NHS Winter Readiness

Karin Smyth Excerpts

Wednesday 30th October 2024 Westminster Hall

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairmanship, Sir Roger. I thank the hon. Member for North Shropshire (Helen Morgan) for securing the debate and hon. Members for taking part.

We have all just rushed from the main Chamber and I think I am the only person here who has come out enthused and excited after what we heard about the massive support offered—particularly for the NHS. It is the first Labour Budget delivered after the 14 years of the coalition and the Tory party’s time in power, and it lays the foundations for fixing our economy.

Just in case people did not clock all the figures, there will be £22.6 billion in day-to-day extra spending on the health budget, including a £3.1 billion increase in the capital budget, £1 billion of which helps address the backlogs of repairs that have been allowed to fester over the past 14 years. There is also an additional £1.5 billion for beds, new capacity for diagnostic tests, surgical hubs and diagnostic centres, to address the key point made by the hon. Member for Meriden and Solihull East (Saqib Bhatti). Let us take some of that funding and not just stop the decline but fix the foundations, setting the path for the next 10 years, as we have clearly articulated in the few weeks that we have been in government. When I speak to my constituents in Bristol South, they are most concerned about the NHS spending every penny of taxpayers’ money wisely, properly and where it needs to be focused. That is why we have concentrated on our three shifts and launched this national conversation—I hope everyone takes part.

We all know the problems, and that is what Lord Darzi helped us address. We also know that winter is a difficult time for our health and care system. Although we cannot predict the severity of the weather, we can predict much of the activity, we know what is likely to hit us most of the time, and we can certainly plan better. I remember working on the issue as a NHS manager back in the day, across primary, community, and secondary care, as well as with ambulance services and local authorities. A systems response is needed, and it is important that we are all involved in preparing and planning.

I also remember just how demoralising it was for staff in the early 2000s, coming into work every day to fight fires and sort out the awful trolley waits—not to mention how unacceptable that was for patients and families. The point about the impact on staff’s mental health and morale was well made by the hon. Member for Winchester (Dr Chambers). I also saw, and was proud to be part of, the changes we made under that Labour Government to end those trolley waits, and we will do that again. That is what Lord Darzi’s report shone a searing spotlight on, including the chronic lack of capital investment that has put many hospitals into a perpetual bed crisis, particularly during peak periods such as winter cold snaps.

While we have inherited a broken NHS, it is not beaten. As we have just heard from the Chancellor, this Government have taken the first steps towards fixing the annual crisis with new capital investment. However, one Budget cannot undo the last 14 years of failure, so while we fix the foundations we are also mitigating the immediate risks. At the very least, going into this winter we will be better prepared than we were last winter. That is because the managers in the NHS will be preparing for winter rather than planning for strikes, which is what they had to do the last three years—already a significant improvement.

The health service does face challenges on all fronts, and the figures are sobering. We have heard some of them today. In September, provisional statistics showed that almost one in 10 A&E patients waited over 12 hours to be admitted, transferred or discharged. The mean category 2 response time in September stood at about 36 minutes—around double the NHS constitutional standard. I recently attended a meeting where officials highlighted the number of attendances requiring admissions are already up by 1.8% in September compared to 2023, which is continuing to place increased pressure of patient flow. Those are the results of deep structural issues in the NHS that will not be fixed overnight. But work is already under way to rebuild resilience and manage pressures across the health and care system this winter.

I will come on to the specific work being done, but I assure hon. Members that the Government are taking the issue extremely seriously. I am already meeting senior leaders in NHS England and the UK Health Security Agency every two weeks to ensure that the risks can be identified quickly and that pressures are managed effectively. Once the peak winter period hits, the meetings will move weekly and include the Secretary of State.

Local NHS systems are best placed to determine how to respond to issues in their local area. That is why NHS England has worked with local systems to ensure robust winter plans are in place at a local level. As someone who knows exactly what is involved in that planning, I pay tribute to the staff for their skill, motivation and commitment to protecting every patient this winter.

[Jim Shannon]

There is no better choice the Government can make than committing that money to the NHS—we all welcome that. Anybody who does not would be insane. I always try to be constructive in my contributions. I asked about staffing and made the suggestion to retain students wherever they do their training. Sometimes they come to the end of it and go somewhere like Australia or New Zealand to get a job. Instead of that, if Government were to consider a bursary-type system to retain the staff, I think we would be able to address some of the pressure that we have.

[Karin Smyth]

I will come on to staffing to address some of those points. The hon. Gentleman makes an excellent point about staff recruitment and retention, which is a key part of our future look at the system.

On winter planning, the Government should not be micromanaging people in local systems as they do their job. Rather, we need to focus our efforts on where they are needed the most. Notwithstanding the excellent work of individual staff, let me repeat: the NHS is broken. None of us should underestimate how difficult this winter could be, but we are taking immediate steps to cushion the blow. First, we have set out our national winter planning priorities to NHS systems, local authorities and social care providers to support operational resilience over the coming months. Secondly, we are standing up the winter operating function seven days a week to respond to pressures in real time.

Thirdly, we are expanding the operational pressures escalation levels framework to give us a clearer picture of what is happening on the ground in all our systems. The framework uses comprehensive data to keep track of hospital pressures, and this year we are expanding its scope to mental health, community care and 111. Fourthly, we are continuing to support systems that are struggling the most through the urgent and emergency care tiering programme. Those are direct interventions to help systems get back on their feet and make the necessary improvements in performance.

Fifthly, we are providing targeted, clinically-led support to 19 of the most pressured hospital sites across the country, to help long waits in A&E and avoidable admissions over winter. Those measures are in addition to the aforementioned meetings that I hold with NHS England and UKHSA every fortnight. I am chairing every one of those meetings to ensure that we identify risks as soon as they arise, while supporting NHS England to mitigate them.

The party of the hon. Member for North Shropshire has called on the Government to set up a winter taskforce to prepare for an NHS winter crisis. Some might describe what we are doing as a taskforce; I actually think that is my job and the Secretary of State’s job, which, as I have outlined, is why we meet regularly with NHSE. I know that the hon. Member and others are sincere in their efforts to be constructive. I am happy to take away any specific suggestions about what we are not doing to help the NHS, because we all want the system to work well.

[Dr Chambers]

There has been no mention of increasing social care packages. Today, I spoke to the CEO of Hampshire hospitals trust, which runs Winchester hospital, and she said the single biggest thing that would make a difference over winter for that hospital, and probably every other one in the country, would be increasing the number of social care packages and ensuring that those well enough to leave hospital can be treated and cared for elsewhere. Why is that not the main focus of the winter measures that the Minister is talking about?

[Karin Smyth]

I will come on to social care, but I will make the broader point that every system is different, and the pressures in every system are different. Some systems suffer worse from poorer levels of primary or community care. Others, particularly those across borders, struggle with discharges and packages of care. One thing I am keen to do, and we are doing it, is try to understand the different drivers of performance in different parts of the system. I think we all have a role to play in that.

I very much support constructive advice from local Members of Parliament, in consultation with their local trusts, about the real drivers in their systems, because we know that some systems are performing much better. We as a new Government want to address that issue, to ensure that taxpayers’ money is being directed to the best place to make the system work better. That is something for the hon. Member for Winchester to take back. The flow is affected for different reasons in different parts of the system.

Several hon. Members have mentioned vaccinations. A key part of winter planning is the annual vaccination campaign, which began on 3 October. I thank the hon. Member for North Norfolk (Steff Aquarone), the hon. Member for Winchester and the Opposition spokesperson, the hon. Member for Meriden and Solihull East, for mentioning their support for vaccination programmes, which is absolutely welcome.

