Health and Care Bill (Twenty First sitting)
(Limited Text - Ministerial Extracts only)
Read Full debateThursday 28th October 2021
(3 years ago)
Public Bill CommitteesHealth and Care Act 2022 View all Health and Care Act 2022 Debates Read Hansard Text Amendment Paper: Public Bill Committee Amendments as at 28 October 2021 - (28 Oct 2021)
The Committee divided: - Ayes: 6 / Noes: 7 - Question accordingly negatived.
Alex Norris (Nottingham North) (Lab/Co-op)
I beg to move, That the clause be read a Second time.
It is a pleasure to resume our consideration with you in the Chair, Ms Elliott. The new clause is in my name and those of my colleagues. If we think about the pandemic and the last 18 months, we will have various views on all sorts of things that have gone on during that period, but I think that one thing that we would be of one mind on is how well our nation’s directors of public health have performed in this crisis. They have been incredible, pulling together the local response and bringing to bear their unique combination of training, relationships and local soft power in order to ensure that the local approaches to dealing with the pandemic in aid of the community have been strong ones. I think we would all say that they have done absolutely superbly.
The new clause seeks to codify a little more formally the place of directors of public health in the system. As we are authoring a new system in the Bill, this is no bad time to do that. The purpose of the new clause is to clarify the roles, powers and duties of directors of public health and to put them on a statutory footing. Whatever structures DPHs sit within, their major role—the reason why as a country we need them and why we invest in them as we do—is that they act as an independent advocate for the health of the population, for system leadership and for the improvement of the system for the population. They are already responsible within their area for a broad range of things, such as measurable health improvement, health protection, public health input, planning, commissioning, reducing inequalities and more. There is a strong reason to put them on a statutory footing. They of course provide an independent advisory function for a wide range of organisations, including the NHS. My local DPH is very good indeed. She often reminds colleagues that she is the system’s DPH rather than just the local authority’s. She may well be hosted by the local authority, but her remit goes much broader, and that is a very good thing. Putting DPHs on a statutory footing would recognise the system leadership role that they have.
The new clause would use a corporation sole model to ensure that directors of public health have scope for independent action; it would ensure that special arrangements are made for them, as officers of the Crown, to bring certain things to the attention of the Attorney General and the chief medical officer, and to ensure public health representation on NHS managing, regulating or commissioning bodies where necessary; and it would guarantee their professional independence in these wider functions. In the vast majority of cases across the country, most of these functions and roles are operating very well indeed, but the new clause would give statutory underpinning to that.
Together, these changes would allow DPHs to have influence across the entire place that they work for and across all policy areas, including budgetary and allocative decisions, and ensure that they have a chance to play their part across all decisions being made in the local community that impact on public health. This proposal would hardwire links between DPHs and the NHS public health workforce who enact public health policy. For place-based officials, having strong links with local and regional NHS employees is not only a benefit but a necessity. It would help to strengthen our response to health inequalities and hence the prevention of ill health—we have spoken at length about that during these proceedings—as well as enhancing relationships for emergencies, which we have seen in recent months.
Where this is done best, it is a strong model. I know that some directors of public health have consultants within their local NHS trust. That is something that the Association of Directors of Public Health is very keen on. If the Bill and the direction of travel are about an integrated system, those kinds of integrators are a very good model of doing that.
These are critical roles. We have seen that in challenging times, but in more general times, as we push on in order to have a healthcare system that is more preventive, that closes inequality gaps and which delivers excellent services to our population, directors of public health will be really key players in it, so I hope that this attempt to put them on a slightly stronger and more consistent footing will be welcome.
The Minister for Health (Edward Argar)
It is a pleasure to see you in the Chair once again, Ms Elliott.
My understanding, in the light of what the shadow Minister has said, is that one of the underlying aims of the new clause is to ensure that the public’s health is at the fore as we reform the health and care system. I have the utmost sympathy with that an aim
The Government recognise the importance of a robust public health system that works to improve the health and wellbeing of the nation and to prevent disease. That is why we have taken decisive steps to reshape our national public health bodies so that we are well equipped to face future challenges. Furthermore, we agree that directors of public health and their teams should have a crucial role at the heart of the new system.
The shadow Minister is absolutely right to say that although directors of public health are hosted by local authorities, they represent the whole system, and we owe them a debt of gratitude. In our past lives, he and I would have worked with DPHs in our local authority contexts, and of course, as Members of Parliament, we have all seen what our local DPHs have had to do over the past year and a half. I suspect that Members who did not know their local DPH have probably got to know them and their work in the community a lot better, which is no bad thing.
This fits naturally with the strategic emphasis on population health that we expect of integrated care systems. Both the Department of Health and Social Care and NHS England have set out in published policy and guidance documents our expectation of directors of public health having an “official role” in integrated care systems. Officials in the Department are working closely with the Association of Directors of Public Health and others to help describe further the place of these roles, the outcomes that we hope collectively to achieve, and the ways in which they can best add value to the system’s impact on health overall.
Although we entirely understand the motivation behind the new clause, I am not sure that it is strictly necessary. It seeks to clarify the roles, powers and duties of DPHs, but their roles and responsibilities are already clearly and accurately set out in legislation and current guidance. The requirement for the recruitment to the role of director of public health, for example, is already clear on professional qualifications, and the registration and regulation requirements are clearly laid out. The new clause may have the effect of reducing the flexibility of the post, although I am sure that the shadow Minister would say that that concern is unfounded.
Furthermore, the current system already provides independence and influence for directors of public health, and that is strengthened by several provisions in the Bill, which includes, for instance, a duty on ICBs to seek advice from persons with the appropriate expertise on prevention and public health, including directors of public health, complementing the existing duty, in the section 6C regulations of the National Health Service Act 2006, for local authorities to provide the NHS with public health advice.
Additionally, we do not believe it necessary to make directors of public health officers of the NHS, as the Bill already provides opportunities for DPHs to link into and influence NHS bodies in their current guise. Integrated care partnerships, for instance, must develop an integrated care strategy to which integrated care boards must have regard in drawing up their commissioning plans. The intended result is to create a plan to meet the health—including public health—and social care needs of the population within their defined geography. That will provide directors of public health with the opportunity to influence NHS commissioning plans to meet wider public health aims.
It is also possible that the new clause would create a number of undesirable consequences—I suspect that the shadow Minister will allay some of those fears in his response. Rather than bringing clarity, the new clause could create confusion and complexity in a system that is already functioning effectively with a clear understanding of the role and how it operates.
The new clause would put a host of prescriptive new requirements on DPHs, including a requirement for them to be officers of the NHS, NHS consultants in public health, and officers of the Crown, while retaining independence of thought and action.
While we certainly understand the motivation of wanting to knit together the system through an individual post, that approach would add a layer of complexity. I believe that it would be challenging for an individual holding that office to seek to balance those complex responsibilities, accountabilities and potentially competing priorities within various organisations. That would also complicate the lines of accountability
My concern is that the new clause is overly prescriptive about the status and nature of the role, which would go against the overall aims of the Bill in terms of permissiveness. Although we hope and expect that directors of public health will act as a nexus for bringing coherence to the local system’s focus on population health, we are not convinced that this level of prescription over permissiveness is appropriate. That reflects a thread of the debate throughout the passage of the legislation on where the appropriate balance should be struck.
Proposed new paragraphs (e) and (h) would weaken the ties that directors of public health have with local authorities. Since the 2012 reforms, there has been widespread consensus that local authorities are best equipped to deal with a wider range of public health matters for their population’s needs. In that context, I pay tribute to local authorities for their role in tackling the pandemic, including those in elected roles. If I recall correctly, the wife and partner of the shadow Minister, the hon. Member for Ellesmere Port and Neston, is active as an elected councillor in a local authority. Many Members of this House will have served in that role, too, and will recognise what local authority councillors and officers do in that space.
