. We are seeing improvements in cancer survival. For instance, in 2010, two thirds of people would survive for one year after a cancer diagnosis; now the figure is three quarters. The NHS is working very hard on further improving cancer diagnosis, and we have reduced the number of people waiting more than 62 days since the pandemic by over a third.

Cervical Screening and Ovarian Cancer

We are catching more cancers early than ever before, and work to raise awareness of cancer signs and symptoms, screening programmes and investment in early diagnosis are all playing their part. We fund community events to raise awareness of ovarian cancer, and NHS England is working to increase cervical screening take-up by providing more convenient appointments, including at weekends and evenings.

I thank the Minister for that answer, but Target Ovarian Cancer has found that 40% of women in the UK wrongly believe that their smear test will detect ovarian cancer. There is currently no viable screening process for ovarian cancer. However, messaging remains unclear when women are going for their smear test. What steps are being taken to ensure that information provided at such screening is clear?

On the one hand, cervical screening is incredibly important and very effective at saving lives from cervical cancer—we estimate that it saves around 5,000 lives per year. There is no evidence to support a screening programme for ovarian cancer, and I will take away the hon. Lady’s question about whether there should be communications about that when people go for a cervical smear.

Vaping: Young People

The hon. Gentleman raises a point of concern across the House that we recognise. That is why we have already taken action, through £3 million to crack down on those selling vapes illegally to children, closing the loophole that allowed free samples to be offered to children, and our call for evidence, so that we can examine what further measures we can take, particularly on the concerns about disposable vapes, which are prevalent among children.

That is helpful, but Labour proposed a new clause to the Health and Care Bill that would have given the Government the primary powers needed to stop the use of sweet names such as gummy bears and Skittles, bright colours and cartoon characters on packaging and labelling of e-cigarettes. The Minister will agree that such promotion aimed directly at young people is highly unacceptable and takes us back to the worst days of cigarette advertising. If the Government are so committed to acting in this space, why did they vote down that new clause?

As I say, we have already taken action. We took measures in April, and the Prime Minister announced further measures in May. We are keen to follow the evidence. That is why we have had a call for evidence. The ministerial team are looking extremely closely at this, and we will take further action to clamp down on something that we all recognise is a risk to children, which is why we are acting on it.

Vapes are smoking-cessation products; they are not confectionery to be sold to children or a way of replacing one generation hooked on nicotine with another. Will my right hon. Friend update the House on the progress that the Medicines and Healthcare products Regulatory Agency has made on licensing e-cigarettes and other inhaled nicotine-containing products as medicines, which would put out a strong message that vaping is a dangerous pastime?

As a former Health Minister, my hon. Friend is well aware of the risks posed by vaping. As the chief medical officer has said,

“If you smoke, vaping is much safer; if you don’t smoke, don’t vape”.

That is why we are toughening up the regime. We are also working with industry as part of our call for evidence, but we are clear on the need to go further. That is exactly what we will do.

Youngsters who try e-cigarettes are at much greater risk of both nicotine addiction and later going on to use tobacco itself, so what consideration have this Government given to banning disposable vapes completely as a way of protecting our young people?

Again, I agree that disposable vapes are a particular concern: in our view, the growth in youth vaping is largely due to the growth in the use of disposable vapes. That is why we have particularly focused on that issue in our call for evidence, and that is what we are considering.

City-centre GP Premises

6. What assessment he has made of the potential impact of guidance issued by District Valuer Services on the availability of city-centre GP premises. (905894)

While it is a very long-standing system, we keep the approach to funding for GP premises under review. We have taken action in the primary care recovery plan to improve access to section 106 funds, so that new homes always come with the GP infrastructure that is needed.

The Secretary of State and his Ministers will know that I first raised this issue in the Chamber on 6 June this year. Integrated care boards, GPs, and now the medical property sector are all telling me that the Treasury rules are out of date and are a massive block to securing much-needed primary care premises in the right places, particularly in city centres such as St Albans. When I have asked the Department via written parliamentary questions for its assessment of how much of a problem this issue is, the Department has told me that it just does not know. Could the Minister please tell us when he will be speaking to colleagues in the Treasury to resolve this issue, so that we can make sure that GP premises are secured where people need them most?

We talk all the time. I am conscious that there are 60% more full-time patient-facing staff in the hon. Lady’s constituency than there were in 2019, which of course puts pressure on premises. The capital allocation for her local ICB between 2022-23 and 2024-25 was £200 million, so the money is there, but I am happy to continue the conversation about how we get the premises in the places where we need them.

Pharmacy Services

We have already been growing the range of NHS services available in pharmacies: we have set up the community pharmacist consultation service, the discharge medicines service, the new medicine service, the blood pressure check service, smoking-cessation services and the contraception service. We are now investing £645 million to go further through the new Pharmacy First scheme for common conditions.

I thank my hon. Friend for his answer, but does he agree that the services offered by pharmacies can be made more efficient? For example, 62 million prescription items are subject to “split and snip” per year. That is where, to get the right number of pills, a pack has to be manually opened up for a couple of pills to be snipped out, then repackaged and relabelled before being reissued. The spare pills are often thrown away. Can that system not be better?

My hon. Friend is completely correct. That is why at the end of last month we laid a statutory instrument before the House to fix the system, so that pharmacists can spend more time using their skills to provide high-end clinical services and less time snipping blister packs.

