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Oral Answers to Questions

Volume 724: debated on Tuesday 6 December 2022

Health and Social Care

The Secretary of State was asked—

Covid-19: PPE Procurement

1. What recent assessment he has made of the adequacy of the steps taken by his Department to secure value for money in procuring PPE during the covid-19 outbreak. (902607)

We procured personal protective equipment at pace so that we could protect the frontline and save lives. In a highly distorted market, we worked around the clock to secure the life-saving PPE that we needed.

The Secretary of State will be aware of the high-profile reports in the media regarding Baroness Mone and her connection with PPE Medpro, contact with Government Ministers and the use of a VIP lane in relation to the procurement of PPE. Will he assure me—and more importantly the public—that a full and thorough investigation will take place into these matters and that, following that investigation, the report will be made public?

I can do much better than that. We have commissioned a full investigation and inquiry into the Government’s handling of covid and, as part of that, I am sure that the inquiry will look at PPE. But it is important to put it into context. We secured 23.2 billion items of PPE, which was a huge step, done at pace, to help protect our frontline.

There are concerns that officials and high-ranking associates have reaped the financial benefits of a deadly disease, shamelessly profiteering on public funds. The SNP has long sought to highlight the Government’s rampant cronyism and corruption, and this PPE plundering is the most egregious case that we have seen so far. In Scotland, the Scottish Government have robust procedures in place to ensure protection of procurement in healthcare. How will the Secretary of State better regulate the cronyism of his colleagues? Will he commit now to scrapping the UK Government’s VIP lane for healthcare contracts?

Again, that ignores both the pressure of time at the start of the pandemic and the fact that there was international competition, with companies competing for scarce resources. It is also the case that although more than 19,000 companies were offering PPE, only 2,600 passed initial due diligence checks.

Hospital Bed Capacity

To support operational resilience, the NHS has set out plans to increase hospital bed capacity by the equivalent of at least 7,000 general and acute beds during the winter. That is alongside £500 million of funding to support quick, safe discharge from hospital and free up capacity, and £1.5 billion of targeted investment funding for new surgical hubs, increasing bed capacity and equipment for elective care recovery.

I am grateful for the Minister’s response. Over the last 20 years, Warrington has had among the highest level of new houses built in the north-west of England, but our healthcare infrastructure has not kept pace. We desperately need a new hospital. Our accident and emergency is at breaking point, we do not have enough beds and there is nowhere for those visiting to park their cars. In 2021, my NHS trust submitted a bid to the Department of Health and Social Care for a new hospital. Will he update us on where we are with that process?

I thank my hon. Friend, who has been a long-standing advocate for a new general hospital for Warrington. The expression of interest from the trust has been received. We are currently in the process of reviewing expressions of interest for the eight new hospitals and aim to announce a final decision by the end of the year. I recently met him to hear about the plans, and the people of Warrington could not have a greater champion than him.

May I associate myself with the remarks of the hon. Member for Warrington South (Andy Carter) about the need for investment in Warrington and Halton Hospitals NHS Trust? It is important that both hospitals have that investment. Part of the capacity problem is the lack of social care capacity in the community, whether in a home or in patients’ own homes. Just recently, I had an email from the chief executive of Whiston Hospital, a large acute hospital, where 115 patients were in beds when they did not need to be—they should have been going out of the hospital—out of a total of 721 adult acute beds. Is that not an example of where the Government are failing to provide enough social care out in the community?

We are investing £500 million to create another 200,000 social care placements, but we have significantly increased the number of physical beds available in our hospitals. In July, before we made the commitment to increase bed capacity, we had 96,375 general and acute beds; in October, we had 97,350. We are also delivering that increased capacity outside of hospital through this winter by creating an extra 2,500 virtual ward beds.

Does my hon. Friend agree that it is high time the outstanding care and skill of Hillingdon Hospital staff was matched by commensurate outstanding facilities, and that it is therefore great news that Hillingdon is one of the 40 new hospitals that the Government are building by 2030? Can he confirm that the full funding package will be announced soon, so the whole project can proceed as soon as possible?

I thank my right hon. Friend for his question. The Secretary of State visited Hillingdon Hospital—a hospital I am also aware of—over the summer. There has been no greater champion of Hillingdon Hospital, or of the new hospitals programme more broadly, than my right hon. Friend. Currently, five hospital schemes are in construction, two are now completed and we aim to announce the next eight by the end of this year.

Two weeks ago, a 5-year-old constituent of mine, Yusuf Nazir, died because we no longer have intensive paediatric beds in Rotherham. September saw record-breaking ambulance handover delays and the proportion of patients waiting more than 12 hours in accident and emergency rose to 13.8%, nearly double last September’s figure. In the last 12 years, Rotherham’s NHS has been hollowed out. What is the Minister going to do to reverse that?

First, let me thank the hon. Lady for her question. I am very sorry to hear about the case she highlights. I understand she has written to the Secretary of State on this issue.

Ambulance waiting times are not where we want them to be. We have increased ambulance staff by 40% since 2010. We have invested, with just under 5,000 more staff in NHS 111; 2,500 more staff in call centres; an extra £450 million last year into A&E departments; the creation of the £500 million discharge fund, which will improve flow through hospitals; and 7,000 extra beds this winter. We understand the system is under considerable pressure. I would be very happy to meet the hon. Lady to discuss the challenges in her own trust.

The current state of mental health treatment sees increasing numbers of people languishing on waiting lists becoming more and more unwell, 1.1 million adults denied treatment, and children stuck in emergency departments for days waiting for mental health beds. Are the Government proud that a systemic cutting of a quarter of NHS mental health beds over the last 12 years has led to more patients receiving treatment in private settings? Does the Secretary of State know how much money is given to private mental health providers? Do the Government honestly think they are getting good value for money?

This is not my direct area of responsibility, but of course mental health does present challenges for A&Es and for hospitals more generally. We are investing an extra £2.3 billion every year in mental health, we have 16% more staff and we have an additional bursary to attract more nurses into mental health. But we do recognise the challenges, and the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield) is working hard to address them.

Neurological Diagnosis and Treatment: Waiting Times

3. What recent steps his Department has taken to reduce waiting times for neurological diagnosis and treatment. (902609)

Reducing waiting times for diagnostics and treatment is a priority for this Government. The delivery plan for tackling the elective backlog sets out steps to recover and transform out-patient services across all specialisms, including neurology.

