Respiratory Health

Karin Smyth Excerpts

Thursday 14th November 2024 Westminster Hall

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairmanship, Mr Rosindell, for the first time in my new role. I thank the hon. Member for Strangford (Jim Shannon) for securing this debate on an important issue, and I thank other Members for their contributions.

As the hon. Member for Hinckley and Bosworth (Dr Evans) said, I am covering for my hon. Friend the Member for Gorton and Denton (Andrew Gwynne). I am pleased to do so. We had an outing this morning, and I was able to talk to the hon. Member for Hinckley and Bosworth earlier, whose first ward area was in this area as a medic. I must say that he is getting his money’s worth out of the NHS at the moment—I hope he does not have to do that again.

One of my jobs as a manager some 15 years ago was with the British Thoracic Society and primary care leading physicians on COPD. It was a project about living and dying with COPD and helping people to understand the disease and navigate it. I learned an awful lot about respiratory disease at that time and how people live and die with it. I commend that work.

I am shocked at some of what we have heard this afternoon and what I found in preparing for this debate about quite how poor things are, and that some basic preventive measures we were talking about 15, 16 or 17 years ago are still not in place. I am really happy to be responding this afternoon. I am not sure I will be able to satisfy everyone’s requests, but I can say on behalf of the Minister for Public Health and Prevention, my hon. Friend the Member for Gorton and Denton, that he will be happy to accept the invitation to the roundtable that the hon. Member for Strangford talks about, and his expertise will be better there than mine. We are keen to pursue that conversation with the hon. Gentleman and the all-party parliamentary group.

As we have heard, one in five of us will be affected by a chronic respiratory disease at some point in our life. These conditions are, sadly, the third biggest contributor to years of life lost in England. Many people out and about using public transport will know the symptoms of poor respiratory health. They might associate a wheezing or raking cough with being indicative of a smoker, but not all ill health is about personal choice. In fact, this common symptom belies a huge range of conditions, only some of them related to smoking and each requiring different interventions. On all those conditions, we are taking forward a combination of immediate bold actions and long-term reforms.

The Government are taking radical action to create the first smoke-free generation. We are clamping down on kids getting hooked on vapes and protecting children and vulnerable people from second-hand smoke. Tobacco is a uniquely harmful product and smoking is the No. 1 preventable cause of death, disability and ill health. The statistics are stark: smoking claims the lives of about 80,000 people a year in the UK and kills up to two thirds of its long-term users. Second-hand or passive smoke is extremely harmful to health. There is no safe level of exposure to smoke: if we can smell cigarette smoke, we are inhaling it. Smoke is harmful, particularly to children, pregnant women or people with pre-existing health conditions such as asthma or heart disease, which may not be visible to the smoker.

Our Tobacco and Vapes Bill, which we introduced last week, will be the single biggest public health intervention since the last Labour Government banned smoking in indoor public spaces. The Bill’s primary aim is to create a smoke-free generation by gradually ending the sale of tobacco products throughout the country and breaking the cycle of addiction and disadvantage, so that someone born after 2009 will never be able to legally buy tobacco. This landmark legislation will also enable the Government to strengthen the existing ban on smoking in public places and to reduce the harms of passive smoking in certain outdoor settings. It will ban vapes and nicotine products from being promoted and advertised, to prevent the next generation from being hooked on nicotine.

We will hear all sorts of arguments against these sorts of policies, with people saying it is the nanny state or that they are anti-growth. However, most smokers—myself included—always wish they had never started. They have had their choice taken away by addiction induced at a young age by the tobacco industry. I remind Members present that smoking costs the economy and wider society some £21.8 billion a year through lost productivity, smoking-related lost earnings, unemployment and early death, as well as the cost to the NHS and social care of over £3 billion. Our action will save thousands of lives and protect the NHS. I pay tribute to charities such as Action on Smoking and Health and Asthma and Lung UK, which have supported our work. Through our changes we will create a healthier society and, in doing so, boost the economy.

As we have heard this afternoon, smoking is only one example of how our respiratory health is influenced by our environment. Even though it has been almost 70 years since the first Clean Air Act was passed, what we breathe remains one of the greatest risks to public health in the UK. As the chief medical officer’s 2022 annual report on air pollution sets out, there is clear evidence that outdoor air pollution contributes to the initiation and development of respiratory diseases such as lung cancer. That is why the Government are committed to a preventive approach in this policy area. I assure people that we are taking a mission-led approach, working across Departments to improve air quality. We want to address the inequalities in the quality of the air that people breathe simply because of where they live.

