Carers and Poverty: Carers UK Report
Baroness Keeley Excerpts(3 days, 14 hours ago)
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Baroness Merron (Lab)
One of the key things in all this is the identification of carers. As has been discussed in your Lordships’ House on a number of occasions, a lot of people do not identify as carers. Therefore, we are encouraging GPs and, in the case of young carers, schools, to identify carers, so that they can get the support they deserve. The noble Lord, Lord Darzi, identified that making sure that unpaid carers receive recognition and support is key, and it will be in the 10-year plan as we go forward.
Baroness Keeley (Lab)
My Lords, I want to raise the issue of the 21-hour study rule whereby an unpaid carer is not allowed to claim carer’s allowance and be in full-time education of more than 21 hours a week. I cannot see a good reason for that rule. It would be very welcome if the Labour Government changed the rule to allow unpaid carers to study without losing their carer’s allowance.
Baroness Merron (Lab)
I thank my noble friend for that and can assure her that I will be discussing that very point with ministerial colleagues and am happy to return to her on it.
National Carers Strategy
Baroness Keeley Excerpts(5 days, 14 hours ago)
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Baroness Keeley
To ask His Majesty’s Government what plans they have to develop a National Carers Strategy.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)
My Lords, we are committed to supporting unpaid carers through our renewed vision for adult social care and the 10-year plan for the National Health Service. We have already taken action to increase the carer’s allowance earning limit, meaning that carers can earn around £2,000 a year more without affecting their entitlement. We have heard the calls for a national carers strategy and will continue to work collaboratively across government to ensure that unpaid carers are visible, valued and supported.
Baroness Keeley (Lab)
I thank my noble friend the Minister for that reply, particularly on cross-governmental working, because I think that is one of the most important aspects. The Labour Government’s first national carers strategy was launched in 1999 by the Prime Minister, Tony Blair. The second strategy in 2008 had the support of Gordon Brown and seven Secretaries of State, because evidence from unpaid carers had shown that support for carers could not be solved by one government department but needed work across several. Sadly, Conservative Governments after 2015 did not continue with the national strategy, preferring a much less effective carers action plan. Carers are partners in care, so will my noble friend the Minister consider the strength of feeling among carers and their support organisations that they need and deserve a high-level strategy across government departments to support them?
Baroness Merron (Lab)
I certainly agree with the emphasis that my noble friend is putting on the need for cross-government working. I know she has been a champion of that for many years in the other place and that she will continue in your Lordships’ House to ensure that unpaid carers are properly supported and recognised. I can tell my noble friend that Minister Kinnock, as the lead Minister for unpaid carers, regularly engages with those with lived experience, the organisations that represent them and—importantly to the point my noble friend is making—with Ministers from other government departments, most recently the Department for Work and Pensions. We will be formalising our cross-government working with relevant departments and NHS England.
NHS Dentistry: Recovery and Reform
Baroness Keeley Excerpts(9 months, 3 weeks ago)
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Victoria Atkins
My right hon. Friend raises an interesting point. Indeed, that is exactly the sort of discussion I am having with my right hon. Friend the Levelling Up Secretary, because I am really interested in having that connected and joined-up approach between planning and health. I think it could bring dividends for us all.
Barbara Keeley (Worsley and Eccles South) (Lab)
I do not believe that what the Secretary of State has described will deal with the complexity of dental problems out there. I have a constituent who was referred to the Manchester Dental Hospital for a possible abscess and was told that even an urgent referral would take a month. In fact, the dental hospital did not get back to her for five months after the referral; it offered her a telephone consultation. The amount of pain and infection meant that she had to seek private treatment at a cost of £4,000, but many cannot afford that, including the young man wheeled into Royal Bolton Hospital in great pain, leaking blood on the floor after trying to remove a painful tooth with pliers. What does the Health Secretary say to patients who have long-standing and complex dental problems and are paying the price by waiting in pain, paying for private treatment or trying to remove their own teeth?
Victoria Atkins
I take that constituency case very seriously. I am really keen to urge the hon. Lady that if a constituent contacts her in future with that level of discomfort and pain, she should advise that constituent to contact 111 and, if necessary, go to accident and emergency—[Interruption.] Labour Members are shaking their heads, but what she has just described is a serious situation. That constituent needs medical attention, and the NHS is there, ready and willing to help. That is the advice that she should be giving her constituents, and I hope that she takes it as seriously as I do. [Interruption.]
Oral Answers to Questions
Baroness Keeley Excerpts(10 months ago)
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Victoria Atkins
I thank my hon. Friend for her interest and, of course, her many years working as a clinical psychologist. She brings that experience to the Chamber. National commissioning guidance to integrated care boards was published in November. It sets out that a mental health in-patient stay for a person with a learning disability
“should be for the minimum time possible, for assessment and/or treatment which can only be provided in hospital”.
In overseeing implementation of the action plan going forwards, the “Building the right support” delivery board will maintain focus on quality of care and on reducing long stays.
Barbara Keeley (Worsley and Eccles South) (Lab)
It is vital for the Government to do more to move autistic people and people with learning disabilities out of in-patient units and back to their communities. Recently, in the trial of staff at Whorlton Hall, we saw staff who were cruel and uncaring. Delivering sentences, the judge said that Whorlton Hall was an
“unpredictable and…frightening place to live”.
Is it not time for the Government to close down those units and move the majority of people into the community?
Draft Anaesthesia Associates and Physician Associates Order 2024
Baroness Keeley Excerpts(10 months, 1 week ago)
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Barbara Keeley (Worsley and Eccles South) (Lab)
It is a pleasure to serve on this Committee with you in the Chair, Dame Caroline. I am pleased to be able to speak in our discussion of this very important area of legislation, as the right hon. Member for Suffolk Coastal just called it. In my view, this issue is so important that we should be debating it in the Chamber; perhaps we could have found a way to do that.
Schedule 1(3)(a) to the order states that the regulator
“has the objective of promoting and maintaining—
(i) public confidence in, and
(ii) proper professional standards and conduct for members of, the anaesthesia associate and physician associate professions”.