In March 2021, my constituent suffered a severe head injury. By the time they have their first neurology appointment in January 2023, they will have waited nearly two years for treatment. In the meantime, they have been unable to work, been rejected for disability benefits and are in severe pain. Does the Minister accept that this wait is unacceptable, and will she outline what support the Department is making available for those who are suffering while they wait for vital appointments?

I thank the hon. Lady. I know she raised her constituent’s case in a Westminster Hall debate on 22 November and my understanding is that they now have an appointment for January, but there is absolutely a backlog from covid patients. We know that. That is why we are putting in over £8 billion in the next three years to deal with that backlog. That is in addition to the £2 billion we have already provided through the elective recovery fund. We have already virtually eliminated the two-year wait and we are now on track, by April, to eliminate waits of 18 months or more.

Social Care Workforce

I thank all those who work in social care for what they do day in, day out for people whose lives depend on care. We are supporting care homes and agencies in their efforts to recruit staff, including with a substantial national recruitment campaign. In fact, colleagues may have seen some of the adverts while watching popular programmes such as “I’m a Celebrity”. We have also added social care workers to the shortage occupation list, so that social care can benefit from international recruitment to increase the workforce in the short term.

A recent report from the Motor Neurone Disease Association, outlined at the all-party group on motor neurone disease, which I chair, found that most unpaid MND carers provide more than 75 hours of care a week, but many are unable to access respite services due to the lack of adequately skilled care workers equipped to care for the complexity of MND sufferers’ needs. Will the Minister commit to increasing specialised training for conditions such as MND in the social care workforce to protect carers’ health and wellbeing?

My hon. Friend makes an important point. I, too, have heard from family carers about the difficulties that they have faced in getting skilled professional help, which, in turn, gives them support and respite. At the moment, we provide £11 million annually for a workforce development fund, which social care employers can access to help to pay for staff training. Looking ahead, we are working on social care workforce reforms, of which training and skills will form a substantial part. I commit to looking into his suggestion that specialist training for MND care should be part of that.

In the lakes, we have a problem with social care: although the people working in the care industry are phenomenal, talented and dedicated, the average age of the population is 10 years above the national average, so the number of people who need to be cared for is greater and the size of the workforce is smaller. Undoubtedly, poor pay, poor conditions and a lack of career prospects are a major problem in recruiting and retaining the care staff that we need. We also have a special problem in our area because of the absence, or indeed, the evaporation, of the long-term private rented sector, which is where the carers normally would have lived. Will the Minister talk to her colleagues in the Department for Levelling Up, Housing and Communities to make sure that we have a comprehensive package for communities such as mine in Cumbria, so that we have well-paid carers and places in which they can afford to live?

The hon. Member makes a really important point. I will say two things. In the short term, we are supporting social care with £500 million through the discharge fund this winter. That will go into increasing capacity in social care and addressing some workforce challenges in areas such as his. In the long term, we are introducing social care reforms, including in the workforce. One thing we need to look at is ensuring that housing is available for the social care workforce.

I have listened to the Minister talk about increased social care, but I do not recognise that in my area. Northampton General Hospital, which is one of the hospitals that serves my constituency, has around 150 patients who could medically be discharged but cannot be. That accounts for 19% of the beds. At the same time, West Northamptonshire Council is closing Spinneyfields, a 51-bed step-down facility in my constituency, yet it has a private finance initiative contract and, for the next seven years, will pay £700,000 for an empty building. How can that be right? Will the Minister sort it out?

I will take away that example from my hon. Friend’s constituency and look into it. I want to see increased capacity in step-down care and social care during this winter and beyond, but particularly during this winter, supported by the £500 million discharge fund. That will go to areas such as his and across the country to help to make sure that people who do not need to be in hospital can be out of it getting the care that they need.

When will the new Health team wake up to the fact that many of the things that we have discussed this morning—but particularly social care—will be solved only by treating local authorities as friends, allies and partners, rather than the enemy? Please can we have action to make local authorities full partners in delivering every sort of care?

After hearing the hon. Member’s point, I should think that he therefore welcomes the fact that we have set up integrated care systems, which bring together health and social care. The £500 million discharge fund that I have mentioned is allocated to local areas to be pooled into the better care fund and spent jointly between local authorities and the NHS. Funding is an important part of this. In the autumn statement, social care received a historic funding settlement of £7.5 billion over the next two years. That is important, as well as ensuring that the NHS and local authorities work together hand in hand.

10-Year Cancer Plan

Earlier this year, we held a successful call for evidence on a new cancer plan, which received 5,000 responses. We are now considering those responses and how we can best support the diagnosis and treatment of cancer patients. I will be in a position to update the House shortly.

I thank the Minister for her response, but it has been five months since July, when the 10-year cancer plan was due to be published, and 10 months since February, when the war on cancer was announced. While the Government have delayed, cancer patients have faced unacceptable waiting times for diagnosis and treatment. Performance over the past five months has been the worst on record against the target of a 62-day wait between the GP referral for suspected cancer and the first treatment. I ask the Minister respectfully: does she agree that we in this House and the people of this country now need a long-term, ambitious plan to reduce waits and ensure that cancer patients in this country have the best outcomes possible? Will she set out a timeline—not just say “shortly”—for delivering such a plan?

As the hon. Gentleman knows, I cannot comment on what is happening in Northern Ireland, because health is a devolved matter. I can only update him on what is happening in England. We are not waiting for a cancer plan to start on the backlogs: that is why this Government are investing £8 billion over three years to clear the elective backlog. We are seeing record numbers of patients. Cancer treatments continued throughout the pandemic, but we are seeing a higher number coming through than usual. Despite the increase of more than 129% in patients getting urgent GP referrals since September 2019, 91% of patients in England are receiving their treatment within 31 days of the decision to treat, compared with just 87% of patients in Northern Ireland in June. We are very committed to reducing cancer waiting times. I suggest that the hon. Gentleman may wish to speak to the Minister in Northern Ireland as well.

Diagnostic activity, whether in vivo or in vitro, forms part of more than 85% of clinical pathways. Will my hon. Friend confirm that it will receive due recognition in the 10-year cancer strategy?