People talk about verifying the figures, but my understanding—I am happy to be corrected—is that we cannot verify the actual figures now. We have started different vaccination rates at different times, so the figures are not directly comparable. We will not really know that until the year works through, which I think people understand. It is too early in the vaccination season to draw firm conclusions, but we all have a role to play in driving and encouraging people to uptake vaccinations across the piece. I recently visited a local hospital in my city of Bristol which has staff hubs and encourages staff to go into the clinics. All Members’ efforts to help with that is really helpful. Vaccination programmes play an essential role in protecting people, particularly the elderly, children and the clinically vulnerable from serious illness during the winter months and in relieving pressures on hospitals and the wider system.

Data from the UK Health Security Agency shows that last year people who received a covid vaccine were around 45% less likely to be admitted to hospital compared with those who did not receive one. That is why we are delivering our usual campaigns for covid and flu for the clinically vulnerable in addition to the RSV work that is going on.

With regard to elective activity, for patients who are referred to a hospital we want to do everything we can to bring down waiting lists, which stood at over 7.5 million in August. The NHS is prioritising patient safety, urgent and cancer care and will continue to do its best to maintain appointments and elective procedures by separating elective care facilities and diagnostics wherever possible. In the longer term, we are going to return to 92% of patients waiting no longer than 18 weeks from referral to treatment in our first term, a standard that has not been met consistently for patients for a decade.

Our hospitals do not operate in isolation. Improving resilience across the whole system, including social care, is essential to winter planning. On 17 September we wrote to all local authorities setting out our priorities for improving resilience across social care ahead of winter, emphasising the importance of close partnerships and joint planning between the NHS and local authorities. We want people to have fair access to locally delivered services that start at home and support them to live independently for as long as possible. That will include building bridges between the NHS and social care services, getting people home from hospital as soon as they are ready, and providing much-needed support to families and friends who are involved in a loved one’s care. We will also work to ensure that people are not stuck in hospital beds when they are well enough to go home.

We cannot forget that the backbone of social care is carers. We have made it clear to all local health and care systems that they must continue to support people providing care for their family and friends throughout the winter. I am sure all hon. Members will join me in supporting the Chancellor’s Budget announcement today to support our carers more widely. We want to make sure that carers can access the support they need to look after their own health and wellbeing, not just that of the people they care for. The better care fund includes funding that can be used for short breaks and respite services for carers. The Government are clear that people who draw on care and support, and their families and carers, should be closely involved in decisions about their care. However, in the long term we clearly need reform. That is why the Secretary of State has called for a new national consensus on social care.

The Government are committed to building a national care service. My hon. Friend the Minister for Care is introducing the first ever fair pay agreement for care workers. Again, we have seen today our commitment to further support carers with improvements to carer’s allowance. That is a start, but we know we have a long way to go.

We are working radically to reform the NHS through the 10-year plan, building a health service that is fit for the future and ready to face every winter confidently. Lord Darzi gave us the diagnosis; the cure can be found in shifting the NHS from treatment to prevention, hospital to home and analogue to digital. That is why last week we launched an extensive engagement exercise with the public, staff and stakeholders to inform that plan. Some right hon. and hon. Members might be keen to see some of the public’s wilder ideas, perhaps, but alongside some of those we have already had many considered and thoughtful responses, and we look forward to outlining our specific plans in the spring.

With regard to the point made by the hon. Member for Strangford (Jim Shannon) about individual training and bursaries and the large number of suggestions about the important issue of recruiting and retaining our staff, we will look closely at the long-term workforce plan—we are already doing that. We are open to suggestions. We need to build a workforce for the future that lines up with our three shifts. It will be a tough process to get right and to keep up with modern technology, but all those ideas will inform that.

I commend the hon. Member for North Shropshire for securing the debate today and colleagues for shining a spotlight on the difficulties that our constituents face. I hope colleagues are reassured. As someone who has worked on winter planning in the NHS, I am fully aware of the challenges that we face. That is why we have taken a strong grip of it from the get-go. I know we cannot go on as we have done for the past 14 years, limping from one winter crisis to the next, improvising and making do with sticking plasters. The Government are winter-proofing the NHS with long-term reform, but until that day we will put every hand on deck to tackle the problems as they arise this winter.

Diabetes Treatments

Karin Smyth Excerpts

Tuesday 29th October 2024 Westminster Hall

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairmanship, Mrs Harris. I welcome the hon. Member for South Northamptonshire (Sarah Bool) to this place, as I have not had a chance to do that. I thank her for securing the debate and sharing her own personal experience. She spoke powerfully about her fear, disbelief and sadness at her own diagnosis.

More than 4.9 million people in the UK have diabetes and 2 million people are now at risk of type 2 diabetes. The impact on the health and wellbeing of the nation and on the lives of people with diabetes and their families cannot be overstated. The hon. Lady has put a superb case this morning. A central mission of this Government is to build a health service and care system fit for the future. As part of that, tackling preventable ill health such as type 2 diabetes is crucial. At the same time, we want to ensure that people with types 1 and 2 diabetes receive the best possible care so that they can live healthier lives wherever they live in the United Kingdom.

As the hon. Member for South Northamptonshire mentioned, a central factor to people with diabetes living well is ensuring that they have access to annual diabetes reviews that cover the eight processes recommended by NICE. Annual diabetic reviews are associated with reduced emergency admissions, amputations, retinopathy and mortality. However, in 2019 only 42% of people with type 1 diabetes received all eight health checks, and that figure dropped significantly during the covid-19 pandemic. The NHS has worked hard to recover these services, and the proportion of people with type 1 and type 2 diabetes receiving all eight care processes reached 43.3% and 62.3% respectively in 2023-24. Although that is an improvement, in order to drive faster uptake the NHS will invest £14.5 million over the next two years to support up to 140,000 people aged between 18 and 39 to receive additional tailored health checks from healthcare staff. That will include support to help break down any stigma associated with the disease and support people with diabetes management through blood sugar-level control, weight management and cardiovascular risk minimisation.

I want to draw attention to what the hon. Lady said about stigma, because it is important. My best friend from university was diagnosed in her early 20s, which was some time ago—she will not thank me for mentioning that. I have family and constituents who have type 1, and I have learnt a lot from them about how important it is to look after oneself and get the care that one needs. I also commend Baroness May and Sir George Howarth. They were a formidable duo in Parliament, raising awareness of what is possible. They were both great servants of their respective parties, and I know they will continue that work.

Technology also plays a critical role in helping people with diabetes to live healthier lives, and I am pleased to hear of the personal impact a hybrid closed loop system has had on the hon. Member’s life. As many will be aware, NICE has made recommendations on offering real-time continuous glucose monitoring and hybrid closed loop technology to adults and children with type 1 and type 2 diabetes. The NHS is making progress, with over 65% of people with type 1 diabetes using glucose monitoring to help manage their condition, and I expect to see similar rapid progress for people with type 2 diabetes.

Following NICE’s final guidance in December 2023 on HCL systems, NHS England has developed a five-year national strategy with guidance for NHS providers on a phased uptake for delivering this life-changing technology to eligible diabetes patients. I am sure the hon. Member and others will be watching that roll-out closely. It started this April with an initial focus on children, young people, pregnant women or those planning to become pregnant, and adults already using pumps who want to transition to a HCL system. The longer implementation period is because of a need to build essential workforce competencies in specialist adult services. To ensure that patients are safe, NHS trusts should only provide HCLs if they have access to specialist, trained clinical staff experienced in providing insulin pumps and continuous glucose monitors for type 1 diabetes. I know that waiting to access this technology is causing many people distress, and I assure the hon. Member that NHS progress in delivering these technologies is a matter of importance to this Government.

I also thank the hon. Member for raising the important issue of type 1 and disordered eating. NHS England has provided funding for eight integrated care boards to support the development and establishment of type 1 disordered eating services in every NHS region. NHS England is drawing on learning from the existing services, other emerging evidence and the findings of a recent parliamentary inquiry to ensure that all areas of the country are supported to improve care for those identified as having type 1 disordered eating.

