NHS Charging Exemption: Ukrainian Residents

Edward Argar Excerpts

Thursday 17th March 2022 Written Statements

[The Minister for Health (Edward Argar)]

I want to update the House about further measures this Government are taking to step up their response to Russia’s invasion of Ukraine, which continues to see hundreds of thousands of people who ordinarily live in Ukraine forced to flee their homes and seek safety and support in other countries.

Today I want to announce new legislative measures in England to exempt Ukrainian residents from NHS charging so that they can access the NHS on broadly the same basis as someone who is ordinarily resident in the UK. We will apply these exemptions retrospectively from 24 February 2022 to further protect people.

Current overseas visitor NHS charging legislation requires us to recover NHS secondary care treatment costs from anyone who does not ordinarily live in the UK, unless an exemption applies to them. Primary care and A&E services and certain types of treatment—including for most infectious diseases—remain free to all, regardless of a person’s home

We have therefore now amended the charging regulations to allow everyone who is ordinarily resident in Ukraine, and their immediate family members, who are lawfully in the UK to access NHS care in England for free, including those who transfer here under official medevac routes.

This will cover all potential treatment needs, except for assisted conception services, to align with the existing exemption for those whose immigration health surcharge fees have been waived. Those who will benefit from this additional exemption include:

Anyone who uses an alternative temporary (less than six months) visa route outside of the family or sponsorship routes

Anyone who chooses to extend their visit or seasonal worker visa temporarily, without going through the IHS system

Anyone who is in the process of switching visas (which could take some time to process).

We have applied a six-month review clause to this policy and it is our hope that this will help not only to provide security and peace of mind for the NHS and those in need, but to remain open to further developments.

Ukrainian residents who are in the UK unlawfully are not covered by these measures but will remain within the scope of existing provisions within the charging regulations. This means that not only treatment needed immediately, but any treatment that cannot safely wait until the overseas visitor can be reasonably expected to leave the UK, must never be withheld or delayed, even when that overseas visitor has indicated that they cannot pay. Some NHS services will remain exempt from charge for all overseas visitors, such as primary care, A&E services and treatment of infectious diseases.

This Government continue to stand shoulder to shoulder with our Ukrainian friends and we are proud to continue to offer support for Ukrainian residents in our country.

[HCWS695]

Draft Food and Feed Safety (Miscellaneous Amendments and Transitional Provisions) Regulations 2022

Edward Argar Excerpts

Thursday 17th March 2022 General Committees

[The Minister for Health (Edward Argar)]

I beg to move,

That the Committee has considered the Draft Food and Feed Safety (Miscellaneous Amendments and Transitional Provisions) Regulations 2022.

It is a pleasure once again to serve under your chairmanship, Ms Rees. It is also a pleasure to serve opposite the shadow Minister, the hon. Member for Cambridge. Over a number of months, the hon. Member for Nottingham North (Alex Norris) and I regularly debated European Union-related statutory instruments in Committee, to the extent that we could almost finish off each other’s speeches by the end of it. I suspect the same was true for the hon. Member for Cambridge and the Minister for Farming, Fisheries and Food, my hon. Friend the Member for Banbury (Victoria Prentis), in a similar context. It is a pleasure to serve opposite him today.

This draft instrument, which concerns food and feed law, is made under powers in the Food Safety Act 1990 and the European Union (Withdrawal) Act 2018. It follows on from the 18 EU exit instruments on food and feed safety made during 2019 and 2020—probably many of them etched on the hon. Gentleman’s mind. The Government’s priority is, as always, to ensure that the high standard of food safety and consumer protection we enjoy in this country continues to be maintained now that the UK has left the European Union.

The draft instrument is technical in nature. None the less, I am sure that hon. Members will welcome a brief summary of the regulations and the changes that we are making. The measure serves three key functions. First, it will ensure that emergency powers can be applied equally to all food and feed entering Great Britain. Retained EU regulation 178/2002 on the general principles of food law provides Ministers with emergency powers to suspend or restrict the placing of food or feed on the market. That can be used where food or feed presents a threat to human health. Legal analysis of article 53 of that regulation identified that, as worded at present, it is not possible for a Minister to exercise those emergency powers over third-country food and feed entering Great Britain via Northern Ireland.

I emphasise that that operability issue is confined only to third-country goods entering Great Britain via Northern Ireland. Emergency powers to restrict third-country products that present a risk to health having access to the Northern Ireland market are already in place. To correct that identified issue, the draft regulations include a technical amendment that will enable all Ministers to apply, equally, the same emergency controls to all food and feed destined for our market, regardless of their place of origin or route of consignment. The amendment does not extend the remit or gravity of the controls that may be introduced, but will ensure that emergency controls are exercisable equally across all parts of the United Kingdom.

Secondly, the draft instrument ensures that authorising provisions for feed additives and for genetically modified food and feed authorisations will be made by legislation. Again, legal analysis of fixed and retained EU law identified that retained EU regulation 1831/2003 on feed additives and retained EU regulation 1829/2003 on GM food and feed contained a number of omissions. The regulations did not sufficiently make it clear that the authorisation decisions for those products must be prescribed in legislation. While that does not prevent Ministers from taking decisions to authorise those products, provision for those decisions to be implemented through legislation makes certain their enforceability in law and, of course, the role of this House. The proposed amendment therefore clarifies the fact that decisions on authorisations for feed additives and for genetically modified food and feed will be prescribed through legislation, thus ensuring consistency with other retained EU law in this area.

Thirdly and finally, the draft instrument provides a period of adjustment for changes to labelling requirements made necessary by EU exit legislation. In preparation for EU exit, changes were made to the legislation on extraction solvents and quick-frozen foods to reflect the fact that the UK would no longer be part of the EU. As a result, relevant food placed on the market on or after 1 January 2021 is required to be labelled with the name and UK address of the legal person responsible for it, rather than an EU contact and address.

The draft instrument provides for a period of adjustment in those sectors, allowing for the continued use of labels with an EU contact and address until 30 September this year. The adjustment applies to England only. The Food Standards Agency has worked with its counterparts in Wales and Scotland to ensure a co-ordinated approach, and similar measures are already in place in those Administrations. Through the hon. Member for Coatbridge, Chryston and Bellshill, I put on the record my gratitude to all the devolved Administrations for the constructive engagement that we have had with them on these matters. The regulations will support food businesses in England that source products from the EU, or from outside the EU, through an EU distributor. They are also in line with the approach being taken by Department for Environment, Food and Rural Affairs to labelling changes within its remit.

Let me make it clear that the SI does not introduce any changes that will impact on the day-to-day operation of food businesses; nor does it introduce any new regulatory burden. The essence of the legislation is unchanged, but it provides benefit for certain businesses by enabling a period of grace in the introduction of the labelling changes.

To the point that I just made to the hon. Member for Coatbridge, Chryston and Bellshill, it is important to note that Scotland and Wales have provided their consent for the SI. The Northern Ireland Department of Health has been briefed on the amendments, and we have engaged positively with the DAs. I welcome their engagement on that and the constructive relationships that officials of the Scottish Government and others have with my officials and officials in DEFRA.

I want to take the opportunity to reassure hon. Members that the overarching aim of the regulations is to provide continuity for business and to ensure that high standards of safety and quality for food and feed regulation continue across the UK. As I said, the changes do not affect the essence of existing legislation. They are simply technical in nature and ensure that emergency provisions that allow for controls on food or feed identified as presenting a serious risk to health may be applied equally to any goods destined for the market. They will ensure that appropriate legislative provision is in place to enable decisions taken to authorise feed additives and GM food or feed to be enacted through legislation. Finally, they will provide for a smooth transition through the transition period, to allow businesses to adjust to the new labelling requirements.

Having effective and functional law in this area is key to ensuring that the high standards of food safety and consumer protection that we enjoy in this country are maintained in the immediate and longer term. I therefore ask hon. Members to support the SI before us.

--- Later in debate ---

[Edward Argar]

I will be brief, but will endeavour to respond to the shadow Minister and to the SNP spokesman, the hon. Member for Coatbridge, Chryston and Bellshill.

If I may, I will turn first to the SNP spokesman’s comments and then come to the shadow Minister’s comments. At the risk of creating a challenge for us in respect of GM—I know that that issue attracts considerable attention across the House—I say, with slight hesitancy, that of course it is open to the hon. Member for Coatbridge, Chryston and Bellshill to choose it for an Opposition day debate. I am sure that the relevant Minister would be delighted to respond. That is obviously a matter for the hon. Gentleman and his party, but there are and will continue to be opportunities in the House for an issue of that public interest to be debated.

More broadly, the hon. Gentleman made the point about the relationship between the devolved Administrations and the UK Government. I have worked throughout the pandemic and through the Brexit period, leading on a number of issues in the relationship with the Scottish Government and others, and I am certainly grateful for the constructive approach. There will be times when we have political differences of opinion. That is in the nature of a democracy and of the stances that we are all elected to espouse. But I certainly have found the relationship to be constructive and open, particularly in the context of the current legislation on health that we are putting through, and I look forward to continuing that open and constructive relationship, at both official and ministerial level, on issues such as this and more broadly.

Turning to the shadow Minister’s comments, I am, as ever, grateful both for his support and for his tone and his reasonable questions. I am always happy to give credit where it is due, and quite rightly he highlighted the creation of the FSA under a Labour Government. That is a matter of fact, and I am certainly happy to give him, on behalf of his party, the credit for that achievement and for what he did there.

The hon. Gentleman highlighted the paragraphs in the explanatory memorandum that set out the Northern Ireland protocol, and the impacts on how the current system or the previous, EU-led system works and how that will transition. I, perhaps like him, always ensure that I read through explanatory memorandums before taking part in a delegated legislation debate. Indeed, I make a point, when it is in my policy area, of actually reading them, given that it is my signature as a Minister on the bottom of them. In this case, it is the signature of the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Erewash (Maggie Throup), who sadly is not able to be here today, but I know that she takes the same approach. I will take this opportunity, if I may, to thank all the exceptionally talented and hard-working officials who have worked on this statutory instrument, got it to this stage and done the due diligence to ensure that we can have this debate and that we have the right materials to make it an informed debate. I am always grateful for the work of incredibly talented officials, who serve not just me as the Minister but this country, whoever is in government.

We continue to maintain the high standards of food and feed safety that the hon. Member for Cambridge highlighted, as set out in the explanatory memorandum. He touched on paragraphs 7.7 and 7.9. I am not aware of any practical events that have been a cause; I think that this is about tidying up and making the legislation fit for purpose. I am not aware of any specific ones. However, should I be informed that I am incorrect, I will of course write to the hon. Gentleman to correct what I have said. But I am not aware of any. The hon. Gentleman asked what procedure would be used. It would be the negative procedure for delegated legislation, in respect of that.

On labelling and the timescale, I hear what the hon. Gentleman says, both about the challenges faced by the sector overall—in recent months, we have seen that manifesting itself in a variety of ways—and about the challenges, potentially challenges we do not yet fully know, coming out of the international situation. But I believe that the labelling deadline, the grace period till September 2022, provides a proportionate and reasonable amount of time to enable industry to adapt. I am very conscious, through my work on the Northern Ireland protocol in the context of medicines and medical devices, of the different lead times that industry needs, depending on the nature of what it has to do to its logistics networks, supply chains or compliance regimes, but in this context I believe that the six-month period is reasonable.

The hon. Gentleman mentioned that of course in 2018 we were in a very different place—I think that is something on which he and I would agree. We may disagree about what has happened since and whether it is for the best or not, but I cannot disagree with his statement of fact that 2018 was a very different place and certainly felt like it.

A common thread running through all the work that we are doing in this space is that we seek to make the relevant regulations and put in place the relevant compliance regime, to protect safety, to protect the consumer and to protect high standards, but, at the same time, to ensure that that is proportionate and does not place an undue burden on business. I believe that with these technical amendments and what they pertain to more broadly, we have struck an appropriate balance.

The hon. Gentleman mentioned the NFU. I suspect I share his view. I have a good relationship with my local branch of the NFU and I pay tribute to the work that it does and that nationally the NFU does to highlight issues relevant to our agriculture and food production industry in this country. We always carefully consider any representations that they or others in this space make.

Finally, the hon. Gentleman talked about the relationship with EFSA. We have no plans to deviate from the current relationship, and that relationship is broadly characterised by close collegiate working. We recognise the importance of data sharing and working in a co-ordinated and, as I said, collegiate way in this space.

As I said, these are technical amendments, but I hope that we have also had the opportunity to explore a little more widely some of what sits behind them. With that, I commend the regulations to the Committee.

Question put and agreed to.

