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Oral Answers to Questions

Volume 744: debated on Tuesday 23 January 2024

Health and Social Care

The Secretary of State was asked—

Alcohol-dependent Parents: Support for Children

1. What steps she is taking with Cabinet colleagues to support the children of alcohol-dependent parents. (901098)

May I start by wishing the hon. Member for Ilford North (Wes Streeting) a speedy recovery?

We are taking a wide-ranging approach to alcohol harms. Some £27 million has been invested in specialist alcohol care teams in a quarter of hospitals with the highest need, and we have published the first ever UK-wide clinical guidelines on harmful drinking and alcohol dependence, as well as providing around £300 million in funding to 75 local authorities through the family hubs and Start for Life programme. Family hubs funded through that programme are encouraged to provide full wrap-around support for families, which may include alcohol support services.

To the Government’s credit, they are currently putting money into addiction services. However, at the same time, there is no national strategy for children of alcohol-dependent parents. That has not always been the case. Between 2017 and 2021, there were local and national helpline services funded through a national strategy. Will the Secretary of State meet me to discuss this matter, as the children in these awful situations are some of the most vulnerable in society?

May I thank my hon. Friend for her care and also for sharing her experiences on this subject? Through the drugs strategy, we have committed an extra £532 million of funding over three years to improve alcohol and drug treatment services, with £15.7 million invested in Lancashire. Last year, we saw a further £2.8 million invested nationally in line with guidance for the extra drugs strategy funding, which allows local authorities to fund targeted services for parents in need of treatment and support for their children and families. I will, of course, be happy to meet my hon. Friend to discuss this further.

I have turned over a new leaf, Mr Speaker.

May I urge the Secretary of State to take this issue very seriously, to direct much more social media at young people and to get into schools the message about the real damage that can be done to the entire life of a child if the mother is drinking alcohol during pregnancy?

I thank the hon. Gentleman for bringing some insight into how we can best reach families. Of course, it is not just mums, but fathers or carers who can have a huge impact on our children. That is why the Under-Secretary of State for Health and Social Care, my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom), is investing so much energy and commitment in our family hubs. We believe that they can be the centre for families to make the very best start to a child’s life.

Hospital Discharge: Social Care

2. What recent progress her Department has made on supporting the timely discharge of patients from hospital into social care. (901099)

Discharging people on time is better for them and frees up hospital beds. We are changing how our health system works to do that: joining up health and social care and care transfer hubs; helping people to recover at home, with more than 10,000 new virtual ward beds; and investing in social care. And it is working. Last month, delayed discharges were down 9% compared with the end of December 2022 despite almost 1,000 extra urgent admissions to hospitals every day in December.

Nearly one in six beds in my local healthcare trust in Buckinghamshire continues to be occupied by patients fit for discharge. A recent King’s Fund report found that the Government’s current practice of providing one-off funding to reduce delay, while welcome, comes with insufficient advance notice to allow for effective planning. What steps is the Minister’s Department taking to ensure the best use of this funding?

One reason we distributed discharge funding back in April last year was to give more advance notice to organisations, so that they could put in place what is needed to speed up discharges. I say to the hon. Lady that our plan is working. That is why, in her own trust, discharges at the end of December were down by a third compared with the previous year.

I note the progress that my hon. Friend referenced, but delayed discharges are still a major issue. Patient flow through a hospital is a critical factor, especially at the front door through emergency departments. We know the role that electronic bed management systems can play in helping that flow. What steps is my hon. Friend taking to ensure that more hospitals roll out that technology?

My hon. Friend is right. I know how much work he did when he had oversight of urgent and emergency care services, which included his contribution to our urgent and emergency care recovery plan that was published almost a year ago. That plan included a host of steps to improve the flow through hospitals, including investment in bed management systems, as he described. The plan is working, which is why we are improving the flow through hospitals and seeing reductions in delayed discharges.

Nurses from Overseas

NHS data shows that we have delivered early on our manifesto commitment to have an extra 50,000 NHS nurses, with the number of nurses working in our NHS increasing from around 301,000 in 2019 to 357,000 today. That has been achieved through boosting training and education routes, ethically recruiting internationally and taking actions to improve retention. Measures such as the health and care visa introduced in 2020 support international recruitment.

I thank the Minister for his answer. As he knows, the national health service would completely collapse without the input and expertise of clinical staff from around the world. One barrier to those people coming to help us are the high fees for applying for permanent residency. Some nurses from countries such as India and the Philippines are having to take out expensive loans just to feel like they are welcome and able to stay in our country. I have presented a private Member’s Bill to exempt NHS clinical staff from paying those high fees to become residents. Will the Minister support the Bill and work with his Home Office colleagues to find a way to make that a reality for those people who work so hard in our health service?

I join my hon. Friend in paying tribute to the enormous contribution made by internationally recruited staff to our NHS. As he will know, immigration policy and fees are a matter for my right hon. Friend the Home Secretary. However, our long-term workforce plan supports international recruitment. In addition to the new visa route, we are exempting health and care staff from the immigration health surcharge.

The Minister will know that without our fantastic workforce, the NHS would not work. I pay tribute to all those hard-working nurses in all our hospitals and care centres, including at St Thomas’ Hospital in my constituency. Does the Minister recognise that in addition to recruiting staff we have to look at retaining staff, who talk about the workload, their mental wellbeing and the fact that the cost of living is having a big impact on them? Does the Minister agree that the Government need to come forward with a wide-ranging plan on addressing workforce planning, pay, training, staff wellbeing and retention?