The Department of Health and Social Care will support the Department for Environment, Food and Rural Affairs to deliver a comprehensive and ambitious clean air strategy. This will include a series of interventions to reduce emissions so that everyone’s exposure to air pollution is reduced. The UK Health Security Agency, which has been talked about this afternoon, is working closely with DEFRA to review how we communicate air-quality information to ensure that members of the public, and vulnerable groups in particular, have what they need to protect themselves.

I commend my hon. Friend the Member for Newcastle-under-Lyme (Adam Jogee) for his work in support of his constituents with regard to Walleys Quarry. The Minister for Public Health and Prevention visited Newcastle-under-Lyme recently and will pursue those discussions with the Environment Agency.

The Government are also taking steps to reduce risks to respiratory health in people’s homes—a point addressed well by the Liberal Democrat spokesperson, the hon. Member for Winchester (Dr Chambers). Living in a home with damp and mould increases the risk of respiratory illness and conditions such as asthma and COPD. It also affects symptom severity and the risk of death for individuals with existing respiratory conditions. We are therefore putting forward an initial £3.4 billion towards heat decarbonisation and household energy efficiency over the next three years, and £1.8 billion to support fuel poverty schemes. That means that over 225,000 households will receive help to reduce their energy bills by more than £200.

The hon. Members for Winchester, for Strangford and for Hinckley and Bosworth made excellent points about vaccinations. We want to encourage everyone, including ourselves—I look around the room, even at myself; I am slightly behind on my flu vaccine—to do all we can ourselves and to encourage others to take up vaccines and prevent some of the related problems.

We recognise, however, that not all ill health can be prevented, so we need to act to help those who need treatment. I assure the hon. Member for Strangford and other contributors that respiratory disease remains a clinical priority.

The NHS long-term plan under the last Government set a series of objectives for improving outcomes for people with respiratory disease through early diagnosis and increased access to treatments. As we have heard, and as I have said, it is quite shocking that that basic objective is not being achieved everywhere. Access to checks and basic preventive care needs to be much better spread across the country. That is why we say that we want to take the best of the NHS to the rest of the NHS. NHS England has 13 respiratory clinical networks across the country, which are vital in providing clinical leadership across primary and secondary care for respiratory services and supporting services in primary care, where of course most patient contact is.

I commend my hon. Friend the Member for Sherwood Forest (Michelle Welsh) for highlighting pulmonary fibrosis. I wish her father and her family well. She is absolutely right that early and accurate diagnosis is a priority for NHS England. Work to make improvements is under way, and that should have an impact on reducing delayed diagnoses of pulmonary fibrosis. As I understand it, access to these treatments has recently been expanded to patients with non-idiopathic pulmonary fibrosis, following the publication of the NICE technology appraisal for treating progressive fibrosing lung diseases. I hope that that goes some way towards reassuring my hon. Friend, who spoke so eloquently today.

As the hon. Member for Strangford and my hon. Friends the Members for Newcastle-under-Lyme, for Blaydon and Consett (Liz Twist) and for Sherwood Forest highlighted, COPD is a major contributor to inequalities in life expectancy and in healthy life expectancy. People living in the most deprived parts of the country are five times more likely to die from COPD than those in the least deprived. I have seen that both in my previous work with those working in the NHS and since becoming the Member of Parliament for Bristol South in 2015. My constituency was home to the Wills tobacco company, a huge employer in the area over many decades. Its legacy can be seen in many different ways, but particularly in the very high rates of smoking in my constituency—up to 32% in some parts. The reduced lives lived in good health, and those shocking early deaths, are things that I see every day. The impact is still very apparent in the shocking statistics on health inequality across my home city of Bristol.

Let me assure hon. Members that this issue remains a priority for all of us in this Government. Reducing health inequalities is a key part of our mission. That requires us to work across Government, and it runs across all parts of Government. In NHS England, Core20PLUS5 is a national approach to inform action to reduce healthcare inequalities at both national and local system level. The approach provides a vehicle for targeted interventions to detect and treat the diseases that are major contributors to life expectancy as well as pressures on the NHS.

We know that there is a particular risk of condition exacerbation around the winter, leading to emergency treatment in hospital and in-patient care. That is why the focus of the Core20PLUS5 action on respiratory health this year has been to increase vaccination uptake, including covid-19, flu and pneumovax, which can protect against serious illnesses such as pneumonia and meningitis.

