Health Inequalities
Jo Churchill Excerpts(4 years, 8 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)
I beg to move an amendment, leave out from “10 Years On” to end and insert:
“notes that Government is committed to level up outcomes to reduce the health gap between wealthy and deprived areas, and supports the Government’s commitment to delivering long-term improvements for everyone no matter who they are, where they live or their social circumstances.”
First, I would like to say that I really welcome this debate on health inequalities, which will help us all to discuss the challenges that we face. Every single one of us, no matter who we are, where we live, or our social circumstances, deserves to live a long and healthy life. Our determination to level up and reduce inequalities by improving the health of the poorest fastest is clear. The recent 10-year anniversary report produced by Professor Marmot comprehensively highlights the important issues, and I thank him for his tireless work in this space, because much of what he drew in the 2010 report is similar to now: these are really complex issues that are very hard to tackle.
Geraint Davies (Swansea West) (Lab/Co-op)
The Minister will be aware that 64,000 people die prematurely from air quality problems, at a cost of £20 billion, and she is probably aware that those deaths tend to be concentrated among poorer areas and poorer families, so does she agree that we should take decisive action on such things as the electrification of cars and diesel duty so that we reduce overall deaths and thereby have a go at reducing health inequalities as well?
Jo Churchill
The hon. Gentleman makes a good point, but it typifies the problems we deal with, because air pollution is the responsibility of the Department for Environment, Food and Rural Affairs, the Department for Transport and the Department of Health and Social Care. They all have a role to play, and we must ensure we take account of that—it is important that we think about all these different challenges. Helping people to live longer healthier lives while narrowing the gap between the richest and the poorest needs action, a point made by the hon. Member for Coventry South (Zarah Sultana).
Jo Churchill
If the hon. Gentleman will just bear with me and let me make a little more progress, I will come back to him.
Going forward, I am clear that we must integrate good health into decisions on housing, transport, education, welfare and the economy, because we know that preventing ill health, both physical and mental, is about more than just access to our health services.
Dr Andrew Murrison (South West Wiltshire) (Con)
In his opening remarks, the Opposition spokesman mentioned smoking cessation just once, yet we know that over half the excess mortality between social classes is directly attributable to smoking. Does the Minister agree that we will not make progress on this important subject unless we get real about this vile poison that has, unfortunately, picked off the poorest for decades and decades? It must stop.
Jo Churchill
I will come on to that point in a few minutes, if my right hon. Friend will bear with me.
Mr Perkins
The Minister is right that this is a very complicated issue and that health inequalities have existed for a considerable amount of time. On the research she refers to, will she tell us whether local government cuts, which have been greater in the poorest areas, with a significant reduction in health education and prevention work, were mentioned as factors for why this continues to be such a major problem?
Jo Churchill
The problems we are dealing with are complex across the piece, which is why we have held the public health budget at the same level this year so that we can start to deliver on them. It is important that local people have local ownership over the issues and challenges in their area, because one size will not fit all.
Jo Churchill
If the hon. Gentleman will bear with me for just a few minutes, I want to push on rather than incur the wrath of Madam Deputy Speaker.
I am clear that there must be integration across Departments, because dealing with these issues is about having a warm home that is suitable for you and those you love, and about having an environment that sustains your health. It is about good education, so that people are equipped with the skills to look after their health. It is about having jobs that are purposeful and rewarding.
The health inequalities challenge is stubborn, persistent and difficult to change, and I recognise the enthusiasm, energy and frustration that those who will speak in this debate will bring. The Government have firmly signalled their intention to take bold action on these issues. We are committed to reducing inequalities and levelling up. To be effective in reducing health inequalities, we need a long-term sustainable approach across all Departments. Early onset diseases, disability and avoidable mortality are concentrated in poor areas, so this is where we must act if we are going to make the system fairer.
Debbie Abrahams (Oldham East and Saddleworth) (Lab)
Will the Minister give way?
Jo Churchill
I ask the hon. Lady to bear with me for just a minute.
It is important that we improve those with the worst-affected health the fastest. It is unacceptable that a man born in Blackpool today can expect 53 years of healthy life, while a man born in Buckinghamshire gets 68 years. We know that there is also inter-area variation, which is unacceptable. We have an opportunity to seize the initiative to do this across the country. The ageing grand challenge is to ensure that everybody can enjoy a further five years of healthy life by 2035, while narrowing the gap between rich and poor.
We set out our intentions in the prevention Green Paper published last year. The public consultation closed in October, following significant engagement. We had some 1,600 responses, which is more than double the average the Department usually receives from such public consultations. We are analysing the responses and developing our reply, which we will publish shortly. We want to shift the focus from treating illnesses to preventing illnesses and driving healthy lives. The NHS long-term plan contains commitments that outline the role the NHS can play in supporting that shift.
We are passionate, and I am passionate, about our commitment to an NHS that is fit for the future. That is why we are funding it with an extra £33.9 billion.
Debbie Abrahams
I commend the Minister for many of the points she is making. I want to clarify the point about interdepartmental work. We know from seminal works such as “The Spirit Level” that when we reduce the gaps between rich and poor, focusing not just on income but on wealth and power inequalities, we get increases in life expectancy across the community, as well as in social mobility, educational attainment and so on. If the Government recognise that, will they commit to considering what impact policies will have on health inequalities as they are being developed?