I completely agree with the hon. Lady, which is why this Government became the first Government ever to introduce a long-term workforce plan. Retention is one of the key pillars of the long-term workforce plan, and we are already seeing that deliver the result of keeping more staff in our NHS.

Accessibility to Dental Services

4. If she will make an assessment of the potential impact of the level of accessibility to dental appointments on urgent dental and oral surgery services. (901101)

I am determined to ensure that everybody who needs NHS dental care can receive it. We have already implemented a package of reforms to improve access and provide fairer remuneration for dentists. That has had an effect, with 1.7 million more adults being seen, 800,000 more children being seen and a 23% increase in NHS activity in the past year. We know we need to do much more, and our dentistry recovery plan will be published shortly, setting out a big package of change.

I listened carefully to what the Minister said. That change has not come to Oxfordshire, for sure—it is in a dire state. An Oxford resident wrote to me saying that when his NHS practice closed, he rang a dozen others across the county. Each one said they were offering NHS services but, in fact, they were not; they were only offering private care. In this cost of living crisis, people simply cannot afford that. As a result, they are waiting in A&E rather than getting treatment, and that ends up in their having oral surgery. What is the Minister doing now to improve the situation in Oxfordshire and across the country?

I am incredibly sympathetic to what the hon. Lady says. In fact, in Buckinghamshire, Oxfordshire and Berkshire West integrated care board, the number of adults seen by an NHS dentist rose in the 24 months to June 2023 from 448,000 to 485,000, with a similar increase in the percentage of children seen. The situation is improving, but I completely agree with her that we need to do more, and we will be coming forward shortly with a big package of dental recovery plan reforms.

I thank my right hon. Friend for her answer. Following my very productive meeting with her only a few days ago, will she confirm that NHS England locally has finally been unblocked and that my constituents in Clacton will soon benefit from more dentists practising on NHS patients?

As my hon. Friend will know, this is a local matter, and it is for his ICB to determine whether it wishes to support the excellent pilot proposal for overseas dental students in Clacton. At the same time, it needs to ensure that its actions are compliant with current legislation and within the delegation agreement with NHS England. I have just written to my hon. Friend about that, and my letter should address his concerns, but of course I would be happy to see him again if he has any further questions.

We were promised “before the summer”, we were promised “after the summer”, we were promised “before Christmas”, we were promised “soon” and now we have been promised “shortly”. The reality is that Labour has a plan and the Government have not. In York, we cannot get an NHS dentist either. Blossom Family Dental Care is just handing back its contract. My constituents have nowhere to go. What is the Minister going to do to ensure that my constituents can access NHS dentistry?

As I said to the hon. Member for Oxford West and Abingdon (Layla Moran), I absolutely understand the challenge for some people. The situation has improved over the last year. Since the covid pandemic, where almost every dentist had to stop working altogether, we have not seen the recovery we want. We are putting in plans—not a paper ambition like the one Labour has put forward, but significant reforms that will enable many more people to be seen by NHS dentists. I say gently to the hon. Member for York Central (Rachael Maskell) that a recent Health Service Journal article states that Humber and North Yorkshire ICB

“have indicated in board papers that dentistry funding will be squeezed to help them balance their books.”

I encourage her to talk to her ICB about that too.

For new patients, accessing an NHS dentist in Peterborough is almost impossible. Should a new medical centre wish to establish a new NHS dental practice, doing so would require flexibility in units of dental activity rates and the ability to recruit dentists from overseas. Would the Minister give that effort her enthusiastic support and encourage NHS bosses to do the same?

My hon. Friend is pushing against an open door. He may be aware that in 2023 we made some legislative changes to give the General Dental Council more flexibility to expand the registration options open to international dentists, tripling the capacity of three sittings of the overseas registration exam from August 2023 and increasing the number of sittings for the part 2 exam in 2024 from three to four.[Official Report, 23 February 2024, Vol. 745, c. 14MC.] (Correction) That will create an additional 1,300 places overall for overseas dentists aiming to work in the UK. We will also be bringing forward measures to enable dental therapists to work at the top of their training, which will expand the capacity. He is right that reform of the UDA is also required and we will be bringing forward our plans shortly.

I want to share with Ministers the experience of Emma from Grimsby, who said:

“NHS dentistry is a joke in the town at the moment. Thankfully I managed to get an emergency appointment in Scunthorpe (after being offered one in Doncaster originally) and I’ve now been referred to hospital to have 3 wisdom teeth removed. My dentist closed at the onset of the pandemic and I’ve not been able to register with an NHS dentist since.”

What does the Minister have to say to Emma and the millions like her who cannot get an appointment when they need one?

The hon. Lady is absolutely right to point that out. Emma has my absolute sympathy and apology for the fact that since the covid pandemic we have not seen the recovery of dentistry that we would have liked. I can tell her that in July 2022 we brought in significant reforms to encourage dentists to take on more NHS patients, but we recognise the need to do more. The long-term workforce plan will increase training places and the overseas registration will improve capacity, as will the changes to dental therapists’ programmes. All those things will improve the situation, but in the meantime we will be bringing forward our recovery plan very soon, which will immediately expand the incentives to NHS dentists.

