Tobacco and Vapes Bill (Second sitting)

Aaron Bell Excerpts

Committee stage
Tuesday 30th April 2024 Public Bill Committees

[The Chair]

Laura, thank you so much for your evidence this afternoon. There are no more questions—we are about to zoom off and vote right now—but you have brought the subject to life with your very colourful descriptions. Thank you so much for that.

[Aaron Bell (Newcastle-under-Lyme) (Con)]

We apologise to the remaining witnesses, who we will try to squeeze in tomorrow.

Ordered, That further consideration be now adjourned.—(Aaron Bell.)

Oral Answers to Questions

Aaron Bell Excerpts

Tuesday 17th October 2023 Commons Chamber

[Will Quince]

I have huge sympathy and empathy with the case that my hon. Friend raises. The National Institute for Health and Care Excellence is rightly independent, and strict and robust processes are in place on drug repurposing and clinical trials. Nevertheless, I would of course be happy to meet him to see what can be done.

[Aaron Bell (Newcastle-under-Lyme) (Con)]

T1. If he will make a statement on his departmental responsibilities.

[The Secretary of State for Health and Social Care (Steve Barclay)]

First, may I welcome Opposition Front-Bench Members to their new roles, as there have been changes since we last met? Since then, we have launched a new £30 million fund to speed up the adoption of tech across the NHS. Even when local pilots prove their effectiveness, it often takes too long for those innovations to be rolled out nationally. This fund can change that, giving integrated care systems across England the chance to invest in tech that is proven to improve care, for instance in detecting cancer sooner. These investments will be made this financial year, getting patients care faster. We are also making more than 200 more medical school places available for universities from next September, accelerating a commitment that we made in the NHS long-term workforce plan and delivering more doctors to areas that need them most.

This Government are listening to patient voices too, particularly on the importance of biological sex in healthcare. That is why, following a consultation later this year, we will amend the NHS constitution to make sure that we respect the privacy, dignity and safety of all patients. The Prime Minister has also unveiled plans to introduce a new law to prevent children who turn 14 this year from ever legally being sold cigarettes, creating the first smokefree generation. Last week, my Department launched an expedited consultation to crack down on youth vaping.

[Aaron Bell]

I thank the Secretary of State for his statement, particularly what he said about tech. On dental provision, I recently met with Dr Khan of Westbury Park dental practice in my constituency to discuss access to NHS dentistry, which is becoming more difficult for many of my constituents. I welcome the plans we have to increase the number of dentists and I reiterate my support for a dental school at Keele University, but those plans will take time. In the short term, there is a huge backlog of overseas clinicians waiting to take the registration exam so that they can practise here. What steps is the Secretary of State taking to expedite this?

[Steve Barclay]

He is right that we are taking both long-term and short-term actions. A key part of the long-term workforce plan is to boost the number of dentists being trained. In the more immediate term, earlier this year we made legislative changes that give the General Dental Council the flexibility to improve the way professionals are registered, giving more flexibility in terms of the skills mix and, for example, tripling the number of people sitting part 1 this year, so that more overseas professionals can be recognised and qualified to practise in the UK.

Mental Health Treatment and Support

Aaron Bell Excerpts

Wednesday 7th June 2023 Commons Chamber

[Vicky Ford (Chelmsford) (Con)]

As you and my hon. Friend the Minister are aware, Madam Deputy Speaker, there has been a tragic, historic issue of in-patient mental health deaths in Essex—it goes back to 2000—over a 20-year period. Roughly 2,000 people have lost their lives. An inquiry has been going on, but, as I said in the House in January, there has been deep concern about the lack of progress and the low level of engagement between Essex Partnership University NHS Foundation Trust and the inquiry. I also pointed out that families who have lost loved ones want to know that lessons have been learned, they want accountability, and, most important, they want to know that patients are not suffering the same today.

At the time, the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien), said that unless there was a

“quantum leap in the level of co-operation”—[Official Report, 31 January 2023; Vol. 727, c. 51WH.]

with the inquiry, it would move to a statutory basis. I know that the Secretary of State treats the matter seriously—he met Essex MPs recently and is close to making a decision—but it has now been four months since that debate, so may we please have a decision soon?

In the meantime, I recently met EPUT to find out what is happening with its service. I will tell some positive stories. In March, EPUT announced that it was going to launch a mental health urgent care unit in Basildon. We have all heard stories of people in mental health crisis going to A&E, waiting hours and hours, and then not getting the specialist service that they need, but that new specialist 24/7 centre saw 200 people in its first month. Instead of what happened historically in A&E—90% of people waiting a long time before being sent home without a care plan—90% of people see the experts within four hours and leave with a care plan. That is transformational. The unit is also piloting a 24-hour paramedic.

Demand in Essex is settling down. It rushed through the roof during covid but is now increasing in line with population growth. Complexity also rose during the pandemic. Prior to the pandemic, about 30% of those going into in-patient units needed to be detained. At the peak of the pandemic and post pandemic, that figure was 70%. It is now down to 60%. Our waiting time to see a psychologist, which rose to a year, is now down to 29 weeks. Vacancies for all positions have been filled, so the trust will be fully staffed from September and expects the waiting list to drop to zero.

Furthermore, EPUT is trying new technologies such as the new and innovative neuromodulation centre, which opened six months ago in Brentwood and is having great success. The trust is also encouraged by the Government’s announcements on electronic patient records. Enabling hospitals and mental health services to share patient records easily between them will make a huge difference. It is great news that the Government are behind that, but we need the funding for it.

Colleagues have mentioned eating disorders. Some may be aware that I suffered from anorexia when I was a teenager. It is still very difficult to talk about one’s own mental health. I encourage everyone in the Chamber to please be mindful of the language that they use; I have found some of the language used so far in the debate very upsetting. I completely agree with my hon. Friend the Member for Watford (Dean Russell) about being mindful of the tone that we use, because there will be people watching who are suffering with mental ill health, and we must not scare them away from getting treatment.