Jo Churchill
The hon. Lady will appreciate that I cannot speak for all Departments, but it is my job to drive home the value of health in those Departments and to ensure that, as she says, we think about the broader consequences across the policy-making piece.
In answer to my right hon. Friend the Member for South West Wiltshire (Dr Murrison), smoking does remain one of the most significant public health challenges. It affects disadvantaged groups in particular and exacerbates inequalities. That is particularly apparent when looking at smoking rates in pregnancy. Three weeks ago, I visited Tameside Hospital in Greater Manchester to see its smoking cessation work. It started with a much higher than average smoking rate, and having a tailored public health budget in the locality has allowed it drive down into the inequality within the community. It has a specialist smoking cessation midwife to help these young women, their families and their partners give up smoking—for their own health, yes, but also for the health of their babies.
Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)
I packed in smoking 15 years ago. I cannot understand why the NHS does not use people like me to go out there and help other people pack it in.
Jo Churchill
I thank the hon. Member—he has just got himself a job as an ambassador. I congratulate him on quitting smoking, because it is hard.
The specialist centre showed me that with the right holistic support and encouragement, the health of both mum and baby can be improved. Such services will be crucial in achieving the ambition of becoming a smoke-free society by 2030.
Similarly, we must tackle the health harms caused by alcohol, and support those who are most vulnerable and at risk from alcohol misuse. Through the NHS plan, up to 50 hospitals with the highest rates of alcohol dependency-related admissions will have alcohol care teams. That could prevent more than 50,000 admissions every five years. Currently, eight of those teams are in operation, providing seven-day services focused on those areas with the highest levels of admissions related to alcohol dependency.
Alcohol addiction has a devastating impact on individuals and their families, and it is unfair that children bear the brunt of their children’s condition. I know that this topic is dear to the heart of the hon. Member for Leicester South (Jonathan Ashworth), who has spoken about it movingly. I pay tribute to the way he has influenced this agenda in this place. I am pleased so say that we are investing another £6 million over three years to help fund support for this vulnerable group.
As is often the case with addiction, there is a toxic mixture of several items. On substance misuse, last Thursday I attended the UK-wide drug summit in Glasgow, along with Home Office Ministers and Ministers from the devolved Administrations. We discussed the challenges associated with drug misuse and listened to Dame Carol Black present her findings from the first phase of her review. I am pleased that my Department will fund and commission the second phase of the review, which will make policy recommendations on treatment, prevention and recovery. Only through the combined efforts of different Departments working together can we hope holistically to improve the health and other outcomes of people with substance misuse problems. Many of us know from our constituency work that they often bounce between various parts of the system. Local authority leadership and action on public health prevention is vital as it will help to focus local measures to decrease health inequalities. As a condition of receiving long term plan funding, every local area across England must set out specific and measurable goals, and ways by which they will narrow health inequalities over the next five and 10 years. Local areas know their localities best.
Jonathan Ashworth
I thank the Minister for her kind words about me a few moments ago. It is an issue dear to my heart and, as she knows, I have run three London marathons to raise funds for alcohol charities—although that is not how I am proposing to fund services in the future.
The Minister has to recognise that whether it is smoking cessation services—I am sure the right hon. Member for South West Wiltshire (Dr Murrison) was not implying that I do not think that smoking cessation is important—or drug and alcohol services, they have suffered from a number of cuts. Directors of public health are desperate to know what their funding grant will be for the next financial year, starting in four weeks’ time. Can she tell us when they will know what their allocations will be, so they can fund all the work that she is talking about?
Jo Churchill
I appreciate that they need to know those figures, and they will know them extremely shortly.
I strongly believe that high-quality primary care is also crucial to early and preventive treatment, and key to reducing the health inequalities we are discussing. We are improving access to primary care by creating an extra 50 million appointments in general practice within the next five years, growing the workforce by 6,000 more doctors and 26,000 more wider primary care professionals. Within that, we want to target NHS resources, so that they can help their localities to level up. Through the targeted enhanced recruitment scheme, we are recruiting trainees to work in the areas of the country where we have had vacancies for years, particularly rural and coastal areas, such as Plymouth, and the coastal area of County Durham and North Yorkshire. It has already proved highly successful, with a fill rate of close to 100% last year, and over-subscription in many parts of the country. For that reason, we will increase the places on the TERS from 276 to 500 in 2021, and then up to 800 in 2020, to make sure that we get the skilled staff in the areas where they can do most good.
Practices, working together within primary care networks, will be asked to take action on health inequalities, to be agreed as part of the next 2021-22 GP contract. What happens in one’s early years, even before one pops out into the world, has an impact well into later life. Pregnancy and early years are therefore a key time to have an impact on inequalities. In particular, the fact that women’s life expectancy is so challenged is of acute importance to me. We have many challenges as we travel through life, and making sure that we are equipped to make the best of our lives, particularly as we often act as primary carers, is hugely important.
Pregnancy and early years are a key time to have an impact on inequalities. Many babies do get a fantastic start, but sadly it is not the case for everyone. Children in more deprived areas are more likely to be exposed to avoidable risks and have poorer outcomes by the time they start school. It is right that all universal support has a focus on reducing inequalities, and that it is targeting investment to meet higher needs. Many children are benefiting from investment in childcare and early years education. Fifteen hours of free early years education for disadvantaged two-year-olds and 15 hours of free early years education for all three and four-year-olds is key. We have also announced our commitment to modernise the healthy child programme to reflect the latest evidence to support families.