Healthcare Professional Regulators' Emergency Registers

Edward Argar Excerpts

Wednesday 16th March 2022 Written Statements

[The Minister for Health (Edward Argar)]

In response to the covid-19 pandemic, to support the National Health Service and social care providers, the Government enabled some healthcare professional regulators to establish temporary emergency registers. The Nursing and Midwifery Council (NMC) and the Health and Care Professions Council (HCPC) maintain emergency registers using powers conferred to them under the Coronavirus Act (CVA) 2020; the General Medical Council (GMC) and the General Pharmaceutical Council (GPhC) maintain emergency registers using existing powers. The circumstances for justifying the continuation of these emergency registers are reducing as the impact of the pandemic reduces. I am today announcing our intention that the emergency registers will close on 30 September 2022. This will provide those healthcare professionals who are practising on the basis of emergency registration six months in which to take up full registration if they so wish. Prior to the closure of the emergency registers the Secretary of State for Health and Social Care (Sajid Javid) will notify the regulators that the emergency conditions no longer apply, and the registers will close.



Context



The NMC and the HCPC currently maintain emergency registers using powers conferred to them under the Coronavirus Act (CVA) 2020. Under section 89 of the CVA, the Act will automatically expire two years after coming into force. This means that, following expiry, the NMC and HCPC will no longer be able to add new registrants to their emergency registers, but those already registered will remain so until the register is subsequently closed. The GMC and the GPhC currently maintain emergency registers using powers they held prior to the pandemic.



The powers to set up emergency registers, both under the CVA s.2 and in the GMC and GPhC legislation, can only be exercised where the Secretary of State declares a state of emergency to exist.



To manage the closure of the emergency registers and mitigate any impact on the NHS workforce we are providing regulators, registrants and employers with six months’ notice of the closure of the registers, in order to facilitate transfers between emergency and permanent registers. At the end of this notice period the Secretary of State for Health and Social Care will notify the regulators that the circumstance required for emergency registration no longer apply. Once this notification is made the emergency registers will close and those professionals on the emergency register will be unable to continue to practice.

[HCWS686]

Multi-hospital NHS Trusts: Transportation

Edward Argar Excerpts

Wednesday 9th March 2022 Westminster Hall

[The Minister for Health (Edward Argar)]

It is a pleasure to serve under your chairmanship, Ms Nokes. I congratulate my hon. Friend the Member for Eastbourne (Caroline Ansell) on securing this important debate. As she alluded to, she has been a regular and persistent—albeit always courteous—campaigner for the NHS in her constituency, for her local hospital and, most importantly, for her constituents and their ability to access the services they need. I am aware of her long-standing interest in the issue. It is fair to say that her constituents are incredibly lucky to be represented by someone with such a passion for Eastbourne.

I join her in paying tribute to her hospital trust and everyone who works there, across the three sites, for what they have done, not just over the past two years in extraordinary circumstances, but what they do every day, year in, year out. I also join her in paying tribute to the Eastbourne Herald, of which I am maybe not as assiduous a reader as I should be. The latest story I read was about disco public lavatories. I have followed the important work undertaken by India Wentworth, since she joined the Herald in 2020, in campaigning on the issue and drawing to public attention the challenges faced by my hon. Friend’s constituents and others in Sussex.

It is rightly the responsibility of clinical commissioning groups—CCGs—or what will soon become integrated care boards and trusts, to plan for reconfigurations of NHS services. It is important that any such plan commands local legitimacy and confidence. I will respond to my hon. Friend’s questions. One was about consultation around reconfigurations, and how public transport and accessibility featured in that. All reconfigurations are subject to four Government tests. The first is strong public and patient engagement. To her point about the 2019 survey, I encourage her trust to continue engaging with that patient voice, including specifically around access. I will come on to access in a moment in the reconfiguration criteria.

Other tests are consistency with current and prospective need for patient choice: a clear clinical evidence base; and support for proposals from clinical commissioners. It is important to hear from as many local people as possible about the practical impacts and concerns. None of the decisions on reconfigurations is easy or straightforward. They are about balancing different needs and benefits. Rightly, in the different reconfigurations my hon. Friend alluded to—ophthalmology and cardiology —as we would expect in any reconfiguration, clinical needs and safety in achieving the best clinical outcome for patients are obviously paramount.

Achieving that sometimes comes with challenging changes to where people may access services, compared with where they previously did so. We would expect, among that consideration of benefits and challenges, patient transport, inequalities and equality of access to feature heavily. I expect my hon. Friend’s trust, in reaching decisions, will have given due weight to such considerations.

I am well aware of the geography of her constituency and that of her near neighbour, my hon. Friend the Member for Hastings and Rye (Sally-Ann Hart), having grown up on Romney Marsh and having late grandparents who lived in the Icklesham/Winchelsea area of my hon. Friend’s constituency. I know the area well, going across to Hastings and further to Bexhill and Eastbourne. I also know the horror which is the A259, on most days. I was going to say at rush hour, but it is not just at rush hour these days. My hon. Friend’s comments about congestion going up from 36% to 60%, certainly on that road, chime with me; and that is going back 20 to 25 years to when I was last regularly in that part of the world.

The challenges of getting between the three sites are considerable. My hon. Friend alluded to the bus routes. There are bus routes but she is right that, certainly in one case, a change must be made to make the connecting journey. A patient going into hospital wants to minimise the stresses and challenges faced in getting there and back.

My hon. Friend alluded to two specific reconfigurations. With regard to the ophthalmology reconfiguration, the travel analysis summary, included as part of the consultation documents, set out that proposals would affect outpatients and people who come to the Conquest Hospital, in the constituency of my hon. Friend the Member for Hastings and Rye, for procedures but do not stay overnight. That is around 27% of all ophthalmology patients who attend East Sussex Healthcare NHS Trust hospitals for treatment and care. The analysis indicates there will be an increase in travel time for around 21% of patients who would use public transport and for 8% of patients who might travel by car—their own car, taxi or similar.

Were the proposals to go ahead, some people would have a shorter journey and others a longer journey to their appointment. The longer journeys would cost more, but, as the trust pointed out to me, people would, hopefully, have fewer appointments overall, would therefore not have to go to the hospital as often, and would not incur cumulatively the cost for the extra appointments that were no longer required, so they should not pay too much more.

My hon. Friend set out the impact on people on low incomes—the 25% who have no car and for whom a taxi or private hire vehicle might be prohibitively expensive—and she gave a moving example in her remarks about the choices that some people might have to face. I expect the trust to consider that extremely carefully.

My hon. Friend touched on the shuttle bus service and gave an example of where it has worked well in providing a service that works for patients, and it has environmental benefits as well. I encourage her trust to continue looking at such options. If it is helpful to my hon. Friend, I will speak to NHS England’s south-east region to see whether it can convene a meeting to discuss that further with her and her trust to see what options might help fill the gap, even if what was initially put forward might be deemed impractical by the trust.

My hon. Friend focused on patients and the impact on them, but she talked about staff as well, and it is important that in considering services and transport services for people to get to, from and between hospital buildings in the same trust, we do not forget the impact on staff. Although I know that sunny Eastbourne, Hastings and Bexhill are wonderful places to live, work in and visit, I will not tempt my hon. Friend to talk about the challenges of the rail links between her constituency and London. Because of the location of the hospitals and trusts, there is still a degree of temptation or ability for highly qualified professionals to perhaps say, “I will have a longer commute and work in London”, or, “I will go and work in a big London teaching hospital”, so we need to do everything we can to make it attractive and easy for people to make the conscious choice to work in the local hospitals to make sure we have the workforce that we need.

My hon. Friend raised other issues. As well as thanking the team and her local paper, she has talked in the past about getting me down to Eastbourne to visit her local hospital—something I have agreed to—and I will see whether that might be possible during the Easter recess. I hope sunny Eastbourne will be sunny by the time we get to April.

[Sally-Ann Hart (Hastings and Rye) (Con)]

I am sure the Minister will join me in congratulating my hon. Friend the Member for Eastbourne (Caroline Ansell) on her well-presented and organised argument. Will the Minister also consider the community volunteering work that went on during the pandemic at HEART, for example, in Hastings? Perhaps a helping hand could be given there. It took patients to hospital and helped in that way, but sometimes these organisations need a bit more resourcing. Will he look at how we could maximise the potential of the community volunteer groups that have really grown throughout the pandemic to see how best we can utilise them in taking people to hospital for appointments?

[Edward Argar]

Before my hon. Friend’s intervention and although my private secretaries will wince at the logistics, I was about to offer to try to come down to Eastbourne, via Bexhill, and then go to see my hon. Friend in Hastings and visit the Conquest. I may then re-live the experiences of travelling along the A259 and possibly regret doing so. None the less, I will be happy to visit her at the same time. She mentioned, rightly, the hugely important role played throughout the pandemic—and in more normal times—by organisations of volunteers, charities and third-sector organisations to help with patient transport.

My hon. Friend mentioned HEART—I entirely endorse what she says about the value of such organisations. I encourage local authorities and NHS trusts to recognise that value and seek to work collaboratively with such organisations to enable them to continue doing that vital work. In same spirit, I am also an occasional reader of the Hastings and St Leonards Observer. I enjoy my local papers. I tend to find the news I get in local newspapers rather more interesting and accurate than some of what I read in national newspapers. Perhaps when we go down to visit her, we might talk to both local papers if that would be helpful.

My hon. Friend the Member for Eastbourne raised a number of points about the bus improvement strategy and the broader approach to improving public transport links in this country. My right hon. Friend the Member for North East Somerset (Mr Rees-Mogg) set out recently in the House that the Government are investing more than £5 billion in buses and cycling during the course of this Parliament. Local authorities have published bus improvement plans, which provide an assessment of existing services in the area, including details of current provision for rural and coastal communities. It is right that those plans are driven by local authorities, who know their areas best and have that local engagement. I encourage them to think broadly, about not just links between a town centre and other areas but the broader transport links that might exist in an area and how public transport can help enhance them, reflecting the patterns of travel that individuals have for particular purposes, be it work, going to a hospital appointment or otherwise.

We recognise that for those unable to travel independently, NHS-funded patient transport services are essential. Those services are commissioned locally for eligible patients with a specific need for transport assistance to and from their care provider for planned appointments and treatment. Although most people can travel to treatment independently or with support from family and friends, as my hon. Friend set out, those services play a hugely important role for those whose medical condition, severe mobility constraint or financial circumstances make that challenging. They deliver around 11 million to 12 million patient journeys each year, covering around half a million miles each weekday.

In August 2021, NHS England and NHS Improvement published the outcome of a review into patient transport services. The review’s final report sets out a new national framework for the services, with the aim of ensuring that they are consistently responsive, fair and sustainable. The first component of the new national framework is a commitment to update the national guidance on eligibility. That commitment responds to the concerns raised by patient groups and others during the review process that access to patient transport services is inconsistent between areas.

[Caroline Ansell]

One of the issues we have seen is reimbursement. It is a hugely bureaucratic process that also involves up-front costs for those who need to access that support. My concern remains that eligibility is still very narrow, yet there is significant movement across the piece, not least from maternity and paediatrics, where transport often involves taking little people. I hope that features in the review.

[Edward Argar]

My hon. Friend is right to highlight the breadth of people and groups who need to be included and reflected in that. We have consulted on the new national eligibility criteria. They have been developed through engagement with a wide range of stakeholders, including patient groups and charities, transport providers, healthcare providers and commissioners. On her question of when, we look forward to publishing them very shortly. If she wishes to make any last-minute representations to the team, she is welcome to write to me.

In the final few seconds I have left, I pay tribute once again to my hon. Friend the Member for Eastbourne for securing this debate and to my hon. Friend the Member for Hastings and Rye for speaking in it, and for their work in this place as such vocal champions of their local communities.

Question put and agreed to.

Draft Human Medicines (Coronavirus and Influenza) (Amendment) Regulations 2022 Draft Human Medicines (Amendments Relating to the Early Access to Medicines Scheme) Regulations 2022

Edward Argar Excerpts

Tuesday 8th March 2022 General Committees

[The Minister for Health (Edward Argar)]

I beg to move,

That the Committee has considered the draft Human Medicines (Coronavirus and Influenza) (Amendment) Regulations 2022.

[The Chair]

With this it will be convenient to consider the draft Human Medicines (Amendments Relating to the Early Access to Medicines Scheme) Regulations 2022.

[Edward Argar]

It is a pleasure to serve under your chairmanship, Ms Rees. It is also a pleasure to be here today. It is right that we debate these important provisions.

I would like to take the opportunity, as we often do at the start of such sittings, to pay tribute to every individual who has been involved, in the UK and beyond, in the development and the roll-out of an unprecedented vaccination campaign, not just in this country, but around the world, from the people who have received their jabs, to the professionals and volunteers who have made this happen and those who have continued to keep our NHS running.

