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Commons Chamber

Volume 742: debated on Tuesday 5 December 2023

House of Commons

Tuesday 5 December 2023

The House met at half-past Eleven o’clock


The Clerk at the Table having informed the House of the unavoidable absence, through illness, of the Speaker from the sittings of the House this week, the Chairman of Ways and Means took the Chair as Deputy Speaker (Standing Order No. 3).

Oral Answers to Questions

Health and Social Care

The Secretary of State was asked—

Dental Services

1. What steps she is taking to improve the commissioning of primary care dental services for vulnerable people. (900466)

16. What recent assessment she has made of the potential impact of levels of availability of dentistry appointments on other NHS services. (900482)

May I, through you, Madam Deputy Speaker, wish Mr Speaker a very speedy recovery?

As Secretary of State for Health and Social Care, I want to reform our NHS and social care system to make it faster, simpler and fairer. Dentistry is a critical part of that. Integrated care boards are responsible for identifying areas of local need and determining the priorities for investment. NHS England published guidance in October this year to help ICBs use their commissioning flexibilities within the national dental contractual framework, and I will be looking carefully at how the boards are identifying need and investment across England, including for vulnerable people.

I am glad that the Minister mentioned ICBs. Liverpool has a very high percentage of children with dental decay, and tooth extraction is the most common hospital procedure for five to nine-year-olds at Alder Hey Children’s Hospital, yet there was a £10 million underspend for primary care dentistry, and instead of investing it in preventive care, NHS England gave permission to all ICBs, including NHS Cheshire and Merseyside, to use the balance to balance their budgets. Will the Minister agree, here and now, to reinstate the ringfenced funding to commission extra capacity for the most vulnerable patients?

I am delighted to be able to inform the hon. Member that NHS England has provided guidance for ICBs that requires dental funding to be ringfenced, with any unused resources redirected to improve NHS dental access in the first instance. Interestingly, ICBs will report their expenditure against the dental ringfence to NHS England as part of their in-year financial planning, which will happen at the end of this financial year.

No, no—you do not get another supplementary question. I was about to call Layla Moran for Question 16, which is grouped with this one, but unfortunately she is not present so I shall go straight to the Chairman of the Health and Social Care Committee.

The Government previously committed to publishing a dental recovery plan, which the former dental Minister, my hon. Friend the Member for Harborough (Neil O’Brien), said that the Government would publish shortly. He also told my Committee:

“We do want everyone who needs one to be able to access an NHS dentist”.

We were surprised, but he said it. We were told that the plan would be published during the summer or before the summer recess. When will the plan be published, if that is still the intention? Presumably it will come alongside the response to our “Dental Services” report, which was due on 14 September.

I thank my hon. Friend and I look forward to being grilled by him and his Committee in due course—at least, I think I do. Perhaps I can assist him, first, on the very important dental report that his Committee published. I am looking through it myself this afternoon and I will be publishing the response and sending it to the Committee imminently. In relation to the dental plan, both the Under-Secretary of State for Health and Social Care, my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom), and I are looking carefully into the needs of communities in rural and coastal areas, as well as in more urban areas, to understand not just the need but the answers that we can provide to help with urgent care and, importantly, preventive care, particularly for our children and vulnerable people in our society.

Last week another dentist in my constituency told my constituents that they were no longer able to provide NHS services. These people have literally nowhere else to go nearby. I want to come back to what my hon. Friend the Member for Liverpool, Riverside (Kim Johnson) asked about the underspend, because we had a meeting with the ICB and it was specifically told that the ringfence was being disapplied. Does the Secretary of State agree that that money should be spent on dental services and that that instruction should be given by her today?

I welcome the guidance that ICBs have received. Cornwall ICB has committed to ringfencing money for dentistry next year, but the truth is that, before it took on that commitment, £4.5 million for unmet units of dental activity was returned to NHS England. What can the Secretary of State do to ensure that Cornwall gets the money that was intended for Cornwall to deliver NHS dentistry?

A theme is emerging of underspend in dental work, which is one of the things that the ministerial team and I are looking at. NHS England emphasised in its guidance to ICBs that the funding should be ringfenced. I very much understand the pressures that my hon. Friend and other south-west Members have been raising over many months on the care that their constituents are getting. To ease pressures in the south-west, NHS England has commissioned additional urgent dental care appointments that people can access through NHS 111.

I begin by welcoming the Secretary of State and her Ministers to their posts.

Last year, the Prime Minister pledged to restore NHS dentistry, including a specific promise to protect its budget, yet last month we learned that he will break that promise and allow ICBs to raid dentistry budgets to fill the gaps. Labour has a plan for 700,000 extra appointments, supervised toothbrushing in schools and a targeted dentistry recruitment scheme in left-behind areas. It is all fully funded by abolishing non-dom tax status. We have a plan, but the Government’s plan is four months overdue. Where is it?

I thank the hon. Lady for her warm welcome. I look forward to discussing these matters with her over the Dispatch Box.

Over the weekend, I was rather pleased to see the Leader of the Opposition’s damascene conversion to the Conservative cause. As the shadow Secretary of State is on his world tour investigating what other health systems are doing, the Labour party may wish to bear in mind the words of wisdom from the great lady herself: “The problem with socialism is that at some point you run out of other people’s money.”

Future Pandemic Preparedness

Lessons from covid-19 have been incorporated into our planning for any future pandemics across a range of areas. That includes the need to prepare for infections through all five routes of transmission, and for the health and social care sectors to have flexible capabilities that can adapt to a range of health threats.

My hon. Friend may have heard that news is emerging from China of yet another respiratory disease spreading through that country. What mechanisms are in place to learn from the covid inquiry when it finishes its work, so that if mistakes were made, we do not make them again in the event that, God forbid, we have another pandemic?

First, early indications show that the respiratory illnesses in China are likely to be due to increasing levels of endemic infection. These are normal infections but at a higher level.

Secondly, we are not waiting for the covid inquiry before we implement lessons learned. One of the key changes we have already made is the introduction of the UK Health Security Agency, which carries out surveillance on both national and international threats. A good example of its work is last year’s strep A outbreak, which it managed and contained very well. This year, the identification of a new covid variant—not a variant of concern—meant we brought forward our autumn vaccination roll-out.

For all of us who lost loved ones, covid-19 is still very raw. I have been following the covid inquiry, and two recommendations have so far come forward. The first is that the lockdown should have been earlier, and the second is that those with covid should not have been sent to care homes—covid went through care homes and cast death everywhere. Has the Minister taken those two lessons on board?

I know the hon. Gentleman had a personal loss to covid, and he is absolutely right to highlight those lessons learned. We are learning lessons, but each pandemic or increase in infection is different. It may have been appropriate to have lockdowns for covid-19, but lockdowns may not be appropriate for other infections, such as strep A or other respiratory illnesses. We set up the UKHSA to provide expert advice. We are learning lessons from the covid inquiry, and we are already taking action.

Hospital Patients: Discharge into Social Care

3. What progress her Department has made on discharging patients from hospitals and moving them into social care. (900468)

When someone no longer needs to be in hospital, it is better for them and better for the NHS for them to go home. That is why we have been working hard to reduce delayed discharges, and we have been making good progress. In England, delayed discharges are down 13% since January, meaning thousands fewer people waiting in hospital and freeing up nearly 2,000 hospital beds every day.

In my constituency of North East Fife, an average of 14% of social care and social work roles are filled when first advertised, but yesterday the Home Secretary announced plans to make it harder to recruit care workers from overseas. What assessment has the Minister made of the effect of that announcement on hospitals’ ability to discharge patients and free up hospital beds for those who need them?

The hon. Member refers to yesterday’s announcement on migration. First, I am very grateful to all the international workers who come here to help in our health and social care system and to care for our loved ones. Clearly, we must get the balance right between migration and making sure that our health and care system has the workforce that it needs. That is what we are doing, both with the migration changes announced yesterday and with our reforms to the social care workforce to ensure that working in social care is appealing to home-grown talent.

Thanks to their own internal chaos, the Conservatives have utterly failed in their promise at the last general election to fix the crisis in social care once and for all. We now have over 150,000 care vacancies and 390,000 care staff leaving their jobs each year, meaning that 60% of patients in England who are fit for discharge are being kept in hospital each day. Will the Minister therefore back Labour’s plan to deliver a fair pay agreement, with better terms, conditions, training and pay, to ensure that we have the staff required to care for all those who need it?

Labour really have not got a leg to stand on when it comes to social care reform. They did not do anything the last time they were in government, and they still do not have a plan for social care. In government, we are reforming social care careers—[Interruption.] If the hon. Lady will take a look at what we are doing, we are introducing a new career structure for people working in social care, introducing new qualifications and investing in training for social care. We are doing what needs to be done to ensure that social care as a career works for UK workers. [Interruption.]

