Oral Answers to Questions
Debate between Edward Argar and Wes Streeting(1 week, 1 day ago)
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Edward Argar (Melton and Syston) (Con)
The Prime Minister’s announcement yesterday of his elective recovery plan mirrored that of Sir Saijd Javid in 2022, but one aspect was different. Our plan explicitly recognised the importance of the workforce being in place to deliver the 9 million extra tests and interpret the results, and it set out proposals to increase that workforce further. What plans has the Secretary of State to boost the workforce in community diagnostic centres specifically, over and above the plans that he inherited from us, to ensure that his elective recovery plan is deliverable?
Wes Streeting
The shadow Secretary of State is right to say that we need staff in place to do the job. The additional funding announced by the Chancellor in the Budget is central to the delivery of this plan—I note that he opposes that funding, which is deeply regrettable—but we need to improve productivity as well. That is why the plan sets out steps to free up patient appointments that are unnecessary or of low clinical value, but, crucially, staff time in productivity gains is also important, so as well as making the most of the additional investment, we are making the most of delivering value for taxpayers’ money—
Edward Argar
On hospices, while the Secretary of State’s pre-Christmas hospice funding announcement was, of course, welcome, the vast bulk of it was in fact non-recurring capital funding, which cannot be used to help them cover the hiked employer national insurance tax on hospices’ most precious asset: their staff. What steps is he taking to ensure that they receive recurring revenue funding, to enable them to cover the additional costs?
Wes Streeting
The £100 million capital investment we set out before Christmas is the biggest boost to hospice funding in a generation, and it comes on top of the £26 million that we announced for the children and young people’s hospice grant. The right hon. Gentleman cannot welcome the investment and keep opposing the means of raising it. Would he cut services or raise other taxes? He has got to answer.
Health and Adult Social Care Reform
Debate between Edward Argar and Wes Streeting(1 week, 2 days ago)
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Edward Argar (Melton and Syston) (Con)
I am grateful to the Secretary of State for his typical courtesy in early sight of his statement, as well for his call last week. Indeed, it was earlier sight than I am used to because I was able to read most of it in the media before coming here, which was not unhelpful.
I echo the Secretary of State’s comments in thanking and paying tribute to NHS and social care staff up and down the country, including those in my university hospitals of Leicester NHS trust, GPs and, indeed, all those in Chorley hospital, Mr Speaker, for all they have done over the festive period. They work full-on day in, day out every day of the year, but they particularly feel the pressure over the festive period when they are not able to spend it with their families, so it is important that we across the Chamber share our recognition of that.
The Secretary of State set out clearly the challenges facing the system. We all know that clinical care, the NHS and social care must work well and as a whole for our health and care system to function, so it is right that his statement addresses both those issues. He also highlighted the challenges we face as an ageing society. We are all living longer, which is a good thing, but that brings challenges of care and more complex needs. Of course, that comes on top of the ongoing challenges of the legacy of the pandemic, which are still with us in many ways.
In his comments, the Secretary of State referred to previous reforms. He opted not to reflect another point in Lord Darzi’s report: his positive remarks about our 2022 reforms, which the Secretary of State knows I took through this House and which laid the foundations on which he is now able to build. Given the serious and cross-party work we have done certainly on social care, I highlight that the challenge is real, and we must address both challenges swiftly.
Before turning to the long term, I turn to the immediate and ask the Secretary of State a few questions about winter and the challenges the NHS is facing. We heard from the Minister before Christmas about the work being done for extra co-ordination and new data, but what extra capacity in beds specifically for the winter period has the Secretary of State put in place to help ease pressure? What additional capacity has he put into A&E? We always recognised that winter is challenging, and we always put in extra resource, support and capacity, so I would be grateful for an update.
I would be grateful for an update from the Secretary of State on the pressure being felt in respect of the “quad-demic” of various challenges faced by the sector. Also, how many critical incidents have trusts declared since 1 December? I would be grateful if he could update us on the pressures being felt and the response to them in the light of the winter weather. In my Melton and Syston constituency in Leicestershire and in many constituencies across the country, we have seen extensive flooding, which has had an impact on our ambulance services in particular.