NHS England is leading on the development of an approach for COPD management. This will support proactive identification and management of risk in patients in winter, to reduce demand on primary and secondary care. My hon. Friend the Member for Blaydon and Consett was absolutely right to highlight the low levels of diagnosis, the number of people living with COPD and other respiratory diseases, and the impact on children that we might not even know about. The plan is to test and evaluate this approach in four sites this winter to help inform decisions on winter planning in the future.

On severe asthma and access to biologic treatment, significant work has been undertaken through the NHS England severe asthma collaborative to develop the capacity of the severe asthma centres. That important work includes streamlining patient pathways to biologic therapy and reducing variation in prescribing and patient management. Patient outcomes are now submitted to the UK severe asthma registry. That has led to improved identification of patients with potential severe asthma in primary and secondary care, resulting in referral to severe asthma centres for consideration of eligibility for biologic therapy.

Action to address avoidable deaths from asthma has not gone far enough. That is why we are working to ensure that asthma care has a higher prioritisation within systems, for example through the national bundle of care for children and young people with asthma workstream, which is intended to improve outcomes for children and young people with asthma.

Looking further forward, a central mission of the Government is to build healthcare that is fit for the future. As hon. Members have noted, our 10-year health plan will focus on the three shifts needed to deliver a modern NHS: from hospital to community, from analogue to digital and from sickness to prevention. That is a long-term challenge and those shifts will take time to deliver, so the plan will consider what immediate actions are needed to get the NHS back on its feet and bring waiting lists down, as well as the longer-term changes needed to make the health service fit for the future.

I thank the hon. Member for Strangford for his commitment to respond to our engagement exercise. I encourage all organisations and individuals to contribute to the 10-year plan at change.nhs.uk. We are keen to work with the public, patients and our partners in all the organisations that support this work. We will listen and co-design the plan with them.

Disease-specific and more general long-term conditions that affect people’s health are a very live issue. Given the level of comorbidities with which people currently live, it is important to look at the person as well as the diseases. We will continue to look at that as part of the development of the 10-year plan; I know that all hon. Members will take an active part in that process. The hon. Gentleman will tell me if there is anything to which I have not responded.

The hon. Member for Hinckley and Bosworth asked for an update on the RSV vaccine. As part of my portfolio working on urgent and emergency care, we are looking closely at a vaccine update, as well as at the presentation of very young children with respiratory disease in the emergency care system; I am sure that he is aware of that issue. If there is anything else that he would like to know, I will ensure that he is written to. On spirometry and fractional exhaled nitric oxide tests, a look at the NICE guidelines is long overdue, so I hope that we see some more progress on that. If I have missed something, Members may write to the Minister for Public Health and Prevention and he will respond very promptly.

I thank the hon. Member for Strangford and the APPG for raising the issue. I am genuinely very pleased to see it being raised. As a contributor to admissions and inequalities, it is a very serious disease and we need to highlight it. I thank him for the invitation to take part in a discussion with healthcare professionals on the way ahead for respiratory health. My ministerial colleagues look forward to discussing that further.

Breast Cancer: Younger Women

Karin Smyth Excerpts

Tuesday 12th November 2024 Westminster Hall

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairmanship, Mr Vickers. I thank the hon. Member for Bath (Wera Hobhouse) for bringing this debate to the House, as well as other hon. Members for their interventions. I also pay tribute to the hon. Lady for championing the story of her constituent Lucy and others, such as Jessica Parsons, who have done so much to raise awareness. We have a powerful role as Members of Parliament, and I commend the hon. Lady for doing an excellent job.

The hon. Lady is absolutely right that awareness raising is key to catching cancer early, and the most effective way to tackle breast cancer in younger women is to encourage them to check their breasts regularly. The NHS is going through the worst crisis in its history, and this Government will turn it around so that cancer patients are diagnosed and treated on time. The investments we are making now in breast cancer treatment and research are part of our plan to make the NHS fit for the future.

Although women of any age can get breast cancer, it is much more likely to occur over the age of 50. That is why our screening programme sends women their first invitation at 50. However, I will take this opportunity to emphasise that the take-up of breast cancer screening is currently below 70%. That is worryingly low, and we are determined to change that. I make a plea to all hon. Members to help the Government achieve greater take-up of breast cancer screening in women over 50. Women need to come forward for screening.

