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Oral Answers to Questions

Volume 729: debated on Tuesday 7 March 2023

Health and Social Care

The Secretary of State was asked—

Access to Mental Health Services

We are investing an additional £2.3 billion a year by 2023-24 so that 2 million more people can access NHS-funded mental health support.

Research by the Royal College of Psychiatrists shows that between July 2021 and July 2022, referrals to child and adolescent mental health services increased by 24%. Labour has set out a fully costed plan to recruit 8,500 new staff. Why have the Government failed to produce their own plan to recruit more mental health staff to reduce waiting times?

We are recruiting more mental health workers, with 7,400 more full-time equivalents in September 2022 compared with September 2021. That reflects the significant additional funding we are providing—the extra £2.3 billion going in by 2023-24.

Perinatal mental health problems affect one in four new or expectant mothers, and 40% of deaths in the first year after pregnancy are related to mental health. What steps are the Government taking to improve support for women with perinatal mental health needs, particularly in the light of the women’s health strategy?

The hon. Gentleman raises an extremely important subject. As well as the additional investment and extra workforce we are putting into mental health, we are looking at this issue as part of our strategies in other areas—for example, our suicide strategy—and examining our capital investment. There is a range of measures to address this very important issue.

My right hon. Friend is aware of the evidence on the use of psychedelic drugs for more effective mental health care. Last month Australia, having assessed the evidence on psilocybin, started the rescheduling process, and Australians suffering from depression will be able to access this medicine from July. In the USA, the Food and Drug Administration has recognised psilocybin as a breakthrough therapy for depression. In Canada, the special access programme allows physicians to request a licence for assisted therapy under certain conditions. Our drug laws remain based on a 50-year-old, unevidenced, prejudiced assessment and nothing else. The Home Office has never commissioned evidence on psilocybin. Does my right hon. Friend understand that this is a primary public health issue, on which he should lead?

I recognise the close interest my hon. Friend takes in this matter, and he is right to draw the House’s attention to international best practice. I agree that we should take an evidence-based approach in which we look at the data shared with regulators in other countries, such as Australia. I am happy to draw the point he makes to the attention of our regulators.

Anorexia affects many young people. One of my constituents had to give up work to look after her daughter, who was diagnosed with anorexia nervosa and made a number of attempts to overdose—the latest just two weeks ago. The daughter is also suspected to be suffering from an obsessive compulsive disorder and an autism spectrum disorder, but has been told that the wait for diagnosis is over two years. Will my right hon. Friend outline what support we can give my constituent and her family? Have we thought about providing personal budgets, so that if the NHS is unable to treat an individual, they can seek treatment outside the NHS?

My right hon. Friend raises an important issue, and I am happy to look into the individual case she describes. Our wider objective in providing extra funding is to ensure that we treat more people, with 2 million more people accessing NHS-funded mental health support by 2023-24 and the number of patients in talking therapies last year up by a fifth from the year before.

There is a mental health staffing crisis of the Government’s own making. Figures out last week show that there are more than 28,000 mental health vacancies in our NHS, which is up on the year before and the year before that. Are we seeing a pattern here? The number of mental health nurses is down 5% since 2010, but do not worry, Mr Speaker: just so the Secretary of State is aware, Labour has a plan to recruit and retain more mental health staff and to get waiting times down. Can he put a word in with the Chancellor in case he wants to nick that too?

It is always good to find a plan that the hon. Lady actually agrees with the shadow Health Secretary on. As we know from her questions, that is not always the case, not least on the use of the independent sector. What we do know is that she has a habit of writing her questions before she hears the previous answer. I just reminded the House of the 7,400 more staff in mental health in September 2022 compared with September 2021. Obviously she had written her question before that point.


2. What assessment he has made of the implications for his policies of the report by the UK Commission on Bereavement entitled “Bereavement is everyone’s business”, published in October 2022. (903904)

I thank the UK Commission on Bereavement and everyone who contributed their experience of bereavement for their input into the report. We are working across Government and with the bereavement sector to consider how the wide range of findings from the report can inform future policy and make a difference to those who are bereaved.

When my parents died just six weeks apart from each other, I know I would have benefited from practical and emotional support. The UK Commission on Bereavement has a number of excellent recommendations. Does the Minister agree that, among those, the idea of integrating support and information about bereavement into palliative care and end-of-life care is one that the Government should look at taking up?

I absolutely agree with my hon. Friend, who has done so much work in this space campaigning for others to have a better experience than he had with the tragic loss of his parents. I can give him an absolute commitment that we are working with partners across health and palliative care to ensure that bereavement support is an integral part of palliative and end-of-life practice. The new Health and Care Act 2022 means that integrated care boards must commission those services, and NHS England has published new statutory guidance on palliative and end-of-life care to give ICBs the information they need, which includes giving bereavement support to those facing a loss.

Doctor Numbers

We have opened five new medical schools in Sunderland, Lancashire, Chelmsford, Lincoln and Canterbury as part of our wider drive to increase the number of doctors.

Does the Secretary of State agree, first, that we must train enough of our own doctors, rather than depend on overseas doctors? Secondly, does he agree that it is important that the less traditional educational institutions are allowed to open or expand medical schools, as they are often in areas where doctors are in short supply?

I agree with my hon. Friend, and that is why we had a 25% increase in the total number of medical school places. On the specific point he raises, we have developed the new apprenticeship route for medical doctors so that we can start to have more training through that route and not just through the undergraduate route.