Turning to reform and elective recovery, I want to support the Secretary of State where he is doing the right thing, and it is important that he is keen to pursue a bold and innovative agenda. It is in all our interests that he is bold, but I call for him to be more ambitious. Those are not words often spoken about him, and I suspect certainly not in No. 10, but I call for him to be bolder and to go further. That is because, as with so much from the Prime Minister with multiple relaunches of previous announcements, what we see here is yet another relaunch of a previous announcement. The difference is the former Secretary of State Sir Sajid Javid’s announcement from 2022 has been reheated and re-served up today. We delivered 160 community diagnostic centres with 9 million additional appointments, and we delivered 18 surgical hubs. How will the Secretary of State’s plan go beyond that? We worked with the independent sector to allow it to be used to help tackle backlogs. We improved technology and the kit available, with £6 billion of investment. The NHS app created during the pandemic was designed and redesigned by my right hon. Friend the Member for North East Cambridgeshire (Steve Barclay) and his team to allow for regular updates. Again, it is right that the Secretary of State is updating the app, but how is he radically changing what was already in place? I certainly already receive text updates—as, I suspect, do others—on treatments and appointments, so my challenge to the Secretary of State is this: what is he doing that is fundamentally different?
The key underpinning point in the former Secretary of State’s plan was on workforce, because none of this can be delivered without the staff to deliver and interpret tests. He set out his plan to grow the workforce, and we have record numbers of doctors and nurses, and increased medical school places. What is this Secretary of State’s plan to grow the workforce and deliver on his ambitions?
Turning to social care, the Secretary of State will know—because I have said it publicly—that I will work constructively with him and the commission. He is right to highlight the challenges that Governments of all complexions have faced, including a Royal Commission, two Green Papers and a comprehensive spending review that did not deliver under Tony Blair and Gordon Brown. Similarly, Theresa May’s reforms did not deliver. We proposed reforms that were due to come in this year, but the Chancellor scrapped them. I think it is important that we look to the future and at how we can work constructively on social care.
I say to the Secretary of State that we will enter into discussions with him and the commission in that spirit, but I challenge him on the pace of his ambitions. The sector is already under pressure, and that has been added to by the national insurance increases, which it does not yet know how it will pay. The real challenge for him is: why 2028? The sector is crying out for a faster pace—be bolder; be more ambitious—and we will work with him to deliver it. It takes a year-plus to deliver a diagnosis—we know the challenges. He has had 14 years in opposition; he should have a plan now.
We will call out the Secretary of State when he gets it wrong or simply re-announces what is already happening, but he is right in his approach to social care and finding a way forward, and we will work constructively for the good of patients and all our constituents. Many of them already feel let down by promises broken by the Labour party over just the past six months, so I ask him not to break this promise, and to work with us, across the House, to deliver the change that our constituents deserve and expect us to work on together to deliver.
Wes Streeting
It seems to be the Conservative line across the board now to say, “You’ve had 14 years in opposition, so why haven’t you sorted it all out in six months?” I say gently that the Conservatives had 14 years in government, and it will take longer than six months to clean up their mess. Honestly, their contributions to discussions in this House might have more credibility and a stronger landing zone if they at least acknowledged their part in the deep mess and malaise that they have created over the past 14 years.
None the less, on social care, I very sincerely and warmly welcome the Conservative party’s support for the independent commission. It is important, as a matter of principle, to try to establish in broad terms the level of consensus about what social care should look like and how it should be delivered to meet the needs of older and disabled people in the 21st century, with changing demography, changing challenges, changing pressures and a changing pace of technology, and about the balance of provision between the individual, the family and the state, and the balance of financial contributions for social care between the individual, the family and the state.
Of course, those issues will inevitably be contested across the party political divide from one election to the next, but just as we have had broad consensus on the national health service since 1948, just as we have had broad consensus on state education since Rab Butler’s reforms, and just as we have mostly had broad consensus for much of the past century on how public services should be delivered, so too should we try to establish the same consensus on social care. That is not to say that we should agree on everything, but we should agree on as much as possible, because whether it was Gordon Brown and Andy Burnham in 2010 or Theresa May in 2017, we can see the extent to which party political wrangling, rancour and sometimes opportunism has sunk well-meaning attempts to grasp the nettle of reform.
