Kettering General Hospital

Derek Twigg Excerpts

Wednesday 2nd February 2022 Westminster Hall

[Derek Twigg (in the Chair)]

Before we begin, I remind Members to observe social distancing and wear masks. I will call Philip Hollobone to move the motion and then the Minister to respond. There will not be an opportunity for the Member in charge to wind up. That is the convention for 30-minute debates, as I know the Member is well aware.

[Mr Philip Hollobone (Kettering) (Con)]

I beg to move,

That this House has considered the redevelopment of Kettering General Hospital.

It is a delight to see you in the Chair, Mr Twigg.

I thank Mr Speaker for granting me this debate, and I welcome the Hospitals Minister to his place. I also welcome my hon. Friend the Member for Northampton South (Andrew Lewer), who is kindly here to support the calls for the redevelopment of Kettering General Hospital. I thank the very hard-working, dedicated and loyal workforce at Kettering General Hospital for all they do to address the healthcare needs of the local population across Northamptonshire, particularly north Northamptonshire—in particular, Simon Weldon, the group chief executive, and Polly Grimmett, the director of strategy at Kettering hospital.

The Hospitals Minister knows Kettering hospital well and has always been extremely attentive and courteous to the healthcare needs of the local population in Kettering and beyond. He kindly visited the hospital on 7 October 2019, and he has responded to Adjournment and Westminster Hall debates on the hospital on 23 October 2019, 8 June 2021 and 10 September 2021. We have had regular meetings with him, most recently on 17 January this year.

I welcome the Government’s unprecedented investment in the NHS as a whole, and their commitment to the national hospital building programme. It has resulted in commitments to Kettering hospital of £46 million for an on-site urgent care hub, £350 million in health infrastructure plan 2 funding for 2025-30 and a write-off in 2020 of all the hospital’s £167 million trust debt. That is a total investment package for the hospital of a staggering £563 million, which is the biggest ever investment in Kettering General Hospital.

Kettering hospital is 125 years old this year. It has been on the same site ever since its inception in 1897. It is a much-loved local hospital that I hope will have a bright future. Let me reassure the Minister that I am not asking for more money. I welcome his recent decision that the two funding streams—the £46 million for the urgent care hub and the £350 million HIP2 funding—be meshed together, so that a synthesis of investment can be provided to the hospital. I have said this to the Minister before, and I repeat it today: promises are one thing, but delivery is quite another, and we now need the cash. The hospital needs the £46 million in cash so that works can continue.

In announcing the award of £46 million for the new urgent care hub in the debate on 23 October 2019, the Minister himself said:

“My officials and NHS England will be in touch with the trust to discuss further details, in order to ensure that funds are released and that work starts on the project as swiftly as possible. I am conscious of the urgency that my hon. Friend the Member for Kettering highlighted.”—[Official Report, 23 October 2019; Vol. 666, c. 30WH.]

I welcomed those words, but that was over two years ago. While we have been promised £46 million, the hospital has not yet received the cash.

My first main ask is for the imminent provision to KGH of the £46 million sustainability and transformation partnership wave 4b funding, which was first pledged in the debate here in October 2019, so that the initial enabling works for the redevelopment of the hospital can continue to 2023-24. Secondly, I reinvite the Minister to visit Kettering hospital. He has kindly visited before and has promised to visit again. I hope that that visit will take place soon.

Thirdly, can we have confirmation that the NHS’s new hospitals programme team will approve, and give feedback on, the hospital’s strategic outline case for its redevelopment, which was submitted early last year, so that the hospital can develop the next stage—an outline business case—in May 2022? Fourthly, can the Minister confirm that he will look favourably on Kettering hospital’s eligibility for £53 million of slippage from other more complicated and larger hospital development schemes—such slippage will inevitably occur across the redevelopment of 40 hospitals—so that work can continue on the Kettering site all the way through to the 2025 to 2030 HIP2 period?

The hospital is straining at the leash to get the redevelopment project under way. Initial work has already commenced, but the hospital must go through various approval processes to fulfil the NHS’s investment requirements. Essentially, there is a three-stage business case approval process: a strategic outline case, an outline business case and a final business case.

The hospital submitted its SOC early last year, but it has not yet received feedback from the new hospitals programme team to inform the outline business case, which it is keen to submit in May this year. Once the OBC is achieved, feedback is required for the final business case. The big risk is that these various business case approval processes are extended too long, which will mean that substantial development on site will be held up.

The second risk is that the hospital needs the cash from the £46 million to allow the initial enabling work to continue. That work covers things such as the reprovisioning of car parking, clinical and office spaces to create construction space for the redevelopment itself, as well as road and utility diversions and site clearance. Without the cash from the £46 million, the risk is that those enabling works will have to stop, and that would be of extreme concern to local people.

The third risk is that the trust does not receive any slippage money from the other 40 hospital building programmes around the country. The Kettering scheme is relatively small, compared with some of the very large hospitals being rebuilt, but it is flexible. It can respond extremely well to receiving any slippage money from those other projects.

Health Inequalities: Office for Health Improvement and Disparities

Derek Twigg Excerpts

Wednesday 26th January 2022 Westminster Hall

[Derek Twigg (in the Chair)]

Before we begin, I remind hon. Members that they are expected to wear face coverings when they are not speaking in the debate. This is in line with the current Government guidance and that of the House of Commons Commission. I remind Members that they are asked by the House to have a covid lateral flow test before coming on to the parliamentary estate. Please also give each other and members of staff space when seated and when entering and leaving the room.

[Peter Dowd (Bootle) (Lab)]

I beg to move,

That this House has considered the Office for Health Improvement and Disparities and health inequalities.