As well as recruiting doctors, how do we retain doctors? A doctor in my constituency says that at the end of the day he takes home £100 a week. That is less than a decorator. What are the Government doing about retaining good doctors like my constituent?

It is worth pointing out to the House that the vacancy rate for doctors has fallen compared with where it was before the pandemic. That is often not the narrative that is put out there, but the right hon. Lady is right to highlight the importance of retention. It is obviously better to retain a doctor, given the cost and time it takes to recruit, and that is about looking at a combination of pay issues, about which we are talking to trade union colleagues, and non-pay issues, which are often a real factor in the quality of work that doctors are doing and often shapes retention issues.

I am afraid that talk is cheap. I was at Worcester University’s medical school yesterday, where I was told directly by the vice-chancellor that that university, which has great facilities, can only recruit international students because the Government will not fund places for domestic students. The NHS has asked for medical school places to be doubled. Labour has a plan to double medical school places, paid for by abolishing the non-dom tax status. Why do the Government not swallow their pride and adopt Labour’s plan in next week’s Budget?

First, as I said a moment ago, we are funding a 25% increase in medical undergraduate places, and we have given a commitment to a workforce plan, as the Chancellor set out in the autumn statement. The question that the shadow Secretary of State should address is his party’s opposition to international recruitment. We have more than 45,000 doctors who have been recruited internationally, yet the Leader of the Opposition says he wants to move away from international recruitment, which is an important source of additional doctors.

Cardiac Arrest

4. What steps his Department has taken to improve survival rates for out-of-hospital cardiac arrest cases. (903906)

There are 60,000 suspected cardiac arrests every year, and I want more people to survive them. That is why we are increasing the number of defibrillators around the county. We now have over 46,000 defibrillators in England, and in December we announced a new £1 million community defibrillators fund to boost that number by at least 1,000.

I am pleased that the Government have committed to a £1 million fund to increase the number of defibrillators in the community. However, 72% of sudden cardiac arrests take place in the home, less affluent areas have lower access to public defibrillators and access is difficult in rural areas. Will the Minister make it her policy to require all new buildings, including residential accommodation, to have a defibrillator in the same way that smoke alarms are required?

A specific objective of the community defibrillators fund is to make sure that defibrillators are installed in places where they are most needed, particularly places where there is higher footfall, as well as places where people are at greater risk of cardiac arrest. That is appropriate to make sure that we have defibrillators where they are most needed, so that we can reduce the number of people dying from cardiac arrest.

Two great organisations in Peterborough, Gemma’s Hearts and the Brotherhood Foundation, exist to try to place more defibrillators in the community, such as those at the Lime Tree pub in Walton and the Chestnuts community centre in Eastfield. How will the community defibrillators fund work with voluntary organisations such as the two that I have mentioned to ensure that we have equitable access across places like Peterborough?

It is fantastic to hear about organisations in my hon. Friend’s community that, like many around the country, are acting at the grassroots to increase the number of defibrillators. Very soon, we will publish the criteria for the fund that I have just announced, opening it up for bids from organisations such as those, and I look forward to bids from them.

New Hospitals

The Government are committed to building 40 new hospitals, which is why we have confirmed an initial £3.7 billion for the first four years of the new hospital programme.

One of those 40 new hospitals is Hillingdon Hospital. At the start of this year, Hillingdon Council granted planning consent for the proposed new hospital, which is much awaited by my constituents. Will my right hon. Friend tell me when we might expect building work to commence?

As my hon. Friend knows, I have been to Hillingdon to look at the scheme. I am aware of how essential it is to his local area. He will know that on 22 February, the Prime Minister spoke at Prime Minister’s questions of the Government’s commitment to building 40 new hospitals, and I hope to announce something on that very shortly.

The conditions at North Manchester General Hospital continue to worsen. Last month, theatres were forced to close for six weeks following a ceiling collapse. It is four years since the Government announced the rebuild under the new hospital programme, but little progress has been made. In January, the leader of Manchester City Council wrote to the Secretary of State offering to host a meeting to discuss the project. Will he commit to accepting the invitation?

I or another member of the ministerial team will, of course, meet the leader of Manchester council to discuss this. We are making progress. The hon. Gentleman will have seen progress, for example, at the Royal Liverpool and the Northern Centre for Cancer Care, but I confirm our commitment to the 40 hospitals programme and hope to say more on that shortly.

I heard the responses from the Secretary of State, and it must be really hard for him to keep up the pretence about these mythical hospitals. Here is the reality of what is happening in hospitals around the country. South Tyneside District Hospital was award winning. Despite widespread opposition from all of us at the Save South Tyneside Hospital campaign, we have seen a loss of key services and a downgrading of other services. Despite the work of the amazing staff, the hospital now requires improvement. Why is his Government forcing that decline?

The Government have committed an initial £3.7 billion, which indicates our commitment to the new hospital programme. As I said, I will have more to say on that shortly.

Kettering General Hospital serves my constituency, and work has already started on building a new hospital—one of the Boris hospitals—so I do not know what all the fuss is about. The Government are getting on and doing the job. Is that correct?

It is. As my hon. Friend will know from another of my visits, which was with him to Kettering, the enabling works are progressing. That is in no small part a tribute to the work that he and neighbouring MPs have done to strongly make the case for Kettering. I know that he will continue to do so, and I look forward to working with him on that.

Health Inequalities

We announced in January that we will publish a major conditions strategy, which will apply a geographical lens to each condition to address disparities in health outcomes. We have doubled the duty on cigarettes since 2010 and now have the lowest smoking rate on record. We are investing an extra £900 million through the drugs strategy, increasing funding by 40%, and to fight obesity we have introduced the sugar tax and measures such as the extra £330 million for school sport.

