Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorders

Andrew Stephenson Excerpts

Wednesday 22nd May 2024 Westminster Hall

[The Minister for Health and Secondary Care (Andrew Stephenson)]

It is a pleasure to serve under your chairmanship, Mr Dowd. I congratulate my hon. Friend the Member for South West Bedfordshire (Andrew Selous) on securing this debate on such an important issue, underlined by the sheer number of MPs who have attended this 30-minute debate today. He is a tireless campaigner for people living with Ehlers-Danlos. He was right to bring some of them to the House back in November, and he was right to bring campaigners again today to sit in the Gallery to ensure that their voices are heard. I also pay tribute to my hon. Friend the Member for Watford (Dean Russell), who spoke from the heart about his wife’s personal experience.

May is awareness month for EDS, and I thank the outstanding charities that do so much to support people living with the condition all year round, especially Ehlers-Danlos Support UK. My hon. Friend said that many people may not have heard of the condition. As Minister for Health and during my constituency work, I come across many people living with debilitating diseases, but it was difficult for me to read some of the stories collected by Ehlers-Danlos Support UK that are collated on its website. Multiple stories show what can be achieved when the correct support is provided, such as the story of Ellie Ovens, who began using a wheelchair in 2018 but returned to France two years later to ski again. That underlines what the hon. Member for Blaydon (Liz Twist) said about how the conditions affect different people in very different ways.

As has been said, although there is no cure for EDS or HSD, treatment can help an individual to manage their symptoms and prevent the condition from worsening. Early diagnosis is key to ensuring that patients are offered the most appropriate treatments and are supported to make lifestyle changes to improve their outcomes. NHS England commissions a national diagnostic service for certain rare types of EDS that can be diagnosed using a genetic test. We do not yet have a genetic test for every type of EDS or HSD, but as the Minister for life sciences I am hopeful about what the future may bring—a point made powerfully by my hon. Friend the Member for North East Bedfordshire (Richard Fuller).

[John McDonnell (Hayes and Harlington) (Lab)]

I thank the Minister for giving way; I know that he has limited time. May I add to the four requests that were made by the hon. Member for South West Bedfordshire (Andrew Selous)? With other conditions for which the Government have appointed an individual MP as the champion, we have seen some remarkable results because of that focus. Will the Government look at appointing a particular champion? I think we have seen the person who is in line today.

[Andrew Stephenson]

That is certainly the kind of thing we would want to consider, among a whole range of things.

In the limited time available, I will try to respond to the specific points made by my hon. Friend the Member for South West Bedfordshire. At the moment, diagnosis for these conditions is based on signs and symptoms, usually by a GP. As my hon. Friend knows, NHS England recommends care for patients with non-inflammatory but painful conditions, and that should be provided in primary and community care settings. That brings care closer to home for those patients, in line with our ambition to get every patient the right care in the right place.

[Ashley Dalton (West Lancashire) (Lab)]

It is not only about being able to diagnose the condition. Constituents have got in touch with me who have been undiagnosed for more than 40 years. They say that the big issue is not necessarily the inability to get a diagnosis, but the complete lack of awareness among medical professionals, so it is not even considered as an option. Will the Minister commit to increasing awareness of this serious condition across medical services so that this can at least be considered?

[Andrew Stephenson]

The hon. Lady makes a powerful point.

When I was preparing for this debate, I looked at the last time that the issue was debated in Parliament. It was a very long time ago. I strongly pay tribute to my hon. Friend the Member for South West Bedfordshire for leading this debate. There have been others: the hon. Member for Huddersfield (Mr Sheerman), who is now in his place, raised this with me at health orals a few months back. There are parliamentarians who are pushing on this, but this is the first specific debate we have had in a while, so we all have a role to play in raising awareness. Again, I pay tribute to my hon. Friend the Member for South West Bedfordshire for securing today’s debate.

My hon. Friend made a strong case for a nationally commissioned diagnosis and treatment service. In preparation for the debate, I raised the matter with NHS England, which tells me that it does not yet feel that it has good evidence that secondary care services are more appropriate for patients with hypermobility and pain, and that if patients were placed on secondary care waiting lists, it would not necessarily be in their best interests. If clear evidence is brought together that a nationally commissioned service would benefit patients, I will be happy to forward those examples to NHS England and ensure that it looks carefully at them.

My hon. Friend also asked for a meeting between himself, campaigners and me. I am happy to commit to that. Perhaps we can talk through the evidence after that to see what the best way forward is. For now, NHS England takes the view that the majority of patients with EDS and HSD can be managed within the community.

As we know, in many cases diagnosis is challenging. In recent years, we have taken great strides in making diagnosis more effective, giving GPs and physiotherapists comprehensive toolkits developed by healthcare professionals for healthcare professionals. I thank the Royal College of General Practitioners for working hand in hand with Ehlers-Danlos Support UK to get that done.

EDS and HSD are complex, chronic conditions that are frequently associated with other comorbidities. Sufferers may require access to a range of specialists, depending on the person. Integrated care boards are responsible for many of the treatment services for patients with EDS and HSD. They have a statutory responsibility to commission services that meet the needs of people in their area and that are in line with national guidance, including guidance from the National Institute for Health and Care Excellence. As my hon. Friend the Member for South West Bedfordshire will accept, NICE is an independent body and it would be wrong for me or any other Minister to interfere in its decision making, but I know that it follows these proceedings carefully and will have heard what my hon. Friend said in the case he has made for EDS and HSD to be included in its guidelines.

My hon. Friend rightly says that people suffering with the condition should have a co-ordinated, multidisciplinary approach to diagnosis and care. That is why we are rolling out new primary care networks across the NHS in England, which are delivering more proactive, personalised and integrated care through access to multidisciplinary teams of GPs, physiotherapists, nurses, pharmacists, podiatrists, physician associates and psychiatrists. NHS England commissions some specialist services for patients with rarer forms of EDS, and a service for patients who have complex EDS is delivered by centres in Sheffield and London. The “Getting it right first time” national specialty report on rheumatology, published in September 2021, has made important recommendations for rheumatology units to work more closely with primary care and achieve the properly joined-up care that I think we all want to see.

As my hon. Friend notes, patients with the condition frequently have other comorbidities, and the Government are committed to giving every patient proper joined-up care centred around them. That is why we announced last year that we will publish a major conditions strategy. The strategy will outline our approach to tackling six groups of major health conditions that contribute to 60% of morbidity in the UK by creating a health and care system focused on prevention, and proactive and person-centred management of health conditions.

The strategy will focus on the challenges, and on the changes that are needed to make the most significant difference across the six groups of major conditions. However, many of the solutions identified will be applicable beyond just those six major conditions to diseases like EDS. Aligning work across several groups of conditions for the strategy will allow us to focus on where there are similarities in approach and ensure care is better centred around the patient.

I thank my hon. Friend for bringing the matter to my attention. I also thank him and other hon. Members for their insightful contributions today. My door will always be open to him to hear how we can improve the lives of people living with EDS across the country. As I committed to earlier in the debate, I am happy to meet him and other campaigners to see how we can deliver an NHS that is faster, simpler and fairer for all.

Question put and agreed to.

Resolved,

That this House has considered the Major Conditions Strategy and people with Ehlers-Danlos syndrome and hypermobility spectrum disorders.

International Health Regulations

Andrew Stephenson Excerpts

Tuesday 14th May 2024 Commons Chamber

[Danny Kruger (Devizes) (Con)]

(Urgent Question): To ask the Secretary of State for Health and Social Care if she will make a statement on the ongoing negotiations on the World Health Organisation pandemic agreement and amendments to the international health regulations ahead of any votes at the World Health Assembly that starts next week.

[The Minister for Health and Secondary Care (Andrew Stephenson)]

I congratulate my hon. Friend on securing this urgent question, and I am grateful for the opportunity to update the House. I want to start by making three promises. First, the Government will only accept the accord and targeted amendments to the international health regulations if they are firmly in the United Kingdom’s national interest, and no text has yet been agreed. We will only accept the accord and amendments by the World Health Assembly and adopt them if it is firmly in the UK’s national interest to do so. Secondly, this Government will only sign up to measures that respect our national sovereignty. Thirdly, under no circumstances will we allow the WHO to have the power to mandate lockdowns. That would be unthinkable and has never been proposed. Protecting our sovereignty is a British red line.

Let me now dispel three myths about the negotiations. First, there is the myth that the negotiations are being led by the WHO. They are not being led by the WHO; they are entirely led by member states. Secondly, there is the idea that we would give away a fifth of our vaccines in the next pandemic. That is simply not true. Of course, we are a generous country and companies may make their own choices to donate vaccines, but that would be and should be entirely their decision. Countries are discussing a voluntary mechanism to which UK businesses could sign up, if they wish, to share vaccines in return for information they may need to develop their products.

The third point is about transparency. This is a point I take extremely seriously, as one who campaigned so hard for this Parliament’s sovereignty. It is not common practice for the Government to give an update on live negotiations, but I met some interested parliamentarians last week to discuss their concerns. I also had the pleasure of leading a Westminster Hall debate in December on these negotiations, which was attended by my hon. Friend and many others, and I will continue to meet him and other concerned parliamentarians as we act in the national interest. Effective agreements can help us to deliver smarter surveillance, swifter pathogen and data sharing, and faster development of pandemic vaccines, tests and treatments that would save lives and protect people both in the UK and around the world.

[Danny Kruger]

Can I say how much I appreciate the commitments that the Minister has just made? I want to acknowledge the good work that he and indeed his predecessors have been doing in Government ahead of the World Health Assembly that meets next week. I am very pleased to hear the commitments he has just made.

My concern is not with the Government’s position, but with the WHO itself. I appreciate the Minister’s point that member states are leading on these proposals, which is worrying in itself, but we know what the real agenda of the WHO is from the drafts that have been submitted in recent months. It wants to have binding powers over national Governments to introduce all sorts of restrictive measures on our citizens; it wants to be able to direct the health budgets of member states; and it wants to introduce global digital health passports and other measures.

The WHO is an organisation that aspires, in words that are still in the draft treaty, to be

“the directing and coordinating authority on international health work, including on pandemic prevention, preparedness and response”.

I appreciate that no text has yet been agreed, which is why it is important that we have a debate, but the proposals in the latest draft published last month are concerning enough. They require national Governments to agree to a whole series of commitments, which will be binding under international law if the UK signs up to them. These cover surveillance of the health of the population, commitments on funding both in the UK and abroad, emergency authorisation of new vaccines or speeded up authorisation processes, giving some vaccines to the WHO to distribute, potentially authorising national Governments to introduce the compulsory vaccination of travellers, and giving very wide discretion to the director general of the WHO to act on his own initiative.

The Government still have the opportunity to oppose the treaty and the regulations as they are currently drafted, and I appreciate that we are waiting to see the final text in the coming days, but can I ask the Minister to clarify very explicitly from the Dispatch Box what the Government’s red lines are? I heard what he said, but could he go a little further on the detail of what he means? Will the Government oppose any text that binds this or a future Government in how they respond to health threats? Finally and crucially, will the Government comply with the CRaG—Constitutional Reform and Governance Act—requirement to put the treaty to a ratification vote in Parliament?

[Andrew Stephenson]

I thank my hon. Friend for the constructive way in which he and other parliamentarians have engaged with this subject matter and the challenges it presents. As I said in my opening remarks, no text has yet been agreed. I set out some of our negotiating red lines, and I am happy to confirm from the Dispatch Box that the current text is not acceptable to us. Therefore, unless the current text is changed and refined, we will not be signing up to it.

My hon. Friend asks how the treaty will be ratified if we reach a position to which the UK Government could agree. The UK treaty-making process means that the accord is of course negotiated and agreed by the Government. As he will know, Parliament plays an important part in scrutinising treaties under the CRaG process and determining how international obligations should be reflected domestically. However, it is important to remember that, because the exact form of the accord has not yet been agreed, the parliamentary adoption process will depend on under which article of the WHO constitution the accord is adopted.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I call the shadow Minister.