Given the national shortage of GPs, does the Minister recognise that there is a potential danger in asking pharmacists to take on the duties of GPs—duties that they are not necessarily qualified to undertake—especially given the already large workload undertaken by pharmacists?

We absolutely recognise the need for patient safety, which is why there will be clear patient group directions and clear pathways about what pharmacists do. They are not taking on the role of GPs, but are providing additional services that will make things more convenient for all of our constituents.

I warmly welcome the Government’s commitment to investing £645 million to enable pharmacists to provide for far more common conditions. I have already visited one of my own local surgeries, the Shakespeare Road medical practice, and seen at first hand how pharmacists are already working in GP surgeries to try to reduce waiting times. Surely, more surgeries should be doing the same, involving pharmacists with enhanced roles in order to cut waiting times in a manner that is safe.

My right hon. Friend is completely correct. That £645 million, of course, comes on top of the £100 million that we have already put in. We have grown the pharmacy workforce hugely—there are 82% more pharmacists now than in 2010—and we are also enabling those people with their high-end skills to do more by reforming regulations. That is not just the blister packs issue; we are enabling them to do convenient things such as hand out bagged medicines even if the pharmacist is not present.

Will the Minister undertake to liaise closely with local community pharmacy representative groups to ensure that the excellent work they have been doing can be maximised, particularly given that the NHS is under severe pressure at the moment?

Absolutely, and I always try to learn lessons from right across the UK. In fact, some of the ideas for reforms have come from listening to local partners. For example, our reforms to enable modern ways of working, hub-and-spoke dispensing and empowering pharmacy technicians have come from talking to those local partners.

People across the country rely on local, accessible pharmacies, but whether it is high street closures or supply problems leading to the absurd situation where women are phoning or visiting multiple pharmacies for a prescribed dose of hormone replacement therapy and other drugs, the Government are again letting people down. They have repeatedly announced plans to expand the role of community pharmacies, but have failed to update legislation that could possibly help. They keep collapsing the business in this place, so we have time to sort it. Why will they not do so?

I have given a flavour of the four different reforms we are making. To give the wider picture, there are more pharmacies in England than there were in 2010, there are 24,000 more pharmacists in England than there were in 2010 and we are putting in £645 million to provide a bunch of services that were not there when Labour was in office. We are very happy to take lessons from the pharmacy sector, but not from the Labour party.

Brain Cancer Treatments

We are working closely with research partners, and although I am pleased to say that more research is being funded, we want to see more research in brain cancer treatments. We continue to encourage more researchers to become involved in what remains a challenging scientific area, with a relatively small research community, but I am confident that the Government’s continued commitment to funding will help us make progress towards effective treatments.

I thank the Minister for that answer, and I am sure—and I know—he will take this very seriously. I have had three constituents in the last year come to see me who have suffered serious brain tumours, and they have had a very similar pathway, which is basically that after a certain point there is little the NHS can do for them. In particular, there is a shortage of neuro-oncologists, and one has spent their life savings on private treatment, even though that was difficult to find. Is there any hope, in the NHS workforce plan, that there will be more oncology training and more support for neuro-oncology, because the survival rate for this cancer is still woefully low?

I thank the hon. Lady for her question, and I am sorry to hear of the experience of her three constituents. There certainly is hope within the long-term workforce plan. As she rightly alludes to, we are reliant on researchers to submit high-quality research proposals, and that requires clinicians specialising in this area. It is something I take very seriously, and I would be very happy to work with her on it.

I refer Members to my entry in the Register of Members’ Financial Interests.

My father, the late Alan Bristow, died of a brain tumour in April 2020. He was 77, and that was incredibly sad, but when a child dies of a brain tumour, it is unbelievably wicked. Brain tumours are still the biggest killer of young people. What can the Minister do to ensure that appropriate funding is being put into research into brain tumours, especially for younger people, and when will the Government respond to the O’Shaughnessy review into clinical trials in the UK, which would help the brain tumour community?

I thank my hon. Friend for his question, and I am sorry to hear of his own personal experience. He is absolutely right that, in relation to children, I am very keen to find a way forward. The Government are committed to finding high-quality brain cancer research, and we expect to spend more as new research progresses. The £40 million of funding announced will remain available, and if we can spend more on the best-quality science, we will do so. We worked really closely with Lord O’Shaughnessy on his review, we have accepted his recommendations and we have put in £121 million to support it.

The Minister is aware, I know, of the outstanding campaigning work that my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) is doing, not least because of the experience of her sister—our late great friend Margaret McDonagh—with glioblastomas. Over decades now, we have seen no improvements in outcomes, no drug trials of any seriousness and no mandatory training of oncologists. I have learned through experience that, when the McDonaghs come knocking, it is best to say yes, and if anyone says no, they will be hit by this unstoppable steamroller. With that cautionary note in mind, might the Minister be prepared to meet me, my hon. Friend and relevant stakeholders across the Department, NHS England and the National Institute for Health and Care Excellence to see what more can be done? There are challenges, I know, but what more can be done to make sure that, for families such as my hon. Friend’s and Margaret’s, and for thousands of others each year, glioblastomas are not simply a death sentence?

