Public Health

Dan Poulter Excerpts

Tuesday 14th December 2021 Commons Chamber

[Wes Streeting]

I direct the hon. Member to the SAGE advice, which is that there is some evidence—I would not put it any stronger than that—on the reduction of transmission. As I say, our primary reason for supporting the measure is to give people the confidence to continue to access hospitality and an added incentive to take up vaccination. On both those tests, our friends on the continent have shown us a better, effective way forward. I dare Government Members to suggest that France, for example, given its history and culture, is not a country that values liberty strongly.

Let me move on, because I must make progress. For the passes to work, people must be able to access tests easily and readily. We cannot continue with the situation in which tests are out of stock and unavailable to the public who are required to take them—not if covid passes are required to work and not if close contacts of covid cases are to be able to take the daily tests required. This morning, the Government’s website showed PCR tests unavailable throughout England, and the only region where lateral flow tests are available today is the south-east. We need immediately to resolve such technical issues and the practical issues of test delivery. The measure on daily testing is the one measure that seems to have united the House in agreement, so the Secretary of State really needs to get a grip and ensure we have access to the tests we need.

On the flexibility to work from home, we have called for workers to be given that flexibility for months and we support the guidance for them to do so where possible. I have addressed the contradiction in respect of people working from home and going out to Christmas parties. We want to protect people’s ability to enjoy Christmas safely this year, which is one of the key arguments for the measure. By limiting people’s interactions at work without disrupting their ability to do their work, we thereby lower contacts and infections and hope to preserve people’s ability to go ahead with the social interactions that they cherish most at this time of year.

As the Prime Minister rather clumsily and unhelpfully tried last week to open a “national conversation” on mandatory vaccinations for the country at large, I wish to make it crystal clear that we do not support mandatory vaccinations in general. I welcome what the Secretary of State has said this afternoon—not the first time he has had to clean up the Prime Minister’s mess. We believe the vaccine is safe and effective and that everyone should choose to have it. I cannot give any stronger endorsement than to say that I have had my first two jabs and will be having my booster on Thursday. I would not take the vaccine or recommend it to others unless I believed it was safe.

I recognise that mandatory vaccination for NHS staff is a difficult issue for colleagues from all parties and in our NHS, but the NHS has asked us for it, patients want it and we are persuaded that the threat of omicron makes it even more important for staff to be vaccinated to protect themselves and to protect the public they serve.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

I draw the House’s attention to my declaration, as a practising NHS doctor, in the Register of Members’ Financial Interests.

I commend the hon. Gentleman for the consensual way he is approaching today’s debate and for the many points he has made with which I agree. On mandatory vaccinations for NHS staff, before I could train in medicine I had to have a Bacillus Calmette-Guérin injection for tuberculosis and a hepatitis injection; otherwise, I could not have practised medicine. It was about protecting my patients. It is the duty of all healthcare professionals to put their patients first, which is why it is absolutely right that they should have mandatory covid vaccinations. Does the hon. Gentleman agree?

[Wes Streeting]

I strongly endorse what the hon. Gentleman said. Infection control is going to be a real challenge this winter because of the nature of the omicron variant. By ensuring that the NHS workforce is fully vaccinated, we will protect not only patients but staff, who already put themselves in harm’s way enough. As the hon. Gentleman, who speaks with real knowledge and expertise, said, this is not a new precedent: NHS staff are already required to inoculate themselves against other diseases. It is a professional duty. The NHS clearly believes that the April deadline gives sufficient time to persuade the workforce to protect themselves, their patients and their loved ones without there being an exodus of staff.

Health and Care Bill

Dan Poulter Excerpts

Report stage
Tuesday 23rd November 2021 Commons Chamber

[Edward Argar]

I am grateful to my hon. Friend for his intervention.

Let me turn briefly to amendments 93 to 98 in the names of my hon. Friend the Member for Broxbourne (Sir Charles Walker) and my right hon. Friend the Member for Maidenhead (Mrs May). I can reassure all right hon. and hon. Members that the Government remain committed to supporting everyone’s mental health and wellbeing. I pay tribute to my right hon. Friend for the work that she did in advancing this agenda when she was Prime Minister.

Secondly, let me clarify that the current references in the Bill to illness and health cover mental and physical health and, therefore, the view taken was that it was not necessary to make that explicit.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

Will the Minister give way?

[Edward Argar]

I fear that I do not have time to cover the other amendments in the four minutes that I have left.

Although I appreciate that my right hon. Friend the Member for Maidenhead and my hon. Friend the Member for Broxbourne will continue to press this matter, may I offer them a meeting with me and the Mental Health Minister to discuss further what they are proposing in advance of the Lords stages? I cannot make any promises or say anything beyond that, but I will meet them to further discuss the sentiments that sit behind their amendments.