--- Later in debate ---

[Andrew Gwynne (Denton and Reddish) (Lab)]

This country has a role and a responsibility in protecting global health. It is a part we played during the covid pandemic. British science stood tall on the world stage, and our country donated 84 million vaccine doses to help vaccinate the world. We learned from the omicron variant that, when it comes to global pandemics, none of us is safe until all of us are safe. We also benefited from researchers around the world sharing early knowledge about covid-19, collaboration that was crucial in protecting British people and ultimately in developing the vaccine. However, there is a clear principle when it comes to national security. It is the same one we follow when we get on to an aeroplane: we apply our own oxygen mask before we help others apply theirs. The Minister says the draft text is not acceptable, and I want to be clear that a Labour Government will not sign anything that would leave our population unprotected in the face of a novel disease.

We are debating a treaty that is still being negotiated by member states, and none of us knows the final content or wording, so can the Minister reconfirm for the House that the Government will not sign up to anything that would compromise the UK’s ability to take domestic decisions on national public health measures? Has he consulted the UK’s life sciences sector ahead of these negotiations, and what conversations has he had with international counterparts and our allies about this treaty and our joint pandemic preparedness? As we work with colleagues around the world to bolster our efforts to tackle novel threats, it is vital that we get the balance right between sharing knowledge and protecting intellectual property, so can he set out his approach to any requirements for time-limited waivers of intellectual property related to vaccines and therapeutics in the event of a global disease outbreak? Finally, it is vital that we are led by science and evidence when tackling the threat of global disease epidemics, so can the Minister tell us what his Department is doing to tackle misinformation about pandemics and vaccines?

[Andrew Stephenson]

I thank the shadow Minister for his remarks. I confirm that we are firmly fighting in Britain’s interests for an accord and strengthened international health regulations that fully respect national sovereignty but can save lives and protect people both in the UK and around the world. They have to fully respect national sovereignty, and that is at the heart of our negotiating position. It will therefore always be up to nation states to decide what is implemented within their own borders.

Just to answer a couple of the hon. Gentleman’s specific points, yes, I have met representatives of the life sciences sector to discuss this and some of the specific proposals—the last meeting we had was last week. With regard to dealing with international counterparts, I will be attending the World Health Assembly in Geneva myself.

My final point is that the hon. Gentleman is right to pay tribute to what this country did globally during the pandemic. Of course, in 2021 we used the G7 presidency to mobilise G7 countries to donate surplus vaccines, and by May 2022 the G7 had donated 1.18 billion doses against the target of 870 million. The UK alone donated over 80 million doses, benefiting 40 countries.

[Sir Liam Fox (North Somerset) (Con)]

We all want better co-ordination in the face of any future pandemic risk, but it is also clear that the WHO wants supranational powers. Will my right hon. Friend guarantee that the UK Government will not accept any obligation that requires the UK to legislate to implement any element of the WHO treaty into UK law?

[Andrew Stephenson]

At the moment we do not envisage any proposal that would require changes to domestic law, and it is highly unlikely that any proposals will come forward in that shape or form. I have some sympathy with what my right hon. Friend says: most organisations such as the WHO will always look to expand their remit, and look to gain more power in order to co-ordinate things. But these negotiations are being led by member states and sovereignty is a key part of the negotiating position of the vast majority of the countries involved. It is not just the UK arguing for this; countries around the world are arguing that this needs to be a high-level agreement that helps co-ordination and information-sharing but in no way ties countries’ hands in how we respond domestically to any future pandemic.

[Kirsty Blackman (Aberdeen North) (SNP)]

We cannot have a repeat of what the WHO called the catastrophic failure of the international community to ensure that covid-19 was fought everywhere with all of our abilities. It will require give and take, with give on the part of OECD countries commensurate with our comparative economic strength and population health. Although there may be disagreements across the House, I think we all agree that pandemics should be fought on an international basis and that other countries should be assisted, where we have the strength and ability to do that. Despite that level of agreement, there has been a persistent barrage of misinformation and disinformation, not least hitting our own inboxes. As negotiations on this proceed, what steps will the UK Government be taking to ensure that the public understand what the treaty will do and to tackle and robustly rebut the misinformation and disinformation that is being spread, particularly about this treaty?

[Andrew Stephenson]

The Scottish National party spokeswoman makes a very important point. There has been a lot of misinformation and disinformation, but that is in part the result of the transparency on all the amendments being published on the WHO website, for example, as well as various other information, which has allowed people to think that that is suddenly the kind of text that would be agreed. We need to be clear that no text whatsoever has been agreed; the negotiations continue. I think most people in this House, and hopefully outside, would recognise that the working draft text most recently published on the WHO website is a significant improvement on the initial drafts. I think we all share an ambition that we will get to a text that can be agreed, but it has to put national interests and national sovereignty at its heart. I will therefore do my best to ensure that the House is kept updated as further iterations of the text emerge—the latest version was published on the WHO website on 17 April.

[Will Quince (Colchester) (Con)]

As the Health Minister who represented the UK at last year’s World Health Assembly and the United Nations General Assembly, I stood at that Dispatch Box and confirmed that we would not sign up to any IHR amendment or any other instrument that would compromise the UK’s ability to make domestic decisions on national measures concerning public health. Can my right hon. Friend confirm that His Majesty’s Government’s position on this remains unchanged and resolute?

[Andrew Stephenson]

I pay tribute to my predecessor for the work he did. Let me reiterate that the UK Government have made it clear that we will not sign up to any accord or any changes in the international health regulations that would cede sovereignty to the WHO in making domestic decisions on national measures concerning public health, such as domestic immunisation programmes or lockdowns.

[Ian Paisley (North Antrim) (DUP)]

Can the Minister confirm that the WHO was slow to react to SARS—severe acute respiratory syndrome—was slow to react to the Ebola crisis, was slow to react to covid-19, and steadfastly refused to criticise in any way the Chinese regime throughout that period? That being the case, will he confirm again from the Dispatch Box that no outside organisation will ever be able to take any decision to do with the internal health and wellbeing of citizens of the United Kingdom of Great Britain and Northern Ireland?

[Andrew Stephenson]

One of the reasons why the WHO has in the past been slow to respond, and why it might be slow in future, is that it is a member state-led organisation governed by the World Health Assembly, which comprises 194 member states operating under the WHO constitution. Any decisions made by the WHO have to be agreed by all member states, including the UK, beforehand, and that does somewhat tie its hands. However, we and many like-minded countries believe that all these decisions are best made domestically depending on the domestic situation. The domestic situation in the UK will be radically different in any future pandemic from the domestic situation in other countries around the world. We have to work collaboratively on things like the sharing of data, but there are many other areas where it is 100 % right that decisions are made in this country by our Government.

[Sir Simon Clarke (Middlesbrough South and East Cleveland) (Con)]

I welcome confirmation from my right hon. Friend that the Government do not consider the current drafting of the proposed treaty to be acceptable; it is good to have that on the record. On a principles-led basis, I do not believe it is in the UK’s national interest to accede to this. Anything that compromises our ability to make sovereign choices is profoundly unwelcome. Can the Minister give a commitment that, regardless of the technicalities of the precise form that any treaty may finally emerge in, if the UK does decide to accede to this treaty, we will have a vote in this House? We can see, certainly on this side of the House—there is no presence on the Labour Benches—that there are real reservations about what this will mean in practice for our ability to make the right choices for our people.

[Andrew Stephenson]

I appreciate the point that my right hon. Friend makes. As I said in answer to an earlier question, because we do not know the exact form that the accord will take, at the moment it is very hard to say what the parliamentary procedure that flows out of it will be, but I certainly will provide any opportunity I can to facilitate as much debate as possible. He and I agree on many things, but here I would just say that, having looked at the detail, I genuinely believe that agreeing a meaningful accord is firmly in the UK’s national interest.

This accord is an opportunity to enhance UK health, economic and national security. An effective accord will improve disease surveillance and prevention by making sure that globally we have the information we need to raise the alarm early. It strengthens research and development to help stop pandemics in their tracks and enables a better co-ordinated global response to pandemics, including getting vaccines, treatments and tests rapidly to where they are needed most.

I genuinely believe that there is a window of opportunity here to get an accord that is in the UK’s national interest. We are not there yet—the current text is unacceptable—but we will keep negotiating, because I believe there is a window of opportunity here to agree something that is genuinely in the UK’s national interest. But if we cannot agree that, we will not sign it.

[Jonathan Edwards (Carmarthen East and Dinefwr) (Ind)]

Public health is devolved in the context of Wales, Scotland and Northern Ireland. Therefore, how often does the Minister engage with the devolved Governments on the UK Government’s negotiating positions in relation to these matters?

[Andrew Stephenson]

As the hon. Gentleman will know, international treaties are a matter for the UK Government, and therefore this is being negotiated by the UK Government. I was appointed as a Minister in the Department of Health back in November, but I am happy to reassure him that I do not see myself as purely the Minister for Health in England—I visited Wales very early on to meet some of the outstanding life sciences companies there, which are developing products that will benefit patients across the entire UK; I visited Northern Ireland to see some of the great universities and outstanding businesses there; and I also visited Scotland to meet Michael Matheson, the then Scottish Health Secretary, and also the University of Edinburgh and various other outstanding universities and businesses. So I very much see the Union, and the impact that everything has on the whole United Kingdom, as being central to these negotiations.

[Sir William Cash (Stone) (Con)]

May I congratulate my hon. Friend the Member for Devizes (Danny Kruger) on securing this urgent question? I also congratulate those on the Government Benches—I note that there is no one on the Opposition Benches, apart from the shadow Minister—for addressing the question of whether any meaningful accord is possible. Supranationality has to be out, as I have said on countless occasions, when it is not in our national interest. Sovereignty has to prevail. I remind the Minister of the regulation brought in by the EU at the time of covid, which had to be abandoned because we put our foot down and said that we would not accept its restrictions on our ability to produce the vaccine. That is a good example. Will he please follow it and make sure we do not have any weasel words?

--- Later in debate ---

[Andrew Stephenson]

I thank my hon. Friend for his passionate and pertinent point. Throughout the negotiations the UK has made it clear—and we will continue to do so—that we will not sign up to any accord that fails to meet our global health and UK health security priorities. Likewise, the UK would not sign up to an accord that cedes sovereignty to the WHO over domestic decisions on national measures concerning public health, such as immunisation programmes or lockdowns. Any necessary or appropriate changes to domestic legislation or new domestic legislation would be made through the usual parliamentary process. However, because we do not yet know the exact details of the accord, I cannot be any clearer on how exactly Parliament will get to scrutinise the accord, if we get to an agreement.

[Sammy Wilson (East Antrim) (DUP)]

The treaty is not just about data sharing and information gathering; it is also about setting up a system of pandemic management under the leadership of the WHO. It has a poor history of management and decision making. Can the Minister give us an assurance that he will not accept any surrendering of UK powers to an international body that can interfere with decisions that will affect the lives of ordinary people here in the United Kingdom? I listened to his response about devolved Governments, and it seems there has not been much discussion with the devolved Administrations. He will not even guarantee a vote in this House on such an important issue. Can he guarantee that we will not undemocratically hand over democratic control to a non-democratic body?

[Andrew Stephenson]

We will not be handing over any kind of control over what we do domestically; national sovereignty is a clear red line, as I made clear in my opening remarks. It is important to recognise that there are challenges with these things, which are being negotiated within the existing international health regulations. The director general of the World Health Organisation already has the ability to declare a public health event of international concern and issue temporary recommendations that provide non-binding guidance to member states. We believe that we need to stay in a situation where the World Health Organisation has an important convening role internationally to discuss issues, but the domestic response to any future pandemic is for domestic Governments to make. Anything that impinges on UK national sovereignty will therefore be unacceptable to us.

[Suella Braverman (Fareham) (Con)]

I want to put on the record my thanks to the Minister for his hard work and for taking the time last week to meet me and colleagues to discuss the terms of this treaty. He will know that I am profoundly sceptical about the World Health Organisation’s ability to manage a global pandemic, in the light of serious errors of judgment, poor leadership and, I am afraid, well-chronicled conflicts of interest that have subsequently emerged. Of course we can help poorer countries and collaborate with other nations, but under no circumstances must we surrender our sovereignty or sign up to a lockdown charter. I hear what he says about how the text currently on the table does not bind our hands, but he will know, as many of us do, that in the heat of an emergency during a real pandemic, irresistible pressure will mount on a Government to make decisions that may well turn out to be wholly harmful, as we found, and the wrong decisions for the good of the country. Will he agree that, fundamentally, to coin a phrase, no pandemic treaty is better than a bad pandemic treaty?

