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Oral Answers to Questions

Volume 746: debated on Tuesday 5 March 2024

Health and Social Care

The Secretary of State was asked—

Fuel Poverty

1. What recent discussions she has had with the Secretary of State for Energy Security and Net Zero on tackling the health impacts of fuel poverty. (901795)

The Government’s 2021 fuel poverty strategy recognised that warm homes can help to reduce health inequalities and pressure on the NHS. That is a key reason why we are delivering a package of cost support worth £3,700 per household on average from 2022 to 2025 and investing heavily in fuel efficiency.

The recent Institute of Health Equity Marmot report highlighted the negative effects of living in cold and uninsulated homes, including respiratory and circulatory diseases and hampered lung and brain development in children. Last year, the Energy Systems Catapult and a number of NHS providers ran a trial of warm homes prescriptions, with NHS practitioners identifying vulnerable patients and supporting them with their energy needs. I think that the Secretary of State has accepted the link between cold homes and health outcomes. If that is the case, are the Government considering expanding this approach, or looking for alternative ways in which the health system and fuel poverty prevention can go hand in hand?

The hon. Gentleman is right to say that a number of local warm homes prescription schemes have offered additional support to help people with health vulnerabilities to stay warm and well. Such schemes are excellent examples of local collaboration between the NHS, local government and other partners—tailored, of course, to the local needs of their areas—and I would be interested to see whether other parts of the NHS choose to take up these sorts of ideas in the future.

Urgent and Emergency Care

A year ago we set out a plan to improve urgent and emergency care, and the plan is working. Performance this winter has been better, with ambulance waits down by nearly a third, and we are learning the lessons from this year to make further improvements in the year ahead.

It is welcome news that the brand-new £30 million A&E campus at Stepping Hill Hospital is nearing completion. However, other buildings on this ageing site are failing and urgently need replacing. Will my hon. Friend ensure that Stepping Hill remains at the heart of hospital facilities in Stockport with rebuilt units, and support new hospital investment and specialist diagnostic hubs across Stockport?

I am delighted that Stepping Hill Hospital will soon have a new emergency care campus, with all the benefits that that will bring to my hon. Friend’s constituents. I know that she is a great campaigner for her local NHS and has already met the Secretary of State about the concern she raises. As well as making her argument so clearly in Westminster, I would encourage her to continue discussions with her local NHS integrated care board, which is responsible for local decisions on capital investment.

Up to £900 million for a brand-new acute hospital is coming to mid-Hampshire and health experts are making the case that it will make huge improvements in care, despite some politically inspired and misinformed opposition. Can my hon. Friend reassure my constituents that those running our local NHS should be listened to, and also that the doctor-led urgent treatment centre in Winchester will continue to provide for three quarters of urgent cases including X-rays, MRI scans and other tests after the new acute hospital is built, which we hope will be at junction 7?

I commend my hon. Friend for her hard work on supporting the new hospital, for the leadership she is providing and for her work on encouraging residents to have their say in the consultation. I cannot prejudge the outcome of the consultation but I agree with her that the new hospital will be great for patients, with its modern facilities. She is right to say that an urgent treatment centre can provide excellent emergency care for the majority of people who attend A&E.

Northampton has been the beneficiary of many welcome new or improved facilities in recent years, including a children’s A&E, a main A&E and the announcement of a community diagnostic centre. However, the missing piece of the jigsaw is an urgent treatment centre, for which I have been campaigning for many years now. Will the Minister inform me on the progress on that centre?

I congratulate my hon. Friend on his successful campaigning for healthcare in Northampton, which is, as he says, benefiting from upgrades to the children’s A&E and the main emergency department and will soon have one of our 160 new clinical diagnostic centres. He will know that his local NHS integrated care board will decide whether to fund a new urgent treatment centre, and I have every confidence in his ability to persuade it of doing so.

It is one of the great successes of the past few years that we now save the lives of a lot more people with an acquired brain injury. Although we might save them in acute and emergency care, however, a national strategy for acquired brain injury is a really important part of ensuring that people have the proper care thereafter. The Government appointed me and the Minister for Health and Secondary Care, the right hon. Member for Pendle (Andrew Stephenson)—he is just passing the hon. Lady a note to inspire her on the subject—to try to publish one. When does she hope that there will be money available to ensure that that strategy is one worth having?

I know that the hon. Gentleman is a great campaigner on this issue; he has worked very hard on it with me in the past, and he now does so with my right hon. Friend the Minister for Health and Secondary Care. I assure him that we are in the process of revising the draft strategy, taking on board feedback from patients, their families, charities and the NHS, and we will publish the strategy in due course. I thank all stakeholders for their continued efforts.

In January, the average category 2 response time for west midlands ambulance service was over 43 minutes. We know that the problems are worse in Shropshire, following stories such as that of a lady who waited 18 hours before seeing a doctor, having contracted an infection following radiation therapy for her cancer treatment. The situation in Shropshire does not seem to be improving as fast as we would like. What steps is the Minister taking to resolve the problem?

Across the country, ambulance response times have come down by a third. We have worked very hard, particularly with areas that face greater challenges, including Shropshire. I have spoken to leaders in the local health system about the ongoing challenges. We are learning lessons about what has worked over the past year, and from where we have not made so much progress, to ensure that we do better in areas such as the hon. Lady’s over the year ahead.

I thank the Minister for her positive answers; they are really appreciated. Bearing in mind the pressure that GPs are under, which is leading to more pressure on emergency provision, what steps are being taken to provide greater incentives for medical students to take on positions in GP surgeries? That would make a big difference.

The hon. Gentleman is absolutely right to talk about the whole health system. One thing we are doing as part of our work on urgent and emergency care is preventing people from being admitted to hospital unnecessarily, or from being brought to A&E in the first place. Primary care is part of that. In our investment in expanding medical school places, we are particularly encouraging medical schools, such as the new Kent and Canterbury Medical School near me, to train students to work more outside hospitals, including in primary care.

Despite watering down the targets for ambulance response times and the A&E four-hour wait, the Government still cannot meet them. We have heard from Members across the House this morning how patients are waiting longer. The new targets say that there will be further improvements in 2024-25, and the Minister has said that again this morning. Can she let us in on what exactly they will be?