Jo Churchill
No, I am going to push on. I would particularly like to give those people making their maiden speech, which is hugely important, the time to do so.
For a good start in life, we need to do better in oral health. Tooth decay is the most common oral disease among children, affecting one in four by the time they start school, and it is the most common reason for admission to hospital for children aged five to nine. It is largely preventable. Improving the oral health of children is a Public Health England priority, and a number of actions are under way. Supervised tooth-brushing and water fluoridation are two evidence-based areas in which we want to go further. When I met a number of dentists recently and asked them what they would do if they had the key that would enable them to do anything, they said that water fluoridation would be one of the key measures to reduce childhood inequality across the country. In 2016-17, one in six children had tooth decay in the south-east compared with one in three in the north, and the variation is even greater among local authorities. I am delighted that two authorities, Durham and Northumberland County Councils, recently announced formal proposals to increase water fluoridation, and I hope to be able to facilitate that.
Obesity is a challenge. It is shocking that children in poorer parts of the country are more than twice as likely to be overweight or obese. Children who are overweight or obese are increasingly developing type 2 diabetes and liver problems, they are more likely to experience bullying, low esteem and a lower quality of life, and they are highly likely to become overweight adults with a higher risk of cancer and heart and liver disease. This is a huge cost to the health and wellbeing of the individual, but also to the NHS and the wider economy.
National cardiovascular disease and diabetes prevention programmes have already been introduced, but we want to go further. NHS England has delivered a diabetes treatment and care programme aimed at reducing variation and improving outcomes for people living with diabetes, thus reducing inequalities. We published the third chapter of the childhood obesity plan in July 2019, with further measures to help to meet our ambition to halve childhood obesity by 2030 and reduce the gap between the most and the least deprived. We have seen some important successes. The average sugar content of drinks subject to the soft drinks industry levy decreased by 28.8% between 2015 and 2018. Significant investment has been made in schools to promote physical activity and healthy eating. The childhood obesity trailblazer programme works with local authorities to address the issue at local level, and that really helps, with authorities working together to ensure that the messages sent to children are healthy food messages. The programme has a strong focus on inequalities and ethnic disparities in the context of childhood obesity, and is helping five local authorities to take innovative action. We have a lot to gain, particularly if we help parents, especially in the most deprived areas, to help their children.
It is clear that there is a great deal to do. Let me reiterate that the Government have made real commitments to real action, and that we will increase our focus on the real challenges that people experience in their lives every day. Reducing health inequalities is not an issue that truly divides the House, and I look forward to hearing the suggestions of Members on both sides of the House so that we can move forward. Their contributions will help to fuel our purpose. We share the common goal of reducing inequalities, and we can work together to achieve it.
Medicines and Medical Devices Bill
Jo Churchill ExcerptsMonday 2nd March 2020
(4 years, 8 months ago)
Commons ChamberRead Full debate Medicines and Medical Devices Act 2021 View all Medicines and Medical Devices Act 2021 Debates Read Hansard Text Read Debate Ministerial Extracts
The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)
First, let me thank all hon. Members for their support in discussing this enabling legislation. It is a pleasure to close this debate on the Medicines and Medical Devices Bill. The Bill is both a piece of legislation to future-proof our regulatory regime going forward and an opportunity to clarify and improve the one that we have now.
I am gratified that hon. Members have approached this debate with thoughtful consideration. Obviously, there is a lot more to discuss in Committee, because several themes came up during the course of this afternoon’s debate on which I can only touch now. I will take up the request of my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) and write to her. I have not had the chance thus far to have a specific briefing with the hon. Member for Central Ayrshire (Dr Whitford), so perhaps we could do so to enable us all to understand our direction of travel.
Patient safety is not a partisan issue; it is paramount. It is what drives us to do what we do. It does not matter which side of the House we sit on, the patient is at the centre of our concern. We hope that, in going forward, we can enhance and strengthen that view and show ourselves as an exemplar to the world in the way that we conduct trials and in the way that the life science and pharmaceutical industries work. We hope to assist the whole industry in making sure that we never compromise on patient safety.
This will be the first opportunity in 40 years for the UK to make choices regarding how we regulate medicines, veterinary medicines and medical devices in the best interests of the UK now that we have left the EU. This is all part of our making sure that we transition smoothly on 1 January next year. Members from all parts of the House feel passionately about the outcome of negotiations on the future relationship. I would like to assure hon. Members that the Bill allows us, in the future, to set rules that are best for the UK, whatever the outcome of those negotiations. The Bill is important, as it makes clear the Government’s commitment to the life science sector, which is worth over £75 billion to our economy and which contributes almost 250,000 jobs to the UK. We are rightly proud of that sector, but innovations and advancement must be matched by rigorous standards to protect patients. I very much take on board the comments of the hon. Member for Twickenham (Munira Wilson), which were particularly pertinent to the experience that she brings to this House. I hope to enjoy more of that debate when we are in Committee.
The Bill sets out clear principles: ensuring patient safety; ensuring their continued access to medicines and devices; and maintaining the attractiveness of the UK as a market and a place for clinical trials. There is a delicate balance there that we must continue to strike, and the debate today demonstrates the paramount importance of all those principles. On that point, I will move on to the comments of hon. Members.