It is a real pleasure to be here under your stewardship this afternoon, Mr Twigg. I thank all those who have come along—all on the Labour side of the House—to debate this important issue, which affects so many of our constituents. I thank the organisations that have provided me with information to help me articulate my points, including the Royal College of Physicians, the Inequalities in Health Alliance, the British Heart Foundation, Cancer Research UK, Maternity Action, the Royal College of Paediatrics and Child Health, the NHS Federation, the UK Vaping Industry Association, Kidney Research UK, the Health Foundation, the Terrence Higgins Trust, Global Blood Therapeutics, the Local Government Association, the Institute of Alcohol Studies, the Children’s Alliance and, as ever, the House of Commons Library, which brings much of this together. I do not believe I have missed any organisation out. If I have, I apologise.

Each organisation made helpful and constructive comments about the matter we are debating today. The extent of health inequalities is remarkably wide—in fact, I felt I understood the extent of such inequalities, but the information from those organisations has widened my knowledge significantly. Each of the organisations had the decency to send me information, so I will read out comments from each of them, if I may.

Alongside its key ask for a cross-governmental strategy to reduce health inequalities, the Inequalities in Health Alliance also asks the Government to

“commence the socio-economic duty, section 1 of the Equality Act 2010”

and to

“adopt a ‘child health in all policies’ approach.”

The Health Foundation notes:

“Public health funding grants to councils have been reduced by £700 million in real terms from 2015/16 to 2019/20. In the Spending Review published in October 2021, the Government said it would maintain the public health grant ‘in real terms’ until 2024/25, but has yet to confirm the amount for 2022/23.”

We are only a couple of months away from the beginning of that financial year. The Terrence Higgins Trust asked me to ask whether the Minister can confirm when local authorities will have their public health grant allocations published. Other organisations also asked that question.

The Institute of Alcohol Studies said:

“People from the most deprived groups in England are 60% more likely to die or be admitted to hospital due to alcohol than those from the least deprived… We believe that for any levelling up agenda to be comprehensively successful, it must address alcohol harm as a top priority.”

The LGA said:

“Councils have seen a significant reduction to their public health budgets in the period between 2015/16 and 2019/20. The recent announcement of a real-terms protection of the public health grant is welcome, but is unlikely to address the impact of the past reductions to funding.”

Cancer Research said that its modelling estimates suggest that

“30,000 extra cases of cancer in the UK each year are attributable to socio-economic deprivation. The two biggest preventable causes of cancer—smoking and overweight and obesity—are more prevalent in deprived groups.”

Kidney Research said:

“Around 3 million people in the UK have kidney disease and every day, 20 people develop kidney failure…. There is also a gender bias associated with kidney disease—women are more likely to be diagnosed with kidney disease and are at higher risk of developing end stage renal failure than men.”

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[Peter Dowd]

My hon. Friend is spot on. That is a key point that we want to tease out today: cross-departmental working.

As with many other health issues, the devil is in the detail. Only by looking into the granularity of the issues can a real understanding of the levels of inequality and disparity be established. I do not have time for more significant references to the organisations concerned, but it really was important for me to get down to the detail of the information that they provided. I will give the documents to the Minister for her perusal in due course.

Before the pandemic, growth in life expectancy had stalled for the most deprived in England. Between 2014 and 2019, people in the least deprived areas saw their life expectancy grow significantly, but there were no significant changes for people in the most deprived areas. For women in the most deprived areas of England, life expectancy fell between 2010 and 2019—a stark fact. The pandemic unambiguously exposed and exacerbated inequalities that have existed in our society for far too long, as many hon. Members will have seen first hand in their constituencies. The pandemic has widened gaps that were already too big to begin with, and once again it is the most vulnerable who have borne the brunt.

We know from the Sir Michael Marmot’s “Build Back Fairer” report that mortality rates for covid in the first wave mirrored mortality rates for other causes. In order words, the causes of health inequalities more widely were similar to the underlying drivers of covid-19 deaths among certain groups. It has been estimated that working-age adults in England’s poorest areas were almost four times more likely to die from covid than those in the wealthiest areas—another stark figure. Now, with the backlog, analysis of waiting list data shows that people living in the most deprived areas are nearly twice as likely to wait more than a year for treatment compared to those living in the least deprived areas. That cannot be right.

Before the pandemic, through the pandemic and now as we emerge, we hope, from the worst of the omicron variant—it is clear that there is a deep-rooted inequality in our society that causes huge inequality in health. The gap in life expectancy is startling. People in my constituency live on average 12 years less than people in Southport—just at the other end of the borough. Those are stark differences in healthy life expectancy—how many years a person spends in good health. Before covid, it was estimated that people in the richest communities in England could expect to live in good health for up to two decades more than the poorest. In Bootle, according to Nomis at the Office for National Statistics, 42% of people who are economically inactive are long-term sick, compared to the national average of 24%.

However, statistics get us only so far. A recent paper from the Royal College of Physicians brings to life the reality of health inequalities. One hospital clinician saw a patient who was extremely malnourished and dehydrated. The patient had been regularly missing meals so she could feed her teenage son. When she first became unwell, she did not call the GP, because she was unable to afford to pay someone to look after her son, and was frightened that he would be taken into care if she had to go to hospital for a long time. She was eventually admitted to hospital with sepsis. There are other stories in the paper of people who missed hospital appointments because they could not afford public transport, people who do not have the kitchen facilities to cook food and someone who was hospitalised because their asthma was aggravated by mould in their flat that the landlord refused to fix.

As we all know, 40 years ago, Sir Douglas Black, a former president of the Royal College of Physicians, was asked by the Department of Health and Social Security to lead an expert committee looking into health and inequality. That now famous Black report was unequivocal and said that while overall health had improved since the introduction of the welfare state, there were widespread health inequalities, the main cause of which were economic inequalities.

In his foreword to the report, the then Secretary of State said:

“the influences at work in explaining the relative health experience of different parts of our society are many and interrelated.”

That is as true today as it was then. It might seem that health inequality is a matter for the Department of Health and Social Care and the NHS but, as other hon. Members have said, health and social care services can only try to cure the ailments created by the environments people live in.