Winter Pressure on NHS Services

We know that winter is hard for the NHS, as it is for other health systems. That is why we started planning for this winter earlier than ever before—back in January, when we published our urgent and emergency care recovery plan, which funds more beds and new ambulances for our NHS, funds more social care in our communities, joins up care, and makes the most of technology, so that more people can get the care they need when and where they most need it.

Two accident and emergency departments serve patients in Hornsey and Wood Green. One is now serving double the number of visits by patients and is buckling under the pressure; and the other has seen 4,000 extra patients this year compared with last. What are the Government going to do about overcrowding in accident and emergency?

The hon. Member is right that our hospitals are busier; we are seeing more patients in A&Es. That is why we are doing two things with our work on urgent and emergency care. One is providing more capacity—more hospital beds, more hours of ambulances on the road, and more capacity in social care to help with discharges. We are also doing things differently by seeing more people out of hospital, avoiding people coming to hospital unnecessarily, and providing more care at home; for instance, our 10,000 “hospital at home” beds are helping people recover at home, which is better for them and better for the system.

I know the considerable work the Department and NHS England have done preparing for winter. Given the importance of the NHS workforce, who do such an incredible job, and noting that there are still a few months to go, will the Minister update the House on the delivery of our manifesto commitment for an additional 50,000 nurses?

I pay tribute to my hon. Friend for the excellent work he did as a Health Minister. It was a real pleasure to work alongside him and see what a difference he made for our constituents across the country. He asks a very good question about the work we are doing to increase the capacity of the NHS and ensure that it has the workforce it needs, including by delivering on our manifesto commitment to 50,000 more nurses for the NHS, which we have achieved.

One way the Minister could help Harrow’s health services be better prepared for this winter and future winters would be to invest in new intensive care beds at Northwick Park Hospital, which serves my constituents. Given that the Government have been told repeatedly that their promised 40 new hospitals are about as real as the Prime Minister’s meat tax, why do Ministers not invest in a hospital that actually exists and provide a new purpose-built intensive care facility at Northwick Park Hospital?

I assure the hon. Member that we are investing in the national health service and, in particular, supporting it to prepare for this winter, ensuring there is more capacity in the system. There will be 5,000 more beds in hospitals around the country this winter, as well as 800 new ambulances on the road. But we are also doing things differently. The future of healthcare is not just about hospitals, but about caring for more people out of hospital. For instance, we are investing in proactive care, so that in every neighbourhood, the people who are more likely to go into hospital are known and reached out to, and the care is available for them. That is one of the things we are doing to ensure that people receive care when and where they need it.

Sleaford and North Hykeham is a beautiful rural constituency, but living in a rural area means people are further from specialist medical services, which is a particular challenge in the winter months when the roads can be difficult to travel on. As the winter approaches, what is the Minister doing to ensure that constituents in rural areas are well looked after?

My hon. Friend makes a very important point about the additional challenges in rural areas. I want to ensure that this winter people get care when they need it and get it faster. We are already seeing progress on that. For instance, we are investing in making sure there are more ambulance hours on the road, and we are seeing ambulances get to people quicker—in fact, this October, they got to people 20 minutes faster than last October. Ambulance handover delays are reducing and we are already seeing progress in A&E, where people are being seen faster, too.

Under the last Labour Government, there was no winter crisis. Under the Tories, we have gone from no winter crisis, to an annual crisis, to a crisis all year around. Rather than tackling the crisis at source, this Government have only sticking-plaster solutions for a few months at a time. How will patients know that a winter crisis has been avoided if problems persist into the spring?

I am really sorry, but the hon. Member’s memory appears to be very short. I was working in healthcare when there was a Labour Government and I remember very well problems for the NHS during winter. She does not even need to look back into the past; she can look at the Labour-run NHS in Wales, where they are having so much difficulty with A&E performance that they even fudged the figures and hid a whole load of patients so people would not notice what was going on.

Vaping: Young People

The hon. Lady raises such an important question on a subject that is dear to both our hearts. We all know it is an offence to sell vapes to children under 18, yet one in five children tried a vape in 2023 alone and the number trying vapes has tripled in the last three years. We know the industry is targeting children, quite cynically. That is unacceptable. Our tobacco and vapes Bill will restrict the appeal and availability of vapes to children, and we are consulting on that right now.

As the Minister rightly said, under-age vaping has increased by 50% in just the past three years. Ministers had the chance to stop this trend two years ago, during the passage of the Health and Care Act 2022, when Labour tabled an amendment to prohibit branding that appeals to children, but Ministers would not support it and Conservative Members voted it down. Does the Minister regret the fact that the Government did not act sooner? When will the planned new legislation be brought to the House? The consultation is welcome, but there is consensus on the issue and action is urgently needed.

The hon. Lady knows full well that making decisions that change legislation requires consultation. That is both the convention and the requirement. The Government have brought forward the consultation as soon as possible. It will close tomorrow and we will introduce legislation as soon as possible in the new year. I think the hon. Lady will find that that legislation really will tackle the problem of the cynical targeting of children.

Primary Care: Patient Access

The hon. Gentleman will be pleased to know that, with huge thanks to all the superb GPs and health teams, our manifesto commitment for 50 million more general practice appointments a year compared with 2019 has now been delivered. Our primary care recovery plan is addressing access challenges by tackling the 8 am rush for appointments, cutting bureaucracy for GPs and, of course, expanding community pharmacy services.

I thank the Minister for her answer, but let me correct her. Since 2014, the number of GP practices in Bedford and Kempston has decreased from 18 to 11; there are fewer doctors, while the patient list has increased; and the number of patients per qualified GP now stands at 2,812, which is a rise of 60%. Will the Minister apologise to GPs and to my constituents, who face a daily struggle to access a GP because her Government have decimated NHS primary care services?

The hon. Gentleman will appreciate that 50 million more appointments between 2019 and now is a fantastic increase. There are just under 4,000 new GPs since 2019, and the hon. Gentleman will appreciate that through the post-covid recovery plan to improve access we have said to GP practices that they should provide urgent appointments on the same day and for every patient within two weeks. That has significantly improved access for patients, and GP appointments are now being hugely supported by access to community first, our flagship programme to improve healthcare throughout the country.

I am incredibly grateful for the significant increase in the number of GP appointments offered to residents in my constituency. However, last week Aspire announced that it wishes to close the Lower Stoke surgery on the Hoo peninsula, where the council proposes to build thousands of homes. Will my right hon. Friend meet me to discuss how I can work further with the integrated care board? I have been trying over a number of years now to work with the ICB so that it can come up with a plan for how it will deliver much-needed services, so I would be very grateful for the Minister’s help.

I am of course always delighted to meet my hon. Friend to talk about issues in her constituency. I reiterate that 50 million more GP appointments is brilliant news. Our flagship Pharmacy First programme will mean that more low-level infections and problems—such as sinusitis, oral contraception, impetigo and various other conditions—can be treated by community pharmacists at great convenience to patients, and it will expand GPs’ ability to deal with more complex problems. All these things are alleviating the pressures on primary care and are very good news right across the country.

A primary care walk-in facility at Warren Farm in my constituency faces closure due to the presence of reinforced autoclaved aerated concrete. The proposal to close the service will mean that services are relocated away from residents who need them. What is the Minister doing to fund the investigation and removal of RAAC in health facilities while making sure that communities can still access the healthcare that they so desperately need?

I am incredibly sympathetic to the hon. Lady’s constituents. The issue of RAAC is one that the Government are determined to resolve. There has been a £698 million programme of new funding to eradicate RAAC from the healthcare system, and that work is under way. She will appreciate that it is for integrated care boards to ensure that the provision is there for all patients but, if she should need help with contacting or negotiating with her ICB, I will be delighted to help her.

A recent report highlighted the fact that in September there were 15,000 missed GP appointments in Cornwall. That is 15,000 appointments that could have gone to people desperately waiting to see their GP. It is happening month after month. Does the Minister agree that that is completely unacceptable, and can she highlight what steps the Government will take to address the issue?

My hon. Friend is right; it is appalling that people book an appointment and then do not show up. In many GP surgeries now they post the numbers of patients who do not turn up for their appointments and urge people to make the effort to cancel. As part of our access to primary care, we are creating digital tools so that GP surgeries can notify patients that they have an upcoming appointment and say, “If you don’t need it, press here and it will cancel the appointment.” Measures such as that make it easier for people to cancel, but he is quite right that it is incumbent on us all, if we book that appointment, to turn up for it.

Health Inequalities

I am pleased to reiterate to my right hon. Friend the Member for Witham (Priti Patel) that Essex is receiving funding from the National Institute for Health and Care Research, which is funded by the Department of Health and Social Care, to promote research into health inequalities and support better health outcomes for her constituents and all residents in Essex.