From their home in local government, DPHs have been able to maintain an independent mindset while playing a critical role in improving and protecting the public’s health. Although it may well evolve in future, that system is working, and we have a strong and solid base that is understood by all system players. I therefore encourage the shadow Minister to continue to work with me and others to make that system work, rather than seeking to press the new clause to a Division.
Alex Norris
I certainly did not intend to add complexity; I was hoping for clarity and consistency. Nevertheless, as the Minister says, those roles are currently functioning effectively, so I will not divide the Committee.
I would say to the Minister and his colleagues, however, that we need a real watching brief on this matter, because assuming that the Bill continues its onward journey and establishes those ICS footprints, there will be a range of different outcomes and organisational cultures. The stronger systems will be those in which the DPHs are at the heart of insight and decision making, and the reverse will be a defining characteristic in systems that are not as good. I certainly hope that we consider the Care Quality Commission reviews that were included in an earlier new clause, and any sector-led improvement, as well as the work those systems do to reflect on what they do and do not do well.
One of the criteria for both streams of improvement ought to be what the DPH does, how central they are, and how sighted they are on decision making. As I have said, in good systems that will be good, and in weak systems it will be weak. Those criteria would be a bellwether of how good the local ICS footprint is. I beg to ask leave to withdraw the motion.
Clause, by leave, withdrawn.
New Clause 45
Duty on integrated care boards to have regard to net zero commitment
“(1) The National Health Service Act 2006 is amended as follows.
(2) After section 14Z43 (inserted by section 19 of this Act) insert—
“14Z43 Duty to have regard to net zero commitment
When procuring or commissioning goods and services on behalf of the NHS, integrated care boards must have regard to NHS England’s commitment to reach net zero by 2040.””—(Justin Madders.)
This new clause would place a duty on integrated care boards to have regard to NHS England’s commitment to reach net zero by 2040.
Brought up, and read the First time.
Edward Argar
There is no doubt that the climate emergency is also a health emergency. Climate change threatens the foundations of good health, with direct and immediate consequences for our patients, the public and the NHS.
The NHS accounts for around 4% to 5% of UK emissions, and the hon. Member for Ellesmere Port and Neston is right to highlight the critical role the NHS has to play in achieving net zero. Although I have some sympathy with the intention of the new clause, I remind the Committee of the commitment. The commitment to be net zero by 2040 applies only to NHS direct emissions, such as those from building energy and does not apply to supply chain emissions that are the target of the new clause. While ICBs should and will consider the environmental impact of their procurement, that consideration must go wider than the commitment made by NHS England to net zero direct NHS emissions.
To support that work, NHS England is already leading the way on the agenda through a dedicated programme of work, which includes ambitious targets for achieving net zero for the NHS carbon footprint plus by 2045 and for its direct emissions by 2040. We fully welcome and endorse those ambitions. As part of that programme of work, under the 2021-22 NHS standard contract, every trust is expected to have a green plan. As NHS England has made clear in its guidance on green plans, published in June 2021:
“Every trust and every ICS is expected to have a Green Plan approved by that organisation’s board or governing body. For trusts, these should be finalised and submitted to ICSs by 14 January 2022. Each ICS is then asked to develop a consolidated system-wide Green Plan by 31 March 2022, to be peer reviewed regionally and subsequently published.”
On the question of procurement, the NHS is already publicly committed to purchasing only from suppliers who are aligned with its net zero ambitions by 2030. Earlier this year, NHS England set its road map giving further details on the expectations of suppliers to 2030. That work is supported by a broad range of additional action on NHS net zero. NHS England will publish the world’s first net zero health building standard; it will apply to all projects being taken forward through the Government’s new hospital programme, which will see 48 new hospitals built across England by 2030—I can almost see the slightly cynical smile through the hon. Gentleman’s mask.
I know the shadow Minister will argue that the new clause would give impetus to the NHS to move towards net zero in the work it is already doing. I am afraid I am not convinced that it is necessary, given the substantial work already under way. The NHS is already showing its commitment, backed up by clear plans.
Justin Madders
I wonder whether the Minister’s nickname in the Department is Steady Eddie, given his consistent responses to many of my new clauses and amendments—consistent, but not always correct. It is very important that the commitment is delivered. We are clearly going to have a disagreement about the best legislative framework in which to do that, but I am not going to push this to a vote. It is clearly an issue that all Members are very keen to see delivered.
I am sure that we will debate the new build programme on a number of other occasions—we may get beyond how many new hospitals it is and on to some of the wider issues. It is a matter we will come back to on a number of occasions.
I beg to ask leave to withdraw the clause.
Clause, by leave, withdrawn.
New Clause 46
Exclusion of NHS bodies from ability to withhold information requested under the Freedom of Information Act 2000 on commercial grounds
“(1) Section 43 of the Freedom of Information Act 2000 is amended as follows.
(2) After subsection (3), insert—
‘(4) Subsection (2) does not apply to information held by NHS England, integrated care boards, NHS Trusts and NHS Foundation Trusts except to the extent that subsection (5) applies.
(5) Subsection (2) applies to information held by NHS England, integrated care trusts, NHS Trusts and NHS Foundation Trusts relating to another organisation if disclosure of the information would in the opinion of the organisation pose a real and significant risk to the commercial interests of that organisation.’” —(Justin Madders.)
This new clause would prevent NHS bodies from withholding information on commercial grounds unless the information related to another organisation and that organisation considered that its disclosure would pose a real and significant risk to the commercial interests of that organisation.
Brought up, and read the First time.
Edward Argar
I can reassure the shadow Minister, the hon. Member for Ellesmere Port and Neston, that I am not aware of how many FOIs he tables, which is possibly as it should be; it suggests that they are handled in the appropriate way by officials, and not by me. I am sure he keeps officials busy with those requests.
I think we can all agree that transparency and openness are of key importance but—this is where the hon. Gentleman and I may diverge slightly in our views—it is also vital that genuinely commercially sensitive information is adequately protected. Section 43 of the Freedom of Information Act recognises the balance that needs to be struck. It exempts from disclosure any information that would, or would be likely to, prejudice the commercial interests of any person, including the public authority holding the information. It is, however, as he will be aware, a qualified exemption. Merely identifying that the information is commercially sensitive is not enough. The public authority holding the information must weigh up the “genuine public interest” arguments in favour of and against disclosure.
I remind the Committee that there is a robust system in place for testing such decisions. We have an independent commissioner who can scrutinise the decisions, who has the right to see the information in question and who is more than capable of challenging public authorities where he believes that disclosure is in the public interest. Beyond that, of course, those requesting the information have a right of appeal to the tribunal.
There genuinely needs to be a level playing field between public and private contractors, but the new clause would, I fear, place NHS bodies at a disadvantage in some commercial negotiations. It could mean that the NHS was not able to protect its commercially sensitive information, whereas other parties could. I struggle to see how an uneven playing field would benefit the general public and protect taxpayers’ money. I fear that the new clause would also place a significant additional burden on NHS bodies at a time of real strain and, as I have highlighted, there are already remedies in place that meet its stated aim.
I am also concerned about the power the new clause could place in the hands of those conducting commercial negotiations with the NHS. It would be for them, not the public authority, to decide if and when the release of information would pose a real and significant threat. It is difficult to see how the opinion of the organisation could be tested or challenged through the usual route of appeal, as they would not be a public authority within the scope of the Act. The Information Commissioner’s Office would be assessing an NHS body on the basis of judgments reached by a third party. I also point out that
“pose a real and significant risk”
is not a test used elsewhere in the Freedom of Information Act, and so could be open to novel interpretation by the originator of the material. For those reasons, I do not think that the new clause would achieve in a fair way what the hon. Gentleman seeks.