Mr Alistair Carmichael (Orkney and Shetland) (LD)
The provisions on veterinary medicines are essentially a straight lift from the human medicines part of the Bill. There is one significant difference, of course: animals that have been prescribed and administered medicines are put into the food chain. With regard to withdrawal periods, that, in turn, can have a significant impact on the access to markets of exported meats. Will the Minister consider later an amendment to clause 8(2), to provide at least some regard to the commercial position of the end meat products?
Jo Churchill
As the right hon. Gentleman knows, I am always happy to have a discussion to see whether any accommodation can be made. As far as veterinary medicines go, I should say that, unlike with human medicines, we pay attention to the environmental impact as they go through.
Dr Neil Hudson (Penrith and The Border) (Con)
I should declare an interest as a veterinary surgeon. I want to bang the drum for part 2 of the Bill and the importance of the way in which it addresses veterinary medicines. The Bill will go some way towards providing assurances to the UK veterinary profession that there will be continuity in its ability to prescribe for and treat a group of patients that have not been discussed much tonight: animal patients in our country.
Jo Churchill
I am happy to give my hon. Friend the assurance that there will be that continuity. That is precisely the aim of the Bill.
The shadow Secretary of State asked me to comment on reports that he had read in the papers today about health security. The UK is open to exploring co-operation between the EU and other specific narrowly defined areas when it is in the interests of both sides—and on matters of health security, it would be foolish not to.
Several Members discussed clinical trials, with a particular eye to the rare diseases cohort, which is obviously, by its nature, small. It is only sensible to ensure that we have the ability to collaborate across Europe to determine that we have the best environment for the development of drugs. I would caution people to breathe before we go forward. We are committed to ensuring that we remain the best place for those on rare disease trials.
The Medicines and Healthcare Products Regulatory Agency has taken steps to ensure that there is absolutely no disruption to clinical trials and that they can continue seamlessly. It is important that we are tempered in tone to ensure that people’s clinical trials carry on. We want a world-leading regulatory system for clinical trials that allows us to collaborate effectively—not only across Europe, but globally. We have one of the best life sciences industries in the world, for which effective collaboration is important.
Now that we have left the European Union, it is important to make it clear that UK sponsors will still be able to run multi-state trials across the world. We want a regulatory system that maintains and enhances the attractiveness of the UK as a site for global co-operation in research.
I move on. We will extend prescribing rights to physician associates through other means. We are discussing the extension of physician associates’ rights for prescribing in the context of the increase in clinical professionals who will be working in the health service. The broader ability of the Bill to ensure prescribing rights will be carried through only in collaboration with the appropriate regulatory oversight, whether from the General Medical Council or the Health & Care Professions Council, depending on whether allied health professionals or physician associates are involved.
The hon. Member for St Helens South and Whiston (Ms Rimmer) asked whether clinical trials data would include those forced to participate. I assure her that clinical data used to support regulatory activity in the UK needs to comply with international good clinical practice standards, including ethical considerations such as the critical principle of informed consent. That means that the appalling cases to which she alluded could not be involved in clinical trials.
Ms Rimmer
There are signs up in Chinese airports saying “Organ transplants this way” in English; there is a clear path through. I am not saying that it is the English who are going, but the system is international. People are going out. France is already taking steps to stop organ tourism.
Jo Churchill
I thank the hon. Member for that intervention.
Let me point out to the shadow Secretary of State that it is possible that the use of artificial intelligence—to determine what treatment to give a patient, for example—would fall within the scope of the regulation-making powers in the future. It is right that we have the tools to respond to this kind of technology in the years ahead. I was most interested by the comments of my hon. Friend the Member for Bolton West (Chris Green) about better patient outcomes. I could not agree with him more about the importance of the life sciences sector, and about using data to inform as we go forward. The MHRA will be able to conduct inspections for manufacturing, distributions, clinical trials, laboratories and pharmacovigilance, and it is important that that continues to ensure that we uphold standards.
There were numerous other comments, particularly about the medicines and medical devices lists and register. I look forward to ensuring that we have a robust debate in Committee about what is best for the patient and the clinician. My hon. Friend the Member for Bosworth (Dr Evans) made an important point about clinicians perhaps annotating patients’ notes with information about why they used a particular medicine or device.
We have spoken about medical devices perhaps being manufactured at a patient’s bedside. The shadow Minister mentioned having a barcode on each device. It would be quite hard to barcode a device when it was manufactured in order to put it on to a register. I hope that having this discussion in later stages will inform us all how best to do this.
I hope that the spirit of this debate—one in which we are all in support of a common purpose—carries through to the examination of the Bill. This legislation offers an opportunity for the UK to protect patients, support the development of an exciting and important sector, and do what is best in the UK for the UK’s interests. I commend this Bill to the House.
Question put and agreed to.
Bill accordingly read a Second time.
Medicines and Medical Devices Bill (Programme)
Motion made, and Question put forthwith (Standing Order No. 83A(7)),
That the following provisions shall apply to the Medicines and Medical Devices Bill:
Committal
(1) The Bill shall be committed to a Public Bill Committee.
Proceedings in Public Bill Committee
(2) Proceedings in the Public Bill Committee shall (so far as not previously concluded) be brought to a conclusion on Thursday 23 April 2020.
(3) The Public Bill Committee shall have leave to sit twice on the first day on which it meets.