I am particularly concerned that what is being seen on social media today fuels eating disorders. The speed at which young girls in particular are shown eating-disorder content on social media by platforms such as TikTok is outrageous. I am glad that the Government are tackling that.

[Aaron Bell (Newcastle-under-Lyme) (Con)]

My right hon. Friend is absolutely right to mention social media, particularly in relation to teenage girls and eating disorders. I praise her for bringing her own experience to the Chamber. Another major contributor to the rise in mental ill health among young people in the last decade has been the isolation that social media can cause through bullying and so on.

[Vicky Ford]

My hon. Friend is completely right about online bullying. It is so important therefore that we get the Online Safety Bill through—it must not be delayed too much, although there are still issues to be looked at in the Lords.

I am very pleased that Ministers have announced that they will criminalise the intentional encouragement of serious self-harm, including eating disorders. I would like them to look again at the toggle on/toggle off issue that I mentioned last time we debated this, and—on another issue that is having an impact on children—to take seriously the need to prevent children from accessing online pornography, which is of an increasingly violent nature. Those matters are all related to the mental health of the nation.

--- Later in debate ---

[Aaron Bell (Newcastle-under-Lyme) (Con)]

It is with some trepidation that I rise to speak in this debate, given the expertise and experience we have heard from all parts of the Chamber so far. I draw particular attention to the speech by my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer), who is no longer in his place but who shared his personal expertise as a clinician, and my hon. Friend the Member for Watford (Dean Russell), who kicked off the Back-Bench speeches from the Government Benches. He made a well-constructed speech that spoke to his expertise in campaigning for mental health so assiduously in this place. I pay tribute to everyone on both sides of the Chamber who has brought forward their own personal experience, their family experiences and their constituency experiences of mental health.

I will not reiterate everything that the Minister and my hon. Friend the Member for Watford said, but the parity of esteem we are working towards in this country is vital, as are the record investment of £2.3 billion that this Government have put into mental health and the extra doctors and nurses who will support people. Most of all, it is about reducing stigma in mental health. It is not unfortunate that we are doing so, but it does create more demand.

The shadow Minister said that the causes of poor mental health were complex, and they are, but she then went on to basically try to lay it all at the door of the Government. That is not remotely fair or accurate, because the statistics are complex too. We should welcome more demand from people who were previously undiagnosed, and we should recognise, as my hon. Friend the Member for Penistone and Stocksbridge (Miriam Cates) did a moment ago, that there have been societal changes, particularly with social media, which I referred to in my intervention.

At the very youngest ages, we are seeing an explosion in autism cases. I speak to the excellent Peter Pan Centre in my constituency, which deals with pre-school children with some of the most severe forms of autism, including those who are non-verbal. Next door is the excellent Merryfields special school, where a number of them end up going. Increasingly, those organisations are saying that the majority of their pupils are those with autism or autism spectrum disorder, and that simply was not the case 10 years ago. Again, that is probably because of better diagnosis—we do not fully understand the explosion in autism—but we must not assume that everything is to do with money being spent on things; it is to do with better understanding of mental health, more awareness and less stigma.

The pandemic affected the mental health of the entire nation, and I recognise that that has put a lot of pressure on young people in schools and universities, which I will talk briefly about as the Member who represents Keele University. On schools, I speak frequently with my heads and with parents who come to me trying to get statements for their kids. As we get a greater understanding of neurodiversity, there is obviously a real interaction between special educational needs and poor mental health. I was speaking to my county council yesterday, and the big issue is the availability of educational psychologists. My county council, Staffordshire, is doing a great job of training more of them itself, but that is a problem across the country, and we need to address it so that we can get children the help that they need with their education and their mental health earlier.

We have heard about the Department for Education funding and the training of senior mental health leads, with 400 already supporting more than 3 million children. There will be up to 500 next year, and more than 60% of state secondaries have a mental health lead. I want to see that get to 100% as soon as possible.

In my final couple of minutes, I will speak a little about universities, as the Member who represents Keele, which has 12,500 students. I am pleased that Keele has, as many universities do, a professional counselling and mental health team to support its students. More generally, the Higher Education Statistics Agency collects data from students on any disability that they have, including mental health conditions. In 2021-22, 416,000 UK students said they had a disability of some kind—that is 19% of UK students—and within that, 119,500 said they had a mental health condition, which is 5.5% of all UK students. That number is three and a half times higher than it was in 2014-15. Higher rates are found among women, undergraduates, full-time students and those in their second or later years. There is an issue here that we have to address, and I am pleased that the Government are doing so.

The covid pandemic fell heavily on students at university, particularly during the lockdowns and associated restrictions. At the height of the pandemic, many students, including those at Keele, struggled with the measures employed to prevent the spread of covid, particularly in university settings. Some had to socially isolate regularly and could not go home to see their parents. They were essentially locked in their room with nobody else there for a long time. Nightline, which co-ordinates student-run listening and information services, reported in November 2022 that it had recorded a 51% increase in calls in 2020-21. Numbers for the next year were 30% higher than that, which indicates that the pandemic has had a continuing effect on universities. I welcome that the Department for Education has asked the Office for Students to distribute £15 million for transition into university.

I am pleased with everything that the Minister said about what we are doing, and I end on the point that there is less stigma, which is a good thing, and if there are more people coming forward, that is a good thing too.

Oral Answers to Questions

Aaron Bell Excerpts

Tuesday 6th June 2023 Commons Chamber

[Neil O’Brien]

I have already mentioned that we have nearly 2,000 more doctors in primary care than we did in 2019, as well as the early delivery of the 26,000 extra clinicians we have brought into primary care. [Interruption.] The Opposition may not want to hear it, but the truth is that we have increased funding for general practice by about a fifth in real terms. We have more doctors and other clinicians, and GPs are doing 10% more appointments every month. We want to continue to build on that, which is why we have the primary care recovery plan and why we have invested a further £645 million in enabling people to get treatment from their pharmacists, freeing up 10 million more GP appointments. We know we must go further, but we are making progress.