May I thank my hon. Friend for all her hard work during her time as a Health Minister? We are going through the responses to the call for evidence right now; as I have indicated, we will update the House shortly. I will very much take her points on board.

My constituent Jesse, who is 24, was diagnosed with grade 4 glioblastoma multiforme, a type of brain cancer. It has been devastating to her. She has had a very difficult year of treatment; crucially, after her initial round of treatment, there were delays in accessing a scan because of the backlogs in the NHS. There is a real need for a proper cancer care plan to make sure that she gets her scans as regularly as necessary. Other patients need them as well, but her scan was two months later than it should have been under the standard of care, leaving her in absolute terror that her cancer would come back. The fear is almost as bad as the disease itself. What plans does the Minister have to make sure that the 10-year cancer plan really gets to grips to the backlog, which is devastating people’s lives?

I am sorry to hear about the experience of the hon. Lady’s constituent. I am sure that she will welcome the 91 community diagnostic centres that have already been set up to provide a range of tests, including CTs, ultrasounds and MRIs. We are expecting to deliver up to 160 community diagnostic centres in total, with the capacity for up to 9 million more scans per year when they are fully operational. That will not just deal with the backlog, but future-proof our diagnostic services.

The Minister will know that cancer is the biggest cause of death in children under 14. There are countless instances of failure and missed opportunity in how we detect it, how we treat it and how we care for children with cancer. I am grateful to her for meeting my constituent Charlotte Fairall earlier this year, who tragically lost her daughter Sophie. Does the Minister agree that we need a childhood cancer mission embedded in the heart of any cancer strategy if we are serious about saving other families from that tragedy?

I thank my hon. Friend for all her hard work in this space and for leading our debate on childhood cancer outcomes in this Chamber. I was delighted to meet her constituent Charlotte, who is campaigning so hard on the issue. I promised her that we would look at a child cancer mission; we will update the House on our progress shortly.

GP Recruitment

In September 2022 there were nearly 2,300 more full-time equivalent doctors in general practice than there were at the same time in 2019, and more than 9,000 GP trainees.

A constituent of mine, a full-time GP in her 50s, told me that the pension rules mean she has to retire, work part-time or emigrate, which is hardly likely to help her patients to obtain appointments with her. Having hinted at a change in doctors’ pension rules last summer, the Government are only now announcing a consultation that will last until next spring, so there will be no change in these crazy rules until next summer at the earliest. Is this not too little, too late?

It is worth reminding the House that there are 3% more doctors this year than last year. As I have said, we have 2,300 more full-time GPs, and we are recruiting more. However, the hon. Lady is absolutely right about doctors’ pensions; that is a material issue, which is why we launched the consultation, and we are working with Treasury colleagues to address these concerns as quickly as possible.

GP numbers are falling in Wales. Healthcare is devolved to the Welsh Labour Government, and although Ynys Môn is represented by five members of the Senedd in Cardiff, healthcare concerns constitute a staggering 25% of my postbag. Does the Secretary of State agree that families throughout Wales are not receiving the healthcare that they need and deserve from the Welsh Labour Government?

I do agree with my hon. Friend, and I think it would help the House to assess the performance of the Welsh Government if there were more transparency. For instance, the Opposition motion on today’s Order Paper refers to vacancies in England. I am sure it will surprise the House to learn that the Welsh Government stopped collecting statistics for workforce vacancies in 2011. I look forward to Opposition Members’ encouraging their Welsh colleagues to be more transparent.

Members on both sides of the House will have been shocked and appalled by the recent deaths of children from streptococcus A, and our thoughts are with all the families affected. Cases are on the rise, and as we head into winter it is vital for parents to be able to secure for their children the care that they so desperately need. The shortage of GPs means that too many are struggling to see a doctor, and now there are reports of shortages of antibiotics as well. What advice can the Secretary of State give parents whose children are exhibiting symptoms but who cannot obtain a GP appointment, and what assurances can he give on the supply and availability of antibiotics?

This is an important issue which I know is of concern to many families throughout the country, so I am pleased to be able to reassure the House about our response. While GPs are important in this regard, so are directors of public health, who are leading the response in respect of, for example, liaison with schools. We are seeing a peak in cases earlier than usual, which we believe is due to lower exposure during the pandemic, which in turn has led to lower immunity. There is no new strain, and that is one of the key points of reassurance, but the UK Health Security Agency has declared a national standard to improve the co-ordination of our response, including what is being done in schools.

Hospitals: New Builds and Upgrades

As we heard earlier, the Government are committed to a programme to create 40 new hospitals by 2030. We have committed £3.7 billion—[Interruption.] The hon. Member for Ilford North (Wes Streeting) will get a go in a moment, and I look forward to hearing him welcome the increase in the Government’s capital spending, not just on our new hospitals programme but on, for instance, elective surgery. We are putting £5.6 billion into more surgical hubs and community diagnostic centres, and £1.7 billion has gone to more than 70 hospitals to enable them to deliver significant upgrades.

Patients in Carshalton and Wallington will benefit massively from the building of a new hospital in Sutton and the improvement of St Helier Hospital under NHS plans approved by the Government. Will my right hon. Friend agree to meet me, and the NHS trusts? They are raring to go and to get spades in the ground next year.

I know they are raring to go because I personally have spoken to the chief exec about this scheme, but I can offer my hon. Friend something better: the Minister of State, Department of Health and Social Care, my hon. Friend the Member for Colchester (Will Quince), will personally be visiting shortly to discuss this further. But I also need to be transparent with the House: we are fundamentally changing how we are going to be building hospitals in the NHS estate—[Laughter.] I am not sure why something as important as new hospitals—learning from the Department for Education and the Ministry of Justice through a more standardised model that allows us to deliver more at a cheaper unit price and get them built quicker—is a source of mirth to Opposition Members. It is important that we standardise those designs, and that is what my colleague the Minister of State will be discussing with my hon. Friend.

The new children’s hospital, the new adult building and the maternity centre at Leeds General Infirmary will bring much-needed new facilities to Leeds and the region, as well as wider economic benefits. It is unusual among the hospital building schemes. As the Secretary of State knows, the site is clear and the plans are ready, so may I urge him to give the go-ahead as soon as possible?