The purpose of the provisions in the draft Human Medicines (Coronavirus and Influenza) (Amendment) Regulations 2022, which, for convenience, I will refer to as the human medicines regulations, is to amend the temporary provisions that cease to have effect on 1 April 2022. The provisions support the continued deployment of safe and effective covid-19 and flu vaccinations at the pace and scale required both now and potentially in the future, while safeguarding patients and limiting disruption to other NHS services.

The SI amends provisions in the Human Medicines Regulations 2012—SI 2012/1916, originally amended by the Human Medicines (Coronavirus and Influenza) (Amendment) Regulations 2020—SI 2020/1125—and the Human Medicines (Coronavirus and Influenza) (Further Amendments) Regulations 2020—SI 2020/1594 —either to make permanent or to extend by a further two years those key regulatory flexibilities.

In summary, the regulations before us make three key provisions permanent. First, they enable injectable, prescription-only medicines, which include vaccines, to be given under a patient group direction commissioned by the NHS or a local authority. That effectively expands the workforce of available vaccinators. Secondly, they enable pharmacy-led covid and flu vaccination services to operate outside their normal registered premises, thereby enabling, for example, pop-up vaccination clinics to be run by pharmacists at convenient locations for patients. Thirdly, they add several additional groups of healthcare professionals to those who can administer vaccines under occupational health schemes, thereby expanding the workforce to vaccinate health and care staff. The final two provisions relate to a further temporary exemption of easements to licensing requirements for the end-stage preparations of vaccines prior to use and the sharing of vaccines between sites.

The mass vaccination roll-out on the scale and pace that has been possible to date would not continue to happen if the regulations are not approved, and the covid-19 and flu vaccination programmes would not be able to continue running as they currently do. Nor would they be able to be re-established at the pace and scale that has been so vital to our recent success. It is therefore crucial that I provide the rationale in support of these important provisions, which I hope will enable members of the Committee to support them.

It is true that we are debating the provisions from a completely different place than at the onset of the pandemic and since the key regulatory flexibilities were first made in late 2020. Where we are now is a place that we can all be proud of—the culmination of a national mission that has helped us to withstand the pandemic and restore more freedoms to people in this country. It is a reminder of what we can accomplish when we all work together and testament to the success of the biggest ever vaccination programme in the history of the NHS. The vaccines remain our best line of defence against the virus and to help us live with covid. That is the reason why it is vital to make some of these provisions permanent or to extend them for a further period.

As the Committee would expect, patient safety is at the heart of any public health vaccination programme, and is therefore at the forefront of the provisions in this statutory instrument. I firmly believe that the provisions to maintain an expanded workforce, able to lawfully administer covid-19 and flu vaccines under occupational health schemes, will ensure that we can continue to provide critical protections to health and care workers, while ensuring that vaccines continue to be administered by highly trained, qualified staff operating under rigorous professional standards.

Similarly, the provisions enabling injectable prescription-only medicines, which include vaccines, to be given under a patient group direction commissioned by the NHS or local authority have been critical to supporting widespread protection from covid-19 and flu among the general public. By making the provisions permanent, I strongly believe that we can ensure that public health benefits are maintained through the roll-out of covid-19 and flu vaccination, while striking the right balance of maintaining the rigorous standards of oversight for vaccines to be given safely and effectively.

The provisions to enable a pharmacist to offer vaccinations at sites other than their registered premises have already supported improved patient access for underserved communities. For example, faith leaders at a mosque in Blackburn in Lancashire worked in partnership with NHS Blackburn with Darwen clinical commissioning group and the local council to turn the mosque into a pop-up vaccination clinic. It was successfully able to target and support at-risk groups from all local communities who had potentially been hesitant to come forward for their vaccine. I pay tribute to the work that was done in that setting. Making those provisions permanent will enable that type of crucial activity to continue when and where it is needed.

The provisions relating to the temporary extension of wholesale dealer licences and end-stage vaccine preparation have already supported the swift and safe distribution of covid-19 and flu vaccines, and will continue to be critical to efficiently delivering any necessary future covid-19 and flu vaccination programmes, as well as reducing the wastage of vaccines. We have seen the success that those provisions have allowed. We are therefore prioritising the implementation of them to give health services the certainty that they need to be able to continue to plan and operate any necessary mass covid-19 and flu vaccination programmes on the same basis as now.

The emergence of the omicron variant and our critical ongoing booster campaign have further highlighted why those key regulatory flexibilities cannot be allowed to fall away on 1 April. Last month, the National Audit Office, in its report on the roll-out of the covid-19 vaccination programme in England, highlighted the balance between central command and control structures and wider empowerment locally, and that that was a success factor in achieving more than 139 million vaccinations in the 15 months since the programme began, 71% of which were administered by GPs and community pharmacies. That was against a planning assumption of 56% of vaccines delivered that way.

There can be no doubt that the provisions in the draft Human Medicines (Coronavirus and Influenza) (Amendment) Regulations are vital, as they have supported the safe delivery of the biggest programme of vaccination in our history and have proved their worth. That said, I know that there may be some concern among the public, and indeed in today’s Committee, that extending or making the provisions permanent might constitute mass vaccination forever by the back door. I appreciate those concerns, but I categorically put on the record for those who might seek to make mischief with such a suggestion that that is not the case. These are enabling provisions only. There is no requirement to use them, and they will not be used unless they are required; rather, they will be a vital addition to the toolkit for the NHS if mass vaccination campaigns against new variants of covid-19 or flu are necessary in the future.

Turning relatively briefly to the second instrument before the Committee, the Government want patients in the UK to be able to access the most effective and innovative medicines as quickly as possible. We have made real strides in recent years to achieve that, including the launch of the Medicines and Healthcare products Regulatory Agency’s innovative licensing and access pathway and reductions in the National Institute for Health and Care Excellence assessment timelines. The early access to medicines scheme is another key aspect of how we deliver on that agenda. The scheme helps to give people with life-threatening or seriously debilitating conditions early access to new medicines that do not yet have a marketing authorisation or licence but where there is a clear unmet medical need.

Since 2014, the scheme has transformed the lives of patients up and down the country. For example, through EAMS UK patients were among some of the first in the world to access the breakthrough treatment pembrolizumab, which I have hopefully pronounced correctly—I challenge my shadow, the hon. Member for Denton and Reddish, to attempt to do it rather more fluently and smoothly than me—with approximately 500 patients with advanced melanoma receiving that medicine when no other treatment was available to them.

Just one new product made available through the EAMS can benefit hundreds of patients. Putting the scheme on a statutory footing allows us to maximise the benefits it offers to patients, as well as to support the early development of medicines by innovative manufacturers in the UK.

The provisions deliver three key benefits. First, they reduce the regulatory burden on manufacturers supplying EAMS medicines, making it easier to supply and assemble EAMS medicines in the UK. Secondly, they will facilitate the collection of real-world data from EAMS to support patient access to novel treatments in the future. Thirdly, they will reaffirm in legislation the importance of patient safety within the scheme. As a package of changes, this will help more patients to benefit safely from EAMS products and ensure the UK remains internationally competitive in the pre-market medicines access landscape.

I am pleased to bring forward the first instruments using the powers under the Medicines and Medical Devices Act 2021, allowing us to use effective regulation to provide patients and the public with timely access to critical medicines and vaccines. The provisions in the instruments are important; they will be in force if mass vaccination campaigns against covid-19 and flu are necessary to protect the public and our freedoms and will also ensure that patients with serious conditions can be offered new, life-changing treatment options.

--- Later in debate ---

[Edward Argar]

I am grateful to both the shadow Minister and the SNP spokesperson for the tone and manner in which they have approached this. Often when our activities in this House are looked at from outside, what is seen is the disagreement across the Dispatch Box in the Chamber, but actually there are many things such as today’s instruments that are of importance to all our constituents, wherever they are in the UK, and there is a great degree of consensus. I am grateful for that, and it is a pleasure, as always, to serve opposite the hon. Member for Denton and Reddish.

Both hon. Members who spoke were right to highlight the collective effort that has been involved in the vaccination programme. We rightly pay tribute regularly to our health and care workers, but it is equally important that we pay tribute to those in central Government, the civil service, local authorities and local councils up and down the country, to volunteers and others who have given of their time and commitment to make this work, and of course to the great British public, who bore the restrictions under which they lived for two years, on and off, to a greater or lesser degree, with fortitude. They have done the right thing and got vaccinated in their millions, and it is right that we say thank you to them for that.

The shadow Minister rightly touched on a number of points. He talked about health inequalities in the context of vaccination. He is absolutely right, and we continue to focus very much on that issue in terms of driving further uptake of the vaccine. A range of different inequalities manifest themselves in this context. The example that I used of a mosque becoming a vaccination centre is, I think, a powerful one. That took place in similar settings up and down this country, in our towns, cities and rural communities. Using such venues to make it easier for people to engage with the vaccination programme is central. That is why the statutory instrument is so important.

Alongside that, we rightly continue to work with community leaders and others to inform and educate people about the reality of the vaccine and its potential to save lives and prevent serious illness, to try to counter some of the dangerous misinformation that can often be found on the internet or elsewhere, and to encourage people to take up the vaccine if they have not already done so. I reassure the SNP spokesperson—though I do not know that he needs reassurance—that we have engaged fully with the devolved Administrations, including the Scottish Government, who have been extremely helpful and supportive in what we are seeking to do here. Through him, I pass on my gratitude to the Government in Scotland.

The shadow Minister rightly highlighted the success of the EAMS programme and what it has achieved, and the example of a medicine being available four months earlier than it otherwise would be, and just what a difference that can make. It is literally the difference between life and death in many circumstances, so it is hugely important. I share his view of the 2016 review. We have made progress today, and will do subsequently, but there is still more to do on the review, and we continue to look at how we can build on it. He talked specifically about the gap that could occur between the EAMS programme and an MA being granted. It is an important point, because if someone is undertaking a course of the medicine or needs to start it, returning to our earlier discussion about timeliness being important, any delay—be it one month or two—can be a real challenge. I commit that we will look at that, in the context of the other 2016 review recommendations that we need to reflect on to see whether we can go further.

I agree with the shadow Minister entirely that it is vital that we do not let up in our vaccination efforts, because the vaccine has been our route out of this highly dangerous pandemic. Nor must we take our foot off the gas in respect of promoting and enabling access to cutting-edge research and treatments for patients in this country—all of our constituents, should they need it. I believe that the two sets of draft regulations before us help to enable us to achieve that goal, and I commend them to the Committee.

Question put and agreed to.

draft Human Medicines (Amendment Relating to the Early Access to Medicines Scheme) Regulations 2022

Resolved,

That the Committee has considered the draft Human Medicines (Amendment Relating to the Early Access to Medicines Scheme) Regulations 2022.—(Edward Argar.)

Oral Answers to Questions

Edward Argar Excerpts

Tuesday 1st March 2022 Commons Chamber

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

6. What steps he is taking to help ensure high standards of performance and efficiency for managers in the NHS.

[The Minister for Health (Edward Argar)]

The NHS is recognised as one of the most efficient health services in the world. Between 2010 and 2018, productivity in the NHS grew faster than in the wider economy. However, there is always room to do more. My right hon. Friend the Secretary of State has commissioned a review led by Dame Linda Pollard and General Sir Gordon Messenger to explore health and social care leadership and management, including the drivers of performance and efficiency, and they will report back later this year.

[Mr Sheerman]

We have learned today that innocent children are being killed in Ukraine. I could not get the Ukrainian colours, but I am wearing my UNICEF tie.

We have brilliant nurses, doctors and support staff, but too often the management of hospitals is not as good as it should be to support them. The Topol review should be kept alive, but we should also make sure that the training of managers is of the utmost importance. A recent survey of the world’s best hospitals had only one British hospital in the top 100: Guy’s and St Thomas’s. Does the Minister agree that this is not good enough?

[Edward Argar]

Possibly at some risk to my political prospects, I find myself in agreement with the hon. Gentleman on the importance of good and effective leadership. Of course I join him in his remarks about Ukraine.

I highlight that 84% of our NHS workforce are either clinically trained or are directly providing clinical support to clinicians, but it is also important that we recognise the importance and value of the administrators and managers who support the team. That is why we need the best people in those roles, and it is why my right hon. Friend the Secretary of State has commissioned the review led by two extremely eminent people. We are determined to continue driving up the quality and standards of management in the NHS.

[Esther McVey (Tatton) (Con)]

7. If he will make an estimate of the percentage of (a) doctors and (b) nurses being paid locum rates in the latest week for which figures are available.