Justin Madders
I am relieved to hear that the Minister is not personally dealing with my FOI requests. I know he is very busy dealing with all the foundation trust applications in his in-tray. He made some fair points about ways in which the new clause might cause unintended consequences, but we wanted to put on record our concern about the way the Freedom of Information Act has been used by some trusts to avoid proper scrutiny. As my hon. Friend the Member for Bristol South said, this is unfortunately part of a pattern in patient safety issues, and that is obviously something we have discussed in this Committee. I will not put the new clause to a vote, and I beg to ask leave to withdraw it.
Clause, by leave, withdrawn.
New Clause 49
Protection of the title of “nurse”
“(1) A person may not practise or carry on business under any name, style or title containing the word “nurse” unless that person is registered with the Nursing and Midwifery Council and entered in sub part 1 or 2 of the register as a Registered Nurse or in the specialist community public health nursing part of the register.
(2) Subsection (1) does not prevent any use of the designation ‘veterinary nurse’, ‘dental nurse’ (for which see section 36K of the Dentists Act 1984) or ‘nursery nurse’.
(3) A person who contravenes subsection (1) is guilty of an offence and liable on summary conviction to a fine not exceeding level four on the standard scale.”—(Justin Madders.)
Brought up, and read the First time.
Dr Philippa Whitford (Central Ayrshire) (SNP)
I rise to support what the shadow Minister said. It has indeed been an area of contention for many years not only that nurses who have been struck off can use the title but that the title is used loosely. We touched on the same issue when we talked about regulation and about aesthetic procedures: when these titles of doctor, and particularly nurse, are used the public have a perception of what that means. They assume it means a registered and regulated practitioner, and therefore the patient is given far too high a degree of trust in the person simply from the use of that title. It should be a protected title.
Edward Argar
As has been set out, the new clause would protect the title of nurse by making it an offence for a person to use that title unless they were registered with the Nursing and Midwifery Council. I entirely understand the intention behind that; as the shadow Minister and the SNP spokesperson have set out, a title such as that comes at any time, but particularly after the past year and a half, with an expectation of the qualifications and duty of care that sit behind it, and brings with it trust. Therefore, it is extremely important that that trust is not in any way abused. I am sympathetic to the intent behind the new clause; I know it is something my constituency neighbour the shadow Secretary of State, the right hon. Member for Leicester South (Jonathan Ashworth), has also spoken about in recent weeks.
The title of registered nurse is protected in law but, as the hon. Member for Ellesmere Port and Neston rightly says, the title of nurse itself is not, given its use across multiple professions, including dental nurses, school nurses, veterinary nurses and so on. As the interim chief nursing officer for Scotland has pointed out, the impact of any change on other groups currently using the title of nurse outside healthcare settings would need to be carefully considered. Quite rightly, the interim CNO said that there is an issue, but it needs to be carefully considered and calibrated.
I am sympathetic to the principle that protection of the title of nurse would be seen as a positive step by the profession, stakeholders and the public. I am also aware of concerns about the potential for confusion in this regard, as highlighted by the petition brought forward by Alison Leary, and I can see the benefit in providing reassurance and clarity to patients and professionals. Given the complexities inherent in making “nurse” a protected title, we need to do further work and gather further evidence to better understand the case for change and the potential impact on some of those other perfectly legitimate professions that use the title.
Dr Whitford
I recognise that the term is also used as highlighted—for example, “nursery nurse”. However, veterinary nurses and dental nurses are registered professionals, and therefore that is outwith the group we are talking about. I can see that there needs to be discussion around the more social “nursery nurse”. School nurses are also nurses.
Edward Argar
They are, but my point was the difference between registered nurses and just using the title “nurse”. The question is how, in legal terms, we catch that. I accept the hon. Lady’s point that they are all registered nurses. However, we have to make sure that, in drafting, the legislation would not inadvertently catch people who may well be perfectly legitimately registered, as she says, but could potentially be caught if we did not draft or consider the measure carefully.
Dr Whitford
I recognise the importance of drafting, but obviously the new clause is seeking to establish that the title “nurse” could be used only by nurses registered with the NMC, dental nurses and veterinary nurses—so that it could not just be used as a title by someone who is not on the register.
Edward Argar
I go back to the point I made: there are some perfectly legitimate professions—where there is an expectation and understanding of what they do and a respect for what they do—who use that title, as she alluded to. That is why we have to think a little more carefully about how we might do that, and whether it is the most effective way of assuring and enhancing patient safety.
Protection of title is only one part of the protection regime; it is important, of course, but there are other parts. We should also look at prosecutions of protection of title offences, which are extremely rare; we need to look at that in the context of how that might be enforced. Part of the reason for that is the availability of offences such as fraud by false representation that carry more substantial penalties including custodial sentences, which, I suspect, are sometimes the mechanism used to prosecute in such cases. Depending on the context in which the title is used, other legal action could be taken against a person, including criminal proceedings, civil proceedings and employment disciplinary proceedings, particularly where the person used the title to gain work or employment. There is also the opportunity to prosecute employers who hold their staff out to be regulated healthcare professionals when they are not.
To give some succour to the hon. Member for Ellesmere Port and Neston, we are committed to reviewing the protection of titles as part of the ongoing Government review of the regulation of healthcare professionals.
Edward Argar
Just one more sentence, then I will give way to the hon. Gentleman before I sit down.
We need to gather further evidence to better understand the case for change and whether it represents the most effective and enforceable way to promote patient safety. However, I will certainly carefully consider the proposals he has put forward, in that context, as will my colleagues. I have a few sentences left, so I will give way while I can.
Justin Madders
The Minister is sympathetic and has highlighted why the issue needs careful consideration throughout the debate. Are we able to get a formal commitment to public consultation on the issue from the Minister today?
Edward Argar
The shadow Minister pushes me a little further than I can go today. However, what I can say is that I have considerable sympathy with what he has said. I will undertake to look at what he and the right hon. Member for Leicester South have said in the context of that review.
Any subsequent change from that review and from consideration thereof probably sits most effectively, in terms of legislative reform, as part of the reform programme for the Nursing and Midwifery Council, which is most effectively taken forward via secondary legislation under section 60 of the Health Act 1999. In the context of that review, and any secondary legislation flowing from it under section 60, we will look at what he set out in his new clause.
Justin Madders
I am grateful to the Minister for his positive comments. We were probably pushing our luck with getting a formal commitment from him, but it sounds like we are probably as close as we are going to get to progress on the matter without pushing the new clause formally to a vote. We will keep a close eye on the issue and will, no doubt, come back to it if progress is not made in orderly time. I beg to ask leave to withdraw the clause.
Clause, by leave, withdrawn.
New Clause 50
Access to innovative medicines and medicinal products review
“(1) The Secretary of State must undertake and publish a review of the use by the NHS of innovative medicines and medicinal products.
(2) The review must—
(a) conclude before 31 December 2022;
(b) consider ways to improve the use of innovative medicines and medicinal products within the NHS in England.
(3) The review may consider—
(a) the creation of a specific pathway to assess medicines and medicinal products for rare and less common conditions;
(b) improvements to the way in which patient and clinical experience is accommodated when considering the adoption of new medicines and medicinal products.”—(Alex Norris.)
This new clause would require the Secretary of State to carry out a review of the assessment and use of innovative medicines and medicinal products, and to consider how to improve access to medicines and medicinal products for people with rare and less common conditions in particular.
Brought up, and read the First time.
Edward Argar
I am grateful to the shadow Minister for this discussion. I reassure members of the Committee that the Government remain absolutely committed to ensuring that UK patients, including those with rare diseases and less common conditions, have access to the most promising medicines and medicinal products. Hon. Members raised some important points, which I will seek to address in my broader response to the new clause.
The first part of the new clause asks the Secretary of State to undertake and publish a review of the use by the NHS of innovative medicines and medicinal products. We have existing reporting tools at our disposal to monitor that. Indeed, NHS Digital publishes a bi-annual report on the use of innovative medicines by the NHS in England, known as the innovation scorecard. The latest publication from June 2021 shows that uptake of over 70% of the NICE-approved medicines reported in the scorecard has increased over the past 12 months. I can assure the Committee that we are committed to further strengthening these innovation metrics and to improving our understanding of the use of innovative medicines and medicinal products in the NHS.