I visited that scheme over the summer. The right hon. Gentleman will know that the costs have inflated significantly since what was signed off by the Treasury in 2019. I think the point that has been missed by Opposition Members is that the way we deliver these schemes is to grip the cost better by using standardisation, and that is what I will be discussing with Leeds General. I agree with him that it is important that the scheme goes ahead, and we need to work together to make sure that it does so at a price that is affordable.

NHS Dental Contract

In July, we made some initial changes to the reformed system to support NHS dentistry. We have invested an extra £50 million, reformed the contract to create more UDA—unit of dental activity—bands to better reflect the fair cost of work, and introduced a minimum UDA to help practices where the levels are low, allowing dentists to deliver 110% of their UDAs to provide more treatment. The number of dentists doing NHS work last year was up 2.3% but we are working on plans to go further.

The changes made to the dental contract last week were a step in the right direction, but they fall some way short of the holistic reform required to help the estimated 25,000 of my constituents who do not yet have an NHS dentist. Will the Minister consider a change whereby the NHS funds subsidies to underprivileged areas such as Blackpool, thereby allowing NHS practice to offer a greater financial incentive to attract new dentists into those areas?

Absolutely; my hon. Friend and I have talked about this. We are looking urgently at payment models and measures to address areas that are struggling to attract the right workforce. The commissioning of dentistry will be coming down to a more accountable local level in April, and we need to build on that.

My constituents in Durham have told me tales of DIY dentistry, missing teeth, children in pain and the unfairness of only being able to access dental care if they can afford it. Things should not be this way. The British Dental Association does not accept that the Government’s new plans go far enough to halt the decay in NHS dentistry provision. Will the Minister tell me when the Government will put in adequate funding and reform so that people in Durham can get the dental care that they need and deserve?

As well as increasing the number of dentists doing NHS work and the amount of work being done, we are taking further steps to look to the longer term and build NHS dentistry. The number of dental school places is up from 810 in 2019 to 970 in 2021, but of course we want to go further. We are making it easier for dentists to come to the UK to practise. In fact, we laid draft secondary legislation on 11 October to give the General Dental Council more flexibility to do that. Around the country, plans are advancing for centres for dental development to provide not only additional dentists but hygienists and other nurses.

Health Inequalities

We are taking action on public health across the board. The £3 billion that we are investing in the drugs strategy will create an extra 50,000 places in drug treatment. We have doubled the duty on cigarettes since 2010 and brought in a minimum excise tax. We now have the lowest smoking rate on record and will go further. The £300 million that we are investing in Start for Life means new or expanded family hubs in 75 local authorities. We are taking action right across Government, from the £55 billion that we are investing in energy support to the measures that we are taking through at the moment to crack down on non-decent housing.

Levelling up is not just about jobs and infrastructure; it is about healthcare too, and dentistry is a key part of that. However, Darlington faces the potential closure of its surgery, which serves 7,000 patients, because the current system of NHS dentistry makes the business case for that surgery unviable. What will my hon. Friend do to ensure that we level up dental services so that my constituents can get the services that they need?

My hon. Friend and I have discussed this, and we are due to meet again shortly. I repeat my offer to speak both to that practice and to local partners so that we can tackle this crucial problem.

Research by the University of Manchester adds to the significant body of evidence showing that addressing disparities in healthcare is key to levelling up. Inequalities have resulted in a 30% productivity gap in the north, which can be attributed to poorer health. Will my hon. Friend outline how the Government are working to address this and to ensure that residents of the north are not at a health and care disadvantage?

I saw that important report, and we have to tackle the problem from both the health end and the economic end. Spending on health in the north grew from £36.5 billion in 2018-19 to £52.6 billion in 2020, so there is significant investment in health and preventing ill health in the north. Economic activity stops people sliding into a cycle of ill health and worklessness, and we are working jointly with the Department for Work and Pensions to roll out more disability employment advisers in jobcentres. The underlying key is to tackle and prevent ill health, hence the £3 billion drug strategy and the measures on smoking, energy and housing.

I will give the Minister a good example of health inequality. Until quite recently, we had a perfectly good consultant-led maternity service based in Caithness. Following the Scottish Government’s rubber-stamping decisions, pregnant mothers now have to make a 200-mile return journey to Inverness to give birth. That glaring inequality is despicable. I hope His Majesty’s Government will share best practice with the Scottish Government on tackling this problem.

I am always keen to work constructively with the Scottish Government. This sounds like a serious problem. My right hon. Friend the Secretary of State set out how we are using our health and capital spend more efficiently, and unfortunately this is an example of where it is not happening in Caithness.

It is well documented that people in rural areas have worse health outcomes than people in urban areas. One driver is that the most vulnerable people lack access to the services they need. Will the Minister consider working with his colleagues in the Department for Transport to figure out how the most vulnerable people can access the healthcare they need?

We are rolling out community diagnostic centres to bring services closer to those who need them, and we are investing in 21,200 extra people working in general practice to make sure that rural services, as well as services in the rest of the country, are improved.

In 2019, the Tories promised to extend healthy life expectancy by five years, but on this they are failing. In the last year, the health disparities White Paper has disappeared, the tobacco control plan has been delayed and they have chickened out on implementing the obesity strategy because the Prime Minister is too cowardly to stand up to his Back Benchers. Health inequalities are widening as a consequence. Does the Minister plan to revive any of these strategies, or have the Conservatives completely given up on prevention?

I have already talked about some of the things we are doing to crack on with improving public health and narrowing inequalities, but I will add some more. We are driving up blood donations from shortage groups and vaccine uptake in areas with the lowest uptake. I mentioned the extra £900 million for drug treatment, taking the total to £3 billion over three years. I will not repeat all the things I mentioned but, across the board, we are working at pace to improve public health and narrow health inequalities.

Sudden Cardiac Arrest

Immediate cardiopulmonary resuscitation doubles or quadruples the chance of surviving an out-of-hospital cardiac arrest. Defibrillation within three to five minutes dramatically improves the chance of survival, which is why NHS England is establishing a network of defibrillators and community first responders to save up to 4,000 lives a year by 2028.