Proceedings on Consideration and up to and including Third Reading
(4) Proceedings on Consideration and any proceedings in legislative grand committee shall (so far as not previously concluded) be brought to a conclusion one hour before the moment of interruption on the day on which proceedings on Consideration are commenced.
(5) Proceedings on Third Reading shall (so far as not previously concluded) be brought to a conclusion at the moment of interruption on that day.
(6) Standing Order No. 83B (Programming committees) shall not apply to proceedings on Consideration and up to and including Third Reading.
Other proceedings
(7) Any other proceedings on the Bill may be programmed.—(James Morris.)
Question agreed to.
Medicines and Medical Devices Bill (Money)
Queen’s recommendation signified.
Motion made, and Question put forthwith (Standing Order No. 52(1)(a)),
That, for the purposes of any Act resulting from the Medicines and Medical Devices Bill, it is expedient to authorise the payment out of money provided by Parliament of:
(1) any expenditure incurred by a Minister of the Crown, a government department, a person holding office under Her Majesty or any other public authority by virtue of the Act; and
(2) any increase attributable to the Act in the sums payable by virtue of any other Act out of money so provided.—(James Morris.)
Question agreed to.
Medicines and Medical Devices Bill (Ways and Means)
Motion made, and Question put forthwith (Standing Order No. 52(1)(a)),
That, for the purposes of any Act resulting from the Medicines and Medical Devices Bill, it is expedient to authorise the charging of fees, or other charges, arising by virtue of the Act.—(James Morris.)
East Leake Health Centre
Jo Churchill Excerpts(4 years, 9 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)
First, I congratulate my hon. Friend the Member for Rushcliffe (Ruth Edwards) on securing this debate, and on how passionately and eloquently she has spoken about the needs of East Leake and of her constituents. I am sure that she will serve her constituency well. She has big boots to fill, following the former Father of the House, who served in this place for 49 years. That length of time can only be admired, can it not?
As I said in a previous debate on GP provision in Derbyshire, we know that general practice sits absolutely at the bedrock of our NHS, and we understand the integral role that GPs play for all of us in the health system locally. This is particularly the case in a rural constituency. I represent a rural constituency, and my hon. Friend the Member for Rutland and Melton (Alicia Kearns) also represents a beautiful rural constituency.
I commend the outstanding work that is being undertaken by Nottinghamshire to improve its primary care estate, because there has been local investment, but continued investment in our primary and community care is vital. That is why the investment of £4.3 million in Rushcliffe CCG’s Cotgrave surgery scheme has been most welcome, and I am sure that patients and NHS staff are benefiting from that scheme and the hub. It serves to draw an even greater distinction between the facilities that my hon. Friend currently has at East Leake and the aspiration for what she would like her constituents to have.
It is reassuring to see that the CCGs in Nottingham and Nottinghamshire have built effective working relationships with all six planning authorities within their geographical area, and those on their boundaries as well. This includes engaging with local plans and strategic housing developments as they are going forward, as well as consulting on individual planning applications.
Ensuring that primary care develops as an area grows is of vital importance, but I would like to turn to the specific subject of East Leake. Improving the primary care estate is an enabler to boosting out-of-hospital care, as my hon. Friend the Member for Rushcliffe so well said. It is a key element in the long-term plan, and delivering our manifesto commitment to improve general practice lies front and centre of what we aim to do over the next four and a half years.
I am pleased to hear that my hon. Friend has made it one of her very first priorities as the new MP for Rushcliffe to drive forward the proposals to improve primary care in her area for her constituents and specifically in East Leake with its very specific needs. I do understand that the current surgery is in need of modernisation, as it is in an old building that is crumbling, and I would like to pay tribute, as she did, to all those members of staff who work there, both clinical staff and also the support staff who back up practices in all our constituencies so that people can access the facilities they need on their doorstep, often working in difficult environments.
My hon. Friend’s proposal to replace the current estate with a modernised health centre and community hub that can accommodate the local GP services, library, social services, dental practice, pharmacy, parish councils, district nurses, physios and mental health facilities—I do not think I have missed any out; I think that was just about the list—plus charities in the building has the potential to address the multifaceted needs that all our local populations have on one site. That co-location of both public service and charities offers the potential to ensure that our local communities’ needs for accessible services are prioritised and well met.
I see that the Cotgrave model, which opened in November 2018, has inspired the new proposal for East Leake. The Cotgrave scheme has been highly successful, integrating primary and community healthcare services with other public sector organisations, and I encourage the local health economy to continue to develop very robust bids and submit them at the next available opportunity for capital funding.
The key reason behind the East Leake proposal was the steady growth in the patient list size, caused by a significant number of housing developments that are going on not only in my hon. Friend’s constituency but across the locality. Ensuring that we have a planned approach so that the right facilities go in the right area is very important. For example, I know there is a planned development at Fairham Pastures of about 3,000 houses, and those 3,000 new homes will have constituents in them. It is incredibly important that when new housing developments are planned, local healthcare provision is in lockstep with it, and we plan that at the same time: we must develop in step with the changing population need so that existing and new residents have access to the healthcare that they need.
As my hon. Friend laid out so articulately, not everybody’s needs are the same for their particular stage of life or the services they are trying to access. This requires strategic co-ordination at national and local levels, including early engagement between healthcare providers and local planning authorities. Our manifesto commitment to support access to primary care services in new housing developments stands. I will work closely with my colleagues across national and local government to deliver better primary care services.