[Andrew Stephenson]

I 100% agree with my right hon. and learned Friend that no treaty is better than a bad treaty. However, if we scroll back to why this process was originally started, it was the former Member for Uxbridge and South Ruislip who led the international calls for this accord. The reason behind it is that we believe that commitments on stronger international collaboration and co-operation on global health are crucial to securing the UK’s health and economic security. However, domestic decisions still have to be left to sovereign nation states to take the right decisions for their countries. I think there is a lot of agreement between my right hon. and learned Friend and me, and I thank her once again for engaging in such constructive fashion and for meeting me to express her and other parliamentarians’ views.

[Stephen Farry (North Down) (Alliance)]

I concur that any new treaty has to be right for the UK. Will the Minister reflect on the meaning of the word “pandemic”, which suggests an element of international spread of disease or a global problem? For the sake of balance in this urgent question, will he emphasise the importance of the UK working collaboratively on an intergovernmental basis with others in how they react to pandemics with restrictions on travel and global vaccine equity? As long as the world is safe, the UK is also safe.

[Andrew Stephenson]

The hon. Gentleman makes an important point. I talked about the leadership shown by the UK Government when we had the G7 presidency back in 2021. In addition to the UK supplying vaccines around the world, as of 2022, an estimated 2.7 million covid-19 deaths had been prevented due to the COVAX-supported vaccination programmes in different countries around the world. We need to work internationally. Sharing data can head off future pandemics, and a good accord would deliver the data sharing and collaboration that can prevent future health emergencies, rather than tie the hands of domestic Governments in responding appropriately to such emergencies.

[Sir Mike Penning (Hemel Hempstead) (Con)]

May I say on behalf of the volunteers and others in the vaccination centres around the country during the pandemic, which I had the honour of working in, that the key is that vaccines are available to us before we give them to anyone else in the world? I am listening to what the Minister is saying, but does he agree that collaboration does not mean compulsion in any way or form?

[Andrew Stephenson]

As a volunteer vaccinator during the pandemic, I 100% agree with my right hon. Friend. We have to look after our own people—our own citizens; the people we are elected to represent—first. We are investing heavily in the British life sciences sector to ensure that it is even more prepared for any future pandemic. We are ensuring that we have more domestic manufacturing capability, so that we can have more vaccines ourselves without being reliant on other countries. However, at the point where a new pandemic is emerging in a part of a world far from our shores, we still need to ensure that the data—particularly the pathogen data—is shared early, so that world-beating British companies, whether the tiny life sciences start-ups or the big pharmaceutical companies, can use it to produce the drugs that will hopefully ensure that it does not become a full-blown pandemic and does not cost as many lives as the last one.

[Andrew Bridgen (North West Leicestershire) (Ind)]

I start by congratulating the hon. Member for Devizes (Danny Kruger) on his timing of this important urgent question. Repeatedly during this session, the Minister has stated that we do not really know what shape the pandemic agreement, accord or treaty will take. Under paragraph 2 of article 55 of the international health regulations, all member states must have a full draft of the amendments to treaties to be voted on four months in advance. Despite the fact that the WHO is breaking its own rules, it is insisting on moving forward with the votes in Geneva on 27 May on the pandemic treaty and the amendments to the international health regulations. Will the Minister join me and many others in calling for a deferment of those votes until this House and others around the world have had a chance to examine these important details?

[Andrew Stephenson]

No, because there is no text that has been agreed. This has been evolving: we have seen new amendments and new, revised drafts. The latest negotiations on the accord took place on 29 April to 10 May and the next round of negotiations will take place on 16 and 17 May and continue on 20 to 25 May, leading up to the World Health Assembly meeting taking place in Geneva on 27 May to 1 June. There has been a lot of progress in getting a text that is more agreeable to a majority of member states, but we are still some way off getting to a text that can be agreed. We are hoping for significant changes in the coming days, and I will do my best to keep the House updated.

[Richard Drax (South Dorset) (Con)]

May I firmly tell the Minister that the road to hell is paved with good intentions? I do not trust bureaucracies, and I certainly do not trust this one. Judging by the way in which it behaved last time, with its instinct to lock us all down—we have seen huge damage from that to every part of our national infrastructure—I suspect that the tendency will be to do the same again, to our detriment. Will the Minister reassure me—he has done so already, but I want to hear it again—that he will, in effect, not sign anything? We do not need to sign something to collaborate with other nations for their good as well as for the good of our own country.

[Andrew Stephenson]

I happily reassure my hon. Friend that national sovereignty comes first. We will continue to do everything that we can to ensure that we get an accord that is agreeable, but if the accord would undermine our sovereignty and our ability to act domestically in any way, we will simply not sign it.

[Jim Shannon (Strangford) (DUP)]

I have been contacted by a large number of constituents who have voiced grave concerns about the powers and rights requested and required by this unelected body. While we may support some of the work carried out to help developing countries, I will not sign away the sovereignty of this nation. Our participation in the WHO should not come with a prerequisite of signing up to these demands. Further, if that is the case, we should no longer be a participating member of the WHO.

--- Later in debate ---

[Andrew Stephenson]

Just to reiterate my point, the Government will only accept the accord and targeted amendments to the international health regulations if they are firmly in the United Kingdom’s national interest, and no text has yet been agreed. We continue the negotiations, and I will do my best to keep right hon. and hon. Members as informed as I can without providing a running commentary on the negotiations, but I genuinely believe that we can get to a position where there is an accord that is in the UK national interest.

[Sir John Redwood (Wokingham) (Con)]

Will the Minister then publish the amendments that the Government are seeking? He says, rightly, that he needs a very different treaty from the one that we see on offer. He needs to persuade other nations, so he should be making a public case; we would then not be so suspicious. There must be no new legal requirement imposed on the United Kingdom.

[Andrew Stephenson]

We do not envisage any new legal requirements being imposed on the United Kingdom, and any changes to our domestic ability to react to any future pandemic would be unacceptable and cross one of our red lines. In this urgent question and in the Westminster Hall debate, which I know my right hon. Friend also participated in, I was as clear as I could be on the UK’s red lines in these negotiations. We have been up front with both Parliament and our international partners in saying that the current text is not agreeable to us, and we are seeking significant changes if we are to reach an accord that will be signed by the United Kingdom.

[Mr Mark Francois (Rayleigh and Wickford) (Con)]

I, too, participated in that Westminster Hall debate. For the record, this urgent question has been running for well over half an hour, during which not a single Labour Back Bencher has been present in the Chamber, let alone asked a question, even though we are discussing, in effect, the medical sovereignty of the United Kingdom.

As there are a lot of Conservatives in the Chamber, may I say to the Minister that we would probably be better not signing this treaty at all? That is not least because many of us have concerns about malign influences on the WHO. If we were to sign it, although I would rather that we did not, will the Minister give us a cast-iron commitment that we will have a vote—dare I say, a meaningful vote—on it in this House before it comes into force?

[Andrew Stephenson]

I thank my right hon. Friend for his powerful point, which I think once again underlines that you can only trust the Conservatives with the NHS. As I have said in answer to a couple of questions, unfortunately, because we do not know the form that the treaty will take, it is hard to set out the parliamentary process for its adoption. There are different parliamentary processes depending on the form that it takes. I make the personal commitment to him that I will do everything that I can to engage the House, but at this point I cannot specify the procedure and processes that would be followed in the House or whether there would be a vote.

[Mr Philip Hollobone (Kettering) (Con)]

I thank my hon. Friend the Member for Devizes (Danny Kruger) for securing the urgent question and Mr Speaker for granting it.

The World Health Organisation is a failing, mega-expensive, unelected, unaccountable supranational body, which is increasingly under the influence of the global elite, funded by a small number of non-state actors, and China is a malign influence over it. Surely the initial drafts of this treaty must have set alarm bells ringing even in Whitehall at this attempted power grab. May I urge the Minister not to sign the treaty? We can have enhanced co-operation and collaboration to counter future pandemics without legally binding commitments.

[Andrew Stephenson]

I would argue that WHO membership gives the UK a seat at the table in global health discussions, allowing us to amplify UK priorities at an international level. There are 194 member states. If we can agree a high-level treaty that does not impinge on our national sovereignty via the negotiation between the 194 member states, I think that will be a good outcome, and a better outcome than trying to negotiate individual agreements with all 194 member states.

[Tom Hunt (Ipswich) (Con)]

I say to my right hon. Friend the Member for Rayleigh and Wickford (Mr Francois) that it is hardly surprising that a debate that largely hinges on national sovereignty is of little interest to the Labour party.

The principle of national democracy is incredibly important to me, many of my constituents and other people in this place. I am absolutely pro-collaboration, but that needs to be done through the national principle, and nothing must be done that undermines the national principle. This debate keeps on returning—we thought that it would end with Brexit, but it did not; it is now going on with the European convention on human rights and the WHO. Will the Minister confirm that, yes, we are pro-collaboration and co-operation, but that when it comes to national sovereignty we should always oppose supranationalism and the worst excesses of globalism?

[Andrew Stephenson]

The UK Government have been clear that we will not sign up to an accord or any international health regulation amendments that would cede sovereignty to the WHO in making domestic decisions on national measures concerning public health, such as domestic immunisation programmes or lockdowns. Respecting national sovereignty rights is a distinct principle in the current draft of the accord, and respecting the sovereign rights of states to adopt, legislate and implement legislation within their jurisdictions remains a distinct principle in the drafted amendments to the IHR. I genuinely believe that there is a window of opportunity to negotiate an accord that is in the UK national interest as well as in the global interest.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I thank the Minister for answering the urgent question.

World ME Day

Andrew Stephenson Excerpts

Wednesday 1st May 2024 Westminster Hall

[The Minister for Health and Secondary Care (Andrew Stephenson)]

It is a pleasure to serve under your chairmanship, Dame Siobhain. I pay tribute to my right hon. Friend the Member for Bromsgrove (Sir Sajid Javid) for bringing forward such an important debate ahead of World ME Day on 12 May. As Health Secretary, he laid the foundations for our cross-Government delivery plan, and from the Back Benches he has been a tireless champion for people living with ME. I join him in welcoming his cousin to the House today. I also pay tribute to the ME Association, Action for ME, Forward ME and many other outstanding charities that do incredible work in this area.

I thank the right hon. Members for Barking (Dame Margaret Hodge) and for Hayes and Harlington (John McDonnell), my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes), my hon. Friend the Member for Devizes (Danny Kruger), the hon. Members for North Shropshire (Helen Morgan), for Putney (Fleur Anderson) and for Strangford (Jim Shannon), the SNP spokeswoman—the hon. Member for Glasgow North West (Carol Monaghan)—and the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), for their thoughtful contributions. I particularly pay tribute to the SNP spokeswoman for the work she has done on the APPG, and to the shadow Minister for coming here today despite his own health challenges.

I will do my best to address as many of the points raised as possible in the time allowed. To start, I will address one of the points made by the right hon. Member for Barking. This is very much a cross-Government piece of work. I will be working very closely particularly with the Department for Education, and others, to ensure that we get this right. It is correct that this is a Health lead, but it is right that it is a cross-Government piece of work.

ME, or chronic fatigue syndrome, is a complex medical condition with a wide array of symptoms. Some people with ME struggle to do even the most basic things that we all take for granted, such as going to the office, seeing a GP, or even taking their children to football. This debate comes at a critical time, as new studies are beginning to pinpoint parts of the brain that affect the condition. A recent report has shown the yearly cost to the UK economy could be above £3 billion. While our understanding is improving, people with ME must receive the right care and support to manage their symptoms and, where possible, to be able to move on with their lives.

Sadly, as my right hon. Friend the Member for Bromsgrove (Sir Sajid Javid) has so eloquently set out today, there has been a real lack of awareness among some medical professionals and the wider public, as also highlighted by my hon. Friend the Member for Devizes and the right hon. Member for Hayes and Harlington. For so long, people were dismissed, ignored or even told their symptoms were all in their head. However, as anyone who lives with ME knows, it is so much more than just feeling very tired; for a quarter of sufferers with severe symptoms, it is truly debilitating.

This is why our delivery plan is vital. As my right hon. Friend the Member for Bromsgrove knows, it has two core principles at its heart. First, we must know more about ME if we are able to improve outcomes. Secondly, we must trust and listen to people with ME to improve their experience. That is why the Government published the interim delivery plan last August, proposing a set of actions on research and education, but also tackling those old attitudes and adapting the language we use to describe the condition. Since then, we have consulted on the interim delivery plan to understand where the plan is strong and where we need to go further. I would like to thank the more than 3,000 people and organisations right across the United Kingdom who took part.