On type 2 diabetes, the hon. Member expressed concerns about access to GLP-1 medications, such as Ozempic. Following intensive work with industry, the broad supply position for GLP-1 medications in the United Kingdom has improved. However, global supply issues remain for specific medicines, including Ozempic. We continue to work closely with manufacturers and others in the supply chain to help ensure the continued supply of GLP-1 receptor agnostics for UK patients, and to resolve the remaining supply issues as quickly as possible, for example by asking suppliers to expedite deliveries.

I now turn to prevention and to the support available for people to put their type 2 diabetes into remission, which, as the hon. Lady outlined, is possible. In fact, I canvassed somebody last weekend who was very proud of their ability to do that. It is great work. Lord Darzi’s report on the NHS, which was published last month, noted the worrying increase in the prevalence of people with type 2 diabetes and the necessity of prevention.

The prevention of diseases, including diabetes, is a priority for this Government. The Healthier You NHS diabetes prevention programme supports people at risk of developing type 2 diabetes to make lifestyle changes, either through face-to -ace group programmes or digital services. The programme reduces the risk of type 2 diabetes by 40%. The programme has also been working to raise awareness among the diabetes healthcare professional community about the growing numbers of children and young adults with type 2 diabetes, and we have heard about that today.

Healthcare professionals need to understand the more aggressive nature of early onset type 2 diabetes, compared with older onset type 2 diabetes, to support earlier diagnosis. Further, given the inequalities in who develops type 2 diabetes and the poorer outcomes for those of south Asian and black ethnicity, which were also mentioned by the hon. Member, the NHS has established a focused engagement campaign, using social media and more traditional approaches to raise awareness and boost the uptake from those groups.

Living with type 2 diabetes is not inevitable if early action is taken to live a healthier life. As the hon. Member said, the NHS type 2 diabetes path to remission programme is a joint initiative between NHS England and Diabetes UK. It provides a low calorie diet and support to people who have been recently diagnosed with type 2 diabetes who are living with obesity or are overweight. This year, the programme has been expanded to make it available across all England, enabling more people to benefit and to recover from type 2 diabetes.

The hon. Member asked specifically about the ELSA study, which I understand is recruiting 20,000 children in the UK, to better understand the potential benefits of screening for type 1 diabetes. I understand that the University of Bristol, in my home city, is also undertaking a similar study, looking at the risk of type 1 diabetes in adults. The Government look forward to seeing the outcome of both of those studies, to help inform future policy making.

By moving from sickness to prevention, the Government want to shorten the amount of time people spend in ill health and prevent illnesses before they happen. That is one of the goals of reforming the NHS, which is part of the Government’s 10-year plan. I know that the hon. Lady will contribute to the debate in the rest of this Parliament.

Question put and agreed to.

Supply of Radioisotopes

Karin Smyth Excerpts

Monday 28th October 2024 Written Statements

[The Minister for Secondary Care (Karin Smyth)]

I am today updating the House on the severe shortage of radioisotopes that the UK is facing. The affected radioisotopes are mainly used for diagnosing cancers, including prostate and breast cancer. It is also used for imaging of organ function in scans, including for the heart. Despite efforts by my Department and NHS England to limit the negative impacts of this shortage, there will be delays to patient access to services relying on the impacted radioisotopes, including cancellations.

This shortage is due to a temporary reduction in the production of molybdenum-99 which is used to generate technetium-99m. The radioisotope technetium-99m is used safely for diagnostics in the NHS. This issue is impacting not only the UK, but countries across Europe, and worldwide.

The shortage of molybdenum-99 is caused by a sudden global disruption of manufacturing capacity, with a number of the nuclear reactors used to produce these elements being out of service. There are six trusted research reactors globally for the supply of molybdenum-99, none of which are in the UK. Some of these reactors are currently out of service to allow for critical repair work; this is essential work necessary for the safe running of the research reactors. Two of the impacted reactors are expected to restart production during the second week of November, with deliveries from these reactors expected to resume in mid-November. My Department, together with relevant experts, is working closely with suppliers to support the process to restart the affected reactors as soon as possible.

There will remain a significantly constrained supply of these radioisotopes to the UK from the remaining reactors. Radioisotopes give off radiation and undergo a process of decay, which means they cannot be stored or kept in reserve. Our priority is to minimise the impact on patients as much as possible. Therefore, my Department is working closely with suppliers, clinical experts, NHS England and devolved Governments to support the allocation of deliveries and ensure there is equitable and fair access across the UK to the constrained supply of stock that is available. NHS England is supporting trusts and hospitals to share available supply and ensure that critical patients are given priority. Guidance is being issued to ensure that patients with the most critical need are prioritised. If any patient is concerned about their treatment, they should discuss this with their clinician at the earliest opportunity.

I know how difficult this will be for affected patients while we face this supply issue. This issue is different in nature to normal supply chain problems due to the unique challenges radioisotope shortages present. My Department is working closely with suppliers and relevant experts to resolve the supply issue as soon as possible. I will continue to keep Parliament updated on our progress to resolve this severe shortage.

[HCWS170]

Point of Care Medicines Manufacture Regulations

Karin Smyth Excerpts

Tuesday 22nd October 2024 Written Statements

[The Minister for Secondary Care (Karin Smyth)]

I am pleased to announce that the draft Human Medicines (Amendment) (Modular Manufacture and Point of Care) Regulations 2024 were laid before Parliament yesterday. When approved by Parliament, this instrument will create a new regulatory framework for innovative manufacturing methods for medicines that must be made near the patient, innovative medicines manufactured at the point of care, and modular manufacturing, where products are manufactured in modular, relocatable units.

The UK will be the first country worldwide to introduce such a regulatory framework. These regulatory changes will support the development of medicines at the forefront of technology, enable patient access to pioneering medicines and help move treatment closer to the patient.

Point of care manufactured products are often highly personalised, such as cell or gene therapies, 3D-printed medicines or treatments derived from a patient’s own blood. These products can have extremely short shelf lives, sometimes as brief as an hour or even a few minutes. This requires manufacturing and supply either at the point of care or close to where the patient is being treated. This could include in hospital wards, operating theatres, community health centres or even the patient’s home.

The current regulations are not geared for manufacturing at multiple different sites across the country in this way, and current regulatory barriers would make such manufacture complicated and burdensome. Current regulations also limit other innovative manufacturing models, such as modular, where products need to be manufactured in relocatable units, for example where cancer biopsies and blood-derived components are taken from a patient and sent to a local manufacturing site to manufacture a personalised cancer vaccine specific to that patient’s disease.

Many of these technologies are currently in early development. Providing regulatory clarity now will enable new products and manufacturing approaches to be developed. A tailored framework will ensure that these novel medicines meet the same rigorous standards of safety, quality and efficacy as more traditional treatments, while removing barriers to using innovative manufacturing methods.

The new framework will bring a range of benefits to:

Patients and carers—who will benefit from access to new and more personal treatments in a timely and more convenient manner with the potential for less travel and time in hospitals,

Healthcare professionals—by providing a greater range and more effective treatment options and improving patients’ response to treatment, and

Innovators—by providing clear regulatory expectations and enabling speedier product development.

This instrument follows a public consultation that gained feedback from a range of individuals and organisations across the UK and internationally. The overwhelming majority of responses were positive, with 91% of respondents agreeing that a new framework was required and 94% agreeing with the framework proposed.

The regulations, along with the associated explanatory memorandum and impact assessment, have been published on gov.uk.

[HCWS152]

Access to Primary Healthcare

Karin Smyth Excerpts

Wednesday 16th October 2024 Commons Chamber

[The Minister for Secondary Care (Karin Smyth)]

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

“; welcomes the urgency with which the new Government commissioned Lord Darzi to conduct an independent investigation of the NHS in England; recognises that within weeks of taking office the Government invested £82 million to recruit 1,000 newly qualified GPs; notes the Government commitment to tackle the dental crisis by providing 700,000 urgent dental appointments and recruiting new dentists to the areas that need them; approves the Government’s commitment to expand the role of pharmacies and better utilise the skills of pharmacists and pharmacy technicians; and welcomes the Government’s commitment to further reduce unnecessary bureaucracy as care shifts from hospital to community.”