I thank the hon. Member for that question and join him in paying tribute to the hon. Member for Mitcham and Morden (Siobhain McDonagh), especially after the tragic loss of her sister, for all the work that she has done in campaigning on this issue. I have spent significant time on the issue and I have met her, the hon. Member for Leicester West (Liz Kendall), campaigners, charities and other hon. Members from across the House. Funding for research is available and, having spoken with the Secretary of State, I know that he is as keen as I am to work with colleagues from across the House. There are issues that transcend party politics and this is certainly one of them. I would be very happy to meet the shadow Secretary of State, the National Institute for Health and Care Research, NHS England, the Tessa Jowell Brain Cancer Mission and clinical specialists to find a way forward.

Mental Ill Health: West Yorkshire

9. What assessment he has made of the adequacy of treatments for complex mental health illnesses in West Yorkshire. (905897)

NHS West Yorkshire integrated care boards have increased their investment in mental health services in line with their overall allocation increase. They have spent more than £591 million in the past financial year on their mental health services.

I thank the Minister for that answer. My constituent, Joanne Allotey, has custody of her young granddaughter, who has complex mental health problems, but local mental health services in Leeds are still chronically underfunded after 13 years of Conservative Government cuts. Will the Minister join me in commending Roundhay high school for the support that it has given the family—this is the same school that the former Prime Minister claimed “let down” children—and commit today to delivering truly effective children’s education, health and care plans?

I absolutely pay tribute to the school in the hon. Gentleman’s constituency. I also point out that Red Kite View is a new unit specifically for young people in his constituency. That 22-bed mental health unit opened last year and aims to eliminate out-of-area placements for young children with mental ill health. I am sure that he would welcome that investment in his constituency.

The Joint Committee on the Draft Mental Health Bill reported back in January this year. One of the most important recommendations we made was about how people, during a period of wellness, could set out how they wish to be treated during a period of illness. The Government have yet to respond to the Joint Committee, but can we have a mental health Bill in the forthcoming King’s Speech, please?

I thank my hon. Friend for raising that issue. There were many recommendations during pre-legislative scrutiny. We are working through those and we hope to be able to respond fully shortly after the summer recess.

As my hon. Friend the Member for Leeds North East (Fabian Hamilton) highlighted, all too often, children are stuck on long waiting lists for treatment. In West Yorkshire, 30,000 children are currently stuck waiting for mental health treatment, and more than 9,000 people have had their mental health referral closed without accessing treatment. Does the Minister find that acceptable? If the answer is no, what will her Government do about it? This picture is not unique to West Yorkshire, but replicated across England. This Government are letting patients down. When is the Minister going to act to tackle the crisis in mental health services?

I thank the shadow Minister for her question. To highlight another initiative in West Yorkshire, the Night OWLS—Overnight West Yorkshire Living/Advice Service—helpline has been set up for children and young people. It is open between 8 pm and 8 am seven days a week for young people to access, in addition to the 24/7 helpline that is available. I am sure that the shadow Minister will also welcome the fact that we have more than 400 mental health support teams in schools in England, covering 3 million children, so that they can access mental health support directly at school.

Health Inequalities

We are tackling the root causes of health inequalities. We have doubled the duty on cigarettes and brought in a minimum excise tax on the cheapest cigarettes. That has helped to drive down smoking rates from 21% to a record low of 13%. We are going further, helping a million smokers with our scheme to get people to stop smoking and start vaping. We have provided £40 million to start rolling out new weight-loss drugs and, in the major conditions strategy, we will talk further about how we will tackle health inequalities.

People in the north-east die younger than people in the rest of England and spend more years in ill health. Increased NHS waiting times leaves them on medication for longer. The north-east has the highest level of people living in poverty, leaving many of my constituents unable to afford prescription charges. Some have told me that they are taking paracetamol instead of prescribed medication, worsening health inequalities. Will the Minister commit to scrapping these unfair prescription charges?

Nine out of 10 prescriptions are not paid for, but free at the point of delivery. On the various important points that the hon. Lady makes, tackling health inequalities is hugely important to us. That is why we are creating 160 extra community diagnostic centres, which are targeted at areas of the highest deprivation. It is why we are rolling out targeted lung health checks in 43 areas of the most deprivation. It is also why we are providing cost of living support worth about £3,300 for the average household in this country. It is one of the most generous schemes anywhere in Europe, exactly to tackle those cost of living pressures and health inequalities.

My hon. Friend will be aware that health inequalities can also be geographical within the south-east, with boroughs such as Bexley having historically received less funding than other parts of London. Does he therefore agree that further investment in the fantastic Queen Mary’s Hospital Sidcup would address that issue and improve health outcomes for people in south-east London?

My hon. Friend is assiduous in making the case for his constituency. Ministers of course will meet him to discuss this matter. I know he is closely following the progress of the CDC bid, which we have been talking about. Those diagnostic centres are doing fantastic work to get earlier diagnosis and save more lives, particularly in areas of deprivation.

From this complacent Minister’s replies already, one would think that health inequalities in England were improving, not widening. Last year, 11,000 people, including 312 children, were hospitalised for malnutrition in the United Kingdom. That is the highest number since comparable records began. Why are so many people in Britain going hungry under the Tories?

We need to have care in discussing these subjects. Eating disorders are a sensitive subject and the statistics the hon. Gentleman is quoting are a mix of different things. I have already talked about the £3,300 of cost of living support that this Government are providing to the average UK household, with more targeted help for more vulnerable households. It is something we are seized of and are working on.

Millions of people with disabilities or serious medical conditions rely on specialist equipment, such as ventilators or home dialysis, which personally costs them more money to run, while giving considerable savings to NHS hospitals. Will the Minister urge Cabinet colleagues in the Department for Work and Pensions to help to tackle health inequalities by ensuring that those people receive a fair and timely reimbursement for those additional costs, which are essential to run the equipment to help keep them alive?