Let me turn to my hon. Friend the Member for Aberconwy (Robin Millar), who made his points powerfully and eloquently, as he always does. As a Government of the whole United Kingdom, we have a duty of care to all citizens in the UK, which is why I welcome the clauses already in this legislation that will bring benefit to residents across the UK.

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[Sajid Javid]

I am happy to give my hon. Friend the commitment that we will look at that. I think everyone in the House agrees that the principle is vital, and I am sure it is supported across the House.

Let me briefly highlight the changes that we have made. First, we have heard the desire of the House to rate and strengthen the safety and performance of the integrated care systems. Working with members of the Health Committee, we have introduced an amendment that gives the Care Quality Commission a role in reviewing ICSs.

Secondly, we have heard concerns about the independence of integrated care boards. While it has never been our intention that anyone with significant involvement or interests in private healthcare should be on an ICB, following a productive meeting with the hon. Members for Nottingham North (Alex Norris) and for Ellesmere Port and Neston (Justin Madders) we tabled an amendment that ensures we write that principle into the constitution of ICBs.

Thirdly, we heard concerns from hon. Members about the potential impact of our proposed restrictions on advertising less healthy food and drink. We must, of course, do that in a pragmatic way, so we have introduced amendments to ensure we do not unintentionally impact UK businesses when they advertise to overseas audiences. Further, we will consult with stakeholders on any further changes to the nutrient profiling model.

Fourthly, and very importantly, the Bill now reflects our commitment to end the crisis in social care and the lottery of how we all pay for it. It is not right and not fair that the heaviest burdens often fall on those who are least able to bear it, so we are introducing a cap on the costs of care so that no one will have to pay more than £86,000 over their lifetime. That cap that will be there for everyone, regardless of any conditions they have, how old they are, how much they earn, or where they live. We will introduce a far more generous testing system, so that everyone will be better off under the new system.

We move a Health and Care Bill that is stronger than before, with those three underpinning principles reinforced: embedding integration, cutting bureaucracy and boosting accountability. On integration, it is not about simply telling the NHS, local authorities and others to work together; it is about helping them to do it by doing things like merging NHS England and NHS Improvement into a single statutory body and establishing integrated care boards to deliver as one.

[Dr Poulter]

I declare an interest as a practising NHS doctor. On integration, my slight disappointment with the Bill is that while it pulls people together in joined-up commissioning boards, there is no commitment to put the money into the same place. If we want to drive joined-up commissioning, we need to put the money into the same place. Will the Secretary of State consider that and how true integration can be achieved as the Bill goes to the House of Lords?

[Sajid Javid]

My hon. Friend makes a very important point and he speaks with deep experience. What I can tell him is that we will shortly be publishing an integration White Paper, which, given what he has just said, I am sure he will welcome.

Health and Care Bill

Dan Poulter Excerpts

Report stage
Monday 22nd November 2021 Commons Chamber

[Edward Argar]

I take my hon. Friend’s amendments in the spirit in which they are of course intended. I recognise the importance and value that those on both sides of this House put on parity of esteem of mental and physical health. I suspect that we may debate the amendments in subsequent groupings and I look forward to responding then.

We have, in the process of drafting this amendment, heard suggestions that we should simply ban private company employees completely from the boards of ICBs. I am afraid that doing so is not so simple, nor would it achieve the desired result in all cases. In fact, our amendment goes further to underline the importance of NHS independence than would an amendment that focused purely on banning employees of private providers. There are clearly some candidates who would be suitable but may have minor interests in private healthcare. GPs, for example, do provide, and have provided, their excellent knowledge and experience of their patients in guiding commissioning decisions, and some may have private practices as well. Excluding them would be to lose their experience from the NHS, and therefore such an involvement with the private sector would clearly not risk undermining the independence of the NHS.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

I draw the House’s attention to my declaration in the Register of Members’ Financial Interests as a practising NHS doctor. A number of GPs have, in recent times, sought to group together into confederations of practices, which could create a bloc interest within a local board area. How will that potential conflict of interest in the commissioning and provision of services be addressed by the Government through legislation?

[Edward Argar]

I am grateful to my hon. Friend, who knows of what he speaks in terms of the operation of healthcare services. We would not wish to exclude GPs or groups of GPs from being able to participate in decision making. That expertise, as we have seen with clinical commissioning groups, can be hugely valuable. What we have sought to do, in an amendment that is technically worded, for want of a better way of putting it, is to strike the right balance while also ensuring that the additional measures on the constitutions of the ICBs and ICPs have to be approved by NHS England to avoid any obvious conflict of interest. But we are not seeking to avoid GPs being able to operate in that space and sitting on ICBs.