[Aaron Bell (Newcastle-under-Lyme) (Con)]

I know the Minister is very keen to see the numbers of elective waits fall, and they have been falling. My constituents in Newcastle-under-Lyme share that aim. So will he welcome the local hospital trust opening not only a new modular theatre for specialised hand surgery, but a central treatment suite for day patients at the County Hospital in Stafford funded by NHS England’s elective recovery plan, which will help cut waits for planned procedures?

[The Minister for Health and Secondary Care (Will Quince)]

I thank my hon. Friend for his question. He has articulately and eloquently set out the improvements being made at Stafford County Hospital, and he has been a strong champion for those works. This is real, visible, positive change that will benefit both residents and patients in Newcastle-under-Lyme and the surrounding areas.

NHS Strikes

Aaron Bell Excerpts

Monday 17th April 2023 Commons Chamber

[Steve Barclay]

The hon. Gentleman makes two important points. The workforce plan is critical, and I have referred to that already. He also raises the importance of early diagnosis of cancer, and he is absolutely right on that. He will have seen that the faster diagnosis standard was met in the latest operational performance data for February, which was extremely welcome news. There is obviously more still to do. That is why we are rolling out the programme of diagnostic centres and surgical hubs. We are redesigning patient pathways to streamline those journeys, and we are looking at variation in performance on such things as faecal immunochemical tests. There is a huge amount of work, but I hope he can see some progress in the latest figures.

More widely in terms of elective recovery, we made progress in the summer on the two-year waits, in stark contrast to Wales, which was significantly above 50,000. We got it under 2,000 in the summer. I will update the House shortly on the 78-week waits. We are working through the key actions in our elective recovery plan as we deal with the consequences of the build-up from the pandemic.

[Aaron Bell (Newcastle-under-Lyme) (Con)]

We all recognise how hard junior doctors work, but if we are to have successful negotiations, we need honesty and integrity in them. Does the Secretary of State share my concern that the BMA’s figure—its central campaign claim—of £14-an-hour pay for junior doctors has been shown to be misleading?

[Steve Barclay]

I do share my hon. Friend’s concern. Full Fact has shown that the figure is inaccurate. It disregards higher pay later in the evenings and at weekends. It ignores the 20% that goes into pensions and that junior doctors, probably more than any other profession, have very quick pay and career progression. That is why, as part of our listening exercise, we made changes to pensions in the Budget. That was a reflection of the fact that senior doctors have often accumulated those pension pots, which is one of the other challenges we are dealing with. It is an indication of the career and pay progression that many junior doctors will see later in their careers.

Covid Pandemic: Testing of Care Home Residents

Aaron Bell Excerpts

Wednesday 1st March 2023 Commons Chamber

[Helen Whately]

I do not recognise the hon. Lady’s account at all. If she looks back at one of the legal cases that has looked into this question, she may find more accurate information about some of the conversations that went on behind the scenes. I can assure her that, as she would expect, in my capacity as social care Minister, I fought the corner for people receiving care—both home care and in care homes—throughout the pandemic.

[Aaron Bell (Newcastle-under-Lyme) (Con)]

Leaked WhatsApp messages will be partial and selective, but in reading even those I note that the Minister was doing her job on behalf of my constituents. In a message on 8 April, she spoke up for a care home in Newcastle-under-Lyme and raised it with the Government and her fellow Ministers. Everyone was doing their best. I served in the lessons learned inquiry, and there are lessons that can be learned with the benefit of hindsight, but the hindsight that we have seen from the Labour Front Bench is opportunistic. Does she agree that the Government were doing everything they could to respond to an unprecedented situation under severe pressure and severe supply and capacity constraints?

NHS Workforce Expansion

Aaron Bell Excerpts

Tuesday 28th February 2023 Commons Chamber

[Helen Whately]

I will make a bit of progress, so that there is the opportunity for Back Benchers to speak.

We have heard and will no doubt continue to hear about how we have been in power for 13 years so far, so it is only right to look at some of the figures since 2010. Since 2010, we have 35,000 more hospital doctors and 46,000 more nurses and health visitors, not to mention a nearly 50% increase in medical consultants and a near 60% increase in paramedics. That is what we have done.

[Aaron Bell (Newcastle-under-Lyme) (Con)]

I am very grateful to the Minister for giving way. In addition to the excellent point she made about the absence of social care in the motion, does she agree that the figures the Opposition have chosen to use in the motion do not give the whole picture at all? They do not include vacancies filled by bank staff, very often from the same hospital.

[Helen Whately]

My hon. Friend makes a very good point about the selective use of figures by Opposition Members.

--- Later in debate ---

[Helen Whately]

I know that the hon. Gentleman feels very strongly about the issue; we have talked about radiotherapy. He will know that we have invested more than £160 million in improving radiotherapy equipment. This year, we are investing an extra £50 million in the cancer and diagnosis workforce. We are continuing to work hard with the NHS on reducing the backlogs that we have seen since the pandemic, when people did not come forward for cancer treatment as they would have in normal times.

[Aaron Bell]

The Minister mentioned non-dom status under the previous Labour Government, and what they said about it. Is she aware that Alistair Darling said that

“such a charge could discourage men and women—doctors and nurses, business men and women—from coming to this country…and we do not want to turn them away”?—[Official Report, 9 October 2007; Vol. 464, c. 171.]

Gordon Brown considered a five-year cap and abandoned it. Ed Balls said that it would end up “costing Britain money”. The supposed heir to Blair is sitting at the Opposition Dispatch Box, opposite the Minister. Is it not surprising that he has not learned more lessons from new Labour?

[Helen Whately]

My hon. Friend makes an excellent point. We hear about this source of funding again and again—we hear that non-doms will provide all this money—but plenty of the shadow Health Secretary’s predecessors in Labour have said that they do not think the policy he suggests would generate any more income whatsoever.

It will imminently be time to give Back Benchers an opportunity to speak, so let me end by saying that it has been an honour to open this debate on behalf of the Government and to respond to the array of misrepresentations from Labour Front Benchers. The NHS exists to care for patients, and they should always be our first priority, but the NHS’s greatest asset is its workforce.