I hope that the regulator takes those duties very seriously, because public trust in physician associates has already been damaged by the very sad death of Emily Chesterton, who died after being seen twice and diagnosed by a physician associate at a local GP practice. Emily was the daughter of my constituents, Marion and Brendan Chesterton, and I raised her case at an Adjournment debate on 6 July 2023. I would like to give details of Emily’s case, because it illustrates the need for the greatest clarity in the distinction between doctors and staff in the medical associate professions.
Emily Chesterton died in November 2022 after suffering a pulmonary embolism, after being seen twice by a physician associate, rather than a GP. She was just 30 years old when she died. Emily was a budding actor in musical theatre. She and her partner had moved to London from Boothstown, in my constituency, to pursue their careers in the arts. They registered with their local GP surgery, the Vale Practice in Crouch End, north London. Emily had been diagnosed with polycystic ovary syndrome and had also contracted covid-19 in late summer 2022. Marion Chesterton, her mother and my constituent, said that Emily had been feeling unwell for a few weeks before she made an appointment at the Vale Practice on 31 October 2022, as she had calf pain and was breathless. Emily believed that this appointment was to see a GP, but the person she was booked to see at the practice was a physician associate.
Physician associates and doctors have a very different depth of expertise. Physician associates have to complete just two years of clinical training, following a biosciences undergraduate degree. Doctors, on the other hand, must complete a five-year medical degree, as well as several years of foundation training and specialism training, interspersed with national exams. As both the Minister and my hon. Friend the Member for Bristol South on the Opposition Front Bench have said, physician associates are intended to support and assist more medically qualified staff, not replace them.
In Emily’s case, after a short appointment, the physician associate diagnosed Emily with a sprain and possibly long covid. Emily was told to rest and take paracetamol. At no point during the appointment at the GP surgery was Emily made aware that the person who had diagnosed her was not a doctor.
A week later, on 7 November, Emily began to feel very unwell. Her leg was swollen and hot, and she struggled to walk a few steps without becoming out of breath. She made another appointment at the Vale Practice and saw the same physician associate. It appears that this was a short appointment, and that Emily’s legs were not examined. The physician associate suggested that Emily’s breathlessness was due to anxiety and long covid. She prescribed propranolol. In messages that Emily sent to her family on that day, it appears that she described seeing “the doctor”, and that she was never told that the person she was consulting for medical assistance was not a fully qualified GP.
In its serious incident report after Emily’s death, the Vale Practice stated that patients should not see a physician associate twice for the same condition. The guidelines make it clear that physician associates cannot prescribe; any prescriptions need to be signed off by a supervising GP. It appears that the oversight of prescribing medication was missing, and the system failed in Emily’s case.
Later in the evening of that same day, 7 November, Emily’s health deteriorated, so she took a propranolol tablet, as advised by the physician associate. She then became drowsy, and then very ill. Her partner Keoni recalled to the inquest that she lost her pulse, and he had to perform CPR on her, which recovered the pulse. He then called an ambulance.
Emily suffered a cardiac arrest on the way to the hospital. Her family had to say their goodbyes to her while she was still on the machine that was pumping her heart for her. Keoni recalled that staff at the A&E department at Whittington Hospital, where Emily died, told him that the propranolol tablet “definitely would not have helped” Emily’s condition, and staff had to give her an antidote to the drug.
The circumstances that led to Emily Chesterton’s death were investigated by a coroner, and there was a hearing at St Pancras coroner’s court on 20 March 2023. Messages from Emily to her partner and family at the time of her appointments were shared at the inquest. These messages provide evidence that Emily believed that she was seeing a doctor. They also provide evidence that the appointments with the physician associate were short, and that Emily was not examined fully.
The coroner’s conclusion was as follows:
“Emily Chesterton died from a pulmonary embolism, a natural cause of death. She attended her general practitioner surgery on the mornings of 31 October and 7 November 2022 with calf pain and shortness of breath, and was seen by the same physician associate on both occasions. She should have been immediately referred to a hospital emergency unit. If she had been on either occasion, the likelihood is that she would have been treated for pulmonary embolism and would have survived.”
That heartbreaking statement lays out clearly the failings in the health system, which should have supported Emily with appropriate care.
Sadly, further failings were evidenced in the incident report that the Vale Practice provided to the coroner. In particular, it was noted that the physician associate who saw Emily did not introduce herself and her role to Emily during the appointment. The practice said that the physician associate had failed to explore the causes of Emily’s symptoms, failed to refer Emily for clinical investigations, and failed to consult a doctor after seeing a patient who had presented twice in one week with significant risk factors for pulmonary embolism. The practice also raised concerns about the physician associate’s overconfidence and lack of insight into the limitations of her clinical knowledge and practice. Although the physician associate’s contract at that practice was later terminated, Mrs Chesterton was upset to learn that she was still practising in the NHS in London, but I understand that that changed after I raised concerns in the Adjournment debate.
I must add that Emily’s is not the only case like this. Sadly, Ben Peters, a previously healthy 25-year-old, died from a heart haemorrhage after being diagnosed with a panic attack by a physician associate. A freedom of information request sent to Scottish health boards found that there have been at least 12 “never events” linked to physician associates in Scottish health authority areas.
These cases demonstrate the urgent need for this profession to be regulated in a way that avoids further confusion among patients, their families and medical staff. To patients, associates and doctors may look the same—they appear to be doing a similar job—but the fact is that the associates do not have the same qualifications or expertise as doctors. I understand that it was originally envisaged that physician assistants would be vital members of multidisciplinary teams, assisting with the workload and contributing to a high quality of care, but the regulator must ensure that there are now clear guidelines for associates to make their role clear to patients when they introduce themselves. As I have described, that did not happen in the case of Emily Chesterton.
There is a bigger question around the titles of associate. At the time of my Adjournment debate, Marion Chesterton raised with me the point that the title sounds
“extremely grand, even grander than a General Practitioner”.
Some have suggested changing the title back to the original title of physician assistants and anaesthesia assistants to avoid that confusion. There may be other solutions that the Minister could consider.