As we speak, officials are analysing thousands of responses and we will publish a summary shortly. These responses will be instrumental in developing the final cross-Government delivery plan, which will be published later this year. I completely understand my right hon. Friend’s frustrations, and he makes a powerful case for publishing the plan before the summer. While I cannot make that commitment at this time, I have assured him privately, and I will do so again today publicly, that I will do all in my power to ensure that the plan is published as soon as possible.

Our consultation had a huge response, which is fantastic, as we wanted the broadest range of voices to inform how we shape the plan, but the responses have also shown just how complex the challenges are. Once we have published our response to the consultation in the spring, it is vital that we go back and work very closely with patient groups to finesse the final plan, which could take some time.

As my right hon. Friend has said, people with ME have for too long been ignored and dismissed. That is why we want to take the time to properly understand the challenges they face and listen to the solutions they propose. It is so important that we get this right. I have heard my right hon. Friend, and I will continue to work hard with officials to come up with a plan that delivers for people with ME as soon as possible.

[John McDonnell]

It would be really helpful if the Minister could write to us about the areas that require the finessing for the eventual final plan.

[Andrew Stephenson]

I am happy to provide an update to Members. I hope that when we provide the summary of the 3,000-plus responses, it will shine a real clear light on that, but I am more than happy to write to everyone who has engaged in today’s debate to provide an update, and perhaps to address any points that I am not able to in the time allowed.

Patients can receive the care they deserve only with timely and accurate diagnosis. Sadly, there is no specific test for ME, which can be challenging to diagnose as it shares some symptoms with other conditions, as set out by the shadow Minister. That is why in 2021 the National Institute for Health and Care Excellence published the new guidelines on the management of ME that several Members mentioned. That was a step forward in helping medical professionals understand the condition so that people could be diagnosed as soon as possible. It also set out best practice for healthcare professionals in the management of ME, and the care and support they should offer patients.

[Carol Monaghan]

Given that we have heard that many health trusts are not implementing the new guidelines, can the Minister or his Department undertake to write to health boards to remind them that they are in place?

[Andrew Stephenson]

I completely understand the frustration that was raised by the hon. Member for North Shropshire and others about the lack of implementation. At the moment, we and NHS England are working hard to understand the barriers to the full implementation of the guidelines. They should have been fully implemented but we acknowledge that they have not. It is so important that we get this plan over the line because the final delivery plan will, without doubt, underline the need to follow NICE guidelines. That will be underpinned by e-learning from the Department on the development of new medical professionals and other initiatives that have been taken as part of the plan. I am keen for that to be looked at. I will now turn to medical training, but I will finally say that the NICE guidelines should be followed, and we are trying to understand why that has sadly not been the case in all too many trusts.

The new guidelines, while important by themselves, must come with a broader cultural shift across the NHS. That is why we have been working with NHS England to develop an e-learning course for health professionals, which they themselves have helped to develop, alongside charities and people living with ME. The Medical Schools Council will promote the course to every medical school in the country, while encouraging schools to take students to meet patients who suffer from ME face to face to help bust some of the myths around the condition.

I want to end by saying a few words about the future. I strongly agree with my right hon. Friend the Member for Bromsgrove on the importance of research. As he knows, the Government are funding research into ME through the National Institute for Health and Care Research and the Medical Research Council. As he kindly mentioned, those institutions came together to fund DecodeME, the world’s largest genome-wide association study of the condition, which was also mentioned by the hon. Member for Putney. We are backing the study with over £3 million to analyse the samples from 25,000 people in the search for genetic differences that may indicate an underlying cause for the increased risk of developing the condition.

The study is already generating key insights. For example, while it has long been known that women are more susceptible to the condition, the DecodeME study has shown for the first time how their experience differs from that of men. I am happy to provide my right hon. Friend the Member for Romsey and Southampton North with the assurance that not only will we do everything to get the plan over the line as quickly as possible, but I will work with people such as the chief scientific adviser, Professor Lucy Chappell, to eradicate the gender bias in research.

Genomics is already revolutionising the way we diagnose and treat a range of conditions, solving riddles for diseases that were mysteries just 10 years ago. By improving understanding, investing in research and implementing our delivery plan, we will go further and faster in the years ahead. I know there is much to do. I will end by paying tribute to my right hon. Friend the Member for Bromsgrove for everything he has done on the matter. I will continue to work with him and other hon. and right hon. Members to ensure we get this right.

Question put and agreed to.

Resolved,

That this House has considered World ME Day.

Preventable Sight Loss

Andrew Stephenson Excerpts

Tuesday 30th April 2024 Westminster Hall

[The Minister for Health and Secondary Care (Andrew Stephenson)]

It is always a pleasure to see a fellow Lancastrian in the Chair, Sir Mark. I thank the hon. Member for Wirral West (Margaret Greenwood) for bringing forward the debate. This is the second debate today on eye health to which I am responding on behalf of the Under-Secretary of State for Health and Social Care, my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom), who has been busy in the Tobacco and Vapes Bill Committee. I also thank those who contributed to the debate—the right hon. Member for Hayes and Harlington (John McDonnell), the hon. Member for Aberdeen North (Kirsty Blackman) and the shadow Minister, the hon. Member for Birmingham, Edgbaston (Preet Kaur Gill)—for their thoughtful contributions.

Preventing sight loss remains one of my right hon. Friend’s top priorities, and it is right that we should dedicate parliamentary time to this important issue. Losing one’s eyesight can be devastating, and I want to pay tribute to some of the charities that I did not have time to mention in this morning’s debate—Fight for Sight, the Vision Foundation and Sightsavers, to name just a few more.

About 2 million people live with sight loss in our country. That number is projected to double by 2050, mainly because of our ageing population. We are doing a huge amount to reduce the number, through preventive measures and early detection. One of the best ways to protect eyesight is through regular sight tests. That point was made eloquently by the hon. Member for Aberdeen North, and I am pleased to confirm to her that I am having my next eye test tomorrow morning.

This debate is why the NHS invests more than £500 million every year on free eye tests for people on benefits, people over 60, and people at risk of serious conditions. That investment delivered more than 12 million NHS sight tests to those groups between 2022 and 2023, and extensive discounts on glasses and contact lenses for children and people on income-related benefits, through NHS optical vouchers.

We have also taken great strides in preventing some of the causes of sight loss, including smoking and obesity. As I mentioned at the start, my right hon. Friend the Member for South Northamptonshire is taking our landmark Tobacco and Vapes Bill through the House, and we are backing quit-smoking campaigns with unprecedented funding and support.

On obesity, we have taken a raft of measures on sugar reduction and healthy eating. We have made strong progress in reducing the average sugar content in soft drinks through the soft drinks levy, and almost halved their sugar content between 2015 and 2019. For two years, we have also been restricting the placement of less-healthy products in shops and online, thereby helping consumers to make healthier choices.

Our wider prevention work goes hand in hand with our efforts to catch eye problems early. Glaucoma—which was covered in the debate this morning—and diabetic retinopathy are two of the main causes of preventable sight losses, and both can cause blindness if left untreated. That is why we are offering screening tests to nearly 4 million patients with diabetes at least once every two years. Since 2010, the number of adults between 16 and 64 who became visually impaired from diabetic retinopathy fell by almost a fifth. Our approach has been commended by the World Health Organisation, and we will build on that progress. In October, we begin phasing in optical coherence tomography scans as part of the screening programme, to reduce unnecessary referrals to hospital eye services and improve the quality of the service overall.

It is vital for patients who need to be in secondary care to have access to timely diagnosis and treatment. That is why we have set ambitious targets to recover services that suffered over the pandemic, through our elective recovery plan, which is backed by more than £8 billion of funding, and why we have expanded surgical hubs and harnessed capacity in the independent sector so that more patients can be seen more quickly. Our plan is working and it is delivering results. Waiting times are falling. The number of patients waiting 78 weeks or longer for ophthalmology treatment has reduced by 96% since its peak. But we know we have much further to go.

While we work to recover from the pandemic, we are reforming eye care services to be fit for the future. NHS England’s transformation programme is currently funding seven projects across each ICS area, testing how improved IT links between primary and secondary care could allow patients to be assessed and triaged virtually. Where appropriate, that would keep patients out of hospital, freeing up hospital eye-service capacity for those who need specialist care the most.

The initiatives have shown promising results. For example, the project in North Central London ICS has improved the flow of information from community optometry to Moorfields Eye Hospital, reducing the triage time from 11 days down to one. The appropriate use of clinics has doubled to more than 70% and reduced the waiting time for first appointments by up to 35 days. NHS England is now using the data from the projects to build the case for a wider roll-out.

[Kirsty Blackman]

I appreciate what the Minister is doing in this policy area. Some of the initiatives he just mentioned, such as electronic assessments and triaging electronically, were put in place in Scotland seven years ago. We decided that they were working and that we would roll them out. Has he spoken to Scottish colleagues and looked at the work done in Scotland in order to ensure that the Government do not have to replicate the same pilots that we have proven do work, so that people can get treatment and things can be put in place more quickly?

--- Later in debate ---

[Andrew Stephenson]

As a proud Unionist, I am always happy to learn from different parts of the United Kingdom. After I was appointed to my role, one of the first things I did was to go to Edinburgh and visit various universities and companies across Scotland, and I saw some of the great work going on in Scotland. I also met the then Health Secretary, Michael Matheson, to talk about areas where we can work together, particularly on things such as research. However, we can also trial different things in different parts of the country. Many people in this House talk about regional variations, which can be a concern. Nevertheless, one of the benefits of being able to trial different things in different regions is that we can learn the lessons, learn what works and then build on that best practice.

As well as helping our primary and secondary care sectors to reach their full potential, we have a long-term plan in place to support our workforce and put it on a sustainable footing, which is the first ever long-term workforce plan for the NHS. We have again increased training places for ophthalmologists in 2024 and improved training for existing staff, helping them to deliver for patients while reaching their full potential.

The right hon. Member for Hayes and Harlington raised what sounded like a very important and serious issue. He will forgive me for saying that this area is not my specialist subject, but I am happy to raise his concerns with my right hon. Friend the Member for South Northamptonshire. However, I will say now, in response to his comments on laser eye surgery, that refractive laser eye surgery is not generally available on the NHS. Doctors who perform such surgery must be registered with the General Medical Council and the Care Quality Commission. All locations where refractive eye surgery is carried out should be monitored and are required to report any adverse events. As I say, I will be happy to relay his concerns to my right hon. Friend.

[John McDonnell]

I appreciate the Minister’s response; that is really helpful. It would also be useful if a Minister met some of the families who have experienced issues in this area, because over the last 20 years we have had the same ministerial response with regard to regulation, and there have just been too many examples where that regulation and monitoring have not worked and therefore people have been endangered. That is why in the Government’s own report Professor Sir Bruce Keogh recommended further regulation; I think we need to revisit that.

[Andrew Stephenson]

I thank the right hon. Gentleman for making those points. I am not instinctively anti-regulation; indeed, just a few weeks ago I put through this place the statutory instrument on the regulation of physician associates and anaesthetist associates. There are certain parts of the healthcare sector where regulation is very much needed and I would very much advocate for it. As I have said, I will defer to my right hon. Friend the Member for South Northamptonshire. This is her ministerial responsibility, and I am sure she will read the right hon. Gentleman’s comments with interest and may want to take the discussions further.

Finally, on research, the Government are backing scientists and researchers to take strides in understanding sight loss and in making new treatments available. Two years ago, we awarded £20 million to Moorfields Biomedical Research Centre to undertake another five years of vision research, and almost £6.5 million to Moorfields Clinical Research Facility to support cutting-edge treatments for all eye conditions.

Eye care services face challenges and we are taking decisive action to address them, both now and in the long term. The hon. Member for Wirral West and I will never agree on the use of the independent sector. I strongly believe, and think the Labour Front Bench team strongly agrees, that using the independent sector enables us to fully realise our healthcare system’s capacity and to reduce the time that patients spend on waiting lists. I would argue that that does not represent any move to privatise our NHS. As I have said on the record before, the overall proportion of NHS England’s spend on independent sector providers has not increased significantly in recent years. In 2013-14, 6.1% of total health spending was spent on the purchase of healthcare from independent sector providers; in 2022-23, the proportion was 6.5%.