NHS: Winter Pressures

Our plan includes opening 5,000 more beds, increasing ambulance capacity, expanding innovative services such as virtual wards and bringing forward covid and flu vaccinations for the most vulnerable. Thanks to the hard work of staff, NHS performance this winter has improved on last year, despite the impact of industrial action.

I am sure the caveat to that was the word “shortly”. I have had constituents contact me in desperation regarding delays at Pinderfields Hospital in my constituency. They tell me they have waited hours in emergency care this winter for routine blood tests—literally all day in some cases—even while in extremely poor health. The Tories’ patchwork reforms and sticking-plaster politics are not fooling anyone. Does the Secretary of State not think that those dangerously long waiting times are a damning indictment of 14 years of Conservative mismanagement? What does she say to my constituents who are suffering right now?

I am sure that the hon. Gentleman is a fair man, and that, being so, he will point out to his constituents, when they call him with their issues, that ambulance response times for category 2 emergency incidents in his local area have in fact been over 30 minutes faster than last year. However, we accept of course that this is a two-year plan and will take time to meet our full ambitions. Interestingly, the latest figures show that we have provided £6.9 million from the community diagnostic centres fund for the development of a community diagnostic centre at Wakefield. Presumably he welcomes that Conservative innovation.

The pressure on services is acute this winter, as it is every year. So far, we have heard very little mention in these 20 minutes of the biggest headache facing trusts, integrated care boards, patients and, of course, the Prime Minister’s pledge to cut the waiting lists further. Given that the British Medical Association ballot on consultants’ action closes today, and that the dispute among doctors in training continues, can the Secretary of State update the House on her message to those voting today, and on where we are in wider industrial disputes, which are a drag anchor on the NHS right now?

My hon. Friend is right to point out that we are in the final few hours of the consultants’ ballot on the pay reform programme that we have offered the British Medical Association. I very much hope that consultants will feel able to support that programme, because it is about bringing together the frankly quite bureaucratic system that they have to deal with at the moment, so that they are assessed in a shorter time with less bother and paperwork, while respecting their need to train and keep up their education and supporting professional activities commitments. I hope that they will agree with us on that. As I have said to the junior doctors committee from this Dispatch Box, should they return with reasonable expectations, we will, of course, reopen negotiations.

The Secretary of State has said that preparation for winter started last January, but 54% of A&E departments were still rated inadequate or needing improvement in December, exacerbating the winter crisis. What will she do differently this year to ensure that we do not have another winter crisis in 2024-25?

Again, the plan that we laid out last year is having a real impact at local level on the services being deployed through our accident and emergency services. We have seen discharge rates improving, for example. We appreciate that there can be local differences, but the importance that we put on maintaining that flow through hospitals is critical to ensuring that the waiting lists and waiting times that the hon. Lady describes are reduced. However, I gently remind the Labour party that it has been running the NHS in Wales for some time now, and it is a great shame that the good people of Wales—[Interruption.] The good people of Wales are waiting longer for their treatment—[Interruption.] They are almost twice as likely—

Order. I am a little bothered, because we have a long way to go on the Order Paper. I call the SNP spokesperson.

We cannot discuss winter pressures in the NHS without acknowledging workforce shortages. The Secretary of State is having to contend with new immigration policies from her Cabinet colleagues that prevent dependants from coming to the UK, meaning that we are asking people to come and care for our loved ones while they leave behind theirs. I imagine that she is frustrated that that is now another barrier to recruiting staff to our health and care sectors. Has she expressed those frustrations to her Cabinet colleagues?

I genuinely want to work with the Scottish Government, because I am troubled, to put it bluntly, that Scotland has some of the worst health outcomes in western Europe. It has the worst level of drug death rates in Europe, the highest alcohol death rates in 14 years, and there was a fall in life expectancy for three years in a row. We offered to allow Scottish patients to receive lifesaving operations in England, but sadly, that offer has been declined. I remain genuinely willing to work with the Scottish Government to help them with their health service.

Child and Adolescent Mental Health Services

We are investing an extra £2.3 billion a year to expand mental health services in England, with the aim of enabling 2 million more people to access mental health support, including 345,000 more children and young people.

Many constituents in Tamworth are coming to me in desperate need of support for their children. Those constituents include Kate, whose daughter is at crisis point and has been without a psychiatrist since November; Roger, who has been waiting 18 months for an autism referral for his daughter; and Jess, who has been waiting for an attention deficit hyperactivity disorder assessment for her son. Will the Minister explain what action she is taking so that children, parents and families in my constituency can get the support they need?

Through the investment we are putting in, particularly in the hon. Lady’s local area, there are a number of initiatives to help support children and young people with their mental health. The Sandbox scheme, which is a funded NHS service, supports those in the south Staffordshire area; Malachi provides family support across Tamworth and east Staffordshire; and Combined Wellbeing, which is an online resource, covers north Staffordshire. There is also the Family Wellbeing Service, Action for Children for those aged five to 18 with mild to moderate mental health needs, and the Staffordshire Emotional Health and Wellbeing Service for those aged five to 18. I would recommend that the hon. Lady’s constituents look up those services, because we are funding them to improve mental health care for children in her local area.