I am not going to pre-empt the publication of targets for the coming year, but, as I have said, we will continue to learn lessons from the progress that we have made this year, including on ambulance response times, which are down by over a third. Anyway, I will take no lessons from Labour, because we know the state of the NHS in Wales.

Social Care

We are making great progress on our 10-year vision for adult social care reform. We have introduced the first ever national career structure for care workers, and we have introduced new assessments by the Care Quality Commission, which will shine a light on how well councils are delivering their social care duties.

I am most grateful to my hon. Friend for that reply. In Suffolk, where the population is increasingly elderly, social care is under enormous pressure, and it is a significant challenge to recruit carers, pay them fairly and provide them with a proper career path. Therefore, I heard what my hon. Friend said, but will she consider commissioning a long-term workforce plan for adult social care equivalent to that for the NHS?

My hon. Friend is right about the importance of the social care workforce: social care is its workforce. I can assure him that we already have a plan for the care workforce, set out in the “People at the Heart of Care” White Paper, and now we are putting it into practice. Our care workforce pathway is already being implemented, our new accredited qualification for care workers will be launched later this year, and we are backing social care with up to £8.6 billion in extra available funding.

I was concerned to hear that a constituent of mine was initially denied access to social care for his mother who suffers from Alzheimer’s despite her inability to administer her own medication. Will the Government look to broadening the criteria of the Care Act 2014 to include those requiring support with administering medication?

We very much want everybody who needs care to get it and everyone who is eligible for financial support should get it. That, of course, is assessed by local authorities. We are introducing Care Quality Commission assurance of social care commissioned by local authorities, to make sure people get the care they deserve and to shine a light on where local authorities are doing a really good job and where others could do better.

The idea of a social care cost cap has dropped off the agenda slightly. I know it is incredibly expensive, but I continue to be contacted by constituents who face losing everything. When often their loved ones have dementia and it is already emotionally an incredibly traumatic time, they have the added anxiety of how they are going to pay for care. The only thing that should matter is what works and is best for their loved one, but there is a cloud of anxiety hanging over society, which we all worry about. Will the Minister confirm that this issue has not lost her attention and that we will continue to consider whether we can introduce a cap?

I thank my hon. Friend for his important question on concerns about the cost of care and how much it costs some people. As he may know—I remind him—the charging reforms were delayed in 2022 by the Chancellor after we listened to local authorities.

A fifth of the social care roles in Westmorland and Furness are currently vacant and unfilled. Coincidentally that is the same proportion of beds in Morecambe Bay that are occupied by patients who are unable to get a care package and therefore leave hospital. The reasons for this are blindingly obvious: the pay and career structures are derisory for hard-working wonderful people and there is a complete absence of genuinely affordable homes for people in those sorts of roles to enable them to live locally. Does the Minister agree that fixing that crisis in my community and others should be the priority for the Chancellor tomorrow, not silly electoral gimmicks?

I recognise the challenges in the hon. Gentleman’s area, although nationally vacancies in social care have fallen by over 20,000. We are reforming adult social care careers to make care a career for the UK workforce. We are putting extra funding into social care—up to £8.6 billion over two years—and introducing CQC assurance to make sure local authorities are doing their best on social care. I would encourage the hon. Gentleman to talk to his local authority and make sure it is paying a fair rate for the care it commissions.

Adult Social Care Workforce

4. What steps she is taking to help increase recruitment and retention in the adult social care sector. (901798)

10. What steps she is taking to help increase recruitment and retention in the adult social care sector. (901804)

19. What steps she is taking to help increase recruitment and retention in the adult social care sector. (901814)

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

I know the Minister will want to join me in thanking every single person who dedicates themselves to working in the social care sector, including perhaps particularly those who have come to the UK from overseas to do so, but it is not sustainable to rely on incoming workers forever. The Migration Advisory Committee has found that Scotland is now less reliant on migrant workers in the social care sector than England, through the simple expedient of paying a decent wage. That might, by the way, also be a good way to stop doctors in England going on strike; the Minister might want to look at that. Has the Minister asked the Chancellor to provide funding in the Budget so that social care workers in England can enjoy the same pay and conditions as their colleagues in Scotland, and if not, why not?

I agree with the hon. Gentleman that we are grateful to all who work in social care, including those who have come here from other countries to care for our loved ones. We also agree that international migration is not a long-term answer to our care workforce needs. That is why we are reforming social care to work as a career, and we are backing that with extra funding—up to £8.6 billion extra for social care over two years.

I am afraid the Minister’s warm words about the social care workforce do not meet the reality check for most people. The Government’s own statistics show that there are at least 152,000 vacancies in social care in England alone, leaving my constituents waiting up to 10 weeks to be discharged from hospital. The Government have been using international recruitment to plug the gaps and as a result have filled over 11,000 vacancies in the past few years, so can the Minister confirm whether recruitment and retention in social care will be better or worse due to Government plans to prevent overseas social care workers bringing family members to the UK?

As I said a moment ago, vacancies have fallen and the care workforce grew by more than 20,000 last year. We are seeing better retention of care workers as well, but we need to go further. That is why we are reforming social care careers, introducing the first ever national career structure for the care workforce and new qualifications and training.

Edinburgh Trade Union Council recently described changes to the healthcare worker visa route as cruel and inhumane. Many of my constituents who have relatives in care share its concerns, as do I. We know the valuable contribution that foreign care workers make to the sector. Ideologically driven change to visas could further exacerbate the recruitment and retention crisis that other Members have so eloquently described. Given that the Government skipped consultation on these changes, will the Minister commit to meeting trade unions and social care leaders in Scotland to understand the impact of these harmful changes?

I am grateful to international care workers who have come to the UK to look after loved ones. Their work has contributed to reducing vacancies and increasing the supply of social care, but we need to get the balance right between international recruitment and our homegrown workforce. We are carrying out ambitious reforms of our adult social care workforce, and therefore it is right, alongside that, to ensure that we have the right numbers of people coming here from overseas for social care. That is why we have worked with the Home Office on changes to visas.

