International Health Regulations 2005

Andrew Stephenson Excerpts

Monday 18th December 2023 Westminster Hall

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

It is a pleasure to see you in the Chair, Sir George, and I am grateful to the British public and the hon. Member for Lancaster and Fleetwood (Cat Smith) for raising the important issues covered in the e-petition we are considering today. I start by thanking for their contributions the hon. Member for North West Leicestershire (Andrew Bridgen) and my hon. Friends the Members for Shipley (Philip Davies), for Devizes (Danny Kruger) and for Christchurch (Sir Christopher Chope), as well as my right hon. Friends the Members for Wokingham (John Redwood) and for Rayleigh and Wickford (Mr Francois). I also thank the hon. Member for Birmingham, Edgbaston (Preet Kaur Gill) for her remarks. I am only surprised not to see our friend the hon. Member for Strangford (Jim Shannon) here, although I am sure that he would be if he were able.

We have held a similar debate on this matter already. However, this debate is slightly different from the one we had in April; the matter before us is whether the House should vote on amendments to the international health regulations. That has stirred discussions both in this place and outside because it relates to two vital aspects of our governance: our sovereignty and our national interest. On both, I am pleased to offer assurances to colleagues and the public that I am satisfied that our approach to the negotiations safeguards our national interest without compromising our sovereignty. I will set out why I believe that before turning to the specific questions put by my right hon. and hon. Friends during the debate.

Why are the negotiations in our national interest? Because the international health regulations do not just exist to protect others from health threats: they directly benefit the UK and help to keep our people safe. The last decade has shown that diseases such as covid, mpox and Ebola do not respect borders. In the case of other health threats, such as the recent case of botulism in France, the IHR allowed us to swiftly engage with French officials to identify and follow up with exposed UK citizens. When Vladimir Putin committed an act of terror on our own soil, the IHR helped to slow and stop the spread in Salisbury. The IHR provide international standards for what it means in practice for each WHO member state to prepare for, detect, prevent and respond to public health events.

[Andrew Bridgen]

I thank the Minister for the speech he is making. The point he is actually making is that the IHR are currently working perfectly adequately—in which case, why do we need to amend them?

[Andrew Stephenson]

The IHR are working well. However, as a number of my hon. and right hon. Friends said in the debate, there has been lots of criticism of how they worked. As the hon. Gentleman will remember, our right hon. Friend who is no longer in this place—Boris Johnson, the former Prime Minister—was one of the leading voices in saying that we should update the IHR, because we surely need to learn lessons and move forwards.

I believe that there is mutual interest—interest for us and for other countries—in working together. One example is delivering a sensitive surveillance system providing an early warning of potential threats to inform decisions that national Governments will make during public health events and emergencies.

[Mr Francois]

The House has already heard that we may have to vote on the amendments, along with others, by the end of May 2024. It is possible that by then we will already have had a general election. The House has heard very plainly from the hon. Member for Birmingham, Edgbaston (Preet Kaur Gill) that the Labour party would be minded to support all the amendments; when we challenged her, she stopped taking interventions. Labour would back these amendments if it was in government. What would the Conservative party do?

[Andrew Stephenson]

I thank my right hon. Friend for that point. I genuinely believe that a lot here is in all our interests, and I do not want to turn this into a party political ding-dong. I genuinely believe that having us in Government leading the negotiations and getting them settled before any general election is firmly in the UK’s national interest, because I believe that we will deliver a treaty that is in the interests of all our citizens and respects national sovereignty. However, I very much hope that an incoming Labour Government would do the same. That is one of the reasons why I believe that we need to make rapid international progress to agree any revisions to the IHR—because I believe that we are in a good place to do that now and should move swiftly, rather than kicking it into the long grass. The last pandemic taught us that trying to make things up as we go along was not the best course of action. Laying some good foundations and providing some better certainty on how things will be dealt with is the best way forwards.

[Sir Christopher Chope]

Surely the regulations and the changes are not just one block that we either accept or reject. The Government can deal with each proposed amended change seriatim—one by one. That is why I hope that my right hon. Friend will spell out, in response to the points that have been made, exactly which of the amendments he supports and which ones he does not.

[Andrew Stephenson]

My hon. Friend tempts me, but he will remember that we did not provide a running commentary on the Brexit negotiations. We do not provide a running commentary on our trade negotiations. We do not believe that is in the national interest. Indeed, it is very clear that no text in the latest draft of the accord, published in October and available on the WHO website, has been agreed yet. The whole text is still under negotiation. The draft is just a basis for negotiations, and it will evolve. There are areas of the new draft that we clearly reject and there are areas that we would like to make even stronger. This is an active negotiation between 193 member states to come up with revisions to the IHR that we all believe, by mutual consensus, will be in our global interest.

[Mr Philip Hollobone (Kettering) (Con)]

Would the Minister be kind enough to answer the question posed by my hon. Friend the Member for Devizes (Danny Kruger)? Who is actually negotiating on this country’s behalf, and which Minister has ultimate responsibility?

[Andrew Stephenson]

The negotiations are being led by civil servants across Whitehall. [Interruption.]

[Sir George Howarth (in the Chair)]

Order.

[Andrew Stephenson]

I do not believe it is right to name those civil servants. I am the overall lead on this in the Department of Health and Social Care. I am working closely and have already met with the Minister of State, Foreign, Commonwealth and Development Office, my right hon. Friend the Member for Sutton Coldfield (Mr Mitchell). Many other Government Departments will also have a very clear interest in this, including the life sciences Minister, my hon. Friend the Member for Arundel and South Downs (Andrew Griffith). Any treaty agreed will of course be subject to cross-Government write-rounds in the usual fashion, to agree a UK-wide position. It is fair to say that there will not just be one pair of eyes from the ministerial ranks looking at this. There will be multiple pairs of eyes looking at this from across Government to ensure that when we get to a deal, it is a deal that can be agreed across Government and that we believe is in the UK national interest.

[John Redwood]

The possibility that the language may shift from saying “may” to “shall” is fundamental. I welcome all that the Minister has said about the current collaboration. I am glad it is working so well, but that is based on advice and urging, rather than requirement. It seems to me that this is just like the British people voting for the Common Market with the assurance that we had a veto on any law we did not like, but then somebody came along and took the vetoes away without seeking the British people’s permission, and the relationship went wrong from thereon. This could do exactly the same to the WHO, if we take away the veto.

[Andrew Stephenson]

I hear where my right hon. Friend comes from and I share his concern. As I hope he will recognise, the WHO is led by its 193 member states, which are currently negotiating this. All international health regulations to date have been agreed by consensus, and we would hope that any changes to the regulations are also agreed by consensus. As I say, there are many amendments and parts of the draft that we would not agree to in their current form. I believe these negotiations will hopefully get us into a position—because I believe it is in all our interests and in the national interest—to agree revisions to the IHR. That has to be done through negotiation and consensus. I think that having an approaching deadline focuses minds, and I think it is the right thing to do.

I will give another concrete example of why I believe this is important. During the pandemic, the genomic data shared by our friends in India and elsewhere helped us to tailor vaccines as new variants emerged around the globe. We all saw over the pandemic that, as the shadow Minister, the hon. Member for Birmingham, Edgbaston said, no one is safe until everyone is safe and that global problems require global solutions.

The best way to protect the UK from the next pandemic is by ensuring all WHO members can contain and respond effectively to public health events through compliance with strengthened IHR. Targeted amendments to the IHR will further strengthen our global health security, by helping Governments plan together, detect pathogens swiftly, and share data where helpful and necessary. The pandemic highlighted weaknesses in the implementation of the IHR for global health emergency response. For example, covid demonstrated that the IHR could be strengthened through a more effective early-warning system with a rapid risk assessment trigger for appropriate responses to public health threats.

[Philip Davies]

Does my right hon. Friend the Minister not fear that what happens in the World Health Organisation negotiations will be very similar to what happens at things such as COP26, COP27 and COP28, at which all these countries sign up to something—most of them knowing full well they have absolutely no intention of following what they have signed up to—and we are left following the agreements when other countries do not even bother?

[Andrew Stephenson]

I hope that no Government would sign up to any treaty that it will not follow. I agree that, in a whole range of areas, countries around the world have sometimes not fulfilled their part of international obligations, but the UK Government will certainly not sign up to something that we do not believe is fair and proportionate, that is not our national interests and that we would not seek to follow ourselves. I share my hon. Friend’s concern that other countries have not followed regulations in the past, and there is no point in our passing strengthened regulations if we do not believe that other countries will follow them. We believe that the regulations are designed to prevent and control the international spread of disease. They are limited to public health risks and designed to avoid unnecessary interference with international traffic and trade. That is why we support the process of agreeing targeted amendments to the IHR as an important way to better prepare for future global health emergencies.

[Sir Christopher Chope]

Can the Minister explain the process in relation to the amendments? He talks about consensus, but what happens if this country does not get its way in relation to some of the amendments that it opposes? Would that mean that, if those amendments are incorporated in the final text, we can and will opt out of them?