I thank the Secretary of State for her response and welcome her to her new role; it is a real pleasure to see her in her position today. My Witham constituents have one of the highest patient-GP ratios in the country. That brings many challenges in accessing the NHS, from primary care to dentistry, social care and hospital appointments, some of which have been exacerbated by industrial action. Will she give an update on the work she is leading to address some of those issues and will she support my work and campaign locally to get a new primary health centre in Witham town?

I thank my right hon. Friend very much for her kind words. She will remember how much I enjoyed sitting on the Front Bench alongside her when we were in the Home Office. In terms of her work in Essex, she is a formidable campaigner and she will know that the decision on such a healthcare centre lies with her integrated care board, to which the Government have given some £183 million of capital funding between 2022 and 2025. I am sure she will make a compelling case to the ICB for such a centre in her constituency. Interestingly, the Mid and South Essex integrated care board is one of seven sites receiving additional support and funding from NHS England to address health inequalities, and I know she will pay close attention to how that is spent.

There were multiple warnings from experts such as Professor Sir Michael Marmot of the widening health inequalities that started in 2015. Covid just exposed and amplified those inequalities, so that in the north there were 17% more deaths, or more than 2,500 avoidable deaths. While I welcome the new Health Secretary to her post and I welcome her announcement this morning, what else is she going to do to address in particular the socioeconomic inequalities that drive those health inequalities?

I thank the hon. Lady for her welcome. Having grown up in Lancashire myself, I very much understand why she is speaking up on behalf of her constituents. There are many different ways that we deal with this, but let me use a couple of headline points. First, we are increasing the public health grant to local authorities, providing more than £3.5 billion this year, so per capita public health grant allocations for the most deprived local authorities are nearly two and a half times greater than for the least deprived.

There is also interesting work going on with family hubs. Indeed, the Under-Secretary of State for Health and Social Care, my right hon. Friend for South Northamptonshire (Dame Andrea Leadsom), who has responsibility for start for life, is leading on that. The family hubs and start for life programme will deliver a step change in outcomes for babies, children and parents in 75 local authorities in England with high deprivation. We believe strongly that if we can give the best start in life to our babies and children, it will bode extremely well for their future years.

A report that is to be published shortly by the all-party parliamentary group for diagnostics, which I chair, has highlighted that community diagnostic centres are essential for tackling health inequalities. I welcome my right hon. Friend to her new role. Will she honour her predecessor’s commitment to meet the all-party group to discuss the benefits of diagnostics in general and the preventive role that they can play in reducing health inequalities across the country?

Not only am I delighted to accept my hon. Friend’s kind invitation, but I am also extremely grateful for her work in that area. Of course, we think that community diagnostic centres are an important and exciting part of healthcare in this country. We have 136 centres operational at the moment, and we know that they have provided 5 million additional tests since July 2021. That is the future and we very much support it.

We know that socioeconomic inequalities drive health inequalities and that poverty increases adverse health effects. Research by the Trussell Trust shows that one in seven people faces hunger across the UK because they simply do not have enough money. Will the Secretary of State raise with her Cabinet colleagues the Trussell Trust joint campaign with the Joseph Rowntree Foundation calling for an essentials guarantee in universal credit to ensure that the basic rate at least covers life’s essentials so as to ensure that people can afford essentials such as food and heating and to mitigate against health inequalities?

Of course, conversations continue between Ministers across Government in terms of helping not just with health inequalities but with inequality of opportunity. That is why I very much hope that the hon. Lady and her colleagues will welcome the thoughtful focus that both the Chancellor and the Secretary of State for Work and Pensions have put into the back to work plan. We know that getting people into work can have enormous benefits, not just financially but, importantly, for their wellbeing. The idea behind the back to work plan is that we do it by working with people to draw out their full potential and help them to lead healthy lives.

Ehlers-Danlos Syndromes and Hypermobility Spectrum Disorder

8. If she will review the provision of health services for people living with (a) Ehlers-Danlos syndromes and (b) hypermobility spectrum disorder. (900474)

We recognise that body-wide symptoms associated with Ehlers-Danlos syndrome and hypermobility spectrum disorder can be disabling and can affect all aspects of life. General rheumatology services, which support people with Ehlers-Danlos syndrome and hypermobility spectrum disorder, are locally commissioned by integrated care boards, which are best placed to make decisions according to local need. The major conditions strategy will focus on six groups of conditions, including musculoskeletal disorders such as these syndromes and disorders.

That is all very well, but I do not think that will convince my constituents or the one in 500 people who suffer from that awful disease. This wonderful talented group of people on the Treasury Bench obviously inhabit an alternate universe. My GP said that these days there is no training or research, and that we do not have the capacity to look into these things. People with EDS have to be assessed by uptrained GPs, but they are not there. Our GP and medical services are on their knees. When will the Minister wake up to that fact?

With respect, the hon. Gentleman is as wrong as usual. NHS England is taking forward work to improve the ways in which services for rare diseases are commissioned, putting patients’ voices at the centre of service delivery and ensuring co-ordinated access to specialist care, treatment, drugs, social care, mental health and special educational support. We will continue to work to improve services in this area.

Maternity Services

Since 2021, we have invested an additional £165 million a year to improve maternity neonatal care; next year, that figure will rise to £186 million. That investment is leading to progress on outcomes: stillbirths have reduced by 23%, and neonatal mortality rates are down by 30%.

Women continue to be failed by maternity services across England, as has been highlighted by a string of scandals including East Kent, Nottingham and Morecambe Bay. The Care Quality Commission’s maternity inspections over the past year downgraded many maternity units, branding two thirds of them as dangerously substandard and highlighting shortages of staff, among other problems. What additional steps is the Minister taking to ensure that a woman can go into maternity services knowing that she and her baby will come out alive, and can she tell us whether the recommendations of the Kirkup and Ockenden reviews have been fully implemented?

The hon. Lady has touched on three inquiries. The Ockenden inquiry covered the period from 2000 to 2019, the Kirkup review covered the period from 2009 to 2020 and the Morecambe Bay inquiry covered the period from 2004 to 2013, so the Labour Government were also responsible for parts of all those periods.

We are introducing radical changes. We are increasing the number of midwives, which is up 14% since 2010, and the number of midwifery training places has increased by 3,650. We have introduced the maternity disparities taskforce to improve outcomes for those women who face the poorest outcomes, and have also introduced a maternity support programme for those trusts that do badly in CQC inspections—32 trusts are going through that improvement programme right now. Those are some of the things we are doing to improve maternity services.

As chair of the all-party parliamentary group for birth trauma, I recently commissioned a survey of mums across the UK via Mumsnet on this issue. I was shocked to discover that one in five mothers was not being offered a six-week GP check post-birth. That means that many women with physical injuries or mental health problems are unfortunately not being diagnosed or offered support, which is very troubling. Will my hon. Friend include birth trauma in the future update to the women’s health strategy, and ensure that all mums receive a post-birth six-week check-up with their GP? That check-up must include both the physical and mental health of the mum, not just focus on the baby.

I pay tribute to my hon. Friend’s work in this place. She will be pleased to know that we are rolling out perinatal pelvic health services in every part of England, which should be in place by the end of March next year. In addition, we are rolling out obstetric anal sphincter injury bundles, which my hon. Friend raised in her debate on birth trauma; those have the potential to reduce the number of tears by 20%. She is absolutely right to be driving this issue forward. It will be covered in the women’s health strategy, but we are not waiting for the second year: we are already making progress in this place.

The Care Quality Commission now says that almost two thirds of England’s maternity services are rated inadequate or requiring improvement in safety, up from 55% last year. The Government have been told time and time again to recruit more midwives, and to value midwives so that they do not want to leave the profession in the first place. As a result of ministerial failure, mothers—especially those from black and ethnic minority groups—do not get the safe, good-quality maternity care that they deserve. What is the Minister’s plan to properly improve maternity care?

The hon. Lady may not have listened to my first answer. We have increased the number of midwives—it is up 14% since 2010—and increased the number of midwifery training places by 3,650. We have also introduced a maternity support programme that is providing intensive support for the 32 trusts that are going through it. The hon. Lady may want to speak to her ministerial colleagues in Wales, where Labour runs the health service, because Healthcare Inspectorate Wales recently issued an immediate improvement notice to Cardiff and Vale University Health Board for its maternity services.

Access to Mental Health Services

We are improving mental health services, transforming them with an extra £2.3 billion a year. We have already seen some improvements in the delivery of those changes from giving mental health services parity of esteem with physical services.

The Minister will know, because it covers her constituency as well, that the Sussex Partnership NHS Foundation Trust does vital work in mental health, but there simply is not the resource, and I am afraid that parroting about parity of esteem does not tackle the issues. Wait times are 190 days for children and young people in her constituency and mine. I recently spoke to a mother in Peacehaven whose son is waiting for an attention deficit hyperactivity disorder diagnosis. His performance at school is in rapid decline, but because of the wait times he is not eligible for support in school via any education, health and care plan to start to turn things around. What assurances can the Minister give my constituents, and indeed her constituents, that the wait times for mental health will come down and that resources will be given to these partnerships, rather than just empty words?