This morning, the shadow Minister in the first Westminster Hall debate, the hon. Member for Denton and Reddish (Andrew Gwynne), talked about making better use of the independent sector to help to ensure that we deliver the best outcomes for patients, and the shadow Minister in this debate, the hon. Member for Birmingham, Edgbaston, reiterated that point. On the use of the independent sector, then, I gently say that it is something on which there is broad cross-party support. While recognising that there are always challenges with the use of the independent sector, it is not in any way a privatisation of the NHS.

I firmly believe that through prevention, innovation and investment in our workforce, we will deliver for all our people across the United Kingdom access to the important healthcare services, including ophthalmology services, that they deserve.

[Sir Mark Hendrick (in the Chair)]

I call Margaret Greenwood to wind up the debate.

Glaucoma and Community Optometry

Andrew Stephenson Excerpts

Tuesday 30th April 2024 Westminster Hall

[The Minister for Health and Secondary Care (Andrew Stephenson)]

It is always a pleasure to see you in the chair, Dame Caroline. Can I start by thanking the hon. Member for Strangford (Jim Shannon) for raising the importance of eye health to the wellbeing of people across our United Kingdom. No Westminster Hall debate is the same without him. I also thank the hon. Member for East Londonderry (Mr Campbell), and the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), for their contributions.

Losing one’s eyesight can be devastating. I pay tribute to the charities that have done so much to help people living with glaucoma, or which are researching a cure: Glaucoma UK, the Glaucoma Foundation and the Royal National Institute for Blind People to name just a few. This morning, we are focusing on glaucoma and the role that can be played by community optometry. This afternoon, there will be a debate on the broader issue of preventable sight loss. I am responding to both debates on behalf of my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom), who is the Minister responsible for primary and secondary eye care services. She is otherwise engaged, as she is a member of the Tobacco and Vapes Bill Committee. I know she would want me to put it on the record and reassure Members throughout the House that that remains one of her top priorities.

As I am standing in today, I want to reassure Members that this is a subject close to my own heart. Glaucoma affected several people on my father’s side of the family—my great aunt, Emily Stephenson, lost her eyesight in her 60s because of glaucoma. I remember visiting her as a child and seeing the RNIB talking book cassette tapes, which she loved, and I am delighted that that service continues today in more formats and with more titles than ever before. My mother, too, lives with glaucoma, so I take this issue very seriously.

Up and down the country, community optometry plays an essential role in protecting people’s eye health. It also plays a key role in the early detection of glaucoma, as most glaucoma patients are identified through routine sight tests. Glaucoma cannot be felt—it does not cause any symptoms, and the eye pressure does not cause any pain. That is why regular sight tests are essential, so that problems such as glaucoma can be diagnosed and treated as early as possible.

As the hon. Member for Strangford suggested, everyone should have a sight test every two years. The NHS invests over £500 million every year in providing sight tests and optical vouchers. Between 2022 and 2023, we delivered over 12 million NHS sight tests free of charge. The tests are widely available for millions of people and the budget is entirely demand led, meaning that there is no cap on how many we will provide. We understand that some people may not prioritise sight tests compared with other healthcare, or they might not know that eye tests are recommended every two years. That is why we are always looking for opportunities to remind the public to have a test, through social media and other campaigns. Sight-test providers such as Specsavers and others on the high street display information about NHS sight-test eligibility.

We are committed to making greater use of community optometry to help to alleviate pressures in secondary care. Many integrated care boards are already commissioning a greater range of services on the high street, including minor and urgent eye care services, pre and post-cataract checks, and glaucoma referral filtering and glaucoma monitoring.

Glaucoma referral filtering schemes have delivered fantastic results, with additional tests that double-check whether a patient really needs to be referred to secondary care. These are tried-and-tested schemes that can save patients time and worry while freeing up space for those who most need specialist attention in hospital. Devon is a great example of that. An old Nightingale ward has been repurposed with equipment to screen large numbers of glaucoma and medical retina patients. The diagnostics hub has demolished the hospital’s backlog from just under 4,000 in April 2022 to just below 500 in October 2023—almost a 90% decrease. In Milton Keynes, 70% of suspected glaucoma patients were discharged following refinement of initial referrals made on the high street. About 50% of integrated care boards currently have a version of those schemes in place, and we are assessing the potential for encouraging the roll-out of those schemes even further.

It is vital that patients who need secondary care have access to timely diagnosis and any necessary clinical treatment. The hon. Member for Strangford is right to say that those services suffered during the pandemic, just as they have across the NHS. That is why we have set an ambitious target to recover services through the elective recovery plan, supported by more than £8 billion of dedicated funding, and it is why we have expanded surgical hubs and harnessed the capacity of the independent sector, so that more patients can be seen more quickly. That has been particularly successful for cataract surgery.

Our plan is working and it is delivering results, as waiting times are falling. The number of patients waiting 78 weeks or longer for ophthalmology has been reduced by 96% since its peak, but we know that we have to go further. As well as cutting waiting lists today, we are looking at how we can reform eye care services to meet the demands of tomorrow. NHS England’s transformation programme is running seven projects across each integrated care system area, such as those that test how improving IT links between primary and secondary care could allow patients to be assessed and triaged virtually, saving them time and freeing up more hospital capacity for patients who need specialist face-to-face care the most. NHS England is gathering data and evaluating different interventions, looking to develop a convincing case on what works best and supporting further expansion.

We are going further and faster to free up hospital capacity. Today, many glaucoma patients often have their condition managed in hospital, but in some cases, where clinically appropriate, there is no reason why they cannot be seen somewhere else in their community that is more convenient for them. In England, it is up to ICBs to commission services based on local need, and some ICBs are already trying new ways of working to do just that.

Finally, on research, I want to recognise just how much potential there is for research and innovation to change the lives both of people who suffer from sight loss and of their families. The UK leads the world in research; we could not be more committed to pioneering new treatments and improving our understanding of sight loss. We put our money where our mouth is by awarding the Moorfields Biomedical Research Centre £20 million to carry out another five years of world-leading research in December 2022. Thirteen out of the 100 leaders and innovators in ophthalmology across the world who were included in The Ophthalmologist’s “Power List 2023” were researchers from Moorfields, and we should be proud that that centre of excellence is right here in London.

[Jim Shannon]

I thank the Minister for his very positive and helpful response. The shadow Minister referred to ophthalmology services increasing by 40% over the next 20 years—those figures might not be entirely accurate, but I think that is what he said. That certainly indicates to me that we need to have a progressive and active programme to ensure that people can get tests in partnership with opticians. The Minister mentioned ICBs and how that will be done; I say this respectfully, but can we have some meat on the bones as to how that would work? I am ever mindful that the Minister wants to see that, but we wish to see that as well.

[Andrew Stephenson]

NHS England is looking at a range of different interventions across the country. One of the benefits we have across England, and of course across the United Kingdom, is that we can try different things, such as models of delivery, in different parts of the United Kingdom and learn lessons from one another.

The current strategy pursued by the NHS is to look at different programmes across England and evaluate them to see what delivers the best outcomes for patients. That will help us to improve access for patients and deliver quality treatment. We hope that that evaluation will enable us to suggest best practice. It will still be up to ICBs to commission services—we believe they should be commissioned locally—but we hope that by providing an evidence base for them they can take decisions in the best interests of their local communities. To address the point made by the shadow Minister, that will address the growing demand for services. We recognise the fact that there will be more demand in the years to come. It will also help to address some of the backlogs with which we have struggled since the pandemic.

I hope I have said a few things to convince the hon. Member for Strangford that, while we still have much to learn from Northern Ireland, the Government take glaucoma extremely seriously. Community optometry is helping us manage the flow of glaucoma patients and it is already deployed effectively in many areas across the country to support patients.

We should be under no illusion about how many people watch Parliamentlive.tv. I think it was Stanley Baldwin who once said that the best way to keep a state secret was to announce it on the Floor of the House of Commons. Nevertheless, I wish to end with an appeal to anyone watching this debate at home: remember to take an eye test and please check the NHS website to see whether you are eligible for help. In preparing for today’s debate, I decided to do just that and I will be having my eyes tested tomorrow morning.

[Dame Caroline Dinenage (in the Chair)]

That is good to know; thank you very much. I call Jim Shannon to wind up the debate.

Oral Answers to Questions

Andrew Stephenson Excerpts

Tuesday 23rd April 2024 Commons Chamber

[Richard Burgon (Leeds East) (Lab)]

2. What steps her Department is taking to reduce waiting times for NHS treatment.

[The Minister for Health and Secondary Care (Andrew Stephenson)]

Happy St George’s day, Mr Speaker.

Cutting waiting lists is one of the Prime Minister’s top priorities. We are spending more than £8 billion on additional elective activity and investing in additional capacity including community diagnostics centres, one such centre being in the hon. Gentleman’s constituency. Since September 2023 overall waiting lists have fallen by almost 200,000—the biggest five-month fall in over 10 years, outside of the pandemic.

[Richard Burgon]

NHS waiting lists have risen threefold since the Tories came to power, and the Prime Minister’s pledge to cut waiting lists is in tatters. Rather than taking responsibility, the Tories first blamed NHS staff who were trying to get better pay, and now they have opened up a new round of media attacks on the sick and the disabled. Why do not the Government instead go after the tax dodgers, as Labour plans to do, to raise funds and help resolve the crisis in our NHS?

[Andrew Stephenson]

Once again the hon. Gentleman does not condemn the strikes. I would gently say that while we are getting waiting lists down in England, Welsh Labour has the longest hospital waits in Great Britain, putting patients at risk because it does not have a plan to clear the backlog. In December 2023 the Welsh Labour Government had the highest number of patients in Great Britain waiting over two years for treatments. It is an outrage; yet that is the blueprint for what the Labour party says it will implement here in England.

[Simon Fell (Barrow and Furness) (Con)]

I see increasing numbers of women coming to my constituency surgeries about chronic urinary tract infections, not for themselves but for their daughters. Unfortunately there seems to be no treatment pathway for chronic UTIs among girls. Does my right hon. Friend have any thoughts about that, and would he agree to meet me to discuss the issue further?

[Andrew Stephenson]

I would be very happy to meet my hon. Friend to discuss the issue.

[Mr Speaker]

I call the shadow Secretary of State.

[Wes Streeting (Ilford North) (Lab)]

Happy St George’s day, Mr Speaker.

Westminster is awash with rumours that the Prime Minister will call a July general election, presumably to avoid giving his Rwanda gimmick the time to fail. I have a very simple question for the Minister: will he repeat the pledge that the Prime Minister made last year and promise that NHS waiting lists will be lower at the time of the general election than when the Prime Minister came to office?

[Andrew Stephenson]

The Prime Minister has been very clear that getting waiting lists down is one of his top priorities, but he has also been clear that performance has been disappointing. One reason is that 1.4 million procedures have had to be rescheduled because of industrial action. I would gently ask the shadow Secretary of State whether he condemns those strikes.

[Anthony Mangnall (Totnes) (Con)]

3. What assessment she has made of the adequacy of oversight mechanisms for the General Medical Council.

[The Minister for Health and Secondary Care (Andrew Stephenson)]

The General Medical Council has been constituted by Parliament to ensure that decisions about individual doctors are independent of both the profession and the Government of the day. The Professional Standards Authority oversees the work of all United Kingdom professional regulators and reports to Parliament on their operational performance. Parliament continues to set and oversee the principles and scope of the regulators’ powers.

[Anthony Mangnall]

Good governance means ensuring transparency, and one concern of my constituents is whether GMC decisions can be appealed. Will the Minister reassure me that we can have better transparency in the GMC on the decisions that it makes?

[Andrew Stephenson]

The GMC and other professional regulators have a statutory duty to investigate any concerns about the fitness to practice of one of their registrants and to take appropriate action to protect the public when that is needed. The regulators are overseen by the Professional Standards Authority for Health and Social Care, which has the power to appeal cases where, in its view, a sanction imposed by a regulator is insufficient to protect the public.

[Jim Shannon (Strangford) (DUP)]

The GMC has seven principles of decision making and consent. How will the Minister ensure that GPs can fulfil their obligations when time constraints on appointments mean that they do not have time to listen to every complaint? People have to book a double appointment to talk about more than one issue. What further support can the Government give GPs to enable them to fulfil their GMC-ordered standards of care?