From a lifetime of talking to staff, I know that what they want is to care for patients in a way they feel proud of. They can do that only if they themselves are cared for, feel valued, are looked after and have enough colleagues to support them. The Government are working flat out on every one of those areas. We are hiring more staff, harnessing new technology, joining up health and social care, and building bridges between parts of the system like never before. I know how tough it has been and, on too many days, how tough it still is on the frontline. I am determined that we will continue to do what is right by health and social care staff, for them and for the people they look after.

--- Later in debate ---

[Aaron Bell (Newcastle-under-Lyme) (Con)]

Thank you, Mr Deputy Speaker. It is a pleasure to catch your eye a little earlier than I did yesterday evening.

I welcome the speech from the SNP Front Bench. It is good to see Scotland is having its say in this debate. I disagree with a lot of what the hon. Member for Central Ayrshire (Dr Whitford) said, but it is good to see that she is standing up for her Government. At the start of this debate, there were no Welsh Labour MPs in here at all. I see that a couple have popped in now. It is interesting, given what Labour claims it is going to do for the NHS in England, that no Welsh Labour MPs have put in to speak in this debate to defend their record in Wales.

I also note that the hon. Lady, in praising how things work in Scotland, did not refer to the recent report by Audit Scotland that said that the plans to hire GPs in Scotland were not on track, the target for more mental health staff was at risk and the number of operations was still 25% below pre-pandemic levels. It was described as an ever-increasing crisis in the Scottish NHS, with the double whammy of nursing vacancies going up at the same time as staff are leaving, yet the man responsible for the NHS in Scotland, Humza Yousaf, is standing to be the next leader of the SNP. Wikipedia does not inform me as to the hon. Lady’s preference in that election—perhaps she has not endorsed anybody yet—but I find it extraordinary that the man responsible for presiding over the state of the NHS in Scotland is putting himself forward to be the next leader of the SNP. It is an astonishing succession failure from Nicola Sturgeon to have such a weak field vying to be First Minister of Scotland, which is a very important job. But as I say, I respect the fact that the hon. Lady is here standing up for what she believes in and standing up for her Government in Holyrood.

Turning to the motion, as I said in my intervention on the Minister—I congratulate her on her speech—I reject some of the premises of the motion and some of the statistics involved. It is pretty rich to be lectured by the Opposition, given the backlogs they left in 2010 when they had no covid to contend with. There is no mention of covid in the motion. They left a 20,000 backlog in elective surgery that successive Governments got down to 1,000—a 95% fall—before the pandemic. [Interruption.] If the hon. Member for Ilford North (Wes Streeting) does not think the pandemic is relevant in the context of backlogs, I don’t know what to tell him. Under the Labour Government there was also a lack of productivity growth in the NHS—it was at less than 1% a year—which we have got back up to 1.7% since 2010. The hon. Gentleman spoke about IT, and I agree with him on that—I used to work in IT—but the Labour Government wasted £12.8 billion on IT for the NHS, which was a complete disaster and exposed as such by the Audit Commission.

[Alex Cunningham (Stockton North) (Lab)]

I do not quite understand this backlog the hon. Gentleman is talking about. I remember when it took three years for somebody to get a knee replacement or a hip replacement. Under the Labour Government it took six to eight weeks. Not 68 weeks; six to eight weeks. Across all elective surgery, we put those lists well and truly through the floor. Surely he can acknowledge that.

[Aaron Bell]

When Labour left office, more than 20,000 people were waiting over a year for elective treatment. Before the pandemic—this was not acknowledged properly—the number of people waiting more than 52 weeks for elective treatment had fallen by 95% in England, to just over 1,000. Those are the statistics. The hon. Gentleman can argue with them if he likes, but they are there in black and white.

As I said, it is interesting to see the lack of contrition about the state of the NHS in Wales, which is a complete mess. I will refer to that in detail later, but only yesterday the NHS Board in North Wales was put into special measures for a second time. I accept that there are challenges everywhere—in Scotland, Wales and England. Indeed, if we look at the comparisons across the continent, we can see that these challenges are international in nature, because everybody is recovering from covid, but I believe that this Government are tackling the challenges, and the workforce challenges, head on.

[Ashley Dalton (West Lancashire) (Lab)]

I am really glad that you have consistently raised the issue of covid. Could you suggest why it is that services such as the overnight children’s A&E at Southport and Ormskirk Hospital in my constituency, which was closed, allegedly due to covid restrictions, still remains closed to this day?

[Ashley Dalton]

Thank you, Mr Deputy Speaker.

[Aaron Bell]

I welcome the hon. Lady to her place and congratulate her on her recent election. I believe that her predecessor, Rosie Cooper, is now responsible for the issue that she has just raised, so perhaps she will have some luck if she speaks to her about that—[Interruption.] Have I got that wrong? I do apologise. By the way, I would like to pay tribute to Rosie Cooper, because I did not have the chance to do so when she left. She handled herself with great dignity in the face of some very unacceptable circumstances, and I pay tribute to her. I see several by-election victors on the Opposition Benches and I congratulate them all. I cannot speak exactly to the hon. Lady’s NHS trust. I am sure that if she writes the Minister or speaks to the NHS trust directly, she might get some answers as to what is going on in Southport, but if she will forgive me, I represent North Staffordshire.

Before I detail the work that the Government are doing, I would like to praise the work of everybody in the NHS—as the Opposition Front Benchers did—and particularly those in North Staffordshire who working in our hospitals and GP surgeries, our health visitors and clinical staff, and those who support those people. It has been a difficult winter—after a difficult few years—with covid and flu peaking simultaneously in December. I am pleased to report that the most recent figures from the integrated care board for Stoke and Staffordshire show that ambulance handovers hugely improved in February, compared with where they were in January, which was unacceptable, as I said in the House at the time. There has been an 8% increase in primary care appointments, compared with a year ago, with 73% delivered face to face—higher than the national average—and waiting times for surgery are falling, including for cancer treatment at the Royal Stoke Hospital. I pay tribute to everybody working at the coalface in the NHS, because I know what difficult work it is and we are all extremely grateful.