The hon. Member is absolutely right: we know that in Sussex we have higher rates of mental health illness than in many other parts of the country, with a 15% increase in Sussex A&E attendances. He might not be aware of them, but multiple schemes are available in Sussex. Health in Mind is offering psychological support to those suffering stress and anxiety, which can be self-referred. We have the Sussex mental health crisis line, now open 24/7, which is accessed via the 111 service. We have mental health professionals rolling out the blue light triage service in Sussex, and we have the Brighton and Hove mental health rapid response service, open 24/7, to which anyone can refer themselves urgently. Perhaps if he looks at some of the services provided locally, he will be able to reassure his constituents.

The Minister mentioned the importance of parity of esteem, and she is quite right, but it is disappointing that the Government had a manifesto commitment in 2017 and 2019 to reform the Mental Health Act 1983, which they have not fulfilled, with no such Bill in the King’s Speech. Would the Minister agree with me that the issues that existed prior to 2017 in relation to the Mental Health Act still exist today with the disproportionate number of black and minority ethnic people being sectioned under that Act, and people with learning disabilities and autism kept in inappropriate settings? Can she give any encouragement to those of us who want to see that reformed, particularly in relation to the appointment of a mental health commissioner to oversee changes to the Act and to advocate for the parity of esteem that she is looking for?

It remains our intention to bring forward a mental health Bill when parliamentary time allows. We have the draft Mental Health Bill, which we have put through pre-legislative scrutiny. We are looking at the report from the Joint Committee and will be responding to that shortly.

Cost of Living: Impact on Mental Health

12. What recent assessment she has made of the potential impact of increases in the cost of living on mental health. (900478)

We are acutely aware of the impact that the cost of living has on mental health, which is why this Conservative Government spent over £350 billion during the pandemic on protecting people’s jobs and over £60 billion during the recent cost of living pressures to pay for their energy bills.

The Centre for Mental Health, the British Psychological Society and others have raised serious concerns about the UK Government’s new back to work plan, warning that the increased threat of applying benefit sanctions or coercing people into jobseeking will be detrimental to claimants struggling with their mental health. Does the Minister share my concern about this, and has she made any representations to her Cabinet colleagues about the mental health impact of these measures?

That is the difference between the SNP and the Conservatives: we have aspiration for people, and we absolutely want to support people with mental health problems and illness to get into work. They should have the same opportunities to get into work, and not just to get a job, but to get a good job and get a career. If we look at its website, Mind supports people getting into work, saying that it is not just a source of income, but provides a “sense of identity” and “structure” as well as support, confidence and ambition.

A recent study by Magic Breakfast and the British Nutrition Foundation found that eating a healthy breakfast can improve the nutritional intake of the most vulnerable children, improving their physical and cognitive development and their mental health. Will my hon. Friend work with colleagues in the Department for Education to consider expanding school breakfast provision in order to reduce the health impact of child food insecurity?

We want a more cross-Government approach to mental health provision, and that is why in our suicide prevention strategy we are working with multiple Departments. My hon. Friend asks about support for nutrition in schools, and I will certainly raise that with colleagues in the Department for Education to see what more can be done.

I welcome the Secretary of State to her new role. Research by the Mental Health Foundation found that the cost of living crisis has left a third of UK adults feeling anxious, more than a quarter feeling stressed, and almost one in 10 feeling hopeless. What representations has the Minister made to Cabinet colleagues regarding the impact of the cost of living crisis on health outcomes since she took up her post?

I have outlined some of the financial support that the Government have given during covid and the cost of living pressures. I also point to schemes that the Treasury has rolled out, such as the Breathing Space programme, which sees enforcement action from creditors halted, and interest frozen for people with problem debt who are experiencing mental health issues, and covers a 60-day period. That is the sort of practical help that this Government are giving to people.

We now move to topical questions. We are running late because questions have been too long, as have answers. I often make this plea. In any case, Members should not be reading their questions—questions are not meant to be read; they are meant to be questions. Can everybody please cut out those bits that say their constituency is beautiful, for example, and just ask a question? We all believe that our constituencies are beautiful, and none more so than mine.

Topical Questions

My priority as Secretary of State is to reform our NHS and social care system to make it faster, simpler and fairer. Since my appointment, we are making progress. To make our system faster, we have hit our manifesto target to recruit and retain 50,000 more nurses for our NHS, and to deliver 50 million more GP appointments, achieving both commitments months ahead of time. We have made an offer to health unions that I hope will end the consultants’ strike, which has disrupted care for the public and put a strain on staff. To make our system simpler, we have announced Pharmacy First, which will make it quicker and easier for millions of people to access healthcare on the high street. To make our system fairer, we have agreed a deal with pharmaceutical companies that will save the NHS £14 billion in medicine costs and give patients access to more life-saving treatment. The NHS is one of the reasons I came into politics—[Interruption.] I know Labour Members do not like to hear that, but I look forward to working with patients and staff across the country—[Interruption.]

Order. I do not need any help, thank you. The Secretary of State has answered the first question at length. I am sure that means she will answer the other questions much more briefly.

People with disabilities and serious health conditions already have higher living costs, and the proposals in the work capability assessment activities and descriptors consultation will mean that if they are reassessed they will lose £390 a month. I appreciate that the Secretary of State is new to her role, but will she commit as a priority to taking this up and consulting Cabinet colleagues, to ensure that people who are disabled and have serious health conditions are not pushed even further into dire poverty?

As I said earlier, careful thought has gone into the announcements that were made in the autumn statement, and of course I will work with the Secretary of State and the Chancellor to ensure that the commitments we already have to people living with disabilities are maintained, and that we have their wellbeing at the heart of all our policy making.

T4. The Secretary of State’s predecessor took a strong interest in the deaths that took place in the Essex mental health trusts, and a statutory inquiry is now taking place. Will she meet me and our Essex colleagues, and the families, to discuss that important inquiry, so that they can have justice for the loved ones they have lost? (900494)

I would be very pleased to meet my right hon. Friend, the families and other Essex MPs to discuss that important inquiry.

With your indulgence, Madam Deputy Speaker, I welcome the Secretary of State and the new members of her Front-Bench team to their roles. I am honoured myself to stand at the Dispatch Box today for the first time on behalf of the shadow Secretary of State for Health, my hon. Friend the Member for Ilford North (Wes Streeting), who is currently in Australia exploring international best practice in healthcare.

Talking of best practice, on this Government’s watch, people with suspected breast cancer are not getting it. The two-week target from GP referral to a first consultant appointment for breast cancer has not been met since March 2020. I know from my own experience of breast cancer that the waiting is terrifying, wondering whether it has been left too late and the cancer has become incurable. How much longer will patients have to wait before the Government can meet their own targets and deliver the timely care that patients need and deserve?

I genuinely thank the hon. Lady for her warm welcome, and indeed I welcome her to her first outing at the Dispatch Box. As she was describing where the hon. Member for Ilford North (Wes Streeting) is, I had images of “I’m a Celebrity… Get Me Out of Here!” Sadly for citizens in Wales, they are experiencing what it is like to live under a healthcare system run by Labour, and they might fully agree with that sentiment.

The hon. Lady raises the important issue of breast cancer, and the NHS has an ambition to diagnose 75% of cancers as stages 1 or 2 by 2028. In January last year we provided £10 million of funding for 28 new breast screening units and nearly 60 life-saving upgrades to services in the areas where they are most needed, because we understand our constituents’ concerns and also their determination that we continue to improve cancer survival rates.

Unfortunately, the reality is that cancer referrals have only got worse with the Conservatives in government. In September 2023, only 74% of urgent cancer referrals to a consultant met that two-week target. That is the second-lowest rate for two-week referrals since 2009. When can the public expect this performance to improve?

We have in fact made progress by delivering record numbers of urgent cancer checks, and levels of first treatments following an urgent cancer referral have been consistently above pre-pandemic levels, with activity in September standing at 108% of pre-pandemic levels on a per working day basis.

T6. Some six months ago, the dentist based at Firthmoor community centre, serving 8,000 of my constituents, handed back its contract to the integrated care board. I was shocked last week to learn that the ICB has still not commenced the tender process to replace that provision. What advice can the Minister give me to ensure that our ICB is doing what it needs to do? (900496)

My hon. Friend has already raised this issue with me several times in the almost two weeks I have been in this post, so he is doing a great job, and he is right to raise it. Tendering exercises for NHS dentistry are bound by current procurement law, but I am happy to meet him to discuss how much faster we can go to get this sorted out.