I recognise that many people want to speak, so I will be as brief as possible. I begin by thanking the hon. Member for North Shropshire (Helen Morgan) for starting this debate. I think she spoke for us all when she said that she spent a lot of time looking for her glasses— I recently decided to go for the varifocal option just to avoid that problem. She also spoke for us all when she said that we all know how great it is when primary care is there for us. I am proud to have worked with primary care across the piece in south Bristol for many years. Although the hon. Lady and I are on opposite sides of the Chamber, I think we can agree that the last Government broke primary care at the same time as they were breaking the NHS.

Throughout my time in opposition, and in my first three months in government, I simply have not met or spoken to a GP, a pharmacist, a dentist or, indeed, anyone else working in primary care who has said, “Everything is going swimmingly. My patients are happy, and this is exactly what I signed up for.” Lord Darzi’s review tells the same story and sets out an enormous charge sheet, and we still have not heard whether the Conservative party agrees or, indeed, whether it will apologise. The list is far too long to repeat in full. Hospital workforces and budgets have shot up, yet full-time equivalent GP numbers have been allowed to shrink by over 1,500 over the last seven years.

Promises to shift resources to the community have been repeatedly broken, and our primary care estate is not fit for purpose. Shockingly, one in five general practice buildings is older than the NHS itself.

[Daisy Cooper (St Albans) (LD)]

The Minister may be aware that I lobbied Health and Treasury Ministers in the previous Government for the best part of a year and a half to review outdated Treasury rules that prevent GP practices that want to move from staying within a city centre—the outdated rules force them to move to ring-road locations, away from the populations they serve. Will the Minister look at this issue with fresh eyes, with her new glasses, and work with Treasury colleagues to review these outdated rules?

[Karin Smyth]

I thank the hon. Lady for her assiduous work in opposition. Looking at the capital estate is one of my favourite new responsibilities, and our commitment to a neighbourhood service means that we need to bring services together. We need to look at this across the piece, to make sure that primary care is provided where it is needed. We often hear about hard-to-reach groups, but I do not think they are that hard to reach. Frankly, services are sometimes located in the wrong area. One of our key commitments is to shift services into communities, and the neighbourhood service programme is part of that.

Just three in 10 NHS dentists are accepting new adult patients, and geographical inequalities are vast. More than 1,200 pharmacies have shut their doors for good since 2017. Again, the record speaks for itself: public satisfaction with general practice has fallen from 80% in 2009 to just 35% last year. If there is any reason why the Conservative Benches are empty, it is because dissatisfaction with access to primary care is so stark, as we learned in July’s general election.

It is absolutely clear that primary care is broken, but NHS staff working in primary care did not break it; the last Government did. They cut funding for the community pharmacy contract, they failed to incentivise enough dentists to perform NHS work, and they pursued a disastrous top-down reorganisation of the NHS, with which we are still living.

The last Government might have broken the NHS, but it is not beaten. NHS staff remain as passionate, dedicated and skilful as ever, and this Government will work in lockstep with them, their counterparts in social care and local partners across the country to fix the NHS.

[Christine Jardine (Edinburgh West) (LD)]

Will the Minister give way?

[Karin Smyth]

I am tempted, but I know that many of the hon. Lady’s colleagues want to speak, and I am sure she is on the list.

Fixing the NHS will take years of discipline and hard work, and we are in this for the long haul. However, we must first clean up the mess we inherited, and that work has begun in earnest. We have found the funding to recruit an extra 1,000 GPs this year as our first step towards fixing the NHS’s front door and making the system more flexible.

[Dr Luke Evans (Hinckley and Bosworth) (Con)]

Will the Minister give way?

[Karin Smyth]

Yes, as that will be one from each side of the aisle.

[Dr Evans]

One of the keys to delivery is the GP partnership model, which is the mechanism by which they are set up. The Secretary of State, who is now in his place, said in 2023 that he wanted to phase out the GP partnership model, although he later reneged on that position. It would be interesting to hear what the Government now perceive to be the best model for delivering primary care, as that is really important for GP partners.

[Karin Smyth]

I wish the hon. Gentleman well with his own access to a GP at the moment. We are committed to working with the profession on the best way to organise primary care. The critical point is that primary care, however it is organised in neighbourhoods, is there for our constituents when they need it. It is not there now. The model is not working and has not worked over a period of time. It has merits, as we have said, and we are continuing to talk to people. I have worked in the sector for a number of years, so I understand the point the hon. Gentleman makes.

[Andrew George (St Ives) (LD)]

On that point, will the Minister give way?

[Karin Smyth]

No, I want to move on. I will take one more intervention from the Government Benches at some point and then it is all fair, but I want to allow time for hon. Members to speak.

In our first week, we pledged to increase the proportion of NHS resources going into primary care, and in our first month, the Government made a down payment on that pledge, providing GP practices with their biggest funding increase in years. But we are not just increasing funding; we are also cutting the red tape that stops many staff doing their jobs.

Some GP practices currently have to fill in more than 150 different forms to refer patients into secondary care services. They are spending as much as 20% of their time on work created by poor communications with their secondary care colleagues. That is totally nonsensical in 2024 and it has to change.

Time spent doing needless paperwork and bureaucracy means appointments lost for patients, which is why we have launched a red tape challenge to bulldoze bureaucracy and free up GPs to deliver more appointments. It will be led by Claire Fuller and Stella Vig, established leaders in primary and secondary care. They will check with staff what is working well and what needs to change, so we can take the best of the NHS to the rest of the NHS.

Initiatives like Consultant Connect in south London allow GPs to talk to mental health consultants in real time, reducing the number of referrals they have to make by 40%. Delivered across the country, such schemes could save thousands of hours of time and create thousands of new appointments—that is what our red tape challenge is all about.

We want to help patients see specialists faster. Starting in November, 111 online will pilot directly referring women with a worrying lump to a breast clinic. That means faster diagnosis for cancer patients and more GP appointments freed up, which is better for patients and better for GPs.

On dentistry, as the hon. Member for North Shropshire outlined, we inherited an NHS dentistry system in disrepair thanks to 14 years of chaos, failure and neglect. As we have to keep reminding Conservative Members, it is a national scandal that tooth decay is the leading cause of hospital admission for five to nine-year-olds. We all see that in our constituencies. The last Government broke their relationship with the British Dental Association, as they broke so many relationships. During the election campaign, we pledged to meet the BDA immediately upon taking office to start rebuilding the relationship, and that is exactly what we did.

The BDA is right that the last Government’s dentistry recovery plan did not go far enough. We are keeping parts of it that are the right solutions, including the golden hello and some other measures, but we want to go further to deliver an NHS rescue plan that gets dentistry back on its feet. We are working around the clock to end the truly Dickensian tooth decay that is blighting our children. As well as our additional urgent appointments for all ages, we will work with local authorities to introduce supervised tooth brushing for three to five-year-olds in our most deprived communities. We will see the difference getting them into healthy habits can make, protecting their teeth from decay and ending the national scandal the last Government presided over.

On pharmacy, previous Governments dithered and delayed, failing to find a sustainable and long-term funding solution. NHS England is working with the sector to assess the cost of providing pharmaceutical services, and we look forward to seeing its outcome. Consultation around this year’s funding and contractual arrangements with Community Pharmacy England did not make it over the line before the election was called, so we are looking at that as a matter of urgency.

We want to continue to make it easier for pharmacists to take referrals and support people with common conditions, using prescribing skills to treat a wider range of conditions and patients. Pharmacists are highly skilled people in our communities. Allowing patients to get the care they need in the community, saving time and freeing up GP appointments by using the skills of pharmacists, will be really helpful for the wider system.

Those are our first steps. Primary care is central to the three big shifts that underpin our ten-year plan to make the NHS fit for the future, taking it from analogue to digital, from sickness to prevention, and from hospital to community.