Research by the University of York linked austerity measures with the deaths of almost 60,000 more people than would be expected in the four years following their introduction. The money a person has will change the decisions they make about their health. It is the difference between having a healthy meal and having a meal at all, or between choosing to pay for the journey to the GP for an ongoing cough or choosing not to.

Housing affects health too. Last year, Shelter found that poor housing was harming the health of a fifth of renters. Our society benefits some people and deprives others, and those structural inequalities drive many of the health inequalities in black, Asian and other minority ethnic groups. We have to address that if we want to tackle this issue.

If we are to prevent ill health in the first place, we need to take action on issues such as how much money people have, poor housing, food quality, communities, place, employment, racism and discrimination, transport, and air pollution. That is why many organisations and coalitions, including the 200 members of the Inequalities in Health Alliance, which is convened by the Royal College of Physicians, have made calls for a cross-Government strategy to reduce health inequalities.

Tackling health inequality requires a considered and co-ordinated approach across myriad factors. Last year, the Government signalled that they recognise the need to look beyond the Department of Health and Social Care and the NHS and to take action on the issues that cause ill health. When the Secretary of State announced the Office for Health Improvement and Disparities in October last year, we were promised a new cross-Government agenda that would look to track the wider determinants of health and reduce disparities. The Health Promotion Taskforce was established.

These are potentially encouraging signs, but I am concerned that we are yet to hear the detail of what the OHID will do to reduce health inequalities. Will the Health Promotion Taskforce have a remit to take action outside the Department of Health and Social Care? When will we see a strategy on reducing health inequalities, so that we know what the Government’s ambition is in this area and we can track progress? Will the Government commit to developing a cross-Government strategy to reduce health inequalities?

Will the Minister set out how the Office for Health Improvement and Disparities will reduce health inequalities? Will he tell us about the work of the Health Promotion Taskforce and how often it meets? What engagement has the OHID had with Government Departments to date, since it was formally established on 1 October 2021? Importantly, will the Minister set out how the OHID will work with integrated care systems and support them to address health inequalities in their areas? I hope he can answer some of those questions.

When the Labour Government first asked Professor Marmot to review health inequalities in 2008, Gordon Brown said:

“The health inequalities we are talking about are not only unjust, condemning millions of men, women and children to avoidable ill-health. They also limit the development and the prosperity of communities, whole nations and even continents.”

He was absolutely right.

This Government were elected on a platform of levelling up, but while covid-19 caused a decrease in life expectancies for most countries between 2019 and 2020, the UK’s life expectancy has fallen below where it was in 2010. The UK was one of only two countries where that happened, the other being the United States.

In 1980, the Government responded to the Black report by saying:

“you might be right about the solution, but it’s going to cost too much.”

After two years of living with the pandemic, which, of course, has hit the most deprived the hardest, it is clear that the real cost lies in not supporting those who need that support most. Only Government can create the conditions for better health by improving the factors that lead to ill health in the first place. I hope the Minister can set out what the Office for Health Improvement and Disparities can do to achieve the aim of reducing inequality, and can confirm that the Government intend to tackle the wider determinants of health, which drive so much of the health inequality that we see.

[Derek Twigg (in the Chair)]

A good number of Members want to speak today. I do not intend to impose a time limit, but it would helpful if you could keep your speeches to around six minutes. That will ensure that everybody gets in. I intend to call the Front Benchers at no later than 3.40 pm.

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

It is a pleasure to serve under your chairmanship, Mr Twigg. I add my congratulations to my hon. Friend the Member for Bootle (Peter Dowd) on securing this debate and on the passionate way that he opened it.

Health inequalities are one of the defining issues of our time and are innately linked not only to how long we live, but to how well we live. Every person across this great country deserves to thrive and live a long, fulfilling and healthy life. That principle informed the creation of our national health service and it continues to drive the work that Opposition Members do.

As colleagues have done, I reinforce to the Minister the perilous position that we find ourselves in with regard to health inequalities. The pandemic has exacerbated the health inequalities that were already widening prior to the first lockdown. Indeed, in February 2020 the King’s Fund reported:

“Males living in the least deprived areas can, at birth, expect to live 9.4 years longer than males in the most deprived areas.”

For females, as we have heard, this gap is 7.4 years. That is not good enough.

Worse, the gap is increasing. Life expectancy has had a steady ascent for 100 years. That ascent began to plateau in 2011. Can the Minister advise what she thinks happened in 2010 that led to that abrupt stalling of life expectancy? It is very real. [Interruption.]

[Derek Twigg (in the Chair)]

Order. The sitting is suspended for 25 minutes for Divisions in the House.

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[Andrew Gwynne]

Before I was interrupted by the Division bell, I was about to say that I have seen at first hand the injustice of health inequality. Denton, the main town in my constituency, where I grew up and have lived, is not a very large town. It has a population of 38,000 people spread over three council wards, and its area is 2.5 miles by 1.5 miles. I grew up in Denton West, which is one of the more prosperous wards in my constituency and in the borough of Tameside.

My best friend at secondary school lived in Denton South, which, conversely, is one of the poorest. We both went to the same school. We were two kids growing up in the same community, at the same school, doing the same things, hanging around together. Yet according to the average life expectancies, he will live 10 years less than I will. That cannot be acceptable, it is not acceptable, and it is one of the reasons I joined the Labour party and became politically active. Tackling those inequalities, not just in a small community such as Denton but across the country, is absolutely what we should be about, in order to improve outcomes for all.

The last decade has been a disaster in terms of inequality, and I say to the Minister that that is the direct consequence of political choices that her party has made. It is a consequence of a decline in real-terms local authority spending, a consequence of a reduction in per-person education spending—a consequence of 12 years of Conservative government. The fact is that it is impossible to corral health inequality into one box. As we have heard in this debate, it is closely tied to social determinants: where people grow up, their environment, their education and their disposable income all contribute to health inequalities. If we are to tackle the crisis, the Government must recognise that they cannot make policy decisions in a vacuum.