Turning to NHS workforce expansion, this Conservative Government are strengthening the NHS workforce. In hospitals we have 5,000 more doctors and 10,500 more nurses compared with October 2021. Compared with 2010, when the last Labour Government left office, we have 37,000 more doctors and 45,000 more nurses in our hospitals. We are also building up the workforce in primary care, recruiting 26,000 more primary care staff by March 2024—a target that is on track, unlike the target in Scotland. In Newcastle-under-Lyme, the number of doctors, nurses and other clinical staff based in GP surgeries has increased by 46% since September 2019. That is 55 additional full-time equivalent people. So we are seeing a growth in Newcastle-under-Lyme as well.

Workforce expansion is also about retention, as the Minister said. Times are tough for everybody, given what Putin’s war in Ukraine has done to inflation, but we have always prioritised NHS workers, especially those earning the least. A million workers received at least an additional £1,400 in their pay packets in the last year, and we accepted the independent pay review in full. During covid in 2021, we protected healthcare workers, giving them a pay rise during a wider public sector pay freeze and when private sector wages were falling. The full-time basic salary of a newly qualified junior nurse at the bottom of band 5 is now over £27,000, and experienced nurses or midwives at the top of band 6 are earning £40,588. On top of that, they get excellent pension provision, so we are looking after our NHS staff by paying them and retaining them.

More generally, we are also increasing the number of beds across the hospital estate. A new ward with 28 beds recently opened at the Royal Stoke University Hospital, but I know Tracy Bullock wants more, and I will speak to the Minister about that. We will need more beds for next winter, because the Royal Stoke is under incredible pressure, not least because of the burden of the New Labour private finance initiative contract that costs them a fortune to maintain. A previous Health Secretary ranked the worst 10 PFI contracts, and I believe that we were 11th or 12th at the time. The hospital has to live with that burden, and I raise it again with the Minister today; we want what went wrong before to be put right.

[Gareth Thomas (Harrow West) (Lab/Co-op)]

I hope the hon. Gentleman will not mind my encouraging the Minister to look, in addition to the case for more investment in his local hospital, at investing more in Northwick Park Hospital, which serves my constituents. It needs a 60-bed intensive care unit to improve the quality of critical care and, crucially, to help attract more critical care nurses and other medical staff.

[Aaron Bell]

I thank the hon. Gentleman for his point; I am sure the Minister has heard it. I will not say any more about that specific case, because I do not know his constituency that well—although I did work in Harrow once upon a time.

We had 120,000 more GP appointments every day in January ’23 compared with January ’22, and we are delivering the biggest ever catch-up—it is a necessary catch-up—over the next three years, with an extra £45.6 billion in funding to help us recover from covid. That will mean 9 million more scans, 9 million more checks and 9 million more procedures for the people who need them.

We know what Labour would do. It claims to have a plan funded through non-dom status, but I doubt that would raise the money, not only for the reasons I gave in the Opposition day debate at the end of January, but because it has already committed that money to breakfast clubs and various other things. There is a never-ending magic money tree that pays for all Labour’s commitments —[Interruption.] I know that the shadow Health Secretary and others have made many unfunded spending commitments. Labour’s answer is always more money, and the answer to how that will be funded is always a non-dom tax, which would not even raise the money Labour claims, as Ed Balls said, as Alastair Darling said, and as Gordon Brown found out for himself.

[Andrew Western (Stretford and Urmston) (Lab)]

Will the hon. Gentleman give way?

[Aaron Bell]

No, I have already spoken for 11 minutes, so I must get to the end—I have heard your strictures, Mr Deputy Speaker.

The NHS in Labour-run Wales has a shocking record of failure. As I said earlier, the health board in north Wales is once again under special measures. Since 2009, the Welsh Labour Government have consistently failed to meet the 95% four-hour target. England and Scotland, as the hon. Member for Central Ayrshire said, do a lot better on that measure. Patients in Wales are twice as likely to wait for hospital treatment, with 21.3% waiting after a referral by a consultant compared with only 12.8% in England. Perhaps the shadow Minister will explain, when summing up, whether he approves of Labour’s record in running the NHS in Wales or condemns it, as we do.

We also know about Labour’s record in government here in Westminster. As I said earlier, the elective surgery figure is a fact. Instead, we are investing record sums in our NHS. We are investing in its buildings and equipment but most of all in its staff. Having delivered for this country throughout covid, having vaccinated us and got us out of lockdown—which I recall the shadow Health Secretary opposing before Christmas 2021—and back to work, we are now helping the NHS to recover. I am proud to support this Government.

[Several hon. Members rose—]

NHS: Long-term Strategy

Aaron Bell Excerpts

Wednesday 11th January 2023 Commons Chamber

[Steve Brine (Winchester) (Con)]

I only have a short time, so I will make a couple of points.

On strikes, since we have a major strike today, I understand that many of the trade unions are saying they will not engage with the independent pay review bodies for the 2023-24 settlement. That is a catastrophic mistake on their part. The shadow Secretary of State, the hon. Member for Ilford North (Wes Streeting), and I were on a well-known evening news programme together the other night. Far from trashing the pay review body, he said that although it may need reform, it is important. I am glad to hear him say that, because it is important, and the alternative is Ministers directly negotiating pay settlements with unions. They have tried to do that in Scotland in recent weeks, and the Royal College of Nursing rejected the offer out of hand. The pay review process may not be perfect and may need reform—our Select Committee hopes to talk to the NHS pay review body soon—but I think that madness lies in pay negotiations around beer and sandwiches in Ministers’ offices. The unions should engage with the pay review process for next year. That would be the smart thing to do on their part.

My second point is about demand. The GMB came before the Select Committee just before Christmas and told us that the number of calls coming into the ambulance service is about 10 times what it was pre-covid. There are 100 times the number of people with flu in the acute setting than at this time last year. Demand is significantly outstripping supply in the health service right now, and I think it is disingenuous not to face that.