We will soon begin a public consultation that will be the biggest listening exercise in NHS history. I look forward to taking part in that and I urge all right hon. and hon. Members, their constituents, and staff across primary care to tell us what is working and what needs to change. We will use their responses to take the best of the NHS to the rest of the NHS and build a neighbourhood health service.

Technology will help doctors, dentists and pharmacists meet demand for same-day appointments, giving patients a digital front door to end the 8 am scramble. Big data will end the cruel postcode lottery of health inequality, so that we can take screening, checks and care directly to the communities that need it most, intervening early to prevent ill health and deterioration. We want colleagues from across primary care to come together with their partners in social care and mental health to work in lockstep, as one team, to treat patients in the comfort of their own homes, which is where those patients want to be. That is the neighbourhood health service that we want to build. That is the future that our constituents want to see.

In the interests of time, Madam Deputy Speaker, I will conclude. Our constituents were let down by the previous Government. They were let down by broken promises, underfunding and a failure to listen to patients and staff. We will repair the damage. We have already begun investing in GPs and pharmacies to fix what is broken. We will cut the red tape, speed up treatment, and build a neighbourhood health service that works for everyone. The NHS may be broken, but it is not beaten. We are determined to rebuild it for our people, our communities and our country.

Oral Answers to Questions

Karin Smyth Excerpts

Tuesday 15th October 2024 Commons Chamber

[Sir Edward Leigh (Gainsborough) (Con)]

1. What steps his Department plans to take to improve health outcomes in the east midlands.

[The Minister for Secondary Care (Karin Smyth)]

Lord Darzi’s report concluded that the health service is in a critical condition across the country, including in the east midlands, where healthy life expectancy has declined in the past decade. Waiting lists in the region stand at slightly below the national average for 18-week waits, at 57% compared to the national average of 58%.

[Sir Edward Leigh]

With two thirds of people having to wait more than four hours at Lincoln County hospital’s A&E department and with horror stories from my constituents of people waiting up to 24 hours, does the Minister understand that if we are to save the NHS and give people the timely appointments they need, we must unleash the full power of the private sector?

[Karin Smyth]

I thank the right hon. Gentleman for helping to underline the shocking inheritance from the previous Government. He is absolutely right. We are committed to cutting waiting times and serving constituents, like mine, by delivering the long-term reform the NHS desperately needs. The Government are committed to the funding model. We are not going to change it. He tries this every time, but we are committed to the funding model as it exists.

[Matt Western (Warwick and Leamington) (Lab)]

A really important part of improving health outcomes in the east midlands, and across the country, is the use of diagnostics. The Rosalind Franklin laboratory, which was set up in my constituency, was closed down just a few months ago at a cost of £0.6 billion. Does my hon. Friend agree that one of the most important things we could do is to restore good quality diagnostics to our NHS?

[Karin Smyth]

My hon. Friend is absolutely right. We are committed to improving diagnostics as part of our reform of the health sector. Analysis of waiting lists shows that 20% of people will end up with a hospital admission, most as a day case. To improve waiting times, the focus must be on early prevention, diagnostics and consultant review at an early stage.

[Mike Tapp (Dover and Deal) (Lab)]

2. What assessment his Department has made of the effectiveness of NHS urgent and emergency care services.

[The Minister for Secondary Care (Karin Smyth)]

The recent independent report by Lord Darzi makes it absolutely clear that urgent and emergency care services are also struggling, with the latest data published last week showing that one in 10 patients spend over 12 hours in A&E. We are committed to returning to service standards that patients rightly expect through our ambitious 10-year plan to reform the health service.

[Mike Tapp]

In September 2021, Victoria hospital in Deal lost provision for blood testing. After a long campaign by residents, it was agreed that it would return. However, that has stalled in the tendering process. Will the Minister meet me to discuss how we can move this forward?

[Karin Smyth]

I commend my hon. Friend for championing this issue on behalf of his constituents. I understand that he has raised it with the chief executive officer of his local trust. He will appreciate that commissioning decisions are a matter for the local integrated care board, in this case Kent and Medway ICB, but I am, of course, very happy to meet him to discuss it further.

[Andrew George (St Ives) (LD)]

I wish the Minister well in her efforts to address this issue, because it is extremely serious. There are very often more than 20 ambulances queueing outside Treliske hospital, which has a serious impact on expectations for patients. Will the Minister please look at the potential for urgent treatment centres to take pressure away from emergency departments, such as the urgent treatment centre at West Cornwall hospital in Penzance, which really needs to be re-established on a 24/7 basis? That would make a real impact.

[Karin Smyth]

I thank the hon. Gentleman for his good wishes. It is, indeed, a huge task we have before us. We will maintain ambulance capacity throughout this winter. He makes a valuable point about alternative models to hospital admissions and treatment in the community. That is a matter for the local ICB, as I know he knows. It needs to look at which model is the best fit, particularly in rural areas, to reduce the pressure on frontline A&E services.

[Paula Barker (Liverpool Wavertree) (Lab)]

Intermediate care for people facing homelessness, which is recommended by the National Institute for Health and Care Excellence, can reduce rough sleeping by around 70%. That is life-changing for people who have been sleeping rough and it plays a significant role in relieving pressure on hospitals. A recent evaluation of intermediate care for people facing homelessness in one county in England found a 56% reduction in A&E visits and a 67% reduction in emergency admissions. What exists currently is a postcode lottery. How can we embed the NICE approach in every integrated care system across England?

[Karin Smyth]

My hon. Friend has highlighted an issue that is often overlooked. Homelessness has risen to shocking levels in the last 14 years. When it was addressed under the last Labour Government, people were moved off the streets, and there was decent care at the front end of the hospital system and support in the community. My hon. Friend is right: there are good examples across the country, and we would like to see them embedded as part of our overall goal, across Government, of reducing the scourge of homelessness in society and once again supporting the front end of the health service.

[Alison Bennett (Mid Sussex) (LD)]

I recently met representatives of the Royal College of Emergency Medicine, who told me that the inadequate state of social care was resulting in the deterioration of people’s physical health, leading to more presentations at emergency departments. Does the Minister agree that if social care were properly funded, pressure on our hospitals would be reduced?

[Karin Smyth]

What we see at the front end of the system is a result of the deterioration throughout the system, and the flow of patients from the community, through discharge and, indeed, through social care. Our ambitious 10-year plan will involve examining the entire patient pathway to ensure that care is provided in the community, closer to home. Prevention is a key part of that, as is the look that we are taking at social care.

[Greg Smith (Mid Buckinghamshire) (Con)]

3. What steps he plans to take to reform adult social care.

--- Later in debate ---

[Blake Stephenson (Mid Bedfordshire) (Con)]

T3. I welcome all efforts to increase the number of GPs throughout England. Residents in new and growing towns such as Wixams in Mid Bedfordshire need a GP surgery. My local councils have been told that they need to put up the capital to deliver one, causing concern about cash flow and borrowing costs. Will the Minister meet me to discuss a new capital investment programme to ensure that residents in new towns such as Wixams do not have to wait for developer contributions to get the services they need?

[The Minister for Secondary Care (Karin Smyth)]

As Lord Darzi outlined, capital development in the NHS is shocking, with a backlog of £11 billion in maintenance. I would be happy to meet the hon. Member to discuss his problem.

[Ruth Jones (Newport West and Islwyn) (Lab)]

T5. Alan Petersen is a senior pharmacist in my constituency. He tells me that pharmacies have experienced high volatility in drugs pricing and big increases in bills in recent years. At the same time, they are expected to do far more in direct consultation with the public. Given the UK Government’s jurisdiction over funding dispensing services in England and Wales, when do they plan to review pharmacy funding?