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[Richard Burgon (Leeds East) (Lab)]

The Health and Care Bill is deeply problematic. I want to focus on two issues that, when combined, mean that it is a complete disaster. It not only makes it easier for private health giants to profit from the national health service; it also makes a charter for corruption because it opens the door to even greater private sector involvement in our NHS. That is why this Bill should really be called the NHS corporate takeover Bill. For example, it allows private corporations to sit on health boards, which make critical decisions about NHS budgets and services, and the Government’s amendment 25 does not go nearly far enough.

Even before this Bill, an unbelievable £100 billion has gone to non-NHS providers of healthcare over the past decade alone, and earlier this year half a million patients have had their GP services quietly passed into the hands of a US health insurance giant. This Bill would lock in yet more privatisation in future, with even less scrutiny, because it means less transparency. It means private health giants getting an even bigger slice of the action with less scrutiny.

[Dr Poulter]

I draw the House’s attention to my declaration in the Register of Members’ Financial Interests as a practising NHS doctor. On the issue of private healthcare provision, the hon. Gentleman will recognise that GPs are in fact small businesses in their own right, and some of them quite large businesses. How does he equate the role of the GP as a small business in the context of his concerns about private healthcare?

[Richard Burgon]

We are not seeking to wage war on GPs; we want to support GPs and properly resource them. We see so many GPs retiring and not being replaced. It is this Government who are waging war on our NHS with this further Americanisation of our NHS. It is a dangerous cocktail where the dodgy contracts we have seen throughout covid risk becoming the norm. The billions squandered on test and trace should serve as a warning of what the Government could do to the whole of our NHS.

There is a sleight of hand going on with this Bill. It is true that under the Bill NHS bodies will no longer have to put services out to competitive tender to the private sector. Such tendering to the private sector was made a requirement under section 75 of the coalition Government’s Health and Social Care Act 2012. It was a shameful Act and its scrapping has long been demanded by those opposed to privatisation of our national health service. However, the change in this Bill does not reverse privatisation, because without making the NHS the default provider, that simply means that contracts can not only still go to private healthcare corporations but can do so without other bids having to have been considered.

To prevent all this, I tabled amendment 9, which I want to put to a vote—unless of course the Government accept it—because it establishes the NHS as the default option. [Interruption.] Conservative Members groan, but the only reason for people not to support my amendment is if they do not believe in the NHS not moving to a privatised insurance model. Why else would people object to the NHS being the default provider of healthcare? The British Medical Association supports it, so the Tory groans are groans against the position of the British Medical Association. Unison supports it, so the Tory groans are groans against the voices of those who work in the NHS—for most of whom, if they need to have more than one job, it is because they do not get paid enough, not because they are trying to get their own snouts in the trough. I will be voting against the whole Bill, but if the Government refuse to accept amendment 9 to make the NHS the default provider, that shows what the Government of the party that objected to the foundation of the NHS in the first place are really up to, despite all the warm words.

NHS Efficiency

Dan Poulter Excerpts

Tuesday 2nd November 2021 Westminster Hall

[Paul Bristow (Peterborough) (Con)]

I beg to move,

That this House has considered NHS efficiency.

It is a pleasure to serve under your chairmanship, Sir Gary. I draw Members’ attention to my entry in the Register of Members’ Financial Interests.

Our NHS is in my DNA. Both of my parents were nurses and worked in the NHS for most of their working lives. It was the NHS that brought my family to Peterborough when I was just five years old, and I have worked in NHS policy for 20 years. My commitment to our NHS and its principles is clear. Few things inspire as much national pride as our national health service, and I want to keep it that way.

The NHS has lost its ranking as the best healthcare system in a study of 11 rich countries by an influential US think tank. Most worryingly of all, it fell to ninth when it came to healthcare outcomes. We must do something about this. We must ensure that the record investment that we are putting into our NHS is spent well. I suggest that that money should come with some very specific key performance indicators that would ensure that it is not wasted.

I feel strongly that the money should be in the gift of Ministers in the Department of Health and Social Care, who are accountable to Parliament, rather than NHS England or NHS Improvement. Like the Department for Levelling Up, Housing and Communities would do with a local authority that does not run a balanced budget or provide statutory services, the Department of Health and Social Care should be able to intervene directly, or at least provide incentives. Recipients would not get their share of the extra cash unless they addressed the challenge of access to care and improved outcomes.