[Andrew Stephenson]

As the hon. Gentleman knows, the Government have committed to delivering 50 million more GP appointments and to making it easier throughout the country to see a doctor. In England in December, we delivered 25.77 million GP appointments compared with 23.31 million in December 2019—an increase of 2.46 million appointments each month. We need to continue to work with programmes such as Pharmacy First, and we are taking other steps to reduce the pressure on GPs so that they have more time to spend with their patients.

[Vicky Ford (Chelmsford) (Con)]

4. What recent progress she has made on retaining GPs.

--- Later in debate ---

[Lee Anderson (Ashfield) (Reform UK)]

6. What steps she is taking to tackle medicine shortages for type 2 diabetes.

[The Minister for Health and Secondary Care (Andrew Stephenson)]

It is vital that people have access to the medicines they need. The Department has been working with the suppliers of medicines used in the treatment of type 2 diabetes to seek commitments from them to address the issues, expedite deliveries and boost supplies. As a result, the position is now much improved compared with a few months ago, with new patients now able to receive these critical medicines. We continue to work with industry to address remaining issues as quickly as possible.

[Lee Anderson]

We know that obesity in this country is costing the NHS about £20 billion a year, and it is a major contributory factor to type 2 diabetes, which is preventable in a lot of cases by having a healthy lifestyle. What more can we do encourage people to eat healthily and therefore save costs in the NHS?

[Andrew Stephenson]

The hon. Member raises a very important point. Obesity is linked to many health conditions, including type 2 diabetes. We are delivering an ambitious programme of work to create a healthy environment to support people in achieving and maintaining a healthy weight. This includes restricting the placements of less healthy products in shops and online, calorie labelling on food sold in restaurants and a tax on the sugary drinks industry, which has removed the equivalent of 45,000 tonnes of sugar from soft drinks.

[Mr Speaker]

I call the Scottish National party spokesperson.

[Kirsty Blackman (Aberdeen North) (SNP)]

A recent Nuffield Trust report shows that medicine shortages are a new normal in the UK. The Minister might claim that this is a global issue, but as the report highlights, shortages are being made worse by Brexit. For example, the creation of a requirement for customs checks at the border and leaving the European Medicines Agency have disrupted the previously smooth supply of medicines. What urgent action will the Minister take to help to tackle the disastrous effects of Brexit on UK medicine supplies?

[Andrew Stephenson]

The SNP, as usual, is a broken record. We all know that diabetes medicine shortages are a global issue affecting countries not just across the whole of the European Union, but across the whole world. Medicine supply chains are highly regulated, complex and global. Issues can occur for multiple reasons, including manufacturing difficulties, regulatory non-compliance, surges in demand, availability of raw materials, sudden spikes in demand, and issues related to the distribution of the product. But once again, as always, the grievance culture of the SNP is: blame everything on Brexit.

[Mrs Paulette Hamilton (Birmingham, Erdington) (Lab)]

7. What steps she is taking to increase levels of nurse recruitment and retention in GP practices.

--- Later in debate ---

[Kenny MacAskill (East Lothian) (Alba)]

8. What steps she is taking to support the recruitment and retention of community and district nurses.

[The Minister for Health and Secondary Care (Andrew Stephenson)]

As the hon. Member may know, in September 2023, we met our commitment to deliver 50,000 more nurses working in the NHS compared with September 2019. As of January 2024, there are over 68,800 full-time equivalent community nurses working in NHS trusts and other core organisations across England, which is over 2,000 more than a year ago. However, we want to go further, which is why the NHS long-term workforce plan sets an ambition to increase training places for district nurses by 150%, to nearly 1,800. It also commits to improving retention in the NHS.

[Kenny MacAskill]

In Scotland, the vacancy rate for registered nursing posts in the community is 8.5%, and for registered district nurses it is 6.6%—in England, the situation is actually worse in most parts. However, these posts are fundamental, not just to care in communities and to our communities themselves, but to addressing bed blocking. It is obviously for the Scottish Government to address terms and conditions of employment, but their overall funding package is dictated by the block grant and Barnett consequentials. Is it not time that the Department stood up for the NHS? When there is money for weapons abroad, why can we not provide care at home? We were told during the referendum that we would be better together and that the NHS would be protected. Instead, it is being undermined.

[Andrew Stephenson]

We hear from Opposition Members who love nothing more than to crow and criticise as their health system declines around them, despite record funding from the UK Government. Scotland has, sadly, some of the worst health outcomes in the western world. Earlier this year, when the UK Government stepped in to offer support, the SNP Health Minister rejected the offer. I reiterate that if the Scottish Government need help to reduce their waiting lists, we stand ready to provide such support.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

9. What steps she is taking to tackle health inequalities.

--- Later in debate ---

[Gill Furniss (Sheffield, Brightside and Hillsborough) (Lab)]

10. What steps she is taking to improve bowel care for people with spinal injuries.

[The Minister for Health and Secondary Care (Andrew Stephenson)]

The hon. Member raises an important issue. It is vital that people with spinal injuries receive care in the most appropriate environment to support their care and rehabilitation. The NHS has developed a range of guidance on the subject, including NHS England’s excellent incontinence care guidance. In addition, guidelines from the National Institute for Health and Care Excellence set out the care that patients with spinal injuries should receive, including through a neurological bowel management programme.

[Gill Furniss]

There is a clear need for a national policy on bowel care in NHS settings for people with spinal injuries. I have listened to patients who have been left feeling abandoned and trapped in a hospital bed without the basic dignity of being able to use the toilet—all because of a lack of training for nurses in providing the necessary support. Will the Minister meet me and representatives of the Spinal Injuries Association to discuss how we can make the situation better and ensure that nobody is denied this basic level of care?

[Andrew Stephenson]

I pay tribute to the hon. Lady for the work that she and the all-party parliamentary group on spinal cord injury have done on the issue. I would be more than happy to meet them.

[Antony Higginbotham (Burnley) (Con)]

11. What steps her Department is taking to improve accident and emergency waiting times in east Lancashire.

--- Later in debate ---

[Dr Rosena Allin-Khan (Tooting) (Lab)]

13. What assessment she has made of the adequacy of mental health support for NHS staff.

[The Minister for Health and Secondary Care (Andrew Stephenson)]

Every day, NHS staff do an extraordinary job for their patients, and it is vital that the NHS supports them in maintaining their mental health. The long-term workforce plan commits the NHS to supporting staff health and wellbeing and asks integrated care systems to develop plans to support them. I am pleased that NHS England is reviewing mental health services for all staff, to ensure that all staff in the NHS have the support that they need.

[Dr Allin-Khan]

Fighting to save a dying child’s life, telling families that their loved one will not make it through the night, and working desperately in substandard conditions—it will come as little shock to hear that all that takes a toll. Last year, 6.4 million mental health sick days were taken across the NHS. Instead of receiving support, our NHS heroes have a Tory Government who treat them with disdain and kick them to the kerb. Will the Minister commit to funding the NHS practitioner health service beyond the next 12 months, or will the Government just try to shut it down again?

[Andrew Stephenson]

As an NHS community first responder who served on the frontline during the pandemic, who had to see people say goodbye to their loved ones for the last time before being admitted to hospital, and who has dealt with cardiac arrests, I know the mental toll that working for or volunteering with the NHS can take on our workforce, and therefore we do give a very high priority to the subject. The NHS people plan sets out a range of actions to build a more modern, compassionate and inclusive culture, and includes a much stronger focus on the availability of quality health and wellbeing support. It is right that we keep services under review, so I will not make a commitment today to continuing to fund something that we have agreed to fund for another year while those services are reviewed.

[Lilian Greenwood (Nottingham South) (Lab)]

14. What steps she is taking to improve healthcare for women.

--- Later in debate ---

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (Con)]

T3. I refer the House to my entry in the Register of Members’ Financial Interests. The British Psychological Society has commended the benefit of Government support for staff mental health and wellbeing hubs and is keen to see that support continue. Will the Minister therefore give an update on the support being provided and the progress being made on the vital issue of staff mental health and wellbeing?

[The Minister for Health and Secondary Care (Andrew Stephenson)]

That is an important point. We know how vital it is to support everyone who is working so hard in our NHS to support patients. NHS England is reviewing mental health services for all staff who need them, to ensure that they can access the support they need. It is working collaboratively with regions and integrated care systems to agree the best approach to doing that.

[Helen Hayes (Dulwich and West Norwood) (Lab)]

T4. There is an increasing incidence of bowel cancer among younger patients, such as my constituent Emily, who received a late diagnosis after many months of attending her GP with iron deficiency anaemia. Younger patients often report that bowel cancer was dismissed as a possibility by their GP because of their age, and that symptoms such as iron deficiency anaemia are not taken seriously enough and are not included currently on the list of commons symptoms on the NHS website. What is the Secretary of State doing to ensure that NHS guidelines and practice are fit for purpose for younger patients, who far too often receive a late diagnosis of bowel cancer?

[Andrew Stephenson]

The hon. Lady makes an important point. As part of the NHS long-term plan, we have an ambition to diagnose 75% of all stageable cancers at stage 1 or 2 by 2028. That means that we need to make significant improvements on the harder-to-detect cancers such as bowel cancer. We are working across systems to deliver those improvements, not only with better screening programmes, but by improving patient pathways. However, I am more than happy to meet her if she wants to have a further conversation specifically about bowel cancer.

[Julian Sturdy (York Outer) (Con)]

Following discussions with constituents who are living with Parkinson’s and with Parkinson’s UK, I am concerned that North Yorkshire has only one dedicated Parkinson’s nurse. Given the complexity of the condition, what steps are being taken further to incentivise nurses to specialise in Parkinson’s and on long-term delivery?

[Andrew Stephenson]

My hon. Friend makes an important point. I know the huge value of Parkinson’s nurses to local patients in my constituency. Under the NHS long-term workforce plan, backed by more than £2.4 billion over the next five years, the NHS will focus on expanding the number of clinicians training for enhanced and advanced roles working as part of multidisciplinary teams with the right skills to meet the changing needs of patients.

[Richard Burgon (Leeds East) (Lab)]

T5. The main issue raised by residents at the community coffee morning at the Compton centre in Leeds yesterday was the difficulty in getting access to dentists. The Secretary of State struggled to give any credible answer on this question today. Is she aware of the “Dentists for All” campaign in The Mirror, and will she back it? Its three demands are: to provide access to an NHS dentist for everyone; to restore funding for dental services and recruit more NHS dentists; and to change the contracts, because they are simply not fit for purpose. Does the Secretary of State agree with that, and, if not, why not?

--- Later in debate ---

[Will Quince (Colchester) (Con)]

Given the importance of the UK’s life sciences sector, could my right hon. Friend update the House on commercial clinical trial recruitment?

[Andrew Stephenson]

Thanks in part to the sterling work of my hon. Friend, monthly average patient recruitment to commercial clinical trials is almost five times the figure it was back in June 2023. That is hugely positive, but there is clearly more to do in this space.

[Bell Ribeiro-Addy (Streatham) (Lab)]

For over a decade, the Camberwell dialysis unit has provided high-quality NHS care to patients in south London, so my constituents were shocked to hear that these services are to be outsourced to Diaverum, a multinational for-profit health corporation, which has already had one of its clinics rated inadequate and put into special measures. Does the Minister accept that privatising the NHS bit by bit has disastrous implications for care, and will he listen to patients in my constituency and commit to maintaining our NHS dialysis provision?

[Andrew Stephenson]

That sums up the usual contradiction on privatisation between Labour Front Benchers and Back Benchers. Any service changes should be based on clear evidence that they will deliver better patient outcomes. In Lambeth, patients who receive dialysis at the new site in Brixton will receive care in a significantly improved environment with brand new facilities, in a great example of an innovative public-private partnership. NHS England has established the renal services transformation programme to reduce unwarranted variation in the quality of access to renal care.

[Stephen Metcalfe (South Basildon and East Thurrock) (Con)]

Will my hon. Friend join me in recognising the good work that the Essex Partnership University NHS Foundation Trust has been doing to improve mental health outcomes, including the creation of a pioneering 24/7 urgent mental health care centre, providing urgent help when it is needed. Is that a model that could be rolled out across the country to improve access to mental health for all?