On the question of pace, I reassure people that in our first six months we have already legislated for fair pay agreements, delivered the biggest expansion of carer’s allowance since the 1970s, and immediately injected £86 million into the disabled facilities grant, with another £86 million to follow from April—£711 million in total over the next year—as well as the increased spending power for local government in the Budget and £880 million for social care specifically. With respect to the people who are saying, “Go faster”, I urge them to bear in mind that we have already done quite a lot in six months. We do not pretend that we have solved all the problems—we have not nearly solved all the problems—but that is not a bad start for a Government who are determined to show that we understand the pressures in social care today and are willing to deliver.
The Dilnot proposals were very good technical responses to a question that Andrew Dilnot was set by David Cameron, but we should reflect on why it was that every single Prime Minister since Lord Cameron, including Lord Cameron himself, did not implement those reforms. There has always been something else in health and social care that has been more pressing and urgent. I am sure that Baroness Casey will consider the Dilnot proposals alongside all the other challenges and potential solutions to the wider issues in social care, but we are determined to respond at pace. That is why the first phase of the Casey commission will report next year, setting out an action plan throughout this Parliament. I hope that we can achieve broad consensus on those actions too.
Turning to the winter situation, the right hon. Gentleman has asked what capacity there is. According to the latest figures, there are 1,300 more acute beds this year than last year. Of course, those figures flex up and down depending on pressures, but the pressures are enormous. The number of beds occupied by flu patients is much higher than this time last year—somewhere between three and four times higher. The number of adult beds closed due to norovirus has reduced in the latest figures, but it is still above last year, when 485 beds were closed—the latest figure is 666. On ambulance responses, we have seen many more call-outs this year. There has been a 3.8% increase in emergency admissions compared with the same period last year, with the highest November on record for A&E attendances. Ambulance response times are nowhere near where we would want them to be because of the enormity of the pressure, which is why I have been out on the frontline, including over the Christmas period. We are not just looking at what we can do to mitigate challenges this year; we are already beginning to plan for next year, because I want to see year-on-year continuous improvement in urgent and emergency care.
I now turn to the challenges on the reform plans we have proposed and set out today. Starting with the workforce, one of the reasons we have emphasised the importance of not just investment but reform is the need to free up the staff capacity that we already have in the NHS to best effect. That means dealing with the number of non-attendances by sending reminders to patients and giving them ease and convenience in rebooking. It is why we are getting rid of unnecessary, low-clinical-value out-patient appointments, with the consent of patients in every case. It is why we are asking general practitioners to do more to manage cases in the community with more advice and guidance, and funding them to do so, working with colleagues in secondary care to ease pressure on hospitals.
Today’s reform plan answers the challenge we have heard from people across the NHS: how do we tackle the elective backlog without doing so at the expense of general practice, urgent and emergency care, community care or social care? The truth is that this is a systemic challenge, and we will only be able to deal with the challenge in the elective backlog by also acting on urgent and emergency care, general practice, community care, and delayed discharges in social care. We are taking a system-wide approach to meeting this essential target.
A number of things are different from under the previous Government. For example, on the deal with those in the independent sector, giving them the stability and certainty of working with this Government gives them the confidence to open and invest in new capital estate and new kit, particularly in parts of the country that are relatively underserved by the independent sector. We have insisted they do that with their own staff and resources, and that they put their money where their mouth is in relation to training new staff to deal with some of those pressures. That is how we will ensure that we will not be taking Peter from the NHS hospital to treat Paul up the road at the independent hospital.
Finally—I am happy to take more questions on the detail of the plan—the shadow Secretary of State asked what is different from 2022? In fact, I think he asked me to commend my predecessor Sir Sajid Javid for his work in 2022. In the bipartisan spirit of the new year, let me commend the work that he and Sir Sajid Javid did in trying to undo Lord Lansley’s disastrous top-down reorganisation, and that was a very good thing to do. There will be a very big difference between this Government and our Conservative predecessors: real delivery, shorter waiting times and an NHS fit for the future.