The daily dump of WhatsApp messages in the papers reminds us of covid and the disproportionate deaths suffered by black, Asian and minority ethnic communities. What with that and the figures showing a 20-year gap between life expectancies in our nation’s most affluent and poorest wards, why is it that the Government scrapped a proposed White Paper on health inequalities?

As I just said, we are driving forward all that work through the major conditions paper. In addition, we have the Start for Life programme, with another £300 million to improve young people’s start in life. We are absolutely committed to tackling health disparities and driving forward work on all fronts.

Vaping was designed as a stop-smoking device for adult smokers, but the flavours, colours and disposable vapes have become a fad for children, encouraging those who have never smoked to take up vaping. What are the Government doing to prevent that?

My hon. Friend is quite right. It is something that we are looking at very closely, as she knows from previous conversations. While vaping can be an aid in quitting smoking—it helped about 800,000 people to do so last year—we must stop its use being driven up among children.

We are just 24 days away from a new financial year. Last week, more than 30 public health leaders said that the delay to releasing the public health allocation for 2023-24 was

“putting public health services at risk”.

Early years support, addiction treatment and stop-smoking services should not have to pay the price of this Minister’s incompetence. He must apologise for treating councils and the health of our communities with such contempt. When will the public health grant be announced?

The public health grant will be announced within days, not weeks. When it is announced, the Opposition will see that, as well as generously funding public health, we will be funding an extra £900 million on drugs spending to transform treatment and an extra £300 million through the Start for Life programme. We will continue to ramp up support for public health.

Childhood Obesity

The Government are committed to addressing childhood obesity. We have introduced calorie labelling for on-the-go food and brought in the sugar tax. To drive up activity, we are spending £330 million a year on school sport through the PE premium and investing £300 million in new facilities through the youth investment fund. We are also spending £150 million a year on healthy food schemes such as school fruit and vegetables, nursery milk and the Healthy Start scheme.

A top local chef in Ashfield agrees with me that cooking meals from scratch is far cheaper and more nutritious than having processed foods and ready meals. Does my hon. Friend agree that it would be a good idea to start teaching children basic cooking skills in school so that they can enjoy a healthier diet as part of our fight against obesity?

My hon. Friend is totally right. As well as the funding that I mentioned for healthy eating in schools, cooking and nutrition are part of the national curriculum from key stages 1 to 3, which aims to teach children how to cook and apply those principles of healthy eating, but I am sure there is more that we can do together.

The announcement of the Government-backed trial in Wolverhampton to introduce a Better Health: Rewards app is welcome, and I congratulate my hon. Friend the Member for Wolverhampton North East (Jane Stevenson), who has campaigned hard for it. My constituency also suffers from poor health outcomes, including excessive levels of childhood obesity, with one in three year 6 children being overweight or obese. How will the Minister monitor the success of the trial? Will he consider extending it to areas such as West Bromwich East?

The Better Health: Rewards pilot that we are funding in Wolverhampton is very exciting, and more than 10,000 residents have already registered with the app. We will be monitoring the lessons of the pilot closely and looking at how we can apply them more broadly.

For such families it is about not necessarily the right food, but the cheapest food, which means that, in many cases, young children become obese through no fault of their own. What can be done to help families to buy healthier foods on a budget that is often minimal?

The hon. Gentleman is completely correct. As well as the actions that we are taking on healthy eating and obesity, that is exactly why we are spending £55 billion to help households and businesses with their energy bills this winter—one of the biggest packages in Europe. It is also why we have the £900 cost of living payment for 8 million poorer households, we are increasing the national living wage to its highest ever level, and we are spending £26 billion on the cost of living support this year. He is completely right and I commend his work on it.

The Scottish Government aim to halve childhood obesity by 2030, but dealing with the consequences of a poor diet alone is not enough. It is essential to address the underlying causes, such as child poverty. What representations has the Minister made to his Cabinet colleagues about the Department for Work and Pensions and the damaging effects of some of its policies on public health outcomes?

I met the SNP’s public health lead last week and had an excellent conversation with her. As well as the sugar tax, we have introduced calorie labelling; volume and location restrictions on high fat, salt and sugar products, which come in from October; the advertising watershed from 2025; and all those other measures, such as school sport and the youth investment fund. We have done all that because we share exactly those concerns about obesity and we are driving forward work to tackle it.

Waiting Times: Cancer

9. What assessment he has made of the adequacy of waiting times for cancer referrals, diagnosis and treatment. (903912)

More people are coming forward to get checked for cancer. Last year, more than 10,000 urgent GP referrals were made per working day and more than 100,000 patients were diagnosed with cancer at an earlier stage, when it is easier to treat.

I thank the Minister for her answer. In south Cumbria, 27% of people diagnosed with cancer wait more than two months for their first treatment, and in north Cumbria that figure is 44%. Let us imagine how terrifying it is for someone to be told that they have a dangerous disease, but that they may need to wait two months for the first intervention—people are dying needlessly. I draw her attention to the campaign run jointly by the all-party parliamentary group for radiotherapy and the Express, which seeks a £1 billion boost to increase capacity and update technology in radiotherapy. Will she meet me to specifically consider the bid for a radiotherapy satellite unit at the Westmorland General Hospital in Kendal, so that we can cut waiting times and save lives?