[Andrew Stephenson]

Yes, that is exactly what consensus means. To be clear, the WHO secretariat is supporting both processes by hosting the international negotiating body and the working group on amendments to the regulations, and by supporting the chairs to prepare texts and answer questions from member states. Both negotiations, however, are member state-led processes. It is member states that are negotiating; it is not the World Health Organisation. I completely appreciate that some see this as a WHO power grab, but it is important to remember that it is a member state-led process.

We came together with other nations through the World Health Organisation to agree a process to negotiate targeted amendments to the IHR at the 75th World Health Assembly back in May 2022. By consensus, we adopted process-related amendments under article 59 of the regulations. The UK supported those amendments because they increased the timeliness of member states’ compliance with future amendments to the IHR. That will better protect us from future global health emergencies. As part of the agreed process, member states could submit proposed amendments for consideration, and to that end a working group, made up of all WHO member states, through which the amendments would be negotiated and agreed was created.

[Andrew Bridgen]

The Minister is being generous with his time. The crucial question on which the Chamber and the public would like an answer from the Minister, who is speaking on behalf of the Government who are negotiating the instruments, is whether the Minister believes that the WHO guidance—recommendations, as they were—becoming mandatory under amendments to article 1 and new article 13A of the treaty are compatible with retaining UK sovereignty.

[Andrew Stephenson]

I think that that was covered in the previous debate and has been covered by various Ministers. We have been clear from the outset of the process that we will not agree to any amendments that cede UK sovereignty. If the UK Government accept an IHR amendment that we have negotiated with our international partners, then, depending on the context of that amendment, changes to international law may be required. In those instances, the Government would prepare any draft legislation, and Parliament would vote on it in the usual way.

It is important to remember that, in and of themselves, IHR amendments and the new pandemic accord do not change the power of UK law. If required, we would ourselves change UK law through our sovereign Parliament, to reflect our international obligations under the IHR amendments. Let me be clear: in all circumstances, the sovereignty of the UK Parliament would remain unchanged and we would remain in control of any future domestic decisions on national public health measures.

[Mr Francois]

I thank the Minister for giving way so often. To be clear and to follow on from my earlier question, he has put on the record that we have a right to opt out of any amendments with which the UK does not agree. That is reassuring. On that basis, if an amendment were to be voted on by the WHO to say that it could impose a lockdown on the United Kingdom without our approval, will the Minister give a commitment that we would opt out of it?

[Andrew Stephenson]

I can give a categorical reassurance to my right hon. Friend that that is a red line for the UK Government. We would never allow the World Health Organisation to impose a lockdown in the UK. That is a clear red line for us. I cannot think of any Minister who would agree to such a request.

I can confidently say to my colleagues—as someone who campaigned for Brexit and who has helped to deliver Brexit in this place—that I am passionate about this country’s sovereignty. I believe that the Government’s position needs to be crystal clear and it is one that I endorse. We support the member state-led process of agreeing targeted amendments to the IHR and the new pandemic accord for the sake of global health preparedness, but we will not agree in any circumstances to provisions that would cede sovereignty to the WHO. That includes the ability to make decisions on national public health measures, whether lockdowns, which we just mentioned, or vaccine programmes.

[Philip Davies]

The Minister will understand people’s nervousness about this. As my right hon. Friend the Member for Wokingham (John Redwood) referred to, in the 1971 White Paper Ted Heath said that there was no question of Britain losing essential sovereignty by joining the Common Market. We saw how that went. My point, and what I am worried about, is whether the Government will have to bring forward proposals that the WHO insists on even if they do not like it, and so bring the power of Government voting to that decision. That is what I worry about, that Parliament will still decide, but that the Government will be forced to bring forward measures in Parliament, even though they may not necessarily agree with them.

[Andrew Stephenson]

I reiterate: this is a member state-led process, with 193 member states negotiating. It will be a difficult negotiation, but all previous regulations have been agreed by consensus. If the text ends up in a position where the UK Government do not feel that we can sign up to it, the other member states may decide to proceed, but they will not be regulations that we are bound by, because we will not agree to them. This is an evolving situation and we have agreed a pathway for negotiations. As right hon. and hon. Members know, the text and the amendments are available online.

May I turn to some of the contributions? I will start with those paying tribute to my right hon. Friend the Member for Rayleigh and Wickford in paying tribute to his wife and other NHS staff, who did an incredible job during the pandemic. Sometimes, when debating technical issues such as this, we can overlook their incredible contribution, but it is right what my right hon. Friend said today. He also talked about the importance of data sharing globally, which I think we would all agree is vital.

My hon. Friend the Member for Devizes asked when the next iteration of the text will be available. No new texts or amendments have been agreed yet, so there is nothing further to be shared. However, we expect negotiations to continue until May 2024, when member states will agree completion at the World Health Assembly. I am actively exploring ways in which I can keep the House informed of further developments, although as I say, the standing position of the Government on such issues is that we do not do a running commentary on negotiations. I am actively looking at what more we can do to keep Members informed.

That leads me on to another question that my hon. Friend asked about the costs of these measures. Obviously, as we have not agreed the provisions of the treaty, we cannot yet estimate how much it might cost and whether we would publish our red lines. Unfortunately, as I say, I will decline to say more on red lines now; I have set out one clear red line today and we have a very clear red line on sovereignty. However, I do not believe that we should run through these negotiations in public; I believe that we should give our negotiators time to reach as much international consensus as possible.

[Mr Hollobone]

The Minister is being extremely generous in giving way. One of the lessons from the Brexit negotiations was that civil servants in the room negotiating were not always following the ministerial line, so may I encourage my right hon. Friend to go himself to the negotiations, repeat what he has told the House today, and make sure that the civil servants who are in the room when he leaves get the message that he has just delivered?

[Andrew Stephenson]

I will certainly bear in mind what my hon. Friend has said. Some of the civil servants involved in the negotiation have already heard clearly from me, the Minister of State, Foreign, Commonwealth and Development Office, my right hon. Friend the Member for Sutton Coldfield, and my hon. Friend the life sciences Minister about various red lines and other things that we are very clear about, so there is clear ministerial input. There will be a part in this process where Ministers can get involved, but I will certainly look into what my hon. Friend the Member for Kettering (Mr Hollobone) suggests and what more I can do to ensure that UK sovereignty is in no way compromised, so that I can continue to provide further reassurance to all those right hon. and hon. Members who have spoken today.

We all want—well, maybe not all of us, but I believe the Government want a strong World Health Organisation that is fit for purpose and able to respond rapidly to global health challenges and future threats. The UK is working with our international partners to shape the WHO in that way.

Our priorities for the amendments and for the accord are global in scope but they are also in pursuit of our national interest. It is in our national interest to prevent another pandemic. Should—God forbid—another pandemic should occur, it is in the national interest to co-operate with others to slow and stop its spread. In these negotiations, I can assure right hon. and hon. Members that I would never countenance acting contrary to our national interest. We will protect our country from future public health emergencies without ceding an inch of sovereignty.

Question put and agreed to.

Resolved,

That this House has considered e-petition 635904, relating to the International Health Regulations 2005.

Sexual Harassment of Surgeons and Other Medical Professionals

Andrew Stephenson Excerpts

Wednesday 13th December 2023 Westminster Hall

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

It is a pleasure to see you in the Chair, Mr Mundell. I am grateful to the hon. Member for Canterbury (Rosie Duffield) for raising this incredibly important issue. She has been a tireless voice for women in this place, on this and many other matters. Our health service holds a special place in all our hearts. It is appalling that NHS staff face sexual assault. The reports the hon. Lady talked about, “Breaking the Silence” and that from Surviving in Scrubs, make for incredibly difficult reading. I salute the authors for their courage and professionalism.

The first report highlights that up to two thirds of women and nearly a quarter of men had been the target of sexual harassment from colleagues in the past five years. It also states that a third of women in surgery have experienced sexual misconduct in their training, including sexual harassment, sexual assault and even rape. Sadly, there is other such published research about the alarming levels of unwanted sexual behaviour happening to NHS staff and patients, including an investigative report by the Women’s Rights Network, which again the hon. Lady mentioned.

Let me be clear: that behaviour is disgusting and deplorable, and has absolutely no place in our hospitals. Staff who dedicate their lives to helping others need to be able to do their jobs without fear of any kind of abuse, let alone sexually motivated remarks, insults or attacks. NHS leaders have a duty of care towards their staff and patients. Ensuring staff are safe and treated with respect is a crucial part of creating safe and compassionate workplaces.

NHS organisations also have clear policies to deal with reports of harassment or bullying. We know that raising and reporting sexual harassment and misconduct is never easy, particularly when the perpetrators are in positions of authority or are patients. However, victims need to feel confident to raise such issues and be reassured that appropriate action will be taken by their employers.

[Caroline Nokes]

I thank the Minister for giving way, and welcome him to his new role, appreciating that he has only been in it a few weeks. I gently say to him that there is a real challenge in our NHS when 10% of women in one study reported unwanted sexual conduct in return for career opportunities. That is absolutely about power, and it is going to take a step change to break down those structures that enable such harassment to continue, behind a veil of silence, so that women are still afraid to speak out.