Puberty-suppressing Hormones
Debate between Edward Argar and Wes Streeting(1 month ago)
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Edward Argar (Melton and Syston) (Con)
I thank the Secretary of State for advance sight of his statement, and for his courtesy in coming to the House to make an oral statement, which gives hon. Members the opportunity to ask him questions.
When the Secretary of State is wrong, we will challenge him robustly and hold him to account, but when he is right, we will support him. That is responsible opposition. In what he sets out today, he is right, and he has my support for what he is doing. Protecting children is one of the most important priorities that a Health Secretary can have. My predecessor, my right hon. Friend the Member for Louth and Horncastle (Victoria Atkins), worked tirelessly to do just that. She set out that it was her priority to protect children and young people from risks to their safety from the prescription of puberty blockers, given the lack of an evidence base. I welcome the Secretary of State’s continuing the work started under the previous Government, and I welcome his support at the time and all that he has done since, including in his statement on 4 September. I associate myself with the three principles that he enunciated when he opened his statement.
With increasing numbers of young people questioning their gender identity, NHS England, with the support of previous Conservative Health Secretaries Matt Hancock and Sir Sajid Javid, commissioned Dr Hilary Cass to examine the state of services for children questioning their gender. That historic review cut through the noise and ideology to lay bare the clear facts, so that we as policymakers can seek to make decisions based on evidence, safety and biological reality, and create a service that better serves the needs of children, as the Secretary of State set out. In the review, Dr Cass made it clear that not enough is known about the lifelong impacts of using puberty blockers on young minds and bodies to be sure that they are safe, and that the robust evidence base was simply not there. In March, NHS England made the landmark decision to end the routine prescription to children of puberty blockers for gender dysphoria. With the support of the then Government, it announced that it was stopping children under 18 from being seen by adult gender services with immediate effect.
As one of the final acts of the previous Government, my right hon. Friend the Member for Louth and Horncastle used emergency powers under section 62 of the Medicines Act 1968 to extend the ban to private clinics selling puberty blockers to young people questioning their gender. It was the right thing to do, and I agree with and pay tribute to her, as I do to the Secretary of State for what he has subsequently done. The safety and wellbeing of children and young people must come above any other concern. I welcome the fact that the Secretary of State renewed the order; his saying that he will make the ban indefinite, given the absence at present of an evidence base; and his seeking to better understand and build that evidence base.
I have a few questions that I hope the Secretary of State can offer clarifications on in a constructive spirit. I hope—I think he alluded to this—that he will confirm that he intends to implement the Cass review’s recommendations in full. Of course, support must be available to children and young people who are questioning their gender identity, and that support must be holistic, multidisciplinary and evidence-led. The Tavistock clinic closed earlier this year, and as he set out, three new regional NHS children and young people’s gender services have opened to provide better, tailored gender services for children and young people—again, that is based on recommendations in the Cass review. Can the Secretary of State provide more detail on the delivery of the remaining regional centres, and say what order they are due to open in, so that children and families can see what is happening in their region? Again, that is about putting the best interests of young people first.
Can the Secretary of State reassure the House that these measures will be UK-wide and that he is working in tandem with the devolved Administrations? Will he advise on what progress has been made thus far—I appreciate that it is early days—on further research into patient care and increasing that evidence base? Can he update the House on the steps taken to continue the work of his predecessor, my right hon. Friend the Member for Louth and Horncastle, when she announced to the House in May the decision to work to close any online loopholes to the regulations put in place? Finally, will he commit—I suspect I know the answer to this one—to keeping the House updated in the months and years ahead on developments in this space?
Our children and young people deserve healthcare that is compassionate, caring, careful and led by the evidence. I associate myself with the Secretary of State’s concluding remarks on the need for the debate to be conducted in a respectful and sensitive way, with the needs of children and young people at its heart. We will support measures that protect children, and support him in bringing forward such measures; we want to work constructively with the Government to give the next generation access to the right healthcare to meet their needs. I look forward to working with him in the months ahead.