The accelerated access collaborative—the umbrella organisation overseeing the health ecosystem—is also continuing to develop the AAC scorecard that monitors the impact of the programmes, and is scoping the development of an overarching innovation metric.
In the second part of the proposed new clause we seek a review to consider ways to improve the use of innovative medicines and medicinal products in the NHS in England. As I am sure right hon. and hon. Members will be aware, the accelerated access review, an independent review published in 2016, set out detailed recommendations to increase the uptake of proven and cost-effective new treatments and technologies in the NHS. The report identified several strategic barriers to UK health innovation, including fragmentation across the system, alongside a lack of horizon scanning and insufficient commercial flexibility in NHS England.
Following publication of the AAR, the Government, the NHS and partner organisations have worked closely together to increase the use of proven and cost-effective medicines. The Government established the accelerated access collaborative to bring together leaders from across the life sciences sector to tackle the barriers to the adoption of innovations in the NHS. It is delivering real success. Last year alone it helped over 300,000 patients to access proven innovations, resulting in 17,000 fewer hospital admissions and 140,000 fewer days spent in hospital, delivering more than £100 million of savings for the NHS. That is thanks to AAC programmes, such as the rapid uptake products programme, which offers bespoke support to NICE-approved innovations to address the systemic barriers that inhibit their widespread use across the NHS, and the early-stage support programme, which supports categories of new, potentially highly effective products that need support through the regulatory and approvals process.
However, the Government acknowledge that there is more we need to do to tackle unwarranted variation in the uptake of clinically proven and cost-effective treatments. This is why we recently published our ambitious life sciences vision, which was co-developed with industry following extensive engagement with stakeholders from charities, patient interest groups, the NHS and the devolved Administrations. The vision lays out our priorities to improve the use of cost-effective innovation, including new medicines and medicinal products within the NHS, with a particular focus on identifying and addressing any unwarranted variation in uptake. The AAC will continue to be at the forefront of that agenda, and work is under way to consider how to best utilise regional, local and frontline delivery partners to support the adoption and spread of proven innovations.
It is important to note that there are already mechanisms in place to assess and support medicinal products for rare and less common conditions. The innovative licensing and access pathway—ILAP—brings together the Medicines and Healthcare products Regulatory Agency, the National Institute for Health and Care Excellence, the NHS and the devolved Administrations to provide tailored, joined-up regulatory and access guidance to businesses. The scheme began operating in 2021, and over 50 applications for innovative medicines have been received so far.
NICE also plays an important role in ensuring that patients have access to promising new innovations, including for patients with rare diseases. Through its technology appraisal and highly specialised technologies programmes, NICE makes recommendations for the NHS on whether new medicines represent a clinically effective and cost-effective use of NHS resources. Where NICE makes a positive recommendation, NHS England and Improvement and clinical commissioning groups are under statutory obligations to fund the technology. It is our intention to extend that obligation to integrated care boards.
Patients with rare diseases are already accessing effective innovations through the NICE programmes. For the drugs for rare diseases—known colloquially as orphan drugs—appraised since 2013, 87% of NICE’s technology appraisal recommendations and 100% of its highly specialised technologies programmes recommendations were positive. That is a significant and positive outcome for patients. However, I am aware of the long-standing challenges, which were alluded to by the hon. Member for Nottingham North, where evidence relating to a medical technology is uncertain. That is a particular challenge regarding rare diseases where, as he said, the population is small.
Dr Whitford
I rise in support of the new clause. It is important to shift the narrative from what is often a structural focus on the NHS, and catching people when they fall, to looking at wellbeing and population to allow people to be healthier and live higher-quality lives for longer.
The hon. Member for Nottingham North mentioned the slowing down of improvement in life expectancy and the variation in life expectancy, but the bigger issue is the failure to improve healthy life expectancy. The 20 years of unhealthy life expectancy faced by many across the UK, particularly in more deprived areas, put pressure on the NHS, and we have seen that come home to roost over the last decade.
A lot of those health issues, or unhealth issues, are laid down in childhood. I am vice-chair of the all-party parliamentary group for health in all policies, which conducted an inquiry into the impact of child poverty. A figure from the Faculty of Public Health that has stayed with me is that the UK loses 1,400 children a year as a direct result of poverty, including by immature birth, small birth weight, foetal alcohol syndrome, fires, road traffic accidents, alcohol and drugs, violence and suicide. That is the number of students in a large secondary school, and if the roof of a large secondary school were collapsing every single year, we would do something about it.
Often, the time to do something about that is in the 1,001 days from conception forward, as the hon. Gentleman said. That means looking at maternal health and nutrition, which is why the early years collaborative in Scotland led to the Best Start grants to mothers and children at birth, on entering nursery and on entering school.
One internationally used measure on the health of our youngest children is infant mortality—death perinatally or in the first year. In 2014, England and Scotland had the same rate of 3.6 per 1,000 live births. In Scotland, we have managed to drive the rate down to 3.2, but in England, it is currently at 3.8. In some poorer areas of the UK, the rate is worse than in parts of the global south and the developing world. That is a brutal statistic.
We talked yesterday about maternal and infant deaths, but this also relates to the attainment gap and other issues faced throughout life by those who struggle in childhood. Investing in early years saves money in the long term. That might be the pitch to the Treasury: if we gave more children a decent start in life, fewer would struggle in the education system, fewer would struggle to get jobs, and fewer would be trapped by addiction or caught in the criminal services system. Instead of picking up the pieces later through the NHS or other public services, surely we should be investing in the best start in life for all our children.
Edward Argar
We believe that the creation of integrated care boards and integrated care partnerships represents a huge opportunity to support and improve the planning and provision of services to ensure that they are more joined up and better meet the needs of expectant parents, parents, infants and young children.
We acknowledge that new clause 51 is intended to ensure that the needs of expectant parents, infants and young children are expressly considered by ICBs and ICPs through the development of a tailored strategy. We are working on bespoke guidance, which will set out the measures ICBs and ICPs should take to ensure that they will deliver for babies, children and young people. That will cover the importance of the ICP integrated care strategies having measurable objectives for babies, children and young people.
The strategy must also set out how assessed needs for the area are to be met. The Department is working with NHS England and NHS Improvement and the Department for Education on the drafting of this bespoke guidance, and we will work with stakeholders in the upcoming months on refining the guidance prior to publication.
As per our general approach to the Bill, although we are clear about the statutory functions that will be conferred on ICBs—as they are currently on clinical commissioning groups—including on children’s safeguarding and special educational needs and disabilities, when it comes to implementation, we want to provide local areas with the flexibility to determine what will work best for their systems. We fear that over-prescribing system approaches in the Bill will make it harder for systems to design the approaches that will work best in their areas. That is why we believe the wording, as currently drafted, is appropriate.
Dr Whitford
I support the new clause. For a surgeon, knowing that an operation that they were trained to carry out, and performed in good faith, has caused harm is one of the worst things that can happen. I remember how I felt in the mid-1980s when we began to realise the impact of contaminated blood. It had a huge impact on how I operated. I used special diathermy techniques to avoid blood transfusion in all elective circumstances, and that is something I carried on throughout my time doing breast cancer surgery.
In this case, there may well have been doctors who were dealing with device companies and so on—that regulatory declaration is absolutely needed—but there will be a much greater number of surgeons who were using a device that was licensed and was given to them as the correct, safe device to use.
I find it shocking that although the report was commissioned by the Government, they have accepted fewer than half of its recommendations. The others directly relate to patients who have suffered harm, whether that is the women who had vaginal meshes inserted, or the mothers of children who were harmed by the use of Primodos or sodium valproate.