[The Minister for Health (Edward Argar)]

In NHS hospital trusts to date in 2021-22, there have been on average 14,826 full-time-equivalent agency nurses and 4,621 medical and dental FTE agency staff. It is hard to draw direct percentage comparisons given different methodologies for measuring such percentages, but my understanding is that overall about 3% of nursing shifts and about 1.5% of doctors’ shifts in hospitals are filled by locums or agency staff.

[Esther McVey]

Can we get greater clarity on that information and have it held centrally, given that wages are such a large proportion of the NHS budget? It is essential to know how many hours are paid at the higher locum rate to ensure value for money for the extra billions of pounds that the Government are putting into the NHS to get waiting lists down and for social care.

[Edward Argar]

I am grateful to my right hon. Friend, who is tireless in her determination to ensure value for money for her and all of our taxpayers’ pounds, particularly in this space. We continue to work hard to drive down agency and locum spend, focusing instead on both bank staff and our full-time recruitment, on which the Secretary of State has set out the success that we have been having. Since 2015, we have controlled agency spend through price caps and procurement frameworks. However, she is absolutely right, and we want to see more full-time NHS employed staff working at NHS rates in our trusts.

[Peter Dowd (Bootle) (Lab)]

9. Whether his Department is taking steps to help improve health outcomes through the implementation of public-private partnerships.

[The Minister for Health (Edward Argar)]

Throughout the pandemic, partnerships between the public and private sectors have been vital in securing the resources to protect public health. As one element of that partnership, independent sector providers, for example, delivered almost 7 million episodes of care for NHS patients between April 2020 and December 2021 according to hospital episode statistics data. We continue to support the partnership approach more broadly as part of our plans both to tackle the backlog of elective care and to improve broader health outcomes.

[Peter Dowd]

I thank the Minister for that response. As he is aware, the national diet and nutrition survey has shown that average intakes of dietary fibre in the United Kingdom are well below recommended levels and less than a quarter of those of countries such as Denmark, where the Government work across industry on a public-private partnership basis to boost wholegrain intakes. What consideration has the Minister given to implementing such an initiative in the United Kingdom to provide a much-needed boost in fibre intakes among the public?

[Edward Argar]

The hon. Gentleman makes a typically sensible and reasonable point. Government advice on a healthy balanced diet is encapsulated in the UK’s national food model, the “Eatwell Guide”. It includes advice on incorporating fibre into the diet through fruit and vegetables, bread, rice and pasta. We set nutritional standards for catering in all Government Departments and related organisations to improve the nutritional content of food served, including increasing fibre. I agree that it would be helpful to increase intakes of fibre in our diet, guided appropriately by clinical and medical advice, and a key element of achieving that is working with industry.

--- Later in debate ---

[Mr Philip Hollobone (Kettering) (Con)]

19. If he will ensure that the NHS new hospital programme team complete approval processes by summer 2022 to allow the preparation of the full business case for the redevelopment of Kettering General Hospital by the local NHS trust.

[The Minister for Health (Edward Argar)]

The joint DHSC and NHSE/I—NHS England and NHS Improvement —programme team is working closely with all schemes in the programme, including Kettering, on how and when new hospitals will be built across the decade. That is to maximise the potential benefits that the programme’s approach can bring for all the new hospitals. We will continue to support all trusts in the programme, including Kettering, to ensure that there is the swift approval of all business cases—including, in this case, for early enabling works—but that will always be in line with due process to ensure that there is value for money, as my hon. Friend would expect.

[Mr Hollobone]

I thank the hospitals Minister very much for his visit to Kettering General Hospital on 17 February. Specifically, can we have feedback from the new hospital team on the strategic outline case for the hospital by the end of April, so that the hospital can submit its outline business case for the next stage in July?

[Edward Argar]

It was a pleasure to visit my hon. Friend’s constituency. He is a forceful advocate for that constituency and for his hospital, as indeed—if I may slightly crave your indulgence, Mr Speaker—was the late Sir David Amess. Today is the day that Southend-on-Sea officially becomes a city, so I just wanted to shoehorn that into the record. On my hon. Friend’s point, we will do everything we can to expedite the approval of business cases while ensuring that due process is followed to make sure that there is value for money.

--- Later in debate ---

[Selaine Saxby (North Devon) (Con)]

T6. Devon’s community hospitals and minor injury units, such as the Tyrrell in Ilfracombe, have been unable to open fully for some time. Would my hon. Friend consider extra help where it is needed to enable them to reopen, because although adding extra capacity is welcome, using what we have effectively is surely essential?

[The Minister for Health (Edward Argar)]

I am grateful to my hon. Friend for her question. The minor injuries units at Ilfracombe and Bideford have been temporarily closed since March 2020 due to the pandemic, to allow skilled staff to be redeployed to the emergency department at North Devon District Hospital to meet clinical needs. The Northern Devon Healthcare NHS Trust continues to work with the local CCG to ensure planning for safe staffing levels for the temporary reconfiguration and for permanent solutions. Were anything to be made permanent, it would of course have to go through the local authority health overview and scrutiny committee. No such referral has been made, and this remains temporary.

[Jessica Morden (Newport East) (Lab)]

T2. Happy St David’s day, Mr Speaker. Physician associates in my constituency, who play a vital role in the NHS, want to hear from the Government when long-awaited regulations that will allow them to take on more responsibility and play an even greater role in our NHS will come forward. Can the Secretary of State update the House and will he meet me and constituents to discuss this?

--- Later in debate ---

[Greg Smith (Buckingham) (Con)]

I am grateful to the Minister for Health for giving his time over recent months to hear the case for an exciting and innovative new health centre for the village of Long Crendon in my constituency, as proposed by the parish council and action group. Will he update the House on where we are with finding funding to help the construction of the project?

[Edward Argar]

My hon. Friend is, as ever, persistent and tenacious in his advocacy of Long Crendon’s surgery plans; not only at the Dispatch Box but whenever he runs into me around this place, it is often the first thing on his lips. I will continue to work with him on the surgery bid and I encourage him to continue to work with his local NHS systems.

[Dame Diana Johnson (Kingston upon Hull North) (Lab)]

Will the Secretary of State meet me as chair of the all-party parliamentary group on sexual and reproductive health in the UK? Can I bring along the Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives, the Royal College of General Practitioners, the Royal Pharmaceutical Society and the Faculty of Sexual and Reproductive Healthcare to explain why the decision to remove telemedicine is wrong for women in this country?

Healthcare Payments to the EEA and Switzerland

Edward Argar Excerpts

Tuesday 22nd February 2022 Written Statements

[The Minister for Health (Edward Argar)]

First Annual Report on International Healthcare Payments under the Healthcare (European Economic Area and Switzerland Arrangements) Act 2019

I have today laid before Parliament the first annual report on international healthcare payments pursuant to section 6 of the Healthcare (European Economic Area and Switzerland Arrangements) Act 2019.

The 2019 Act was enacted as a result of the UK’s decision to leave the EU. It provided the legislative means to respond to a wide range of possible outcomes of the UK’s exit from the EU in relation to reciprocal healthcare, including the implementation of new reciprocal healthcare agreements with a European economic area (EEA) state, Switzerland or an international organisation.

The 2019 Act implements the social security co-ordination protocol to the UK-EU trade and co-operation agreement. That agreement ensures UK residents continue to benefit from reciprocal healthcare arrangements, including covering necessary healthcare when travelling to Europe (previously known as the EHIC scheme, now the GHIC scheme). Planned healthcare arrangements have also continued after EU exit (known as the S2 scheme); and eligible pensioners, frontier workers and certain other groups can have their healthcare costs covered when they move to the EU (known as S1 scheme). Under the 2019 Act, the UK has also implemented the various separation agreements with the European economic area and Switzerland.

Building on the successful continuation of EU reciprocal healthcare agreements, the Government now wish to negotiate further agreements with other states to bring greater benefits for UK nationals. The Health and Care Bill includes amendments to the 2019 Act which will enable us to implement comprehensive healthcare agreements with countries outside the EEA and Switzerland.

This report covers payments made under the powers conferred by the 2019 Act between the end of the transition period on 31 December 2020 and 31 March 2021. During this period only one payment was made under the 2019 Act payment powers for discretionary planned treatment. Other payments made to the EEA and Switzerland during this period were for healthcare incurred prior to the end of the transition period. These payments are reimbursable as a matter of EU law and not therefore paid pursuant to the 2019 Act. Member states are now in the process of submitting claims which have been paid under the 2019 Act, details of which will be provided in the second report which will be published after the end of March 2022.

[HCWS619]

Ambulance Services in England

Edward Argar Excerpts

Thursday 10th February 2022 Commons Chamber

[The Minister for Health (Edward Argar)]

Reflecting the rest of the week, Mr Deputy Speaker.

I am grateful to the hon. Member for Ellesmere Port and Neston (Justin Madders) for securing this important debate. In the same spirit, this is rather nice; it is like déjà vu: he used to shadow me at that Dispatch Box and in Committee. It is a pleasure to respond to his debate on this occasion.

However, I must say that responding to the hon. Gentleman is a pleasure slightly tempered by caution on my part, because I know the depths of his expertise on this subject after his many years shadowing the Minister for Health—I think he shadowed my predecessors as well. He has great depth of knowledge in this space. He is and has been a notable advocate for our ambulance service and what it needs, and he looks forensically into those issues. I also know that he is a diligent reader of The BMJ, the Health Service Journal and various other excellent trade and specialist publications. It is a genuine pleasure to respond to him on this extremely important issue. It is a shame that the way in which the House allocates debates means that this is the last debate of the day, so there are few Members in the Chamber for it, because it is important. However, those we have in the Chamber are quality, and I look both at the shadow Minister—sorry, the former shadow Minister—and the hon. Member for City of Chester (Christian Matheson).

As the hon. Member for Ellesmere Port and Neston highlighted, ambulance services have faced extraordinary pressures during the pandemic. I am sure that the House will join me and the shadow Minister—the former shadow Minister; by force of habit, I keep calling him the shadow Minister. The hon. Gentleman and I have not always agreed, but we have been as one in paying tribute to all those who work in our ambulance services up and down the country. They have done an amazing job over the past two years, during the pandemic, to the very best of their ability. Of course, they do that amazing job day in, day out; irrespective of pandemics, they always do everything they can to support those who need them.

The hon. Gentleman rightly highlights that the pandemic has placed significant demands on the service. In January 2022, it answered more than 800,000 calls. That is an increase of 11% on January 2020 and is one of the factors placing significant pressures on ambulance services, the wider NHS and the A&E departments to which they will take people when they feel that there is a clinical need. Although 999 calls tend to highlight the demand related to more serious medical conditions, many ambulance services are also responsible for 111 calls, which, in December last year, saw an increase of 15.5% compared with December 2019.

I use those statistics to illustrate the demand pressures, but I understand that behind those numbers, in every case, lies a human story—someone in need of care, someone worried and anxious, with friends and family anxious for them—so before I seek to go into the reasons, statistics and our plans and support, I want to say that I am sorry for patients who have suffered the impact of those service pressures. I want to be very clear that patients should expect and receive the highest standards of service and care.

The hon. Gentleman highlighted some specific examples, including the case of Bina Patel. He is right that the right hon. Member for Ashton-under-Lyne (Angela Rayner) has raised that with me. I have asked for full information because I want to get back to her with as full an answer as I can, and I hope that he can convey that to her, if he speaks to her before I do. I am fully aware of her correspondence raising this on behalf of the family.

Let me turn to ambulance response times and the reasons sitting behind some of the pressures. The ambulance service is facing a range of challenges that are impacting on its performance. The hon. Gentleman will be familiar with many of them, including the impact, still, of infection prevention and control measures not only in the ambulance service but particularly in A&E departments and wider acute clinical settings. Higher instances of delays in the handover of ambulance patients into A&E as a result of some of those factors, which I will turn to, are therefore leading to ambulances waiting for longer in queues and not being as swiftly out and about on the road and able to respond to calls. So there are knock-on effects there.

One of the key challenges, which the hon. Gentleman will be very familiar with, remains the question of flow through an A&E and through a hospital. I am referring to the flow of patients out of ambulances into the A&E, who are then able to be treated in the A&E and discharged, hopefully, or who are then, in some cases, able to be admitted to a bed in a hospital ward. To do that, we have to see discharges continue of patients who no longer meet the criteria to reside because they have recovered sufficiently, and the national discharge taskforce has done a huge amount of work on addressing that challenge.

In recent months, we have seen the combined pressures of winter—the hon. Gentleman and I are familiar with those on an annual basis—and the impact of the omicron variant on the number of hospitalisations, which have not been as high as many feared and predicted, thankfully, but which have still had a significant impact on hospital beds. The combination of those factors, coupled with a high level of workforce sickness absence rates, including through positive covid tests—particularly over recent months with omicron—has created pressures that we would not expect to be systemic or built into the system. That partly reflects longer term pressures, and I will move on to what we are doing to address those, but a large element of it is down to the specific circumstances of the past winter.