Getting the approach to associates right will become even more urgent as the profession grows in line with the proposals set out in the NHS long-term workforce plan. There is certainly a need to tackle workforce shortages in the NHS, as my hon. Friend the Member for Bristol South said. A lack of qualified professionals is the root cause of many of the challenges that our health service faces. We must be careful that any adaptations to the workforce to fix those issues do not push existing professionals out.
I had many GPs write to me after my Adjournment debate about Emily’s case. One told me,
“There is much talk amongst GP locums of work drying up, possibly due to the increasing use of Additional Roles Reimbursement Scheme staff (including the associate roles) to fill vacancies (and these are much cheaper than employing locum GPs), and last week there was considerable disquiet about the Surrey practice that made its salaried GPs redundant due to ‘new ways of working’.”
He wrote on,
“For GPs—salarieds, locums, and trainees—who have been working in an over-stretched, high-stress system, and [who have] been told that there is a national shortage of GPs—this leaves many wondering about the security of their career and exploring other options. I am seriously concerned that the many intelligent, enthusiastic and valuable people in training and working as GPs are looking at options outside the NHS, outside medicine, and outside the country.”
I am sure the Minister would agree that this is deeply concerning when the UK already faces intense competition from other countries to retain our doctors. While multidisciplinary teams with a diversity of roles are vital, doctors must still be valued. Most importantly, patients and clinicians must have a clear understanding of the skills, qualifications and limitations of those providing care.
I want to acknowledge that there have been many tragic cases leading to avoidable deaths of patients that have involved other roles. We could look at the case of Connor Sparrowhawk, an epileptic teenager who had a seizure and drowned in a bath at a hospital unit run by Southern Health. Connor was just 18. Dame Caroline, you will know well the case of Oliver McGowan, who died in Southmead Hospital at the age of 18. Oliver was prescribed the anti-psychotic medication olanzapine by a consultant in the hospital, despite his notes saying that he had reacted badly to it previously. Oliver died as a result of the brain injury caused by the medication.
Those are tragic cases, but in neither of them was it the role and the limitations of an NHS professional that caused the problem. The issues I have raised are about the safety of patients and the accepted standards of knowledge, training and experience that we should expect from our medical professionals in order for them to provide a high quality of care. I hope that the Minister notes the points raised in this debate, and takes steps to ensure that the NHS workforce delivers for patient safety.
Andrew Stephenson
I thank my right hon. Friend the Member for Suffolk Coastal and the hon. Members for Bristol South, for Leicester East, for Worsley and Eccles South, for York Central, and for Wirral West for their contributions to today’s debate.
I would like to turn first to the contribution by the hon. Member for Worsley and Eccles South, who spoke movingly on behalf of her constituents Marion and Brendan Chesterton about the death of their daughter, Emily. I know that the hon. Lady also did so in a very moving fashion during an Adjournment debate, which was responded to by my predecessor, my hon. Friend the Member for Colchester (Will Quince). Ahead of today’s debate, I was very keen to listen to that debate, so I watched it back and I am keen to see what more we can do to learn lessons.
No family should ever have to endure the loss of a child, and no words from me will assuage the family’s grief. However, I hope that by passing this order we are helping to ensure that some lessons have been learned and that we can deliver improved patient safety through better regulation of these roles. I recognise that there have been delays to the previously published timescale for the regulation of AAs and PAs. Although that is in part due to the pandemic, it is important to reiterate that this work is being taken forward as part of a broader package of reforms of regulators, governing a whole range of medical professions. That work is significant and complex. On that basis, a huge amount of work and input from all the regulators and a range of stakeholders has contributed to the draft legislation for AAs and PAs, which will be used as a template for reforms to other regulatory bodies.
Throughout this process, officials from my Department have met the BMA and other stakeholders to develop the policy behind this legislation. On the basis of feedback received through public consultation and additional targeted engagement, officials have made a number of amendments to the draft order to ensure that the legislation is fit for purpose and delivers the flexibility and autonomy required to empower regulators to be able to introduce new regulatory processes that would better serve patients and their registrants. That engagement has been crucial in shaping both our policy intention and the resultant legislation to ensure that it remains a practical piece of legislation that can be used by regulators.
The forthcoming GMC rules consultation, which will follow the passage of this order, represents a further opportunity for the BMA and others to have input into the regulation of these roles. When I met the GMC, I was assured that they were confident that they could bring forward this consultation quickly so that there are no further delays to the timetable of implementing these regulations.
Turning to the AA and PA titles, which quite a few Members have raised today, the physician associate title has been well established in the UK since 2014, and the Government have no plans to change the titles of PAs or AAs. As set out in the National Institute for Health and Care Excellence guidelines, all healthcare professionals directly involved in patient care should introduce themselves and explain their role to the patient. AAs and PAs are not and should never be referred to as medical practitioners, doctors or consultants.
The GMC has published interim standards for AAs and PAs in advance of regulation that make it clear that professionals should always introduce their role to patients and set out their responsibilities in the team. Ahead of regulation by the GMC, the Faculty of Physician Associates has issued guidance for PAs, supervisors, employers and organisations that helps to provide a structured and standardised way of using the title. In addition, NHS England has produced patient-facing materials that have been shared widely with GP practices to support patient awareness and understanding of the PA role.
Barbara Keeley
I thank the Minister for his words of sympathy; I will pass them on to Mr and Mrs Chesterton. On patient-facing advertising, I think a couple of months ago, I raised with the previous Secretary of State for Health, the right hon. Member for North East Cambridgeshire (Steve Barclay), a post from Norfolk and Waveney integrated care system that read, “Got abdominal pain that isn’t going away? A Physician Associate based in your GP practice can help…They are highly skilled at diagnosing conditions”. That was marketing material related to the role, which does not help. We have had tragic cases like Emily’s, and it does not help to have over-egged advertising like that. Can the Minister can say anything about that?