On average, 150 people a day die from sudden cardiac arrest outside hospital. Access to a defibrillator is crucial for survival. Without one, the chance of surviving drops by 10% every minute. I welcome the Government’s commitment to rolling out defibrillators across state-funded schools in England and Wales, but I share the concern that, because of significant ongoing supply chain issues, it might not be achieved. Can the Minister explain how the Department is helping to reach the target of supplying 20,000 defibrillators by 2023?

As the hon. Lady says, access to a defibrillator makes a great difference to the survival prospects of somebody having a sudden cardiac arrest, which most commonly happens either at home or in the workplace. Since May 2020, the Government have required all new school builds and refurbishments to have defibrillators installed. I am happy to look into the concern she raises and get back to her. I am also working on other initiatives to make sure we get more defibrillators into public places.

Like many of my Lincolnshire constituents, I live in a remote village and in the unlikely event of my having a sudden cardiac arrest—I am sure that would disappoint people—there is no prospect of an ambulance coming within 10, 15 or even 20 minutes. The Government could make themselves really popular in rural areas by having a massive campaign to roll out defibrillators in most villages. For instance, we have a good opportunity to put a defibrillator in all those red telephone boxes that BT are now closing down.

My right hon. Friend makes an important point, and this is exactly why work is going on to increase the number of defibrillators across the community, for instance, in villages such as his. Many villages will already have them. We are also supporting the NHS to train community first responders to make sure that there are people all across the community who have the skills to do CPR— cardiopulmonary resuscitation—and use a defibrillator. I look forward to being able to announce shortly a new initiative that will mean further defibrillators across our communities.

Social Care Reform

We are already putting social care reforms into practice. For instance, we want care providers to adopt digital care records, and more than 50% have already done so. I am determined to shine more light on our social care system, so our new Care Quality Commission-led assurance of local authorities’ social care duties will start in April.

One of the worst vacancy rates across the NHS is that of geriatricians. What urgent action is the Minister putting in place to ensure that people either at home with domiciliary care or in social care settings are seeing a geriatrician consultant regularly? If there is a shortage, which I believe there is, what action is she taking to have more doctors train as geriatricians?

The hon. Lady makes an important point about people who are receiving social care also having access to the healthcare they need and these systems working together across our health and social care systems. We are training more doctors overall, and we have an increase in medical school places, which is leading to more doctors coming through. I am happy to take away and look at her question about the number of geriatricians.

On delivering social care reform, does the Minister agree that we also need to be looking at how the funding packages work, particularly across borders? I have a constituent whose case falls between two local authorities. Will she agree to meet me as a matter of urgency to make sure that this poor constituent receives the funding she needs for her husband’s care?

As announced in the autumn statement, we have a record funding settlement of £7.5 billion going into the social care system over the next two years, to improve both access and quality of care. I am happy to meet my right hon. Friend to look into the specific challenge that she has outlined, because it is important that local areas are working together across boundaries.

Let’s just tell it like it is on the Government’s record on social care reform. Their cap on care costs was first promised 10 years ago. In 2015, they delayed it and in 2017 they scrapped it. In 2019, the right hon. Member for Uxbridge and South Ruislip (Boris Johnson) again promised to fix the crisis in social care, but last month the Chancellor buried the policy, once and for all. After 12 long years, what have Conservative Members got to show on social care: the highest ever staff vacancies; millions left without the care they need; hospitals full of people who do not need to be there; and families picking up the strain. Isn’t the truth on social care, just as with our economy, transport, housing and schools, that the Conservatives have run out of excuses and run out of road, and the country deserves a change?

We have delayed our social care charging reforms because we listened to those in the system and we heard local authorities asking for more time to prepare. Importantly, we have allowed local authorities to keep the money allocated to that in their bank accounts to fund some of the current pressures on social care. I ask the hon. Lady to recognise the record funding settlement for social care in the autumn statement—£7.5 billion for social care over the next two years—which she has not even acknowledged. That is coupled with the fact that we are pressing full steam ahead with our system-wide reforms to social care, with funding of more than £1 billion to support the workforce and innovations in social care and to transform the quality and access to social care across the country.

New Hospitals Programme: King’s Lynn

12. What recent assessment he has made of the expressions of interest submitted by Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust to be part of the new hospitals programme. (902619)

I had the question down as No.13, but given who is asking the question I can guess that it is related to the build of the King’s Lynn hospital.

I visited the site and looked at the scheme over the summer. I made it clear in a speech that I gave to NHS Providers that addressing the concerns of the RAAC—the rebar autoclaved aerated concrete——hospitals is my No. 1 priority. Obviously, I cannot comment on individual schemes while the process is ongoing, but I can assure my hon. Friend that we are working actively on it.

I warmly welcome the priority that my right hon. Friend has put on resolving the serious RAAC concrete issues at the Queen Elizabeth Hospital, but the decision on this was due in the spring. Christmas is coming and the only question that people in North West Norfolk have is, when will we get the present that everyone wants—a new hospital for the staff and patients?

I note the extensive support that my hon. Friend has among parliamentary colleagues, including my right hon. Friend the Member for South West Norfolk (Elizabeth Truss), who has recently added her support to the scheme. He will be aware that we allocated £20 million last year and £30 million this year to address some of the immediate issues, but we recognise that it is a priority and we are working on it.

NHS Dentists

13. What recent steps his Department has taken to increase the number of dentists working in the NHS. (902620)

As well as making it more attractive to practise in the NHS, the number of dental school places is up from 810 in 2019 to 970 in 2021, making it easier for qualified dentists to come to the UK. We are putting through secondary legislation on that and encouraging new centres for dental development.

Is the Minister aware that there is a particular problem in Bridlington in my constituency, where an increasing number of residents are finding it not just difficult to access NHS dental care, but impossible to do so? Recently, a dental practice in the town has closed. Will he agree to meet me on this matter to see what can be done to resolve the issue, hopefully sooner rather than later?

Of course, I would be keen to meet to try to address those issues and to build on the work that we are doing nationally.

York has had a dental desert for years. It is six years now to see an NHS dentist and the Government have made no change to improve that situation, or to bring more NHS centres into my area. In March, dentistry will be moving into integrated care systems and integrated care boards. How are they going to solve the problem?