[Andrew Stephenson]

I pay tribute to my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes), who is the Chair of the Women and Equalities Committee, for her work in this area. I completely agree with her point; there needs to be a serious culture change. We would all recognise that over many years the NHS has been fantastic in treating patients. However, quite often the same clinicians, in many regards, have not been as compassionate when looking after each other.

The workplace culture that has developed in parts of the NHS need addressing. Even though I am new to my role, with only three weeks in post, as part of the NHS long-term workforce plan, I am looking at that culture and the staff leaver rates across a whole range of different parts of the profession. That is important because we must ensure that people have a safe and enjoyable working environment. At the moment, reports such as those detailed by the hon. Member for Canterbury show that in far too many trusts, employers are falling well short of providing that supportive environment, which is the least people should expect.

Turning to what has been happening, most NHS organisations now have trained staff to help colleagues raise concerns in this area. That includes a network of more than 1,000 local freedom to speak up guardians across all trusts, supported by an independent national guardian to help drive positive cultural change. We have also established a confidential helpline for staff who want to speak up but need guidance about what to do and where to turn. That, again, goes to the point made earlier by my right hon. Friend the Member for Romsey and Southampton North about the experience of people complaining but being passed from pillar to post between the GMC and trust. I hope that the confidential helpline will help make a difference.

NHS organisations must do everything they can to stamp out the unacceptable behaviours at all levels across the health and care system. In April, the former Secretary of State, my right hon. Friend the Member for North East Cambridgeshire (Steve Barclay), convened an urgent meeting with NHS England to ensure that NHS organisations are doing more to tackle such behaviours. We have made some progress, although I acknowledge that there is much more to do.

This year, NHS England broadened and strengthened the remit of its domestic abuse and sexual violence programme, which was established in 2022, to address sexual harassment and misconduct on NHS premises. All trusts and integrated care boards were asked by NHS England to appoint an executive and operational lead for domestic abuse and sexual violence. Those leads are reviewing their policies, training and support systems to enhance support for staff and patients.

In September, NHS England launched the first ever NHS sexual safety charter across the healthcare system. There are now 200 signatories, including NHS employers and the Royal College of Surgeons. Signatories commit to taking a zero-tolerance approach to any inappropriate or harmful sexual behaviours in the workplace by implementing all 10 charter commitments by July 2024. The commitments include establishing clear reporting mechanisms, implementing training programmes and providing essential support for those involved in investigations. NHS England will use the new network of domestic abuse and sexual violence leads to share and promote good practice and develop practical solutions in implementing the new charter.

Data capture is also a key commitment in the charter and to gauge the charter’s impact, the NHS staff survey now includes a question related specifically to sexual safety. That systematic approach reflects a commitment to transparency and accountability in creating a safer working environment. The Equality Act 2010 has also been amended this year to include a new duty on employers to take steps to prevent the sexual harassment of their employees. Implementation of the charter will assist NHS employers with meeting the duty when it comes into force next October.

The GMC is unable to consider complaints about registrants that relate to matters more than five years old unless it considers it to be in the public interest to do so, which has been raised during the debate. We are modernising the legislation that governs professional regulators, which includes removing the five-year rule as part of the reforms to regulatory legislation for doctors. It will allow the GMC greater discretion to consider whether a concern should be investigated. Introducing those changes remains a top priority for the Government.

I hope that these measures show that we are committed to addressing the problem with targeted action. However, I acknowledge that there is more to do, and I would be happy to work with the hon. Member for Canterbury and Members across the House to ensure that we get it right. We will not be satisfied until the number of staff facing sexual harassment is down to zero. There must be a collective effort across our health service to enact change. Strong and effective leadership is crucial, and it starts from the top. The Government, with NHS England driving this work, are calling upon all NHS boards to sign the sexual safety charter and ensure that their healthcare settings are safe places for our current and future workforce.

I will close by acknowledging the bravery of all those women and men who have come forward with their experiences of sexual harassment and misconduct in the healthcare workforce. That includes the testimonies in the report from Surviving in Scrubs, some of which the hon. Member for Canterbury read out. It takes incredible bravery and selflessness to come forward. Thanks to those brave women, and some men, we are getting ever closer to ending the scourge of sexual assault in our health service. I thank the hon. Member for putting a spotlight on the issue today. We must not tolerate it.

Question put and agreed to.

Crohn’s and Colitis Awareness Week

Andrew Stephenson Excerpts

Tuesday 12th December 2023 Commons Chamber

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

Let me start by congratulating the hon. Member for Livingston (Hannah Bardell) on securing this debate on this important issue. She is a tireless campaigner for those living with bowel conditions, particularly Crohn’s and colitis, and she has spoken movingly this evening about her own family’s experience of the condition. I also pay tribute to the hon. Members for Chesham and Amersham (Sarah Green), for Strangford (Jim Shannon), for Upper Bann (Carla Lockhart) and for East Renfrewshire (Kirsten Oswald) for their contributions. I will try to address as many of the points that have been made in the time allowed to me.

It is important that we all do everything we can to break the stigma and ensure that sufferers’ voices are heard. The hon. Member for Livingston has already done invaluable work in helping to re-establish the all-party group on Crohn’s and colitis. I also wish to pay tribute to the charities that support half a million people living with IBD across the UK all year round—Crohn’s and Colitis UK, the Crohn’s in Childhood Research Association, and the Crohn’s and Colitis Foundation, to name just a few. On this issue, as with so many others, it is vital that we do everything we can to break down the barriers to those affected from accessing healthcare. As Crohn’s and Colitis UK has said, “it takes guts” to come forward with your story, and I salute its “cut the crap” campaign. I look forward to working with the hon. Lady as we find solutions to improve the lives of people living with this disease. As she has rightly said, living with Crohn’s and colitis can be a daily struggle. Symptoms of the disease can be embarrassing, leading to people feeling isolated and not reaching out for the support they need.

I will focus briefly on three things my Department and NHS England are doing to help sufferers: raising professional awareness, improving diagnosis and research. I begin with the crucial point about raising awareness, as getting people diagnosed as early as possible is key.

There are two kinds of awareness. First, as the hon. Member for Chesham and Amersham mentioned, there is raising awareness among the public. Stigma is the invisible wall preventing people from seeking the help they need and campaigners are central to smashing that stigma, because of their reach into communities across the country. Campaigners, like the hon. Member for Livingston’s constituent Steven Sharp, have done much to raise awareness and break down that invisible wall. They encourage people to get to their GPs and ask the right questions. I am keen for us to be backing people like Steven every step of the way.

By helping GPs to recognise the symptoms of Crohn’s and colitis through NHS England’s “Getting it right the first time” gastroenterology programme, conditions can be diagnosed as quickly as possible. The programme supports primary care services, driving appropriate referrals and managing inflammatory bowel disease in the community, and is estimated to reduce emergency admissions by more than 6,500 a year. It has been commended by the King’s Fund, which is not always in the habit of showering praise on the Government.

It is also right that doctors should be properly trained to treat the symptoms of Crohn’s and colitis as they appear. In the past five years, the National Institute for Health and Care Excellence has produced a range of guidance to ensure that the care doctors provide for Crohn’s is based on the best possible evidence.

Early diagnosis can make a clear difference to people’s quality of life. We are working hard to improve early diagnosis rates through the “Getting it right the first time” programme and through measures that include more six and seven-day services, extended hours, reviewed and expanded endoscopy capacity, and improved patient flow. NHS England is working closely with front-line clinical experts, patient representatives and leading charities to develop evidence-based tools that improve care. The work includes provision of a right care scenario on inflammatory bowel disease. That will set out our expectations of high-quality, joined-up care at every point of the patient journey, from diagnosis to treatment. Officials assure me this is being finalised and will be delivered in the coming year.

NHS England’s national bladder and bowel health project is delivering better care to people with inflammatory bowel disease, with a focus on developing clinical pathways. Making a diagnosis of Crohn’s and colitis can be difficult and frustrating for patients as the condition can be confused with irritable bowel syndrome, so I am pleased that NICE has recently made faecal calprotectin tests available on the NHS as a non-invasive, inexpensive method for assessing patients before invasive procedures are required.

As the Minister responsible for life sciences, I am passionate that we can do everything we can to accomplish better patient outcomes through investing more in research. That is key to gaining a better understanding of the causes of inflammatory bowel disease, leading to better diagnosis, treatment and outcomes.

[Jim Shannon]

I thank the Minister for his comprehensive response, by which I am sure hon. Members are encouraged. However, the hon. Member for Livingston and I asked specifically about PIPs, which we are very concerned about. I know that is not the Minister’s responsibility, but will he undertake to speak to the relevant Minister to ensure there are movements to help and improve that system?

[Andrew Stephenson]

I am happy to give the hon. Member that undertaking. As he rightly acknowledges, I am not a Department for Work and Pensions Minister. I do not want to tread on their toes, but I will be relaying the clear views expressed during the debate to DWP Ministers because it is important that we get the benefit system right to support all people living with conditions such as these.