[Aaron Bell (Newcastle-under-Lyme) (Con)]

I am grateful to my hon. Friend for his work in chairing the Select Committee, and for the joint session with the Science and Technology Committee, on which I sit, about the lessons learned from covid. We heard that there are lessons for the NHS to learn for the future. Does he not find it a bit strange that there is no mention whatever of covid in the Opposition’s motion? Clearly, covid—combined with flu and everything else that he talks about—is one of the reasons behind the acute pressures that we have experienced this winter.

[Steve Brine]

I said in the House on Monday that covid has put the health service on its knees—it has done so to health services in the UK and around the world. To repeat what I have just said, it is disingenuous to suggest that the problems faced by our health service right now are not caused by our covid experience. The number of people presenting with suspected cancers is through the roof. That is good—many of those cases will turn out not to be cancer, which is even better—but so many people are coming forward because we suppressed demand during that time, and it is adding to the demand outstripping the supply in the health service right now.

--- Later in debate ---

[John Redwood]

Yes, indeed. From my hon. Friend’s own expertise, I am sure she is right. When people talk about productivity, they do not believe that hard-pressed staff have to work harder; they are saying there must be smarter working, making jobs more manageable or enabling them to concentrate on the things they are most skilled at, with more relief for the other necessary record keeping, which may indeed need slimming.

My hon. Friend is right that we could expand our training places further, but as we have heard there has been a big increase in educational provision and it takes seven years for it to flow through. I am glad we are getting to the point where we will see some benefits from that. We need more homegrown talent. Many people are attracted to the privileged career of being a doctor and the more we can allow to do that, the better. However, given the immediate urgency of needing more capacity, and therefore more doctors and nurses, the most obvious place is to look at all those who have already had the training and have left the profession or the NHS for one reason or another. Some may be in early retirement. That is probably not something my hon. Friend wants to change because she enjoys her new job, but there are many others who are not in a very important job like her who might be attracted back. I hope the Treasury will be engaged in the review, because I hear from doctors, as many do, that the quirk in the tax system at just over £100,000 where some of the better paid doctors are resting, producing a more penal 60% rate, is an impediment to extra working. I also hear about the pension problems that have been cited on both sides of the House. The Government need to take those issues more seriously if they wish to accelerate returns.

Ministers have very clearly set out that they want more NHS staff and have obtained much larger budgets in the last three years to help bring that about. They have also said very clearly that the public’s priority—and indeed the Opposition’s priority—is to get more treatments and get those waiting lists and waiting times down for those needing more urgent or emergency care. Those Ministers must translate that through the senior health service managers into ways of spending that extra money. If it needs a bit more extra money, there is always some extra available—every time we meet another additional sum is announced—but it has to be well spent. It has to be spent on motivating and recruiting the medical workforce.

[Aaron Bell]

Will my right hon. Friend give way?

[John Redwood]

I had better not, because we are very short of time for colleagues.

The money has to be well spent and I hope that senior managers, as they give us a published workforce plan, will share more of their thinking. It is not good at the moment that there is such a breakdown in relations with talented and important staff in the health service. There is a complex system of pay reviews, increments, promotions and gradings of activities. All those things have flexibility within them. I look to the senior managers on six-figure salaries to take their responsibilities seriously and get the workforce back on side, using those flexibilities within the system, because we deeply need them to be.

We need more supply because there is excess demand, for understandable reasons. Huge sums of money were tipped into the system to deal with covid. Not all of it was well spent, but that was understandable given the unknown nature of the beast at the beginning, and the obvious pressures in this place and elsewhere to get instant results with personal protective equipment, testing and so forth. That is now behind us, but unfortunately it disrupted normal hospital work and normal GP work and created backlogs.

I urge the Government to understand that part of the answer is having more bed spaces in hospitals, with the staff to back them up. I do not know why so many senior health executives never want to admit that. They always say that there are lots of bottlenecks and other issues. Yes, of course we need to move people on from hospital as soon as it is safe to do so, and of course we need more capacity in social care, but I say to Ministers that it would be great to have a bit more capacity in the main hospitals to give us extra flexibility and take some of the pressure off. Could not some of the extra £20 billion, £30 billion, £40 billion or £50 billion that has been found in recent years be spent on the combination of physical capacity and the staff to support it that we so need?

--- Later in debate ---

[Dr Luke Evans (Bosworth) (Con)]

As a parliamentary candidate, I was once asked by a journalist, “We have 30 seconds left on the panel. How would you solve the NHS?” I said, “If I had that answer, I would not be sitting here with you.” Mr Deputy Speaker, you have given me four minutes to do it, and I will do my best.

My hon. Friend the Member for Erewash (Maggie Throup) made an important point about context, and it goes back to when the NHS was formed in the 1940s and 1950s. We have an ageing population. In the last two decades we have seen a 50% increase in the number of 100-year-olds. Many people over 70 have four, five or six medical conditions and are on multiple medications. Technology has moved far forward, too.

When I started training, a cholecystectomy to remove the gallbladder was open surgery that required a person to be in hospital for a week. It can now be done within 24 hours. When we started people on routine blood pressure medications such as ACE inhibitors—many Members will know ramipril—they had to stay in hospital to have their kidneys checked. We now start it routinely for millions of people across the country.

That is the pace at which we are moving in the west and the developed world, and we have to try to keep up. Throw in a pandemic and workforce shortages, and we can see why every western country with a developed care system is struggling. That is the backdrop of what we are dealing with.

On top of that, demand and supply have gone up, but they have not gone up equally. Services are working hard to provide more tests and more appointments than ever before, yet demand is growing partly because the pandemic led to later and more complex presentations. In the Health and Social Care Committee we have heard that there are 27.5 million GP appointments a month, which is up by 2 million on 2019, yet it is still not enough.

In my area of Leicestershire and Rutland, we have enough GP appointments for everyone to be seen seven times a year, but the problem is that appointment rates are disproportionate. Some young people never need to go, and many older people need routine follow-ups. This is the backdrop we are dealing with. Members on both sides of the House talk a lot about long-term plans, but I would like to focus on day-to-day stuff.