I am keen to help Ministers. I almost feel thwarted, because progress on many of the things that I spoke about at the party conference last month have started to be reflected in Government announcements. That is obviously a good thing, but extra money must come with strengthened incentives to do the right thing and, quite honestly, consequences for not doing the right thing.

The first area in which we need to make progress is local NHS management. Local government has had to make a series of savings in recent years. Armies of local government managers all doing the same jobs in neighbouring local authorities have been an easy target for those defending the interests of taxpayers. However, local authorities have done rather a good job of sharing senior officers. For instance, the chief executive of Peterborough City Council is also the chief executive of Cambridgeshire County Council. As a former Hammersmith and Fulham councillor, I also remember the 2011 tri-borough shared services agreement in west London, between Westminster, Kensington and Chelsea, and Hammersmith and Fulham, which saved over £33 million in just four years. Labour-controlled Hammersmith and Fulham petulantly took their toys home a couple of years later, but the bi-borough arrangement is still saving the taxpayer millions, and this practice is replicated across the country.

That practice is unheard of in our NHS, but why is that? There are no reasons why NHS trusts and new integrated care systems cannot share officers and back-office functions. Let us do away with every NHS trust having its own specific CEO, finance director, human resources director, estates director or diversity director. It is not controversial to ask our NHS to learn from local government. If certain localities cannot make those management savings, are unwilling to share back-office functions, cannot look to make savings, why would we give them the extra cash? I suggest a KPI on a reduction in management costs and back-office costs. I think it would be warmly welcomed by the taxpayer and those in our NHS who know that money is wasted.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

I draw colleagues’ attention to my declaration of interest as a practising NHS doctor. Does my hon. Friend agree that one of the challenges is attracting good expertise, perhaps from the business world, into the NHS and that that sometimes costs money and resources? While he is wishing, correctly, to make savings in back-office costs, we should not be too prescriptive because we need to make sure the best people are coming into the NHS, both from within and without, to deliver the productivity gains he desires.

[Paul Bristow]

That is a characteristically well-made point by my hon. Friend. In the current system, NHS chief executives spend 18 months in one trust, then travel to another, spend 18 months there and then travel to another. That is no time at all to get to grips with the challenges that these organisations face. We absolutely need people from the private sector to come in and do these jobs. If they were doing these jobs on a larger scale, that would be welcome. I am specifically requesting that we look to local government, where people have come in and transformed services. I suggest we do the same in our NHS.

My second point is on innovation and new ways of working. Innovation is the way an organisation develops. It should be a constant process—trying to do things better, improving outcomes for patients and trying to be more productive. Across the NHS there are those that innovate with new technology, those that adopt new pathways and service delivery, and clinicians who want to train and learn new techniques. However, the NHS can be poor at spreading best practice at pace and scale. Like any bureaucracy, it can be slow at looking at new ways of working.

There have been attempts to address this. We spent millions funding organisations such as Getting It Right First Time—GIRFT—under Professor Tim Briggs, which is a national programme designed to improve the treatment and care of patients and collect best practice. We created the National Institute for Health and Care Excellence—NICE—which, when it was created, was considered to be a model for the world to emulate on determining the cost-effectiveness of technologies and drugs. NICE also produces quality standards that set out priority areas for quality improvement in health and social care. After all this work has been done and all this money has been spent, many parts of our NHS just ignore it. They say things such as, “This can’t possibly apply to us,” or, “This is merely guidance, and we don’t need to do this here.”

The use of insulin pumps and implantable cardiac defibrillators or vascular technologies should not depend on where someone lives, but it does. The solution is certainly not to reduce GIRFT’s budget from £22 million to £10.8 million, but that is what has happened. GIRFT should be empowered to develop best practices in primary and community care, and we should look at the GIRFT model of hot emergency and cold elective centres to help us power through the backlog.

What is the solution? How do we make outliers adopt best practice and do the right thing? A KPI, and perhaps even GIRFT or NICE, can help us with technology and pathway adoption, which could transform productivity, powering us through the backlog. Backed up with an incentive such as a generous and workable best practice tariff, a KPI could focus attention. If outliers persist in a practice that has been shown to be outdated and to follow pathways that do not lead to optimum outcomes, why would we give them the extra money?

On capacity, staffing is recognised to be a risk factor in delivery for our NHS. The money is there, but it takes a long time to train a doctor, GP or nurse. That is why every hour of a medical professional’s time is valuable. We have to make sure that they are doing what they are paid for and what they went into medicine to do.

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[The Minister for Care and Mental Health (Gillian Keegan)]

It is a pleasure to serve under your chairmanship, Sir Gary.