Sodium valproate is still an excellent anti-epileptic and will not disappear, but it is not a matter for specialist centres. It is so widely used that it is critical that within primary care and on product boxes it is made clear that women who are looking to conceive or who are of child-bearing age should not be left on Epilim; that should be discussed with them right from when they are young teenagers, so they can think about the impact later on.
The recommendations that have not been accepted are not to do with reorganising licensing, or a yellow card system; they are all recommendations that relate to women. That is really disappointing. The redress for them—the setting up of specialist centres to try to repair the damage as far as possible—is what is not being provided. The Government should look at the fact that those are the recommendations they have skirted around and not accepted. These women and the children affected have gone through enough.
Edward Argar
It is quite right that we articulate once again the suffering that was the genesis of the review. The hon. Members for Nottingham North and for Central Ayrshire spoke with passion on the issue. We are talking about procedures that had a dreadful impact on individuals and their families.
The Government recognise the effect that the independent medicines and medical devices safety review, and the lived experiences behind it, has had on all the women and children impacted, and their families. That is why, on the day after the review was published, the Government issued a full and unreserved apology on behalf of the health and care sector for the time it took to listen and respond.
I am grateful to Baroness Cumberlege for all the time and effort she put into her report. As hon. Members will be aware, that sentiment was expressed at the time by the Minister responsible for responding to the report, who is now of course the Secretary of State for Digital, Culture, Media and Sport.
The Government published our response to the review on 21 July this year, after carefully considering each of the review’s nine strategic recommendations and the 50 actions for improvement in greater depth. Our response set out an ambitious programme for change that, at its core, is focused on improving patient safety.
The Government accepted the vast majority of the strategic recommendations and actions for improvement. I reassure the Committee that we are committed to making progress on all accepted recommendations at pace. That is why, in our response to the review, we committed to publishing an update on our progress in implementing the accepted recommendations 12 months after the initial response. I know that hon. and right hon. Members from across the House will rightly vigorously continue to hold the Government to account on that. I reassure them that the Government take very seriously our responsibility to implement the accepted recommendations at pace.
Many of the recommendations will introduce large-scale changes to patient safety, and we have a duty to get their implementation right. I hope it will encourage hon. Members to hear that the Government have already made strong progress on implementing many of the accepted recommendations of the review. I will turn to those in more detail, because I think it is important that we update the Committee and the House.
Karin Smyth
I rise to support the comments made by my hon. Friend the Member for Nottingham North. He is absolutely right that this new clause follows neatly from the previous one, because I am in no doubt that if women were more involved and more listened to and had more power within the healthcare system, the debacle around vaginal mesh would not have got so far, and we would not sadly still be in a state where the recommendations have not been implemented. This is about power, listening, and having a voice in the system with regards to reproductive healthcare planning.
In the Chamber last week, I said regarding my hon. Friend the Member for Swansea East’s menopause revolution that when we worked on a women’s health strategy in the late 1980s, we barely mentioned the menopause. We were looking at reproductive rights even then, and for those of us who have followed this issue over a period of 30-odd years, it is deeply worrying to see where we still are. Again, this comes back to very basic patient care. I will certainly be supporting my hon. Friend the Member for Swansea East tomorrow to start the menopause revolution, which is going terribly well. We are hoping for serious improvements in healthcare over the coming years, and this new clause highlighting reproductive healthcare planning is really significant for the voice it should give to women at this important stage in their lives.
Edward Argar
It is possibly lucky for the Government that the hon. Member for Swansea East is not on this Committee, because she can be extremely persuasive. In my role at the Ministry of Justice, she managed to get a number of things out of me by persistent campaigning.
I am grateful for the opportunity to have this debate today. Women’s reproductive health remains a priority, and it is vital that women’s voices are listened to, particularly when it comes to their own healthcare. That is why we are developing a new section of the reproductive health strategy, which will of course sit alongside the developing women’s health strategy. They will both seek to address issues relating to women’s reproductive health.
Edward Argar
The hon. Lady may be about to agree with me; she is welcome to do so.
Dr Whitford
When we debated vaginal mesh, Primodos and valproate in the Chamber, one of the big issues that came up—I certainly spoke about it—was the issue within medicine, with doctors. What work will be done with Health Education England and medical schools to ensure that young student doctors, and doctors in early training, recognise this terrible dismissal of women’s concerns about all aspects of their health? The menopause is a classic, but there are many others.
Edward Argar
The hon. Lady is absolutely right to raise that. We need to get across, loud and clear, to our future clinicians almost right from the start—from their training and early education—the message that everyone’s health concerns matter equally, subject, obviously, to clinical decision making. I hope and believe that HEE and others will engage with that process in the context of the women’s health strategy. We do not want it to be a document that just sits on a shelf, or want it to look at issues in a siloed way; it should look at them across the piece. Over many years, there have been strategies on particular aspects of health. In the strategy, we seek to bring together a whole range of factors, so that we can look at how women interact with the healthcare system, and how to meet their needs holistically.
We want to maximise the independence of ICBs, so that they function in the way that best suits the needs of their patients and their organisations. We are therefore keeping their legislative obligations proportionate; that brings us back to a debate that the Committee has had multiple times about the permissive nature of the legislation. I agree that appropriate representation is essential in healthcare planning. I fear that the new clause is overly specific and not necessarily in keeping with the obligations on ICBs set out in clause 19 on general functions.
The Bill already puts obligations on ICBs that will help to ensure that relevant groups are fully represented and consulted in decision making. In particular, ICBs will need to ensure that they have taken appropriate advice from a broad range of those with professional expertise. As the work of ICBs will inevitably cover reproductive health, that requirement ensures that relevant groups are included in this work. Furthermore, as we discussed in the opening sittings of the Committee, local areas will have the flexibility to determine any further membership of the ICB beyond the minimum for which we have legislated. That discretion will allow local areas to ensure appropriate representation.
On working in partnership with the non-profit sector and local community groups, I recognise the essential role that those organisations and groups play, and agree that they should be involved in strategic decision making where appropriate. Each ICB and their partner local authorities will be required to establish an integrated care partnership. We expect the ICP to bring together organisations from across health, social care and public health, and representatives from wider areas where appropriate. That could include organisations from the voluntary and community sector. The ICP will be tasked with promoting partnership arrangements and developing a plan to address the health, social care and public health needs in its area. As that will include reproductive healthcare needs, we would expect relevant local groups to be represented. The ICB and local authorities will have to have regard to that plan when making decisions. That will enable more joined-up planning and provision, both in the NHS and by local authorities, which will enhance the services that people receive.
Existing and proposed duties already address the concerns underlying the new clause and ensure effective public involvement. We have concerns about imposing additional duties on individual services. Our approach enables local NHS bodies, supported by national guidance, to decide how best to involve patients and the public in the planning of commissioning arrangements, and in developing and considering proposals to change them, so we are not convinced that the additions in the new clause in respect of reproductive healthcare are necessary.
Alex Norris
I am grateful for the contribution from my hon. Friend the Member for Bristol South. Many people will be looking with great interest at what happens tomorrow. She spoke about the menopause not having been on the political agenda for such a long time. I think that that has changed, and not before time, so we are all very much looking forward to what will happen.
We have tested the Minister on the permissiveness point quite a lot, so by this, the 22nd sitting of the Committee, I think it is possibly an established fact, and I do not intend to divide the Committee, but I do want to come back on what he said about the sufficiency of the duties as drawn. When we have pushed for individual plans for each ICB—say, on inequalities, on the first 1,001 days and on drugs and health—there has almost been a sense of, “Well, of course these bodies will want to do that. It will be their local decision, but of course the evidence will drive them to do that.” I do not think we can say, on women’s health, that that is an “of course”, because we know that actually, historically, it can be very much an afterthought.