Brexit broke Britain and it is continuing to wreak havoc on supply chains. The shortage of ADHD medication is now set to drag on into next spring. The shortage has seen 70% of patients forced to ration their supply of ADHD drugs, with 62% reporting an increase in suicidal thoughts. What steps is the Minister taking to ensure that supplies of these vital medications are reaching pharmacies across the UK?

T9. My local practice, on Heath Lane in Earl Shilton, released its “did not attend” figures. Between 20 November and 24 November, 69 appointments—including 36 GP appointments and 28 nursing appointments—were missed. That was 12 hours lost in five days. If that is happening up and down Hinckley and Bosworth and across the country, that is thousands of hours being missed. I know that the Government are keen to see more on data, so will they consider statementing patients on how much missed appointments cost, because clinically that would make a big difference to the awareness of what people are cashing out on? (900499)

May I thank my hon. Friend for bringing his professional expertise to the Chamber? Of course, minimising “did not attends” is a critical part of ensuring that clinical time is optimised, and I will take his suggestion away and mull it over.

T2. I understand that pathology staffing levels at Royal Blackburn Hospital have not been reviewed for 15 years and the workload is up 300%. The national deficit in pathology is a ticking time bomb, as hospitals are unable to offer surgical and emergency services. What steps is the Minister taking to address recruitment and ensure that staff and patients are safe? (900492)

I understand the hon. Lady’s concern. As she knows, we share a local NHS hospital trust. I am very keen to work with her on this issue. Of course, this Government are the first to introduce a long-term workforce plan for the NHS, which will deliver thousands more clinicians for a range of services across the NHS in the years to come.

Last month, the National Institute for Health and Care Excellence said that Kaftrio, Orkambi and Symkevi are effective treatments against cystic fibrosis, but are too expensive to put on the NHS’s list. CF is a death sentence, so what can the Secretary of State do to make sure that this medication is put on the shelves to save thousands of lives in the future?

My hon. Friend makes a very important point. NICE has yet to publish its final guidance and is continuing to work with all parties to address the issues raised in the draft guidance. The Government encourage manufacturers to work with NICE in setting a price that represents value for the NHS. I can assure the House that existing and new patients who are started on treatment while the NICE evaluation is ongoing will have access after it has issued its final recommendations, irrespective of the outcome.

T3. As we know, there are strong links between financial difficulties, mental health and suicide. The poorest 10% are twice as likely to die from suicide than the wealthiest 10%. With so many people struggling to make ends meet, how is the Minister going to ensure that those seeking financial support get access to mental health support, and that those seeking mental health support get access to help with their finances? (900493)

May I pay tribute to the hon. Lady for her work on the all-party parliamentary group on suicide and self-harm prevention? She knows that financial difficulty is a priority area in the suicide prevention strategy, because we know it is a high risk factor. That is why suicide is now everyone’s business—not just the Department of Health and Social Care, but our colleagues at the Department for Work and Pensions, His Majesty’s Revenue and Customs and all Government Departments. Anyone who has financial stress and pressure will be given support to reduce their risk of suicide.

My constituent Dan Archer runs the highly successful Visiting Angels care agency, which has an annual staff turnover rate of just 13%, compared with an industry average of 60%. The secret to his success is very straightforward: paying decent wages, investing in training, valuing staff and prioritising client satisfaction. As a consequence, an enormous amount of money is saved on recruitment and invested into training and retention instead. Would the Minister meet my constituent to learn more about the success of Visiting Angels and how it can be shared more widely to help solve the shortage of workers in the care sector?

Order. Can Members please cut their questions in half? Otherwise, I will have to stop this questions session and people will not get a chance at all.

I would be delighted to meet my hon. Friend’s constituent. What the employer does is really important for retention and recruitment of adult social care staff, along with our ambitious workforce reforms for the care workforce.

T5. The Health Secretary declared at the weekend that the Government will miss their target to cut NHS waiting times if doctors strike to defend their pay and conditions, but she seems to forget that since the Tories took power in 2010, waiting lists for hospital treatments are up, A&E waiting times are up, cancer referral times are up and ambulance response times are up. The only thing that has fallen is not waiting times; it is public confidence in the Government. Will the Minister finally admit that the threat to waiting time targets is not striking doctors, but her party being in government? (900495)

I assume from the hon. Gentleman’s question that he fully supports our efforts to get consultants back into hospitals as well as junior doctors and doctors in training. It is all very well to sit there commenting, but we on the Government side of the House are working with doctors to try to help them look after the NHS for us all.

While I recognise that money does not grow on trees, neither do teeth. Can my right hon. Friend advise me of how quickly my North Devon constituents will be able to see the NHS dentists they so desperately need?

My hon. Friend is absolutely right: there is a lot more that we can do. We are working at pace to see what announcements we can make on the dental recovery plan as soon as possible. In the meantime, she will be aware that, in the south-west, NHS England has commissioned additional urgent dental care appointments that people can access via NHS 111.

T7. Last week, the former Health Secretary admitted at the covid inquiry that sick pay across the UK is “far too low”. It is far lower than the European average and encourages people to go to work when they should be getting better. Does the Secretary of State agree with her predecessor? What discussions will she have with her Cabinet colleagues to improve the inadequate sick pay system? (900497)

I will not comment on evidence from the covid inquiry, given that it is an independent inquiry. However, on the general principle of encouraging people back into work, we have the plans set out by the Secretary of State for Work and Pensions and the Chancellor at the autumn statement. We want to encourage people back into work and to support them when they fall ill and need help from the state.

Last year, I asked the Government to show me the money with respect to £118 million of long-awaited capital funding for south Essex hospitals. With £8 million now delivered and the other £110 million now confirmed to be on its way, will the Secretary of State please come with me to Southend Hospital and see how that vital money will transform care in Southend and Leigh-on-Sea?

I will be delighted to visit that hospital with my hon. Friend—I suspect that I will be visiting a lot of hospitals.

T8. Was the Secretary of State consulted about yesterday’s announcement by the Home Secretary? If she was, did she agree with him that it will have no impact on overseas recruitment, or does she hear the fear of care providers about its consequences? (900498)

Yes, I was. What is more, we looked carefully at the figures in relation to overseas care workers. We are grateful to all international people who work in our NHS and our care system, but we need to tackle the migration rate, which is too high. The package presented yesterday by the Government is a thoughtful and careful one to tackle legal migration.

Stroud Maternity Hospital is doing a great job, but the post-natal beds are still not open. We have been chasing a ministerial meeting about that for some time. Will my hon. Friend meet me and the Gloucestershire NHS scrutiny chair, Andrew Gravells, to discuss the issue? We think that we need some help with the Care Quality Commission.

I am happy to meet my hon. Friend to discuss that specific issue. We are doing a piece of work on a capital survey of all maternity units as well as working with the CQC on how capital infrastructure—beds and so forth—are impacting on maternity performance.

T10. Attention deficit hyperactivity disorder medications are essential to many people. In response to my written question last month, the Department outlined “disruptions to the supply”, which are expected to “resolve in early 2024”. How have the Government allowed that to happen? What plans does the Department have to prevent a similar situation from occurring in the future? (900500)

As I said in an earlier response, there is a global shortage of ADHD medication. As we set out in our response to her written question, we expect that to be resolved shortly.

Lobular breast cancer treatment must be improved. Will the Minister meet my constituent and me to discuss how?

Cancer remains the leading cause of death by disease in children and young people, with nearly 500 dying every single year, yet the Government continue to reject calls for a dedicated children’s cancer plan. Why is that?

As the hon. Member knows, cancer will be part of the Government’s long-term strategy for diseases. Improving cancer treatment wait times is a top priority for the Government, with a key focus on the elective care recovery plan backed by an additional £8 billion in revenue funding across the spending review period.

In response to a written question that I submitted, I was told that the Department of Health and Social Care holds no central data for diagnosis and treatment of those with eating disorders and has no idea how many mental health nurse appointments are available in GP surgeries, despite all the funding. Do Ministers agree that that is a disgrace?

NHS England holds some of that data. Central data is one of the things that we are introducing right now to improve our access to data. It makes it difficult to plan services when we do not have that dataset, but we are working to resolve that as quickly as we can.

Farmers face many serious mental health challenges, including the financial precipice that this Government have led them to. According to the Farm Safety Foundation, 95% of young farmers in this country identify poor mental health as their biggest hidden challenge. Will the Minister meet me and the Secretary of State for Environment, Food and Rural Affairs to discuss how we can best support farmers and farm workers to develop robust mental health strategies?

I attended the National Farmers Union session in Westminster just before the launch of our suicide prevention strategy. We recognise that isolation and loneliness in rural communities is an issue. I am happy to meet any hon. Members who wish to discuss how we can better support farmers, improve their mental health and reduce suicide rates.

Will the primary care Minister join me in congratulating the Conservative Mayor of Bedford borough for proposing council money to invest in primary care facilities in Great Barford, Wootton, Wixams and Kempston? Will she condemn Labour and Liberal Democrat councils for voting it down?