It is pleasing to hear that in the case of East Leake, the CCG has a very effective process in place with Rushcliffe Borough Council regarding the local plan and subsequent housing developments, and that it has, through the borough council, secured section 106 money and other contributions which will help to offset some of the capital cost my hon. Friend outlined. I would say, however, that we are still looking at a large sum for East Leake, which is why the bid must be robust when it comes forward. As I have stated, improving the quality of general practice is a leading priority for the Government. Consequently, I have asked that I be kept informed about East Leake as we go forward.
Nationally, we recognise that improving the primary care estate is integral to strengthening general practice. Policies and funds will therefore be aimed specifically at improving the estate. The full amount of available sustainability and transformation partnerships has been worked through and allocated to those successful schemes that have been announced, but we will consider proposals from the NHS for the multi-year capital plan to support the transformation plans outlined in the long-term plan. Further capital funding for transformation will be confirmed in due course. The work my hon. Friend is doing now is therefore very important. Furthermore, the primary care estates and technology transformation fund aims to accelerate changes in general practice infrastructure to enable improvement in access and service quality, as we see more services delivered off-site and so on. The fund is investing £800 million in both capital and revenue between 2016 and 2021. That is in addition to annual investment in GP IT and business-as-usual capital.
The policy options to address the estate challenge have also been considered in the general practice premises policy review. NHS England and Improvement intends to develop an implementation framework following the outcome of capital decisions in the future spending review. The health infrastructure plan, published in September 2019, recognises that community care and primary care are critical to the delivery of personalised and preventive health. This requires investment in the right buildings and facilities to enable staff to harness technology and deliver better care across the piece.
The plan will deliver a long-term rolling five-year programme of investment in health infrastructure, including capital to not only build the new hospitals we hear so much about, but to modernise our primary care estate, invest in new diagnostics—also part of the ask at East Leake—and technology, and help eradicate critical safety issues in the NHS estate. Future NHS capital funding, including for primary care, will be considered as part of the Department’s multi-year settlement at the next capital review.
Improving the NHS primary care estate is only part of the transformation. It needs very close alignment with the workforce plan to ensure not just the buildings but the workforce and technology to back up delivery. As such, I want to reassure my hon. Friend that tackling these issues lies at the heart of our determination to strengthen general practice and primary care more broadly. We are committed to growing the workforce by 6,000 more doctors in general practice and 6,000 more primary care professionals for the services she is asking for, such as physiotherapists, physician associates, pharmacists and many others. She mentioned mental health, and access to a dietician can help those who are struggling with their weight. Allied health professionals can provide a great service in front-facing primary care. We are also looking to create an additional 50 million appointments a year in the next five years within primary care.
We are committed to delivering those ambitions. That will, of course, mean that we need a modern, dynamic and expanded estate that can fully accommodate the expanded workforce and deliver high-quality care for patients. That is why we need the local NHS, supported by dedicated MPs, to continue to develop robust and ambitious plans so that it is ready to benefit from the Government’s ambitious capital spending programme when it is laid out.
I know that the Secretary of State and I will be hearing a lot more from my hon. Friend about East Leake and other needs in her constituency. I would be delighted to accept her kind invitation to visit East Leake and to talk more broadly about what the healthcare offer is in the locality, so that we can better understand how to provide effective, efficient and high-quality care for not only the residents of East Leake, but the broader constituency and area of Nottinghamshire.
Question put and agreed to.
GP Provision: Pilsley
Jo Churchill Excerpts(4 years, 9 months ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)
I congratulate my hon. Friend the Member for Bolsover (Mark Fletcher) on securing this debate about GP provision in Pilsley. We know that general practice is the lifeblood of the NHS, and we understand the essential role that local practices play in their community, and this is particularly the case in rural areas such as Pilsley.
Before I address the specific issue of the proposed closure of the Pilsley branch surgery, I would like to mention the local work that is being done in Derbyshire that partly explains some of the things that my hon. Friend was talking about. First, Derby and Derbyshire CCG has been active in working with NHS England to expand the local workforce, and I am very pleased that three new GPs have been recruited in Derbyshire, one of them indeed by Staffa Healthcare. Secondly, the CCG has made progress in ensuring that GPs remain in the NHS and within general practice in particular, An example of that progress is the “GP Aspire” programme launched by the GP taskforce in Derbyshire. The programme started as a pilot back in 2018 and now provides support to all GPs across Derbyshire at any stage of their career. That includes, among other things, one-to-one careers guidance, signposting for wellbeing, mentoring, leadership and mental health advice. Since its launch, the programme has had some 116 individual contacts from Derbyshire GPs.
Retaining experienced GPs and encouraging more into the profession is the way we will be able to deliver more services across the nation and get more appointments into primary care, so people can get the right care from the right healthcare professional. On that, I add that I understand my hon. Friend’s point about pharmacies because the right appointment with the right healthcare professional for individuals will be hugely important as we begin to understand how to better work with the national health service across all the different healthcare professions.
I turn to the proposed closure of Pilsley branch surgery. As my hon. Friend outlined, the closure of a GP surgery is considered and decided by the local CCG, following the application from a GP provider. Such a decision understandably stirs up strong emotions within the local community, as he explained so well.