--- Later in debate ---

[Rebecca Long Bailey (Salford) (Ind)]

T7. Ingleside, the only birthing centre in the city of Salford, was temporarily closed in 2022 amid an acute midwifery staffing deficit across Greater Manchester. Will the Minister be kind enough to meet me to discuss what he can do to ensure that that unit reopens safely as soon as possible?

[Karin Smyth]

My hon. Friend is right to raise the crisis of midwifery services. We have already had debates in Westminster Hall about this, and the issue affects the entire country. It is a priority for this Government, and I am of course happy to meet her to discuss her constituency issue.

[Olly Glover (Didcot and Wantage) (LD)]

T8. Lord Darzi’s report highlighted the importance of local focus and alignment to co-ordinating local services and improving health, contributing to reduced hospital admissions. In Oxfordshire, the integrated care board is proposing to remove Oxfordshire’s dedicated place director. Will the Secretary of State give his support to place- based roles to maintain local authority alignment, as recommended in Lord Darzi’s report?

Baby Loss Certificates Extension

Karin Smyth Excerpts

Thursday 10th October 2024 Written Statements

[The Minister for Secondary Care (Karin Smyth)]

My hon. Friend the Under-Secretary of State for Patient Safety, Women’s Health and Mental Health (Baroness Merron) has made the following statement:

I wish to inform the House that an extension to the baby loss certificate service has been launched.

The baby loss certificate service is a voluntary scheme to enable parents who have experienced a pre-24 weeks baby or pregnancy loss to record and receive a certificate to provide recognition of their loss if they wish to do so.

Until this extension, this service was only open to parents who experienced a loss since 1 September 2018. We are removing this eligibility restriction so that the service is now available for all historic losses, with no backdate, as well as future losses.

The baby loss certificate service is not a compulsory certificate; it will remain the choice of all parents how they wish to manage the difficult time around a loss. Its introduction was a recommendation from the independent pregnancy loss review published in July 2023, which examined the impact on families of not being able to formally register a baby or pregnancy loss before 24 weeks gestation. So far, over 50,000 certificates have been issued.

Following this announcement, eligibility will now be:

Either parent (i.e., mothers, fathers, surrogates) who have experienced a pregnancy loss through miscarriage, ectopic/molar pregnancy or termination for medical reasons at less than 24 weeks gestation (i.e. up to 23 weeks plus six days gestation), or pre-28 week baby loss (i.e. up to 27 weeks plus six days gestation) for losses prior to October 1992.

Parents resident in England.

Parents who have experienced a historic pregnancy loss or experience a future pregnancy loss.

Parents aged 16 years and over.

Ensuring this important service is available for all losses, regardless of how long ago the loss was or when it may occur in the future, demonstrates this Government’s commitment to delivering personalised and compassionate care for women, and support for parents who have suffered a baby loss.

[HCWS123]

Maternity Services: Gloucestershire

Karin Smyth Excerpts

Wednesday 9th October 2024 Westminster Hall

[The Minister for Secondary Care (Karin Smyth)]

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

With your leave, I will start with a few words to mark Baby Loss Awareness Week. Many mums and dads across the country have suffered the heartbreak of losing a baby. Everyone deals with grief in a different way, but it has been moving to hear from parents how baby loss certificates have allowed them to process what they have gone through and have helped give them closure.

That is why this week we launched an extension to the baby loss certificate service, which is a voluntary scheme to enable parents who have experienced a pregnancy loss to record and receive a certificate to provide recognition of their loss, should they wish. Until now the service was only open to parents who had experienced a loss since 1 September 2018, but today we are removing that restriction, making the certificates available for every parent who has lost a child. We will update the House with a formal written statement shortly. The Government are committed to delivering compassionate care for women and support for parents who have suffered a baby loss. It is the right thing to do.

I think this has been a genuinely good debate. We have heard from experts—I commend the Opposition spokesperson the hon. Member for Sleaford and North Hykeham (Dr Johnson) and my hon. Friend the Member for Stroud (Dr Opher) for the work they do—and others have shared experiences. I knew that the hon. Member for Cheltenham (Max Wilkinson) would bring forward good points too, so I contacted the trust myself so that I could give the hon. Gentleman and hon. Members present my frank assessment of what is happening on the ground.

To reiterate, as of August 2024 the midwifery vacancy rate in the Gloucestershire hospitals NHS foundation trust stood at 13%—the equivalent of 32 full-time midwives. That level is high for the south-west, though roughly in line with the national average. In April 2022, the Care Quality Commission gave the trust a warning notice for the maternity service, and rated it “inadequate” a year later. In May this year, the CQC issued the section 31 notice—a severe warning that requires at minimum an immediate action and improvement plan, which, as colleagues will know, in some other settings could result in a closure. It issued that after seeing postpartum haemorrhage rates, poor foetal monitoring and high levels of agency staffing.

The hon. Member for Cheltenham and others from the area are right to be concerned. We can all agree that it is unacceptable when new mothers do not receive the highest possible standard of care. As my right hon. Friend the Secretary of State has said, we should be honest about the problems in our NHS and serious about fixing them. Maternity services are very far from where we want them to be. Childbirth should not be something that women fear or look back on with trauma. Safety is obviously paramount. As the hon. Member for Cheltenham said, it should be a special moment.

I thank the hon. Member for Thornbury and Yate (Claire Young) for sharing her experiences. I was in hospital for two weeks after having my first child, and it is a traumatic time, so the length of time she mentioned must have been very difficult. My second came out so quickly that I was in and out of hospital before we knew it. My third child, as has been mentioned, was almost delivered at home by my husband after we had chosen a home birth. He is not medically qualified, so I can tell you that the sound of the doorbell ringing for the midwives’ arrival was the best sound I have heard in my life.

To the second question asked by the hon. Member for Cheltenham, I will outline the steps the trust is taking to improve the situation. They include a new director of midwifery, an education and training midwife and a perinatal quality and governance lead. To improve retention, the new leadership has introduced a retire and return scheme and is holding monthly events for senior leadership to listen to staff and address their concerns. The trust has recruited 33 new midwifery starters since 2023, including from overseas. Ten midwives are due to start this month, with a further 10 expected in January. But there is still a gap. That is why the Aveta birthing unit and the postnatal beds at Stroud maternity will remain temporarily closed until they reach safe levels of staffing. The trust clearly felt that it could not continue those services without putting new mothers at risk, which is an impossible situation to be in.

I am pleased that the birthing unit at Stroud remains open, but the other closures have had an impact on women, their families and the local community, as has been eloquently expressed by my hon. Friend the Member for Gloucester and mentioned by my hon. Friend the Member for Thornbury and Yate. The impact goes further afield to my own city of Bristol. In addition to those measures, the trust is developing new apprenticeship schemes; building partnerships with universities, including Worcester and Oxford Brookes; and launching a midwifery attraction campaign in the autumn.

Although the trust has had positive feedback from last year’s new starters, I am pleased that it is carrying out regular assessments, as per the recommendations in the Ockenden review, to ensure that midwives have the right skills to serve the people of Gloucestershire. The turnover rate is now settling, and I know the hon. Member for Cheltenham and other colleagues will do everything they can to help convince midwives that his county is a great place to live and work. The passion for those units is very evident here today, which I am sure will be welcome to those trusts.

I know from my career in the NHS that such changes take a long time. It is too soon to make an assessment until all the new midwives have started. However, we are not waiting for the CQC to do the rounds to ensure that the picture is improving. The local maternity and neonatal systems team and the regional NHS England team are meeting with the trust on a fortnightly basis to review progress. The trust’s monthly board reports will report on progress; I know hon. Members will be watching carefully.

It is important to give the new team space to prove themselves. I am hopeful that we will see improvements in time. At a national level, whenever trusts and maternity units do not perform on our watch, we will steer them back to safer ground. That is why we are supporting Gloucestershire maternity services through the national maternity safety support programme. That means that the trust is supported by a maternity improvement adviser for midwifery and obstetrics, who helps the trust to embed the maternity improvement plan.