Andrew Stephenson
I completely agree. Things like that do not help, and that is why bringing forward these regulations will help. The GMC is obviously very keen to start its consultation and have the regulations introduced. As soon as this is set out in statute, it will be very helpful, not just for PAs but everybody, particularly employers and others, in ensuring that they never oversell the abilities of a PA and are clear about the role of a PA or AA in an integrated health team.
Turning to the shadow Minister, the hon. Member for Bristol South, I thank her for her contribution and join her in paying tribute to the PAs and AAs already working in our NHS. She asked about the impact on training opportunities for junior doctors, which leads me on to addressing quite a few of the points about why we have decided to go with the GMC as the regulator. The assessment of the most appropriate regulatory body for AAs and PAs was completed in 2019 following a public consultation. The majority of respondents were in favour of the GMC taking on regulation, including the professional bodies representing the two roles and the medical royal colleges. For the record, from a total of over 3,000 responses, 59% of respondents felt that the GMC was the most appropriate, while 20% thought it should be the HCPC.
Regulation of the associate roles by the GMC will allow it to take a holistic approach to the education, training and standards of associate and doctor roles. That will enable a more coherent and co-ordinated approach to regulation, hopefully ensuring that concerns around training places for junior doctors, for example, are addressed appropriately. I am happy to reassure the shadow Minister that I will continue to work with all stakeholders to ensure that we get the regulations right.
I thank the hon. Member for York Central, who spoke knowledgeably about these roles. We would all agree that it has been long recognised that we need to reform the legislative framework for the regulation of healthcare professionals to make things faster and more flexible. The current UK model needs to change to better protect patients, support our health service and help the workforce to meet future challenges.
Successive Governments have considered such reforms, but they have never come to fruition until now. While it is our intention to work as swiftly as possible to deliver reform for each regulator and profession, we will prioritise delivery based on criteria including the size of the registrant base, the need for reform, and our assessment of regulators’ readiness to implement the changes. Based on those criteria, we intend to start working with the regulators to develop reform legislation for their professions over the next couple of years.
The hon. Lady asked about fee levels. I believe the GMC’s current plan is to charge AAs and PAs a fee of £221 per annum, adjusted for inflation. That is what PAs are currently paying the FPA—of course, AAs do not currently pay a fee. The GMC, like the NMC and other regulators, works on the basis of their activities being funded by the fees from registrants, which is an important way of keeping them independent from Government.
This draft order represents a vital step forward to improve patient safety by ensuring that PAs and AAs meet the standards that we expect of all regulated professionals and that they can be held to account if serious concerns are raised. I hope that I have addressed as many of the points raised by the Committee as I can, but I am more than happy to continue dialogue with the Opposition Front-Bench team and others to ensure we get the changes right. I commend the draft order to the Committee.
Building an NHS Fit for the Future
Baroness Keeley Excerpts(1 year ago)
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Wes Streeting (Ilford North) (Lab)
I congratulate the Minister on being the great survivor of the Department of Health and Social Care. She must surely be due a carriage clock or the long service medal by now. The only long-term decision for a brighter future seems to be that she is still in her place, although she did not offer much of a brighter future.
More positively, I see far more than one nervous face on the Government Benches—I see lots of nervous faces among those contemplating the next general election—but one is undoubtedly that of the hon. Member for Uxbridge and South Ruislip (Steve Tuckwell). I congratulate him on his election and wish him well for his maiden speech, which I can confidently say will be the best speech we hear from those on the Conservative Benches all day.
At a time when patients cannot get a doctor’s appointment, families are struggling to pay the mortgage and major conflicts are having an impact on our economy and security, the Prime Minister has spent the past five days deciding whether to sack his Home Secretary for publicly disobeying him, undermining the police and inflaming tensions on our streets. Finally, having had the sheer poor judgment to have appointed someone to such high office when she had already been forced to resign for a serious national security leak, he has summoned up the guts to sack the worst Home Secretary in history. Yet, as we see, the merry-go-round of the Conservative clown show continues. After 13 years, the Conservatives have run out of names at the bottom of the barrel, so they are starting all over again. May I offer my sympathies to the Conservative Members who did not get the call from No. 10 today? What kind of message does it send to their constituents that their own party leader cannot find a suitable candidate for Foreign Secretary among the 350 Conservative MPs who sit in this House?
The arsonist has today returned to the fire, because when it comes to the national health service, Lord Cameron has quite a lot to answer for as the architect of austerity and the biggest top-down reorganisation in the history of the NHS—a £3 billion disaster that has led straight to the biggest crisis in the history of the NHS. That is before we even begin to take into account his record of ushering in the “golden” age between Britain and China; taking 20,000 police officers off our streets; and having food bank Britain leave more than 1 million people dependent on charity to feed themselves and their families. That is Lord Cameron’s legacy and as the current Prime Minister admits, “some mistakes were made”. Who is he trying to kid when he tells us that this recycled Conservative Government offer the change our country needs?
I would welcome the Secretary of State for Health and Social Care, the hon. Member for Louth and Horncastle (Victoria Atkins) to her position, but of course she is not here this afternoon, having just been appointed earlier today. She is the fifth Secretary of State for Health and Social Care that I have faced in this job in less than two years, although, to be fair, two of those appointments were the right hon. Member for North East Cambridgeshire (Steve Barclay). The Government said they would make
“Long-term decisions for a brighter future”,
but they cannot even deliver a long-term Secretary of State for Health.
We know where the Secretary of State is—she will be in the Department being briefed about the challenges of the job and being brought up to speed. No doubt she and new Ministers will want to review the decisions she is inheriting and to start to think afresh about whether she wants to proceed with those decisions as they have been working through the machine. That is why it is so grossly irresponsible to change Ministers every five minutes and constantly churn from one face to another, when it is clear to everyone but the Prime Minister that it is not just a change of faces around the Cabinet table that we need, but a change of Government.