That leads me to the issue of the Office for Health Improvement and Disparities. I note that one of OHID’s key priorities is to

“develop strong partnerships across government, communities, industry and employers, to act on the wider factors that contribute to people’s health, such as work, housing and education”.

That is music to my ears. It is clearly a positive and welcome aspiration, but three months on from OHID’s launch, we have yet to see any clear indication that cross-Department work has actually been prioritised by the Government. This point has been made by the Inequalities in Health Alliance, an organisation with more than 200 members, including the Royal College of Physicians. The IHA has asked the Government to underpin and strengthen OHID’s work with an explicit cross-Government strategy to reduce health inequalities, involving all Departments, and led by and accountable to the Prime Minister. So far, the Government have been resistant to committing to that.

I would be grateful if the Minister, in her response, could advise us what assessment she has made of the request from the IHA and whether her Department will commit to developing a specific cross-Government strategy. In addition, can she set out how OHID will assess its own effectiveness, and what influence it will have on other Departments? Will she also outline what engagement OHID has had with other Departments since it was established back in October? We need to know that OHID is not just more warm words with very little in the way of positive action. The Government cannot point to OHID with one hand and then, with the other, undermine the work that it purports to do.

For example, last October, the very month in which OHID was formed, the Chancellor of the Exchequer ended the £20-a-week uplift to universal credit. That plunged 300,000 children into poverty pretty much overnight. That political decision obviously has a negative public health impact for people across the country, yet apparently that was not something the Chancellor either considered or seemed particularly concerned about at the time. Can the Minister advise us how OHID will prevent further such disastrous policies from being implemented? If she cannot, I simply do not see how it will solve the crisis of health inequality in this country. I would be grateful, too, if she could outline what role OHID will play with regard to the new integrated care systems. Some clarity on that would be very much appreciated, particularly in advance of the Health and Care Bill’s anticipated return to the Commons in the next few weeks.

Finally, I want to touch on the subject of levelling up and its relationship to health inequalities. It has become somewhat of a go-to phrase for the Government. It should perhaps be a cause of concern to the Minister that, more than two years into this Administration, the levelling-up White Paper still has not been published. On that note, I want to press her on what exactly the Government’s priorities are.

In 2020, Professor Sir Michael Marmot published “Build Back Fairer” in Greater Manchester, which called for several policy interventions from the Government. Professor Marmot proposed investment in jobs, housing, education and services, and made particular reference to tackling the social conditions that cause inequalities at local and community level. We saw local authority public health funding cut by 24% per capita in real terms between 2015-16 and 2020-21. That is the equivalent of a reduction of £1 billion, which cannot be right. We need to restore public health funding to local authorities, so that local teams are able to provide vital services that communities need to stay healthy.

In conclusion, we went into the pandemic with health inequalities already growing, which left Britain’s poorest areas, as well as those in black, Asian and minority ethnic communities, acutely vulnerable to covid-19. That is totally unacceptable. We are now in 2022; we should not be living in a society with such extreme levels of health inequality. It is not right, and it needs fixing. The Government must do more and can do more, and they must do better.

[Derek Twigg (in the Chair)]

The debate will finish no later than 4.25 pm. I know that the Minister is aware of the need to allow two or three minutes at the end for the hon. Member for Bootle (Peter Dowd) to wind up.

Covid-19 Update

Derek Twigg Excerpts

Monday 13th December 2021 Commons Chamber

[Sajid Javid]

First, I thank my right hon. Friend for being a vaccinator and for all the work he has done personally to help this country get through the pandemic. Of course there is a distinction—he is absolutely right. The NHS can offer an individual a jab—they might receive an email or a text saying, “Please come forward. Either book or walk in. You are eligible.”—but the individual has to come forward and take up that offer. That is why a huge amount of effort—even more effort than before—will go into persuading people to come forward.

[Derek Twigg (Halton) (Lab)]

May I ask the Secretary of State why the Government have no coherent plan for dealing with delays to elective surgery and treatment? I say that because I asked some parliamentary questions about what impact the recently announced Government funding will have on waiting times over the next three years, but the answer said that no estimate has been made at this time. I then asked what assessment has been made about private sector capacity. Again, I was told that no estimate has been made. I ask the Secretary of State: where is the plan to deal with the huge backlog of elective treatment? Macmillan estimates that there are 50,000 missing cancer diagnoses in the UK and that 32,000 people are waiting for their first cancer treatment in England.

[Sajid Javid]

I remind the hon. Gentleman that the Government have already announced the biggest catch-up fund for electives that the country has ever seen in order to deal with that challenge.. There is an extra £2 billion for the second half of this year and a minimum of £8 billion over the next three years, and the NHS is working on a detailed plan which will be published as soon as it is ready.

Adult Social Care

Derek Twigg Excerpts

Wednesday 1st December 2021 Commons Chamber

[Gillian Keegan]

My right hon. Friend is absolutely right. More than 250 organisations worked with us to develop this White Paper, and I want to thank them for their input. Of course they welcome the steps that we are taking. I do not know how many Green Papers, White Papers and other papers they have tried to get some change from, but this one is finally starting on the road to deliver and transform the sector. He is right to say that the longer we can have some understanding of the settlement for funding, the better, and I am sure that my colleagues who are working on that will have heard his question.

[Derek Twigg (Halton) (Lab)]

It is disappointing that the Minister does not take seriously our genuine concerns about the crisis in social care. She will have received a copy of the letter sent to MPs recently from the Association of Directors of Adult Social Services. Why does she believe that it said that, in its professional judgment, these measures as they stand

“will not fix the crisis in social care”?