As the hon. Gentleman said, if someone suspects that they have cancer, it is extremely worrying for them to have to wait for a diagnosis—or for the all-clear, as happens for the majority of people—or, if they have had their diagnosis, for treatment. That is why we are working hard to speed up access to cancer diagnosis and treatment, and we are looking at all the options to do that. To give him some examples: NHS England is driving ahead to open new community diagnostic centres, 92 of which are already operational; rolling out faecal immunochemical testing for people with possible lower gastrointestinal tract cancer; and rolling out teledermatology to speed up the diagnosis of skin cancer. We are also seeing backlogs coming down.

Ambulance Response Times

We published the urgent and emergency care recovery plan, which set out a number of measures to improve patient flow within hospitals, which has an impact on ambulance performance. In addition, we are purchasing 800 new ambulances, which will be on the road this year.

The Secretary of State will be aware that, in 2007, the last Labour Government closed the accident and emergency at Burnley General Teaching Hospital. When I speak to my constituents about ambulance wait times, the one thing that they always return to is bringing back the A&E at Burnley, which the Labour Government took away. I have raised this issue with Health Ministers since the day I was elected, so will he set out whether it will ever be possible to bring back the A&E that Labour closed? Will he meet me to discuss it?

My hon. Friend is right to highlight the consequences of closures such as that, PFI or other issues that are still felt in communities such as Burnley. He will also know that it is for the integrated care board to look at commissioning decisions and I know that he will make his case powerfully to that board.

The Welsh Labour Government have a service level agreement with the Welsh ambulance service to hand over patients to hospital within 15 minutes. At the Wrexham Maelor Hospital, this target is consistently missed, and a recent handover took eight hours 36 minutes. Does the Secretary of State agree that the Welsh Government need to stop playing the blame game and start working in partnership for the betterment of patients?

My hon. Friend raises an extremely powerful point. It is not only those targets in Wales that are being missed. She will know that people are almost twice as likely to be waiting for treatment in the Labour-run Welsh NHS than they are in England: 21.3% in Wales compared with 12.8% in England. She will also know that the number of two-year waits for operations in Wales, at over 50,000, is considerably higher than that in England, which is below 2,000.

On 30 January, the Secretary of State agreed to meet me and my colleagues who represent the other parts of Shropshire to discuss the particularly acute issues that we have been seeing at our hospitals. That meeting is not in the diary. Will he commit to arranging that as soon as possible, so that we can get these issues addressed?

I apologise to the hon. Lady because she raises a perfectly fair point. I will do all I can to expedite that meeting.

NHS Backlogs: Eye Healthcare

The elective recovery plan sets out how we are tackling backlogs, including in eye care. As well as having over 4,900 more doctors and 11,000 more nurses than last year, we also have 92 community diagnostic centres operational and 89 surgical hubs, and we are boosting capacity in 180 trusts with expanded wards and modular theatres. Two-year waits have been virtually eliminated, and we now aim to eliminate 18-month waits by April.

The backlogs have meant that the number of patients waiting for ophthalmology treatment has increased by 41% in the last three years, and that is over 630,000 people in England. Average waiting times have increased substantially, and the number of patients starting treatment within 18 weeks of referral has dropped to 62%. We know that delays to treatment can and will lead to avoidable sight loss, and we need a plan to tackle the eye care crisis in the NHS. I recently visited the fantastic eye department at St Thomas’s Hospital, which is doing an incredible job in managing this. Will the Minister back my plan for a Bill and visit the brilliant service that it is delivering?

This is exactly why we are investing the extra £8 billion in elective recovery. Ophthalmology 52-week waits are coming down from 42,000 to just under 27,000. But can I pay tribute to the hon. Lady for her passion for this subject? We had a Westminster Hall debate the other day and she had to run to be there—such is her passion—but she made it. I thank her for all her work on this matter.

When my right hon. Friend the Health Secretary joined me at the Queen Elizabeth Hospital in King’s Lynn, he saw the new West Norfolk eye centre, which is enabling an extra 2,000 appointments and 2,000 more injections every year to help to deal with the backlogs. Does that not just demonstrate the difference that new buildings can make to better patient care, but underline the importance of the Queen Elizabeth Hospital being added to the Government’s new hospitals building programme, which I know he is working hard to achieve?

Hormone Replacement Therapy: Cost

12. What steps he is taking to help reduce the cost of hormone replacement therapy for people with menopause symptoms. (903915)

This is a great opportunity to remind the House that, from 1 April, women will be able to apply for an HRT prepayment prescription for less than £20 a year to pay for all their HRT, whether they are on patches, gels or dual hormones.

Although these cost reductions are welcome, England is still the only UK nation not to offer free prescriptions. Instead, the UK Government are penalising those who are experiencing menopause who need these medications to improve their symptoms. Will the Minister not consider following Scotland’s lead and scrap prescription charges to better provide accessible menopause support?

I remind the hon. Lady that about 60% of women in England who are on hormone replacement therapy are already exempt from prescription charges, but we are reducing the cost by hundreds of pounds a year for the remaining women who do pay. We respect the Scottish Government’s decision to provide free prescriptions, but it would cost us in England £651 million a year to provide free paracetamol to millionaires and we do not think that is the best use of taxpayer money.

With International Women’s Day tomorrow, I want to pay tribute to the menopause warriors—all the amazing individual women and organisations who have forced this issue up the agenda, including my hon. Friend the Member for Swansea East (Carolyn Harris). It was her private Member’s Bill that made Ministers finally agree to cut the cost of HRT prescriptions, but questions remain. Will all products that help with menopause symptoms be eligible for the prescription prepayment scheme? What are Ministers doing to end the ongoing and unacceptable shortages in HRT that are causing women such anxiety, and if this issue is such a priority for the Government, why has not the menopause taskforce met since June last year—let me warn the Minister, the warriors do not want to wait?