One problem has been that having large, remote regional commissioning for dentistry has meant that it is more unlikely that specific local problems will be picked up. That is why we are taking the step that the hon. Member has described. She is now complaining about it, even though it is a measure to get more local accountability over the way that services are commissioned.

Medical Students: University Places

14. What recent discussions he has had with the Secretary of State for Education on increasing the number of university places for medical students; and if he will make a statement. (902621)

The Department has commissioned NHS England to develop a long-term workforce plan. That plan will help to ensure that we have the right numbers of staff, including doctors with the right skills, to deliver high-quality services fit for the future. The plan will be independently verified. We have funded 1,500 more medical school places in England and opened five new medical schools in Sunderland, Lancashire, Chelmsford, Lincoln and Canterbury, and there are record numbers of medical students in training.

I thank my hon. Friend for his answer. He will know that it takes five or six gruelling years to get a Bachelor of Medicine or a Bachelor of Surgery degree—or Doctor of Medicine in Scotland—but many students, having graduated, think that they would prefer more structured development by working as hospital doctors. What can we do to encourage young graduates to go into general practice?

We have record numbers going into general practice, which is the remit of the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien), but part of the plan is to make it more attractive through practice improvement through cloud-based telephony, the additional roles reimbursement scheme, the 24,000 extra staff in primary care, developing multi-function staff so that people can develop their skills and have specialism but still practise as a GP, increasing the use of pharmacy, moving towards more continuity of care and the new GP contract for 2024-25.

But when are we going to see the workforce plan? The other day I spoke to a radiologist who runs a radiology department. There are meant to be 15, but there are only five and they have not had a single person apply. It needs more radiologists and radiographers. We have a national shortage of dermatologists, which is one reason why skin cancers are not being picked up, and a national shortage of pathologists and histopathologists. We need a dramatic increase in the number of people working in the NHS. When are we going to see that workforce plan?

As I said, we have committed to publishing a comprehensive workforce strategy, which, as the Chancellor set out, will be independently verified. That will come soon. We have also set out new pension flexibilities. However, it is important to point out that we have 29,000 more nurses and we are on track to meet our 50,000 target. We have 3,700 more doctors compared with last year, 9,100 extra nurses and 2,300 more GPs.

Topical Questions

We know that women can benefit from more personalised care, especially in pregnancy. The Tommy’s app is a new clinical decision tool for the NHS and for women, another example of how we are using artificial intelligence to improve our maternity system. That will help to end some of the variation in maternity care from hospital to hospital. I am pleased to tell hon. Members, particularly my hon. Friend the Member for Rutland and Melton (Alicia Kearns), who is a great champion of improved mental health, that today my Department, through our National Institute for Health and Care Research, has agreed to provide the funding needed for the next stage of the app’s development. I pay tribute to Sienna and all those other babies born stillborn to their parents and thank all those in this Chamber who have campaigned passionately on this important issue.

Another dental practice in my constituency recently handed back its NHS contract. When I contacted local NHS management about the impact of the closure, it stated that the area in question was adjudged to be well served for NHS dentistry practices because there are 11 practices within a half-mile radius. The experience of my constituents, now left searching for NHS dental services, is that none of those practices is accepting new NHS patients. What is the Secretary of State doing to ensure that assessments of the sufficiency of NHS dental services reflect the real situation on the ground, and when will we see a sustainable solution to the problems my constituents face?

The hon. Lady raises an important issue that is of concern across the House, as we have already seen in the exchanges the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien) answered. That in part was why, during the pandemic, we used £1.7 billion of funding to protect dentistry and why we got a commitment through the £3 billion a year funding of dentistry, but we are looking at how we localise that commissioning to get better value out of the contract, which was the point my hon. Friend raised.

T2. At 1 o’clock today, patient safety expert Dr Bill Kirkup will be speaking to MPs at the all-party parliamentary group for whistleblowing, to which all colleagues are invited. It is a timely meeting following last week’s “Newsnight” programme, which highlighted yet another NHS trust where a culture of fear left staff unable to speak up on patient safety concerns. It is clear change is needed. Does my hon. Friend agree that supporting whistleblowers in the NHS is crucial to patient safety? (902633)

My hon. Friend is so right. I praise her work with the APPG and I know many colleagues will want to attend. Whistleblowers can save lives and improve healthcare, as I have seen in my own constituency, and she is right to be pressing on this matter.

The chairman of the Conservative party claims that NHS strikes are exactly what Vladimir Putin wants, so why is not the Health Secretary negotiating to prevent them from going ahead?

I have seen the hon. Gentleman make that claim across the media a number of times. Just to reassure him, my door is open and I have been clear with the trade unions that I am available; I am available to them this afternoon or tomorrow. It is not I who set a precondition for those talks. When I met the trade unions, they raised a number of issues; not only pay, but safety of staff and other conditions, the estate, tech and so forth, and I am happy to engage with them on those points.

We get the warm words about wanting to negotiate, but a Government source briefed The Times last week that the Secretary of State’s plan is to wait for public sentiment to turn against striking nurses, saying:

“This is going to affect a lot of people…it could have a big impact on a lot of them and…in the end they will get fed up”.

He knows that this winter is going to be the most difficult that the NHS has ever faced, and he is using nurses as scapegoats to avoid the blame. That is the shameful truth, isn’t it?

First, it is a bit bizarre that, at departmental questions, the best the hon. Gentleman can manage is “a Government source”. Secondly, the revelation from that Government source is that this will affect “a lot of people”. I do not think that comes as any surprise. That is why we regret the action and are very open to having talks. The point is that he himself does not support the 19% pay demand of the trade unions. He stands here saying that we should be talking while he himself does not accept their proposal.

T4. There have been several changes of Ministers, as we know, but officials have carried on working through these changes, so can we know on what day, date and time the long-promised and overdue tobacco control plan will finally be published? (902636)

Whatever format our next steps forward are set out in, we will be pushing forward very quickly and aggressively on this. This year, we are putting £35 million into the NHS to support our services for everyone who goes in to stop smoking. We have doubled duty on cigarettes and brought in a minimum excise tax. Women who are pregnant now routinely get a carbon monoxide test. National campaigns such as Stoptober have now helped 2.1 million people to quit smoking. We are also supporting a future medically licensed vaping product as a quitting aid. We will be pressing forward at the greatest speed.

