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Health and Social Care

Volume 742: debated on Tuesday 5 December 2023

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.