The managers of the wonderful care home I visited in Dunstable on Friday were annoyed by the number of job applicants for care places who were making the interview stage and then not arriving on the day. Can the Minister have a word with ministerial colleagues at the Department for Work and Pensions to ensure that job coaches are certain that jobseekers are not wasting the time of care homes? It is not fair, and those who work in care homes are busy people with a lot to do.

I work closely with colleagues in the Department for Work and Pensions on the recruitment of people looking for jobs in social care, and I will raise that point with my colleague in the Department.

It was the Minister’s party that promised to fix the crisis in social care “once and for all”. With vacancy rates almost three times above the national average and turnover rates for new staff at more than 45%, it is clear that the Government failed. Labour’s plan for a national care service with clear standards for providers and a new deal for staff will give social care the fundamental reset it needs. The Government have done it with our workforce plan, and they have half-heartedly tried it with dentistry. Does the Minister want to copy our homework once again?

Let us be honest, Labour has no plan for social care. Whatever the shadow Minister says, it is unfunded. There is no funding committed to it and it is not meaningful. Those of us on the Conservative side of the House are reforming adult social care. We not only have a plan, but it is in progress.

I have asked the Secretary of State a number of times how she intends to recruit and retain social care staff, particularly with the visa changes coming into effect next Monday, stopping those from overseas coming to fill skills gaps from bringing their spouse or dependants with them. I ask again: how does the Secretary of State intend to improve the recruitment and retention of staff in the social care sector while her colleagues effectively work to undermine her?

We are grateful to international workers coming to support us in social care and improving supply, but we have to get the balance right between international recruitment and our domestic workforce. In England, we are reforming social care careers to make social care work a career for our homegrown workforce, and I encourage her to make sure the SNP does the same in Scotland.

Maternity Services: North London

5. What discussions she has had with the North Central London integrated care system on the potential closure of maternity services in north London. (901799)

Improving maternity care is a year 2 priority in our women’s health strategy for this year. Any decisions around maternity services need to be focusing on improving outcomes for mums and babies. However, decisions on the local reconfiguration of services are made by local integrated care boards and local trusts.

The maternity unit at the Royal Free Hospital in my constituency is facing closure. Last week, I met with doctors from the unit who told me that the Royal Free is uniquely placed to help mothers with diabetes, pregnant women with HIV, and mothers who require interventional radiology. The Royal Free is the only local provider that offers this life-changing treatment 24 hours a day, seven days a week. Does the Minister agree that the Royal Free maternity unit has to stay open for the sake of those vulnerable groups of women?

I thank the hon. Lady for raising her concerns, but as I said, this is a public consultation. It runs for 14 weeks and will close on 17 March. I urge her to raise her concerns as part of that consultation. It is absolutely crucial that we keep expertise in our maternity services, but I understand that the local proposals by the trust and the integrated care board outline plans for £40 million of significant additional investment into maternity services. Those decisions are for the local ICB and the local trust. The deadline is 17 March, and I urge the hon. Lady to ensure she takes part in that process.

Remaining in north London, can I bring to those on the Treasury Bench my concern over the quality of nursing care at Barnet Hospital? An elderly constituent of mine, who is in her 80s, was admitted there recently. She asked to use the lavatory but was told no one could take her, and was handed a nappy; she waited three hours until someone could actually take her to the loo. She is a coeliac, but was not offered any food for coeliacs during her 10-day stay because nobody had read her notes. She was also moved around her bed by her arms despite having a broken shoulder, which nobody knew as nobody had read her notes.

I am very sorry to hear about the experience of my hon. Friend’s constituent. That level of care is absolutely unacceptable. I know he has raised this particular issue with the Patient Safety Commissioner, Henrietta Hughes, but I am very happy to meet with my hon. Friend and his constituent to discuss those complaints, because that care is not acceptable.

Gynaecology Treatment

At Buckinghamshire Healthcare NHS Trust, the number of gynaecology patients waiting more than 52 weeks reduced by over 30% between August and December, but I sympathise with the many women who are still waiting too long. NHS England has been doing targeted work to help trusts with the most long waiters to support gynaecology patients in the community where appropriate, and to find specialist services that can treat them as quickly as possible.

My local NHS trust recently stated that the average wait for a gynaecology appointment is 18 weeks, with patients starting treatment within 24 weeks, but that does not include those on cancer pathways. One of my constituents who had been identified as having abnormal cells in her cervix waited more than 60 weeks for a diagnostic assessment. She is one of many contacting me with tales of long delays for gynaecology appointments and paying to go private out of desperation. What steps is the Department taking to reduce waiting times for gynaecology assessments and treatment for those on cancer pathways?

Significant investment is going in to reduce both general wait times and cancer wait times. More patients on the cancer pathway have been seen than ever before; nearly 220,000 patients were seen last December following an urgent GP referral for suspected cancer, representing 117% of December 2019 levels. We continue to keep this under review and continue to strive to make the system go faster and reduce the elective backlog.

NHS figures from December show that the number of women waiting for gynaecological treatment reached another record high of nearly 600,000. That number has tripled since 2012. A Labour Government will cut NHS waiting lists in England by funding 2 million more appointments a year. What can the Minister say to the women waiting urgently for treatment?

I would say that we are sticking to our plan to back the NHS to cut waiting lists and make our NHS fairer, simpler and faster. When there is no strike action, that plan is working. We already eliminated the longest waits, and, in November, we saw the biggest fall in waiting lists outside of the pandemic in more than a decade, alongside record investment in things like women’s health hubs. We are prioritising women’s health.

Primary Care

8. What assessment she has made of the adequacy of primary care provision in rural communities. (901802)

We have met our manifesto commitment to deliver a record extra 50 million GP appointments annually. Our primary care recovery plan addresses increased GP access and expands community pharmacy services nationwide with Pharmacy First. Our NHS dentist reform plan also allocates resources for 2.5 million appointments, targeting rural and coastal communities.

I thank the Secretary of State for her response, and I thank the Minister for Health and Secondary Care, my right hon. Friend the Member for Pendle (Andrew Stephenson), for visiting the community diagnostic centre and minor injuries unit at the Herts and Essex Hospital yesterday and all the fantastic staff there.