It is a shame that, on International Women’s Day, the shadow Minister cannot welcome the progress we are making on the menopause. Labour could have done this. We are the first Government to reduce the cost of HRT for women. [Interruption.] The shadow Secretary of State, the hon. Member for Ilford North (Wes Streeting), wants to listen because this is important for women. All licensed HRT products will be available on the prepayment certificate. On the issue of shortages, over 70 products are available to women. Last year, 19 of them were facing a shortage. Thanks to the work of this Government, that is down to five products, and Utrogestan, a product widely used by women, is now back in stock and is being distributed to pharmacies. We are passionate about making HRT more available. There has been a 50% increase in the number of women getting HRT prescriptions. That is a tremendous success for women and we are reducing the cost.

Members: Correspondence

14. When he plans to reply to the letter of 24 January from the right hon. Member for Tatton on non-covid excess deaths. (903917)

In my letter to my right hon. Friend, I noted that it is likely that a combination of factors has contributed to potential excess deaths, including high flu prevalence, ongoing covid-19, and the disruption to the treatment and detection of conditions such as heart disease. But I know she is very thoughtful about this and follows it closely, and I will endeavour to get her more details.

I am pleased my question has now resulted in a response, for which I am grateful. However, from that response, I was none the wiser as to how the Government have explained the non-covid excess deaths we have seen. So can the Minister give us an insight into the reasons for the non-covid excess deaths since the pandemic?

Even if we just take one disease such as cardiovascular disease, there was disruption to screening, to referrals and to treatment from the covid pandemic. It was noted at the time that that would happen and there would be consequences from it, but let me set out in more detail to my right hon. Friend all the exact facts and figures on this, because I know she has been following it closely.

When the Minister dug out the letter from the right hon. Member for Tatton (Esther McVey), I wonder whether he also stumbled upon my letter of 8 February to the Secretary of State about the desperate need for new intensive care investment at Northwick Park Hospital in my constituency, and whether he might expedite a reply on that issue.

Primary Care Staff Numbers

Since March 2019, GPs have recruited over 25,000 staff such as pharmacists, physiotherapists and mental health practitioners, and we are on track to hit our 26,000 additional staff commitment.

As a doctor myself, I will be very happy to see one of those many fantastic professionals the Secretary of State mentioned, including pharmacists and physios, in the primary care setting, but I understand from local GPs that patients do not always have the confidence to do that and 111 is not necessarily directing people to see the wider team. Can we ensure 111 is set up to direct people to different professionals, and can we do something to promote and educate the public on how fantastic that wider healthcare team is in primary care?

My hon. Friend is absolutely right, which is why I commissioned through NHS England a review of 111. It was initially designed for a different purpose. That allows the GP service to be the front door it has become in the NHS. Through the chief executive of Milton Keynes University Hospital, we have done significant work on the NHS app, so it can better enable patients to get to the right place for the care they need.

In January, over 45,000 people in Oxfordshire waited more than two weeks to see their GP and 12,000 waited over a month. The top reason given when I visited surgeries was that they simply cannot recruit the doctors they need. For example, Kennington health centre has been forced to close part time because it cannot find a replacement for a retiring partner. That is clearly unsustainable. Will the Secretary of State consider introducing a weighting for GPs in areas of high cost of living outside London? Will he meet me to discuss the specific issues in Oxfordshire?

The hon. Member is right to highlight the pressure on primary care, which is why, in the answer I gave a moment ago, I said it is also about looking at the wider skills mix within primary care. She mentions doctors specifically. We have 2,200 more doctors in general practice than before the pandemic. It is about having the right skills mix alongside the doctors to meet the significant increased demand since the pandemic.

Demand for GP appointments in Oxfordshire is indeed acute. It is driven in part by the need to continue to treat people with long-term medical conditions. Will my right hon. Friend consider what can be done to rebalance the system, so that instead of dealing with people when they present with acute symptoms, more is done to ensure people can be treated at the primary and community level?

My hon. Friend highlights an absolutely brilliant point, one I am extremely seized of, which is: how do we get detection much sooner, looking at genomics, screening and identifying issues before the patient is even necessarily aware that they have a condition. Early care delivers far better patient outcomes but it is also far cheaper to deliver. That prevention, as he highlights, is extremely important.

The primary care crisis in Plymouth is getting worse, but there is a cross-party solution in Plymouth, which is to build a new super health hub, the Cavell centre, in the city centre. The Government have withdrawn the £41 million funding for that, but the Minister’s predecessor offered to put pressure on Devon’s integrated care board to see what could be funded locally and whether there is a national-local partnership that could deliver this pioneering pilot project, which could really improve healthcare in Plymouth that would be a model for the rest of the country. Will the Secretary of State look at Devon’s ICB and whether he could put pressure on that ICB to fund that pioneering project?

The hon. Gentleman reasonably highlights that the commissioning is a decision for the ICB, but also rightly draws attention to the opportunity to look at different models, for example, how we look across communities at economies of scale, and how we combine that with modern methods of construction to deliver projects far more quickly. I am happy to look, with Devon ICB, at the issue he raises.

I really welcome the increase in patient care staff in GP practices in my constituency, but can I appeal to the Secretary of State to fix the problem with the taxation of GPs’ pensions, which is forcing many into early retirement just when we need their services the most?