As the Secretary of State sits in the Department being briefed by her civil servants, I will help them out with the induction by offering her a primer on what she inherits: millions of patients a month unable to get a GP appointment when they need one; 24 hours in A&E—not just a television programme, but a reality for far too many; ambulances not arriving on time, if they arrive at all; the 12th month of the worst strikes in the history of the National Health Service; NHS dentistry in managed decline, to the point where people are forced to pull out their own teeth—DIY dentistry in 21st century Britain; a generation of young people who have paid the price for lockdowns with their mental health, forced to wait years for the support they need; the longest waiting lists and the lowest patient satisfaction in history. That is the record of the Secretary of State’s seven predecessors: failure, upon failure, upon failure, upon failure, upon failure, upon failure, upon failure.
Barbara Keeley (Worsley and Eccles South) (Lab)
My hon. Friend is absolutely right about that list of failures—it is shocking. I would like to add to the list that over 2,000 autistic people or people with learning disabilities are detained in inappropriate units, when this Government promised over 10 years ago to close them all down.
Wes Streeting
I thank my hon. Friend for her intervention. As I make progress through my speech I will come back to the breath-taking complacency about mental health we heard from the Minister a moment ago.
Given the scale of the crisis and given that the Prime Minister has made fixing waiting lists one his five priorities, hon. Members might have expected something in the King’s Speech to deal with it. Instead, we got nothing on the NHS as it heads into its most challenging winter yet and we got nothing on social care, just kicking the can down the road and delaying reforms until after the election. There was nothing on dentistry, despite even Conservative Back Benchers crying out for a rescue plan, and nothing on mental health, despite the Conservative party committing to reform, not just in its last manifesto but in its last two manifestos.
It was the longest King’s Speech in almost a decade, with the fewest Bills. Does that not just sum up the modern Conservative party? Plenty of slogans, but no solutions. What we got was a Bill that will not come into effect until after the general election and a sack-the-nurses Bill. On the tobacco and vapes Bill, the question is not whether Labour will support it, but whether the Conservative party will support it. Government Members will remember that I first proposed that smoking ban back in January. I say they will remember, because they made their feelings known in newspapers at the time. They called it “nanny state” and
“an attack on ordinary people and their culture”.
They accused me of “health fascism”. Well, they can now make their considered and nuanced views known to the new Secretary of State—I am sure she is looking forward to receiving them. It just demonstrates that where Labour leads, the Government follow.
The Prime Minister may be too weak to whip his Back Benchers to vote that crucial measure through, but on the Opposition Benches we will put country first and party second. Labour MPs will go through the voting Lobby and make sure that the legislation is passed, so that young people today are even less likely to smoke than they are to vote Conservative.
I am afraid to disappoint the Government, but we will not be supporting the other Bill in the King’s Speech that relates to health. Most people look at the crisis in the NHS and think it needs more doctors and nurses. The Conservative party looks at the health service and concludes that we need to sack more doctors and nurses. The Government are saying that public servants should be sacked for failing to provide minimum standards on strike days, but the Government have not met the four-hour A&E standard since 2015; they have not met the standard for treatment within 18 weeks since 2016; and they were doing so badly on meeting cancer waiting time standards that they have simply got rid of the standards altogether. If the Conservatives are proposing to sack doctors and nurses for failing to provide minimum service levels, can we now sack Ministers for failing to meet minimum standards on non-strike days?
The new Health and Social Care Secretary has an opportunity to break with the past year. Strikes are crippling the NHS and they are putting patients in harm’s way. Her predecessor may have thought that they were a useful excuse for his failure, but they were, and are, a misery for patients and staff alike. The Government must stop the scapegoating of NHS staff, go into these negotiations with good faith, work at finding a solution, and, finally, bring these strikes to an end. There will be no progress on turning around our national health service until the Government make some progress.
When summing up I hope the Minister will explain why action was not taken on the Mental Health Act 2007, because, I am afraid, the Minister’s opening remarks were entirely unsatisfactory. The Bill has gone through Committee. It has cross-party support. It is ready to go, so where is it? The treatment of people with learning disabilities and autism under the current Act shames our society. The disproportionate impact on black people, who are four times more likely to be sectioned than white people, is appalling. Prisons and police cells are no place for people with mental ill-health. Surely that is not controversial in 2023. It is, as the former Prime Minister, the right hon. Member for Maidenhead (Mrs May), said, “a burning injustice”. I cannot understand why the Government have broken their promise to address that matter finally.
It is long past time that mental health was treated with the same seriousness as physical health. Labour will not only reform the Mental Health Act in our first King’s Speech, but recruit thousands more mental health professionals, provide hubs in every community, and set up mental health support in every school, so that young people can get the help they need when they need it. [Interruption.] The Minister says that they have done that. What planet is she living on? This is the problem with these Ministers. Even when the faces change, the lines remain the same. The Minister has not changed, but she is still reading from the same failed script. This is the problem with the Conservative party. Its message to the country is simple: “You have never had it so good. Everything is going really well. The reason we are churning all the Ministers in our Cabinet is that they are doing such a good job. It is job done and time to give someone else a chance.” I am afraid that that is why these Conservatives are so out of touch and will struggle at the next general election if their message to the country is that it has never had it so good.
Furthermore, unlike this Government, who crashed the economy in the most reckless way, we will pay for our policies, making sure that they are fully costed and fully funded—in this case, by ending tax breaks for private schools and private equity fund managers. Politics is about choices: Labour chooses the wellbeing of the many, not the interests of the few, and we will fight the election on those lines any time. I say call the election tomorrow, because we are ready.
When it comes to dentistry, I should also say farewell to two former Ministers, the hon. Members for Colchester (Will Quince) and for Harborough (Neil O’Brien). As the hon. Member for Harborough departs Government, I hope that he does not take with him his pledge to bring forward a recovery plan for NHS dental services. It has been seven months since he announced that such a plan would be forthcoming, yet it is now nowhere to be seen. Indeed, last week, integrated care systems were given permission to raid their dentistry budget underspends and to remove the ringfence. That follows a pilot in Cornwall, trialling making NHS dentistry available only to children and the most vulnerable. It is the managed decline of NHS dentistry before our eyes. If people want to know what the future of the NHS would look like with five more years of the Conservative Government, they need only look at the ghost of Christmas past in NHS dentistry. The Conservatives blame the previous Labour Government, but they have been in power for 13 years. In 2010, we stood on a manifesto committed to reforming the NHS dental contract. They have had 13 years to do it, and they have failed again and again, leaving us in the situation that we are in today, with Dickensian stories of desperate people performing DIY dentistry and tooth decay being the most common cause of children aged six to 10 being admitted to hospital. It did not need to be this way.