Absolutely. We are conscious of the additional needs of people who have equipment like that. By the end of June, the Government had covered nearly half of a typical household’s energy bill through the support schemes we put in place, but we are always looking at what more we can do to help vulnerable households.

Primary Care

11. What assessment his Department has made of the potential impact of primary care service closures on public health. (905900)

Each integrated care board is required to ensure access to GP services for all. Overall, more people are being seen in general practice than ever before—about 10% more than before the pandemic—but where some practices close, the local ICB has to ensure that patients are transferred smoothly to other practices.

Park View medical centre in West Derby, one of the most deprived areas of my city, is facing imminent closure, and there has been a lack of transparency and accountability throughout the process when dealing with the ICB to get the decision reversed. In the Minister’s reply to my letter, he said it was essential that, if a GP surgery closes, it does not lead to a reduction in the quality of care for patients in the locality. Park View patients have been clear that dispersal to other surgeries would be catastrophic, especially when all GPs are already facing huge pressures. Will the Minister urgently intervene to halt the closure due to the legal insufficiency of the consultation process and meet me and patients?

I have looked carefully at that case, on which the hon. Gentleman has been campaigning. The incumbent provider chose not to bid for the future contract for Park View medical centre, and NHS Cheshire and Merseyside decided that the best thing was to help patients to transfer to neighbouring practices. Patients will only be transferred to practices rated as good, and there are 10 other practices rated as good within a 1-mile radius of Park View. Since 2019, there has been an increase in the number of patient-facing staff of about 50% in the constituency. That means there are more people in his GP surgeries. We are working hard to ensure high-quality GP services in his constituency.

Health is devolved to Labour in Cardiff. Ynys Môn is represented by five Members of the Senedd, yet health represents a third of my postbag, particularly relating to access to primary care in Holyhead. Does the Minister agree that families in Holyhead are not getting the healthcare they need and deserve?

Yes, it is true, I am afraid. People are about twice as likely to be waiting for treatment in the Welsh NHS. Waits are also longer in Wales, with 30,000 people waiting more than two years for treatment, even though those have been eliminated in England. England spends more on general practice than Scotland or Wales, despite the fact that Wales has 20% more funding, and England has also grown spending on general practice faster than either Scotland or Wales. We are highly focused on getting good primary care services in England. There are always lessons that we can learn from each other, but there are definitely lessons that Welsh Labour can learn from the English NHS.

Vaccine Development and Evaluation

The vaccine development and evaluation centre, backed by £65 million for state-of-the-art facilities, at the Porton Down site has been operational since early last year. It supported the autumn vaccine roll-out and the spring vaccine roll-out earlier this year.

In November 2021, Dame Kate Bingham rightly called the decision to withdraw support for the Valneva whole virus vaccine “inexplicable” because a broad portfolio of vaccines is important as we move forward against future variants. The British Society for Immunology states that there is an urgent need for second and third-generation covid vaccines, including universal mucosal vaccines with longer-lasting protective immunity. With growing public concern and mounting clinical and scientific evidence of vaccine injury from mRNA, why is the UK not seeking to harness the power of all technologies instead of establishing an inexplicable exclusive relationship with Moderna?

I confirm to the hon. Gentleman that, in the recent spring campaign, we deployed four approved vaccines—Pfizer-BioNTech, Moderna, Novavax and Sanofi-GSK—as part of our roll-out. We are using a range of vaccines to protect us from the pandemic.

Young People’s Mental Health: Housing

13. Whether his Department has made an assessment with Cabinet colleagues of the potential impact of the availability of housing on young people’s mental health. (905902)

We are working with a number of Government Departments, including the Department for Work and Pensions and the Department for Levelling Up, Housing and Communities, to tackle the effect of housing insecurity on young people’s mental health.

The mental health of young people is being impacted by the fact that net migration is far too high and we are not building nearly enough houses. The Government need to take action on that, but young people worry that, with an ageing population, the health service will not be able to provide for them in future. May I commend to the Minister the excellent paper published by the former Labour Prime Minister Tony Blair, which suggests things such as co-payments and personalised apps? Would it not be ironic if a former Labour Prime Minister were more radical on reform of the NHS than a Conservative Government?

Actually, under this Government, last year, the number of first-time buyers passed the 400,000 mark, which is the highest number in 19 years. I will not take any lectures from a former Labour Prime Minister because when Labour was in government it saddled the NHS with a £10 billion failed IT system that never saw the light of day, an £80 billion failed private finance initiative contract that NHS trusts are still paying for, and a GP contract that enabled opt-out at weekends and evenings, which patients still suffer from.

Today marks the three-year anniversary of the death of Tom Pirie, who tragically took his own life just days after being assessed as at low risk of doing so by his counsellor. Over the last few years, I have been working with Tom’s father Philip on his campaign to improve suicide risk assessment procedure, particularly in view of the upcoming 10-year suicide prevention strategy review. Will the Minister join me in paying tribute to Tom’s life and Philip’s excellent work in his memory by providing us with an update as to when we can expect the review to be published?

I absolutely pay tribute to Tom and to his father. I reassure him that we have many campaigners. Only last week, we received the baton of hope at No. 10 from those campaigning to reduce the number of suicides in this country. We are working on the suicide prevention plan and hope to be able to publish it very soon.