An application to close Pilsley branch surgery was submitted by Staffa Health in 2019. On the recommendation of the CCG, the public consultation was launched on 24 June. Staffa Health employed a wide range of feedback approaches during the 60-day period, including: meetings with staff; meetings with stakeholders and the patient participation group; issuing a letter, a “frequently asked questions” sheet and a questionnaire to all registered patients; text-message alerts to raise awareness of the consultation; and three face-to-face drop-in sessions. However, I understand what my hon. Friend said about the use of modern technology and how that may not always cover all patients who access local surgeries.
In addition to the consultation, the local petition calling for the closure to be halted, which got 592 individual signatures, was presented, and I join my hon. Friend in paying tribute to Sheila Baldwin and Wendy Hardwick, who organised it. I commit here and now to ensuring that my officials write to the CCG to ask it to set out how it has fully taken on board the views of the ladies and the broader petition and the action that it intends to take in response. Those local views can often help to deliver the most sensible solutions for everybody.
Following the conclusion of the consultation, Staffa Health decided to continue with its application to close the Pilsley branch to ensure the long-term sustainability of its whole practice across the three other local settings. A report was compiled and submitted to the CCG engagement committee for review on 8 January, and it commended the consultation for being “robust”. The report was also submitted to Derbyshire County Council’s improvement and scrutiny committee, and the final decision regarding the future of the Pilsley surgery will now be made by Derby and Derbyshire CCG’s primary care co-commissioning committee. The committee has been asked by Staffa Health to approve the closure, but to postpone it for a year from the date that approval is given. That postponement is to allow time to increase the number of consultation rooms at the neighbouring Tibshelf surgery and to address car parking issues. Those specific concerns have been raised through the consultation to date.
The committee met on 22 January and decided at the meeting to defer its decision to the next meeting on 26 February, which I understand will be after my hon. Friend has met the Secretary of State with Staffa Health. In the run-up to and following the PCCC’s decision, the CCG and Staffa Health are urged to continue to listen to the concerns that have been raised and to ensure that appropriate action is taken to reduce the impact on the community, which my hon. Friend laid out so eloquently.
As I stated, improving access to general practice is a leading priority for our Government and, consequently, I have asked that I be kept informed about developments regarding the future of Pilsley branch surgery. I understand that workforce shortages have been cited as a reason behind the application to close, as my hon. Friend said, and I appreciate how challenging the situation is for GP surgeries across the country. As the hon. Member for Strangford (Jim Shannon) outlined, it affects all of us, north to south, east to west, and particularly those trying to deliver across large rural areas and multiple sites, where delivery is extremely challenging. As such, I reassure my hon. Friend that tackling this issue lies at the heart of our determination to strengthen general practice and support those who work in it. We are committed to increasing the workforce, providing about 6,000 more doctors and 6,000 more primary care professionals such as physiotherapists, pharmacists and physician associates, on top of the 20,000 primary care professionals to whose funding NHS England is contributing.
Jim Shannon
Earlier, I referred to the possibility of a scheme allowing student doctors to commit themselves to five years in a general practice and thereby offset some of their student fees. Would the Department be prepared at least to consider that?
Jo Churchill
As the hon. Gentleman knows, we are always prepared to consider anything that will help to sustain the viability of the entire workforce. Offering appropriate career development, for instance, is important to ensuring that we retain doctors, nurses and other healthcare professionals. We do not just want to train them; we want to keep them as well.
Last year Health Education England recruited the largest ever number of GP trainees—some 3,540—but the system is under significant strain, and more trainees will be required to meet our target of 6,000 general practitioners. The five medical schools that are currently coming onstream will be to central to that objective. However, training new staff is only one piece of the jigsaw. As I have said, retention is just as important. The GP contract recognises that, and sets out an ambitious programme of initiatives which, by 2023-24, will support existing doctors. As well as introducing those workforce measures, we intend over the next 12 months to reduce the unnecessary burden of bureaucracy that often restricts GPs.
Our review has been agreed as part of this year’s contract, and will begin with a ministerial round table that will seek input from our partners across Government and general practice. Our aim is to free up valuable time for doctors and primary care professionals, while also ensuring that Government agencies, departments and patients have the necessary access to information. By recruiting and retaining more doctors in primary care, covering a wider range of specialisms, we will reduce the burden of bureaucracy placed on them and create additional capacity over the next five years. However, this is also about delivering care in the most appropriate setting as we strengthen general practice, and at the heart of each and every one of those settings is the patient. That can only work if we listen to the concerns and views of all involved in general practice, both staff and patients.
I commend my hon. Friend’s tenacity. He has lobbied both the Secretary of State and me to ensure that we know about the challenges at the Pilsley surgery, and that we listen and then continue a conversation that involves me but also, most importantly, the Secretary of State when he and my hon. Friend meet Staffa Health shortly. We will act on what we are hearing.
Question put and agreed to.
Health and Social Care
Jo Churchill Excerpts(4 years, 9 months ago)
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Mrs Hodgson
In October last year, the Government confirmed that the local authority public health grant will increase by 1% in real terms in 2020-21. However, this funding has not yet been allocated to local authorities. How will the Government financially support local authorities to establish the routine commissioning of PrEP by April?
Jo Churchill
As I said, NHS England and NHS Improvement have already agreed, within the ring-fenced funding for public health, to fund the ongoing costs of drugs for PrEP going forward. There will be an additional allocation of funds to cover the PrEP roll-out completely.
[Official Report, 28 January 2020, Vol. 670, c. 658.]