Frontier Estates committed to building a GP surgery as part of the wider Stortford Fields development. However, citing inflated build costs, it now questions the viability of the plans despite months of negotiations and efforts by the local NHS to find a solution. Will my right hon. Friend work with colleagues in the Department for Levelling Up, Housing and Communities, with whom I have already met on this issue, to ensure that Frontier really engages with the process and builds the surgery it promised my constituents?

I congratulate my hon. Friend on the enormous amount of work she has done in her constituency to secure that community diagnostic centre. We have rolled out some 160 or so of those centres across England —we want to do more—and they are supplying some 6 million tests and scans for patients across England.

On the important issue that my hon. Friend raised, my officials and Levelling Up officials are already considering how primary care infrastructure can be better supported in the planning process to ease the pressure on primary care estates, particularly in areas of housing growth. I know that she will continue to be as conscientious in her campaigning on that as she is on other matters.

Rural communities need local, easily accessible primary care. Since Long Crendon surgery closed during the pandemic, patients in that village and surrounding villages have been displaced, mainly to Brill and Thame, for GP appointments. For the vulnerable and those without private cars, the absence of regular bus services can mean an unaffordable £25 at least in taxis to see a GP. I have raised many times an innovative approach to building a new health centre in Long Crendon by the parish council, which has the land and the agreement by the ICB for the rent to put Unity Health in there—we just need the money to build it. Will my right hon. Friend break down every barrier to help us get that health centre built in Long Crendon?

Again, I very much admire the effort and determination that my hon. Friend is showing to stand up for his constituents. He will know that sadly I am constrained from commenting on individual cases, but what I do know is that the innovation he is showing alongside his parish council—and, indeed, I would hope, his local integrated care board—is the approach we want to adopt across our rural and coastal communities to ensure that they, too, have the access to primary care that we all expect.

Equal access to primary care is so important, but the use of physician associates is downright dangerous. Does the Secretary of State agree that patients have the right to see a qualified GP and not be fobbed off with a two-tier primary care system?

I understand the concerns—we have seen them in the media—but, please, we in this House have a responsibility to our constituents and to professionals working in healthcare, including our clinicians and physician associates. In fact, physician associates have been working in the NHS for some two decades. They are there to work with doctors to assist them, freeing up doctors’ time to focus on the tasks that only they are qualified to do. We have been very careful to listen to the concerns raised, which is why we recently announced intentions to regulate them. But, please, we must all take that responsibility for ensuring that we are not spreading concern. Actually, these roles can have a very positive effect on healthcare system.

My constituents are fed up with battling to see a GP. I have been working hard across party lines with local councillors and the ICB, but I was surprised to hear from the Prime Minister in response to a question last week that only £2 million was allocated to my ICB for primary care, and that it should raid its hospital refurbishment budget instead. Could the Secretary of State advise me which part of the much needed hospital investment should be overlooked to compensate for the failure to invest in primary care locally?

Again, it is for integrated care boards to assess the needs of their area. If there are concerns about access to primary care, we are keen to give them the autonomy to make decisions about how they spend their budget. We have set expectations of integrated care boards in a couple of respects—in particular, we expect them to use the money that we have provided for dental care and we have set clear expectations that integrated care boards will introduce at least one women’s health hub in their area this year.

While we are talking about the recovery of primary care and the Secretary of State is at the Dispatch Box, the recovering access plan released last May talked about high-quality online consultation, text messaging services and online booking tools. They were due in July, but that became August and then December, and I understand that it has now been delayed indefinitely due to a claim made against NHS England in what is a £300 million project. That delay is hitting access to primary care. Will the Secretary of State update the House?

We are determined to bring not just primary care but the whole NHS up to speed with technology. We are firm advocates of the idea that technology can help free clinicians’ time and ensure that they are spending time looking at their patients rather than at computer screens. In primary care, we are working to ensure the digital telephony services that have played such a critical role in providing those 50 million additional appointments, as I described. I will take away my hon. Friend’s points, and look into them carefully.

I have been corresponding with the Primary Care Minister, the right hon. Member for South Northamptonshire (Dame Andrea Leadsom), and her predecessors about urgently needing to protect general practice locations in city centres from outdated Treasury rules that potentially force them to move to ring-road locations. The Minister’s latest reply suggested that the ICB could use capital funding to pay for new premises, but my ICB claims that that is against the rules. Would she and her officials please urgently meet me and my local ICB to bottom out what the rules are and urgently protect our city centre GP locations?

The simple fact is that the Conservatives have been in power for 14 years, and general practice has never been in a worse state. Despite slogging their guts out, GPs are struggling because this Government have cut 2,000 GPs since 2015, making it even harder for patients to get an appointment. Given that, why has the Government decided that the NHS needs what the Institute for Fiscal Studies has described as the biggest funding cut since the 1970s?

It has been a very long time since Labour were in government, but even the hon. Gentleman knows that Ministers will never comment on fiscal events the day before they occur. Let me introduce some facts into his analysis. We have now delivered on our manifesto commitment for 50 million more general practice appointments per year, with 363.8 million booked in the last 12 months. That compares with 312 million deliveredin the 12 months to December 2019. [Interruption.] If the hon. Gentleman stopped shouting, perhaps he would be able to hear me. About 62,000 more appointments were delivered per working day last December, excluding covid vaccinations. We have our primary care recovery plan, and it is working. Of course there is more to do, but even the hon. Gentleman would not be so churlish as to deny those extra 50 million appointments.

Tobacco and Vaping: Legislation

The hon. Member will know that, shockingly, smoking kills 80,000 people across the UK every year, and costs society £17 billion in ill health and loss of productivity. The Government will introduce the tobacco and vapes Bill shortly. I am delighted to say that Northern Ireland Ministers announced just this morning that we will legislate for the whole of the United Kingdom.

I thank the Minister for that answer. I just want to say that the age-related Bill on the sale of tobacco products will create the first generation of smoke-free people in the United Kingdom. All politics is local, and it is vital that we have the same legislation in Northern Ireland. In Northern Ireland, smoking contributes to at least 1,300 smoking-related cancers per year. Some 13.9% of the people in my constituency continue to smoke, irrespective of the guidance given. I am glad to hear the Minister’s assurance on the legislation, but will the Government engage with the Northern Ireland Executive to ensure it is on their priority list?