Hormone Replacement Therapy

We continue to engage regularly with our suppliers to prevent and mitigate supply issues in the short term. We have over 70 HRT products. The vast majority are available. We have two that have serious shortage protocols attached to them, but we are hoping to improve supply on those very soon.

Although shortages of Utrogestan are ongoing, there is no alternative progesterone product recommended on the serious shortage protocol. Taking oestrogen without progesterone can be dangerous. Provera is a synthetic progesterone alternative to Utrogestan, but it is not included on the HRT prepayment certificate. Will the Minister commit to placing Provera on the list of products covered by the prepayment certificate as a priority and issue a public health warning highlighting the risks of taking oestrogen without progesterone?

We are in the process of issuing another bulletin to both GPs and pharmacists on the serious shortage protocols and to make clear the alternatives available. That is a clinical decision. I will certainly look at the issue of Provera because medicines have to tick off a number of criteria to be eligible for the prepayment certificate. I will certainly look into that particular drug on the hon. Lady’s behalf.

Social Care Workforce

Social care depends on the skills and compassion of our care workforce. That is why we are investing £250 million in reforming care as a career, with a new care qualification, specialist training courses for experienced care workers and a new career structure to support progression, alongside increased funding for social care, our national recruitment campaign and the care worker visa.

My right hon. Friend is right. We have some good news: Skills for Care data shows that home care job vacancies are falling—something I hear when I speak to home care providers. Looking ahead to next winter, I want every local authority to have enough home care on hand. That is why I emphasised the importance of home care when we distributed £600 million of discharge funding to local councils and NHS organisations in April. We are asking all local authorities to plan ahead and book enough home care in advance for this coming winter.

Is this not the very day to thank our care workers up and down the country? So many families depend on those people who toil away, day by day, visiting houses, often not being paid in between their visits. Could we look closely at recruitment and the agencies involved? Let us get real pay for care workers up, now.

I think that every day is a good day to thank our care workers for their skills, compassion and hard work. We gave social care a record funding settlement of up to £7.5 billion in the autumn statement, which is being used to help local authorities increase the fees that they pay to care providers, in turn enabling care providers to pay their workforce better. That is going hand in hand with extra funding to support discharge into social care this winter and our reforms for the care workforce.

Care Settings: Family Visits

I know how important it is for people in care homes, hospitals and hospices to see their family and friends. The majority of health and care providers follow national guidance. I do not want anyone to worry about not being able to visit a loved one, which is why in June we launched a consultation to change the law on visiting.

As the Minister knows, last month I introduced my ten-minute rule Bill, the Care Supporters Bill, to make sure that we recognise in law the value of the care of a loved one. Will her consultation differentiate between a care supporter and a visitor? Currently, the Care Quality Commission does not investigate individual cases. Will it have the power to do that in future?

First, I commend the hon. Member for his campaign on this issue. He has been a powerful advocate and draws on his own experience, as do I. He is probably asking me to pre-empt the outcome of the consultation. I encourage him and others concerned about this matter to put their views into that consultation, and we will respond once it is closed.

International Health Regulations

18. What recent progress he has made in negotiations with the World Health Organisation on proposed amendments to the International Health Regulations 2005. (905907)

The UK continues to negotiate on amendments, alongside other member states of the World Health Organisation. We want to ensure that the International Health Regulations are effective in preventing and responding to potential health threats, leaving the UK better prepared for future health emergencies. We anticipate negotiations to continue until the 77th World Health Assembly in May next year.

Will the Minister assure me that the proposed changes to the International Health Regulations being negotiated will not give new rule-making powers, such as those tabled by Bangladesh, to the WHO director general to make binding directions on matters including border closures, quarantining and vaccine passports? Even the WHO’s own expert review committee has raised concerns over such significant increases in power.

As my right hon. Friend will know, the UK has a strong commitment and duty to implement international law, but on this matter we have been absolutely clear. I can certainly assure her that we will not sign up to any IHR amendment or any other instrument that would compromise the UK’s ability to make domestic decisions on national measures concerning public health.

Can the Minister confirm whether the House will get a vote on the amendments to the International Health Regulations, or will we not?

Should the UK Government wish to accept an IHR amendment, changes to domestic law to reflect proposed obligations may indeed be required. The Government would therefore prepare draft legislation and bring it before Parliament in the usual way. Let me repeat that in all circumstances, the sovereignty of the UK Parliament would remain unchanged and the UK would retain control of any future decisions around national public health measures.

Coroners: Stillbirths

19. If he will publish the results of the consultation on giving powers to coroners to investigate stillbirths. (905908)

The consultation on giving powers to coroners to investigate stillbirths received 334 responses, including from bereaved parents, charities, the Chief Coroner, clinicians and a range of other organisations.

Mr Speaker, you are very familiar with the problems over the implementation of my Civil Partnerships, Marriages and Deaths (Registration etc) Act 2019, which passed this House in February 2019. Section 4 remains incomplete. The consultation was completed in June 2019. Mr Speaker, you are aware that I made six attempts to get a meeting with the Minister and a Justice Minister. Eventually, I got it in March, after the Leader of the House intervened. Four months on, I have heard nothing and the consultation remains unpublished. What will it take to get this legislation, which everyone wants and which was passed unanimously, into law?

I thank my hon. Friend for his work in this space and I apologise for the delay in publishing the consultation. I met him along with a Justice Minister, and I assure him that we hope to publish it very soon.