I say to the new Secretary of State and her team that she may not have a plan, but Labour does, and she is more than welcome to nick it. We will deliver 700,000 more urgent appointments a year, recruit dentists to the areas most in need, introduce supervised toothbrushing in schools to prevent children’s teeth from rotting, and reform the NHS dental contract so that everyone who needs an NHS dentist can get one—
Barbara Keeley (Worsley and Eccles South) (Lab)
The shadow Health Secretary, my hon. Friend the Member for Ilford North (Wes Streeting), raised the fact that there have been five Health Secretaries in two years. The Conservatives have also had 12 Culture Secretaries since 2010, so perhaps it should not surprise us that, among the many glaring omissions in the Gracious Speech, there was an absence of any measures to support those who work in Britain’s cultural sector, and particularly musicians. I want to focus on that.
Music industry leaders tell me that their sector feels left behind. Freelancers feel left out in the cold without the financial stability they deserve. In too many communities, cultural provision is now dependent on the good will of talented individuals who are prepared to manage on shoestring budgets with low income levels. We can do so much better in this country. As a music leader recently told me:
“The warning bell has been ringing for years, and this Government seems to have taken for granted the drive, passion and sacrifice which has somehow kept the industry alive.”
I have been told repeatedly that the problems faced by creatives come back to this: a decline in arts education, which is leading to skills shortages; falling funding levels; and the challenges to touring caused by the Government’s failure to get a visa waiver for touring in the Brexit deal. The Government choose to ignore those problems and pretend that they are supporting the sector adequately—even today they are setting ambitious growth targets for the creative sector. I want to begin by looking at the squeeze on arts education, and in particular the decline in music education.
We know that state-funded schools are increasingly unable to provide strong music education—or in some cases any music education. Policies such as the English baccalaureate, combined with the crisis in music teacher recruitment and squeezed school budgets, have led to a reduced provision of music education for young people in state schools. On average, music provision in state-funded schools is only 47 minutes a week. That is significantly below the Government’s target of one hour, which is a bare minimum. Compare that paltry target with parts of Germany, where secondary school students study music for at least two hours a week, or Finland, where music is studied for eight hours a week. Meanwhile, the uptake of music at A-level has fallen by a catastrophic 45% since 2010. There is a similarly worrying picture when it comes to studying music at GCSE.
In this difficult environment for schools and teachers, the role of music education hubs is all the more important, yet those hubs have had their funding reduced by 17% in real terms since 2011, and Government plans to reduce the number of hubs risk a further deterioration of the music offer. The Government’s failed education policies mean that the opportunities to gain the skills necessary to be a musician are becoming increasingly the preserve of those young people whose families who can afford to pay privately, either through attending independent schools or through private music tuition. As a result of those Conservative policies, less than a quarter of the music and performing arts workforce now come from a working-class background.
As well as fewer opportunities in schools, there are now barriers to both budding and established musicians touring beyond the UK’s borders. The failure of the former Culture Secretary to obtain a touring agreement with the European Union for cultural workers resulted in an appalling mess of red tape and extortionate fees for bands and orchestras looking to perform in EU countries. Agents, promoters, record labels and musicians have all told me that this is proving devastating for artists, particularly those trying to break into the industry. The freelance opera singer Paul Carey Jones said:
“As ever, it’s those at the start of their careers, without the backing of an established reputation, who will suffer the most…the consequent long-term damage to the UK’s position as a global force in the performing arts is incalculable.”
In a recent interview on LBC, the Culture Secretary implied that sorting out the mess of visas for touring musicians is not under the control of her Government, but it is up to the Government to renegotiate it and to find a solution for touring musicians.
Then there are the financial challenges that many musicians face. A recent survey by the Musicians’ Union found that musicians earn, on average, just £20,700 a year from music. Nearly a quarter of musicians reported that they did not earn enough to support themselves or their families, even after their lengthy training. There is a direct link between the working conditions of musicians and decisions to cut arts and culture budgets. Local authorities are the biggest funders of culture in the UK, but, as we know, they have suffered a 40% real-terms reduction in central Government spending since 2010. That has meant a £1.4 billion shortfall in spending on culture, heritage and libraries. Meanwhile, Arts Council England had its per capita budget reduced by 13% between 2009-10 and 2021-22. It is therefore no surprise that the number of filled jobs in music is falling.
In the last year alone, the number of filled jobs in music performing and visual arts fell by a tenth—a drop of 35,000 roles. That reduction is even greater in roles relating to instrument manufacture, sound recording and the operating of music venues. How can we expect children and young people to aspire to work in the music industry if there are no jobs for them to go into?
Funding shortfalls may also sadly have an impact on the important work undertaken by music organisations in health and care. For example, the Liverpool philharmonic has just celebrated 15 years of its music and health programme, which works with the NHS to help people access music to support their recovery and their wellbeing. Another brilliant health initiative is the English National Opera’s “Breathe” programme, where ENO chorus members have used singing techniques to aid recovery from covid-19 or long covid. There is also a great deal of work involving musicians bringing joy to people with dementia and those living in care homes.
The failure to support musicians and other creatives is not a peripheral issue, because expression in all its forms is central to the task of recreating a sense of community, identity, pride and hope, and our creative workers are at the heart of that potential. We will never achieve the diversity needed for the arts sector to thrive under the Tory policies I have discussed. The systemic failure to protect creative workers under this Conservative Government has led to working-class representation in the creative industries halving since the 1970s.
Today, the Culture Secretary is in Manchester, praising the creative industries as a driver of economic growth. At the same time, she is presiding over the cutting of the funding streams that feed them, and expects them to run on empty, doing more with less, year after year. It is time for this Government finally to accept that their policies have failed, and that Britain’s culture sector would be better off under a Labour Government.