I can tell the hon. Gentleman that the Secretary of State met the Northern Ireland Health Minister just yesterday. I absolutely assure him that all parts of the United Kingdom will be included in the once-in-a-generation public health intervention that will save millions of lives.

I urge my right hon. Friend to get on with introducing the Bill, because every single day we delay, more people die of cancer and other smoking-related diseases. Equally, in creating the first generation of people who will not be allowed to buy cigarettes or tobacco products—that is excellent—does she agree that one concern is that young people are now taking up vaping instead of smoking, and that vaping is clearly a path towards nicotine addiction?

Yes. My hon. Friend raises an incredibly important point. There is no doubt that tobacco and vaping companies are now trying to recruit children, putting vapes, including many illegal vapes, next to the sweet counter with extraordinary flavours such as bubble gum and berry blast, which are clearly not designed, as was originally proposed, for adult smokers to be able to quit smoking by moving to vaping. He is absolutely right and we will bring forward this once-in-a-generation legislation shortly.

Community and District Nurses

12. What steps she plans to take to improve the recruitment and retention of community and district nurses. (901806)

We have delivered our manifesto commitment of 50,000 more nurses six months early. There are now almost 361,000 nurses working across the NHS. As part of that, community nursing has grown by over 9% since 2019.

There has been a crisis brewing in community-facing nursing over the past decade, with the number of district nurses down by 40% and health visitor numbers in England and Wales falling by almost a third. What guarantees will the Minister provide that this vital workforce will be supported, when health budgets in all the nations of the UK are under increasing strain and NHS funding faces a £2 billion black hole, and cuts to spending in England have a consequential impact on budgets in Scotland?

Record funding is going into our NHS. In addition to the 9% increase in community nursing since 2019, we are investing over £2.4 billion in education and training through the NHS long term workforce plan, which commits to increasing training places for district nurses by 41% by the end of the decade. Since 2010, we have delivered over 63,300 more nurses and midwives into our NHS.

Draft Mental Health Bill

13. When she plans to respond to the Joint Committee on the Draft Mental Health Bill’s report entitled “Draft Mental Health Bill 2022”, published on 19 January 2023. (901807)

I put on record my thanks to the members of the pre-legislative scrutiny Committee, which scrutinised our draft Mental Health Bill. We are looking at the recommendations and will respond to the Committee’s report shortly.

It is now over a year since the Joint Committee report on the draft Mental Health Bill was published. Despite repeated promises of reform, the Government have failed to act. More than 50,000 people are held under the Mental Health Act 1983. It is an outrage to them and to campaigners that reform has been de-prioritised. Will the Minister confirm when the Government plan to bring a formal Bill to Parliament and what conversations they have had with the Chancellor in the run-up to the Budget to ensure the reforms are properly resourced?

As I have said, we have published our draft Bill, it has undergone pre-legislative scrutiny and I shall respond to the Committee’s recommendations shortly, but this is not just about legislative reform. As a result of the £143 million that we have invested in crisis support, we have already seen less use of the Mental Health Act 1983 because people are being seen earlier: our crisis cafés and crisis telephone services, for example, have led to a 15% reduction in the use of the Act.

It is a number of years since we promised to reform mental health legislation that reflects a time when people with severe mental ill health were viewed as problems to be managed rather than as individuals. I believe that we on these Benches, as Conservatives, should be doing everything we can to empower people and respect their liberties. It simply is not right that in the 21st century people’s health conditions are being managed through the forced administration of drugs, which pays no respect to their liberties. May I reiterate the urgency with which measures should be introduced, particularly as people with lived experience have relived their trauma to provide the benefit of their experiences?

I absolutely entirely agree. That is why the Government published the draft Bill in January last year, and why it underwent pre-legislative scrutiny. I gave evidence to the Committee, and we are working our way through its detailed recommendations and will publish our response shortly. However, that is in addition to our significant reform of mental health services, particularly earlier intervention and crisis cafés. We have seen the impact of that: 15% fewer detentions under the Mental Health Act, 8% fewer admissions to hospitals and 12% fewer admissions from our mental health crisis telephone centres, which are now available across England 24/7.

Healthcare for Women

Women’s health is one of my top priorities. As we approach International Women’s Day, we have already improved access to contraception and the treatment of urinary tract infections through Pharmacy First, announced £50 million of funding for research on maternity disparities and other health conditions affecting women, and set the expectation that each integrated care board area will have at least one women’s health hub operating this year.

For more than a decade I have been raising the appalling, often agonising treatment of many women who need hysteroscopies in the NHS. They are being left with unnecessary trauma and are reluctant to engage further with doctors, which is quite simply life-threatening. However, the medical establishment continues to resist change and the Government shirk their leadership role. Earlier this year the Secretary of State set out her priorities for the women’s health strategy, and access to pain-free hysteroscopy was not included. Why?

I thank the hon. Lady for her work in this regard, and I absolutely acknowledge the issues that women are experiencing with this highly invasive procedure at what is often an extremely distressing time in their lives. We are waiting for the Royal College of Obstetricians and Gynaecologists to update its guidelines on best practice in hysteroscopies. Following consultation last year that is under peer review, and is due to published soon. However, as the hon. Lady knows, I am clear that it should not be the responsibility of women in those very distressing circumstances to ask for pain relief. Clinicians must assume that a woman wants it, and discuss that with her before the procedure.

I welcome the Government’s recent refresh of the women’s health strategy and the addition to it of birth trauma. However, I am currently chairing a national inquiry into birth trauma, and we are hearing from mothers throughout the United Kingdom about some of the severe mental health conditions that they are facing, including postpartum psychosis. I have been particularly concerned to hear about the risk of suicide among new mothers. What action are the Government taking to address this?

Let me put on record my admiration for my hon. Friend’s action in sharing her own experiences in order to improve healthcare for women across the country. She will know of yesterday’s important announcement about suicide prevention, elements of which addressed exactly the concerns that she has rightly raised. Thanks to her hard work, we have also announced that within eight weeks or so of giving birth mums will be asked by GPs whether they are okay, and we hope very much that that will open up the conversation with women who may be struggling.