Intellectual property protections are an important way of protecting healthcare companies’ innovations, as we know. However, developments on intellectual property can also impact the rights of individuals, limiting access to affordable, life-saving and essential medical products. What recent representations has the Secretary of State made to colleagues in the Department for International Trade to seek assurances that nothing in the proposed free trade agreement with India will impact or jeopardise access to affordable medicines for NHS patients in Scotland?

I can reassure the hon. Gentleman on that. I would have thought that he would also welcome the commitment to a £15 billion to £20 billion increase in R&D investment, the championing of life sciences that the Minister for Health, my hon. Friend the Member for Colchester (Will Quince), has been leading on, and the opportunity we have to address greater variation within the NHS by bringing forward the innovations from our life industry and applying them much more quickly.

T7. Several GP practices in Rother Valley, such as Swallownest Health Centre, operate a policy of having to ring the doctor’s surgery at 8 am for an appointment. Residents find themselves being placed 50th or 60th in the queue, and are then told that no appointment is available and to call back the next day. This is clearly an unacceptable way to offer appointments. What steps are my hon. Friends taking to stop the current failed booking system and instead guarantee a system of pre-booked appointments at all GP surgeries? (902639)

That is something that we are working on very actively. As well as financially supporting GPs to roll out new and better ways of managing their appointments, we are looking at what criteria we expect from GPs. We already set out some moves in our summer action plan, but we will be looking further at preventing the lamentable situation my hon. Friend describes of people being asked to ring back or being held in long phone queues. That is not acceptable.

T3.   The public are not daft. They know that the backlogs in the NHS existed well before the pandemic, they know that the NHS was already on its knees, and they know that it was this Tory Government who brought it to its knees. So why do the Government not take up Labour’s policy of scrapping non-dom status, use the £3.6 billion to train nurses, doctors and midwives, and get the NHS back on its feet? People in east Hull want nurses, not non-doms. (902634)

The data is very clear; in fact, it is very stark on the extent to which the backlog is driven predominantly by the pandemic. That is why we have a programme, through the extra investment in the autumn statement: the £6.6 billion over the next two years going into the NHS, but also the £2.8 billion next year and £4.7 billion the year after into social care, and £8 billion in 2024. We recognise the size of those backlogs, so we can fund the surgical hubs and diagnostic centres.

I met local care providers last Friday, and they raised two main points with me: concerns about energy costs and covid in care homes. They were keen to see their nursing staff vaccinated with residents, all at the same time. I recognise that that happens in some places, but can we look at making it the norm throughout the country?

My hon. Friend makes an important point. The NHS is strongly encouraging local vaccination teams to vaccinate staff, as well as residents when they visit care homes. That should be normal practice. I am happy to look into it, if that is not happening in her area. I take this opportunity to encourage any health or social care worker who has not had their covid or flu jab this winter to please go ahead and get one.

T5. Parents are becoming increasingly worried about the current prevalence of strep A. It is a time of year when parents are going to have children with high temperatures and sore throats, so concern is likely to be very high. There are also concerns about the availability of antibiotics. Does the Secretary of State believe that this is a moment where the Government need to make a statement and show clear leadership to calm people down and reassure them about the situation? (902637)

We held a cross-party briefing last night on strep A. We want to reassure parents, and if their children have symptoms and they are concerned, please seek help. GPs are ready and A&E departments are ready, and we have directors of public health proactively going into schools where there are cases. There is no shortage of antibiotics—we want to reassure people on that—and we are keeping an eye on that on a daily basis.

The East Lancashire community diagnosis centre already includes Burnley hospital, and as part of that we are opening two new endoscopy rooms in the spring. Residents, the trust and I know that the local hospital can do even more to reduce the covid backlog with the right Government investment. Will the Minister agree to meet me to discuss phase 9 of the hospital’s development, which would bring a brand-new radiology suite?

My hon. Friend is a strong champion for Burnley, and I congratulate Burnley General Teaching Hospital on the incredible innovative work it is doing. He is right that rolling out 91 out of 160 CDCs is a tremendous effort, but we want to go further, and I would be delighted to meet my hon. Friend to discuss these plans further.

T8.   Last week, the First Minister of Wales, Mark Drakeford, said that pay awards are not being funded at the level they should be. The Wales TUC general secretary said that unless we have a fairer funding settlement for Wales, we are going to struggle going forward. When will this Government listen to the Welsh Government and the Welsh trade unions and provide the proper funded pay award that NHS staff deserve? (902640)

I simply direct the hon. Member to the Barnett consequentials. As a former Chief Secretary who has had those discussions with the Welsh Finance Minister I know, and the hon. Lady should know, that Wales gets significantly more funding per head of population than England. I hope she welcomes the fact that, through the extra £6.6 billion in the autumn statement, the First Minister will have a significant uplift, and it is for him to decide how he wishes to spend that money.

I was recently contacted by Amanda in my beautiful constituency of South West Hertfordshire, whose 88-year-old mother had fallen in her flat and unfortunately broken her hip. After waiting for five hours and making two calls to 999, her mother was still lying on the floor. Once they arrived at A&E, Amanda and her mother waited several more hours before being seen. Can my right hon. Friend assure the House that he is doing everything possible to find a solution to this system-wide issue?

My hon. Friend raises an extremely important case. I am happy to meet him to discuss it further, because it is a concerning case and I am keen to engage with him on it.

T9. My hon. Friend the Member for Denton and Reddish (Andrew Gwynne), the shadow Minister for public health, touched on health inequalities earlier, but I did not hear the Health Secretary recommit to publishing the White Paper by the deadline. Does he understand that the cost of living crisis and poverty are leading to greater health inequalities and that action is needed urgently? Can he recommit to that White Paper being published? (902641)

We are absolutely committed to addressing health inequalities. Rather than simply looking at 10 years’ time, we are looking at the immediate actions we can take, because what matters—[Interruption.] Those on the Opposition Front Bench chunter about White Papers, but what I am interested in is immediate delivery—what we can be doing now, rather than speculating about what is done in 10 years’ time.