I will, if I may, return to the research point. We are investing more than £1 billion a year in health research with the National Institute of Health and Care Research. We are funding 60 projects on Crohn’s and colitis research, backed by more than £33 million over the past five years. I appeal to every scientist who may be interested in research in this area to keep applying for grants through the NIHR. I will leave no stone unturned in finding out what more can be done to address the needs of people affected by these conditions. I look forward to working with the hon. Lady to create the kind of care that people deserve. Whatever our political differences, I am sure that we will agree that half a million people living with inflammatory bowel disease are entitled to the highest possible standards of care and support.

I will continue engaging with the hon. Lady and with NHS England to make sure that the “Getting it right first time” programme is delivering results for patients on the ground. I began this speech by talking about the invisible wall preventing people from accessing the healthcare that they need. Let us tear down that wall together.

Question put and agreed to.

Anaesthesia Associates and Physician Associates: Regulation

Andrew Stephenson Excerpts

Monday 11th December 2023 Written Statements

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

Today I am pleased to announce that we published the response to the Government’s consultation on the legislation that will empower the General Medical Council to regulate anaesthesia associate and physician associate roles.

This is an important step towards UK-wide statutory regulation of anaesthesia associates and physician associates under the GMC. The Government intend to lay the necessary legislation in both Houses. The legislation will also be laid before the Scottish Parliament.

Physician associates work under the supervision of doctors, taking medical histories, carrying out physical examinations, performing some medical procedures and analysing test results. Anaesthesia associates review patients before surgery, initiate and manage medications, administer fluids and blood therapy during surgery, and ensure that there is a plan for patients following their operation. Both roles can work autonomously, but always under the supervision of a fully trained and experienced doctor.

Earlier this year NHS England published its long-term workforce plan—the first of its kind in the history of the NHS—which included the ambition to grow medical associate roles as part of multidisciplinary teams. The plan commits to increasing the physician associate workforce to 10,000 by 2036-37 and the anaesthesia associate workforce to 2,000 over the same period.

Regulation will provide a standardised framework of governance and assurance for clinical practice and professional conduct in order to enable these roles to make a greater contribution to patient care. The GMC will have responsibility for and oversight of both doctors and these medical associate roles, allowing it to take a holistic approach to education, training and standards.

These two medical associate roles will be the first to be regulated under a reformed legislative framework. We will subsequently be using this framework to modernise all healthcare professional regulators’ governing legislation, following the Law Commission’s report, “Regulation of Health and Social Care Professionals”.

Subject to parliamentary scrutiny, this legislation will instruct the GMC to commence regulation in 12 months, requiring it to consult on its own rules, policies and guidance needed to begin regulation of these associate roles.

The response to the consultation has been published on www.gov.uk and I have deposited a copy in the Libraries of both Houses.

[HCWS113]

Oral Answers to Questions

Andrew Stephenson Excerpts

Tuesday 5th December 2023 Commons Chamber

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

8. If she will review the provision of health services for people living with (a) Ehlers-Danlos syndromes and (b) hypermobility spectrum disorder.

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

We recognise that body-wide symptoms associated with Ehlers-Danlos syndrome and hypermobility spectrum disorder can be disabling and can affect all aspects of life. General rheumatology services, which support people with Ehlers-Danlos syndrome and hypermobility spectrum disorder, are locally commissioned by integrated care boards, which are best placed to make decisions according to local need. The major conditions strategy will focus on six groups of conditions, including musculoskeletal disorders such as these syndromes and disorders.

[Mr Sheerman]

That is all very well, but I do not think that will convince my constituents or the one in 500 people who suffer from that awful disease. This wonderful talented group of people on the Treasury Bench obviously inhabit an alternate universe. My GP said that these days there is no training or research, and that we do not have the capacity to look into these things. People with EDS have to be assessed by uptrained GPs, but they are not there. Our GP and medical services are on their knees. When will the Minister wake up to that fact?

[Andrew Stephenson]

With respect, the hon. Gentleman is as wrong as usual. NHS England is taking forward work to improve the ways in which services for rare diseases are commissioned, putting patients’ voices at the centre of service delivery and ensuring co-ordinated access to specialist care, treatment, drugs, social care, mental health and special educational support. We will continue to work to improve services in this area.

[Feryal Clark (Enfield North) (Lab)]

10. What steps she is taking to improve maternity services.

--- Later in debate ---

[Kate Hollern (Blackburn) (Lab)]

T2. I understand that pathology staffing levels at Royal Blackburn Hospital have not been reviewed for 15 years and the workload is up 300%. The national deficit in pathology is a ticking time bomb, as hospitals are unable to offer surgical and emergency services. What steps is the Minister taking to address recruitment and ensure that staff and patients are safe?

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

I understand the hon. Lady’s concern. As she knows, we share a local NHS hospital trust. I am very keen to work with her on this issue. Of course, this Government are the first to introduce a long-term workforce plan for the NHS, which will deliver thousands more clinicians for a range of services across the NHS in the years to come.

[Lee Anderson (Ashfield) (Con)]

Last month, the National Institute for Health and Care Excellence said that Kaftrio, Orkambi and Symkevi are effective treatments against cystic fibrosis, but are too expensive to put on the NHS’s list. CF is a death sentence, so what can the Secretary of State do to make sure that this medication is put on the shelves to save thousands of lives in the future?

[Andrew Stephenson]

My hon. Friend makes a very important point. NICE has yet to publish its final guidance and is continuing to work with all parties to address the issues raised in the draft guidance. The Government encourage manufacturers to work with NICE in setting a price that represents value for the NHS. I can assure the House that existing and new patients who are started on treatment while the NICE evaluation is ongoing will have access after it has issued its final recommendations, irrespective of the outcome.

[Liz Twist (Blaydon) (Lab)]

T3. As we know, there are strong links between financial difficulties, mental health and suicide. The poorest 10% are twice as likely to die from suicide than the wealthiest 10%. With so many people struggling to make ends meet, how is the Minister going to ensure that those seeking financial support get access to mental health support, and that those seeking mental health support get access to help with their finances?

--- Later in debate ---

[Jeremy Quin (Horsham) (Con)]

Lobular breast cancer treatment must be improved. Will the Minister meet my constituent and me to discuss how?

[Andrew Stephenson]

Yes.

[Madam Deputy Speaker (Dame Eleanor Laing)]

Excellent—that is how to do it.

[Mrs Emma Lewell-Buck (South Shields) (Lab)]

Cancer remains the leading cause of death by disease in children and young people, with nearly 500 dying every single year, yet the Government continue to reject calls for a dedicated children’s cancer plan. Why is that?

[Andrew Stephenson]

As the hon. Member knows, cancer will be part of the Government’s long-term strategy for diseases. Improving cancer treatment wait times is a top priority for the Government, with a key focus on the elective care recovery plan backed by an additional £8 billion in revenue funding across the spending review period.

[Jonathan Gullis (Stoke-on-Trent North) (Con)]

In response to a written question that I submitted, I was told that the Department of Health and Social Care holds no central data for diagnosis and treatment of those with eating disorders and has no idea how many mental health nurse appointments are available in GP surgeries, despite all the funding. Do Ministers agree that that is a disgrace?

--- Later in debate ---

[Pete Wishart (Perth and North Perthshire) (SNP)]

My constituent Air Marshal Dr David Walker, an inspirational leader and academic, sadly died of glioblastoma in June. When diagnosed, he and his wife Catherine were shocked to learn of the woefully low funding for brain and other less survivable cancers and established the charity the Right to Hope with Cancer. Will the Minister show the courage and leadership so epitomised by the life of Air Marshal Walker, and properly resource and fund less survivable cancers, so that everyone living with cancer has some sort of hope?

[Andrew Stephenson]

The hon. Gentleman makes an important point. My 23-year-old constituent Laura Nuttall, from Barrowford, died in May, five years after being diagnosed with a glioblastoma, having been given just a year to live. Before her diagnosis, Laura did work experience in my parliamentary and constituency offices. She was one of the most remarkable people I have ever met. As I get up to speed in my new ministerial role, he can rest assured that I will make as much progress as possible in this area. It is a personal priority to me.

Draft Health Care Services (Provider Selection Regime) Regulations 2023

Andrew Stephenson Excerpts

Tuesday 28th November 2023 General Committees

[The Minister of State, Department of Health and Social Care (Andrew Stephenson)]

I beg to move,

That the Committee has considered the draft Health Care Services (Provider Selection Regime) Regulations 2023.

It is a pleasure to serve under your chairmanship, Mr Efford. I will begin by setting out the policy context for the regulations. The House will know that the challenges we face as a country are changing, and the NHS is changing to address them. We have an ageing population, an increase in people with multiple health conditions, and persistent inequalities in health outcomes. We must respond to those challenges. To do so, we need to provide an empowering framework that allows the NHS to combine the value of competition with collaboration, to best promote the interests of patients. These regulations do that. They will establish a provider selection regime from 1 January 2024.