[Aaron Bell]

I am grateful to my hon. Friend for bringing us his experience from before he came into this place, and he is right to look at the long-term demographic challenges. Does he agree that they will require the NHS to become even more efficient and productive? That is not just something we are asking for; it is what the staff in the NHS want, because they are aware that they are still delivering analogue services in a digital age.

[Dr Evans]

My hon. Friend has hit the nail on the head, and that is where I want to focus my remarks, because simple day-to-day changes to make the working clinician’s life better in turn improve productivity, patient care and patient satisfaction.

As with the Sky cycling team, looking for percentage gains brings big outcomes. So let us go through a quick list of some things we could do. We could have a root-and-branch review of prescribing. How much time is spent with patients waiting for prescriptions in hospitals to be dispensed? How much time is wasted by GPs signing prescriptions on paper? We have electronic prescribing but the prescriptions still get printed out to be signed. A root-and-branch review of prescribing all the way through would solve that problem, making this system more streamlined and fit for the 21st century. It would also save wastage, because there is an estimated £1 billion-worth of medication in Mr and Mrs Jones’s back cupboard just in case.

What about the IT? I am talking not about singing and dancing robots, but simply about making the IT for the day-to-day clinician work like their mobile phone does. That is not too much to ask. We could address the interface between primary and secondary care, allowing secondary care to be able to book blood tests into primary care and vice versa. This stuff does not happen. We no longer send faxes but we still send letters instead, and we pay someone to scan them so that a doctor can have a look at them and sign them off. We could cap list sizes, on a graded time for GPs. We are recruiting more GPs and it is going to take time, but that is a way of ensuring demand and at the same time continuity of care.

What about all the other stuff associated with the administrative time of looking after doctors to make sure they are fit for purpose? There is so much red tape when someone tries to join a performers list or come off one, or start an induction in a hospital. This is simple stuff we can change now, today. We can further do that by enabling the new ICBs, because my biggest worry with them is that they are going to ask for permission not for forgiveness. These 42 regional areas will be able to design the difference that can stick for the future.

I was hoping we might be able to spend these few hours today talking about the wider picture, because this all comes from context. The biggest question this House has to answer is what is the purpose of the NHS and what should it do? We all agree with the principles of clinical need and not to have to pay, but how do we deliver that for the 21st century?

--- Later in debate ---

[Aaron Bell (Newcastle-under-Lyme) (Con)]

In line with the wording of the amendment, which I rise to support, I thank all NHS staff, particularly those in Newcastle-under-Lyme and in north Staffordshire at the Royal Stoke University Hospital, which, as the Secretary of State acknowledged both on Monday and today, has been under the severe pressures we have seen throughout the health service over the last month. As he acknowledged, many people have had unacceptable experiences. I have seen examples of that in my inbox and I have fought for my constituents in those cases.

I also thank the local leadership, the integrated care board and, in particular, Tracy Bullock, the chief executive of the University Hospitals of North Midlands NHS Trust, for their time in briefing MPs about what has been going on. We have suffered the fourth highest level of flu in the United Kingdom at the Royal Stoke; it is the fourth worst-hit trust. We were running up to 30 flu admissions per day in December. I am pleased to say that that is now back down to a more normal level; it is about 10% of that. Of course, a lot of those flu admissions were people aged 85-plus who needed critical care.

As I said in an intervention, there is absolutely no acknowledgment of covid in the Opposition’s motion, despite the fact that there are still covid cases in hospitals and the backlog has had an effect on all our NHS services. That needs to be acknowledged.

To say a little more about the Royal Stoke, we are pleased that a new ward of 28 beds will be open next week thanks to Government investment last year. I know that Tracy will want me to request from the Minister even more capacity for next winter. The Royal Stoke is still in a very difficult position because of Labour’s private finance initiative—it is one of the most indebted hospitals in the country. That has been raised with multiple Secretaries of State. I know that it is an expensive thing to sort out because Labour wasted so much money on PFI, but we need to address it.

The Government have a long-term plan, as many on the Conservative Benches have said. It is about doctors and nurses and more GP appointments. We have record numbers of people in training as undergraduates and on nursing and midwifery courses. It is also about the long-term strategy, new surgical hubs, community diagnostic centres—my hon. Friend the Member for Peterborough (Paul Bristow) talked about his one—and our elected recovery taskforce, putting more spare capacity in the independent sector to use.

We know about elective recovery because we had to recover in 2010, when we inherited 20,000 people waiting more than a year for elective surgery. We got that down before the pandemic to under 1,000. Forgive me if I say that all the lectures from Opposition Members about how marvellous things were under the Labour Government ring a little bit hollow, especially as a Staffordshire MP. We experienced the absolute scandal of Mid Staffs under the previous Labour Government. I applaud the work that the current Chancellor, the former Health Secretary, did to get avoidable deaths down. That did not happen under the previous Labour Government.

I am very short of time, but I commend in particular the speech of my hon. Friend the Member for Bosworth (Dr Evans) who brought his experience to bear. There is so much that needs to be achieved through productivity and innovation in the NHS, and that is how we will get a long-term NHS fit for the future.

Special Educational Needs and Children’s Mental Health Services

Aaron Bell Excerpts

Wednesday 9th February 2022 Westminster Hall

[Aaron Bell (Newcastle-under-Lyme) (Con)]

It is a pleasure to serve under your chairmanship, Ms Fovargue, and a real pleasure to follow the hon. Member for Sheffield, Hallam (Olivia Blake), who made a powerful speech. Sharing her personal experience in this place is a brave thing to do. It has informed our debate, and I am sure that the Minister will refer to that when she sums up.