The agony and damage of undiagnosed and untreated mental health conditions is nowhere more acute than in rural areas, where we see an epidemic of silent suffering. The Norfolk and Suffolk NHS Foundation Trust has long struggled with a series of management problems. I am sure the Minister has seen the recent report highlighting that between 2019 and 2022, we saw over 8,500 avoidable deaths—that is nearly 45 a week. Will she agree to meet me, other Norfolk and Suffolk MPs, and those affected to look at what is really going on here and make sure that we turn that trust into a beacon of the best mental health services, rather than the worst?

I thank my hon. Friend for raising this issue. We were holding regular meetings with Norfolk and Suffolk MPs, the trust, the Care Quality Commission and NHS England, and with the new management team, that trust did appear to finally be turning things around. However, I am concerned to hear the points that my hon. Friend has raised. I am very happy to restart those meetings and will ask my office to arrange them as quickly as possible.

Adult Social Care

8. What steps she is taking to increase staff recruitment and retention in the adult social care sector. (901107)

Care is a skilled profession, and I want care workers to get the support and recognition they deserve. This month, we took the next step in our ambitious care workforce reforms, publishing the first ever national career structure for the care workforce alongside our new nationally recognised care qualification.

Ambitious care workforce reforms—it is all blah, isn’t it? We have had 14 years of Conservative Government, and we have a crisis in every area of the NHS. Job insecurity, poor working conditions and low pay—one in five care workers is living in poverty—are all reasons why we have a recruitment and retention crisis in social care. Is not the truth that that is a damning indictment of 14 years of Conservative Government, and the only thing that is going to sort out social care and the crisis in recruitment and retention is a general election?

I am actually really shocked by the way the hon. Member referred to the care workforce, with terms like “It is all blah”—very shocking. I am determined that care workers should get the recognition they deserve. We have a 10-year plan for social care, and it is working: the care workforce grew by over 20,000 last year, vacancies in social care are down, and retention is up. We are reforming social care so that it works as a career. That is why, as I said a moment ago—I wish the hon. Member had been listening—we have introduced the first ever career pathway for social care workers and a new national care qualification.

But according to Care England and Hft, 54% of social care providers have increased their reliance on agency staff; 44% have turned down new admissions; and 18% have had to close services altogether. Labour’s fair pay agreements will ensure that staff in the sector are treated with the dignity and respect that will make them want to stay, but after 14 years, why do Ministers not have a proper plan to address the workforce crisis facing adult social care? Is it because it is a crisis of their making?

We have a plan for the social care workforce, and it is working. The social care workforce increased by over 20,000 last year, and it is still going up. But I will take no lectures from the hon. Member. In fact, his hon. Friend the Member for Bristol South (Karin Smyth), early this morning on television, made it clear that Labour does not have a plan for social care—or if it does, it is clear that it will cost a lot of money and is yet another unfunded Labour plan.

Men’s Health

I assure my right hon. Friend that this Government are committed to improving men’s health. That is why, in November, we announced a suite of measures, including a £16 million fund for a new prostate cancer screening trial, and the recruitment of a men’s health ambassador. We have also launched our men’s health taskforce to tackle the biggest health issues facing men.

I thank the Minister for that answer, and I would urge her to continue to make men’s health a top priority. In particular, can she look at how we can detect prostate cancer better and sooner? It is the most common cause of male cancer in the United Kingdom, and anything that can be done to reduce that number will be most welcome.

I thank my right hon. Friend and male colleagues on the Government Benches, including my hon. Friend the Member for Don Valley (Nick Fletcher), who are fighting so hard to improve men’s health. He is absolutely right: 12,000 men a year die from prostate cancer. That is why we are investing in the £16 million prostate cancer trial called Transform, using methods such as MRI to detect prostate cancer rather than PSA, which can be inaccurate. Thousands of men will be recruited. We are hoping that the trial will start in the spring, with recruitment in the autumn, including the recruitment of black men, who are disproportionately affected by prostate cancer.

Does the Minister agree, however, that the information she has just given about why screening for prostate cancer does not happen for men is based on a study that is 20 years old? There are 12,000 deaths a year—it is the biggest killer among men, and the second biggest killer among all people—yet here is this evil cancer for which there is no screening programme whatsoever. Will she take steps to update current NHS guidance to ensure that all those at high risk of prostate cancer receive a targeted early detection service? I think she has hinted that she may be doing that, but will she finally introduce mass screening for prostate cancer? It is the only cancer without specifically commissioned early diagnosis work, and men are dying unnecessarily because of the failure to bring this in.

We have more than hinted: we have just announced a £16 million pilot study of prostate cancer screening. We have a plan to tackle those 12,000 deaths a year, and it will work, because until now we have not had a diagnostic test. PSA is not a sensitive test in all prostate cancers: there are many men with prostate cancer who do not express PSA. That is why the Transform study, using detection tools such as MRI, will be trialled, and if they are effective, such tools will be rolled out across the country.

Midwifery and Maternity Services

10. What steps she is taking to increase the recruitment and retention of NHS midwifery and maternity staff. (901109)

We are investing an additional £165 million a year to improve maternity and neonatal care, rising to £186 million a year from April. This will increase the number of midwifery posts and improve the quality of care that mothers and babies receive. As of October last year, there were 23,100 full-time equivalent midwives working in NHS trusts and other core organisations in England, which is more than 1,000 more than a year ago and 3,500 more than in 2010.