--- Later in debate ---

[Greg Smith (Buckingham) (Con)]

As a practical measure to improve radiotherapy waiting times, will the Minister agree to further work on the radiotherapy dataset, to include the collection of data on delays at each stage of the radiotherapy pathway, and by tumour type, so that we can better understand pinch points in services?

[Andrew Stephenson]

We are working to improve radiotherapy services across the NHS, and I would be happy to meet my hon. Friend to discuss that in more detail.

[Daisy Cooper (St Albans) (LD)]

West Hertfordshire Hospital Trust is at the front of the queue for the new hospital programme. We have the land, planning permission, building design, political and staff support, and enabling works are under way. But, like many other trusts around the country, the hospital trust is being asked to submit business case after business case. Will the Secretary of State clarify whether those delays are down to bureaucracy and the new hospital programme, or are they deliberate delaying tactics by a Government who do not want to release funds to hospitals before the general election?

Health Services: Cross-border Co-operation

Andrew Stephenson Excerpts

Tuesday 16th April 2024 Westminster Hall

[The Minister for Health and Secondary Care (Andrew Stephenson)]

It is a pleasure to see you in the Chair, Dame Caroline. I congratulate my hon. Friend the Member for Ynys Môn (Virginia Crosbie) on securing this debate on cross-border healthcare. I know the performance of health services across the United Kingdom is a subject close to her heart, as it is for my hon. Friend the Member for Vale of Clwyd (Dr Davies) and the hon. Members for Strangford (Jim Shannon) and for Caithness, Sutherland and Easter Ross (Jamie Stone), who have all made important contributions to the debate. My hon. Friend the Member for Ynys Môn works tirelessly on improving local health services in her constituency, including by campaigning for an integrated health centre in Holyhead and championing the importance of mental health by pushing for 100 members of the public to undergo a mental health training course in Anglesey.

Although my hon. Friend rightly said that healthcare in Wales has been devolved for 25 years, as a representative of the UK Government and a proud Unionist, I feel it is important that all four nations work together where that is of benefit to the people we represent. For that reason, within my first few weeks in post, I was pleased to visit Wales, Scotland and Northern Ireland to look at the different approaches being taken to the shared challenges that we face.

During my visit to Wales, I heard directly from some GPs in the constituency of my right hon. Friend the Member for Vale of Glamorgan (Alun Cairns) and met some of the pioneering Welsh life sciences companies whose innovations have so much to offer the NHS across the whole United Kingdom. I would, of course, be delighted to visit the constituency of my hon. Friend the Member for Ynys Môn to learn more about the challenges that she faces there.

Without doubt, one of the biggest challenges facing all four nations is dealing with the legacy of covid-19, which has left us with record waiting lists. Cutting waiting lists in England is one of the Government’s top priorities, and by delivering on the actions set out in the delivery plan for tackling the covid-19 backlog of elective care, we are making good progress on tackling the longest waits. Thanks to the incredible work of NHS staff, as of February this year the number of patients waiting over 18 months had been reduced by almost 90% in England, which is a far faster reduction than we have seen in Wales or Scotland.

A core part of that approach has been empowering patients to make decisions on their care by choosing their provider. Improved choice can not only lead to shorter waiting times for patients and incentivise providers to offer appointments, but have a positive impact on the overall patient experience. However, as the former Health Secretary, my right hon. Friend the Member for North East Cambridgeshire (Steve Barclay), said last year, it is vital that the UK Government and devolved Administrations work together to ensure that no matter where they live, patients can access the care that they need when they need it.

As my hon. Friend the Member for Ynys Môn said, a genuine offer was made to the devolved Administrations, which remains open. We continue our commitment to working closer with the devolved Administrations on elective recovery and access to primary care, on top of the existing cross-border arrangements to allow patients who live in Scotland and Wales to access care in England under certain circumstances, which is paid for by the relevant Administration. That is important because when adjusted for data differences, the Welsh waiting list of 677,000 represents 21.6 patient pathways per 100 population compared with 13.3 per 100 in England. The magnitude of the difference between England and Wales cannot be accounted for by divergent definitions. That is why the current Secretary of State, my right hon. Friend the Member for Louth and Horncastle (Victoria Atkins), will be engaging with her counterparts as her predecessor did.

I am pleased to confirm that the next meeting of the inter-ministerial group for health and social care will take place on 24 April. Further, we have agreed to take forward those meetings quarterly. The inter-ministerial group includes Ministers from the UK Government and the devolved Governments who have health and adult social care matters in their portfolios. It provides a forum for strategic discussion between the portfolio Ministers on health and adult social care policy issues, enabling them to engage on areas of shared interest and, where possible, collaborate on policy development and address shared challenges. Moreover, officials have been working on sharing lessons and comparing approaches to demand management and supporting the patients who have been waiting the longest, including through the “Getting it right first time” programme. Those discussions have been constructive in highlighting the benefits of sharing approaches to elective recovery.

My hon. Friend the Member for Ynys Môn made some excellent points about how critical data is as a tool for improving health and tackling inequalities. This Government and the devolved Administrations have been doing important work to improve data comparability in the UK. Not only is it fundamental that citizens can scrutinise the performance of their health services, but a coherent picture of health across the UK is essential to policy evaluation so that we can provide robust challenge and support where it is needed, and build a deeper understanding of the health outcomes in the different parts of the United Kingdom. The Office for National Statistics has recently expanded its cross-Government work and partnered with health bodies in all four nations to ensure that data is coherent, accessible and meets users’ needs. Through that approach, we will enhance our collaborative working and ensure that health services work for every citizen, regardless of geography.

I pay tribute to my hon. Friend for the work that she has done to improve health services in Wales and promote the importance of cross-border health co-operation across the entire United Kingdom. She raises the concerns of her constituents with me and other Health Ministers week in, week out. Her constituents could wish for no better representative than her. I hope that what I have said today shows that we are committed to improving health services for everyone across the whole of our United Kingdom.

Question put and agreed to.

NHS England: Financial Directions

Andrew Stephenson Excerpts

Tuesday 26th March 2024 Written Statements

[The Minister for Health and Secondary Care (Andrew Stephenson)]

The Under-Secretary of State for Health and Social Care, my noble Friend Lord Markham, has made the following written statement:

“I am revising the 2023-24 financial directions to NHS England made on 30 March 2023 and setting the 2024-25 financial directions to NHS England. The amendment to the total revenue resource use limit for 2023-24 has been agreed with NHS England as required under section 223D(4) of the National Health Service Act 2006.

The directions include a number of transfers of funding between the Department of Health and Social Care and NHS England that are in addition to the headline spending review/autumn statement settlement for the NHS. This includes the outcome of the supplementary estimates process and the spring Budget 2024. Funding is being transferred for the voluntary scheme for branded medicines pricing, access and growth (VPAG), the covid-19 vaccination programme, 2023-24 pay awards, as well as to fulfil manifesto commitments on primary care, car parking and nursing recruitment.

The directions will be laid in Parliament and published on gov.uk. The existing NHS mandate remains unchanged by these publications.”

[HCWS388]

Access to Migraine Treatment

Andrew Stephenson Excerpts

Wednesday 20th March 2024 Westminster Hall

[The Minister for Health and Secondary Care (Andrew Stephenson)]

It is a pleasure to serve under your chairmanship, Mr Mundell.

I start by thanking my hon. Friend the Member for Bishop Auckland (Dehenna Davison) for securing this very important debate. I know that she has long been a champion for those living with migraine, and that her own ongoing struggle with chronic migraine, which she talked about, made it difficult, if not impossible, on some days to keep up with the demands of her ministerial role. Since leaving that role she has continued to shine a light on the impact of migraine at work and on what it means to live with migraine.

I also pay tribute to the outstanding charities that support the estimated 10 million people in the UK who live with migraine. For example, the Migraine Trust does fantastic work in empowering, informing and supporting patients, and in driving improvements in treatment and care.

I thank my right hon. Friends the Members for South Staffordshire (Sir Gavin Williamson) and for Romsey and Southampton North (Caroline Nokes), my hon. Friend the Member for Kettering (Mr Hollobone), and the hon. Members for South Antrim (Paul Girvan), for East Londonderry (Mr Campbell), for Midlothian (Owen Thompson), for Greenwich and Woolwich (Matthew Pennycook) and for Bristol South (Karin Smyth) for their contributions to the debate. In those contributions, almost all right hon. and hon. Members talked about the stigma around migraine, with many setting out their own personal experiences of it. We all know that awareness is key to addressing discrimination, so I very much welcome each and every contribution to this morning’s debate.

Migraine is one of the most common neurological conditions, affecting about 10 million people in the UK, yet in this House we very rarely speak about it and its impact. Many of us have first-hand experience of migraine, or at least some insight into the enormously debilitating effect that it can have on people living with it. Indeed, my own sister, Andrea Stephenson, who I know you know, Mr Mundell, and who many other Members may know, suffers from migraine and I have seen the impact that it has had on her over the years.

As we have heard this morning, migraine is a severe and painful long-term health condition and, as my hon. Friend the Member for Bishop Auckland so eloquently said, it is so much more than just a really bad headache. Anyone who lives with migraine knows that it can have a very significant and negative impact on quality of life. Perhaps the cruellest aspect of the condition is its ability to strike with little or no warning, disrupting people’s ability to perform even the most basic daily tasks. Migraine symptoms can last for days, affecting all aspects of life, including family and work life and the ability to engage in social activities. Even between attacks, migraine can impact on quality of life, especially when people try to limit daily activities to prevent another migraine.

Although the human cost is important—it is the most important factor—it is worth reflecting on the economic cost, which my hon. Friend the Member for Bishop Auckland and my right hon. Friend the Member for South Staffordshire set out so well in their speeches. That is why timely access to appropriate and effective care and treatment is so important. Accurate, timely diagnosis can ensure that people can access migraine treatments as early as possible, helping them to get the care that they need to treat attacks when they strike and prevent future ones. There is no specific test to diagnose migraines; for an accurate diagnosis, GPs must identify a pattern of recurring headaches along with the other associated symptoms. Migraines can be unpredictable, sometimes occurring without the other symptoms normally associated with the condition, so obtaining an accurate diagnosis can take some time.

The NICE guidelines on headaches and the diagnosis and management of headaches in young people and adults, last updated in December 2021, set out best practice for healthcare professionals in the care, treatment and support of people who suffer from headaches, including migraine. They aim to improve the recognition and management of headaches and migraine with more targeted treatments to improve the quality of life for people with headaches and reduce unnecessary investigations. NICE has also produced a clinical knowledge summary on migraine. Clinical knowledge summaries are concise, accessible summaries of the current evidence for primary care professionals, focusing on the most common and significant presentations in primary care. They give trusted information to support safe decision making and improve standards of patient care.

The usual treatment approaches to migraine are designed to either stop or prevent attacks. Treatment for acute migraine includes medications such as analgesics, triptans and antiemetics. Treatments to stop or reduce the frequency of migraine attacks include medications such as beta blockers, tricyclic antidepressants and anti-epileptics. We are committed to supporting timely and consistent access to new, effective medicines for NHS patients, so I am pleased that in October 2023, NICE published technology appraisal guidance recommending Rimegepant for the acute treatment of migraine. Rimegepant is recommended where patients have tried at least two triptans but they did not work well enough; where patients cannot take triptans or where they were not tolerated; or where other medication has been tried but did not work well enough. In separate guidance, last year NICE also recommended Rimegepant as an option for preventing episodic migraine in adults where at least three previous preventive treatments have failed, opening a way for 145,000 people in England to choose that option.

[Sir Gavin Williamson]

I appreciate the Minister’s setting out all that has been done. A few hon. Members mentioned CGRP blockers. I am sure that an exciting announcement may be coming, but if not, can the Minister reassure us that they can be looked at, to ensure that something emerges and is done about them?

[Andrew Stephenson]

My right hon. Friend anticipated my next point. Several hon. Members mentioned the difficulties experienced by some patients in accessing CGRP blockers. That issue was raised by the hon. Member for East Londonderry in his intervention. I note my right hon. Friend’s concern, and the comments of my hon. Friend the Member for Bishop Auckland about the NICE guidelines being reviewed to allow specialist treatment such as CGRP blockers to be made available as a first-line therapy.