Amma Birth Companions has just been recognised in the 2024 GSK IMPACT awards. The charity is doing really important work to support vulnerable asylum seekers and refugees who would otherwise face giving birth alone. Will the Secretary of State meet the charity to discuss its work and research, given the disparities that continue for this group of women?

The hon. Lady describes a very interesting piece of work. I will ask my ministerial colleague to meet the charity, as we want to support women. Indeed, part of our work across the women’s health strategy is ensuring that maternity services are not just safe, but trusted by mums-to-be.

With regard to healthcare for women, a gynaecologist who claimed that Hammersmith would be better if it were “Jew free” has been ruled as not racist, but merely

“comfortable with using discriminatory language”,

according to the Medical Practitioners Tribunal Service. He was merely suspended for three months and is due to start seeing patients again in a few weeks. I am concerned that this doctor may be a danger to Jewish patients. I am also concerned that the tribunal is defective and its decision is grossly unreasonable. Will the Secretary of State instruct Government lawyers to begin judicial review proceedings against the tribunal?

I sincerely thank my right hon. and learned Friend for raising this issue. As the Prime Minister set out on the steps of Downing Street last week, there are people whose ideology and dogma are in direct conflict with our country’s shared values. Just as we will not stand for that across the country, nor will I stand for it in our NHS. I have already written to NHS England and regulators, setting out their responsibilities and our expectations of them, and I can assure my right hon. and learned Friend that I will be looking into this issue with great urgency and great care.

Topical Questions

I am committed to making our NHS faster, simpler and fairer for all, including families, which is why the Government have recently introduced baby loss certificates. Nothing can diminish the pain of losing a baby, but we hope that this formal recognition of a life lost can help families to live alongside their grief. Indeed, since we announced the launch some two weeks ago, more than 37,000 certificates have been requested by parents.

That same commitment to families is why we are rolling out Martha’s rule across England, giving patients and their families the automatic right to a rapid review of their case—24 hours a day, seven days a week. Families and carers know when something is not right or their loved one’s condition is deteriorating. Martha’s rule not only recognises this powerful instinct, but allows anyone concerned to act on it and to make sure that the NHS listens.

With your permission, Mr Speaker, for which I am very grateful, I would like to alert the House to a written ministerial statement and a detailed letter from NHS England that has been laid this morning. It addresses a historical issue whereby women who received radiotherapy above the waist to treat Hodgkin lymphoma, and who were therefore at a higher risk of breast cancer, were not given annual checks. Yesterday, the NHS wrote to the 1,487 women affected in order to inform them. We expect all women to be offered a scan within the next three months, and NHS England has established a helpline and briefed GPs and relevant charities. The vast majority of this group of women will already have been receiving screening on a three-yearly basis, but NHS England wants to ensure that they receive annual tests, in line with the clinical guidance.

I wanted to alert hon. Members to that because, with the letters having been sent out yesterday, it is perfectly possible—indeed, probable—that they will start to receive queries from their constituents. I will of course keep the House updated. I emphasise, however, that what I have given is a summary, and I would encourage hon. Members to look at the very detailed letter from NHS England in order to reassure their constituents that we are scooping up everybody we can to look after them at this very troubling time.

Like many people here, I was delighted by last month’s NHS dentistry recovery plan. How many new NHS dental appointments does the Secretary of State expect to be available in my constituency of Weston-super-Mare, and by when?

I thank my hon. Friend for supporting our dental recovery plan. Indeed, he is one of many colleagues who campaigned hard for it. I am pleased to inform him that dental activity, as measured by courses of treatment, has increased by 15% on the previous year in his local integrated care board area, and our plan will support further increases to dental access through some 2.5 million additional appointments across the country, including in his constituency. The first measure, namely new patient premiums, went live on Friday, and we hope to have the results very soon.

With a general election in the air, I welcome what the Secretary of State has said about baby loss certificates and Martha’s rule—there is genuine cross-party agreement on this. I also thank her for advance notice of today’s important written ministerial statement.

However, with a general election in the air and given the Secretary of State’s principled, vocal and consistent opposition to funding the NHS by abolishing the non-dom tax status, on a scale of one to 10—one being utterly shameless and 10 being highly embarrassed—how red-faced will she be when the Chancellor adopts Labour’s policy tomorrow?

One of the joys of being at the Government Dispatch Box is that not only do we have to deal with very serious matters, such as I have just set out, but we get to have a knockabout on the Labour party’s electioneering. The hon. Gentleman will know the Conservatives’ proud record on funding our NHS since 2010. I invite him to wait for tomorrow’s Budget to see what more this Conservative Government are doing to support our constituents, and to help our economy grow for a bright future.

The Under-Secretary of State for Health and Social Care, the hon. Member for Lewes (Maria Caulfield), has said that the policy will be

“as much use as an ashtray on a motorbike.”—[Official Report, 28 February 2023; Vol. 728, c. 710.]

As she speeds down the A23 back to Lewes, to defend her constituency against the Liberal Democrats, how on earth will she feel with all those embers of the Conservatives’ 14-year record blowing in her face?

Is it not now clear that, with the Government having adopted Labour’s workforce plan, Labour’s dentistry recruitment plan and now Labour’s NHS funding plan, when it comes to a record to be proud of, and when it comes to finding the answers, only Labour can deliver an NHS that is fit for the future?

The Leader of the Opposition is a former barrister, and barristers like to rely on evidence, so let me give some evidence on what the Labour-run NHS in Wales looks like. People are almost twice as likely to be waiting for treatment under the Labour-run Welsh NHS—21.3% of people in Wales are waiting for hospital treatment after a consultant referral, compared with 12.8% in England. Patients in Labour-run Wales are, on average, waiting five weeks longer for NHS treatment than patients in England, and the number of patients in Wales who are escaping to seek treatment in England has increased by 40% in two years. But don’t worry, folks, according to the Leader of the Opposition this is the blueprint—

Order. I remind everyone that these are topical questions. It is about the many Members I need to get in, rather than the ping-pong over the Dispatch Box. Let us move on to Andrew Jones as a good example.