The hon. Gentleman touched on the support in place to improve services, and asked what we are going to do about it, and what is being done to address these issues. He is true to form from when he shadowed me, as he will always set out the challenge and ask me what I am going to do or am doing about it, rightly holding the Government to account. Because of the pressures I mentioned we have put in place strong support to improve ambulance response times, including a £55 million investment in staffing capacity to manage winter pressures to the end of March. All trusts are receiving part of that funding, which will increase call handling and operational response capacity, boosting staff numbers by around 700.

NHS England has strengthened its health and wellbeing support for ambulance trusts, recognising the pressure of the job on those working in the ambulance services, with £1.75 million being invested to support the wellbeing of frontline ambulance staff during the current pressures. NHS England and Improvement is undertaking targeted support for the most challenged hospitals, to improve their patient handover processes, helping ambulances to get swiftly back out on the road. That is focused on the most challenged hospital sites where delays are predominantly concentrated, with the 29 acute trusts operating those sites being responsible for more than 60% of the 60 million-plus handover delays nationally. That is targeted support for trusts that have particular challenges, either from the current situation or where there are underlying issues that we need to resolve.

There is capital investment of £4.4 million to keep an additional 154 ambulances on the road this winter, and a £75 million investment in NHS 111 to boost staff numbers by just over 1,000, boosting call taking and clinical advice capacity that will better help patients at home, and better help triage those who genuinely need an ambulance and those who can be treated safely in a different context. There is continuous central monitoring and support for ambulance trusts from NHS England’s national ambulance co-ordination centre, and we have also made significant long-term investments in the ambulance workforce. The number of NHS ambulance staff and support staff has increased by 38% since July 2010.

More broadly, alongside the ambitious plan set out by the Government earlier this week, showing how we will invest the significant additional resources in outcomes for patients, just over a year ago we invested £450 million in A and E departments, to help mitigate the impact through increased capacity of infection prevention and control measures. I have regular direct meetings about discharge rates, and what we can do further to improve the flow of patients through hospital trusts within NHS England, with members of the taskforce on that.

I am pleased to reassure the hon. Gentleman that those measures have had an impact, and we are seeing improvements in response times from the peak of the pressures in December. Performance data for January, published today, shows significant improvement against all response time categories. Performance for category 1 calls—the most serious calls, classified as life-threatening—has largely been maintained at around nine minutes on average over the past several months, and improved to eight minutes and 31 seconds in the latest figures. That is despite a 19% increase in the number of incidents in that category compared with December 2019. Average responses to category 2 calls improved by more than 15 minutes compared with December, and the 90th centile responses to category 3 calls by more than two hours.

We recognise that that is welcome progress, as I am sure the hon. Gentleman would agree, but there is much further to go to recover fully from the pandemic’s impact on response times and to sustain that improvement. We welcome the service’s hard work and dedication and pay tribute to it for making those changes and delivering the significant improvements on which I am updating the hon. Gentleman.

[Justin Madders]

As always, the Minister is being courteous and comprehensive in his response. Will he comment on the concern expressed earlier about patients being told, when visited by the service, that they needed to go to hospital but should find their own way there? That is extremely worrying, and we should be clear that it is not what we expect to happen.

[Edward Argar]

I am grateful to the hon. Gentleman—I keep feeling tempted to say shadow Minister; he is a shadow Minister but he is no longer my shadow—for that point. He is right that when people ring 999 they should be given the appropriate clinical advice on whether they need to go to hospital, and if they do, an ambulance should be sent. I suspect that in individual cases a call handler may have made a tough clinical decision about the fastest way to get someone to hospital given the availability of ambulances, but the hon. Gentleman is right that if someone rings 999 and their condition is clinically deemed to require an ambulance and swift transfer to hospital, they should be able to expect an ambulance to come, assist them and take them to hospital.

At a time when the NHS is facing unprecedented demand, ambulance services are absorbing some of the increase in pressure. They are treating more people over the phone and finding other ways to reduce pressure in a clinically safe way. With clinical support in control rooms, the ambulance service is closing around 11% of 999 calls with clinical advice over the phone. That is far more than the 6.5% achieved in January 2020 and saves valuable ambulance resources for response to genuinely more urgent clinical needs.

Let me say a little about North West Ambulance Service, if that is helpful to the hon. Gentleman—I know that he and the hon. Member for City of Chester take a close interest in their local ambulance service. Our support and investment has benefited the North West Ambulance Service. The hon. Member for Ellesmere Port and Neston’s local trust received £6.2 million of funding, which it has used to increase its workforce for operational and contact centre teams. The trust is also engaged with regional NHS England and Improvement and commissioning teams to develop a six-point winter plan that seeks to address six key areas throughout the winter period. As it starts to get a little warmer and the daffodils start to come out, it is tempting for people to think that winter has passed, but winter pressures in the NHS can continue into late February and occasionally a bit beyond. I wanted to add that caveat.

Three systems-led initiatives focus on the reduction of hospital handover times, the improvement of pathways for patients with mental health presentations and ensuring that alternatives to emergency departments—including access to primary care and other non-emergency-department pathways—are available to North West Ambulance Service in a timely and responsive manner.

Hospital handover delays continue to challenge the North West Ambulance Service footprint. Through its Every Minute Matters collaboration, which began three years ago, the trust has been working with other hospital trusts on improvements by working with senior leadership teams in hospital trusts to ensure there is a shared understanding of the risks of handover delays and a lack of ambulance resources to respond to patients in the community, to revisit action cards for operational commanders and, crucially, to recognise and thank staff for their continued reporting of delays and willingness to highlight problems to their managers or to the trust.

The trust’s strategic winter plan has been activated and includes details of the measures in place to handle winter pressures and mitigate the effects of increased demand and a loss of capacity. The plan is comprehensive and covers a wide range of topics and details on the preparation for various scenarios. It includes several continuous improvement initiatives for support during the winter period.

In summary, North West Ambulance Service is increasing its double-crewed ambulance capacity in line with winter funding arrangements, reducing conveyance to emergency departments and reducing the number of lost operational hours caused by day-to-day operational challenges. The trust has already seen significant improvements in the number of patients managed effectively through telephone advice, which helps free up ambulances to be deployed to where they are most needed. The trust has recruited additional paramedics and emergency medical technicians and upskilled its ambulance care assistants to blue light driving standard, thereby enabling the trust to deploy 269 additional frontline staff by the end of December.

I close by reiterating the Government’s commitment to support the ambulance service. We retain regular contact with ambulance services, trusts and those delivering on the frontline to help to ensure that patients and the ambulance service receive the care and support that they need. I am grateful to the hon. Member for Ellesmere Port and Neston for bringing this matter to the House.

Question put and agreed to.

Dementia Research in the UK

Edward Argar Excerpts

Thursday 10th February 2022 Commons Chamber

[The Minister for Health (Edward Argar)]

In response to one of the points made by the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), I would not take away from the hon. Member for Ellesmere Port and Neston (Justin Madders), who has the Adjournment debate, the honour of having the last debate before the House rises. The shadow Minister is absolutely right about the importance of the subject we are debating, and I am grateful to him, as always, for his tone and what he has said. I find myself in agreement with him perhaps more often than is good for my promotion prospects; that is one for the Whips not to note in their book.

I thank the hon. Member for Oldham East and Saddleworth (Debbie Abrahams) for securing this hugely important debate. Before I was a Minister, I had the privilege of working with her and the all-party group as one of her co-chairs. I pay tribute to her for her work and her dedication to this issue, which is one of the most important that we will debate in this House, and to the work of the all-party group and the various charities that engage with it so diligently and give so much of their time.

I hope the hon. Lady will find it encouraging that even though this policy area falls within the ministerial portfolio of my hon. Friend the Minister for Care and Mental Health—I am, therefore, taking this debate on her behalf—I still read the reports and calls for evidence that the all-party group puts out. I will turn to the dementia moonshot in a moment, but I particularly remember the report from, I think, September last year with its overall recommendation and seven subsequent recommendations. I hope it reassures the hon. Lady to know that I continue to follow very closely the important work that she and the all-party group do. I hope that she will pass on to the all-party group, and the Members of this House who serve on it, my gratitude for their work.

The hon. Member for Denton and Reddish, and indeed all hon. Members who have spoken, have highlighted in different ways either personal or constituency experience, or the work of organisations in their constituencies. As a Minister, I do not often get the opportunity to pay tribute to particular organisations in my constituency, unless I can somehow work them into debates that I am responding to. I join Members in highlighting a number of them, including the memory café, which I have visited, in Syston in my constituency. I had the privilege of visiting, pre pandemic, the Cedar Mews care home, which specialises in providing care for people with dementia, and working with local Dementia UK members in their campaign to raise the funding to secure an Admiral nurse to help people with dementia and their families in Leicestershire. We are all very familiar with Macmillan nurses, and it is important that we take this opportunity to pay tribute to the work of Admiral nurses in this context and raise their profile.

The hon. Lady will know that, like my right hon. and gallant Friend the Member for Beckenham (Bob Stewart), I am a dementia friend from my days on the all-party group. I encourage all hon. and right hon. Members who have not engaged with that process to do so. It involves undertaking an incredibly thought-provoking and valuable session, which will make hon. and right hon. Members look at these issues in a different light, however well informed they think they are. I commend that programme.

This debate on dementia research is very timely, since the Government are currently developing their new dementia strategy, as has been mentioned. The new strategy will set out our plans for dementia for future years, and it includes our ambitions for dementia research. We are working closely with patients, researchers, funders and charities to develop these plans, and we look forward to setting out—I think the shadow Minister and other hon. and right hon. Members called for this—a bold approach to the challenges of dementia.

The central recommendation in the APPG report on dementia—it has been mentioned by a number of hon. and right hon. Members—was for the Government to deliver on the election manifesto pledge on dementia research, but I know that they entirely understand the impact of the pandemic. The SNP Government in Scotland, for perfectly good reasons, have had to break their pledge to deliver a fourth dementia strategy from 2020, following their highly successful third dementia strategy because they were unable to consult and develop their plans and had to prioritise dealing with the pandemic. For exactly the same reasons, the pandemic has had the same impact on the UK Government’s focus and on the funding, which we had to put into covid over that period.

I will turn to the manifesto pledge in a minute, but I know—I may get the pronunciation wrong—that the hon. Member for Coatbridge, Chryston and Bellshill (Steven Bonnar) is a reasonable and sensible gentleman. My comments may not do him any favours with his Whips, but I know he will appreciate the impact that dealing with the pandemic had on the ability of the UK Government, and indeed the devolved Administrations, to implement their ambitious plans at the time they wanted to. However, that does not take away from the commitment of both the UK Government and the Scottish Government, now that the pandemic has receded, to get on with delivering what I know we all want to see, and I think that is a shared ambition.

I can reassure the House that we remain absolutely committed to supporting research into dementia. The funding pledge that the hon. Member for Denton and Reddish highlighted in his remarks was in the 2019 manifesto, but of course we still have some time in this Parliament to run—I believe—and it is a longer-term pledge. There is still an opportunity to deliver on that and the Government still recognise the importance of that commitment. I will turn to funding in a moment and pick up the point made by my hon. Friend the Member for Bexhill and Battle (Huw Merriman).

The impact of the pandemic has been significant, and of course people with dementia, and their families and carers, have been very hard hit by its effects and by the necessary measures to combat it. I do not think anyone could have put it more effectively and more movingly than the hon. Member for Ochil and South Perthshire (John Nicolson) who, in order to help our understanding, shared with the House—I know it will have been difficult—and therefore with the country, his experiences and those of his mother Marion. I pay huge tribute to him for his courage and bravery in talking about something that I know will still be very painful. From what he and Madam Deputy Speaker, the right hon. Member for Epping Forest (Dame Eleanor Laing), said at the time, I know how close he was to his mother. Sadly, I never met Marion, but I get the impression that she was a wonderful and amazing lady. I pay tribute to him for his courage.

[John Nicolson]

Thank you.

[Edward Argar]

The hon. Gentleman is absolutely right, and I think he speaks for thousands across this country who will have had a similar experience during the course of the pandemic. We must never forget every one of the people lost during this pandemic, whatever medical reason caused that, and we must never forget the families and carers of those with dementia.

As we have heard from hon. and right hon. Members—the hon. Member for Oldham East and Saddleworth talked about her mother, as did the hon. Member for Ealing Central and Acton (Dr Huq), who is no longer in her place—the challenge and the impact of dementia are huge. Dementia is a heartbreaking condition that, sadly, impacts many of us, or will do, either directly or through family and friends. More than 850,000 people in the UK have dementia, and they are supported by a similar number of carers, many of whom are older people themselves, and we must never forget the debt we owe to each and every one of them. Of course, in a sense they do not see it as our owing them a debt. They do it out of love for their relatives and their friends, and that possibly even adds to the gratitude that we as a country should show them in recognition of what they do.