My right hon. Friend is a very experienced parliamentarian and will know that issues of tax are a matter for my right hon. Friend the Chancellor, but I draw her attention to “Our plan for patients”, which sets out a package of NHS pension scheme measures.

NHS dentists form a really important part of the primary care workforce. However, in places such as York, we have a complete desert, where my constituents just cannot receive NHS dentistry. What is the Secretary of State going to do for my constituents, so that their oral health needs are addressed?

We will set out to the House in due course a recovery plan to deal in particular with primary care but also dentistry. We recognise that, notwithstanding the fiscal support that was offered to protect dentistry through the pandemic, it is an area of acute interest across the House. The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien), will be saying more on that very shortly.

Cost of Living: Mental Health

21. What recent assessment he has made of the potential impact of the cost of living crisis on long-term trends in levels of mental ill health. (903926)

Last year, £50 million was invested through the promotion of the better mental health fund in 40 local authorities that have the most deprived parts of the country. That is to boost prevention and early intervention and to support those hardest hit by the pandemic and the cost of living.

The Royal College of Psychiatrists in Scotland found that 52% of Scots are concerned about the impact that rising prices are having on their mental health. Poverty is a key driver of poor mental health, and those already struggling with poor mental health and money worries are likely to be the hardest hit. What discussions has the Minister had with her Cabinet colleagues on the consequences of policies, such as the punitive sanctions regime, that are shown to increase anxiety and harm to people’s mental health?

This Government have been supporting people with the cost of living through the £37 billion package, and £15 billion of targeted support for those most in need. That includes £150 of help with council tax, £400 for electricity, the 8 million people supported by the £1,200 payment and paying towards half of people’s energy costs. This Government are serious about helping people with the cost of living at this time.

I welcome the Government’s commitment to tackling mental ill health, in particular the recent funding that we have received in Stafford for a new crisis assessment centre at St George’s Hospital. What further steps are the Government taking to improve access to mental health support, especially in our schools?

I thank my hon. Friend for her hard work securing that funding for the crisis centre in her constituency. These centres make such a difference, because they are based in the community and can intervene at an earlier stage when someone is facing difficulty. They are on top of measures such as our mental health ambulances, which will also respond to people in crisis, and supporting our local communities to deal with mental health as well as those with a mental illness.

Access to Primary Care

We have increased real-terms spending on general practice by more than a fifth since 2015. We are growing the workforce, with 2,200 more doctors and 25,000 extra primary care clinicians compared with 2019. We have the most GPs in training ever, up from 2,600 to 4,000. In January there were 11% more appointments in general practice than in the same month before the pandemic. I pay tribute to the work that general practitioners are doing.

Under the Tories, the number of qualified GPs has fallen to a record low, which is hitting local communities across the UK very hard. In January, in Erdington, Kingstanding and Castle Vale, more than 2,000 people had to wait more than a month for a GP appointment. Is it not the case that the longer the Tories are in power, the longer patients will have to wait?

As well as the 2,200 extra doctors in primary care, I mentioned the 25,000 extra other clinicians. That means that in the hon. Lady’s constituency there are 55% more staff working directly with patients than before.

At a time when GP and A&E services are under pressure, I am pleased to see the ministerial team’s focus on helping people to see a doctor when they need to. Does the Minister agree that walk-in centres, such as ours in Norwich city centre, are helpful, popular and necessary?

My right hon. Friend is absolutely right; walk-in centres are a key part of primary care. We are looking at how they can do more, and I pay tribute to all the work they are already doing.

Topical Questions

On Friday I was proud to announce the winners of the third round of the artificial intelligence in health and care award. Winners included projects within the NHS that identify women at risk of stillbirth, help with neurological conditions, find lung blockages and assess the quality of transplant organs, as well as a number of projects focused on cancer, identifying people’s predisposition and its presence. Since its inception in 2019, the AI in health and care award has invested more than £123 million in 86 promising projects, supporting more than 300,000 patients. AI will come to save countless lives in the NHS in the years to come, and that begins with the investment today.

The Secretary of State should know that I am the co-chair of the all-party parliamentary group for access to medical cannabis under prescription, for children with intractable epilepsy. The situation is as intolerable as ever. Both product supply and cost are causing families great pain, and their children are desperate. I urge the Secretary of State to meet me to discuss convening a roundtable to help identify solutions to the crisis of lack of access. I am still awaiting a response from his Minister from 18 January 2023.

I am very aware of the hon. Lady’s work as chair of the APPG, so I am not surprised that she asks about that important issue, which she has been assiduous in raising. I will flag up the follow-up with my ministerial colleague. I draw the hon. Lady’s attention to the fact that the National Institute for Health and Care Research remains open to research proposals in this area. I encourage her to ensure through her work on the APPG that bids are made to generate the evidence that the clinicians who make decisions on prescribing need.

T6.   Betsi Cadwaladr University Health Board was taken out of special measures in 2020 without any tangible improvements. Last week, the board walked out en masse because it no longer had faith in the Welsh Labour Government. The health service is now back in special measures. The Welsh Government run the NHS in Wales, so if the First Minister of Wales were to ask, would the UK Government step in to support them? (903933)

We are always happy to assist colleagues across the United Kingdom as part of our commitment to the Union. My hon. Friend is right to highlight current performance in Wales. As I have said, patients are waiting twice as long for hospital treatment in Wales as in England, and more than 50,000 people in Wales are waiting for more than two years for their operation.