Topical Questions

Last week, on behalf of the Government, I signed a landmark partnership agreement with the pharmaceutical giant BioNTech. It aims to deliver 10,000 personalised mRNA cancer immunotherapies, including vaccines, to UK patients by 2030. This work will harness the groundbreaking mRNA technology that BioNTech used in its world-first cancer vaccine. Cancer vaccines work by stimulating patients’ immune systems to recognise and eliminate cancer cells, preventing their spread. Trials for BioNTech’s colorectal cancer vaccine are under way at multiple sites across the UK. To accelerate trials further, BioNTech is partnering with NHS England’s new cancer vaccine launch pad, a platform that makes it easier for both early and late stage cancer patients to join vaccine trials. In the coming years, hundreds of patients identified by the launch pad will join trials for BioNTech’s personalised cancer therapies, broadening the treatment options available to cancer patients. I hope the whole House will welcome the opportunity the deal offers future patients.

The announcement that a new hospital between Winchester and Basingstoke is going ahead is much welcomed by my constituents who will use it, as well as by those from other constituencies. It will provide a centre of excellence with better medical outcomes. Will my right hon. Friend meet local MPs, so we can update him on why the hospital needs to be built as soon as possible?

I am always very happy for my hon. Friend and other colleagues to meet me or Lord Markham, who leads the capital programme. It is an important scheme. We are delivering it through the standardised Hospital 2.0 approach, using modern methods of construction. We are keen to progress early supported works on site, working closely with colleagues.

Last week, the Health Secretary said that he was willing to offer doctors a higher pay rise. Last night, the Chancellor slapped him down, saying that any increased offer will have to be paid for by cuts. How can the Health Secretary negotiate an end to the NHS strikes when he cannot even negotiate with his own Chancellor?

We have been clear throughout that Government decisions on the pay review bodies’ recommendations are taken on a cross-Government basis. The agreement that we reached with the largest group of NHS staff, those on “Agenda for Change”, has demonstrated that we are willing to work constructively with trade union colleagues, but the demand from junior doctors for a 35% increase is not affordable—indeed, the hon. Gentleman himself has said that he does not support it.

But the worst strikes in the history of the NHS are still to come. The impact of the junior doctors’ strikes and the consultants’ strikes will be devastating for patients. The Secretary of State has failed to stop these strikes for seven months. He has lost the confidence of nurses, radiologists, junior doctors and consultants, and he cannot even successfully negotiate with his Chancellor, so what is his plan to stop these strikes going ahead?

The hon. Gentleman’s message is not even consistent with what he said at the weekend in the media: that he was not in a position to offer more money to the NHS, and that the shadow Chancellor had made that clear—in a vain attempt to demonstrate some sort of fiscal responsibility. The hon. Gentleman has been clear that he does not support the 35% demand from doctors in training. We are demonstrating that we are working constructively with groups such as the “Agenda for Change” group—the largest staff group, made up of over 1 million staff—with which we have reached a deal. We have also been responding constructively to the British Medical Association’s principal demand for consultants, which was for changes to pension taxation. We are willing to engage constructively with trade union colleagues, but the 35% demand is not affordable. He needs to decide on his position. Which is it: his position at the weekend that the Opposition are not offering more money, or his position today, which seems to be that they will?

T2.   I have campaigned for more health services for my constituents since I was elected, and 97% of those who responded to my recent health services survey felt that we did not have enough doctors for the number of people in the constituency. Will my hon. Friend meet me to discuss how to sort this out and get my constituents the health services that they deserve? (905915)

We are conscious that more is going on in general practice than ever before. There are 10% more appointments than before the pandemic, as well as 29,000 extra clinicians and nearly 2,000 more doctors, but we are conscious of the pressures that puts on the estate locally. I would be very happy to meet and have further conversations with my hon. Friend.

T3. I am sure that the Secretary of State shares my concern that school nurses report increasing rates of children presenting with health issues resulting from poor nutrition. In Scotland, the SNP Government have rolled out universal free school meals for all pupils in primary years 1 to 5 and special schools, and the expansion of the programme continues. What discussion has the Secretary of State had with Cabinet colleagues about following Scotland’s lead and expanding free school meal provision in England to improve children’s health and wellbeing? (905916)

Of course we have regular discussions, not just with Cabinet colleagues, but with our counterparts across the UK. I had a meeting just yesterday with Health Ministers, including my counterpart in Scotland, on the shared challenges. On the issue that the hon. Lady raises, as the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien) said a moment ago, we are providing significant support for households—over £3,300 in support—but we also have measures that target schools, including holiday support measures and wider health and wellbeing measures, such as our significant investment in school sport.

T4.   The Minister is fully aware of Bupa’s decision to close its dental clinic in York, at Holgate Park. I put on record my thanks to him for working with me to find a solution for those constituents affected by the decision. What is being done to reassess out-of-date dental contracts, so that we can ensure that increased demand is met and that my constituents get the access to dental care that they deserve? (905917)

We are taking action, which is why the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough met my hon. Friend recently. In his area of Humber and North Yorkshire, there has been an increase in the number of children seen by NHS dentists over the previous 12 months, so the picture is improving, but we recognise that there is more to do; that is why we have made a number of reforms to the dental contract and why we will announce further plans shortly.