Hon. Members have mentioned the Office for National Statistics data on deaths due to dementia and Alzheimer’s disease in 2019, and the hon. Member for Oldham East and Saddleworth made a very important point. In common parlance and commentary, people talk about Alzheimer’s as dementia and dementia as a single disease, but she is right to talk about dementia as an overarching term for a variety of diseases. I will return to education and awareness-raising. ONS statistics show that in 2019 deaths attributed to dementia decreased for the first time since 2009, but they remained the leading cause of death, accounting for 12.5% of all registered deaths in that year.

On the point that I was making to the hon. Lady, there are three key elements that we as a society and as a country need to look at. First, we need to raise people’s awareness and understanding of dementia. We want to have a society in which we all think and feel differently about dementia; one where there is less fear, stigma and discrimination and more understanding. While many thousands of people have dementia, we must not see it as an inevitable part of ageing. I will return to that.

In the past 20 to 30 years, we have seen a breaking down of the taboo and unwillingness to speak about cancer, for example. As a society and as individuals, we talk much more in our national and individual discourse about cancer and what we can do to help prevent it, to treat it, and to make people feel less alone when they have a cancer diagnosis. We have made progress on dementia, but we still have a long way to go to raise that awareness and have that national debate. All hon. Members play a huge role in stimulating that debate, and today’s debate has helped to do that.

To return to the heart of the matter, perhaps one reason why people do not engage with it or talk about it—they may feel frightened—is that although with cancer we know that there are diagnostic tests and that every day we are making new discoveries that help increase the opportunity to find a cure and treat it or so that people can live longer and well with it, we are not there yet with dementia. I suspect that there is an element of people thinking, “Well, if I get the answer and nothing really can be done, do I want to know?” The short answer is that it is always better to know, because that allows the person to plan and have those conversations. Through knowing, they can also help advance that research. However, I understand the entirely human reaction of people thinking, “Maybe I’d prefer not to know.” We need to continue that conversation.

The second hugely important aspect is support and care for people with dementia and for those who care for them. While we seek to improve prevention and diagnosis as well as seeking that cure, we need to ensure that those living with dementia and those who are supporting them feel that they in turn are supported. We are determined to support those living with dementia to live the fullest possible life for as long as possible and to support those who care for them.

Alongside that, the third element—in a sense, this is the crux of some of the speeches and the debate—is research into testing and diagnosis. While it is not often the case, I think that hon. Members in the Chamber are as one in seeking one goal: the day we find a cure for dementia—or, at the very least, something that can delay it or treat it.

While we wait for that day, it is important to recognise the point made about prevention by the hon. Member for Nottingham South (Lilian Greenwood). There is much that we do know about how people can help reduce their risk of dementia through lifestyle factors and a range of other things. They may not be exclusive, but there is an opportunity for people to take simple steps that help prevent or reduce the risk of getting dementia. We need to do more to spread that message and raise awareness of that in our society. I am grateful to her for making that point, because we want to reduce the number of preventable dementia cases.

I will return to other points subsequently, but let me turn to research and the moonshot that has been mentioned. The new dementia strategy will set out our plans to tackle dementia over the coming years. I try not to be partisan, so I pay tribute to the Scottish Government’s 2017 to 2020 dementia care strategy—I think it was their third—as well as the two related workforce programmes and a range of other measures. We can always learn from each other and best practice in different parts of our Union, and we should certainly be willing to do that in a space such as this. The hon. Member for Central Ayrshire (Dr Whitford) has kindly invited me to Edinburgh to see a range of things that she wishes to showcase to me. I hope that I will be able to take her up on that offer and also see my opposite number in Scotland, Secretary Humza Yousaf.

Hon. Members raised a question about the devolved Administrations and working together. I think the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier), who is no longer in her place, mentioned the joint dementia research work. We are working with the Alzheimer’s Society, Alzheimer’s Research UK and Alzheimer Scotland. We are jointly funding that work to ensure that, notwithstanding other contexts in this House where we may have debates about our Union, we are genuinely working together to deliver a positive outcome.

Increasing research spend takes time. I hope that hon. Members will recognise the impact that the past two years have had on the spending prioritisation, as we have had to focus to meet the immediacy of the covid situation. However, we have committed to invest at least £375 million in neurodegenerative disease research over the next five years. To the point made by the hon. Member for Denton and Reddish, we are working across Government to finalise outcomes from the spending review and to identify ways to significantly boost research on dementia.

With that in mind, I turn to my hon. Friend the Member for Bexhill and Battle, who says that in this context, I will always have a friend in him. I always find that I do have a friend in him; I have known him for a long time. Without straying into territory more properly reserved to the Chief Secretary and the Chancellor, let me say that there is a joint ambition across Government to continue to drive this agenda forward. Knowing my hon. Friend as I do, and watching his work as Chair of the Transport Committee, I suspect that he will not hold back in expressing his views on matters such as this, about which he is passionate.

The £5 billion investment in health-related research and development announced in the 2021 spending review reflects the Government’s broader commitment to support research into the most pressing health challenges of our time, including dementia. A number of specific points have been raised by the APPG and other Members. I will touch on as many as I can in the time available, but seek to leave five minutes for the hon. Member for Oldham East and Saddleworth, because I suspect she will want to come back on some of these points, given her work.

I turn to prevention, including what the Office for Health Improvement and Disparities will do to help reduce people’s risk of developing dementia. The APPG report recommended that the new Office for Health Improvement and Disparities launch public information campaigns on dementia risk reduction. OHID is involved in the development of the new dementia strategy, which will include proposals on prevention and risk reduction. The concept of brain health as part of encouraging people to reduce their dementia risk—going to the point made by the hon. Member for Nottingham South—is being actively explored. OHID has been working with the Alzheimer’s Society and Alzheimer’s Research UK to review public facing materials aimed at raising public awareness of dementia risk reduction.

I should take this opportunity—I fear I omitted to do so in my opening remarks—to pay tribute to Alzheimer’s Research UK, Dementia UK, the Alzheimer’s Society and the myriad local charities and groups that are working so hard to drive forward this agenda, and to support people with dementia and their families, as well as the research space. I add my tribute to that of the hon. Member for Denton and Reddish to the Greater Manchester research centre. Sadly it does not fall within my portfolio, but he and I might be dextrous in finding a reason within my portfolio that allows me to go and visit it with him jointly, which we would both enjoy.

More than 15 million people aged between 40 and 74 are eligible for an NHS health check in England, and during such a check, individuals are made aware that exercise, healthy weight, healthy diet and reduced alcohol consumption help maintain a healthy brain, and we need to continue to emphasise that message and the support that is out there through those health checks. I think it was the hon. Member for Oldham East and Saddleworth who touched on early diagnosis—it is not just about focusing on research for a cure, but on diagnosis. Timely diagnosis of dementia, as with so many other diseases, plays a hugely important part in ensuring that a person with dementia can access the advice, information, care and support that can help them plan and to live well with the condition and remain independent for as long as possible.

Everyone with dementia should have meaningful care following diagnosis, including information on local services, access to relevant advice and support and what happens next. Carers should be made aware of and offered the opportunity for the respite and support they need. DHSC guidance is already available, titled “After diagnosis of dementia: what to expect from health and care services”. When we set out our dementia strategy, diagnosis will be a key element of that.

Medical research charities have come up in this context, too, because it is not just about the big institutions—small institutions, academic institutions and charities are all playing their part in this space. I agree with Members in the analogy they drew with the vaccines and what can be achieved and what was achieved when there is an imperative to do it. I find myself agreeing with the shadow Minister. When we put our minds to doing something as a society and a country, there are often no limits to what we can achieve, as we have seen. We must put the same focus on this issue.

We recognise that the pandemic has caused problems across the sector and that many charities are facing difficulties just as their services are needed most. Medical research charities are a vital part of our life sciences ecosystem, and they provide significant research funding and training. Importantly, they amplify the voices of patients and their families in that process. Officials at the Department have been closely liaising with the medical research charities to better understand the impact of the pandemic on them and to seek to identify how we can work together to support their research and them. In that context, just one example is that my Department, alongside the Department for Business, Energy and Industrial Strategy, has announced a £20 million support package to help support early career researchers funded by charities. That will protect that pipeline of talent coming through the research system, to which Members have referred.

We have a rich dementia research ecosystem and we need to continue to support it. Through the UK Dementia Research Institute, scientists have made huge leaps in understanding the mechanisms underlying disease progression, and researchers have developed potential new diagnostics and treatments. It is painstaking work. The hon. Lady will remember when the focus was very much on amyloids, and whether that would produce a route to that cure. Often with research it is one step forward, two steps back, two steps forward, one step back, so the sustainability of investment and focus is vital if we are to make the breakthrough that we all wish to see.

Dementias Platform UK has established technology-based networks to better understand how dementia starts and to support experimental medicine studies. As the APPG report recognises, in partnership with the Alzheimer’s Society and Alzheimer’s Research UK, people with dementia and their carers continue to be recruited via Join Dementia Research to take part in a range of important research.

Through our National Institute for Health Research, we are supporting high-quality studies on preventing dementia through interventions targeted at known risk factors, service provision, care and care technology. There are many examples, but to give one, the “Well-being and Health for People Living with Dementia”, or WHELD programme developed an intervention to improve wellbeing for people with dementia in care homes and to reduce unnecessary prescribing of anti-psychotic drugs. In the 2021 spending review, as I have alluded to, we announced that £5 billion investment in health-related research and development. That reflects our commitment to support research, including in dementia.

We have taken positive action over the past year, notwithstanding the pandemic, to lay the ground for further developments and further research. Within the National Institute for Health Research, we launched a new £9 million call inviting research proposals on the early detection of dementia using digital technology. We launched a £3.6 million research for social care call to address important social care questions relating to dementia. The hon. Member for Oldham East and Saddleworth has taken a close interest in that, both in her previous shadow ministerial role and on the all-party parliamentary group on dementia, and I think that the APPG has called for evidence on social care impacts. We launched a highlight notice on dementia that invites ambitious dementia research applications; it signals to the community that dementia is a priority area for the NIHR.

As we work across Government to finalise the outcomes of the spending review and look towards the spring, the House, the Government and the country need to retain a focus on this issue, which is one of the most testing challenges we face as a society. We are living longer, which is a great testament to advances in medical science and in its ability to fix our bodies and keep them going for longer. The ability to understand, repair and treat our brains has perhaps not moved forward at the same pace, so we are living longer with dementia. That is, in a sense, positive, but it presents challenges for society, and it is why we must retain a focus on dementia.

We need to continue to build on our successes in order to accelerate the progress on dementia research, but we cannot do that alone. We will continue to work on this across Government, and with charities and the research community. By and large, we share the objectives of the shadow Minister and his colleagues. We may disagree from time to time on how to get there, but I suspect that we have, and will retain, a common objective. Crucially, we must work with people with dementia and their families to bring forward our ambitious plans for our new dementia strategy.

It has been a great privilege and pleasure to wind up such an important debate, and to speak on a topic that is not in my ministerial portfolio, but in which I have taken such a close interest over the years. We owe it to our constituents and future generations to rise to meet the challenges of our ageing society and of dementia. We must redouble our efforts to do that; when we do, I believe that our society and our country will meet the challenge of dementia and find the cure that we all seek.

Integration White Paper

Edward Argar Excerpts

Wednesday 9th February 2022 Commons Chamber

[The Minister for Health (Edward Argar)]

With permission, I would like to make a statement on the integration White Paper.

The covid-19 pandemic has been a living example of the importance of working together as one. Whether it is the extraordinary success of the vaccination programme or the work to identify and protect the most vulnerable, we were at our best when we were working across traditional boundaries towards a common goal. We must learn the lessons of the pandemic and channel this spirit of collaboration.

Although huge progress has been made in bringing together our health and care services and local government, our system often remains fragmented and too often fails to deliver joined-up services that meet people’s needs. Thanks to incredible advances in health and care, people are enjoying longer life expectancies, but may be living with more complex needs for longer. Navigating a complex health and care system to meet those needs can be hard, especially when services are often funded, managed and delivered separately. People too often find that they are having to force services to work together, rather than experiencing a seamless, joined-up health and care journey.

If we are to succeed in our goals of levelling up our nation, we must keep working to make integrated health and care a reality across England. Today, we are publishing the integration White Paper, which shows how we will get there. It is the next step in our ambitious programme of reform, building on the Health and Care Bill and the social care reform White Paper, which this Government introduced to the House in December.