When nurses and paramedics voted to take strike action, the Secretary of State refused to negotiate and said that the pay review body’s decision was final. He has now U-turned, but not before 144,000 operations and appointments were cancelled through his incompetence. Will he now apologise to patients for this avoidable disruption?

What the hon. Gentleman omits to remind the House is that at the time the demand from trade unions was for a 19% consolidated pay rise, which is very different from the basis on which talks have been entered into. The point is that we are in discussions with trade union colleagues. Trade unions and the Government have a shared purpose—to address the very real challenges that we recognise the NHS workforce have faced, particularly in the context of the pandemic—and a shared desire, which is to focus on patients and ensure that they get the right care to support them.

I think patients know who to trust, and it is nurses, not the Secretary of State. The Government have still learned nothing: despite a 98% vote in favour of strikes, the Secretary of State was sent to meet junior doctors without a mandate from the Prime Minister to negotiate. What is the point of this Health Secretary if he is in office but not in charge?

I have come to the House literally from a meeting with the trade unions: I met the NHS Staff Council this morning. Once again, hon. Members on the Opposition Front Bench are writing their questions before they see what is actually happening.

T8. Sean Lynk, aged 30, in Ashfield, took his own life just before Christmas. No one saw it coming. Male suicide takes the lives of 12 young men every day in this country. It is the biggest killer of young males under the age of 40. Sean’s father Graham is coming next week to watch me speak in a Westminster Hall debate on male suicide, so could somebody from the Health team please meet Graham and me next Monday? (903935)

I thank my hon. Friend for raising this important issue. We are launching a prevention of suicide strategy, and male suicide will be a particular focus, as it is a high-risk group. The debate next week will be answered by a Minister in the Department for Education, because it relates specifically to the national curriculum, but I am very happy to meet my hon. Friend and his constituent.

Unprotected sun exposure causes skin cancer, and some 16,000 cases are diagnosed each year. Affordable sunscreen is therefore essential for protection. Will the Secretary of State help to tackle the issue by supporting the Sun Protection Products (Value Added Tax) Bill, a ten-minute rule Bill promoted by my hon. Friend the Member for East Dunbartonshire (Amy Callaghan) that would remove VAT on sun protection products?

Sun exposure is one of the most significant causes of cancer. That is one reason why we are working so hard with the NHS to reduce backlogs for people who are waiting for cancer diagnosis and treatment, including by rolling out teledermatology across the NHS to reduce diagnosis times. However, the hon. Gentleman’s question about VAT and skin cancer is a matter for the Treasury.

T9. Finding and fixing the underlying causes of health inequalities has defeated Governments of all types for decades. Less well-off British families still live significantly shorter, sicker lives than richer families, cramping their life chances and making it harder to avoid or escape poverty. The long-expected health inequalities White Paper is essential to changing that. Does the Secretary of State expect it to be published this month? If not, will he meet me to discuss it? (903936)

As we heard earlier from the Parliamentary Under-Secretary of State, my hon. Friend the Member for Harborough (Neil O’Brien), the major conditions strategy report will deal with those issues. However, it is also important to consider the variation in performance between integrated care boards and how we can raise the bottom quartile to the level of the top quartile—there is far too much variation within the NHS—and to be data-driven, so that when it comes to genomics and screening we can target the outliers more precisely. That is what is behind the issue to which my hon. Friend has rightly drawn attention.

T2. Will the 10-year cancer plan feature the distinctive approach that is required in relation to the early diagnosis of brain tumours? (903929)

Cancer will be a substantial part of the major conditions strategy. We will be looking at the major causes of ill health in the country, of which cancer is, of course, one. Part of that will involve ensuring that we are good at diagnosing cancer, because the earlier it is diagnosed, the more treatable it is, and hence the better the outcomes for people with cancer will be.

I welcome today’s announcement of the appointment of Professor Deanfield as the Government’s prevention champion with a focus on cardiovascular disease, one of the main causes of which is, of course, smoking. May I ask where we are with an updated tobacco control plan, and whether the Minister will look again at the introduction of a “smoke-free fund” paid for by the tobacco industry to boost those new public health budgets?

We will be setting out our next steps on smoking shortly, but we already have the lowest smoking level on record: it has fallen to 13%, partly as a result of the doubling of duty on cigarettes and partly owing to the introduction of a minimum excise tax. We will be investing £35 million in the NHS this year to ensure that all smokers who are admitted to hospital are given NHS-funded tobacco treatment.

T3. Recent analysis from Macmillan Cancer Support shows that 2022 was the worst year on record for cancer waiting times. Will the Minister consider the introduction of an urgent support package for UK cancer services in the upcoming Budget to support our hard-working staff and to ensure that there is additional capacity to deal with the current pressures on the system? (903930)

It is indeed a worrying experience for people to be waiting to know whether they have cancer or, having received a diagnosis, to be waiting for treatment. However, I can assure the hon. Gentleman that more people are currently coming forward for cancer checks, more people are being treated for cancer, and the NHS is reducing some of the backlogs following the pandemic.

I welcome the Government’s actions to deal with obesity, but it remains an increasing health issue for our nation. Does my right hon. Friend agree that educating children and parents about healthy eating should be a top priority—

My right hon. Friend’s question was so good that I was eager to answer it early. He is right to highlight this issue, which is being dealt with as part of a wider thrust within Government work on prevention, which is how we can empower the patient. That means getting more data to patients and using genomics and screening to ensure that they are better informed and can therefore opt to take decisions on healthy eating, rather than the state trying to impose those decisions on them in a top-down manner.