Wes Streeting
I thank the shadow Secretary of State for the constructive way in which he has responded to the statement, and for the tone with which he has approached the issue. It is worth everyone bearing in mind that every word of statements in this House, and indeed online, are often hung upon by a particularly vulnerable group of children and young people. Many of them feel afraid about the environment in which they are growing up, as do their families. Establishing an environment in which we can discuss issues with their welfare and wellbeing at its heart is therefore the right way to approach these issues. As I have said many times before—and I am sure the shadow Secretary of State agrees—we need less heat and more light, and we can show leadership together in trying to provide that climate.
I am absolutely committed to the full implementation of the Cass review. The shadow Secretary of State asked about the implementation of new children and young people’s services on gender incongruence. As I said, the north-west London and Bristol services are now open. A fourth service is planned in the east of England for spring next year. We want a specialist gender service in every region by 2026, and of course I will keep him and the House updated on that.
I am working closely with my counterparts in the devolved Governments. I particularly welcome the engagement I have had with my counterpart in Northern Ireland and his predecessor, the hon. Member for South Antrim (Robin Swann), who is within my line of sight. I appreciate the way we have been able to work together on this and many other issues. The shadow Secretary of State asked about loopholes. I will keep the matter under close observation and review.
With regard to sanctions, penalties and enforcement, it is worth pointing out that breach of the order is a criminal offence under the Medicines Act 1968. It is a criminal offence to supply these medicines outside the terms of the order. That means pharmacists who dispense medicines against prescriptions that are not valid may be liable to criminal prosecution. It is a criminal offence to possess the medicines where the individual had responsible cause to know the medicine had been sold or supplied in breach of the terms of the order. There are fines and penalties associated with that, including case-by-case and regulatory enforcement by the General Pharmaceutical Council.
We have approached the matter in an evidence-based and considered way, and with the welfare and interests of children and young people at the heart of our decision making. I urge everyone else involved in the provision of health and care to do the same.
Oral Answers to Questions
Debate between Edward Argar and Wes Streeting(1 month, 3 weeks ago)
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Wes Streeting
It is thanks to this Government and the action we have taken that, for the first time in three years, we go into winter without the spectre of national strikes looming over the NHS, and with NHS staff on the frontline not the picket line. It is thanks to the priority this Government have given to prevention that we have already delivered almost 15 million covid-19 and flu vaccinations, alongside the new RSV—respiratory syncytial virus—vaccination to help vulnerable groups for the first time. The shadow Secretary of State mentions the winter fuel allowance. This Government are protecting support for the poorest pensioners to protect them not just this winter, but every winter, and over the coming years the value of the pension will of course rise with the cost of living.
Edward Argar
I am grateful for that response but, just as my hon. Friends have highlighted in respect of the damaging impact of increases in employer national insurance contributions on GPs, hospices and care providers, I fear it was another example of the Government simply not answering the question and not having a plan yet. Either the Government have not done their homework and, as with the impact of NICs increases, they have not thought this through and do not know, or worse, they do not care—which is it?
Wes Streeting
This Government are prepared for winter and we are already standing up the operational response to winter pressures. On funding, the right hon. Gentleman was in government just before the general election. Is he saying that his Government did not provide enough funding for the NHS this winter? If not, why not? If he does accept that it is enough money, he will surely welcome the extra investment that the Chancellor is putting into the NHS from next year.
Income Tax (Charge)
Debate between Edward Argar and Wes Streeting(2 months, 1 week ago)
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Edward Argar
I will make a little progress, but then I will happily give way to my hon. Friend.
Apart from the press releases and the reviews, where is the action? We need to see where the £22 billion will be spent. What plans does the Secretary of State have for additional investment for the NHS this winter? He knows, as I knew when I was a Minister, that winter in the NHS is always challenging. I look forward to him setting out what additional investment he plans.
Edward Argar
I will give way to my hon. Friend the Member for Hamble Valley (Paul Holmes) in a second. Nice try, Secretary of State.
Is the right hon. Gentleman directing where that NHS funding goes himself, or will it be for his officials or NHS England to set the priorities for that, and who will be held accountable for ensuring that it is prioritised in the right places?