In 2019, engagement across the NHS identified that use of the current procurement rules presented a bureaucratic barrier to bringing NHS organisations and partners together. The NHS wanted a framework that would allow it to be flexible in different scenarios; that allowed for competition, without defaulting to it; and that supported the increased need for alignment of services, so that we can join up care for patients. The Government developed this legislative framework in the light of those requests. In June 2019, the Health and Social Care Committee agreed that that was the right approach to

“ease the burden procurement rules have placed on the NHS, ensuring commissioners have discretion over when to conduct a procurement process”.

As colleagues from across the health system have emphasised, we must seek a balance. We want a system-driven approach to planning services, but recognise the importance of provider diversity for innovation and value. That is why my officials have worked closely with a broad range of colleagues and organisations across the system, including commissioners and providers of health care services, to prepare this statutory instrument. That work included extensive consultation. In 2021, NHS England published a consultation on the detail of the policy behind this instrument. Some 420 responses were received from NHS representative bodies and individuals, and 70% of respondents agreed or strongly agreed with the detailed proposals set out in that consultation. The Department of Health and Social Care published a further consultation in 2022 that aimed to inform the detail of our regulations.

Our voluntary impact assessment shows that in the most likely scenarios, this instrument will deliver a saving to the NHS by reducing bureaucracy. It is difficult to provide a precise figure ahead of the monitoring of any such regime, but Members who have read the impact assessment will be aware that our central estimates suggest that savings of up to around £230 million a year are possible.

Of course, as many Members will know, getting the balance of a framework right, so that it promotes the best culture and behaviour on the ground, is tricky. I am glad, therefore, that our engagement with stakeholders has resulted in an agreement to establish an independently chaired panel for contested decisions made under this regime.

Legislation and guidance are only part of the story of how the new legislation will influence outcomes. That is why my Department is committed to monitoring and evaluating this new regime from its implementation.

To summarise, this instrument reflects engagement and careful balancing to present commissioners with the right options for procurement, so that they can go about finding the most collaborative, value-adding solutions that will work for patients. I commend the regulations to the Committee.

--- Later in debate ---

[Andrew Stephenson]

I thank hon. Members for their contributions and I will try to address as many of the points as possible in the time allowed.

I thank the shadow Minister, the hon. Member for Birmingham, Edgbaston, for her support for the regulations. She talked about greater accountability and transparency, which are vital to the process. We feel that they are ingrained in the regulations, but if there is anything more that we can do to ensure that that is the outcome of the process, we are keen to work with her on that.

I have been assured by my officials that good progress is being made in putting together the independent panel, but I am keen to see it in place in good time for the commencement of the regulations. The shadow Minister asked about service user involvement in the procurement process. As she may know, commissioners must follow NHSE guidance on people and communities, which guides how commissioners must involve patients and the public in commissioning healthcare services. That advice is available online if Members want to see more details.

We probably disagree about some of the controversy around the procurement of PPE during the covid pandemic. Let me be clear that the draft regulations apply only to the arrangement of healthcare services that are delivered to patients. That does not include the procurement of goods or other services, which will continue to be procured under the wider rules in the Procurement Act 2023 from October next year.

At the same time, let me reassure hon. Members that every effort was made to quality-assure the products that the Government procured during the pandemic. Estimates of demand relied on a reasonable worst-case scenario in a very fast-moving situation, and of course the reasonable worst-case scenario was that we would need to purchase significant amounts of PPE. Despite the enormous challenge, we conducted due diligence on more than 19,000 companies, and only around 2,600 companies made it through that initial process. All offers, regardless of the route through which they were identified, underwent rigorous assessment, and, importantly, the source of the offer did not affect the way that the offer was treated. To protect patients and staff, the Government spent £12 billion on PPE for the covid response, which was a time when we needed to act fast to protect the public. Of that, only 3%, or £673 million-worth, was not fit for use.

Moving forward, we have established a contract dissolution team to maximise the value obtained from PPE contracts. The team is reviewing contracts that did not perform, either wholly or in part, to find ways to allow the PPE to be used, replaced or refunded. Our current trajectory should see the Department recovering significant amounts of money.

I turn to the contribution of the hon. Member for Wirral West and her concern about the so-called privatisation of the NHS. I recognise that that issue comes up in debates time and again. To discuss the point properly, we must recognise that the independent sector includes a broad range of organisations, all of which have an important role to play in the day-to-day delivery of NHS services. It includes the work of charities, social enterprises and cutting-edge independent diagnostic centres, each of which has its own role to play in the NHS to ensure that patients receive the best possible care—I was pleased that the shadow Minister acknowledged that.

[Margaret Greenwood]

I thank the Minister for making that point. He is talking about charities, but he must recognise that where a private provider is delivering NHS services, the money has to go to shareholders. That money could be spent on patient care. He can talk about charities, but that is not what I am talking about, as he knows. He is probably going to get on to this now, but can he give a clear assurance that the most suitable provider process will not lead to the replacement of NHS providers by private or other independent sector organisations when the contracts come up for renewal?

[Andrew Stephenson]

The most suitable provider process is designed with the NHS to give the right level of flexibility for the NHS. Commissioners can choose how to balance the key criteria, so value is used alongside the other criteria set out in the process. I know the hon. Lady has come to many debates over the years and said that the Government are privatising the NHS. In 2013-14, 6.1% of total health spending was spent on the purchase of healthcare from the independent sector. In 2021-22, the figure was 5.9%, so the idea that we are privatising the NHS is just nonsense. I want to ensure that that is on the record.

[Adam Holloway]

To me, this is complete nonsense. It is absolutely ridiculous to say that if a private provider does something, the profits go to shareholders and are not reinvested in the NHS. The hon. Member for Wirral West is basically saying that the means of production should be entirely in the hands of the state. What about when we buy tanks? Do we say that we should make the tanks ourselves and not let evil BAE Systems shareholders take the profits? It is preposterous.

[Andrew Stephenson]

My hon. Friend put that eloquently and made a very good point.

The shadow Minister, the hon. Member for Birmingham, Edgbaston, mentioned one of her recent visits, so I want to put on the record one of my recent visits. Just last week, I visited University College London Hospitals NHS Foundation Trust, which opened a Macmillan Cancer Centre in 2012. It is a diagnostic centre that treats a wide range of cancer and non-cancer conditions, and it is integrated with the Macmillan support and information service for patients and their carers and families. To me, that is integration in action, which is what we are looking at today. The statutory instrument recognises the important role that all providers play by treating none of them differently, irrespective of whether they are a statutory NHS body, an independent social enterprise or a charity. Indeed, the Committee knows that the NHS already relies on a diversity of providers, because what is most important is doing what is right by patients.

I hope I have provided sufficient answers to the questions raised by hon. Members today. The regulations are necessary to enable the transformation that the NHS needs to deliver better joined-up services, and I commend them to the Committee.

Question put and agreed to.

World Stroke Day

Andrew Stephenson Excerpts

Thursday 23rd November 2023 Westminster Hall

[Rachael Maskell (York Central) (Lab/Co-op)]

Thank you for those kind words, Mr Hollobone. I will open by saying that I used to be a physiotherapist working in acute care, specialising in stroke care, so I bring other experience to the debate as well. I serve on the all-party parliamentary group on stroke, and I am indebted to the hon. Member for Bromley and Chislehurst (Sir Robert Neill) for securing today’s debate. We work assiduously on this issue here in Parliament, and it is so important for all our constituents. We believe there is real scope for change within the Government’s approach to help our constituents not only to prevent stroke, but to survive stroke, and to benefit from that.

As the hon. Member for Bromley and Chislehurst said, every single five minutes, somebody will experience a stroke. For some people, it will be brief—a transient ischaemic attack. For other people, it will clearly be very serious indeed, and for some people it will lead to mortality. To bring that home, during the course of the debate another 18 people will have experienced strokes. The urgency is now, and we cannot lose time. Over the course of a year, around 100,000 individuals experience stroke, but that means that 100,000 families also come into contact with the NHS. As a result, it is really important that the Government renew their focus. Although we welcome the major conditions strategy, it is simply not enough. Of course, the major conditions strategy is so major that the necessary focus needs to be brought to the fore. I suggest that we make 2024 a year of stroke, so that we really bring that focus down to deliver. If we had that focus across the system, we could make such a difference.

I will not go into all the statistics that my hon. Friend the Member for Bromley and Chislehurst did, but I just want to say that stroke is very avoidable. Of the people who experience it, 80% will have risk factors that can be controlled. We must talk about prevention. As a vice-chair of the Health and Social Care Committee, I must mention our inquiry into prevention in health and social care, which I am sure the Minister will pay much attention to. We must look at how we prevent individuals having stroke. Of course, we can undertake monitoring, for instance around blood pressure, with high blood pressure being an indicator and also atrial fibrillation. This is also about lifestyle choices; it is really important that we remember that smoking is still a major cause of stroke. We must ensure that individuals have early help, not least if there is a familial issue with stroke, to see how we can avoid that.