NICE develops its recommendations independently, based on an assessment of the available evidence of clinical effectiveness and cost-effectiveness and through extensive engagement with interested parties. It is right that those decisions are taken independently on the basis of the available evidence, so it would not be appropriate for me to intervene directly. However, NICE keeps its recommendations under active surveillance, and if significant new evidence emerged it would review its guidance. I very much hope that NICE has been listening to what has been said by hon. and right hon. Members in this debate and looks at the emerging evidence from charities, such as the Migraine Trust, which might prompt it to review the guidance.

The NHS in England is legally required to make funding available for treatments that have been recommended by NICE. If there are any concerns about the availability of a NICE-recommended treatment in a particular area, it is important that hon. and right hon. Members raise those with their local integrated care boards in the first instance. However, I would be more than happy to look into situations where Members still have concerns.

My hon. Friend the Member for Bishop Auckland raised the issue of CGRPs and prescribing rights in primary care. That is an interesting point. I have asked the Medicines and Healthcare products Regulatory Agency to look into this matter and I will write to my hon. Friend in the coming days.

Similarly, I will take away the point made by my right hon. Friend the Member for South Staffordshire about what more we can do to better utilise our local pharmacies. The Under-Secretary of State for Health and Social Care, my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom), is responsible for pharmacy policy. She has already overseen the roll-out of Pharmacy First, ensuring that more conditions than ever before can be addressed by pharmacists, rather than people having to wait to see a GP.

At the moment, we expect that patients suffering from migraine would normally be treated first by their GP. If this failed to resolve the problem, patients would be referred to a consultant neurologist for further investigations and tests. We recognise the challenges within secondary care, in terms of waiting list size and the length of wait, with patients waiting far too long to access the specialist care they need. Neurology is particularly challenging at the moment, with a need for more neurologists, specialist nurses and allied health professionals.

We are committed to reducing waiting lists. To this end, we commissioned NHS England to develop a long-term plan for the NHS workforce for the next 15 years, which was published in June 2023. This sets out how we would deliver the doctors, nurses and other professionals that will be needed, also taking into account improvements in retention and productivity. The plan looks at the mix and number of staff required and has set out the actions and reform across the NHS that are needed to reduce the supply gap and improve retention. The plan will help ensure that we have the right number of staff with the right skills to transform and deliver high-quality services for the future.

My hon. Friend the Member for Bishop Auckland, the hon. Member for Greenwich and Woolwich and my right hon. Friend the Member for South Staffordshire all raised the issue of awareness amongst GPs. UK medical schools determine the content of their own curricula. The delivery of these undergraduate curricula must meet standards set by the General Medical Council. The standards require the curriculum to be formed in a way that allows all medical students, by the time they complete their medical degree, to meet the GMC’s outcomes for graduates, which describe the knowledge, skills and behaviours they must show as newly registered doctors. Therefore, whilst not all curricula will necessarily highlight specific conditions, they all nevertheless emphasise the skills and approaches that a healthcare practitioner must develop to ensure accurate and timely diagnoses and treatment plans for patients, including for migraine.

All healthcare professionals, including GPs, are responsible for ensuring that their clinical knowledge remains up to date and for identifying learning needs as part of their continuing professional development. The Royal College of General Practitioners has developed e-learning resources to update primary care clinicians on the nature of migraine, the different diagnoses and how to approach a patient with headache.

Through NHS England’s getting it right first time—or GIRFT—programme, we are also offering practical solutions for managing the demand for services within secondary care. There have been major advances in treating neurological conditions, including migraine, but services often struggle to keep pace with innovation, which has a significant impact on outcomes for people living with those conditions. GIRFT is a national programme which is designed to improve the treatment and care of patients through in-depth, clinically led review of specialties to examine how they are currently being done and how they could be improved. The GIRFT national specialty report for neurology, published in September 2021, makes a number of recommendations applicable to migraine. For example, the report highlights that providing support and advice to GPs in diagnosing and managing patients with headache can improve management of patients without a patient necessarily having to be seen as an out-patient. GP access to CT and MRI imaging would also enhance GPs’ ability to manage headaches in the community using appropriate guidelines.

As several right hon. and hon. Members said, research is key. Investing in research is a key component of supporting people living with migraine. It plays a vital role in providing those working in the NHS with the evidence they need to better support patients and provide access to pioneering treatments, diagnostics and services. The Department of Health and Social Care funds research through the National Institute for Health Research, which has funded and supported a range of research projects on migraine over the past five years, including studies to assess the efficacy and cost-effectiveness of drugs to prevent and treat migraines, and resources and training on self-management. For example, a study that is close to completion is looking at the comparative clinical cost-effectiveness of pharmacological treatments for adults with chronic migraine.

I once again thank right hon. and hon. Members for their insightful points. I hope they and my hon. Friend the Member for Bishop Auckland are reassured by some of the measures I have outlined today. I recognise that we must go further, and I assure them that I will continue to support people living with migraine through system transformation, NIHR research and exploring and investing in new treatments to ensure we are delivering real results for patients on the ground.

Defibrillators

Andrew Stephenson Excerpts

Wednesday 20th March 2024 Westminster Hall

[The Minister for Health and Secondary Care (Andrew Stephenson)]

It is a pleasure to serve under your chairmanship, Dame Maria. I start by congratulating my hon. Friend the Member for Stoke-on-Trent North (Jonathan Gullis) on securing this important debate. I know that he is a passionate and vocal supporter of increasing access to life-saving public defibrillators and first aid training. I pay tribute to the work of the all-party parliamentary group on defibrillators and look forward to reading its report in due course. I also pay tribute to the hon. Member for Strangford (Jim Shannon), my hon. Friends the Member for Havant (Alan Mak), and my right hon. Friend the Member for South Staffordshire (Sir Gavin Williamson) for their contributions to this short debate.

Public defibrillators can really be the difference between life and death for people who suffer what are known as out-of-hospital cardiac arrests. According to the British Heart Foundation, automated external defibrillators, AEDs, are used by bystanders in around only 10% of these types of incidents, but early defibrillation—within three to five minutes of collapse—can increase survival rates by as much as 50% to 70%. That is why we are working hard to increase the number of community defibrillators, increase public awareness and tackle the wider causes of heart attacks. I am proud that we have introduced the community automated external defibrillators fund. The £1 million match fund allows communities across England to bid for AEDs in places with high footfall, in more remote areas that have longer waiting times for emergency medical responses, in areas with high numbers of vulnerable people, and in areas that host activities that mean they are more likely to be needed.

[Sir Gavin Williamson]

I congratulate the Department of Health and Social Care on that fund. My hon. Friend the Member for Stoke-on-Trent North (Jonathan Gullis) and I referred to the charity AED Donate. There is a lot of charitable work going on in this sector. I wondered whether it would be possible for the Minister to arrange for the charity to meet up with suitable officials, so that it can best understand how it can deliver the Department’s aims and so that the Department has an understanding of what it is delivering in communities across the country.

[Andrew Stephenson]

My right hon. Friend makes a very important point. I join him in paying tribute to that organisation. I would be happy to arrange a meeting with relevant officials in the Department.

Our partners on the programme of rolling out defibrillators are Smarter Society and the London Hearts charity. They have been assessing applications for delivering additional AEDs, working with a wide and diverse range of groups. The first hundred devices that Smarter Society distributed were fully funded, and our partners at the University of Warwick helped us to prioritise the areas of greater deprivation without an AED in situ.

I am delighted to update hon. Members and tell them that, as of 12 March, Smarter Society and London Hearts have now delivered 1,590 AEDs and are working to deliver more. I would also like to pay tribute to the work of my hon. Friends in the Department for Education, who are ensuring that every state school has access to a defibrillator. I am told more than 20,000 devices have been delivered to almost 18,000 schools. That will drastically increase the chances of surviving cardiac arrest for pupils and school staff across England.

The Department for Education has supported schools in making the defibrillators available to the community, having offered external heated defibrillator cabinets to primary, special and alternative provision schools in areas of deprivation, where access to defibrillators is typically lower. It has also provided internal cabinets to secondary schools with two or more defibrillators, so one device can be placed at a sports facility where cardiac arrest is more likely to happen.

All state-funded schools are required to teach first aid as part of the mandatory relationship, sex and health education curriculum—another positive change made by the Conservatives since 2010—since we have been in government. That involves children over 12 being taught CPR and the use of a defibrillator. The Department for Education has also provided awareness videos showing how simple the defibrillators are to use, and it is encouraging schools to share the videos in staff meetings and assemblies. That will ensure that as many people as possible are able to respond in an emergency.

I know that making defibrillators as affordable as possible is important to my hon. Friend the Member for Stoke-on-Trent North, as he set out in his speech. The Government and I agree, although we have to keep these matters under review. He will appreciate that matters relating to VAT are for my right hon. Friend the Chancellor of the Exchequer.

Although having access to defibrillators is important, just as important is knowing where they are, so that they can be used in a time of crisis. That is why the NHS is working in partnership with the British Heart Foundation, the Resuscitation Council UK and the Association of Ambulance Chief Executives to set up The Circuit, which my hon. Friend talked about. The Circuit is a national database that will make it easier for ambulance services quickly to identify the nearest defibrillator when assisting someone who is having an out of hospital cardiac arrest.

As of 1 March, there were 86,337 defibrillators in the UK—68,509 in England— registered on The Circuit. We encourage everyone with an AED to register it. I can assure the House that all defibrillators granted by the community automated external defibrillator fund must be registered on The Circuit. The registration is completed by what is known as a defibrillator guardian—someone nominated by the organisation hosting the device. That role involves registering it on The Circuit, regularly checking the defibrillator to ensure that it can be used, and keeping the record updated. As I hope my hon. Friend appreciates, that is both an effective and a pragmatic approach to ensuring that defibrillators are where we think they should be, and that they continue to be ready for use in times of crisis.

I reinforce the fact that defibrillators are designed for ease of use. If there is one message I want to land in today’s debate, it is that these simple devices are easy to use, yet life-saving. Anyone can use them without formal training. That said, training is actively helpful in increasing the confident use of defibrillators in a community setting. For that reason, the NHS has partnered with St John Ambulance to help people gain the skills they need. That includes a national network of community advocates championing the importance of first-aid training, and training up 60,000 people, which will save up to 4,000 lives a year by 2028.

I would like to take the opportunity to pay tribute to those organisations and others that work tirelessly to improve defibrillator access and first aid training in communities across the country. Their contributions are crucial in getting help for people in some of the toughest moments of their lives and I cannot thank them enough.

My hon. Friend the Member for Stoke-on-Trent North has raised the idea of requiring defibrillator training as part of driving tests. My hon. Friend the Member for Colchester (Will Quince) was a strong supporter of that as my immediate predecessor in this role. While this is primarily a matter for the Department for Transport, I know that my hon. Friend the Member for Stoke-on-Trent North will continue to make representations in this area. I assure him that the Government are always happy to engage in those discussions.

I am also aware of my hon. Friend’s interest in ensuring that all emergency vehicles carry AEDs as a matter of course. While the Government fully recognise that the equipment carried by emergency vehicles is an operational matter, I encourage all services to consider the benefits of carrying AEDs as a matter of routine.

On a personal note, I would like to pay tribute to David Brown, the incredible team leader of the Pendle, Padiham and Burnley community first responder team, of which I am part. I was backed up by David on the first ever cardiac arrest I attended as a community first responder almost 10 years ago. He does incredible work delivering CPR training across Pendle, as well as putting in thousands of hours as a volunteer with the North West Ambulance Service.

I would also like to pay tribute to my late constituent, Ruth Sutton. In 2016, Ruth saw a photo of me in the local newspaper unveiling a new community defibrillator in the Pendleside village of Blacko. She contacted me to see how we could get even more defibrillators across Pendle. Over the following months, she worked with me and the North West Ambulance Service, investigating possible locations to install new defibrillator cabinets. By 2018, Pendle had the best coverage for public access defibrillators in Lancashire, with 20 cabinets installed: a real, lasting legacy of a remarkable lady.

I hope that our prevention and treatment work, including the forthcoming major conditions strategy, which my Department is in the final stages of drawing up, will act as a guiding light for a faster, simpler and fairer NHS. In combination with our efforts to increase defibrillators and increase first aid training across the country, we will improve our ability to intervene in an emergency situation and to save lives.

I once again thank my hon. Friend the Member for Stoke-on-Trent North for securing this incredibly important debate. I look forward to working with him long into the future to make progress on this vital issue.

Question put and agreed to.