We are seeing a sad increase in suicide rates across the country. In 2012, the then Government published a 10-year cross-Government suicide prevention plan. Earlier this year, the Government under the leadership of my right hon. Friend the Member for Uxbridge and South Ruislip (Boris Johnson) committed to a new 10-year plan that would be published before the start of 2023. There is no sign of that cross-Government 10-year suicide prevention plan, but maybe I am wrong, and perhaps the Government are about to publish it, because I know that so much of the work has already been done. May I ask my right hon. Friend the Secretary of State to show that he takes suicide prevention seriously and publish this plan as soon as possible?

I thank my right hon. Friend and pay tribute to him for all his work in this area; he has driven this agenda forward. I want to reassure him that we are looking at that. He will understand that we have had some changes in recent weeks, but I assure him that tackling the issue of suicide is a high priority, and we will make an announcement shortly.

In a case that is sadly all too typical, a GP in Ealing, who has seen their patient list go up from 3,000 to 9,000 in the last decade, had plans approved for expansion, but NHS estates now will not cough up. What are the Government doing to support doctors in inadequate premises who cannot increase their patient lists to expand and modernise in the current climate?

The total activity done by GPs was about 7% up in October compared with the previous year. We are actively looking at the way that capital works and the contributions of section 106 and the local integrated care board, to ensure that, as well as having those 2,300 extra doctors and 21,000 extra staff, GPs also have good facilities to work in.

Access to dentistry is an acute issue for West Oxfordshire. Can Ministers explain what they are doing to help rural areas such as mine, and can we meet to discuss it further?

I have mentioned the fact that the number of NHS dentists was up 2% to 2.3% last year, as well as the extra £50 million and the reforms we have made to the contract, but we will go further. We want to address those areas, and particularly rural areas, where more provision is urgently needed.

The chair of the Royal College of General Practitioners has expressed concerns about patients with chronic conditions such as asthma, diabetes and even serious mental health conditions refusing sick notes because they cannot afford time off work. What discussions has the Secretary of State had with Cabinet colleagues about the adequacy of statutory sick pay during this cost of living crisis?

I refer the hon. Lady to the autumn statement, in which my right hon. Friend the Chancellor set out a wide range of support packages to help with the cost of living across the United Kingdom, including the cost of energy. That is part of wider discussions that we have on a regular basis with the Treasury.

The pandemic has had a devastating effect on the number of people waiting for treatment. In 2019, there were 54 women waiting more than a year to see a gynaecologist. That number is now more than 40,000. What is my right hon. Friend doing to reduce this wait?

This is a good illustration of the challenge the country faces with backlogs that are very much driven by the pandemic. We are working with senior figures such as Jim Mackey and Professor Tim Briggs and the Getting It Right First Time programme to look at patient pathways, how we use our diagnostics and our surgical hubs and streamlining the way we get services to patients where backlogs have built up.

This morning, we tragically learned that a five-year-old girl who was a P2 pupil at Black Mountain Primary School died yesterday in Belfast with strep A. I am grateful to the Minister for the answer she gave to the hon. Member for Eltham (Clive Efford) on strep A and her encouraging commitment that antibiotics including penicillin are available, but can she ensure that our public health agencies across this United Kingdom co-operate with one another and that if additional resource is required, it will be made available?

I am very sorry to hear about that tragic case in Northern Ireland. We want to reassure people that, while there is a slightly higher number of cases than usual for this time of year, the UK Health Security Agency is on top of this and is not concerned that there is a wider outbreak than would be expected. We want to encourage parents who are concerned that their children are not responding to get help as soon as possible. Antibiotics are available, and local directors of public health should be co-ordinating local activity, but if there are any concerns, Members should come and see me.

On Saturday, I visited Chalkwell Grange, a brilliant new care home in picturesque Leigh-on-Sea which is struggling to recruit due to the guidance that all care workers should wear face masks. Will the Secretary of State give care homes the best Christmas present ever and change the word “should” to “can” or “may”, to put them in charge of their own infection control?

I thank my hon. Friend; it is good to hear that she has visited a local care home. I have also heard what she heard from staff. Although face masks are important for infection control, we know that they have downsides, such as making communication harder. I have asked for updated public health advice on the use of masks in care homes and I look forward to updating hon. Members and the social care sector on the guidance about that shortly.

My constituent is a victim of sexual misconduct by a medical professional, but they cannot challenge that professional’s fitness to practice because of the five-year rule. The General Medical Council wants that rule to be scrapped and the Government consulted on whether to get rid of it more than a year ago. Can the Minister say whether it is the Government’s intention to scrap it? Will she meet me to discuss how important it is that the GMC can explore whether a potentially dangerous medical professional who is still practising may be unfit to do so?

I thank the hon. Lady for her campaigning on this serious issue. I am happy to meet her and I suggest that we also meet the patient safety commissioner, Henrietta Hughes, to discuss it further.

Can the Secretary of State give the House an undertaking that no NHS or social care facility will be decommissioned and used to house asylum seekers in Northamptonshire or the rest of the country?

I am not aware of any proposal on those lines. On my hon. Friend’s earlier point, as I said, I am happy to meet him to discuss the issue of step-down care and I am sure that there will be an opportunity to discuss any other concerns that he has at the same time.

My constituent Margaret Cramman is a full-time carer for her daughter. Throughout the pandemic, she was denied respite care. Now the care setting insists on testing for visitors and mask wearing for staff, which causes distress to some of the young people being cared for, who rely on vital facial recognition. Nearly all the other covid guidance has been reviewed, but the guidance for respite care remains the same. Why are carers and those they care for always an afterthought for the Government?

I point the hon. Member to the answer that I gave to my hon. Friend the Member for Southend West (Anna Firth) a moment ago specifically about face masks. I have asked for updated guidance for the social care sector on the use of face masks. I recognise the difficulties they cause—for instance, in communication—and I am looking forward to being able to give an update to hon. Members and the sector on that shortly.

What assessment has the Secretary of State made of geographic variation in access to innovative liver cancer treatments, such as selective internal radiation therapy?

It is a brilliant question on which to close, because one of the things that all hon. Members should be hugely interested in is how we are adopting innovation more quickly and industrialising that innovation across the NHS as a whole, as opposed to in silos. That is something that we are focused on in the Department and it is a key priority. I am happy to speak to the Scottish Government and others about how we can work together on that.