I am glad that my hon. Friend has raised this issue. He is absolutely right; in local authorities we need mayors and integrated care boards supporting primary care and not listening to the Opposition, who talk it down the whole time. The 50 million more GP appointments is something to celebrate.

Given that obesity now costs the NHS and our economy much more than smoking, why does the Secretary of State support a total ban on smoking but think that measures to tackle obesity are nannyish?

The right hon. Gentleman raises a completely artificial barrier. Smoking is totally preventable; it is the cause of one in four cancers and 75,000 deaths. It is unbelievably appalling. Obesity is a complex area and one that the Government are focused on. We need to tackle it, but it is entirely different.

Would the Health Secretary please agree to meet me to discuss improved access to GPs and dentists in Bracknell Forest and Wokingham boroughs?

My constituent Air Marshal Dr David Walker, an inspirational leader and academic, sadly died of glioblastoma in June. When diagnosed, he and his wife Catherine were shocked to learn of the woefully low funding for brain and other less survivable cancers and established the charity the Right to Hope with Cancer. Will the Minister show the courage and leadership so epitomised by the life of Air Marshal Walker, and properly resource and fund less survivable cancers, so that everyone living with cancer has some sort of hope?

The hon. Gentleman makes an important point. My 23-year-old constituent Laura Nuttall, from Barrowford, died in May, five years after being diagnosed with a glioblastoma, having been given just a year to live. Before her diagnosis, Laura did work experience in my parliamentary and constituency offices. She was one of the most remarkable people I have ever met. As I get up to speed in my new ministerial role, he can rest assured that I will make as much progress as possible in this area. It is a personal priority to me.

Order. We have gone considerably over time because I have endeavoured to ensure that everyone whose name is on the Order Paper has had a chance either in substantive questions or in topical questions to ask questions on these important subjects on behalf of their constituents. Again, I appeal to Members: they are not meant to read questions, they should just ask them. It is not meant to be a speech, and it is certainly not meant to be drafted for Twitter or Instagram. It should be a question to the Minister. Let us hope for some improvement.

I apologise to the right hon. Member for Wentworth and Dearne (John Healey) for keeping him waiting to ask his urgent question.

Middle East: UK Military Deployments

(Urgent Question): To ask the Secretary of State for Defence to make a statement on UK military deployments to the middle east.

Since Hamas’s horrendous attack on Israel on 7 October, we have increased our military presence in the region. This is to support contingency planning, monitor the evolving situation, and be ready to react and respond. As the right hon. Gentleman will know, I deployed a Royal Navy task group to the eastern Mediterranean, including RFA Lyme Bay and RFA Argus, three Merlin helicopters and a company of Royal Marines as a contingency measure. HMS Diamond is sailing through the Red sea to provide maritime security. HMS Lancaster is already in the middle east.

This morning, I provided a written ministerial statement notifying the House that unarmed military surveillance flights will begin in support of hostage rescue. The UK Government have been working with partners across the region to secure the release of hostages, including British nationals who have been kidnapped. I will move heaven and earth to bring our hostages home. The UK Ministry of Defence will conduct surveillance flights over the eastern Mediterranean, including operating in airspace over Israel and Gaza. The surveillance aircraft will be unmanned. They do not have a combat role and will be tasked solely to locate hostages. Only information relating to hostage rescue will be passed to the relevant authorities responsible for those rescues.

The MOD is working on land, air and maritime routes to deliver urgently needed humanitarian aid. Four RAF flights carrying over 74 tonnes of aid have landed in Egypt. I am considering whether RFA Argus and RFA Lyme Bay can support medical and humanitarian aid provision, given that their original purpose was potentially to take non-combatants out of the area. The MOD routinely deploys significant numbers of military personnel in the wider middle east for operations such as counter-Daesh, training, maritime security and other reasons. There is currently a force laid down across the region of nearly 2,500 military personnel.

Later this week, the Chief of the Defence Staff and I are visiting sovereign base areas, the Republic of Cyprus, the Occupied Palestinian Territories and Israel. I will, of course, report back to the House after that visit. Our objectives include to demonstrate and reaffirm the UK’s continued support for Israel, while continuing to press for adherence to international humanitarian law; to emphasise the importance the UK places on humanitarian aid reaching Gaza; to facilitate a deeper understanding of Israel’s planned next steps in Gaza now that the current pause has ended, and activity along the northern border; and to reaffirm the United Kingdom’s continued belief in a two-state solution and support for a viable and sovereign Palestinian state alongside a safe and secure Israel.

Across the House, we welcomed last week’s pause in fighting and we are all deeply concerned about its restarting. It was a glimmer of light in the recent dark days to see hostages reunite with families, aid reach desperate Palestinians and diplomacy extend the initial pause. There can only be the long-term settlement the Secretary of State talks about if Hamas cannot carry out a terror attack again like that on 7 October, but the military operations in north Gaza cannot be repeated in the same way in the south. Far too many innocent civilians have been killed. As the US Defence Secretary said:

“you can only win in urban warfare by protecting civilians.”

Israel must take all steps to protect civilians, meet the duties of international law and secure flows of aid into Gaza.

I welcome the Secretary of State to the Dispatch Box for his first statement, particularly as this week marks 100 days in the job. The UK has an important role to play to strengthen regional stability in the middle east. That is why the Leader of the Opposition has met and spoken with leaders in the region, including from Jordan, Palestine, Israel and Qatar. That is why the shadow Foreign Secretary, my right hon. Friend the Member for Tottenham (Mr Lammy), has visited the region twice in recent weeks, and that is why we welcomed the initial deployment of UK forces on 13 October. They will do the job with total professionalism, and we thank them for that.

Since then, however—according to an answer given to me by the Secretary of State—the total number of UK personnel has risen to at least 4,500, and the escalation risks have risen as well. How will the Secretary of State ensure that UK surveillance flights support hostage rescue and not Israeli operations? How many British hostages remain in Gaza? How will the UK Navy ships that the Secretary of State has deployed protect commercial shipping routes? What action is the Secretary of State taking to boost protection for UK personnel, especially those at joint allied bases? What is he doing to open up the maritime routes for humanitarian aid that he has told us about today? Finally, how many more RAF aid flights will take off this month to get much-needed aid into Gaza as the winter cold sets in?

I thank the right hon. Gentleman for his questions. I should just say that unarmed but not necessarily unmanned aircraft—initially, the Shadow R1 —are taking on the task of looking for the hostages.

The right hon. Gentleman asked about the information flow; I can reassure the House that only the United Kingdom will have the ability to provide that information, and that is how we will ensure that it is used for the appropriate purposes. He asked about the number of hostages; the United Kingdom has not confirmed exact numbers, partly because it is still unclear whether some may have died in the original 7 October event or in subsequent events, and whether some may be being held. We do not want to cause additional stress, but we know that there are still British hostages being held.

The right hon. Gentleman asked about protecting the ships. They are, of course, extremely capable ships—the last ship to be deployed, HMS Diamond, is capable of looking after herself, one might say—and we are benefiting from a great deal of co-operation with allies in the region to assist with that force protection. The right hon. Gentleman also asked about British forces in the wider region who may be in, for example, Syria or Iraq. Again, we take their force protection very seriously. As the right hon. Gentleman will understand, I cannot go into operational specifics, but we keep it under constant review.

Lastly, the right hon. Gentleman asked about humanitarian aid. This country has provided £60 million-worth of additional aid made available for Palestinians, and four flights have taken off so far. Members on both sides of the House will realise that the problem is not just providing the aid but getting it into Gaza. The Rafah crossing presents a considerable barrier to that, for all sorts of security reasons. I am actively looking at different routes, and the right hon. Gentleman will understand that that is one of the reasons I am going to the region this week.

I welcome the Secretary of State’s answers, including his confirmation that, as has been reported, the Shadow R1 is being deployed. I note that the intention is to use a range of surveillance aircraft. Will the Secretary of State tell us what other assets he is intending to use? Given the significant tasking, the threats to shipping and the ongoing commitments to, for example, Operation Shader, will he comment on what is being deprioritised to allow this mission to take place? Finally, in view of the recent threats to the Rivet Joint aircraft—I know that there are defensive aid suites on board—will he confirm that due consideration is being given to the protection of crews, given all the likely threats in the area and the presence of Iran?

My hon. Friend will know that we have a number of capabilities for intelligence, surveillance and reconnaissance. The Rivet Joint, which he mentioned, has been involved in carrying out missions elsewhere, and—as I think he hinted—has attracted unprofessional behaviour from other air forces. We have the P-8 available as well, along with the Shadow R1 and others. Exactly which aircraft and machinery perform these roles will depend on operational circumstances, but I can confirm that we have not had to pull resources away from other urgent work to provide this cover.