I thank the Secretary of State for that response. The Royal College of Midwives estimates that there is a shortage of around 2,500 full-time midwives working in the NHS. I know that at first hand from Cossham Hospital in my constituency, which has a wonderful birth centre, but it has been closed for most of the last few years, because it simply cannot get the midwives to staff it—they have to go elsewhere where more serious cases need to be dealt with. What is she doing specifically about the retention of midwives? I know that student numbers are, thankfully, coming up, but a lot of midwives are choosing to leave the profession because there is not enough flexibility in their work.

I think we all agree that a career as a midwife is just one of the most rewarding and fulfilling careers that one can hope for. That is why we have placed such priority on retention in the long-term workforce plan that we launched last year. The national retention programme for midwifery and nursing has prioritised five actions to support staff retention, including menopause guidance, because we know that that can be an issue for midwives, and valuing them and their contribution is also a key objective of NHS England’s three-year plan for maternity services.

As well as recruitment and retention, training matters. Anglia Ruskin University has a campus in Chelmsford and is the provider of the largest number of health and social care degrees in the country, training midwives, nurses and, since the medical school opened, doctors. Will the Secretary of State back the campaign to expand the medical school in Chelmsford so that we can train even more local people to work in our local NHS?

I thank my right hon. Friend for raising her local college, which does amazing work for the whole of the NHS as well as in her local area. I may have to retain a discreet silence over that particular application but I know that if any Member is sure to advocate effectively for their local area, it is my right hon. Friend.

Recruiting and retraining more NHS staff is crucial if women are to get gynaecology, obstetric and maternity care. I would like to share the story of Sandy Simmons. She was told 11 months ago that she needed surgery for a uterine prolapse; today, after nearly a year of pain, she is still waiting. Labour candidates such as Keir Cozens in Great Yarmouth are speaking up for women like Sandy and the 905 women waiting more than a year for treatment in Norfolk and Norwich University Hospital. Will the Secretary of State apologise to these women—or, like the Prime Minister, will she just walk away?

I was genuinely delighted to welcome the hon. Lady to the Government’s women’s health summit last week to announce the consolidation, and indeed the improvement, of the women’s health strategy that this Government have launched. We saw significant success last year with hormone replacement therapy improvements and she knows, because she attended the summit, that I have just announced a £50 million research fund looking at maternity disparities and also research into female-specific conditions. Any concern she has about operation times she should take up with the local trust and it will perhaps tell her what impact industrial action has had, sadly, on elective surgery.

Cancer: Early Diagnosis

I know this is an issue close to my right hon. Friend’s heart and pay tribute to her for her work as vice-chairman of the all-party group on radiotherapy. The pandemic has of course presented a real challenge to delivering the Government target to diagnose 75% of stageable cancers at stage 1 or stage 2 by 2028, but I am pleased to be able to tell the House that we are coming through that and last year diagnosed more cancers at stage 1 and stage 2 than ever before.

Cancer Research UK has published an ambitious plan, “Longer, better lives”, which reminds us that for some cancer patients just a few weeks of delay can make the difference between whether they can be offered curative treatment or just palliative care. Will the new diagnostic centres being opened by the Government, including at Finchley Memorial Hospital, bring waiting times down and secure that early diagnosis that is so important to surviving cancer?

My right hon. Friend makes an important point. Diagnostic checks are a key part of the cancer pathway and the 150 community diagnostic centres opened by this Government, including the one at the Finchley Memorial Hospital, will provide earlier diagnostic tests, support earlier diagnosis and bring down waiting times, benefiting millions of patients. These centres have delivered more than 6 million additional tests for all elective activity since July 2021 and we expect the Finchley Memorial Hospital CDC to provide over 126,000 tests for elective care in the next financial year.

I thank the Minister for that response. Research and development is very important; it means we can find more cures for cancer. My father, who is dead and gone, survived cancer on three occasions; that happened because of advances in finding cures. What is being done to work alongside those in research and development to ensure that even more cancers can be cured and we can go from a 50% rate to perhaps a 60% or even 70% rate for those who live longer?

I was delighted that one of my first visits in the new year was to Northern Ireland to see some of the life sciences companies, particularly those based around Queen’s University Belfast. That sector in Northern Ireland is flourishing. We are keen to support companies working in research and bring together world-leading universities such as Queen’s with the private sector and the NHS to deliver improved outcomes for all patients across every part of the United Kingdom.

Sickle Cell Disease

12. What steps she is taking to improve healthcare outcomes for patients with sickle cell disease. (901111)

I know this is an important issue for the hon. Lady in her role as chair of the sickle cell and thalassaemia all-party parliamentary group. We are working hard to provide the best possible care to those living with sickle cell disease. That includes boosting Ro subtype blood donation numbers, identifying improvements in clinical pathways and delivering world-leading treatments, such as the new blood-matching genetic test announced by NHS England yesterday, which will reduce the risk of side effects and offer more personalised care.

I congratulate NHS England on the launch of the new blood-matching genetic test for sickle cell patients, but it has been more than two years since the “No One’s Listening” report, which made the key recommendation that sickle cell patients receive pain relief within 30 minutes of attending accident and emergency. Why is that still not happening for sickle cell patients, and would the Minister like to meet me and the Sickle Cell Society to discuss how to achieve that?