The thought that I might leave colleagues with on this issue is that we are having a growing conversation in this country about misogyny, and one of the things that you will hear men say a lot—I have said this myself, because I mean it—is, “We have to hold one another to account for the things we say and the way we act.” I completely agree with that. In that spirit, we have to understand that if a lot of the basic reproductive healthcare things that we are talking about today happened to men, we would be doing them in McDonald’s drive-thrus. It is as simple as that. Therefore, if we are to have an honest conversation with one another about misogyny in this country, it is that sort of thing that we mean. It is not always about pointing fingers and blaming, or policing jokes, which I think is important; it is actually about saying that services are different because these things do not happen to us and we should be more mindful of that and should want to change. I beg to ask leave to withdraw the motion.
Clause, by leave, withdrawn.
New Clause 54
Enhanced data collection
“(1) The National Health Service Act 2006 is amended as follows.
(2) After section 14Z43 (inserted by section 19 of this Act) insert—
“14Z43A Duty to develop data collection systems
Integrated care boards must—
(a) develop single whole-system IT systems across the whole of their integrated care system with the explicit purpose of supporting data collection and sharing;
(b) prioritise the use of those data systems for streamlining patient pathways;
(c) establish mandatory standards for patient-initiated follow ups; and
(d) use the data systems developed under paragraph (a) to report on a regular basis performance against improving patient outcomes in line with the standards established under paragraph (c).””—(Alex Norris.)
This new clause requires ICSs to develop digital data collection and sharing systems, and use them to track performance against mandatory standards, with specific regard to patient-initiated follow ups.
Brought up, and read the First time.
Dr Whitford
On new clause 54, I just want to speak to proposed new subsection (d)—the use of data to assess performance against outcomes. Between 2009 and 2019, there was really no significant national audit of quality of breast cancer services in England, even though some of that audit had been carried out in previous years. Part of that was due to the fracturing of the system from the social care Act. There might be only one breast unit within an area, and quality was left to commissioners. How can commissioners measure whether a local breast unit is treating people properly or achieving the aspired-to targets?
In Scotland, 19 of the commonest cancers are audited; I was involved in developing the breast cancer standards in 2000, and they have been updated many times since. They are assessed annually with an annual peer review conference, where clinicians will openly discuss the challenges they face and therefore will share the solutions many of them have come up with. The clinical things that we know will affect the survival and outcomes of our women in the future are all set as national benchmarks. It is important that, while data would be collected locally, it is benchmarked against national standards.
The Getting It Right First Time project was restarted in England a few years ago but, to my knowledge, although the Getting It Right First Time for breast cancer report was completed at the end of 2019, I have not seen it published. That appeared to be due to the election in December 2019; perhaps the Minister can clarify whether the breast cancer GIRFT report has now been published, when it might be published and what other GIRFT reports have come out.
The problem is that, even if that report were published now, two years after its completion, it would largely be based on data from 2018, and therefore clinicians would shrug their shoulders and say, “Out of date.” It is important that data is used in a timeous manner to audit as quickly as possible, so that the audit loop can be closed and services improved. Having led on this process in Scotland, I saw the change in standards between 2001, when we began the first assessment, and 2005, and it is an incredibly satisfying, not frightening, thing for clinicians to see year on year the quality of care delivered by their unit driven up. There must be national standards, but local audit.
Edward Argar
This new clause would create an obligation on ICBs to develop system-wide data-sharing IT systems. It would also require them to set and report on targets linked to outputs from this system. I recognise the importance of effective IT systems for the efficient delivery of services and for holding systems to account. However, we must set that against seeking to maximise the independence of ICBs to function in a manner that best suits the needs of their patients and organisations.
The obligations set out in the Bill are designed to establish a framework which ensures that ICBs fulfil their functions properly, while granting them as much discretion as possible in how they do so. The provisions in the Bill strike the balance between conferring the necessary duties and functions on ICBs to operate safely and effectively, and avoiding being overly prescriptive in any specific area. By placing too many statutory duties on ICBs, the risk is that innovation and locally led solutions may be stymied and focus may be taken away from their primary function of arranging for the provision of health services.
Of course, ICBs should be committed to improving patient pathways. However, we believe the duties already set out in the Bill are sufficient to ensure this happens. Further to the requirements set out in the Bill, there are already specific relevant provisions elsewhere in legislation. Section 251B of the Health and Social Care Act 2012 places a duty on certain health or social care organisations, which would include ICBs, to share information about an individual with certain persons where this will facilitate the provision of health services or care to the individual and is in the individual’s best interests.
In addition, there is significant work already under way on data strategy, which will have a direct impact on ICBs. The data strategy “Data Saves Lives: Reshaping health and social care with data” sets out commitments to transform the way that data is used across the health and care system, giving patients control of their health data and enabling staff to save more lives through improved care and treatment. It recognises that ICBs will help the NHS to join up data and delivery more seamlessly, working side by side with local government, third sector partners, and the wider health and care system to address long-term challenges, and sets out that each ICB will be expected to use digital and data to drive systems working, connect health and care providers, improve outcomes and put the citizen at the heart of their own care.
The data strategy was published in draft for engagement in June and a final version will be published by the end of the year. It sets out a range of commitments to ensure that health and care professionals have the data they need to provide the best possible care, that local and national decision makers are supported with data, and that data for adult social care are improved. It also includes commitments on every ICB having shared care records in place, and commitments in relation to data sharing between NHS organisations and supporting the underpinning infrastructure in order to ease data sharing.
Alex Norris
I beg to move, That the clause be read a Second time.
Domestic abuse is an issue of significant interest across this place. We know that two women a week are killed by a current or former partner in England and Wales alone. As we mentioned the other day, a quarter of women will experience domestic abuse in the course of their lifetime, which has devastating effects. It impacts on both the physical and mental health of survivors and their children, and it has a terrible cost in general to everybody, including a financial cost.
New clause 56 would impose a duty at a local level to ensure that GPs have access to specialist domestic violence and abuse training. It is something that would be very welcome, and we are proposing a duty for integrated care boards to provide that. GPs are a credible point of contact for people in violent relationships. Some 80% of women in a violent relationship seek help from health services first. In some cases, that is their only contact. Training for GPs is vital to ensure that such contact is of the best possible quality. A study of women in violent relationships in the Netherlands found that 50% of women who did not speak to their GP about the matter would have done so if the GP had been in a position to approach it. Moreover, 50% of the women who did talk to their GP did so because they hoped to be referred on, so they wanted to have a high-quality conversation with someone who knew the system.
From my time prior to this place and my experience in Nottingham, I have a lot of enthusiasm for the IRIS programme—the identification and referral to improve safety programme. A trial carried out by Bristol University found that the training programme led to up to six times more women receiving the help they needed, and that it boosted the number of referrals to specialist domestic violence agencies. After IRIS training, GPs reported being better able to assess domestic violence risks and a greater awareness of services, while 99% of service users felt listened to and 87% felt safer.
The evidence is that such training works. This is of course not the way in which we should write a new clause, but I am saying that IRIS should be universal or something like it. I would leave the “something like it” to the provider market and to commissioners but, in general, the principle is that all GPs should have training so that they can understand and act on domestic abuse and have the right resources to provide support and make skilful onward referrals, so that the system can wrap its arms around an individual who is trying to get out of an abusive situation. That would be exceptionally important for such women, and I hope the Minister will have some thoughts about how we can get to a universal, IRIS-like level of engagement with our GPs.
Edward Argar
The new clause would require ICBs to provide specialist domestic violence and abuse training, support and referral programmes to all GPs, with the aim of strengthening the health response to domestic abuse and improving links between the NHS and voluntary sector support for victims. We have concerns about the new clause, which is why we cannot accept it, but I hope that I can set out to the shadow Minister my reasoning.
Domestic abuse, as we discussed yesterday when considering another proposed new clause, is a terrible crime, and it can have a devastating impact on victims and survivors. It is also important that we remember that children are often just as much victims as the victims themselves, through the experiences that they have of domestic abuse and domestic violence. The Government are clear that there is absolutely no excuse for abuse. Tackling domestic abuse and supporting victims, survivors and their children is a key priority for Government, now more than ever.