I welcome the idea and the timeliness of this debate. My hon. Friend the Member for Peterborough (Paul Bristow) has raised an important issue, and I know many hon. Members present have great experience of various parts of the NHS, including my hon. Friends the Members for Watford (Dean Russell), for Bosworth (Dr Evans) and for Central Suffolk and North Ipswich (Dr Poulter). I thank them for their contributions to the debate.

We all have a responsibility to taxpayers to make sure that the NHS uses its resources as effectively as possible. To do that, we need to ensure that productivity grows every year, which is why the NHS long-term plan includes financial test 2:

“The NHS will achieve cash-releasing productivity growth of at least 1.1% per year.”

I make it clear that increasing productivity does not mean making staff work harder or making cuts. It means getting the most out of every £1 the NHS spends, and making sure that as much as possible is spent on frontline care. It means doctors and nurses doing the tasks they are trained to do and that nobody else can do. It means buying the right drugs at the right price. It means more patients getting the right treatment in the right place at the right time. That is good for patients, good for clinicians and good for the taxpayer.

Thanks to the hard work and innovative mindset of many NHS staff, the NHS is regularly recognised as one of the world’s most efficient health systems, although I take the point made by my hon. Friend the Member for Watford that there are different ways of measuring efficiency globally. In fact, in the decade before the pandemic, productivity growth in the NHS was faster than in the wider economy, as was independently verified by the Office for National Statistics.

Furthermore, the UK spends only around 2% of healthcare expenditure on administration—we spend a lot on the NHS, but only 2% of it on administration—and managers make up only 2.6% of the NHS workforce of 1.35 million. They might be an easy target for criticism, but good managers are of course essential to making services work, and many of us will have had experience of that throughout our various careers. If there were no managers, clinicians would have to manage their own workforce, logistics, finances and websites, and spend less time with patients. None the less, we want to improve the quality of management further, which is why we have asked General Sir Gordon Messenger to lead a review of leadership in health and social care.

[Dr Poulter]

I refer to my earlier declaration about my entry in the Register of Members’ Financial Interests, as a practising NHS doctor. On the point that the Minister just made, of course we want to promote clinical leadership in the NHS in senior management positions, because we know that that benefits patients and leads to efficiencies, but we also need to consider the fact that although there are many good NHS managers, a lot of them have never had experience of life outside the NHS. I wonder whether my hon. Friend the Minister could briefly say how we can draw in better business experience and other experience, so that NHS managers have broader experience, and can bring that benefit to the NHS and drive efficiencies.

Long Covid

Dan Poulter Excerpts

Thursday 14th January 2021 Commons Chamber

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con) [V]]

I draw the House’s attention to my declaration in the Register of Members’ Financial Interests as a practising NHS doctor who has been working on the frontline throughout the covid pandemic.

There is no doubt that long covid has a life-changing impact on the lives of some of the people whom it affects. We often do not hear much about young people when we discuss the impact of covid on our hospitals and when we talk about death rates, because, predominantly, the illness seems to have immediate adverse physical outcomes for older people. Very often, though, it is young people who are the victims of the life-changing impacts of long covid. As the hon. Member for Oxford West and Abingdon (Layla Moran) outlined, it is a subject that we are learning more about literally by the day, and we still need to better evaluate the data and the statistics on long covid. Undoubtedly, we are seeing a group of individuals who are experiencing the effects of covid often many weeks or months after their initial infection, and it is those individuals who need help.

Although we welcome the fact that the NHS has set up a new care pathway and new long covid treatment centres, there are some specific asks that I have of the Minister. First, we need that national register and better data. The covid app that has been set up by King’s College London and Professor Tim Spector is an excellent start at getting some national-level data on people who have covid symptoms, people who have positive antibodies for covid, and, indeed, the effectiveness of the vaccine. The key point is that we need that data to better understand the impacts of long covid and to treat people more effectively.

My second key ask, in the time that I have available to me, is to look at the mental health impact of long covid on people. We have a cohort of people who have been traumatised with post-traumatic stress disorder symptoms while being treated for covid in intensive care. For many of them, it will take weeks and months to recover. That group need special attention in particular. I look forward to hearing from the Minister for Patient Safety, Suicide Prevention and Mental Health, my hon. Friend the Member for Mid Bedfordshire (Ms Dorries), who is replying to the debate, and welcome other contributions today.