I of course would be happy to meet the hon. Lady and the Sickle Cell Society to look at how we can improve patient experiences and ensure that all patients benefit from timely access to the medications they need. I am delighted that she welcomes yesterday’s announcement. It is an example of how the NHS can bring forward world-firsts and is leading the way to transform patient care and improve patient outcomes.

Urgent and Emergency Care

Almost a year ago, we published our urgent and emergency care recovery plan. The NHS has already halved the waiting times for category 2 ambulances and brought down waits in A&E. We are determined to cut NHS waits, and our plan is working.

Rugby is one of the fastest growing places in the UK. While we have had additional services introduced at our local Hospital of St Cross, my constituents have insufficient accident and emergency provision. Thousands of local residents have signed my petition for doctor-led accident and emergency care at the Hospital of St Cross. I know it is a matter for the integrated care board, but will the Minister give her support? As a previous Minister, my hon. Friend the Member for Colchester (Will Quince) and the previous Secretary of State have visited in the past few months, and I invite this Minister to do likewise.

I thank my hon. Friend for his invitation. He has been a tireless campaigner on this issue on behalf of his constituents. The future of healthcare is about getting people the care that they need, where they need it and when they need it, and Rugby is no different. New local NHS services are bringing care closer to home in his area, such as the new imaging unit at the Hospital of St Cross that opened in September.

Access to urgent and emergency care can be greater facilitated when greater protection is offered to staff, particularly the many who suffer attacks in emergency departments at hospitals across the United Kingdom—often by people who are intoxicated.

The hon. Member makes an important point. The safety of our staff in the national health service is important, including those in urgent and emergency care departments, as well as the ambulance services. He is absolutely right to point that out, and it is never acceptable for anyone, including patients, to be violent towards staff.

Mental Health Services

We are investing a record amount in NHS mental health services, committing £2.3 billion extra a year for the expansion and transformation of services in England, which will enable 2 million more people to access mental health support.

If only the reality was that rosy. The entire sector is calling out for reform of the Mental Health Act 1983. With our mental health services in crisis, why did the Government scrap the long-awaited and overdue mental health Bill, which could have started to alleviate pressures on trusts by reducing the numbers of people detained inappropriately and making services more fit for purpose? Is it not true that we need a Labour Government to take action on this issue?

I have news for the hon. Gentleman, because we have a plan and it is working. Our investment of £143 million into crisis support is showing early evidence of reducing admissions—admissions are 8% lower. With the crisis telephone services, which are available 24/7, we have admissions down 12%. More importantly, detentions under the Mental Health Act are 15% lower. We have a plan, and it is working.

In-patient Units: People with Learning Disabilities

15. What recent progress her Department has made on reducing the number of people with a learning disability in in-patient units. (901114)

We have made progress against our target to reduce learning disability and autism in-patient numbers in England by 50% since 2015. For people with a learning disability without an autism diagnosis, there has been a 58% net reduction; for people with a learning disability who are autistic, the net reduction is 35%.

I thank the Secretary of State for that comprehensive answer. As chair of the all-party parliamentary group for disability, I have been hearing from organisations such as Mencap that remain concerned that people with learning difficulties are disproportionately detained for five to 10 years and for over 10 years. Will she reassure those organisations that the “Building the right support” action plan will continue to progress the great work that is being done?

I thank my hon. Friend for her interest and, of course, her many years working as a clinical psychologist. She brings that experience to the Chamber. National commissioning guidance to integrated care boards was published in November. It sets out that a mental health in-patient stay for a person with a learning disability

“should be for the minimum time possible, for assessment and/or treatment which can only be provided in hospital”.

In overseeing implementation of the action plan going forwards, the “Building the right support” delivery board will maintain focus on quality of care and on reducing long stays.

It is vital for the Government to do more to move autistic people and people with learning disabilities out of in-patient units and back to their communities. Recently, in the trial of staff at Whorlton Hall, we saw staff who were cruel and uncaring. Delivering sentences, the judge said that Whorlton Hall was an

“unpredictable and…frightening place to live”.

Is it not time for the Government to close down those units and move the majority of people into the community?

I thank the hon. Lady for raising that point. We were all dismayed and upset to see the experiences of residents in those units, and we saw the correct criminal outcomes—if I am allowed to say that—for those involved in those assaults. A review is going on as to how those issues are affecting the estate as a whole, but we are clear that in-patient stays should happen only when they are strictly necessary. We must be mindful that clinicians will be taking many situations into account, including not just the safety of the patient but the safety of the wider community.

Topical Questions

Women’s health needs are often overlooked and under-researched. Through our women’s health strategy, the Government are changing that. Last year, we made menopause a priority, helping almost half a million women get hormone replacement therapy for less than £20 a year. This year, we are building on that work and will have a women’s health hub in every integrated care board area in England. We will promote research into conditions that only affect women, such as endometriosis and lobular breast cancer, and those that affect women differently from men, such as heart attack symptoms.

We have also launched the first research challenge—worth £50 million—to tackle maternity disparities that have no place in modern Britain. Following the brave campaigns of my hon. Friends the Members for Hyndburn (Sara Britcliffe) and for Stafford (Theo Clarke), by March we will make dedicated maternal mental and physical healthcare available to every woman in England.