It is important to repeat the denunciation of the death cult known as Hamas. Given the war of attrition that is now taking place in south Gaza, let me reiterate from the SNP Benches the call for an immediate ceasefire, because I am afraid that a pause will not suffice. The view from here, at least, is that without a ceasefire we will see yet another graveyard from which fundamentalism will rise.

Let me ask a specific question. The Secretary of State mentioned reconnaissance missions looking, rightfully, for UK citizens being held by Hamas. Does he agree that any information coming out of those reconnaissance missions that sees illegal activity under international law should be handed over to the International Criminal Court for its ongoing investigation into the operations in Gaza?

The hon. Gentleman is right to stress the abominable, disgraceful, disgusting behaviour of Hamas. He calls for a permanent ceasefire; I suggest that that would be a heck of a lot easier if Hamas released the hostages they are holding right now.

As I stressed earlier, we will be in charge of the reconnaissance information, which will focus exclusively on hostage recovery and will be passed only to the appropriate authorities.

Those on both Front Benches seem to agree that Hamas must not remain in control in Gaza. Is any thought being given to how, once they have been removed, they can be prevented from coming back? There will need to be policing, and a moderate major Arab neighbour of Israel has said that a two-state solution can happen only if it is enforced. Will we have a hand in that enforcement? If not, how can it possibly happen?

My right hon. Friend is an expert on these matters, and he is right: there has to be an international outcome to this, and a solution. I am afraid that in recent decades there has not been sufficient global focus on a two-state solution because it seemed to be an unsolvable problem, and it has slipped into the background. My right hon. Friend is also right to say that there must be a global coalition which will need to include Arab states. A huge amount of work is being undertaken for what some people call “the day after”.

May I ask a slightly wider question? What are the Government doing specifically to prevent escalation and promote regional stability?

I think that if on 7 October we had projected forward eight weeks and known what we know now, we would have been very concerned about this leading to a widescale regional escalation. It is a credit to the United Kingdom and the professionalism of our services that, after the United States, we have deployed the most military assistance to the area. I have been told by a fair number of the Arab states that they appreciate the deterrent that that has placed on Iran and its many proxies in the area. Certainly the fact that eight weeks later we have not seen that expand is a credit to the British laydown.

In recent weeks we have seen Houthi rebel attacks on shipping in the Red sea, and back in June there were reports of harassment of shipping in the strait of Hormuz by the Islamic Revolutionary Guard Corps and Iranian attempts to consolidate control of contested islands. What action is the UK taking with our allies to protect freedom of navigation?

My right hon. Friend is right. We have seen the Houthi, out of Yemen, try to take advantage of the situation and, for the first time in a very long period, we have seen Somali pirates becoming involved. That is why I have sent HMS Diamond to the Gulf, and it is why HMS Lancaster is there as well. Let me reassure my right hon. Friend: I am working very closely with our international partners on how we can dissuade people from engaging in activity of this kind in what are international shipping waters. That includes the conversations that I had in the United States last week with my opposite number, the American Defence Secretary, Lloyd Austin.

How can the Secretary of State reassure me that the defence resources and attention now been focused on the middle east will not in any way reduce what we are able to commit to in support of our friends in Ukraine?

I hope the right hon. Gentleman will know of my personal interest in and dedication to Ukraine. I can absolutely reassure him that this is not defocusing that work in any way, shape or form. We are ensuring that we continue to provide daily support to our Ukrainian friends, and I have a very close relationship with the Ukrainian Defence Secretary Umerov, Deputy Prime Minister Kubrakov, President Zelensky and many others within their system.

It is important that Israel abides by the law of armed conflict, but in that context I welcome the deployment of these assets, not least to try to locate the British hostages. The Secretary of State will know that, ultimately, Hamas and Hezbollah are funded and trained by Iran, so what discussions has he had with our new Foreign Secretary about when, oh when, we will finally declare that the Islamic Revolutionary Guard Corps should be banned?

The IRGC and its position are kept under constant review. I know that my right hon. Friend the Foreign Secretary is constantly looking at the region. He has been out there already and will be weighing up the advantages of things such as being able to have a post in-country against what it would mean to carry out such a ban. I also know that my right hon. Friend the Member for Rayleigh and Wickford (Mr Francois) will know how to take that up with the Foreign Secretary.

Further to the question from my hon. Friend the Member for West Dunbartonshire (Martin Docherty-Hughes), with the International Criminal Court stepping up its work in Gaza and the Government again confirming their surveillance flights over Gaza, will the Government hand over any and all evidence of war crimes to the ICC, whether they are committed by Hamas following the 7 October atrocities or in the ongoing massacre of Gazan civilians, particularly children, by the Israel Defence Forces?

The easiest way to bring this to an end, as I hinted earlier, would be for Hamas, a terrorist organisation, to release the hostages that they have, to stop firing rockets into Israel in a completely indiscriminate way, which I think the whole House should condemn, and to allow this thing to be brought to a close. As I have said repeatedly, it is important that Israel should adhere to international humanitarian law. I will be making that point publicly and have made that point all along to my Israeli counterpart, Minister Gallant. I wonder why, however, the concern is not about the hostages who are being held and how this situation could be brought to a conclusion much faster if they were released.

I am pleased to hear that contingency planning is taking place. Would the Secretary of State consider tasking the aircraft carrier to the region as well? Behind Hamas sits Iran, behind Iran sits Russia, and behind Russia sits China. We are seeing new alliances forming, and the world’s ability to deal with these challenges is being severely tested, as are our own armed forces, who are now increasingly overstretched. What conversations is he having now with the Chancellor about increasing the defence spend in the Budget in the spring?

I will go for the last of my right hon. Friend’s many good questions. This Government are committed to 2.5%, as conditions allow. I know that he will be making his own representations to the Chancellor. I have previously talked about my own belief that we need to reach not just that 2.5% but 3% and higher.

It was reassuring last week, in answer to my question, to hear the Minister for Armed Forces, the right hon. Member for Wells (James Heappey) telling us that UK surveillance flights would not involve the use of intelligence for target acquisition. I also welcome the Secretary of State talking today about how information that would be helpful to hostage recovery will be passed to the so-called appropriate authorities. We have now heard two questions about the International Criminal Court. Will the UK pass any evidence that it gathers of any breaches of international humanitarian law by combatants in Gaza to the ICC?

As the hon. Gentleman says, that question has been asked, and I have answered it a couple of times. The intelligence, surveillance and reconnaissance—ISR—flights are to look for British hostages and indeed other hostages. That is the information that will be gathered from those flights. Of course, if we saw anything else, we would most certainly alert our partners, but the purpose is to find our hostages and bring them home.

We all ultimately want peace in the region, and we all want to see humanitarian aid getting through. I welcome what my right hon. Friend has said about HMS Diamond joining HMS Lancaster, because does that not send a signal to Iran that its support for terror groups is not acceptable and must not continue, and that through this action we will prevent further bloodshed in the region?

My right hon. Friend is absolutely right. It is important that we send that deterrent message, and it is working. I have called on all parties not to think that this is an opportunity to get involved and cause further regional escalation, and so far, I am pleased to say that our deterrent has helped to keep a lid on that.

This conflict has already cost over 15,000 Palestinian civilian lives and over 1,200 Israeli lives. The US Defence Secretary has said:

“You replace a tactical victory with a strategic defeat…I have repeatedly made clear to Israel’s leaders that protecting civilians in Gaza is both a moral responsibility and a strategic imperative.”

We know that regional escalation is a real threat. What will the Secretary of State be doing to work with Arab states and the US to apply pressure on the warring parties to bring an end to this war so that we do not see other countries, including our own and the US, becoming engulfed in a wider regional conflict?

I was actually with Lloyd Austin, the US Defence Secretary, when he spoke those words, I believe, and we agree entirely. To make it absolutely clear, Israel needs to comply with international humanitarian law. It needs to go out of its way to warn people when it goes after the terrorists, who use those people as human shields as a matter of routine. The hon. Lady rightly asks what we are doing with our Arab partners in the region. This will be my second visit to the region and I speak to my Arab counterparts all the time. They have welcomed our deterrents, but they also want us to work with the international community on making sure that, on the following day, when this is complete, the solution is not left to chance as it was before and that we are all working together to bring about a safer, more peaceful middle east for Israel and for Gaza.

I welcome the deployment of HMS Diamond and HMS Lancaster and the potential deployment of two further ships, but what discussions has my right hon. Friend had with our NATO and EU partners about perhaps sharing the burden? What progress has he made on that? Shadow R1 is a slow-moving specialist manned aircraft, but it is unarmed in a region that has Iranian proxies with quite good capabilities, as well as Syria and Russian activity. How confident is he that the advice he has received has not put those servicemen in extreme harm’s way?