Ockenden Review

Dan Poulter Excerpts

Thursday 10th December 2020 Commons Chamber

[Ms Dorries]

As I said, the vast majority of the recommendations on Morecambe Bay have been implemented. Of those that were for wider NHS consideration, 14 have been implemented and 11 have not. However, this is not a case of us overnight going out and saying, “Right, this is how you change”—it takes a vast amount of work in policy, process and delivery. Those 11 recommendations are being worked on and have been worked on since the report on Morecambe Bay happened. The hon. Gentleman is right to highlight the fact that we do not have consistency across the NHS in terms of care or delivery. That is what we are working towards. We are currently developing a core curriculum of training that will be multi-disciplinary and we hope will rolled out next year. It will be undertaken by midwives, doctors, obstetricians and everybody working in the maternity unit so that they are all at a certain point of skill in terms of consistency, they are all aware of the lessons to be learned from the past in terms of safety, and they implement the recommendations that go across the UK in maternity units. Most maternity units in the UK operate well and deliver babies safely. We have fantastic maternity services in the UK. However, we do have difficult trusts. As in all disciplines, they are not all the same. This is about the outliers—the hospitals that we are working to identify early. With the core curriculum, we are making sure that everybody working in maternity units across the UK has the same standard and level of training.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con) [V]]

I welcome the considered tone the Minister has taken today in responding to the difficult contents of this report and in promoting a clinically led response to the findings rather than allowing knee-jerk political reactions that often do not lead to the right results. Let me pick up on one thing. What we see throughout a number of reports, be it Mid Staffs, Morecambe Bay or now this one, is that management is often central to setting a culture that allows mistakes and deaths to occur. When a clinician is found to be negligent, they have a responsible body—the Nursing and Midwifery Council or the General Medical Council—that can take action against them, but what are we going to do to ensure that managers receive better training and that we stop the revolving door of bad managers who are responsible for poor care being employed elsewhere in the NHS?

[Ms Dorries]

I thank my hon. Friend, who, again, is a predecessor in my Department—a former Health Minister. He is absolutely right to talk about strong leadership. Strong leadership has been established across the system. In the context of maternity services, which is what we are talking about, we have the maternity safety champions who are being led by Dr Matthew Jolly, the national clinical director of maternity and women’s health, and Professor Jacqueline Dunkley-Bent OBE, the chief midwifery officer for England. There are lead clinicians who are leading clinically.

In terms of the management of the Shrewsbury and Telford trust, there have been eight chief executives in 10 years. That is not good. Good practice does not come from a revolving door of chief executives and board members who constantly rotate, because there is no continuation of learning, no loyalty, and no commitment to good outcomes at the hospital. We have to change this revolving door of boards and chief executives. The chief executive who is there now has our confidence, and we are assured that she will put in place the recommendations of the report, but my hon. Friend is right: it is crucial that we work on this revolving door of managers and those who are not clinically led, because that is part of the problem. He is right to identify that, and I want to reassure him that it is something we are aware of.

Covid-19 Vaccine Roll-out

Dan Poulter Excerpts

Tuesday 8th December 2020 Commons Chamber

[Matt Hancock]

The Oxford-AstraZeneca vaccine, should it be approved, does have easier logistical and distributional qualities—it does not have to be stored at minus 70°—so that helps. Of course, the JCVI will consider the clinical properties of any vaccine that comes forward when deciding who it can be distributed to, so that is taken into account. Finally, the hon. Gentleman is right to say that this has been an international as well as a UK success. I had a text exchange with my German opposite number this morning to thank, through him, the German scientists who have done so much to make this possible.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con) [V]]

I draw the House’s attention to my declaration in the Register of Members’ Financial Interests, as a practising NHS psychiatrist who has been working on the frontline throughout this pandemic. The Secretary of State will be aware that mental health patients are often an afterthought of policymakers, although I am sure that is not the case for him, and that many of them have multiple medical comorbidities, which make them more vulnerable to covid-19. Will he reassure me that patients in mental health services, particularly in-patients, and NHS staff who work in in-patient mental health services will be prioritised for this vaccine and will not be an afterthought?

[Matt Hancock]

Absolutely. NHS staff are in the second priority cohort set out by the JCVI, and that includes all patient-facing staff in the NHS and social care. Patients who are clinically vulnerable to covid absolutely have their rightful place in the prioritisation, according to clinical need.

Covid-19 Update

Dan Poulter Excerpts

Thursday 15th October 2020 Commons Chamber

[Matt Hancock]

We are expanding capacity at the hospital in York. Of course, in York there are two overlapping epidemics, one among students and one among the general population. As the hon. Lady says, though, the spread is increasing among the older population, who are of course the most at risk from covid. The number of cases increased by 60% in York over the last week, so I welcome her support for the measures that we are taking, and I am happy to continue to talk to her about what more might be needed, because this is best done on a cross-party, cross-community basis. My message to everybody in York, a city I know and love, is that it is very important that all of us abide by these rules and reduce social contact. That way we can start to get the increase in the number of cases in York coming down.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con) [V]]

I draw the House’s attention to my declaration in the Register of Members’ Interests as a practising NHS doctor, who has been practising on the frontline during the pandemic.