[Gillian Keegan]

What I have said is that this is a huge step forward. I do not think that I can stand here and say we will fix the whole crisis in social care overnight. As I have said, this is also something that countries all over the world are grappling with. I think that when that letter was written, the short-term funding of £162.5 million had not been sent out to local councils. I hope that they are using that money wisely to increase capacity and retention in the care sector.

Chronic Obstructive Pulmonary Disease

Derek Twigg Excerpts

Wednesday 17th November 2021 Westminster Hall

[Derek Twigg (Halton) (Lab)]

It is a pleasure to serve under your chairmanship, Ms Nokes, and I congratulate my neighbour, my hon. Friend the Member for Weaver Vale (Mike Amesbury), on securing this important debate.

I welcome the British Lung Foundation report, “Insights from those living with chronic obstructive pulmonary disease (COPD) around the UK”. I completely support its call for Governments and health services across the nations of the UK to rapidly commit to funding for national health services to get lung health strategies back on track, and to tackle the respiratory backlog. I note the finding that while respiratory conditions are supposedly a clinical priority, that does not seem to be the case in practice, and we need to see ambitious targets for improving COPD prevention, diagnosis and care.

It is truly frightening and disturbing to watch someone suffering with COPD, or chronic chest disease, fighting for their breath; especially when they are stuck on a trolly in a long queue outside A&E or left all day waiting for a hospital bed to become available. Watching them struggle for every breath with very low oxygen levels is distressing for both the individual and the families. My constituency has historically high rates of lung disease, including lung cancer, for a mix of reasons such as its industrial legacy and, of course, high rates of smoking and deprivation. As we have heard, COPD is the fifth most common cause of death in the UK, resulting in 30,000 deaths per year.

There are 3,878 patients on Halton GP registers for COPD—a prevalence of 2.9% of GP registered patients. That is higher than the England average of 1.9%, and slightly higher than the Cheshire and Merseyside average of 2.6%. There is variation between different GPs in Halton, with prevalence’s ranging from 1.3% to 4.1%. The Halton prevalence has not changed since the last publication in 2018-19. Over the past five years it has increased very slightly from 2.6% in 2015-16. The latest published data from 2017 to 2019 shows that Halton’s mortality rate for COPD was higher than England and the north-west’s. Halton’s rate was 70.5 per 100,000 of the population, whereas England’s was 50.4, and the north-west’s was 63.3.

Death rates from COPD are higher for males than females in Halton; this is also the case both nationally and regionally. As I referred to earlier, it has been estimated that there are many more patients nationally with COPD who have not been diagnosed; the most recent 2015 estimate suggested a COPD prevalence of 3.3% in Halton. This would mean that there are potentially around 550 people in Halton who are not diagnosed at this point in time.

I must refer to hospital admissions, because we know the pressures that our hospitals are under. Most people with COPD are managed in primary care, but for some the condition will deteriorate or be undiagnosed, which can result in emergency unplanned admissions to hospital. The latest published data for 2019-20 shows that Halton had a higher rate of emergency hospital admissions for COPD than England. Halton’s rate was 502 per 100,000 of the population, whereas England’s was 415 per 100,000 people. The female rate of emergency hospital admissions is also contributing to the overall high rate.

Several worrying findings came out of the British Lung Foundation report, and given the limited time I can only highlight just a few of those—some of them have previously been referred to by hon. Friends. As we have heard, thousands of people are missing out on diagnosis. The British Lung Foundation conducted a survey of over 8,000 people with COPD between December 2020 and May 2021. Even before the pandemic, it is clear from the responses that many people with COPD had experienced unacceptable delays before a diagnosis was made.

Recent Government figures found that diagnosis rates, which were already far too low, plummeted even further. In 2020 there was a 51% reduction in COPD diagnosis when compared with 2019, meaning that around 46,000 people in England alone missed out on a diagnosis. Again, the latest figures available in Halton suggest that 550 people have missed out on a diagnosis.

I know from the figures I obtained from the local health commission support unit that GP referrals to respiratory medicine in Halton are still not at pre-pandemic levels. As of November 2021, diagnostic tests for spirometry have not yet properly resumed. It is particularly worrying that the British Lung Foundation found that, across the UK, over three quarters of those with COPD did not receive what NICE clinical guidance defines as the five fundamentals of COPD care, but I will not go into them because my hon. Friend the Member for Weaver Vale referred to them earlier.

The British Lung Foundation believes that the national health service should amend guidance for GPs across the UK to ensure proactive case finding among high-risk groups to identify COPD and other lung conditions such as idiopathic pulmonary fibrosis and lung cancer in a timely way. Questions on respiratory health should be made a mandatory part of the NHS health check to help identify many undiagnosed cases of COPD. Smoking cessation schemes, which we have heard about today, must continue to be a priority, with more effort and drive put into them and, importantly, with better data on success rates.

I would like to make a specific plea for more resources to be put into community rapid response teams who, when they work well and get to patients and treat them at an early stage before they deteriorate, can and do in many cases prevent hospitalisation, easing the pressures on hospitals. They are a really important part of the health service and we need to concentrate more on them. Once people get to hospital, some of them people are very ill, so the more we can do to prevent it in the first place, the better.

The covid pandemic is, without doubt, a major contributing factor to the challenges facing primary and secondary care. The Government’s failure to properly address staffing shortages and better diagnostic facilities over the past 11 years, and prior to the start of the pandemic, is a significant reason why the current pressures on the NHS are so acute. A shortage of GPs is not helping quick diagnosis and rapid treatment. As I referred to during the Budget debates, the number of patients per GP practice is 22% higher than in 2015, but the GP workforce has not expanded with this rise in patient need. Nor has it helped that there are over 90,000 staff vacancies in the NHS.

The fact is that the Government have allowed this situation to occur since they first came into power in 2010. The Government need to get their act together and ensure that they have a workable, funded plan in place to transform the quality of life of people living with COPD, to prevent more people from developing it in future and to stop unnecessary suffering.