I also want to talk about health checks. It is really important to make those early interventions. We heard today about a 41-year-old who experienced a stroke, and one in four people who experience a stroke are under retirement age, so we must remember that it is often younger people who experience the need for this process. As a result, we should monitor people. The health checks that came in for those aged 40 are not often applied within integrated care board areas. We need a real sea change there, because monitoring things such as what is happening with blood pressure as early as we can, with really quick tests, can make a sizeable difference.

The Health and Social Care Committee has just returned from Singapore, where we heard about the early healthcare interventions being made there and, of course, saw the outcomes. If the Minister is determined to make a difference in his short time in the role before my hon. Friend the Member for Denton and Reddish (Andrew Gwynne) takes charge, introducing those interventions to monitor what is happening could be a life-changer.

I also want to highlight how we need to respond. Response is too slow, and I want to challenge the system. For ambulances, a stroke is currently a category 2 call. I would like it to be made a category 1 call and the response expedited, because every minute that passes in the golden hour can make a difference to somebody’s future and whether they will experience severe disability—or, indeed, die—or receive interventions that could prevent such disability. Changing the categorisation would save both money and lives. It is important to look at that again. It could make a difference, not least because the time lags for the ambulance service on category 1 and category 2 calls at the moment mean that categorisations are insufficient to get patients to the right place at the right time in order to get the right interventions. I hope that the Minister will take that away and carry out some work in that area to expedite the process towards diagnosis and treatment.

I turn to diagnosis. In a country like Germany, individuals are diagnosed at the kerbside, at home, or wherever they have their stroke, and the process will start immediately. At the point that the patient is experiencing deficits—perhaps they are still going through a cerebral event—or as soon as the ambulance is called, the clock starts on the diagnostic process and then treatment. Using the best diagnostic techniques to scan at the kerbside, using AI to help, we know—[Interruption.] It looks like the Minister is in some pain; perhaps he needs my physio skills.

[The Minister of State, Department of Health and Social Care (Andrew Stephenson)]

Sorry; it is my shoulder.

[Rachael Maskell]

Being able to undertake the diagnostic process really early means being able to get the information into the stroke unit of the hospital as early as possible, so that when the patient arrives at the door, they are whipped through the system and interventions can start. The problem is that we have such a time lag that intervention is often too late. Will the Minister look at what is happening on a global scale with interventions that could really make a difference?

Of course, there are two types of stroke: some people have a cerebral bleed and some have an infarct, or a blockage, where the brain is starved of oxygen. As a result, different treatments are undertaken. There is thrombolysis, which is a medical intervention to blast a clot through, and mechanical thrombectomy, which the hon. Member for Bromley and Chislehurst talked about, where a wire is fed through the femoral artery into the brain, captures the clot and withdraws it. As a result, the brain can receive the oxygen it needs so that it does not experience the damage that we have heard about.

We need to increase the specialist interventional neuroradiologist workforce. It is a highly trained specialism; we need enough of them, and a sufficient supply. We should have a workforce plan for the specialism to ensure we are training sufficiently and expanding the workforce. In other countries, there has been a real increase in the number of people able to access this treatment. As we have heard, the average across the UK is 3.3%, but in other countries it is 10%. Not all patients can benefit from this life-saving treatment, but of those who can, only about a third get access to it.

We need to think about where the centres are based. It is important that they are in major centres because doctors need to do a lot of these procedures to be expert in them. We need people to be expert in them, but we also need more centres. I ask the Minister to look at the mapping of that, and at specialist commissioning through NHS England to ensure provision right across the country. Will he also work with the ICBs in this area?

We need a specialist workforce. It is positive that we are training more people in stroke specialisms, but in physiotherapy, for example, significant further training is needed on Bobath—a technique used in stroke rehabilitation—and we need to ensure that it is easily accessible. Other professionals do not get the same access to training budgets as medics, so there is often a lag in getting people through the specialist training that is needed. I ask the Minister to look at that to ensure that the workforce is trained in the best techniques to treat stroke, and to carry that specialism.

This is all about investing to save money, because the better the intervention, the better the outcome for the patient. We need physios, occupational therapists, speech and language specialists—there is a significant shortage of them—and clinical psychologists to work as a team around the patient. They often work together. To give hon. Members an idea of how long it takes, a physio can spend an hour a day with a patient, because they have to break down and rebuild their tone and spasticity, which takes time. But as they are sitting the patient up, the speech therapist often comes along and does a swallow test, and an OT may do some function work. That team needs to come together. Unfortunately, the gaps in the workforce mean that it is hard to have the quality of treatment that will benefit the patient, from the most acute phases of the stroke right through to rehabilitation.

Of course, we want patients to go to stroke units—specialist rehabilitation places—where they can benefit from therapeutic intervention and get the best outcomes possible to optimise their baseline before they are discharged back home. Being in that environment is really important, but at the point of discharge, after all that cost—we have talked about diagnosis, intervention and therapy—what happens? Well, experiences are very varied, and 45% of survivors feel abandoned, so we know something is going wrong. Individuals can easily lose confidence and function.

If an individual is on a pathway to a care home, the care home should be properly trained in supporting people who have had a stroke. Everything matters: the person’s positioning, how they lie in bed, how they sit in a chair and how their hand rests can make a real difference to their function, and their hygiene and personal care. It is necessary to ensure that, if they are mobilising, it has an impact. How patients are transferred can make a difference to those outcomes, so it is important that a person is discharged not just to a care home, but to a care home that has undergone proper training. If someone is moving to the community, we need to ensure that the family around them are trained in how to support them, just as carers who provide domiciliary care must be.

I want to pick up on what the hon. Member for Bromley and Chislehurst said about people seeing improvements in their baseline functioning. It is possible that individuals do and will. Through the process of neuroplasticity, a person’s brain changes and can make alterations and repair, so we need to ensure that, when somebody gets home, there is ongoing therapeutic intervention. It is easy to slip into bad ways and take shortcuts, which can undo some of that good work, and those interventions to top people up can make a difference and keep people functional, mobile and independent. If people miss out on those interventions, they will rapidly require more acute care.

I draw the Minister’s attention to that and ask him to look at the whole pipeline. The lack of support is clear: only 37% of patients got their six-month check last year, which is completely insufficient. We need the figure to be 100%, so there is clearly some work for the Government to do. We are talking about 40,000 people who missed out altogether, which affects ongoing care and support. In the same way that a cancer care navigator works with patients, we need somebody who co-ordinates care and individual support on the stroke pathway, as a permanent process.

As I have already said, we have an opportunity next year to make a seismic difference to individuals by focusing on stroke. I hope that the Minister will take that opportunity, with a laser focus on a new stroke strategy across the country. If he does not, I will badger my hon. Friend the Member for Denton and Reddish to take that on, whenever he gets the first opportunity. It is important that we do that.

Finally, research in this area could be improved, and investment in research is needed. As we have seen in recent times, investment in thrombectomy has been a game changer. It gives people who experience a stroke real hope. Other interventions can and will be made: we need to understand more about our brain health, therapeutic interventions, and how to use new technologies to help people to be independent and live full and comprehensive lives. I trust that the Government will look at the research base and at investment in research as an opportunity. I trust that they will also work with the voluntary organisations that work so hard in this area—they are real experts—to ensure that we have the best stroke strategy and stroke outcomes that any country could ever have.

--- Later in debate ---

[The Minister of State, Department of Health and Social Care (Andrew Stephenson)]

It is a great pleasure to see you in the Chair, Mr Hollobone. I congratulate my hon. Friend the Member for Bromley and Chislehurst (Sir Robert Neill) on opening today’s debate, which is on such an important issue. He is a tireless campaigner for stroke survivors, and his experience is invaluable in bringing their voice into this place. I am sure that his wife is very proud of the work that he does.

I pay tribute to the hon. Member for York Central (Rachael Maskell) for her thoughtful contribution, drawing on her own professional experience, and for the helpful and constructive suggestions that she put forward during the debate. I also pay tribute to the hon. Member for Strangford (Jim Shannon) for his contribution and his kind words. As he knows, I have family in Northern Ireland, and I think it is vital that on issues as important as this, England, Scotland, Wales and Northern Ireland work together where we can to deliver the best outcomes for patients—something that I was also very grateful to hear the SNP spokesperson, the hon. Member for Motherwell and Wishaw (Marion Fellows), making clear in her response to the debate. I also thank the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), for his contribution.

[Sir George Howarth in the Chair]

Finally, I thank my hard-working Parliamentary Private Secretary, my hon. Friend the Member for North Norfolk (Duncan Baker). He is not allowed to speak in the debate, but he was a founder member of the all-party parliamentary group on stroke. He lost his stepfather to a stroke in July 2019, just five months before he was elected to this place, and the stroke issue is a huge priority for him; he has done an awful lot of work on it since he was elected to the House.