The Domestic Abuse Act 2021 and the forthcoming domestic abuse strategy will help to provide a whole-system approach to protect and support victims and their children. The measures in the 2021 Act seek to promote awareness by introducing a statutory definition of domestic abuse, and to recognise children, as I alluded to, as victims in their own right, in order to protect and support both, tackle perpetrators, transform the justice response, and drive consistency and better performance in the response to domestic abuse.
The 2021 Act also sets out the convening of local domestic abuse partnership boards, with healthcare representation. We recognise the key role that healthcare services play within a whole-system approach to tackling domestic violence. Healthcare services must identify signs of risk and harm, enable victims and survivors to come forward, and provide timely integrated care and support. We know how important it is that statutory agencies and professionals properly understand and react to domestic abuse. However, I hope that I can reassure the Committee that placing in the Bill a formal duty on ICBs to ensure that specialist domestic violence and abuse training, support and referral programmes are universally available to all GPs is not necessary.
General practice is delivered by multidisciplinary teams, rather than just GPs, and existing Care Quality Commission registration requirements include a review of practices’ safeguarding processes. In addition, NHSEI’s ICS people guidance sets an expectation that ICBs will foster learning and continuing professional development. Going further, the Bill, in proposed new section 14Z41 of the National Health Service Act 2006, imposes a duty that each ICB
“must, in exercising its functions, have regard to the need to promote education and training for the persons mentioned in section 1F(1)”
of the 2006 Act.
Sarah Owen (Luton North) (Lab)
Again, I break the convention that Whips do not speak, because this issue is close to my heart. I listened carefully to the discussions yesterday, and to what the shadow Minister, my hon. Friend the Member for Nottingham North, and the Minister have said on the new clause, but if we looked at domestic abuse as a disease or virus, given the fact that it kills women, it kills people in their homes, and has mental and economic impacts that affect people’s overall health, we would certainly ensure that GPs were trained on it. Why can we not do the same thing with domestic abuse?
Edward Argar
I am grateful to the hon. Lady. In part, the reason is because this is sadly not a well drafted new clause. It is very narrowly drafted to GPs, not recognising the multidisciplinary nature of how healthcare is delivered in GP practices. I suspect that we all have correspondence from constituents—whether happy or unhappy—going to doctor associates, practice nurses and others. That is one of my key concerns, but let me articulate a little more what is already being done. I see where she is coming from. As I mentioned yesterday, I was the Minister with responsibility for victims of domestic violence, and of crime in general, when I was in the Ministry of Justice, so it is something that I am very familiar with. It is about raising awareness not just with GPs, but within the police and a range of agencies. My challenge, just before she intervened, was partly about the way the new clause is drawn, but let me articulate a little further our views on it. I am keen to do so before the business possibly collapses early in the House, and we have to adjourn in order that I can respond to the Adjournment debate.
Section 1F of the 2006 Act defines a wide group of people, covering persons who are employed, or who are considering becoming employed, in an activity that involves or is connected with the provision of services as part of the health service in England. That duty on ICBs would already cover general practitioners, but it goes wider. I appreciate that the new clause goes beyond training, so I will also discuss the support and referral elements that the hon. Member for Nottingham North talked about.
The NHS provides care and support to victims of domestic abuse through a range of healthcare services. This response is centred around ensuring that healthcare professionals are trained to spot the signs of domestic abuse and those at risk; to make safe and sensitive enquiry of the issue; to know where to refer people to get further support, and to know when and how to share information appropriately with colleagues and other organisations.
All NHS staff must undertake annual mandatory safeguarding training, which includes focus on domestic abuse. NHS England, NHS Improvement and Health Education England are reviewing mandatory safeguarding training for all health professionals to ensure that they are fully equipped with the key skills, knowledge and principles to protect all citizens. The Government published an online domestic abuse resource for health professionals and have developed a number of training modules with the Institute of Health Professionals, the Royal College of Nursing and the Royal College of General Practitioners.
From 2018 to 2020, the Department managed £2 million of funding for the domestic abuse pathfinder programme, which created a model health response for survivors of domestic violence and abuse in acute, community and mental health services. The pathfinder toolkit was published in 2020 as the result of emerging promising practice at our pilot sites, coupled with the expertise of the pathfinder consortium of specialist domestic abuse organisations, to encourage best practice across the health system. Pathfinder has given us a model for our response to domestic abuse in healthcare. It is a model for integrated, joined-up and trauma-informed care and support, with healthcare settings and the voluntary sector working together.
As the shadow Minister mentioned, the Department of Health and Social Care has also funded the IRIS programme, to which I pay tribute. IRIS is a training, referral and advocacy model to support clinicians in better supporting patients who are affected by domestic violence and abuse, and to increase the awareness of domestic violence and abuse within general practice. IRIS is recognised by the DHSC as good practice, and via the National Institute for Health Research we funded a study that demonstrated the effectiveness of the IRIS programme at scale. I am delighted to note that the study won the 2020 Royal College of General Practitioners research paper of the year award.
I am proud that the Government have championed the building of that evidence base. I believe that it would not be best or appropriate, however, for the legislation to require local health and care systems to adopt specific programmes. Indeed, such detailed requirements would reduce local health and care partners’ flexibility to meet the needs of their local populations or to engage with particular local organisations and expertise in delivering their programmes.
Beyond ICBs, I see a huge opportunity for integrated care partnerships to support improved services for victims of domestic abuse, sexual violence and other forms of harm, through better partnership working and joint planning of services. The Government have also developed a cross-Government strategy for tackling violence against women and girls, and will develop a cross-Government domestic abuse strategy.
As committed to in the tackling violence against women and girls strategy, the DHSC will continue to work closely with NHS England and NHS Improvement to promote evidence-based approaches to tackling violence and abuse through guidance and engagement with the new system.
Alex Norris
I am grateful to the Minister for his response. I am more than happy to wait for the domestic abuse strategy, but I really hope that such measures will feature in it, and that when the strategy goes around various Departments for their comments, the Minister will make a commitment—
Edward Argar
May I make the offer to the hon. Gentleman that I or the relevant Minister leading on this—whoever is more appropriate—will engage directly with him?
Alex Norris
That is very welcome, and in that spirit, I beg to ask leave to withdraw the motion.
Clause, by leave, withdrawn.
New Clause 57
Cancer strategy
“Within 12 months the Secretary of State must—
(a) publish a new cancer strategy; and
(b) either designate a minister or appoint a national lead with responsibility for enacting its implementation.” —(Alex Norris.)
This new clause requires the publication of a new cancer strategy, with a minister or other person made responsible for its delivery.
Brought up, and read the First time.
Alex Norris
I am conscious of other business, so if I am interrupted, I will not take it as rudeness.
Alex Norris
New clauses 57 and 64 both relate to cancer. It is not quite possible to quantify the damage done by cancer in this country because we end up just throwing big numbers around. In the UK, there are 375,000 new cases and 166,000 cancer deaths each year. Each of those numbers represents a person with a devastated family. I lost my father to cancer in my infancy—35 years ago in January—and that loss is something that lives with a family for the rest of their lives.
We know that one in two people born after 1960 will be diagnosed with cancer. Our investment in cancer services is £5 billion a year, but the cost dwarfs that, at over £18 billion. Nearly 40% of cancers are preventable. Happily—this is something we should be proud of in this country—the developments that we are making in medical and technological areas mean that cancers are increasingly survivable, with the survival rate doubling in the last four decades. Better diagnosis and treatments mean that nearly 50% of those diagnosed with cancer in England and Wales now survive for 10 or more years, and there is no reason for that to stop increasing.