A recent freedom of information request by the Labour party revealed that mental health patients were left waiting more than 5.4 million hours for treatment in A&E last year. Last week, one of my constituents spent five days in A&E waiting for a bed on a psychiatric ward. When will the Government bring an end to this shameful situation?

We are taking significant action on mental health, which is why we are investing £2.3 billion more, compared with four years ago. We have targeted measures as part of our urgent and emergency care recovery plan, including 100 mental health ambulances. We are putting in additional capacity, such as crisis cafés, to support emergency departments. We are also making mental health support available through 111 for the first time, which will allow us to get to issues early, before people are admitted to hospital.

T5. I was delighted when the Government awarded Stockton a new £25 million diagnostic hub, but my local Labour council, which is a partner in delivering the project, appears happy to accept months of delays in completing it. Does my hon. Friend agree that Labour’s delays could cost lives? Will he work with me to ensure that all partners understand the urgency of the project? (905918)

That is hugely frustrating, because I know how hard my hon. Friend campaigned for the Stockton community diagnostic centre and that he recognises the urgency of increasing diagnostic capacity locally. Delivery plans have to be agreed at a local level, so I urge Stockton council to work with him to meet the ambitious timeline and get Stockton CDC open as soon as possible.

A recent report by the Trussell Trust warns that people facing hunger are more likely to be affected by spiralling debt and a decline in their physical and mental health. The same report shows that one in seven people in the UK faced hunger in the last year due to a lack of money. Will the Minister make representations to his colleagues at the Department for Work and Pensions about increasing support for low-income households, thereby improving public health outcomes for all?

It is to protect public health that we have provided cost of living support worth £3,300 on average per household, and that is why we have been paying about half of people’s average electricity and other energy bills. However, we always look at further things we can do to drive improvements in public health.

T7. What steps is the Department taking to prevent chronic kidney disease, given that the recent report published by Kidney Research UK predicts a significant rise in cases of kidney failure in 10 years’ time? (905922)

In the last three years, the National Institute for Health and Care Research has invested more than £30 million in kidney disease research. NHS England is following a national approach to reduce healthcare inequalities, with a specific focus on some of the risk factors for kidney disease, such as chronic respiratory disease. As diabetes is the most common cause of kidney disease, it will be a focus of our major conditions strategy.

Four in 10 people who visit low vision clinics have been diagnosed with clinical depression. It is vital that blind and partially sighted people have access to psychological therapies throughout their sight loss journey to address the impacts. However, National Institute for Health and Care Excellence guidance does not include psychological support in the eye care pathway. Will the Secretary of State commit to reviewing the NICE guidance to ensure that psychological therapies are integrated into the eye care pathway?

The hon. Lady raises an important issue. I would be keen to take it away and look at it to see how we can work together to pick it up.

T8. Many of my constituents are still struggling to get NHS dental appointments, so what is happening right now—this week, this month—to increase the availability of NHS dental appointments for them? (905923)

I know how intensely my hon. Friend is campaigning on this issue. The amount of NHS dentistry being delivered has gone up by a fifth over the last year, partly as a result of the reforms we are already rolling out. He will have seen in the workforce plan that we are going to increase training places for dentists by 40% so that we have the NHS dentists we need. However, that is not all we will do, and our forthcoming dental plan will take further steps.

We have known for a while that our life expectancy is shorter than it was in 2010. However, we are now seeing impacts on children in the UK, who are about 7 cm shorter at five compared, for example, with the children of our neighbours in Holland. What is the Secretary of State doing on this issue, and will he support the all-party parliamentary group on health in all policies in assessing the impacts on health and health inequalities?

Of course we are taking action to improve public health, and that includes children’s nutrition. That is why we are spending £150 million on healthy food schemes, such as the school fruit and vegetable scheme, the nursery milk scheme and Healthy Start. It is also why we are investing £330 million a year in school sport and the PE premium and a further £300 million through the youth investment fund. We will continue to take action on this key issue.

I am delighted that a new diagnostic centre is shortly to be built at our terrific Woking Community Hospital, very close to Woking town centre. Does the Minister agree that providing state-of-the-art diagnostic care right in the heart of the community can cut NHS waiting lists, reduce carbon emissions and, most importantly, help to optimise health outcomes for patients?

Not only do I agree, but I have been with my hon. Friend to see this scheme at first hand. He has championed the scheme vociferously and helped to secure that investment for his constituents. I look forward to working with him to ensure it is delivered as quickly as possible.

Plans to remove overnight primary care clinicians from Westmorland General Hospital three nights a week are a massive risk to our community and mean that, overnight, people will be reliant on Barrow or Penrith for an out-of-hours doctor. Will the Secretary of State instruct the ICB to intervene to protect people in South Lakeland from this massive reduction in the quality and accessibility of services?

Some of us remember when the Lib Dems were for greater localism. One of the things we are looking at is how to empower commissioners, on a place-based basis, to make decisions on where best to place services. We need to move more services into the community upstream, to address the frail elderly before they get to hospital and to have more community services. I am happy to look at the specific issue the hon. Gentleman raises, but I would have thought the Lib Dems would support the general trend of empowering integrated commissioning systems to make place-based decisions.

Several important pharmacies in my constituency, including the one in Hawkhurst, have been experiencing pressures, with long queues of customers sometimes going outside the door. It is said that access to trained pharmacists is proving very challenging. Will the Secretary of State comment on the situation and say what steps he might be able to take to alleviate the pressure?