To clarify the record on the two ships that my right hon. Friend mentions, HMS Lancaster was already there and HMS Diamond is there now, and there are two Royal Fleet Auxiliary ships, which I sent right at the beginning of this conflict. In answer to his broader question, for security, making sure that our personnel are kept safe is always at the heart of what we do. I appreciate his concern, and I know that he will understand that I cannot go into the detail of how we ensure that protection, but it is very much upmost in our minds wherever and whenever we deploy.

Yesterday I asked the Under-Secretary of State for Foreign, Commonwealth and Development Affairs, the hon. Member for Aldershot (Leo Docherty), whether the UK Government were in a position to contribute to the International Criminal Court’s call for evidence in its investigation of potential breaches of international humanitarian law. He said:

“Not at this stage, but we will continue to take note.”—[Official Report, 4 December 2023; Vol. 742, c. 34.]

Surely, if the UK Government are actively collecting drone and surveillance images of the war zone, the answer to that question should have been yes?

I would have thought that the No. 1 concern would be to locate the British hostages, and that is where the surveillance work will focus. The FCDO will be best placed to answer the hon. Gentleman’s specific question.

I am grateful to the Defence Secretary for confirming that the MOD is currently rightly focused on regional security and containment but, inasmuch as the UK has a responsibility to Israel, we also have a responsibility to the people of Gaza. Can he therefore reassure me that His Majesty’s forces will not become involved in any military action unless it is in direct support of British interests or British nationals?

The right hon. Member for New Forest East (Sir Julian Lewis) mentioned future arrangements. Can the Secretary of State give the House an assurance that there will be no deployment of British troops on the ground in Gaza, Israel or the west bank without the approval of this House?

The Houthis, who are attacking British and American cargo ships, and Hamas are basically two sides of the same coin. They are Iranian-funded, Iranian-trained and, of course, Iranian-guided terrorist groups that are publicly committed to the destruction of Israel. Does the Defence Secretary agree that using UK military assets in support of our ally is crucial to deterring further escalation? None of us wants further escalation.

I particularly welcome the UK’s deployment of drones to help locate hostages, including British hostages. In the days after 7 October, the Defence Secretary said:

“No nation should stand alone in the face of such evil”.

Will he repeat that crucial support today and in the difficult days ahead? I thank him for his support.

I clarify again that these are not necessarily only drones. Some will be piloted or will be unarmed. My right hon. and learned Friend is absolutely right that no nation should stand alone. It is easy to forget how this all began, when the Hamas terrorist group thought it was a plan to go into Israel to butcher men, women and children, cut off heads and rape people.

One of the keys to securing and sustaining any ceasefire, pending a wider political solution, may be a UN, or UN-authorised, peacekeeping or monitoring presence on the ground. For various reasons, historical and otherwise, such a presence may have to be led by the Arab states. Does the Secretary of State foresee any situation in which the MOD could provide back-up support to such a presence? Is any planning being done for such a scenario?

As the hon. Gentleman can imagine—and this was included in my conversations in the States last week—there is a huge amount of international work about what happens afterwards and how it will be structured. It is rather too soon, I am afraid, to predict exactly how it will look, but I do not think he is too far off the mark to think that this needs to be a truly global response. It will need to involve Arab partners. We will do whatever we can to support that, but I see no circumstances in which British troops would be on the ground.

Can my right hon. Friend elaborate on the efforts the Government are making to de-escalate the conflict, in the hope that this would reduce civilian casualties?

Of course, the single biggest thing that could happen to escalate this conflict would be for it to turn into a regional conflict. I am thinking, in particular, of Hezbollah on the northern border with Lebanon, as well as what could happen from Syria, from Iranian-backed terrorists in Iraq and, of course, from the Houthis. This could get worse in a variety of places, which is why sending ships and military for deterrent purposes has been so vital and has been our primary approach to preventing this conflict from turning into a bigger regional conflict.

Can the Secretary of State tell us what role the RAF base in Cyprus is currently playing in this situation? Is any military matériel being moved through that base?

The hon. Lady will know that the RAF bases in Cyprus are a very useful asset. They are being used, for example, to provide support to our military in the area. To answer her specific question, I can assure her that we have provided no offensive military weapons to Israel during this conflict. In fact, our military exports to Israel are quite low. Last year’s figure was something like £48 million, which is not a very significant amount of money. During the conflict, we would provide only defensive matériel, or matériel that might help with the recovery of hostages.

I applaud the decisive actions of my right hon. Friend and the Government to defend our strategic ally, Israel, against Hamas, but the grim reality on the ground right now is that Hamas continue to fire dozens of rockets at Israeli towns and cities. The Iran-backed terror group have fired more than 10,000 rockets since 7 October and show no sign of stopping their violent attacks against Israel. Will my right hon. Friend not only commit to continuing his support for Israel in defending itself against Hamas, but reassure the House that every possible step is being taken to counter Iran’s links across the region, which are causing instability?

My hon. Friend makes an excellent point that the conflict would be over immediately if hostages were released and Hamas stopped firing rockets into Israel—there would not be a cause for conflict. Indeed, that is the policy Israel followed for many years, hoping that, even though rocket attacks continued, Hamas would not take advantage of their own population by using them as human shields and building infrastructure under hospitals, schools and homes. Unfortunately, that is not the Hamas way. That is what they have done, and my hon. Friend is absolutely right to identify Iran as being behind this whole evil business.

The Secretary of State needs to be very clear with the House: 15,000 people have already died in Gaza, and 1,200 have died in Israel. Israel is clearly pushing the entire population southwards, if not out of the Gaza strip altogether. Is Britain involved in the military actions that Israel has taken, either physically or by providing information in support of those military activities? I think the House needs to be told. What is the long-term aim of British military involvement in Gaza?

The simple answer is no, and I hope that clears it up. I am surprised to hear the right hon. Gentleman talk just about people being killed. They were murdered. They were slaughtered. It was not just some coincidental thing. I understand and share the concerns about the requirement on Israel, on us and on everyone else to follow international humanitarian law. When Israel drops leaflets, when it drops what it calls a “knock” or a “tap” and does not bomb until afterwards, when it calls people to ask them to move, when it issues maps showing where Hamas have their tunnels and asks people to move away from them, that is a far cry from what Hamas did on 7 October, when they went after men, women and children.

I welcome my right hon. Friend’s statement on increased UK military deployment in the middle east. Thanks to the armed forces parliamentary scheme, I have been privileged to meet some of the highly skilled RAF and Royal Navy personnel who serve our country. Will my right hon. Friend join me in paying tribute to their exemplary professionalism and sense of duty as they undertake this extremely important work in the middle east, not just on behalf of our country and people in the middle east, but on behalf of every civilised democracy in the world?

I absolutely join my hon. Friend. They are the most remarkable people, often operating in very difficult circumstances. I am very much looking forward to meeting some of them in the region this week.

We have seen increased bombardment in southern Gaza after the pause. We are also seeing increased violence in the west bank, supported by extremist settler Ministers. What talks is the Secretary of State having with Israel to stop the increase in settler violence in the west bank?

I certainly will not be pulling my punches when I speak to my Israeli counterparts. The violence in the west bank is unacceptable and it must be controlled—stopped, in fact. None of that, in any way, shape or form, separates us from our utter condemnation of how this whole thing was started in the first place with Hamas, but the hon. Lady is right about that settler violence.

Medical Aid for Palestinians has warned that Israel’s indiscriminate bombing and siege is making it impossible to sustain human life in Gaza. With 1.8 million civilians displaced and a lack of clean water and sanitation, it is just a matter of time before a cholera outbreak kills many thousands more. The Secretary of State has been unequivocal that the main purpose of surveillance is to help find hostages, which is fine, but for the fifth time of asking: if clear evidence is found of breaches of humanitarian law, will the UK Government share that evidence with the International Criminal Court?

The simple answer is that we will always follow international humanitarian law and its requirements. I want to say, with reference to the aid picture on the ground, that one of the primary reasons for my visit this coming week is to work on ensuring that the international community can get more aid into Gaza, and the United Kingdom will be leading on that point.

I very much thank the Secretary of State and the Government for the stance they have taken. It is one that I and my constituents very much support, as we do finding a solution. May I also thank the Government for working tirelessly with partners abroad to bring home British nationals trapped in Gaza? Will the Secretary of State perhaps provide assurances that surveillance flights will continue to fly over the eastern Mediterranean as long as there are still risks to British nationals remaining in Gaza?

I can certainly provide an assurance that we will always do whatever we are able to do in the circumstances. During the recent pause, for example, part of the deal was that surveillance flights were not flown, but we would always ensure that we are trying to assist. In particular, given that this entire episode began with something of a surveillance failure, the UK has always been keen to help; from the very early days of this conflict we have provided additional intelligence, surveillance and reconnaissance over the eastern Mediterranean. What is new now is for that to be over Gaza, relating to the hostages specifically.