I recently met two constituents with experience of invasive lobular breast cancer. Invasive lobular carcinoma is the second most common form of breast cancer, but it is not generally picked up by mammograms, and it behaves differently from other breast cancers. However, lobular breast cancer has been understudied and underfunded, and it urgently needs research funding. Will the Secretary of State tell the House what specific actions her Government are taking to address those gaps? Will she also reply to the Lobular Moon Shot Project, to which she—

I gently remind the hon. Lady about the statement that I just gave. Last week we held the women’s health summit, at which I announced that we are encouraging research into conditions such as lobular breast cancer. I made that announcement because of two amazing women I met recently who were living with the condition. They were introduced to me by my right hon. Friend the Member for Horsham (Sir Jeremy Quin) and my right hon. Friend—

Order. Please can I just say that these are topicals? I have got to get through a big list, and lots of Members are standing. We need short, punchy questions, and the same with answers.

T6. I have been carrying out a health survey of thousands of residents in Harrogate and Knaresborough, to ask them for their experiences and views of the NHS. I will share the results with local healthcare professionals, to support them and their work. When the results are in, will the Secretary of State meet me to discuss how they will help inform and shape our local healthcare planning ? (901128)

I would be delighted to meet my hon. Friend to discuss that. As always, he is an excellent advocate for his constituency, and I will enjoy listening to the results of his survey.

Mike Reader, Labour’s candidate for Northampton South, shared with me the horrific experience of Stanley, who had severe abdominal pain and called an ambulance, only to be told it would take hours and to go to A&E. There, he was told to wait for assessment on a patio chair outside. It was 3°. Who is to blame?

I am very sorry to hear of the experience of that specific constituent. Because of challenges that the NHS faces, particularly our urgent and emergency care services, almost a year ago we set out our urgent and emergency care recovery plan, to speed up care for people in A&E and reduce waits. That plan is working. We are seeing ambulances get to people quicker, and people treated quicker in A&E.

That is not a one-off. Why will the Minister not take a shred of responsivity for the chaos that her party has caused our NHS? The last Labour Government achieved the shortest waits and the highest patient satisfaction in NHS history. The Conservatives have delivered the longest waits and the lowest patient satisfaction in history. Let us have that general election, so that she can defend her abysmal record to the public.

The hon. Gentleman obviously was not listening to my answer; in fact, he was reading aloud. Our urgent and emergency care plan is working. It is reducing rates in A&E, and ambulances are getting to people faster. Meanwhile, I am sorry to say that in the Labour-run NHS in Wales, more than half of patients are waiting more than four hours in A&E.

T7. What steps is the Minister taking to ascertain the cause of ongoing problems affecting access to riluzole, the only licensed drug for the treatment of motor neurone disease in the UK, to provide clarity to the MND community and ensure that normal supply is restored as soon as possible? (901129)

We understand how worrying the possibility of medication shortages can be. There is a supply issue with riluzole 50 mg tablets, caused by a supplier experiencing manufacturing issues. We have a well-established procedure in place to deal with such issues, and are working with the industry, the NHS and others to resolve it as quickly as possible. We have contacted alternative suppliers and have secured sufficient volumes of stock.

Cancer Research UK has found that too much UV radiation is the third biggest cause of cancer across these isles. Does the Secretary of State recognise that cost is a barrier for people wishing to protect their skin from the sun, and will she commit to having conversations with Cabinet colleagues to remove VAT on sun protection products, which will help protect NHS budgets and ultimately save lives?

We see that as part of a much wider campaign to ensure that we treat the sun safely, by reducing the amount of time we spend in the sun, particularly during peak hours of the day in summertime. I keep all these discussions in play with my Treasury colleagues.

T10. Rural constituencies such as mine are seeing a growing number of dentists withdraw from NHS provision. What steps is the Department taking to ensure that vital dental care is provided for everyone, particularly in rural communities? (901132)

My hon. Friend is a great advocate for her community, and I pay tribute to her for working with determination to see more access to dentistry in Cornwall. She is right to do so. We have a plan, which is almost ready. I urge her to wait just a little longer. She, like all colleagues across the House, will see significant and real measures to improve access to dentistry.

T2. NHS staff have expressed concerns about the Anaesthesia Associates and Physician Associates Order 2024. Can the Minister tell me if resource will be needed for AAs and PAs to be properly supervised by doctors on a one to one ratio? Will he meet trade unions and professional bodies as a matter of urgency to clarify the Government’s position on this hugely important public health issue? (901124)

PAs and AAs are an essential part of the reform piece to the long-term workforce plan. I note that the order was passed by the House last night without a Division, so I am grateful for that cross-party support. We are working with the General Medical Council, the British Medical Association and others to ensure that the regulations are fit for the purpose. We look forward to the GMC launching its consultation on the fine print of the regulations very soon.

As my constituents have to travel to Tamworth, Burton or Derby for diagnostic tests, can I encourage the Secretary of State to look favourably on a bid for a new much-needed community diagnostic centre in South Derbyshire?

I thank my hon. Friend sincerely for her question. The good news is that community diagnostic centres have now delivered over 6 million additional tests and scans since July 2021 thanks to the hard work of NHS staff, but I will of course be delighted to meet her to discuss her plans for her local constituency.