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[Gillian Keegan]

I will come to that, and I will also come to the questions about recovery and catch-up, which a number of people mentioned.

To increase access to pulmonary rehabilitation, a population management approach will be used in primary care to find eligible patients from existing COPD registers who have not previously been referred to rehabilitation. New models of providing rehabilitation to those with mild COPD, including digital tools, will be offered to give support to a wider group of patients with rehabilitation and self-management support.

The use of COPD discharge bundles, where appropriate, will also help to increase referrals to pulmonary rehabilitation, and the NHS long-term plan will build on a range of existing national initiatives focused on respiratory disease. The quality and outcomes framework, or QOF, ensures that all GP practices establish and maintain a register of patients with a COPD diagnosis, and the QOF for 2021-22 includes the improved respiratory indicator, including the recording of the number of exacerbations and assessments of breathlessness, and an offer of referral to PR.

NICE quality standards have been published, with the aim of raising the standard of care that those with COPD receive. The NHS RightCare Pathway for COPD is being rolled out nationally. This pathway defines the core components of an optimal service for people with COPD, and it includes timely access to PR as part of the optimal treatment pathway. It provides resources to support local health economies, and the pathway also concentrates improvement efforts on addressing variation and population health.

At the beginning of the pandemic, NICE published rapid guidance on COPD, which outlines how to communicate with, treat and care for patients suffering from COPD. It also outlines how healthcare workers should modify their usual care and service delivery during the pandemic.

[Derek Twigg]

I am listening carefully to what the Minister is saying, but one of the problems that I referred to briefly in my speech is that of being able to see a GP—not necessarily just for diagnosis, but when someone becomes ill. I wonder how she can square that circle in terms of what has been put in place, if people cannot get to see a GP in person in the first place.

[Gillian Keegan]

Of course, access to GPs’ services is a concern that all Members will have heard a number of their constituents raise. That is why we put in place £250 million to increase access to face-to-face GP appointments as part of the recovery plans, which are quite extensive for the NHS.

The guidelines I was talking about aim to highlight ways to support people with COPD, such as signposting charities and support groups for better health and wellbeing. They recommend using technology to reduce some in-person appointments, while making sure not to provide a service that would increase health inequalities through a lack of digital access—it is additional, not instead of—as well as offering advice on how to modify care during the pandemic.

A number of questions were raised about the recovery plan, and how to restore services for patients and restore the diagnostics to pre-pandemic levels, or above them. The 2021-22 priorities and operational planning guidance set the priorities for NHS England and NHS Improvement, and includes tackling the backlog for non-urgent treatment such as services for lung disease patients. That plan aims to stabilise total waiting lists, and eliminate waiting times of two years or more and the increase in waiting times of more than one year. We have made £1.5 billion available to assist local teams to increase their capacity and invest in other measures to achieve those priorities, and the 2021 spending review announced £2.3 billion to increase the volume of diagnostic activity and open community diagnostic centres to provide more clinical tests, including for patients with lung disease.

Targeted lung health checks are running in the parts of the country with the highest rates of mortality from lung cancer. However, those projects will not just identify more cancers, but pick up a range of other health conditions, including COPD. People aged between 55 and 74 who have ever smoked are now offered a free lung health check closer to where they live. They may then have a lung cancer screen scan if that check shows that they need one. A review undertaken by Professor Sir Mike Richards highlighted that patients with respiratory symptoms would benefit from community diagnostic centres, due to the number of diagnostic tests that will be made available. As well as supporting patients with COPD, the Government are committed to strategies that will help to prevent that condition, as a number of Members have mentioned.

Covid-19 Update

Derek Twigg Excerpts

Monday 7th June 2021 Commons Chamber

[Matt Hancock]

A propos my previous answer, there is again a balance here. Obviously, we want to go as fast as possible, but, on the other hand, the strength of overall protection people get grows, on the latest clinical advice, up to an eight-week gap. So a longer gap gives them better overall long-term protection. That is why we have reduced the gap from the 12 weeks we had at the start, because we wanted to get as many first jabs done with the early doses we had, to eight weeks; but the clinical recommendation is not to go below eight weeks, because people would end up with weaker overall protection from both jabs. That is the reason for our approach, but ultimately we want to go as fast as we clinically safely can with the programme. For that, we need all the good folk of Hazel Grove who are doing so much to make this happen and to deliver jabs in arms, and I thank them all.

[Derek Twigg (Halton) (Lab) [V]]

A number of my constituents were out in Portugal and were taken completely by surprise by the Government’s about-turn on their advice and rules on travel to Portugal. It has cost some of them many hundreds of pounds. It is important that we remember that hundreds of thousands of jobs depend on the travel industry, and many people in my constituency work in that industry or rely on it. The Government must start to be clear about what they are going to do about travel overseas. Given the high number of people in this country who have been vaccinated, subject to the countries they are going to having high rates of vaccination and low rates of covid, there is no reason why they should not be able to travel.

[Matt Hancock]

I cannot say any more than I have already said. We take a cautious approach to travel because of the risk of new variants, which could undermine the whole thing. We have a traffic-light system because some countries are safer to travel to than others.

Covid-19: Social Care

Derek Twigg Excerpts

Thursday 22nd April 2021 Westminster Hall

[Derek Twigg (in the Chair)]

I remind hon. Members that there have been some changes to normal practice in order to support the new hybrid arrangements. Timings of debates have been amended to allow technical arrangements to be made for the next debate. There are also suspensions between each debate.

I remind Members attending physically and virtually that they must arrive for the start of the Westminster Hall debates. Members are expected to remain for the entire debate. I also remind Members participating virtually that they are visible at all times, both to each other and to us in the Boothroyd Room. If Members attending virtually have any technical problems, they should email the Westminster Hall Clerks’ email address.

Members attending physically should clean their spaces before they use them and before they leave the room. I remind Members that Mr Speaker has stated that masks should be worn in Westminster Hall.