The Secretary of State is right to introduce these measures today, and he is right to see a full national lockdown as a very last resort. May I bring him back to the issue of testing? Tremendous strides have been made in expanding national testing capacity to many hundreds of thousands a day from a standing start, but a number of hospitals still face challenges in getting NHS staff tested. I am aware of some hospitals that are being offered only 15 tests a day for their staff. Will he please look into this matter urgently? It is vital that the NHS has the staff available to treat patients, particularly given the second wave that we are now facing.

[Matt Hancock]

Absolutely. We are making significant progress in this area. My hon. Friend will have seen the announcement by the NHS on Monday that we are expanding the asymptomatic testing of members of NHS staff in tier 3 areas, and we are also expanding the capacity for covid tests within the NHS itself. He is absolutely right to raise this issue, and we are making a lot of progress.

Health Inequalities

Dan Poulter Excerpts

Wednesday 4th March 2020 Commons Chamber

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

Thank you for calling me, Madam Deputy Speaker, and I draw your attention to my declaration in the Register of Members’ Financial Interests as a practising NHS psychiatrist.

It is a pleasure to follow the hon. Member for Central Ayrshire (Dr Whitford), who is absolutely right to highlight the fact that health inequalities and their determinants go much wider than the NHS. We are talking about issues to do with housing, poverty and employment. We know that poverty and deprivation are associated with poor health outcomes, both physical and mental, and health inequalities.

In that respect, some of what I am going to say will ask the Government to revisit legislation that we passed as part of the Health and Social Care Act 2012 in relation to addiction services. That is where I shall concentrate my remarks, because we are all aware that addiction services treat some of the most vulnerable people in society, but face particular challenges and treat people often with some of the lowest life expectancies. In that respect, we must recognise that the changing commissioning arrangements, the move towards commissioning of addiction services by local government and some of the funding restraints that are present in the system have impacted on the quality of service delivery.

I shall touch on Dame Carol Black’s report later, but we have seen that, in some areas, there is now minimal provision in many addiction services, and local authorities often look towards the lowest bidder to provide their services. I hope Members on both sides of the House think that is not necessarily a good thing, because we want to see effective addiction services that make a difference for patients and for the people who need them. What we see, though, is that services have deteriorated over the past few years. Services have become increasingly fragmented, and the numbers of dependent opioid users and opioid deaths are rising. That may well be because there are greater medical comorbidities in that particular group, and the age profile may be associated with a higher mortality rate.

Dame Carol Black’s report makes some important points about the challenges. She includes a timeline that indicates how addiction services have been delivered, and she highlights that in 2005, under the previous Labour Government, a ring-fenced, pooled treatment budget was created, centrally funded and allocated on need. Additional funding contributions were made by local authorities, the police and the NHS. Funding increased from £50 million to nearly £500 million during the 2000s, which saw a step change in the ability of addiction services to respond to the needs of local populations.

The biggest change in the delivery of addiction services came with the Health and Social Care Act, in which responsibility for the commissioning of drug and alcohol services moved to local authorities. I do not need to rehearse many of the arguments, but it is worth highlighting some of the challenges we now face. A number of those challenges are a direct consequence of that change in commissioning arrangements.

Overall funding for treatment has fallen by 17%. It is not possible to disaggregate alcohol and drug treatment spend, but many local authorities will have reduced expenditure on drug and alcohol treatment by far larger amounts, with residential services—that is in-patient facilities—being particularly hard hit. The report says:

“Likely many areas are now offering the bare minimum service with large increases in worker caseloads an inevitability. The overall numbers in treatment have fallen at a similar rate as funding with the largest decreases seen in opiate users (and those in treatment for alcohol only).”

At the same time, we are aware from Home Office data that the prevalence of opiate and crack use is increasing and that the number of opiate users in treatment is falling, so there is a challenge for the Government to address in how those services are delivered and commissioned.

We should also recognise that many people who are in need of addiction services have two or more other complex needs. From Dame Carol Black’s report, we see that over 70% are unemployed, close to 40% also need mental health treatment, over 15% are homeless and over 25% have been referred from the criminal justice system. She states:

“Over 60% of opiate clients have two or more complex needs alongside their drug use”.