There are a number of measures in the primary care recovery plan, from how we better use the skills mix within pharmacies to how we deregulate some of the tasks that take up pharmacists’ time, such as the requirement for a pharmacist to be present after drugs have already been prepared or to clip out tablets because they do not match the number prescribed by a GP. There are a number of areas in which we can better use the skills mix, and there are areas where we can take load off pharmacists. We are also funding additional services through Pharmacy First to support the pharmacy model.

The number of deaths increased by 13.5% in December 2022, particularly around influenza and pneumonia—up by 26.2%—so York’s public health team want to know what the Government are going to do about winter planning and when.

We set out comprehensive plans for winter preparation in the urgent and emergency recovery plan. Similar to what I said a moment ago, this includes making much better use of community schemes, particularly those targeted at the frail elderly, and making better use of technology through schemes such as virtual wards. It has also put additional bed capacity into hospitals, with more than £1 billion of funding for 5,000 more permanent beds to help alleviate the pressure on bed occupancy and get flow through hospitals, which is so important to addressing the pressure on ambulances.

Back to NHS dentistry, I am afraid. Later this week, the Select Committee will publish its report on NHS dentistry services. Spoiler alert: it will be uncomfortable reading for some. Will the Secretary of State tell us when and how he plans to bring forward plans for the tie-in of newly qualified dentists? Could that go hand in hand with a “return to the NHS” campaign for dentists who have already left that part of the service?

It is characteristically astute of my hon. Friend to zero in on the tie-in, which is an important part of the long-term workforce plan. Around two thirds of dentists do not go into NHS work after training, so having a tie-in is more pertinent there than it might be elsewhere in the NHS workforce.[Official Report, 12 July 2023, Vol. 736, c. 8MC.] I look forward to the Select Committee’s report but, with some of the reforms already in place, we are boosting the number of patients treated. There were a fifth more dental treatments in 2022 than in the previous year. We are also making NHS dentistry more attractive with some of the changes to the previous 2006 contract, but we recognise that there is more to do, which is why we will shortly set out our dental recovery plan.

I have received a wave of concern from clinicians on the safety of using physician associates, following my Adjournment debate last week in which I raised the death of Emily Chesterton, the 30-year-old daughter of my constituents Marion and Brendan. Emily died of a pulmonary embolism after being seen twice by the same physician associate at her GP practice. The physician associate failed to refer her to a doctor or to a hospital emergency unit for tests, which the coroner concluded could have prevented her death.

Yesterday, on “Good Morning Britain”, the Secretary of State boasted of increasing the number of people working in primary care, presumably including the workforce plan proposal to triple the use of physician associates. Will he look urgently at the details of Emily Chesterton’s case and ask himself whether lessons can be learned to avoid other preventable deaths?

Having responded to the hon. Lady’s Adjournment debate last Thursday, I hear the calls she has made. I know that she has also written to the Secretary of State, and I will ensure that she gets a full response, with answers to all the questions she raises.

My good friend the mental health Minister—the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield)—will know that I have been busy beavering away, together with the UK Government’s mental health ambassador, Dr Alex George, on the early support mental health hubs project. It will relieve pressure on child and adolescent mental health services and save undue distress and money. The pilot scheme is ready to go. Might I suggest that the shared outcomes fund could be the means to press on with the pilot?

Dr Alex George does a lot of fantastic work. I am due to meet him shortly in the coming days, and I look forward to that discussion. My hon. Friend is right to highlight the importance of getting more mental health support into the community, which is exactly what our additional funding is focused on delivering.

Eighteen community pharmacists in my constituency are reporting challenges on medicine supplies. What more is the Minister going to do to get a grip of this situation?

We have a long-standing team in the Department focused on medical supplies, which are a continual issue; as a matter of routine business, there are often challenges in that area. If the hon. Gentleman has specific issues he wishes to raise, we would be happy to look at them, but we have a dedicated team in the Department that focuses on that exact point.

As my right hon. Friend knows, I have been campaigning for £118 million of capital funding, the majority of it for Southend University Hospital, ever since I was elected. I am grateful that he has recently confirmed that the funding is secure. A new business plan is being submitted, including £9 million of enabling funding. Will he look upon that favourably and swiftly?

As my hon. Friend knows, I have already met her to discuss this scheme, and the impediment was the business plan that came forward from the local trust—further work was being done on that. She is right to highlight our capital investment more widely. This Government have committed to investing in the biggest ever hospital building programme, with more than £20 billion. That is in addition to our long-term workforce plan—the first time the NHS has done this—in which we are making a further £2.4 billion of investment.

Is the Minister aware that the NHS North East and North Cumbria mental health and wellbeing hub is due to close this September? With mental health care in crisis in County Durham, that is an insult to the health and social care staff who desperately rely on those services. Will the Minister reverse that decision?

There are two issues here. One is how much investment we are prioritising towards mental health; the other is how local commissioners choose to prioritise services within those communities, and whether we try to run all of those decisions from the centre in Whitehall or embrace the 42 integrated care systems and allow them to make commissioning decisions. The bottom line is that we are spending much more on mental health, with an increase of £2.3 billion compared with the position four years ago. That is allowing us to replace 500 dormitory beds and provide 100 mental health ambulances, three new mental health hospitals, 160 projects such as crisis cafés to support accident and emergency, and £75 million to help those with mental health challenges get back into work, which is one of the best prevention measures we can take for people who are suffering with their mental health.