I know that the hon. Member for Cheltenham and others will continue to hold the trust to account, until it is delivering for women in their constituencies. I am grateful to him for obtaining this debate and giving me the chance to put the Government’s position on the record. With regard to his third question, like many trusts in this position, the trust does have the budget for establishment; it is the recruitment and retention of midwives that is the issue. Some trusts do different things with incentives; I do not know whether this trust is particularly doing that. That might be something he would wish to pick up with the trust at another time.

On more general maternity improvements, in September the CQC published a report that demonstrated how much the previous Government let down new mothers in this country. Lord Darzi’s report has shown that, despite some improvements, there is still a disgraceful inequality of outcomes for black and minority ethnic women, as we have heard again today. We will look at every recommendation in the CQC report, and if officials object to any of them, I expect to hear a very good reason why.

There is ongoing work to improve maternity and neonatal services across England. The NHS put in place a three-year delivery plan to make maternity and neonatal care safer, fairer and more tailored to every new mother’s needs.

I shall now discuss the Government’s wider ambition. Choice—which was mentioned today by my hon. Friend the Member for Stroud and the hon. Member for Thornbury and Yate—is for us absolutely a key part of maternity care. As the hon. Member for Winchester said, our NHS must listen to and work with women and families on how their care is planned and received, based on what matters to them.

To get maternity care back on its feet, we need to train thousands more midwives as part of the NHS workforce plan, while encouraging experienced midwives to stay in the NHS. Many hon. Members, including the hon. Member for Cheltenham, spoke of recruiting midwives, with regard to morale and workload. That was also mentioned by the hon. Members for Tewkesbury (Cameron Thomas) and for Carshalton and Wallington (Bobby Dean). The NHS will deliver the people plan, giving a stronger focus to a modern, compassionate, inclusive culture, which absolutely has to be part of our forward look in the 10-year plan.

We will ensure that trusts failing on maternity care are robustly supported into rapid improvement. We are setting an explicit target to close the black and Asian maternity mortality gap. NHS England is on the right track, boosting the workforce through training, apprenticeships, postgraduate conversion, return to midwifery programmes and international recruitment. I have been clear that the Government will build on those programmes, not replace them.

Finally, I want to end by restating our unwavering commitment to maternity services across the nation, including in Gloucestershire. We are actively working to improve staffing levels and are planning for the future needs of Gloucestershire’s maternity services. I say to the constituents of the hon. Member for Cheltenham that I hear his concerns and completely understand them, and I will work with him to set this right.

The Opposition spokesperson is an assiduous writer, and I have answered a number of her letters, but if I have not responded to particular points from the previous debate before recess, I apologise, and will ensure that that happens after this debate. She has raised important questions.

In the constituency of the hon. Member for Cheltenham and in mine, women have had to bear the brunt of inaction for the past 14 years, but this Government will deliver for women, not just in the south-west but in the country as a whole.

[Sir Christopher Chope (in the Chair)]

I call Max Wilkinson to respond to this very well-informed debate.

NHS Performance: Darzi Investigation

Karin Smyth Excerpts

Monday 7th October 2024 Commons Chamber

[The Minister for Secondary Care (Karin Smyth)]

I thank all Members for their contributions to this debate. We should all be grateful to Lord Darzi for his rapid and comprehensive review, although we still do not seem to know at the end of this debate whether the Opposition agree with the diagnosis or not. Essentially, it is evidence of their record, and they do not like it.

This has been a passionate debate with colleagues from all parts of the House addressing how 14 years of failure have damaged their constituencies, let down the people they represent and broken the NHS. Lord Darzi’s report is as breathtaking as it is distressing, whether it is discussing the chaos unleashed by Andrew Lansley’s top-down reorganisation, the plunge in productivity and patient satisfaction, the disproportionate impact of the pandemic compared with countries across the world or the failure to modernise ways of working. It beggars belief how the previous Government allowed that to happen on their watch. Behind every page of that report, we should remember the real-world suffering caused by the neglect. It is a record of missed opportunities and squandered potential.

Those things are all the more galling for me, as someone who has worked in the NHS and who still cares passionately about its survival. In fact, the reorganisation was so bad that it led me to stand for Parliament. I would not be here today, were it not for Andrew Lansley. The House can make of that what they will. When I worked for the NHS under the previous Labour Government, I saw at first hand the power of politics to improve the system. I saw a health service delivering the shortest waiting times and highest patient satisfaction in history, and since then I have seen it decline in my constituency and the effect that has had on my constituents. When the system lets them down, they have no other options. They cannot afford to go private, they do not have the assets to sell and their families are in the same boat. Health inequalities and inequality of access led me to join the health service, and the Lansley reforms drove me to become an MP. That is why I will not rest until we have completed our health mission to restore the fundamental promise of our NHS: that it will be there for all our constituents when they need it. The charge sheet is too long for me to make too many comments on it.

In the short time I have, I will address the maiden speeches in particular. I worked with my hon. Friend the Member for South Norfolk (Ben Goldsborough) in opposition. I was so delighted to hear that he had won the day after the election. He talked about the global reach of South Norfolk and in particular productivity at the University of East Anglia, which I went to as a student 40 years ago this week, astonishingly. It makes a huge contribution to the economy of South Norfolk, and I know that he will be a good champion. I wish him good luck on SEND and justice. South Norfolk is lucky to have him.

The hon. Member for Esher and Walton (Monica Harding) gave a lovely history of her constituency. She moved us all with the tragic story of the death of her constituents’ 19-year-son. She has kept her promise to that mother already in her place today.

My hon. Friend the Member for South West Norfolk (Terry Jermy) is a worthy successor to his predecessor. He rightly highlights poverty, particularly in rural areas, and he spoke so eloquently about his father, his care and sadly his death. That is an experience that many people will recognise from covid and will be moved by. I am pleased he is using that experience in this place. His dad and Councillor Thelma would be very proud of him.

My hon. Friend the Member for Gloucester (Alex McIntyre) —I am delighted to have another new Labour Member in the south-west—did a great campaign while having a young family. His passion and pride for Gloucester shone through, whether that is the Romans’ military innovation or that Viennetta comes from Gloucester, which I did not know—shame on me. He wants to achieve for all the people in the rich diversity of Gloucester.

The hon. Member for St Neots and Mid Cambridgeshire (Ian Sollom) is the first and longest-serving Member for his constituency, and long may that last. I look forward to his explaining black holes to us all.

It is not a thing, but the hon. Member for Mid Dunbartonshire (Susan Murray) certainly wins the award for suited people coming to represent their constituents. She spoke movingly about her predecessor and the cost of caring for her partner.

Finally, my hon. Friend the Member for Basingstoke (Luke Murphy) spoke movingly about his family’s hard work and dedication that led him to this place. Cromwell and Jane Austen would be very proud of his editing capabilities.

There is an old Irish joke about somebody travelling down from the city to a wedding in the countryside. He cannot remember how to get there so asks a farmer for directions. The farmer says, “I wouldn’t start from here.” None of us wants to start from here, but this is where the last Government left us, with a broken NHS, a social care system on its knees and an economy failing its people. That is why early next year the Government will publish a 10-year plan setting out how we will deliver the three big shifts that will make the NHS fit for the future.

As my right hon. Friend the Secretary of State said, the choice before us today is to reform or die. There are no quick fixes. But as Lord Darzi reminded us, the NHS’s “vital signs are strong”. We can tap into the immense reservoir of dedication and talent in our universities, life sciences sector and, above all, the NHS. Getting the NHS back on its feet will be a team effort. Working with patients and the public, alongside 1.5 million NHS staff, we will rebuild our public services, fix the foundations of our economy—

Medicines

Karin Smyth Excerpts

Monday 9th September 2024 Commons Chamber

[The Minister for Secondary Care (Karin Smyth)]

I beg to move,

That the draft Human Medicines (Amendments Relating to Naloxone and Transfers of Functions) Regulations 2024, which were laid before this House on 29 July, be approved.