T2. Thank you very much, Mr Speaker. I am talking to my local integrated care board about establishing the first centre of dental excellence in North Yorkshire, to be located in Harrogate, to build on the dental recovery plan. Does my right hon. Friend the Secretary of State agree that boosting capacity is critical to catching up from the pandemic, and that centres of dental excellence are a very good way to achieve it? (901822)

I completely agree with my hon. Friend that we need more capacity in our dental workforce, and I know he will be a big advocate for his constituency. We set out in the first ever NHS long-term workforce plan that we will increase dentistry training places by 40% by 2031-32. Our dental recovery plan sets out many different measures to improve capacity.

Later this month I will be 10 years cancer free, having survived melanoma first as a teenager and again in my early 20s. Can the Secretary of State look me in the eye and guarantee that she is doing all she can to prevent others from getting the same diagnosis ?

Again, I thank the hon. Lady for sharing her experience, and of course we are doing all we can. I know that the SNP Scottish Government share our determination to ensure that cancer treatment continues to improve. England is diagnosing earlier and treating more. We have seen cancer survival rates improve by almost 10 percentage points since 2005, but we also know that four in 10 cancers could be prevented, which is exactly why we are bringing forward the smoke-free generation work. Of course, if the Scottish Government would like us to help with some of their waiting lists, we genuinely stand ready to do so.

T3. The general practice estates and technology transformation fund supported projects in my constituency and was appreciated by my local integrated care board. What evaluation has been made of it, and will it be continued? (901823)

I have had a number of meetings with my hon. Friend and know that he is determined to resolve some of these long-standing issues in his constituency. I have assured him that ICBs have the freedom to increase capital for primary care in their region, so long as their plans remain within their overall capital allocation. I will certainly be happy to meet him again to talk about what more measures we can take to support his constituents.

T4. I held my first dental summit since the publication of the Government’s dental recovery plan, which I have to say was met with disappointment and frustration. The reason for that is that is not enough funding or flexibility, or the resolution to the contract. Will the Minister set out the timetable for when the dental contract will be resolved? (901824)

I am very surprised and disappointed to hear the hon. Lady say that. We are delivering 2.5 million more appointments through the new patient premium, which started last Friday. We will have information within a month to see which dentists have taken up this generous new patient premium to ensure that many more people get access to dentistry. Not only that, but we have golden hellos to attract dentists to areas that are underserved, mobile dental vans and, importantly, a new focus on Smile4life. That is going to ensure that all babies and young children have that fabulous smile for life.

T5. The Pharmacy First service has proved popular in Amber Valley, but some pharmacists report confusion because the ear infection service applies only to under 18s and patients are being referred to pharmacies when they should not be. Will the Minister either extend the service to over-18s or ensure that NHS communications are clear that this service is only for children? (901825)

My hon. Friend raises an important point. He will be aware that a decision was taken that ear wax removal services are better done in the community and that ear syringing can cause problems. That area is under review and I am happy to write to him to address the specific point he makes about over-18s and children.

T7.   I absolutely agree that we should redouble our efforts to recruit and retain more home-grown carers, as the Welsh Government are doing by paying them all at least the real living wage, but in the short term we have to rely on foreign workers. From her earlier answers, it appears that the Social Care Minister is happy to deprive them of the enjoyment of their own family life, while we expect them to give our relatives loving care. Will she think again and speak to Home Office colleagues about dropping this totally inhumane ban? (901828)

As the hon. Lady will have heard me say earlier, we are grateful to international care workers who come to care for our loved ones in this country. We need to get the balance right between international recruitment and our home-grown care workforce. On the question specifically on dependants, I say to her that every care worker who comes here to do work in the UK has a choice as to whether to come here or not.

T8. I thank the Health and Secondary Care Minister for visiting the new medical school in Chelmsford yesterday. This is the first time that students have ever been able to train as doctors in Essex in its history, and the results are phenomenal. This is living proof of the Government’s commitment to train the NHS staff of the future. What progress is he making to increase work placements for students so that we can train even more doctors, nurses and people for important roles such as physician associates? (901829)

I thank my right hon. Friend for her question and her kind invite to visit her constituency. I pay tribute to all the work she has done to secure investment in Anglia Ruskin University. She is right to highlight the importance of delivering clinical placements as part of the long-term workforce plan. I assure her that we are working closely with NHS England and partners in health and education to ensure that happens.

Medicine shortages have doubled in the UK in the last two years. There might be some global pressures, but two issues have particularly affected the UK: first, the post-Brexit regulatory framework; and secondly, the fact that the pound has tanked, making it more expensive to buy medicines. What are the Government doing to undo that Brexit dividend?

The hon. Gentleman sounds like a broken record, as usual. The Department has no evidence to suggest that EU exit is leading to sustained medicine shortages. Shortages occur for a wide range of reasons and are affecting countries all over the world.

Rural Norfolk is experiencing a dental crisis and a generation of children are in danger of going without dental care. I welcome the dental recovery plan, but I notice that it will be four or five years before we get more dentists. Last week, NHS Norfolk and Waveney integrated care board announced a £17 million underspend on dentistry. Will the Minister agree to meet with me and the ICB to work out how we get more money out now to help dentistry in Norfolk today?

One of the many ways we have tackled access to dental care is to ensure that those dentists who have a contract to conduct NHS work are using them to the top of their licence. We are encouraging dentists to do that through the new patient premium and a higher rate paid for units of dental activity. There is so much more to the plan. Labour keeps trying to claim credit for our plan, but the truth is that our plan promises 2.5 million appointments while its plan promises a miserly 700,000.

It is imperative that we tackle the scourge of mental ill health in children and young people. Labour will ensure access to mental health support in every school and establish an open-access mental health hub in every community, paid for by charging VAT on private school fees. Why will the Government not adopt that plan?

I have a news flash for the hon. Lady: we are already doing all that work. Mental health support teams are being rolled out in schools—44% of pupils now have access to a mental health support team, rising to 50% shortly. Over 13,800 schools and colleges now have a trained senior mental health lead. Only last week we announced 24 early support hubs for 11 to 25-year-olds—they will not need a referral; they can drop in. There are 24/7 helplines available that can be accessed through 111. That is what we are doing.