--- Later in debate ---

[Liz Kendall (Leicester West) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Twigg, and very nice to see so many people present in person. One of the things that we have all missed during this pandemic is human interaction, possibly even in Parliament.

I congratulate my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes) on securing this debate and on her brilliant speech, every word of which I agree with. I thank her and the right hon. Member for Ashford (Damian Green) for their work on the APPG. Every week, I have read the readout of their discussion, even if I have not been able to attend, and that real-time information has been hugely important. I also pay tribute to my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), who was the shadow Minister for Social Care before me and from whom I have learnt a great deal over many years.

I will say something about the impact of the pandemic on the users of services, staff, families and the wider community, who have not been touched on so far. I will also talk about the underlying reasons why we have failed to prioritise and secure longer-term reforms to social care. We cannot deal with a problem unless we understand why it is there; that is how we get progress.

As other hon. Members have said, the emerging tragedy in social care over the course of this pandemic will be etched on all our brains for the rest of our lives. To see 41,500 care home residents dying from covid-19, including those residents who ended up dying in hospital, has been brutal for every single one of those people, their families and all the staff who have gone through unimaginable horror caring for people at this difficult time.

The sad reality is that the proportion of care home residents who have died in England is higher than in almost any other country that we have data for, especially in Europe, where it is surpassed only by the proportion who died in care homes in Slovenia, Belgium and, unfortunately, Scotland—despite what the hon. Member for Linlithgow and East Falkirk (Martyn Day) said. Scotland has had one of the highest rates of care home resident deaths. That is a serious problem. I will come on to why, whatever Ministers said, I think that a protective ring of steel was not put around care homes. That is related to the deep-seated problems and our fundamental challenges. We must ensure that it never happens again.

People living with dementia have been particularly badly hit by the pandemic. A third of all covid-19 deaths have been of people living with dementia. Also, the deaths of people with dementia even where covid-19 has not been present have been significantly higher. I will say something about this later, but I think the fact that so many people in care homes have been prevented from seeing their loved ones means that those with dementia have gone downhill fast. When people lose their memory, which is what dementia is, their family is their memory. No matter how hard care home staff try, family are the ones who know what films people liked or what music they liked to play, and without their absolute involvement and interaction, we have seen many care home residents with dementia go downhill fast.

I also want to touch on a point made continually by my hon. Friend the Member for Worsley and Eccles South: the impact of covid-19 on people with learning disabilities. They are six times more likely to die than the general population and, horrifically, for those aged 18 to 34, they are 30 times more likely to die. To be honest, however, that should come as no surprise to us, because we know that people with learning disabilities have far worse health outcomes and are more likely to die early because of their lack of proper access to care.

Everybody has rightly paid tribute to the amazing work of care staff, who have given more than almost anybody during this pandemic. Tragically, they were twice as likely as the general population to die from covid-19 during the first wave. That presents two really big issues.

There was an appalling lack of access to PPE, especially in the first wave. I met frontline care workers who told terrible stories of having only one mask to last the whole day, from client to client, when seeing clients with dementia, who cannot help but spit on to the mask when they are talking, so the care worker thinks, “I haven’t got another mask to see my next client.” A survey by GMB found that 85% of frontline care workers said that they were worried about the risks to their own health and that of their families, and that one in five thought about quitting cause of the lack of PPE.

That has been compounded by the low pay and poor terms and conditions of frontline care workers. We have heard time and again that many workers who needed to self-isolate or shield were forced to take unpaid leave or rely on statutory sick pay, leaving them desperately out of pocket, unable to pay their bills and facing an awful choice between going to work or being unable to put food on the table. A Unison survey found that those are absolutely essential issues that must be addressed. One care worker said:

“I was Covid-positive after contracting it at work and was off for three weeks. I have a mortgage to pay and bills, and I don’t know how I’m expected to survive. I put my life on the line, survived and was repaid with SSP.”

Three quarters of frontline care workers do not make the real living wage. Many do not even make the minimum wage at the end of the week because they are not paid for travel time between clients. We cannot deliver a better system of social care without transforming the pay, terms, training and conditions of the care workforce.

On families, there are two issues. One is unpaid family carers, who have done so much more to care for their elderly or disabled loved ones during this pandemic. There were 9 million of them in the UK, but since the pandemic struck, there have been an extra 4.5 million—it is astonishing that we have not heard more about that during the debate. They are providing even more care than usual, without breaks, and their own physical and mental health has suffered as a result. Families are as important as the paid workforce in delivering care in this country. We need a new deal—a partnership between families and the Government—to support those carers in doing their best to look after their loved ones.

We then have the families who have been banned from seeing their loved ones in care homes, and who are now also unable even to take their loved ones out for a walk or a cup of tea, because they would have to self-isolate for 14 days. We have to completely rethink that. Since June, we have been arguing that families should be treated as key workers and have access to all the testing, PPE, vaccinations and so on, so that they can safely visit their loved ones. That is not just a term or a gimmick, however; they actually are key workers. We cannot have good-quality care for older or disabled people without families’ involvement.

I urge the Minister, as I have done many times when discussing this topic, to have a rethink about this. The guidance still is not working—it is wrong on the 14-day self-isolation—and we may have to look at legislation to enshrine the rights of care home residents. They are not prisoners. Quite frankly, if we all think that, when we end up in a care home, we will be banned from seeing our family and will not be allowed out, what kind of future is that? It will be a future that we fear, rather than a future for which we look forward to getting older, and that must change.

On the wider community, one of the positive things from the pandemic—I am very proud of what has happened in Leicester, the city that I represent—is how many voluntary groups and mutual aid groups have sprung up to try to do things such as helping older people with shopping, delivering it quicker than either the local authority or the private sector ever could. That support for the wider community—ringing older people to help them if they are isolated—has got to be part of our future social care system, too.