This White Paper has been shaped by the real-world experience of people, as well as by that of nurses, care workers and doctors on the frontline, drawing on some of the great examples of collaborative working we have seen, particularly during the pandemic. It will make health and care systems fit for the future, boost the health of local communities and make it easier to access health and care services. It is a plan with people and outcomes at its heart—no more endless form filling, no impenetrable processes and no more bureaucracy that sees too many people getting lost in the system and not receiving the care they need.

First, we will ensure strong leadership and accountability, which is critical to delivering integration. Local leaders have a unique relationship with the people they serve. Our plans will bring together local leaders to deliver on shared outcomes, all in the best interests of their local communities, and encourage local arrangements that provide clarity over health and care services in each area, including aligning and pooling budgets. This arrangement has already been successfully adopted in several local areas. We have suggested a model that meets these criteria, and we expect areas to develop appropriate arrangements by spring of next year. Local NHS and local authority leaders will be empowered to deliver against these outcomes, and will be accountable for delivery and performance against them. They will be supported by a new national leadership programme addressing the skills required to deliver effective system transformation and strong local collaboration.

Integration supports transparency, and joining up NHS and local authority data means that we can provide local people with better insights about how their area’s health and care services are performing. With access to more information, they will be more empowered to make decisions about where and how they access care. There will be a new single accountable person for delivery of a shared health and care plan at local level. In practice, that could mean an individual with a dual role across health and care or a single lead for a place-based arrangement.

Secondly, we will do more to join up care. At the moment, too many people are bounced around the system or have to tell their story multiple times to different professionals to get the care that they need, which is frustrating for people and frontline workers alike. There are so many opportunities here. Closer working between primary and secondary care can allow care that is closer to home, keeping people healthy and independent for longer, and closer working between mental health and social care services can reduce crisis admissions and improve the quality of life for those living with mental illness. The White Paper sets out how we will get there, using the power of data to give local leaders the information that they need to establish new, joined-up services to tackle the issues facing their communities.

Thirdly, we will make the best use of the huge advances in digital and data. We have seen throughout the pandemic how digital tools can empower people to look after their health and take greater control of their care—for instance, through the NHS app or remote monitoring technologies. Where several organisations are involved in one person’s care, there is a real opportunity to bring together data safely to create a seamless and joined-up experience. The White Paper reiterates our commitment to having shared records in place for all people by 2024, providing local people with a single, functional health and care record that everyone involved in care can access in a secure way. That will mean every professional having access to the key facts relating to a person’s condition, such as their diagnoses and medications. That will improve care, too, with professionals able to make care plans in full knowledge of the facts.

We have seen a rapid expansion of digital channels in primary and secondary care services in recent years, but there is plenty more that we can do. This year, one million people will be supported by digitally enabled care pathways in the comfort of their home. The White Paper sets out how we will open up even more ways for people to access health and adult social care services remotely. We will also support digital transformation by formally recognising the digital data and technology profession within the NHS “Agenda for Change”, and including basic digital, data and technology skills in the training of all health and care staff. Integrated care systems will be tasked with developing digital investment plans so that we can ensure that digital capability is strong right across the board. That means data flowing seamlessly across all care settings, with technology transforming care so that it is personalised to the patient.

Finally, the White Paper shows the part that the workforce can play. The health and care workforce is one of the biggest assets that we have, and we want to make it easier for people working in health and care to feel confident in how the system works together in the best interests of those they care for and to feel empowered to progress their careers across the health and care family. To drive that, integrated care systems will support joint health and care workforce planning. We will improve training and ongoing learning and development opportunities for staff. That means creating more opportunities for joint continuous development and joint roles across health and social care, increasing the number of clinical practice placements in adult social care for health undergraduates and exploring the introduction of an integrated skills passport to allow health and care staff to transfer their skills and knowledge between the NHS, public health and social care.

The White Paper represents a further step in our journey of reform, building on the foundation laid in the Health and Care Bill, looking ahead to a future of health and care in this country with people at its very heart. It paints a vivid picture of a health and care system with more personalised care and greater transparency and choice, where early intervention prevents the most serious diseases, using the power of integration to give people the right care, in the right place, at the right time.

[Karin Smyth (Bristol South) (Lab)]

I thank the Minister for advance sight of his statement, which I got about 30 minutes ago, but I confess that I read most of it some 30 years ago when I was developing joint services. After waiting an eternity for the Department of Health and Social Care White Paper, the Government are spoiling us with their third paper of the year. All these papers are necessary to try to remedy the disastrous Lansley Act—the Health and Social Care Act 2012.

We acknowledge that reversing that Act and the integration of health and social care, however it is defined, is extremely difficult, but this integration will not be delivered by the White Paper and it is certainly not well defined. It is not clear how this fits with the Health and Care Bill, which is currently in the Lords. Even the experts involved in the Committee and elsewhere are repeatedly tripping over crucial issues such as the relationship between integrated care boards, integrated care partnerships and integrated care systems. How do they work with health and wellbeing boards? Where is the clinical leadership? Where is the accountability to local people? I banged on a lot about accountability in the Bill Committee so I am glad that somebody was at least listening and that we seem to have a bit of progress, but where are the voices of local people who are increasingly being asked to pay more for less?

Like a house made of crepe paper, this gossamer-thin White Paper collapses with the faintest breeze of scrutiny. Let us be clear: it is not a plan, nor is it even a starting strategy. It is just a series of woolly claims about how things could be better, unsupported by any evidence or analysis of the resources and organisational and funding flow changes that will obviously be necessary. It could have been written at any time over the past 30 years. It contains little that is new and nothing to illustrate new thinking or new attitudes. It relies on the bogus assumption that because something may work for a while on a small scale, it will obviously work everywhere. It is not any kind of plan for integrated care that people will recognise; these are just aspirations about integrated systems.

There is little to explain how a joined-up system would be managed, how it would be accountable to the public, patients and service-users, how the funding will be allocated and shared or how performance would be assessed and weaknesses addressed. Nothing in the White Paper addresses the key issue of balancing what is locally determined against national standards and national entitlements.

Crucially, there is nothing to address the key barrier to integration—that social care and the NHS are in different empires with no level playing field. One is means-tested and one is not. One has national criteria for entitlement and one does not. The way in which they are governed and funded is totally different and they are kept going by two separate workforces with no aligned terms and conditions.

I welcome the announcement of a skills passport and we will certainly look at the detail of that. However, unless there is pooled funding on a major scale—out-of-hospital funding—there will be no system drivers to really improve integration. This White Paper is again about simply encouraging, but we have had 30 years of that.

The reality is that the White Paper is remarkable for what it does not do. It does not seem to help children and young people. It does not address the challenge of how to care for and support working-age adults with a disability. It does not really value or assist the informal workforce or carers.

Our NHS and care system is under enormous pressure after years of austerity funding made incalculably worse by the impact of the covid pandemic, but the challenges that it faces are manifest, from a legacy of a “hospital first” approach to a decades-long failure to share care records. That runs alongside chronic underfunding and devaluing of public health, huge gaps in the workforce and wholly inadequate social care provision, with more than 500,000 people waiting for assessment and hundreds of thousands more denied access to care of any kind because the barrier for access is far too high.

This is a will-o’-the-wisp White Paper: one minute it is there before us only to vanish at a glance. The truth is that there does not seem to be anything of note that cannot already be done. Fundamentally, what is the point of it? As things stand, the number of patients waiting for care will continue to rise for the next two years, and there is no plan—not even the ambition—to get waiting times and waiting lists down to the record lows seen under the last Labour Government.

Worse still, these proposals will see patients paying more in tax but waiting longer for care. The Government are blaming covid, but will the Minister tell us when the target for NHS patients in England to be treated within 18 weeks was last met? If he cannot remember, it was in fact in 2016, four years before the pandemic. It is clear from the announcement yesterday and here today—just as it is from the decade of Tory mismanagement that left the NHS ill-equipped to cope with covid—that the longer we give the Conservatives in office, the longer patients will wait. Their time really is up.

Today is not a serious endeavour; it is a greatest hits of soundbites and buzzwords, randomly assembled to make a decent press release and get an outing on the evening bulletins. It is a desperate desire to own the news cycle and calm Tory Back Benchers’ nerves. It really is disappointing and it is simply not good enough.

[Edward Argar]

It is a pleasure to see the shadow Minister in her place—she will know that I genuinely mean that, because she and I spent many happy days upstairs in Committee debating exactly these issues. This White Paper sets out clearly the next steps and builds on the strong foundations of integration that that legislation put forward, with the integrated care boards, integrated care providers and integrated care systems, which our deliberations in Committee and in this House demonstrated were clear, understandable and effective in providing locally based governance; bringing together at an ICB level NHS services within a locality, and within an ICP broader ranges of services, including housing providers and others. This has been bringing together the national health service we have with the localised delivery we all seek.

That is one of the key points of the White Paper: the next steps in how to deliver place-based solutions and allow the system to continue to evolve organically through that permissive approach that characterises the legislation we are putting through Parliament, rather than the prescriptive approach that the Labour party at times appears to prefer. The White Paper contains new thinking on new ways forward, drawing on not just the lessons of the pandemic but much longer-standing arrangements within localities, recognising best practice for integration between health and social care, and reflecting that organic development that occurs within a place as local leaders, local communities and those using the services work together to deliver services that work best for them.

The hon. Lady touched on how some of this might work in practice and talked about funding and budgets. We have made it clear—I used to use this when I was a local councillor—that section 75 of the National Health Service Act 2006, on the ability to pool budgets, has been effective, but it is time to go further and explore whether that remains the most effective vehicle by which that sharing of budgets can be undertaken, so it is right that we look at this.

The hon. Lady touched more broadly on social care and the NHS. I have to say to her that we announced our White Paper for social care last September. She mentioned the plethora of White Papers. We rightly recognise the different parts of the health and social care system and have clear plans for each of them. Those different White Papers together form a coherent whole, putting forward reform proposals that will make a difference for patients and others alike. I have to say to the Opposition that, much as they may gently chide us on this, in 13 years in government they had two Green Papers, one royal commission and one spending review priority, but still no reforms to improve social care provision in this country. This Government have seized the nettle and brought forward proposals that will genuinely move us forward.

Finally, on the hon. Lady’s points about yesterday’s announcement on NHS waiting lists, this Government have been transparent with the British people about the challenge ahead of us and about our plan to meet that challenge. Our approach, which combines ambition with realism, has been welcomed by stakeholders across the health and social care space. Ours is the party of the NHS. We are the party that has put the resources into that NHS, with £33.9 billion put into law at the start of 2020, and then record funding through the health and care levy, which the Labour party voted against.

[Jeremy Hunt (South West Surrey) (Con)]

As one in the long line of former Health Secretaries with scars on their back—to quote Sir Tony, if we are allowed to—from when they tried to integrate the health and care systems, I warmly welcome this White Paper. I think it is more than aspirations. But there are three central elements of the plumbing that we have to get right, and I want to ask the Minister, who I know is very committed to this, for his response.

First, previous attempts to have pooled budgets for vulnerable people have been bedevilled by the fact that the NHS has not wanted to pool its budgets with an underfunded social care system. The grant to local government is still not generous, to say the least. The Select Committee on Health and Social Care recommended an increase of £7 billion a year by the end of the Parliament, but it is actually going up by £2 billion a year. What will we do to overcome the resistance in the NHS to merging budgets with a social care system that is feeling very stretched?

Secondly, it is a very big step forward that everyone will have a single electronic health and care record by 2024, but my simple question is whether the public will be able to access the data. Patients are the best guarantors and defenders of their own health, so they should be able to access everything that professionals can see about them.

My third question is about having a single professional responsible for someone’s care. What is the role of GPs in that? For most members of the public, the central person responsible for their care is their GP. Is it not time to go back to the days when everyone had their own family doctor, instead of a different doctor every time they call the surgery? They might not see the same person every time, but there should be someone at the GP surgery who is responsible for their overall care, whether that is in the health system or the social care system.

[Edward Argar]

My right hon. Friend speaks with typical wisdom and common sense on these issues. I will briefly address each of his three points in turn.

On pooled and shared budgets, I have to say that I think section 75 of the National Health Service Act 2006 has worked well. When I was cabinet member for health and adult social care at my council—I had more hair then, and it was not grey—I also sat on a primary care trust board as a non-executive member. I had a senior director of that PCT on my management team; we forged a common purpose, recognising that there would be some areas in which NHS moneys were greater than those put in by the local authority and vice versa, but the shared goal was achievable only when we worked together. I think that there is genuinely something to build on, and the ICSs, ICBs and ICPs at the upper level will be the vehicle to move the process forward. When I was doing it, there was a degree of personal relationship moving it forward, rather than necessarily a systematised approach, but I genuinely think that there is a willingness and a recognition of the need for this.