Mid and South Essex integrated care board is seeking to remove vital community health services from St Peter’s Hospital in Maldon. Will the Minister meet me and our right hon. Friend the Member for Maldon (Sir John Whittingdale) to discuss the proposals? They will affect both our constituencies and are causing a great deal of concern.

I thank the Secretary of State for her offer to help cut waiting lists in Scotland. I listened to the frankly delusional statements from the SNP Benches about the state of the NHS in Scotland. We are in dire straits and suffer the same problems, particularly about GPs and appointments disappearing. When are we going to see an improvement in appointment availability?

The hon. Lady will no doubt be extremely envious of the fact that in England there are 50 million more GP appointments now every year, which is a fantastic achievement by this Government. She will want to look at what is happening in Scotland, which has some of the worst health outcomes in western Europe, and challenge SNP Ministers over drug and alcohol death rates and falls in life expectancy.

Will my right hon. Friend explain an anomaly in the “Agenda for Change” pay deal as it affects non-NHS providers? People working in the NHS for non-NHS providers may be eligible for extra money if the organisation they work for is in financial difficulties, but not if it is not. So badly run organisations are being rewarded and well-run organisations are being penalised, which seems to me to be perverse.

I am happy to meet my right hon. Friend to discuss the matter. We have reached pay settlements with the “Agenda for Change” unions, and we continue to reach pay deals with other unions. We are also supporting non-NHS providers whose contracts are dynamically aligned. It is a complex area, so I am more than happy to meet my right hon. Friend to discuss his concerns.

The Secretary of State will know that NHS England is expected to announce the decision about the primary children’s centre for cancer treatment in south London and south-east London. Evelina London Children’s Hospital in my constituency is one of the only specialist centres in south London. Does she agree that the final decision should be made as soon as possible in order to benefit staff, patients and families? Will she join me in visiting Evelina London?

I thank the hon. Lady for her question. In fairness, colleagues from across the House have been raising this issue with me because it affects a large population of London and the surrounding areas. I must leave it to NHS England to finish its consultation process, but I would be very happy to visit not just the Evelina but our other wonderful hospitals that look after children.

Given the expansion of health services through Pharmacy First, what action is my right hon. Friend the Minister taking to ensure that communities such as Sandiacre in my constituency, whose branch of Boots is due to close at the end of the month, are not left without access to such vital services?

I am very happy to discuss that matter with my hon. Friend, who is a huge advocate for her constituency. It is always disappointing when a community pharmacy closes, but she will know that the launch of Pharmacy First on 31 January expanded the value and contribution of all our community pharmacies. It has been met with a £645 million investment over this year and next.

On access to primary care provision, will the Secretary of State assure the House that she will liaise with Health Ministers in the devolved Departments to ensure that rural communities do not lose out because of their isolated locations?

I am very happy to give that assurance. I was delighted to meet Minister Swann yesterday to discuss his plans for Northern Ireland healthcare, including access to primary care.

I remind Members of my entry in the Register of Members’ Financial Interests. The Medicines and Healthcare products Regulatory Agency’s international recognition procedure will ensure faster access to innovative treatments, but it will realise its full potential only if it is matched by the National Institute for Health and Care Excellence’s evaluation process. What is my right hon. Friend the Minister doing to ensure that the two processes are aligned?

My hon. Friend will be aware that there have been delays with approvals by the MHRA and NICE. We are keen to ensure that those delays are reduced, and I am delighted to tell the House that significant progress has been made in both organisations. I am happy to work with my hon. Friend and both organisations to ensure that progress continues to be made.

Figures obtained by the British Dental Association project that £8 million of the NHS budget in Somerset is going unspent. Will the Minister explain to my constituent, who is suffering in dental agony, why that is happening?

I encourage the hon. Lady to hold her integrated care board to account. We invest more than £3 billion a year in dentistry, and our dental recovery plan means that significant money is available for NHS dentistry. It is for the integrated care board to commission those units of dental activity, which now offer more money—a minimum of £28 per UDA. I am happy to meet the hon. Lady if she finds she is not getting anywhere with her ICB.

I am currently working with a brilliant local pharmacist, Fizz, to open a new NHS dental practice in Belfairs in my constituency. Premises and dentists have been lined up, but we need the ICB to commission the service. Will the Minister meet me, my local ICB and Fizz to unlock that vital service as soon as possible?

I am delighted to hear about that really good news for my hon. Friend’s constituents—I know she works tirelessly for them. Of course, I will be very happy to meet her.

Wendy Hart had a high white blood cell count when she was discharged from the Royal Devon and Exeter Hospital. Her husband, Terence, described a dreadful, pointless 60-mile round trip home and back to hospital before Wendy died of sepsis. Will the Minister consider distances between acute hospitals and rural communities when reviewing hospital discharge guidance?

I am very sorry to hear about what happened to the hon. Gentleman’s constituent. I send my condolences to her family and loved ones. Clearly, it is very important that discharge decisions are led by clinicians, who can make a clinical decision about whether somebody is medically ready to be discharged. I have no doubt that the family may well take up that decision with local NHS organisations.

No doctor wants to be on strike, so I welcome the new deal with the consultant unions. It shows that by being reasonable, pragmatic and acting in good faith, unions can deliver for their members. Does my right hon. Friend agree?

My hon. Friend knows only too well the importance of industrial action and the impact it can have on patients and on the NHS as a whole. I am pleased that the BMA has announced today, following the previous settlement that was narrowly rejected in its ballot, that it has been able to get back around the table with my officials and me. We have been able to find a fair and reasonable settlement that the BMA will advocate for and recommend to its members. We hope that that shows those who are choosing to strike that constructive negotiations, and trying to sort out some of the concerns that we know clinicians have, can be dealt with in a reasonable manner, which is of benefit not just to staff, but to patients.

The hon. Gentleman has caught me off guard—I will write to him. I am keen to continue working with him on that issue. As he knows, we have already shared draft details of the acquired brain injury strategy with him and members of the all-party parliamentary group, and I am very keen to continue working collaboratively on that issue with him.