Oral Answers to Questions
Baroness Keeley Excerpts(1 year, 1 month ago)
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Steve Barclay
I very much welcome my right hon. Friend signalling that we are ahead of the manifesto commitment not just in nurses being recruited, but in key additional roles in primary care, where the target was 26,000 and actually 31,000 have now been recruited. He is right about the importance of clinical research. The O’Shaughnessy review speeds that up and reduces the cost. It better leverages the taxpayer pound in investment from the private sector, and standardises contracts across NHS trusts to bring the time down. We are also looking at innovation in areas such as the NHS app to better empower patients to take part in clinical research trials. That ensures they are at the front of the queue in getting the latest medicine, which is exactly where we want the NHS to be.
Barbara Keeley (Worsley and Eccles South) (Lab)
The Secretary of State did not mention the increase planned in the number of physician associates. The Norfolk and Waveney integrated care system has posted:
“Got abdominal pain that isn’t going away? A Physician Associate based in your GP practice can help…They are highly skilled at diagnosing conditions”.
After the tragic case of Emily Chesterton, who was misdiagnosed after seeing a physician associate twice at a GP practice and no GP at any point, when will the lesson be learned that the NHS workforce cannot be safely expanded by this route of associates with only two years’ medical training?
Steve Barclay
All clinical roles need to have the right regulation around them, and we need to ensure that patient safety is to the fore. The hon. Lady gives a very good illustration of how the Labour party talks about reform, but not when it comes to the reform of new roles, having new roles in the NHS and having a ladder of opportunity for people to come into the NHS. Physician associates are people with masters’ degrees: these people are highly skilled. Of course, we need to get the regulation right. However, the Labour party talks about reform, but when it comes to standing up to the trade unions, it is not willing to do so, which is why, when there is an innovation such as physician associates, it wants to block it.
Countess of Chester Hospital Inquiry
Baroness Keeley Excerpts(1 year, 2 months ago)
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Steve Barclay
A number of steps have already been taken; I am thinking, for example, of the role of medical examiners working in conjunction with the role of the coroner. Those are the sort of areas that the inquiry will look at: the roles of the coroner, the medical director, the Royal College of Paediatrics and Child Health report in 2016, who had sight of that and what action was taken, and the role of the board, including the non-exec lead, in terms of issues around patient safety. So a range of areas will be looked at, which is the whole purpose of having this inquiry. A number of steps have already been put in place, but it is important that we learn the lesson where clinicians have raised concerns and those concerns were not acted on.
Barbara Keeley (Worsley and Eccles South) (Lab)
I co-signed a letter to the Health Secretary from Salford MPs and the Salford City Mayor detailing that two senior managers from the Countess of Chester Hospital who were accused, as we have been discussing, of repeatedly ignoring warnings about Ms Letby’s actions then left that hospital and were employed or seconded to NHS trusts in Greater Manchester, including Salford Royal NHS Foundation Trust and the Northern Care Alliance. The two managers were re-employed well after the police had launched their investigation into Lucy Letby. This raises serious questions about NHS governance, HR processes, safety, risk assessment and the role of regulators, as already raised by the Labour Front Bench and my hon. Friend the Member for Weaver Vale (Mike Amesbury). I want to join our concerns from Salford with the concerns the Health Secretary says are already being expressed about the governance issues raised by the re-employment of managers at that time and ask for assurances that this will be fully explored in Justice Thirlwall’s inquiry.
Steve Barclay
The hon. Lady raises extremely important issues and I am happy to give her the assurance that these issues will be explored. NHS England is looking at that. On the concerns expressed around the regulation of managers, the chief exec of NHS England hosted a meeting last week with key stakeholders to discuss these very issues and I will of course relay to the chief exec the points she has raised.
Under-age Vaping
Baroness Keeley Excerpts(1 year, 4 months ago)
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Andrew Gwynne
The hon. Lady makes a powerful case. Those are precisely the reasons why we have called this debate. It should shock each and every one of us. The ease of access to e-cigarettes for children, many younger than the ages she gave as an example, just cannot be allowed. We must be doing all we can on e-cigarettes, as we did to tackle the packaging and advertising of actual cigarettes, to ensure that children are weaned off their nicotine addiction and that other children do not start vaping in the first place.
Barbara Keeley (Worsley and Eccles South) (Lab)
My hon. Friend is making a very effective speech to open this debate. He quoted the figure of 30% for Yorkshire and the Humber. The figure for the north-west is 29%, which shows very little difference. Those figures are twice that for London, so it may be that some hon. Members are not aware of how bad the problem is getting. The Royal College of Paediatrics and Child Health has warned that youth vaping is fast becoming an epidemic. Worryingly, the number of children admitted to hospital as a result of vaping has almost quadrupled. Is my hon. Friend, as a fellow Greater Manchester MP, concerned about how many more children might suffer those health impacts before the Government take the action that is needed?
Andrew Gwynne
I am very grateful to my hon. Friend. As a Greater Manchester MP, I see the problem in my constituency and she will see it in hers. It concerns me greatly, because within our city region there are already communities that have some of the worst health inequalities. A lot of those health inequalities have been exacerbated by a higher than average prevalence of smoking. Even now, as smoking rates have declined, there are still communities in the areas we represent that have an abnormally high number of smokers. I do not want, in tackling smoking and reducing some of the health inequalities that are caused through smoking, to be storing up future problems with a new generation caused as a direct consequence of vaping or, more sinisterly, as a gateway to smoking later on in life. She is absolutely right.
Neil O’Brien
I completely agree with the hon. Lady on that point; this is exactly what our enforcement squad is doing, and I completely agree about the importance of doing it.
On the call for evidence, we will be producing our response in early autumn, identifying and outlining areas where the Government will go further. The key point is that we need evidence to take effective action to stop children vaping. While that call for evidence has been running, we have already taken further steps. At the end of May, the Prime Minister announced several new measures to support our efforts to tackle youth and kids’ vaping. That included closing the loophole in our laws that has been allowing companies to give out free samples of vapes to under-18s, which ASH estimates could total as many as 20,000 a year. He also announced that we will overhaul the rules on selling nicotine-free vapes to under-18s and on issuing fines to shops selling vapes to the under-18s.