I would like to start as my hon. Friend the Member for Bromley and Chislehurst and so many of the contributors today did, by paying tribute to the outstanding charities that support people up and down the country to thrive after stroke. I know that my hon. Friend works closely with the Stroke Association. I was pleased to meet its CEO, Juliet Bouverie, this morning while on a visit to the Royal Berkshire Hospital to see the innovative ways that the hospital is harnessing technology to improve stroke care. I look forward to continuing to engage with her, including on the major conditions strategy, which I will cover later in my speech. I also commend the many other charities involved in this field of work, such as The Brain Charity, Think Ahead Stroke and the other—many much smaller—charities referred to by many hon. Members today. They all do fantastic work to support patients and drive forward improvements in care.

Sir George, it is excellent to see you now in the Chair. In recent years we have made great progress in understanding the condition, but as has been said, more than 100,000 people have a stroke in the UK every year. As the hon. Member for York Central reminded us, that means that during this one debate alone, 18 people will have experienced a stroke. One third of them will be left with some form of long-term disability. I am grateful to hon. Members for giving me the opportunity, less than a month after World Stroke Day, to update the House on the work that the Government are doing in this space.

I will now address as many of the points that have been raised in the debate as I can. The Government’s priority is to prevent stroke in the first place. That is why I am pleased that we are rolling out an innovative, new digital NHS health check in the spring. The original programme saw the highest number of NHS checks between April and June since its creation in 2013. We are backing the programme with £17 million to deliver a million extra checks in the first four years. We have also appointed Professor John Deanfield to develop an ambitious vision for a modern, personalised cardio- vascular disease prevention service. We are investing up to £645 million over two years to expand services offered by community pharmacies, including expanding blood pressure services. That extra capacity in the first year could prevent over 1,350 cardiovascular events, including strokes.

One ambition of the NHS long-term plan is the inclusion of a national stroke programme, seeking to improve stroke services through increased access to specialist stroke units, with a flexible and skilled workforce and better rehabilitation services. We are making progress on expanding the range of scanning across the country. Between April and June, over 95% of stroke patients were scanned within 12 hours of arrival into hospital, and 87% of patients eligible for thrombolysis received clot-busting drugs to treat their stroke. While there is of course more to be done, stroke patients now have better access to scans than ever before, but as many have said, integration is key. That is why, since April 2021, we have established 20 integrated stroke delivery networks, which bring together key partners in our fight against stroke to deliver joined-up whole pathway transformation across integrated care systems. They are now responsible for delivering optimum stroke pathways and ensuring that patients receive high-quality specialist care from before they are admitted to hospital through to rehabilitation and life after stroke.

Over the past 10 years there have been clear improvements in access to community stroke care, and the percentage of patients discharged from hospital to community stroke services has risen to 61% from just 41% 10 years ago. Every patient with acute stroke should gain swift access to a stroke unit within four hours and receive early multidisciplinary assessment. The latest data shows that 60% of patients are currently admitted to a stroke unit within that time. We have to ensure that we do better across the whole United Kingdom. That has improved over the past five years, but I recognise, as many have said, that more needs to be done. I am pleased that NHS England is trialling a new virtual consultation project between paramedics and stroke teams. We are confident that these innovative pilots will ensure timely access for patients accessing stroke units. That is being promoted across the country, and I am pleased that phase 1 was successfully completed this month and phase 2 began last month.

The hon. Member for York Central made an interesting point about whether stroke cases could be classified as cat 1 by the ambulance service. That is something I am quite passionate about. For the past nine years, I have been a community first responder with North West Ambulance Service. She will probably be aware that at the moment only cardiac and respiratory arrests are classified as cat 1, so I am not sure that that is a change I instinctively would support. However, I completely and utterly agree that it is critical that ambulances arrive as soon as possible, and that we triage patients to the correct services as soon as possible. I am happy to look at that and some of the other suggestions she made because she suggested an awful lot of good things that if we are not already looking at, we should be.

There is strong evidence that, when used appropriately, thrombectomy significantly reduces the severity of disability caused by stroke. Thrombectomy is a suitable treatment for around 10% of stroke patients and is available now in 24 centres in England, with a further two non-neuroscience centres on the way. NHS England has assured me that it remains committed and on track to reach its 10% target for all eligible patients to receive a thrombectomy by the end of 2025-26. The latest data shows that the thrombectomy rate has more than doubled in the past three years. To reach the target, the General Medical Council has approved the thrombectomy credential to support neuroradiologists to perform the procedure and increase the number that can be conducted. We have made great progress in getting cutting-edge AI technology into now over 90% of acute stroke-care providers in England. AI brain-scanning is now installed in all these thrombectomy units, reducing the time between patients’ first experiencing stroke-like symptoms and receiving treatment by more than 60 minutes. I saw that for myself this morning at the Royal Berkshire Hospital and I was incredibly impressed.

We know that stroke survivors commonly experience serious psychological, emotional and cognitive effects. Those greatly impact a person’s rehabilitation, quality of life and ability to return to work. We understand that there is a high level of demand for space in hospitals for rehabilitation services, which play an important role in a patient’s recovery and discharge from hospital. NHS England has taken important steps to increase capacity as part of its winter planning by ensuring that functions such as physiotherapy have the space they need in hospitals to operate effectively.

Of course, stroke treatment is dependent on our amazing NHS staff providing the care. There has been good progress in addressing staff shortages in several rehabilitation areas, although again I appreciate that more needs to be done. Between 2019 and 2023, we grew the number of full-time equivalent physiotherapists working in the NHS by almost a fifth, to over 23,000. NHSE has been working to increase the number of available student placements, and we have developed the speech therapy apprenticeship. Clinical neuropsychologists are a flexible workforce specifically trained to intervene across multiple care pathways, including stroke, acquired brain injury and other conditions. By 2024, NHSE will have doubled the number of training places available compared with the start of 2022.

The major conditions strategy will tackle conditions that contribute most to morbidity and mortality across the population in England. The strategy will cover prevention and treatment for cardiovascular disease across a person’s whole lifetime. As I have already touched upon, some of the key planks of the strategy include prevention, unlocking the transformative power of AI, and tackling the comorbidities that cause ill health in the first place. We published the strategy in August, and I hope to keep my hon. Friend the Member for Bromley and Chislehurst and other Members across the House updated on progress.

My hon. Friend—and most Members who spoke—raised concerns about the variation of stroke services across England. The NHS England national thrombectomy implementation group is gathering data on regional variations in access to mechanical thrombectomy. It will report on the outcomes of that by the end of this year, and if I can, I look forward to sharing that information with the APPG and others. The major conditions strategy will set out that integrated care systems tackle clusters of disadvantages in their local areas. That will include addressing variations in outcomes and the care that people receive in the context of the recovery from the pandemic.

This Government have a profound ambition to improve the lives and health outcomes of people in this country who have survived a stroke. The contributions today have played a vital role in pushing this agenda forward. I am happy to reassure my hon. Friend, and the other Members who have spoken, that I will continue to do everything I can for this matter to remain a top priority for our health service, and that the thrombectomy target will stay on track. I am especially grateful to my hon. Friend for everything that he has done to encourage his constituents to sign up for the Our Future Health programme. Our work here will have huge benefits both to patients and to our NHS overall, so that all survivors may survive and thrive after stroke.

Commercial Clinical Trials Review

Andrew Stephenson Excerpts

Wednesday 22nd November 2023 Written Statements

[The Minister of State, Department of Health and Social Care (Andrew Stephenson)]

The UK demonstrated its strength in clinical research during the pandemic through the rapid design and set-up of studies. Over 2 million people participated in covid-19 trials for treatments and vaccines across the UK.

The collaboration that arose between researchers, the Government, the life sciences sector and the NHS drove one of the greatest joint missions in history, something that no other country or international organisation was able to deliver at the pace and scale that we did.

Despite this remarkable success, data published by the Association of the British Pharmaceutical Industry (ABPI) in October 2022 highlighted a decline in the number of commercial contract clinical trials initiated in the UK, primarily in 2020 and 2021. This was due to the challenge of the pandemic, as many studies were paused to allow the system to focus on nationally prioritised covid-19 studies. This change was needed to address the urgent need to identify treatments.

While the collaboration seen during the pandemic showed the agility and resilience of the clinical trial sector in the UK, the Government have recognised that more work needed to be done to sustain and grow this momentum, and to build and strengthen the sector. The Government vision is to unleash the full potential of UK clinical research delivery to help address health inequalities, bolster economic growth and improve the lives of people right across the UK. Clinical research delivery partners across the UK have been working on a co-ordinated plan to transform delivery of clinical research in the UK since 2021, as set out in “Saving and Improving Lives: the Future of UK Clinical Research Delivery” https://www.gov.uk/government/publications/the-future-of-uk-clinical-research-delivery/saving-and-improving-lives-the-future-of-uk-clinical-research-delivery

In February 2023 the Government commissioned Lord O’Shaughnessy to conduct an independent review to offer recommendations on how to resolve key challenges in conducting commercial clinical trials in the UK and improve the UK commercial clinical trial environment.