I congratulate my hon. Friend the Member for Newbury (Laura Farris) on securing the debate. Like her, I have been contacted by so many distressed parents of children with special educational needs. Their experiences of trying to get support for their children are summed up in exactly the word she used: a battle—it is really a battle. EHCPs are the entry ticket to specialist support, but the whole application and appeal processes seem designed to be difficult and time-consuming. As my hon. Friend said, too many times people have to repeat things that they have already said again and again. We must ensure that we have a tell-it-once approach to such things, however long the waiting list might be—she spoke movingly about that as well.

My constituent Samantha King’s four-year-old, for example, was receiving one-to-one nursery support in Wales before they moved to Newcastle-under-Lyme. She supplied extensive documentary evidence of the child’s need when they moved, yet she described having her child’s application refused on the basis that she had not included the reports that she had in fact submitted. That is all too common—things get lost and people have to fill in almost exactly the same form again or for another authority. It is extremely tedious and it breaks people down, and that is why this is such a battle.

Parents then find that they have to appeal to SENDIST, the special educational needs and disability tribunal, as the main route to access an EHCP. We need to analyse the proportion of successful appeals. If local authorities are turning down applications that are successful on appeal, those at the top of that league table need to think about why that is the case. They need to consider applications more carefully in the first place.

Even when someone gets an EHCP, the battle continues. Parents in my constituency report annual reviews not taking place, or the plans not being updated for months following review, severely impacting on a child’s progress through education. A lot of things go wrong in the transitions between stages of education or into work.

[Sir Robert Buckland (South Swindon) (Con)]

I am grateful to my hon. Friend for mentioning transition, because it is there that a condition such as autism or ADHD can turn into a mental health condition. Does he agree that one of the key issues for the Government to consider is the training and availability of clinicians? Funding is now much better than it was, but we still do not have the trained clinicians who could cut through the waiting lists, which are causing so much frustration to far too many families.

[Aaron Bell]

My right hon. and learned Friend is absolutely correct about the availability of clinicians. His intervention also speaks to the point made by the hon. Member for Sheffield, Hallam that if these conditions are not treated at school, they can lead to severely negative mental health outcomes later in life.

My constituent Mr Winkle has fought for many years to obtain suitable educational and therapeutic support for his son. Following a tribunal decision last month, he was sent a revised EHCP that still contained a number of inaccuracies, including out-of-date details about his son’s residential placement. I want to talk a little about residential placements, which have not been raised much so far, because the lack of suitable placements causes distress to many families.

One constituent described how the 14-year-old in her care only receives an hour’s at-home tuition a day, because a suitable therapeutic placement with a small and consistent staff team cannot be found. Alternatively, children are given residential educational provision that is unsuitable, which can cause them to regress and even, in one case, to self-harm.

Another common complaint is that social workers change too regularly, so the social worker does not truly know the child. Parents may not be told who the new social worker is and many have described the difficulty they experience when trying to get in touch with professionals, as telephone calls are not returned.

Despite parents being the ones with the most knowledge of the child or young person they are caring for, they struggle to be heard. Should they then complain, they describe encountering a complaints process that is frankly not fit for purpose: timescales are not followed; complaints sometimes seem to be ignored completely; and it is only possible to complain to the ombudsman with a final response, but that often never seems to arrive, and even when they do complain, it will take months for the ombudsman to reply. Furthermore, adults involved in the care of children can become fearful of complaining, in case there are reprisals in the form of their contact with the child being blocked.

Added to that is the struggle to obtain adequate mental health treatment. One constituent of mine was told that the priority waiting list for CAMHS—not the list to which my hon. Friend the Member for Newbury was referring earlier—is 11 months in Staffordshire. That is the priority list. Only this week, a constituent described how she is desperate for respite provision, having accepted a child back into her care on the basis that the local authority would support her.

The local authority has been good at keeping in touch, but its hands have been tied by what it says is a lack of resources. As well as struggling to find an educational placement for the young person, it has only just found an agency to take him on outings twice a week. After five and a half months of caring 24/7, my constituent is exhausted and in the terrible position of considering having to say that she can no longer look after the young man. She has been let down by a breach of implied trust—the local authority told her that it would support her, but it has not been able to.

As Members of Parliament, we inevitably hear the failures, rather than the success stories, but I welcome any support that can be given to improve the experience of so many. As my constituent Mr Winkle said:

“In this journey I have communicated with many regulatory bodies each claiming to have the child’s interests wishes and safety at the forefront of their agenda...but as I have experienced this is certainly not so...my assumption is that it’s a closed circle and these entities do not know how to facilitate or co-ordinate any kind of solution and just want it to ‘Go Away’.”

I am sure that is not the full truth of it, but that is the experience that people are having out there.

I welcome the imminent Green Paper and the additional funding, but too many people have been failed for far too long. I hope the Minister will be able to address that when she responds.

Elective Treatment

Aaron Bell Excerpts

Tuesday 8th February 2022 Commons Chamber

[Sajid Javid]

Yes. I join my hon. Friend in thanking GPs up and down the country for all their phenomenal work throughout the pandemic amid the huge pressure that they have had to deal with. He is right about making sure that channels of communication with GPs are as varied as possible and are available to everyone in all age groups so that we can better support early diagnosis.

[Aaron Bell (Newcastle-under-Lyme) (Con)]

I thank my right hon. Friend for his statement and for his leadership as we recover from covid. I must say that I find the words of the hon. Member for Ilford North (Wes Streeting) a bit hollow when the Opposition voted against £36 billion recently.

May I raise the matter of recovery in our emergency care? The Secretary of State will know that too many people in Newcastle-under-Lyme have had to wait too long for ambulances recently. Will he or his Ministers help to bring together West Midlands ambulance service, Royal Stoke University Hospital and the clinical commissioning groups to find a solution so that we can get patients into hospital and back out again as quickly as possible?

[Sajid Javid]

I thank my hon. Friend for reminding the House that the Labour party voted against additional investment in the NHS. He is right to talk about the impact on urgent care, particularly for ambulance services and especially during the recent omicron wave. We invested an additional £55 million in ambulance services over the winter. A lot more needs to be done to support urgent care, but the plans that we will shortly set out for the integration of healthcare with social care will certainly help to relieve many of those pressures.