Let me move on to why we have seen the problems that we are all relating here. The immediate and glaring issue, as the Alzheimer’s Society has said, of why we have seen such problems in the care sector, is that the pandemic struck at a time when social care was already overstretched and undervalued. Local authority care budgets have been cut by £8 billion in real terms since 2010 and that has pushed many to absolute breaking point. It is not morally right, but it does not make economic sense either, because if staff are not paid properly and there is high turnover and vacancy rates and family carers are not supported and their health suffers and they end up in hospital, that costs us all far more.

It is also the failure to put in place long-term reforms, as the right hon. Member for Ashford (Damian Green) said. Why is that the case? It is a big challenge, but it is not rocket science, to ask for older and disabled people to live as normal a life and as full and fulfilling a life as possible, with help to get up, washed, dressed and fed, maybe go to the shops, with help for a disabled person to live independently and maybe have a job. It is not that complicated, yet we have ended up in this crisis. Why?

First, when the NHS and the wider welfare state was created, average life expectancy was 63. Now, it is 80. We did not live in a world where people lived for so many years, and so we have been scrabbling to catch up ever since, with a fragmented and piecemeal system. Secondly, in many ways we have left it to families—“This is a family issue; families should look after elderly or disabled relatives.” Yes, and they want to. They want to do all they can, but they need help and support, especially in a world where women work; they want to work and balance their family lives. Thirdly, it is about caring and caring is women’s work—undervalued, underpaid and yet some of the most important work in our society.

What that all adds up to is a failure to understand that a third of our lives will now be lived aged over 65. We have got to transform society—not just the care sector, but housing, transport and planning—because getting older should be something that we look forward to with hope and optimism, not fear. It is my lovely mum’s birthday today. She is so worried about the pandemic, but I am afraid, when I was discussing this debate, she said, “You know what, Liz? You know what we feel? At best, ignorable; at worst, expendable.” That is not a country that any of us want to live in.

The legacy of this pandemic must be to transform services and support so that every older and disabled person can live the life they choose. It is politically controversial and my strong advice to the Government would be to bring forward proposals early on, because the closer we get to an election, the worse it will be. The Labour party was accused of a death tax; the Conservatives have been accused of a dementia tax. In the end, it is not us who suffer. It is the people who use services and their families.

We need a long-term settlement for older and disabled people that pools our resources and shares our risks and has a fair balance of funding across the generations. That is surely within our grasp. I know Opposition Members will continue to do everything they can to secure a better future for all.

[Derek Twigg (in the Chair)]

I remind the Minister to leave a few minutes at the end for Helen Hayes to wind up.

World Social Work Day

Derek Twigg Excerpts

Thursday 18th March 2021 Westminster Hall

[Derek Twigg (in the Chair)]

I remind hon. Members that there have been some changes to normal practice in order to support the new hybrid arrangements. Timings of debates have been amended to allow technical arrangements to be made for the next debate. There will be suspensions between each debate. I remind Members participating physically and virtually that they must arrive for the start of debates in Westminster Hall or, in this case, in the Boothroyd Room. Members are expected to remain for the entire debate. I must also remind Members participating virtually that they are visible at all times, both to each other and to us in the Boothroyd Room. If Members attending virtually have any technical problems, they should email the Westminster Hall Clerks’ email address. Members attending physically should clean their spaces before they use them and before they leave the room.

Future of Health and Care

Derek Twigg Excerpts

Thursday 11th February 2021 Commons Chamber

[Matt Hancock]

With an ask like that, it is hard to say anything other than yes, enthusiastically. I am keen to work with my hon. Friend, who is such an incredible voice for the Isle of Wight. The services on the Isle of Wight, by its island nature, are more closely aligned together than in many other parts of the country, but nevertheless suffer from some of the bureaucratic silo requirements in current legislation. I hope that these proposals will be received enthusiastically by all those involved in the provision of health, social care and public health on the Isle of Wight because they will remove the legislative barriers to closer integration and allow them to continue in the direction in which I know they are enthusiastically working with my hon. Friend’s support.

[Derek Twigg (Halton) (Lab) [V]]

In the middle of a pandemic, when its implications for future healthcare are still not fully understood and when NHS staff are exhausted, with no respite on the horizon, there are real concerns that the Secretary of State is embarking on this reorganisation now. So how will these plans specifically address the lengthening backlog in cancer treatments in Halton and the north-west? How will replacing local decision making with large sub-regional health bodies allow greater local accountability and encourage local innovation?

[Matt Hancock]

The devolution of decision making to integrated care systems will help to join up care and deliver it more effectively. That is one reason why these proposals have been received so enthusiastically by the NHS itself and by NHS colleagues, including from local government, not least because the proposals originated from proposals from the NHS. I look forward to working with the hon. Gentleman and suggest that he works with his local NHS to make sure that this legislation goes through in the most high-quality way possible and that we have a high-quality debate on it, so that it can serve his constituents in exactly the way he sets out.

Covid-19 Update

Derek Twigg Excerpts

Monday 14th December 2020 Commons Chamber

[Matt Hancock]

I am thrilled at the number of former clinicians who have come back to support this. In fact, I met some of them when I went to Milton Keynes to see the vaccine being injected. I will look into the little whizzing box that is preventing my right hon. Friend’s constituent from applying.

[Derek Twigg (Halton) (Lab)]

As the Secretary of State knows, I asked back in April to have mass testing in Halton—better late than never. I decided to go down to the new mass testing centre at Ditton Community Centre in Widnes in my constituency this morning and have a test, which I am pleased to say was negative. It took 10 minutes, and I had the result back in 30 minutes. When does the Secretary of State expect the vulnerable and elderly to have had their second dose of the vaccine?

[Matt Hancock]

There has to be a 21-day window from the first vaccine dose to the second. We are aiming to send out invitations so that people can come as close to that 21-day marker as possible. Clinically, the 21 days is a minimum not a maximum, but the goal is clearly on or as close to the 21st day as possible.