Edward Argar
New clause 57 seeks to commission, as the shadow Minister has said, a new cancer strategy and to designate a Minister or appoint a national lead with responsibility for enacting its implementation. The Government’s current cancer strategy is incorporated in the NHS long-term plan, published in 2019. That plan sets out ambitions that by 2028 the proportion of cancers diagnosed at stages 1 and 2 will rise from around 54% to 75% of cancer patients, and 55,000 more people each year will survive their cancer for at least five years after diagnosis. The shadow Minister is right to highlight the importance of the issue as something that touches everyone in some way, directly or indirectly. In the midst of the pandemic last year, I lost my uncle to cancer, and I suspect families all over the country are experiencing something similar among their family and friends. That is in the nature of the disease that we are talking about.
The NHS long-term plan contains a series of commitments to support the ambition. It focuses primarily on fast and early diagnosis, raising greater awareness of the symptoms of cancer, lowering the threshold for referral by GPs, accelerating access to diagnosis and treatment, and maximising the number of cancers that we can identify through screening. That ambition was intentionally set at a stretching level. Achieving it requires material progress in all of the long-term plan’s activities as well as successful innovation. The covid-19 pandemic has made the ambition even more challenging because of the additional pressure it has put on the NHS. It is still too early to assess the extent of the pandemic’s effect on that ambition in the long term. We remain absolutely committed to the need to prioritise earlier diagnosis to improve cancer outcomes. This ambition was strongly supported by the many cancer charities that worked with us to agree the priorities for the NHS cancer programme, and I pay tribute to them all.
I understand the intention behind the new clause. The covid-19 pandemic affected all NHS services in creating an environment unforeseen at the time by the long-term plan. In response to the pandemic, NHS England and NHS Improvement set up the cancer recovery taskforce, which provided advice and guidance on the national strategy for the recovery of cancer services. It monitored progress against the aims of restoring demand, reducing waiting times and ensuring sufficient capacity for cancer diagnosis and treatment. The taskforce published the cancer recovery plan in December last year, which fed into NHS operational and planning guidance outlining how the NHS would return to its pre-pandemic cancer performance within the long-term plan. It is thanks to the taskforce and forward planning that the CQC’s “State of Care 2020/21” report says that cancer services have achieved the best response and recovery, generally closing the gap in access on pre-pandemic levels more than any other area, although it notes that this still leaves a large backlog, which the recovery plan is focused on tackling.
The long-term plan commits NHS England and NHS Improvement to speed up the path from innovation to business as usual, spreading proven new techniques and technologies and reducing variations. I therefore consider the new clause, while it covers an important issue and quite rightly draws it to the attention of the Committee, not strictly necessary, because an ambitious cancer plan is already embedded in the long-term plan, with clear plans in place to support the recovery of cancer services from the pandemic specifically. We are fully committed to the actions within these plans and to seeing the long-term plan to its conclusion.
Dr Whitford
The Minister has not mentioned the workforce, specifically in radiology, which is very much the central specialty in diagnosing cancer. The data show that, once someone has been recognised as a cancer patient, they are still being treated relatively quickly—as he highlights, there is a shorter gap—but the problem is actually diagnosing someone, and the radiology workforce has a drastic shortage.
Edward Argar
I am grateful to the hon. Lady, who is distinguished in this field herself, from her previous career. She quite rightly highlights the importance of the workforce. Since 2010, in both radiology and radiography, there have been significant percentage increases in the workforce of those specialist professions. However, she is right to highlight that, while we have seen a significant percentage increase, in absolute terms we still need to do more to grow those professions. We have plans in place to do that, but that is a slow task; it can, in some cases, take up to 10 or 12 years to become an experienced specialist in that field.
On those increases since 2010, the Government would argue that we put measures in place, but it is also important to recognise that the previous Labour Government were working on this as well, hence the pull-through; those radiologists and radiographers did not magically appear immediately after 2010. There were programmes in place before and after that, so it is right that we recognise the contribution of the Opposition when they were in Government.
Finally, the new clause also seeks to place a Minister or national leader in charge of that new cancer plan. My ministerial role includes responsibility for elective recovery and recovery from the pandemic—our plan to tackle those waiting lists. As the shadow Minister knows, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), the former Under-Secretary of State for Health, who briefly sat on this Committee, had responsibility for cancer services specifically, as does the new Under-Secretary. Dame Cally Palmer is the national lead as the national cancer director at NHS England and NHS Improvement. She has a distinguished career as chief executive of the Royal Marsden Hospital in parallel. We are jointly responsible for the current cancer plan. It is therefore unnecessary to include that new duty when we already have those accountabilities.
I will move on briefly to new clause 64, which we are considering with new clause 57. It seeks to legislate for an additional duty on the Secretary of State to publish data on cancer waiting lists, cancer diagnoses and action being taken to reduce the number of patients waiting for cancer treatment in England. Again, I understand the intention behind the new clause. Cancer is one of the greatest challenges to people’s health, as we set out. I would like to highlight first the fact that the Government are already delivering on the request for monthly publication of cancer performance data. Ensuring transparency of data is a priority. Each month, we publish official statistics on waiting list data, including the number of patients who began cancer treatment and waited longer than 62 days for treatment. NHS England also publishes monthly management data on the number of people currently waiting longer than 62 days for diagnosis or treatment. The new clause calls for data that is very similar to what is already published, and we therefore consider that it would be duplicative.
Secondly, on the request to publish predictions—that is not something that is currently done. Doing so would likely result in unhelpful poor-quality assumptions or modelling that could lead to expectations or an understanding that is not reflected in the reality of the data that comes through. While we look at all data sources internally, it would not be in the best interests of scrutiny and, potentially, patients to publish poor-quality predictions with a limited confidence factor.
Thirdly, there is no evidence of need. Following the success of campaigns such as Help Us, Help You, we have seen the public seek medical attention for symptoms that might be cancer, while cancer referrals from GPs have been at record levels since March. At the same time, the NHS has been delivering high-quality and innovative solutions to improve cancer care and treatment. We have announced funding for elective recovery, including cancer services, of £2 billion this year and £8 billion over the next three years, which will increase activity and deliver millions more checks, scans, procedures and treatments. We will continue to publish and review the monthly official statistics to monitor progress.
Finally, on the request for the Secretary of State to publish a report every six months on the actions taken to reduce the number of patients awaiting cancer treatment, I should state that the NHS has already undertaken extensive work to reduce the number of patients waiting for treatment and to continue progress in delivering the long-term plan ambitions for cancer. We will publish the elective recovery delivery plan later this year, which will set out how the NHS will deliver increased elective capacity and how cancer patients will be prioritised for access.
Furthermore, the NHS cancer programme already regularly reports on progress through both NHSEI and DHSC governance structures, through publication of monthly data on cancer waiting times and through regular communications products. We would therefore argue that the new clause is duplicative. While I assure the Committee that we are taking urgent action to reduce cancer waiting lists, we consider the new clause to be unnecessary.
Alex Norris
I am grateful for that answer, which reflects the current difference in public policy between the Government and the Opposition. At oral questions to the Health Secretary, I always ask and will continue to ask whether the Government’s position is that the current plans and status will be sufficient to meet the challenges and the backlog—we think they are not. While the system was overheated before the pandemic, it has been distressed by the last 18 months. We do not think that asking that system to meet both emergent and old problems will work. However, that is probably a point for oral questions and future debates, rather than this Public Bill Committee. On that basis, I will withdraw the clause.
As we are coming to the end of the debate, I might gently say to the Minister, on his point that the Government do not make predictions because they might be unhelpful in the future, that it feels as if, every time he goes on the news, the Health Secretary puts waiting lists up by another million in an extraordinary attempt to manage expectations. Was it 13 million last time? It just goes up and up. I do not think it is quite fair to say that Ministers do not do that—the Health Secretary, at least, certainly does. Nevertheless, that is no reason not to withdraw the clause, and I therefore beg to ask leave to withdraw the clause.
Clause, by leave, withdrawn.
Ordered, That further consideration be now adjourned. —(Steve Double.)