On public access to electronic records, my right hon. Friend’s central point is absolutely right: it is important to recognise that such data is our data and individuals’ data. We must always be wary about doing something to someone, as opposed to in partnership with them. That principle will underpin our approach in this space.

Finally, my right hon. Friend referred to a single responsible professional—not a single point of contact, but someone who brings together an individual’s care. He is right to highlight the importance of general practitioners. May I put on record my gratitude to GPs not only for all their work over the past two years, and for all they do day in, day out, but for the wisdom and care that they bring to addressing their patients’ needs?

Since my right hon. Friend’s time as Secretary of State, there has been a continual drive to increase the number of doctors in our health service. Not all will become general practitioners, but we need to continue to make general practice accessible and to encourage people to choose it as an incredibly exciting and rewarding career. One of the key elements of making what he describes work is building up a body of general practitioners who are able to perform such tasks. I pay tribute to his work; we are continuing that work and building on his foundations. I am grateful for his questions and for his contributions.

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

I am grateful to the Minister for advance sight of his statement. I think it fair to say that England is late to the integration game; Scotland and Wales have been legislating and moving in that direction for 20 years. The Scottish Government are pushing forward plans for a national care service to ensure that social care is fit for the 21st century, and have developed the NHS Pharmacy First Scotland scheme to spread the burden of frontline care and make pharmacies the first port of call for patients when GP and hospital visits are not necessary.

What lessons have been learned from the devolved nations? Any new plan for the NHS will not change the reality of the challenges facing the NHS organisation across all four of our nations, including that of vacancies. While Scotland’s workforce has grown by 20% under the SNP, Brexit is still hampering our ability to recruit from EU nations. Will the Minister discuss loosening Brexit and immigration controls with his fellow Ministers to help alleviate that situation?

[Edward Argar]

I saw the hon. Gentleman’s final point coming. To his original point, we are always happy to speak to the devolved Administrations and learn from their ideas, just as I am sure they occasionally look to England to see what they can learn—that is part of being a member of this Union. I speak regularly to the hon. Member for Central Ayrshire (Dr Whitford), including about such matters. To his final point, all I would say is that since 2010 we have seen around 30,000 more doctors and 38,000 more nurses in the English NHS—I have highlighted the role that my right hon. Friend the Member for South West Surrey (Jeremy Hunt) played in that—so I think we are doing a pretty good job of continuing to grow the workforce. There is much more to do, but we have a plan and we are delivering on it.

[Lucy Allan (Telford) (Con)]

I welcome this ambitious and much-needed programme of reform. One of the greatest challenges is ensuring the accountability of NHS bodies to local people, and I wonder whether the Minister could say a bit more about how these plans will ensure that local NHS bodies are accountable to the local people they serve.

--- Later in debate ---

[Edward Argar]

These plans build on what we are proposing in our legislation. At the heart of the Bill are integrated care systems, which bring together at ICB level and ICP level the local authorities that are elected to represent their areas, local people—Healthwatch will have a key voice in this space—and of course the local NHS.

[Stephanie Peacock (Barnsley East) (Lab)]

The clinical commissioning group in Barnsley says that it is struggling with unprecedented capacity issues. With a record 6 million patients waiting for planned NHS treatment across the UK, can the Minister explain how we will tackle the crisis in waiting times through this White Paper?

[Edward Argar]

The hon. Lady will have seen yesterday the announcement and publication of our plan to tackle waiting lists caused by the covid pandemic, the investment that underpins that, the approach to the workforce and how we will bring those waiting lists down. This White Paper builds on that; they are complementary and work together. This is about looking to the future to improve how our systems work together, but we set out a clear and comprehensive plan yesterday to do exactly what she speaks of.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

I declare my interest as a doctor. I wonder what the practical consequences of this will be. Can I suggest to my hon. Friend, whom I admire greatly, that one of those practical consequences might be to end the awful business of people waiting for weeks and weeks in acute hospital beds for discharge to more appropriate settings in the community? It does them no good, it is massively expensive to the system, and it prevents them moving on to places that can better care for them and give them what they need while allowing the acute sector to do what it can do, which is to manage people who are acutely unwell. At the moment we have 10,000 people in the system waiting for discharge. That will not do, and I would be interested to know from my hon. Friend how these proposals will help.

[Edward Argar]

I am grateful to my right hon. Friend in this respect. Discharge of people from hospital safely, either into a care home setting or back to their own home with support, is vital not only for their own health outcomes but for the flow of patients through our acute hospitals to enable A&Es and other parts of the system to function effectively. Through the national discharge taskforce and through the work we have done throughout the pandemic, we are bringing together acute hospitals and local authorities, and we have made huge strides together within localities in improving this and learning lessons. This White Paper sets out a way in which they can be embedded to ensure that they continue to deliver long-lasting benefits.

[Daisy Cooper (St Albans) (LD)]

My constituent Lynn is a powerful and loving advocate for her husband Andy, but she is at her wits’ end because she has to repeat the same information time and time again to nurses, consultants, dementia specialists, carers and the Department for Work and Pensions. When will the White Paper make her life a little bit easier? Despite her frustrations, she knows that all those professionals are working incredibly hard, but there just are not enough of them. How can it be that the Minister has said in this statement that he wants integrated care systems to have a joint health and care workforce plan, but he is still refusing to put that commitment to a workforce strategy into the Health and Care Bill?

[Edward Argar]

I am grateful to the hon. Lady for her comments and for highlighting the situation Lynn and Andy find themselves in. What we seek to do, through what I said about care records, is exactly what she and I think they would wish to see, which is to reduce the number of unnecessary or duplicative interactions with the system.

She touches on workforce. I set out in my remarks earlier that since 2010, under this Government, there have been over 30,000 more doctors and 38,000 more nurses. In just the past year, we have seen a huge increase in the number of nurses—I think 11,000—and an increase of about 5,000 doctors. We continue to grow the workforce and we are already working to do so. My right hon. Friend the Member for South West Surrey (Jeremy Hunt), who is no longer in his place, set a lot of that in motion. We have also commissioned from Health Education England and NHS England, now that we have announced their merger, the long-term 10-year workforce strategy, which I look forward to with interest.

[Mr Philip Hollobone (Kettering) (Con)]

Kettering General Hospital and Northampton General Hospital have between them 1,100 beds, 300 of which are occupied mainly by elderly patients who have completed their medical treatment and await discharge either into a care home or a domiciliary care setting. Meanwhile, adult social care is provided by the two unitary authorities, which contract with over 80 different domiciliary care providers. Would the Minister welcome ambitious proposals from Northamptonshire along the lines of those already being pursued by Northumbria Healthcare NHS Foundation Trust, whereby the NHS itself provides domiciliary care? Unless we get those 300 patients into an appropriate setting out of hospital, our hospitals will for ever be clogged up.

[Edward Argar]

I am grateful to my hon. Friend, who quite rightly never misses an opportunity to pay tribute to his local hospital trust. As he knows, I am always happy—as is my hon. Friend the Minister for Care and Mental Health—to hear any ideas for innovation that may improve outcomes for patients and communities.

[Liz Twist (Blaydon) (Lab)]

As we have heard, councils and health service bodies have been taking the opportunity to work together in the absence of Government action. In Gateshead, we have a joint commissioning director for health and care, which has worked out very well. So things have been happening without the White Paper. The key to addressing integration is the workforce. With thousands of NHS vacancies and thousands of social care vacancies, we really need to address that issue. We need a comprehensive, detailed plan on restructuring the social care workforce to ensure it is recognised as much as the NHS workforce.

[Edward Argar]

I am grateful to the hon. Lady, although I am not entirely convinced on her point about the absence of Government action. Yes, co-operation has been happening organically from the ground up, but that has been encouraged and supported by Government action—including various pots of funding, for example relating to discharge during the pandemic—driving that activity and helping to foster that culture of co-operation. She highlights the importance of the workforce and the need for increasing numbers. That is a point I have already acknowledged. I have made clear that the Government have a plan and are already delivering increases in the workforce.

[Richard Fuller (North East Bedfordshire) (Con)]

I welcome the White Paper, not least because we have had to put through a very painful tax increase and want the Government to get on with things, but also because the Minister faces considerable challenges, including demoralising intransigence between competing bureaucracies, a hugely complex task of integrating information systems, and the need to rip up and replace the truly horrendous workforce planning system for change of pay and other conditions, as other Members have said. All those things are going to bog the Minister down, so will he do two things? First, will he set up a special taskforce to look at quick wins to start to deliver improvements? Secondly, reinforcing what my right hon. Friend the Member for South West Surrey (Jeremy Hunt), the Chair of the Health and Social Care Committee said, will the Minister agree to put control of, and full information about, patient records in the hands of patients, so that they can use effective choice?

[Edward Argar]

My hon. Friend is absolutely right. He is, I think, alluding to the fact that quite considerable inputs in the form of taxpayers’ money and resources go into the system. Members sometimes fall into the trap of talking about inputs as the ultimate result, whereas my hon. Friend quite rightly talks about outcomes for patients and ensuring that money is well spent and delivers reform and improved outcomes. That is exactly what this paper is determined to achieve.

On my hon. Friend’s final two points, I will certainly consider taskforces. We have used one on tackling delayed discharge, so I know their value. I also take his point about data, and underpinning that is something that underpins all our work: co-design and doing things with patients, not to them. We must recognise that it is their data and that they should have control of it.

[Margaret Greenwood (Wirral West) (Lab)]

The Minister talks about ICBs, but he knows full well that they are able, under his Bill, to delegate functions and budgets to private providers, which represents a clear Government privatisation agenda.

The Minister talks about transferring skills and knowledge across the NHS, public health and social care, but how will that work in practice? Will the NHS be running training courses for private sector care organisations? If so, why should the NHS hand over valuable intellectual property and spend time gifting it to big business? Will he explain what that will mean for NHS staff?

[Edward Argar]

We have had these debates before. The hon. Lady knows that the pace of privatisation was fastest under the last Labour Government, when the increase in spend on the private sector was much steeper. We have always been clear in our belief in the founding principles of our NHS, which is free at the point of need, but we have also been clear, as have every other Government since the foundation of the NHS, that there continues to be a role for voluntary sector organisations and private sector providers in that context.

On the hon. Lady’s final point, it is important, as in this White Paper, that we bring out the opportunity to help increase knowledge and share skills across the NHS, local authorities and the voluntary sector.

[James Sunderland (Bracknell) (Con)]

Given this excellent statement, it would be remiss of me not to thank the Minister publicly for the decision to retain the Frimley integrated care system, which was absolutely the right thing to do.

Will the Minister outline his plans for lessons from the best-performing ICSs to be shared across all ICSs, so that we can keep costs down and improve efficiency right across the network?

[Edward Argar]

My hon. Friend knows, by virtue of the outcome, the persuasive and compelling case made by him and other right hon. and hon. Members from both sides of the Chamber in respect of Frimley ICS and its boundaries. As so often in this place, my view is, “If you ain’t broke, don’t fix it,” and his ICS is doing a fantastic job and other ICSs can learn from its success. Mechanisms and organisations through which chairs of ICSs get together and share best practice already exist, but we will continue to examine whether that could be better systematised, so that best practice can be disseminated more widely.

[Rachel Hopkins (Luton South) (Lab)]

We have heard already how budgets can be pulled, how place leaders can be appointed and, importantly, how shared outcomes can be set between health and care through our health and wellbeing boards with local authorities. Will the Minister assure me that accountability of the single accountable person will come through democratic structures, such as health and wellbeing boards or local authorities, to ensure that that if the public are unhappy, they can change things by voting them out?

[Edward Argar]

The hon. Lady will know from the debates on the Health and Care Bill that we are moving forward with opportunities for local authorities to be engaged not just at partnership level, as some are already, but more directly with the NHS at the ICB level. Health and wellbeing boards will continue to be a hugely important part of that.

[Kerry McCarthy (Bristol East) (Lab)]

There is a lot of what, to me, seems to be rather mind-numbing jargon in the statement, but only one mention of nurses. Could the Minister tell me—ideally without the jargon—about the impact of the statement on the nursing profession?

[Edward Argar]

As I mentioned in my earlier answers, this White Paper needs to be taken in conjunction with what we announced yesterday in respect of waiting list recovery, the September social care White Paper and, more broadly, our approach to growing our nursing profession, through increasing the skills and numbers in that profession. We are already well on target for 50,000 more nurses in the profession.

This White Paper looks at the specific aspect of the integration of social care and health and permissive ways for local areas to come up with their most effective place-based arrangements, many of which are already in development. It is, quite rightly, not specific about any individual profession, nor do we believe it should be, because it is for local places to develop their own local plans to reflect their local needs.

[Madam Deputy Speaker]

I thank the Minister for his statement.