The Prime Minister also announced that we will update the school curriculum, to emphasise the health risks of vaping within relationships, sex and health education lessons, just as schools currently do for smoking and drinking, so that kids understand the risks of vaping. We will be writing to police forces to ensure dedicated school liaison officers across the country are using the new resources available to keep illegal vapes out of schools.
I want to use this opportunity to outline the work we are doing to successfully reduce smoking, not least because the Opposition Front-Bench spokesperson touched on it. In the 1970s, more than 40% of people smoked, and it was still 21% in 2010. Since then, we have taken a series of steps, including doubling excise duties and introducing a minimum excise tax on the cheapest cigarettes, that have helped to drive down smoking to a record low of just 13% in England.
We have gone from 21% to 13%, but of course we want to go further. In 2019, we announced our ambition for England to go smoke-free by 2030, which is considered to be 5% or less. Over the past decade, we have made significant progress towards making England smoke free. We have continued to invest in local stop-smoking services, to help smokers get the right support for them. We continue to work in support of the NHS. Last year alone, we provided £35 million to the NHS long-term plan commitments on smoking.
Youth smoking rates are now at their lowest rates on record. In 2021, just 3.3% of 15-year-olds were regular smokers, although of course we want to reduce that figure even further. Through the new measures I announced in April, the Government will be supporting many more smokers to quit through the tobacco reduction strategy. Some 1 million smokers will be encouraged to Swap to Stop, swapping cigarettes for vapes under a new national scheme that targets those who are most at risk and gives them free vapes. That is first scheme of its kind in the world. It is based on experience from the successful local pilots, and is an evidence-based initiative.
Likewise, we will offer innovative, but evidence-based, financial incentives for all women to stop smoking in pregnancy. Again, this is based on evidence that has been gathered during local pilot schemes and the strategy will be implemented at a national level. Shortly, we will launch a consultation on cigarette pack inserts to provide further information to support smokers to quit, which is something Canada has done successfully.
Further, those who supply tobacco for sale in the UK must be registered for tobacco track and trace, and obtain an economic operator ID. We brought in that scheme to tackle illegal tobacco, but we now want to use the existing system in a new way, to help strengthen enforcement and to target the illicit market. From now on, when people are found selling illicit tobacco, we will not just seize their products but remove their economic operator ID, so they will no longer be able to buy or sell tobacco. We are exploring how to share information with local partners about who is registered on the track and trace system, so that they know who is and who is not legally entitled to sell tobacco in their areas, helping to drive enforcement.
We are committed to doing all we can to prevent children from starting to vape and we are already taking robust action in a range of areas. We are actively working on ways that we can go further, but it is essential that those methods are evidence based and that we have measures that will be effective.
Barbara Keeley
The Minister will have heard the figures given earlier: my hon. Friend the Member for Denton and Reddish (Andrew Gwynne) said that 30% of secondary school pupils in Yorkshire and Humberside have tried vaping and I said that the figure for the north-west was 29%. I quoted the Royal College of Paediatrics and Child Health saying that youth vaping is “fast becoming epidemic”. He is talking about an evidence-based plan, but what is the situation around evidence? My local area still has very high levels of smoking, but we are now seeing the same pattern tracking in vaping among young people as we did in smoking. Does he agree that there needs to be different and further action in those places where the figures are so bad?
Neil O’Brien
The theme of my speech is that we have already taken action and we will continue to take action, but that it has to be evidence based. A range of suggestions has been made during the debate, and I am sure there will be more, about different things to do with flavours, packaging, colours and marketing. There needs to be evidence and definition about those things. Some people will probably say that we should ban all flavours; some will say, “Let’s ban all coloured vapes”; some will say that we should have plain packaging or vapes should be hidden from view. We will need to take an evidence-based view on all those issues, rather than just assuming that one knows the answer immediately.
It is not totally obvious to me what the position is of the Opposition Front Bench team on any of those issues—whether they would ban all colours, ban all flavours, demand plain packaging, or want the same kind of restrictions as there are for cigarettes in terms of where they are placed in shops. I am happy to take an intervention if the shadow team have answers to those questions. Is it a yes or a no to those things?
Oral Answers to Questions
Baroness Keeley Excerpts(1 year, 4 months ago)
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Steve Barclay
It is characteristically astute of my hon. Friend to zero in on the tie-in, which is an important part of the long-term workforce plan. Around two thirds of dentists do not go into NHS work after training, so having a tie-in is more pertinent there than it might be elsewhere in the NHS workforce. I look forward to the Select Committee’s report but, with some of the reforms already in place, we are boosting the number of patients treated. There were a fifth more dental treatments in 2022 than in the previous year. We are also making NHS dentistry more attractive with some of the changes to the previous 2006 contract, but we recognise that there is more to do, which is why we will shortly set out our dental recovery plan.
Barbara Keeley (Worsley and Eccles South) (Lab)
I have received a wave of concern from clinicians on the safety of using physician associates, following my Adjournment debate last week in which I raised the death of Emily Chesterton, the 30-year-old daughter of my constituents Marion and Brendan. Emily died of a pulmonary embolism after being seen twice by the same physician associate at her GP practice. The physician associate failed to refer her to a doctor or to a hospital emergency unit for tests, which the coroner concluded could have prevented her death.
Yesterday, on “Good Morning Britain”, the Secretary of State boasted of increasing the number of people working in primary care, presumably including the workforce plan proposal to triple the use of physician associates. Will he look urgently at the details of Emily Chesterton’s case and ask himself whether lessons can be learned to avoid other preventable deaths?
Will Quince
Having responded to the hon. Lady’s Adjournment debate last Thursday, I hear the calls she has made. I know that she has also written to the Secretary of State, and I will ensure that she gets a full response, with answers to all the questions she raises.