I, too, congratulate you on your election, Madam Deputy Speaker; it really is a pleasure to see you in the Chair.

The draft statutory instrument will amend the Human Medicines Regulations 2012 to expand access to naloxone: a lifesaving medication that reverses the effects of an overdose from opioid drugs. In addition, the SI will keep the regulations current by updating references to Public Health England and the Health and Social Care Board, following the dissolution of those bodies.

Hon. Members will no doubt know of the devastating impact of illicit drugs. Drugs destroy lives, tear families apart and make our streets less safe. Almost 3,000 people died of drug misuse in England in 2022—the highest number since records began in 1993. Drug misuse deaths have doubled over the past 10 years, and people die from drug misuse at a tragically young age, often in their 40s. Almost half of drug misuse deaths in 2022 involved opiates such as heroin.

These deaths are avoidable. Dedicated drug treatment services provide the path to recovery, and my Department is continuing to invest in improvements to local treatment services, which have faced significant cutbacks. We also know that over half the people struggling with opiate addiction are not engaged in treatment at all. That means that significant numbers of an incredibly vulnerable population are at increased risk of accidentally overdosing and dying.

People who experience addiction often have multiple complex needs, and we know that there is a strong link between addiction and deprivation. The rate of drug misuse deaths in the most deprived areas of England is almost three times higher than in the least deprived. Nearly a third of people in treatment for drug or alcohol problems reportedly have a disability, around one in six have a housing problem, and around 70% have a mental health treatment need. Tackling this issue supports the Government’s health mission, ensuring that people can live longer, happier lives, as well as our collective efforts to break down barriers to opportunity and create a fairer society.

Naloxone is a highly effective antidote against opiate overdose. It can be administered quickly and safely by anyone in an emergency, but currently exemptions in the human medicines regulations targeted at specific providers enable supply only by drug and alcohol treatment services, which limits the reach of this lifesaving medicine. Widening the statutory framework will mean that more services and professionals are able to supply this medication. That means easier access to it for people at risk and their loved ones. In short, the legislation will save lives. We are already seeing the benefits of professionals outside the health service, such as police officers, being able to administer naloxone. North Yorkshire police have already saved seven lives since April, when naloxone was rolled out across the force.

The draft instrument proposes two key UK-wide changes to existing regulations. First, it will expand the list of services and professionals named in the regulations who are able to give out naloxone without a prescription. In short, that means that professionals such as registered nurses and probation officers will be able to provide take-home supplies of naloxone where appropriate, should they wish to do so. Secondly, we propose to establish national registration services across the whole of the United Kingdom. That will enable all other services and professionals who are unable to be named in the legislation, including housing and homelessness services, to register and procure naloxone, subject to the passage of this statutory instrument. I look forward to working with colleagues across the devolved Governments on this important issue; I thank them for their work to date, and their continued support.

I reassure hon. Members that we are not compromising on safety with these changes. This is an extremely safe and effective measure, even when administered by a layperson with no prior experience. It has an effect only if the person has taken opioids, and is already widely used across the UK and internationally. We are taking steps to mitigate any, very limited, risks associated with wider access. We will provide updated guidance for services in scope, and set out robust requirements for training and safeguarding. The new powers are enabling but not mandatory. The intention is not to create new burdens for services, but to provide an opportunity for provision based on local need. I am confident in the support for the changes across sectors, which was evident in the responses to my Department’s consultation earlier this year, over 90% of which were in support.

I recognise the long-standing calls for these changes among experts in this area. For instance, the Advisory Council on the Misuse of Drugs is an independent expert body that advises the Government on drug-related issues in the UK. In 2022, it published a review of naloxone implementation that called for more work to widen access to the medication. Similarly, Dame Carol Black’s independent review of drugs also highlighted expansion as a vital harm-reduction measure. I pay tribute to Dame Carol for the work that she has done to drive improvements in drug treatment and recovery, and express my gratitude for her continued advice and expertise.

The importance of this work only continues to increase as time goes on. Hon. Members may be aware of the growing threat posed by synthetic opioids. These synthetic drugs, such as nitazenes and fentanyl, are often more potent and more deadly. The Government are taking a range of steps to prevent the rise of these dangerous drugs in the UK, but the availability of naloxone will be vital to our ability to respond and save lives.

Addiction is not a choice. It is often fuelled by wider issues, such as trauma and housing instability. This is a complex public health issue and must be tackled as such. We must change the narrative on addiction to one that is about preventing drug use, reducing harm and enabling recovery. The changes in the legislation are simple and low risk, but have the potential to save countless lives. On that basis, I commend the draft regulations to the House.

[Madam Deputy Speaker (Judith Cummins)]

I call the shadow Minister.

--- Later in debate ---

[Karin Smyth]

This evening, I am standing in for my hon. Friend the public health Minister, who could not be here. I might offer to stand in again, such has been the rare outbreak of unanimity across this House. I know from my own experience in the sector that that is often the case with public health measures, as so much work is done in the background, and there is broad agreement on the need for prevention and the great work that has been done before. I thank Members, particularly the Opposition spokespeople, for their support this evening and their comments, which are testament to the work done by officials and by the previous Administration to get us to this point. The consultation was very well received.

I support the comments of the Opposition spokesperson, the hon. Member for Runnymede and Weybridge (Dr Spencer), about recognising World Suicide Prevention Day. Suicide, particularly among men, is something that has affected most families—most of us, I think—and it has certainly affected many people in this House, so the hon. Member is right to raise those issues. He asked about training, and I can confirm that training and data reporting requirements will be attached to this measure. That training will be required to meet some broad objectives, including the safe administration of naloxone, safe storage, and how to train someone else to handle and administer it safely. Training on its use is already well established in most parts of the country alongside naloxone provision, and each product has its own established training set out by the manufacturer. I have heard the professional points that the hon. Member has raised, and if he has any further requirements, my hon. Friend the public health Minister would be happy to write to him.

Other excellent points were made about keeping this issue under review, which we absolutely will be doing. The hon. Member for Brighton Pavilion (Siân Berry) made her points well, and they are now on the record. The Government will be looking to work on our prevention strategy across all Departments—including the Ministry of Justice, the Home Office, the Ministry of Housing, Communities and Local Government, the Department for Work and Pensions, and the Department for Education—to ensure that we take a preventive, public health-led approach to this issue. I also thank the hon. Member for South Antrim (Robin Swann), who has brought his expertise in Northern Ireland into this House for this debate. I am sure this issue will come back before the House in the future.

[Jim Shannon]

In my contribution I asked a question—which the hon. Member for South Antrim (Robin Swann) has reminded me of—about ensuring that medical staff who have the expertise to administer naloxone, but do so outside of their job, are covered and that there is no comeback against them. Could the Minister answer that question?

[Karin Smyth]

I understand that there are some concerns about that issue, and we will make sure that the hon. Member receives a full answer from my hon. Friend the public health Minister.

In short, these changes will widen access to life-saving medicine. I am sure hon. Members will agree that any death from an illicit drug is tragic and preventable, so I am pleased that we are taking this step and that we have the support of the House this evening for reducing drug-related deaths. On that basis, I hope hon. Members will join me in supporting these important regulatory changes, which I commend to the House.

Question put and agreed to.

Resolved,

That the draft Human Medicines (Amendments Relating to Naloxone and Transfers of Functions) Regulations 2024, which were laid before this House on 29 July, be approved.

[Gareth Snell (Stoke-on-Trent Central) (Lab/Co-op)]

On a point of order, Madam Deputy Speaker. Last Thursday, during questions to the Leader of the House on the statement of business, I asked a question about BTecs in relation to colleges. Although it is registered in the Register of Members’ Financial Interests that I am a governor of two colleges, I failed to draw the House’s attention to that fact before asking my question. The two colleges that I am a governor of are affected by the answer, so I take this opportunity to place that on the record, and offer my unreserved apology to the House accordingly.