T3. New British Heart Foundation analysis shows that the number of people dying before the age of 75 in England from heart and circulatory diseases has risen to its highest level in over a decade. The rate of premature deaths from cardiovascular disease has now increased in England for three years back to back. Why are the Government taking such a long time to get to grips with this crisis? (901125)

The NHS long-term plan commits to a number of key ambitions to improve care and outcomes for individuals suffering from cardiovascular disease, including enhanced diagnostic support in the community, better personalised planning, and increasing access to cardiac rehabilitation. Those ambitions will support the delivery of the aim to prevent 150,000 heart attacks, strokes and dementia cases by 2029.

The single biggest concern my constituents raise about healthcare is access to GPs, especially in Blackrod and Westhoughton. What more can my right hon. Friend do to ensure we have better GP access?

I am pleased to tell my hon. Friend that our NHS long-term plan sets out a real-terms increase of at least £4.5 billion a year for primary and community care by 2023-24. We now have over 2,000 more full-time equivalent GPs working in our NHS, and we have had the amazing achievement of more than 50 million more appointments per year, beating our target several months early. Things are improving significantly, and there are many more measures I would be delighted to talk to him privately about.

T4. In the NHS in Cheshire and Merseyside between April and June last year, the 62-day cancer waiting time target was not met. If the target had been achieved, around 150 extra patients would have been treated on time. What would the Secretary of State like to say to those 150 patients? (901126)

The 62-day backlog has fallen by 27% since its peak in May 2020. We know there is more to be done, and that is why we are bringing forward more measures as early as possible. In April 2023, more than nine in 10 patients—90%—started their first cancer treatment within one month of a decision to treat.

Many of my constituents who use Regis Medical Centre have been left angry and frustrated by the botched implementation of an Anima booking system, leading to them being unable to get an appointment or the treatment they need. Will the Secretary of State meet me to discuss how we can learn the lessons from that botched implementation and make sure trust in that GP surgery is restored?

T5. I recently met the staff of a pharmacy in Bruton in my constituency to hear about some of the challenges it is facing. Community pharmacists are dispensing some of the country’s most widely prescribed drugs at a loss, therefore subsidising the NHS. What steps is the Secretary of State’s Department taking to prevent the closure of community pharmacists? (901127)

We are ensuring that community pharmacists have an even greater role in primary care than they have already. For example, we saw the first stage of the roll-out of Pharmacy First in December, with blood pressure checks and contraceptive care being rolled out. I am very pleased that we are on track to deliver the full roll-out of Pharmacy First by the end of the month.

The colour of someone’s skin should not have an impact on the reliability of medical devices, but we know that that is what happened during the pandemic for many black and Asian patients. When I was the Health Secretary, I commissioned an independent review of the equity of medical devices from Professor Dame Margaret Whitehead. Her report was handed to the Department in June last year, but the Department has not yet published it or responded to it. I know that my right hon. Friend cares about health inequalities as much as I do, so may I ask her to publish the report, along with a full Government response, as a matter of urgency?

I thank my right hon. Friend for commissioning that vital piece of work. I am giving the matter my closest attention, and I hope very much to be in a position to respond to his points in due course.

T8. This week the Riverside unit in my constituency, which treats young people with severe eating disorders, had to close temporarily because of concerns about its ability to provide safe care. What are the Government doing to ensure that young people who, in many cases, go through mental health crises as a result of their eating disorders receive the care that they need as close to home as possible? (901130)

As the hon. Lady will know, we are investing more in mental health services for young people in particular and, indeed, for those with eating disorders. We are seeing more young people more quickly than ever before, but if the hon. Lady wishes to raise a local issue with me, I shall be happy to meet her and discuss it.

The opening of a new block of operating theatres next month marks the latest investment in Torbay Hospital, but it is, of course, a prelude to the major rebuilding work. When does the Secretary of State plan to deliver the next update on the progress of that project?

I am delighted that the House is as happy about that expansion as the hon. Gentleman and I are. I will meet him to go through his plans, because I know how carefully he has campaigned for this important asset in his constituency.

T9. In the early hours of Friday morning, I arrived at the Royal Lancaster Infirmary with my sick son in an ambulance. As we walked past trolleys in the corridor, the nurse who was treating him said, “Our A&E unit is too small. We were promised a new hospital four years ago, but I think they have forgotten about us.” Can the Secretary of State tell that nurse, my constituent, whether we have indeed forgotten about that new hospital? (901131)

The hon. Lady is aware of my knowledge not only of that hospital, but of her local area. I will look into this matter for her, because I want to ensure that the good people of Lancashire, Mr Speaker, are looked after as we would all hope and expect.

I warmly welcome what my right hon. Friend said last week about encouraging research on lobular breast cancer, and I look forward to meeting the Under-Secretary of State for Health and Social Care, the hon. Member for Lewes (Maria Caulfield), shortly to work out how we can operationalise what is her clear ambition.

I thank my right hon. Friend and my hon. Friend the Member for Bishop Auckland (Dehenna Davison) for bringing two amazing women to talk to me about the impact of lobular cancer. For the benefit of Members on both sides of the House, last week we sent out a “Dear colleague” letter and graphics about the women’s health strategy so that we can all help our constituents to understand what this Conservative Government are doing to ensure that the healthcare of women is faster, simpler and fairer.