Letter of correction from the Under-Secretary of State for Health and Social Care, the hon. Member for Bury St Edmunds (Jo Churchill):
An error has been identified in the response I gave to the hon. Member for Washington and Sunderland West (Mrs Hodgson).
The correct response should have been:
Jo Churchill
As I said, NHS England and NHS Improvement have already agreed, within the ring-fenced funding for public health, to fund the ongoing costs of drugs for PrEP going forward. We will provide information on how other elements of the programme will be funded and how commissioners will be supported shortly.
Oral Answers to Questions
Jo Churchill Excerpts(4 years, 9 months ago)
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Peter Kyle (Hove) (Lab)
The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)
I have spoken to the relevant Ministers in the Ministry of Housing, Communities and Local Government, and my officials are working closely with other key stakeholders to ensure that we deliver routine commissioning of PrEP—pre-exposure prophylaxis—to help end new HIV transmissions. This is a key interest not only of many hon. Members but of many broader stakeholders, and I know the issue is particularly dear to the hon. Member’s heart.
Peter Kyle
I am grateful for the Minister’s response and for the Secretary of State’s announcement that he wants routine commissioning of PrEP by April, but what he and the Department have not done is spell out how they will achieve it. The PrEP trial will end this year, and we need a guarantee that every single person who needs and wants PrEP will get it from April.
Jo Churchill
I assure the hon. Gentleman that NHS England and NHS Improvement have already agreed to fund all the ongoing costs of the drugs for PrEP going forward. We will provide information on how the other elements of the programme will be funded and how commissioners will be supported. He is right that the trial ends in July, but routine commissioning will be rolled out from April—we will make sure they dovetail. It is hugely important that PrEP is available for each and every person who wishes to access it.
Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)
In October last year, the Government confirmed that the local authority public health grant will increase by 1% in real terms in 2020-21. However, this funding has not yet been allocated to local authorities. How will the Government financially support local authorities to establish the routine commissioning of PrEP by April?
Jo Churchill
As I said, NHS England and NHS Improvement have already agreed, within the ring-fenced funding for public health, to fund the ongoing costs of drugs for PrEP going forward. There will be an additional allocation of funds to cover the PrEP roll-out completely[Official Report, 3 February 2020, Vol. 671, c. 1MC.].
Daniel Kawczynski (Shrewsbury and Atcham) (Con)
Karl Turner (Kingston upon Hull East) (Lab)
The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)
We are determined to address the long-standing inequalities that exist in many areas, be they in access, outcomes or people’s experience of their local health service. Our world-leading childhood obesity plan, NHS health checks, the tobacco control plan and the diabetes prevention programme all see us leading the way, but there is undoubtedly more targeted work to do on this complex issue, particularly in areas of high need.
Karl Turner
The recent mental health prevention Green Paper recognised the link between deprivation and poor mental health outcomes. Along with the proper funding of frontline and early intervention services, mental health inequality needs urgent action, so when will the Minister get to work to sort out this mess? People in east Hull desperately need access to services that are currently not available.
Jo Churchill
I agree with the hon. Member. I and my hon. Friend the Member for Mid Bedfordshire (Ms Dorries), who has responsibility for the mental health element of the portfolio, are working hand in glove on this. Often, it is the dual toxicity of addiction—be it substance or alcohol abuse—and mental ill health that drives health inequalities. We are targeting the matter and working together on access to make sure that we drive down these health inequalities.
Tracey Crouch (Chatham and Aylesford) (Con)
Many people with severe conditions such as agoraphobia face inequalities in accessing life-saving services such as cervical smear tests. What is my hon. Friend doing to ensure that these services can be administered outside a clinical setting, thus reducing health inequalities for those who, for whatever reason, are housebound?
Jo Churchill
No woman should be denied access to vital screening. I believe that my hon. Friend is referring to a particular matter in her constituency where it has been very difficult for somebody to access screening. I am happy to meet her to see how we can work through this. We are actually working on a home kit for cervical screening, which should help in time, but nobody should be denied access. We are committed to improving access for all women, and I will be happy to meet her to see what we can do.
Patricia Gibson (North Ayrshire and Arran) (SNP)
Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)
There are real concerns in east London about the big delays in the breast cancer screening programme, meaning that many women are not getting their first screening until close to their 53rd birthday. Will the Minister meet me and other concerned east London MPs to ensure that we tackle that, to the benefit of our constituents?
The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)
I would be delighted to meet the hon. Lady and other east London MPs. Mike Richards has done a review of screening, and we need to level up and ensure that everybody can access screening.
Stephen Crabb (Preseli Pembrokeshire) (Con)
Jo Churchill
I am delighted to join my right hon. Friend in congratulating Jo’s Cervical Cancer Trust on the work it does. I had the pleasure of meeting its team only last week, who do fantastic work to raise awareness of vital cervical screening. He is right about Mike Richards’s review. We must ensure that we screen all the available population in order to see cervical cancer eliminated for good, which would be brilliant. I am delighted to support this year’s “Smear for smear” campaign. There is nothing shameful about human papillomavirus, and we must bust the myths, because being tested can save someone’s life.
Rosie Duffield (Canterbury) (Lab)
Following the desperately upsetting news headlines last week about preventable baby deaths at East Kent, including that of Harry Richford, aged just seven days old, whose death was described by the coroner as “wholly avoidable”, will the Secretary of State join me and Harry’s family in calling for a full, transparent public inquiry?