T4. I chair the all-party parliamentary group on osteoporosis and bone health. Our recent report, supported by the Royal Osteoporosis Society, showed that an investment of just £27 million pounds a year in fracture liaison services would deliver more than £600 million pounds of savings for the NHS over five years. Will the Minister meet me and the ROS to discuss our report, and will he commit himself to ending the postcode lottery by providing 100% coverage for FLS for over-50s in England? (903931)

I am happy for a member of the ministerial team to meet the hon. Lady, who has made a compelling case about the return on investment. We will obviously need to scrutinise it in more detail, and I am sure that my colleagues will look forward to doing so.

The Secretary of State is aware of Medway’s case for being part of the Government’s hospital building programme. It was the hardest-hit area during covid-19, and it has some of the greatest health inequalities in the country, and one of the busiest accident and emergency units in Kent. Will the Secretary of State visit Medway with me to witness our urgent need, so that we can be part of that hospital building programme for the future?

My hon. Friend is right to highlight the issues in Medway and those in Kent as a whole. When I met the chief executive of Maidstone Hospital yesterday, we discussed some of the innovation that it has introduced and the benefits of that innovation across the board. As for the new hospitals programme, I remind my hon. Friend of the comments made by my right hon. Friend the Prime Minister on 22 February, when he confirmed the Government’s commitment to that programme.

T5. Every day, the families of women who took the drug Primodos in the 1960s and ’70s continue to suffer the consequences of a lifetime of disability. Baroness Cumberlege’s review made it clear that Primodos caused avoidable harm and that the families should be given redress, so why have the Government recently refused three mediation requests on behalf of those families? (903932)

The hon. Gentleman will know that we have huge sympathy for those affected by Primodos. He will also know that there is a legal case at the moment so I am unable comment at this time, but I am happy to discuss it with him further.

Over the past year or so, Bedfordshire’s fire service and ambulance service have taken innovative steps to co-operate to bring response times down. They are now working on a plan to deepen that co-operation. Will my right hon. Friend facilitate a meeting with the leaders of the fire service and ambulance service in due course when that plan is ready?

My hon. Friend is right to highlight the community services that we are doing as part of our urgent and emergency recovery plan, looking at how we deliver care quicker through innovative models. One of those involves better co-operation with the fire service.

T7. York and Chester have many similarities, and it would appear that a complete absence of any access to dental services is another one. Can I impress on the Minister the urgency of improving access to NHS dentistry, because it is essential that my constituents do not have to travel for miles and worry for months? (903934)

We will be setting out further steps shortly, but there are 6.5% more dentists doing work for the NHS than in 2010 and we have started the reforms with more units of dental activity bands and a minimum UDA.

Does my right hon. Friend accept that about one third of the activity that takes place in GP surgeries could be transferred to pharmacies? What is he doing to promote that policy and deal with the British Medical Association’s reluctance to co-operate?

My hon. Friend is right to highlight the fact that a number of services that GPs currently offer could be performed by pharmacists, and we are looking at that in the context of the primary care recovery plan. This is also about looking at how we can relieve some of the workload pressure within primary care, and that is why we have recruited 25,000 additional staff to support GPs. It is also why we have over 2,000 more doctors in primary care.

T10. Some 30% of disabled people, including many of my constituents, are having to cut back on using essential medical equipment at home due to rising energy bills. Some 70,000 people have signed the charity Sense’s petition calling for long-term ongoing support for disabled people and their families. Will the Secretary of State deliver that support as a matter of urgency? (903937)

That is exactly why we are spending £55 billion this winter to help households and businesses with their energy bills. That is one of the largest support packages in Europe.

Does my right hon. Friend agree that community-based drop-in mental health services such as the Link centres in North Devon are vital to remote rural communities? Will he urge Devon County Council not only to continue those services but to improve and extend the model?

It is for schemes such as those that my hon. Friend highlights that we are investing a further £2.3 billion a year in mental health services, and that in turn is facilitating an extra 2 million patients accessing NHS-funded mental health support.

More than £300 million of the NHS dentistry budget is set to be clawed back by NHS England at the end of this month. That is not because of a lack of demand; it is because the Government’s NHS dental contract is broken and dentists are walking away from NHS work. Will the Government ringfence these funds, rolled over to next year, so that people who desperately need dental treatment can get those appointments?

That is exactly why we will continue to reform the contract as the hon. Lady suggests, and it is why we have started allowing dentists to do 110% of their UDAs, but she is right and we will go further.

I refer the House to my entry in the Register of Members’ Financial Interests, including my co-chairing of the all-party parliamentary group for hospice and end of life care. Now that integrated care boards have a duty to commission palliative care, what steps is my right hon. Friend taking to assess delivery? Will he join me in calling for the North East and North Cumbria ICB to listen to the hospices in the Tees Valley, which would save our hospices and save the NHS money?

My hon. Friend is right to draw the House’s attention to the extremely important work of hospices and to the fact that commissioning decisions are devolved to the integrated care boards so that they can target funding in the way that best serves local communities. He is quite right to lobby on their behalf and I am sure that his relevant ICB will take note of that.

Before we come to the statement on the Illegal Migration Bill, I wish to make a brief statement.

I am aware that there are a number of cases before the courts that relate to the subject matter of the Bill. Given the national importance of the issues to be discussed, I am prepared to exercise a waiver and allow brief references to those cases. However, I would ask Members to exercise caution and not to refer in detail to issues that are being considered by the courts.