In the brief time I have left, it is worth reflecting that reduced funding is available to treat those people, but the commissioning arrangements mean that drug and alcohol services are commissioned by local authorities and are no longer integrated or joined up with the NHS, which makes it much harder to treat people with co-existent mental health problems; to find housing solutions, as the NHS does on a daily basis, for patients with a housing need; and to address some of the challenges we face in joining up and integrating care with the criminal justice system.

I hope the Minister will take away those challenges.

[Jonathan Ashworth]

Will the hon. Gentleman give way?

[Dr Poulter]

I will give way very briefly.

[Jonathan Ashworth]

I am grateful to the hon. Gentleman —I am sorry, Madam Deputy Speaker, but I will be very brief.

The hon. Gentleman is making an excellent speech, and I agree with every word—I hope I have not ruined his career prospects by saying that. Does he agree that the way in which services are commissioned, and the lack of integration with wider mental health services, is leading to a problem in recruiting addiction psychiatrists into the sector?

--- Later in debate ---

[Dr Poulter]

Absolutely, and that key problem was also highlighted in Dame Carol Black’s report. I should refer to my declaration in the Register of Members’ Financial Interests at this point. I believe that in London there are only five training posts available in addiction psychiatry. We have a lack of addiction psychiatrists, of trainee psychiatrists coming through with accreditation in the area of addictions, of nurses with a specialism in that and of a properly trained workforce in addictions, as a result of the commissioning arrangements. That is a real challenge, and we have to address it.

Part of the reason for that is the separate commissioning pathway we now have through local authorities. It was flagged up as a challenge when the 2012 Act passed through this House, but the warnings given at that time have, unfortunately, come to fruition, and this is now causing challenges in the production pathway of addiction workers. The real challenge faced by the sector is that the people whom addiction services are trying to care for are now falling through the cracks of those fragmented services and the quality of service provision is not as good as it should be. I know the Minister will look at this constructively, but I hope it will be taken away and examined, so that we can see how we can put things in a better place for people experiencing alcohol and drug dependency, as they are often the people who have the greatest health inequalities.

[Several hon. Members rose—]

Social Care

Dan Poulter Excerpts

Tuesday 25th February 2020 Commons Chamber

[The Secretary of State for Health and Social Care (Matt Hancock)]

I beg to move an amendment, to leave out from “House” to the end of the Question and add:

“notes that the Government is committed to fixing the crisis in social care; and supports the Government’s commitment to find a long term solution for the growing need for care and commitment to an ambitious three point plan, including extra funding every year, seeking a cross party consensus and ensuring the prerequisite of any solution is a guarantee that no one needing care has to sell their home to pay for it.”

This is a welcome opportunity to debate social care—a subject of vital importance—and I want to set out how we must rise to the challenges and celebrate all that is good. We must recognise at the start of the debate that there is much to celebrate, including the millions of people who work in social care, to whom we pay tribute. I want to welcome someone who is new to working in social care: my hon. Friend the Member for Faversham and Mid Kent (Helen Whately), who has joined the team as Minister for Care. I pay tribute to her predecessor, my hon. Friend the Member for Gosport (Caroline Dinenage), who led the care system so effectively and delivered a legacy of better training, better recruitment and a real focus on carers; that is a legacy to be proud of.

Let me start with the context for this debate. It is rightly about both adults of working age and older adults. The people of this country are living longer. Over the next decade, the population aged 75 and over is set to increase by 1.5 million, and over the next 20 years, the number of people aged 65 and over is set to increase by almost half. That is emphatically a good thing. More people living for longer is not some problem to be managed; it is an opportunity to be welcomed, and welcome it we do.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

My right hon. Friend is right to highlight the significant challenge that an ageing population with multiple medical co-morbidities presents to the health and care system. In that context, it is not just about extra funding, which is obviously welcome to the care system; it is also about transforming the way we deliver care. Is it not time to consider a single point of commissioning for health and social care? If we were designing the system today, given the demographic challenges he has outlined, it would look very different from the system we have.

[Matt Hancock]

My hon. Friend is right that it is about more than just money. The money is, of course, important, but it is also about how the system is structured. There are parts of the country where the co-commissioning he calls for already exists, and we can see the improvement in efficiency that we get out of that. The hon. Member for Worsley and Eccles South (Barbara Keeley) rightly mentioned those with learning disabilities and autism, of whom there are more than 2,000 in in-patient settings. We are reducing that number and supporting more people to move into the community, including in the example that she mentioned. She talked about the challenge of that requiring more money. Actually, community settings are often better for the patient and cost the taxpayer less. As my hon. Friend says, improving the commissioning and the system is a critical part of the solution, so that yet more people can be moved out of in-patient settings.