In May 2023 Lord O’Shaughnessy’s review into commercial clinical trials was published. The review set out 27 recommendations, including priority actions to progress in 2023 and longer-term ambitions for UK commercial clinical trials. The review acknowledged the improvements already made and underway and highlighted areas where the system could go faster and further.

Alongside the publication of the review, the Government published an interim response to the review where the Government made five headline commitments backed by up to £121 million.

The five headline commitments were:

To substantially reduce the time taken for approval of commercial clinical trials, with a goal of reaching a 60-day turnaround for all approvals;

To deliver a comprehensive and mandatory national approach to contracting;

To provide “real-time” data on commercial clinical activity in the UK;

To establish a common approach to contacting patients about research; and

To establish clinical trial acceleration networks (CTANs).

In addition to these commitments, the Government also accepted in principle the foundational action to develop SMART objectives for all of the ambitions in the vision for clinical research delivery, with owners held to account for delivery by the Life Sciences Council.

Since the publication of the review and the initial Government response we have made excellent progress. For example, in September 2023 the MHRA met the target of all studies receiving regulatory approval within 60 days. This is a significant achievement, providing much-needed predictability and stability for study sponsors and funders.

Furthermore, recruitment to commercial contract research is now an average of over 5,000 a month, in comparison with a pre-pandemic average of 3,200; 82% of commercial studies are on track; and set-up of new commercial studies has been reduced by over 100 days (36%) since our new approach was implemented in October 2022.

Collaborative research funded by both the life sciences industry and non-commercial funders, such as medical research charities, has also recovered to match our pre-pandemic baseline of over 6,900 people recruited on average each month.

Building on this success, I am pleased today to announce to the House the publication of the Government’s full response to Lord O’Shaughnessy’s review, coinciding with the quarterly meeting of the Life Sciences Council. We have accepted all of the problem statements and the majority of the report’s recommendations. In some places we have proposed alternative ways to deliver the ambition behind the recommendation.

This response sets out a full system-wide response with cross-sector input outlining that over the next two years delivery partners will:

Fully implement the five headline commitments announced in May 2023;

Make progress in tackling all the problem statements identified by Lord O’Shaughnessy;

Continue work to improve the operating environment for all types of clinical research using national performance indicators and being transparent about the latest status of these metrics; and

Increase adoption of more innovative, decentralised models of clinical trial delivery through clinical trial delivery accelerators in vaccines and dementia

The response builds upon the strong foundation that is our clinical research ecosystem, integrating the recommendations made by Lord O’Shaughnessy into the existing future for UK clinical research delivery framework, to make the UK one of the best places in the world to conduct clinical trials.

The health needs of the UK and our research system are broad and diverse. We are committed to maintaining a rich and balanced portfolio, early and late phase, commercial and non-commercial with a range of methodologies and sizes.

The response updates and supersedes our previous plans and provides renewed focus to ensure that we make the progress necessary to ensure that we are a global leader in the delivery of life sciences research while also ensuring continued progress towards our 10-year vision.

Implementation of the response will begin immediately, with quarterly updates and monthly cross-sector communications being made publicly available on the “Future of UK clinical research delivery” microsite.

The publication today provides a clear signal to the health research system that this Government remain committed to making the UK a world leader in conducting clinical research of all types.

Copies of the Government’s response have been deposited in the Libraries of both Houses.

[HCWS61]

Healthcare Students: Pay and Financial Support

Andrew Stephenson Excerpts

Monday 20th November 2023 Westminster Hall

[The Minister of State, Department of Health and Social Care (Andrew Stephenson)]

It is a great pleasure to see you in the Chair, Ms Fovargue, for my first Westminster Hall debate in my new role. I am grateful to the British public for raising the important issues covered in the three petitions we are considering today, and to the hon. Member for Battersea (Marsha De Cordova) for opening the debate. I also thank the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), for his contribution and his qualified welcome to me in my new role, and the hon. Member for Sheffield Central (Paul Blomfield) for his interventions during the debate.

Our students are the future of our NHS, so it is imperative that we not only support them throughout their studies, but ensure that as many as possible go on to successful careers in healthcare. The Government recognise the unique nature of healthcare degrees, the intensity of the courses and the additional financial pressures that clinical placements can cause, which is why we are doing as much as we can with the funding available to us to ensure that clinical students have the financial support they need to succeed.

Two of the petitions focus on pay for student placements. While they are on placement, student nurses, midwives and allied health professionals make valuable contributions to clinical teams, but the purpose of such placements is student development, not meeting staffing needs. They exist to give students the opportunity to learn and to acquire the skills and experience they need to graduate and join the professional register. That is why we believe that clinical placements should not be described as jobs. Students are not contracted to provide care and do not hold contracts of employment, so while we recognise the significant contribution made by students, the Government do not plan to introduce pay for students on placement at this time.

[Marsha De Cordova]

The Government are not planning to look at this issue again, but have they looked at the impact of student nurses being taken out of the workforce in NHS care settings, to see how the workforce would manage without them? They play a vital role. Yes, they are learning and so forth, but they also fulfil another role. Have the Government carried out any assessment of the impact of taking them away from that by not giving them pay?

[Andrew Stephenson]

The Government and the professional bodies that set the rules for student placements have made it very clear that if the students are not there, the setting should still be clinically safe and procedures should be able to be conducted. All student placements should be in addition to regular staffing; they should not be used to fill gaps in staffing rotas. That is not to suggest in any way that students on placement do not make a significant contribution—I think we all agree that they do, and I pay tribute to them for the contribution they make—but in all settings, if the students are not there the employed staff should be able to continue to deliver NHS services in the way that we all want.

We do not wish to introduce pay for students on placement, but we do intend to continue to listen to students’ concerns about the cost of training and to consider what we can do to support them, building on the work we have already done. Since September 2020, all eligible nursing, midwifery and allied health professional students have benefitted from a non-repayable, non-income-assessed training grant of at least £5,000 per academic year from the learning support fund. On 1 September this year, we announced a 50% increase to the travel and accommodation payments available through the learning support fund, ensuring that students are appropriately reimbursed for travelling to clinical placements.

The Government are not just supporting the more traditional routes into education and training. As we set out in the first ever NHS long-term workforce plan, we are expanding alternative routes into healthcare, enabling people from diverse backgrounds and those for whom a traditional university degree is not possible, or is not the right thing for them, to bring their unique skills and perspectives to the NHS. We are now offering blended learning courses, allowing students to take some of their courses online, and more than a quarter of nurses’ mandatory practice learning hours can now be delivered via innovative simulation. We are also continuing to expand our apprenticeship offer, allowing students to study towards a degree while also learning on the job. As set out in the long-term workforce plan, we will deliver a huge increase in the number of clinical staff apprenticeships; we intend to get them up from 7% today to 20% by 2032. That is building on the success of our existing registered nursing degree apprenticeship programme; more than 10,000 students have started on that course since 2017.

We are providing a more diverse set of pathways into healthcare careers in order to open up more opportunities for staff to progress and move into new roles. Thanks to an increase in the number of associate roles, such as nursing associates, it will be possible to join the NHS as an apprentice healthcare support worker and go on to qualify as a registered nurse.

I would like to pick up on a point made by the hon. Member for Sheffield Central, who talked about the UCAS figures showing a 16% decline in applications. The drop in applications compared with previous years reflects an expected rebalancing following the unprecedented demand for healthcare courses during the pandemic. At the June application deadline this year, there were 44,000 applicants for nursery and midwifery courses in England, which is an increase of 12% compared with this time in 2019. The latest data shows that over 22,000 students have accepted places on nursing and midwifery courses in England, which is an increase of 6% compared with the same time in 2019. If we look at allied health professionals, 2,200 more graduates enrolled on paramedic science courses overall in England in 2021-22 than did so in 2019-20, which represents a 30% increase.

Let me address the second issue raised today: childcare payments for student midwives, nurses and paramedics during their placement hours. The Government understand how important childcare is for studying parents, and we believe that they should have every opportunity to continue in education and achieve their aspirations. As the Minister for Skills, Apprenticeships and Higher Education set out in our response to the petition, the Government provide a range of financial support to students with children. They are eligible for 15 hours of free early education for three and four-year-olds, and full-time students on undergraduate courses who have dependent children could also be eligible for the childcare grant and the parents’ learning allowance. The childcare grant covers whichever is the lowest: 85% of childcare costs or a fixed maximum amount of around £190 a week for one child or £320 for two or more children. The parents’ learning allowance of up to £1,915 a year does not have to be repaid; it is paid in three instalments—one at the start of each term—and goes directly into students’ bank accounts. What is more, as part of the learning support fund, my Department offers all eligible nursing, midwifery and allied health professional students an additional non-repayable and non-income-assessed grant of £2,000 per academic year towards childcare costs.

Using the budgets available to us, the Government will continue to provide students who have children with as many opportunities and as much support as possible to allow them to pursue a career in healthcare. As we set out in the first ever NHS long-term workforce plan, a robust and resilient education and training system is critical to the future of our NHS, because, by having the right people with the right skills in the right places, we can deliver first-class care for patients, now and into the long-term future.