Taken as a whole, the evidence does not support regular mammograms for women below the age of 50. Decisions on screening, including the age at which to offer it, are made by experts on the UK National Screening Committee, and those decisions are kept under review so that they continue to be based on the best available research. Ultrasound can be used as a diagnostic tool, but it is not appropriate for screening. Mammograms provide a fuller picture of the breast, and are better able to spot early signs of cancer. As the hon. Lady said, mammograms used for screening are less reliable for younger women given their denser breast tissue. Change in the screening age could mean a greater risk of false negatives, where cancer is missed, and there would also be a greater risk of false positives, which may lead to invasive testing when there is no need for it. Our approach is in line with that of most European countries, which screen women between the ages of 50 and 69.

For younger women who have a greater risk because of their family history, we offer screening using mammogram or an MRI scan. As I have said, the most effective way to tackle breast cancer in younger women is to encourage them to check their breasts regularly, and to consult their GP straight away if they have any concerns.

[Wera Hobhouse]

Lucy did that and was dismissed. Today’s debate is particularly important for awareness raising among the medical profession to ensure that women, particularly those who know about a family history of breast cancer—some do not—are not dismissed and are taken seriously.

--- Later in debate ---

[Karin Smyth]

The hon. Member makes a powerful point. When people come in, particularly with a family history, their relationship with their GP should be better and should take that history into account.

We know that the sooner cancer is diagnosed, the more treatment options are available, and that treatment is more likely to be effective with an early diagnosis. Primary care and GPs are essential in that pathway and I agree with the hon. Lady that we need to pay attention to the upward trend in demand. NHS England runs campaigns to increase knowledge and awareness of key symptoms, but we can all do more. Breast cancer is thankfully rare among younger women, but the more aware they are of the symptoms, the likelier they are to see their GP, and the GP will be made more aware of those trends.

I would like to take this opportunity to highlight Breast Cancer Now’s “Touch, Look, Check” advice. The NHS and the Government support this advice, and I encourage women no matter how young or old they are to check their breasts often. Breast cancer remains one of the most common cancers in England; almost 50,000 people are diagnosed each year. Instances of many types of cancer are rising among young people in this country, and we are not yet certain of the cause of that. Although breast cancer is thankfully less common in younger women, we cannot afford to be complacent and, as the hon. Lady has highlighted, we must remember the human stories behind that number—the lives disrupted, the trepidation of diagnosis and the uncertainty faced by loved ones. We can take some comfort from the fact that more women are surviving breast cancer than ever before. Between 2016 and 2020, the one-year survival rate for breast cancer was over 96%, enabled by advances in screening, treatment and care.

There is much more to be done, and I want to reassure hon. Members that it is a top priority of this Government to speed up the diagnosis and treatment of every type of cancer. On 30 October, my right hon. Friend the Chancellor restated and backed that commitment. The first Labour Budget committed £70 million for new radiotherapy treatment machines and £1.5 billion for new surgical hubs and diagnostic scanners. This investment will allow the NHS to undertake 30,000 more procedures each year, and the capacity for diagnostic tests will increase to 1.25 million. This further funding will enable us to ensure that cancer can be diagnosed or ruled out as quickly as possible, which is something we all want to see.

We also continue to pave the way in identifying the best possible testing and treatment for all types of cancer. Research is a crucial part of this. That is why the National Institute for Health and Care Research has spent £33 million on directly funding breast cancer research in the last five years. But investment alone will not be enough to tackle the problems facing the NHS; it would be like pouring water into a leaky bucket. We need investment and reform. People who work in the NHS, as I have, see first hand what is great but also what is not working—the things more money will simply not fix. As my right hon. Friend the Secretary of State has said, we need to take the best of the NHS.

We need to do more to meet the challenges presented cancer now and in the future for people of all ages. We recently launched the biggest national conversation about the future of the NHS since its birth to help to shape our 10-year plan, which will allow us to do more to prevent cancer where we can, identifying it as early and as quickly as possible and treating it with speed and precision. But we need suggestions from hon. Members on how to go further. We need to learn from the experiences of people like Lucy, which the hon. Member for Bath outlined today. I urge everyone to visit change.nhs.uk and help us build a health service fit for the future.

I thank the hon. Lady for bringing this important matter to the House and raising her constituent’s issue. I thank all hon. Members who have made such valuable contributions on this important subject. I am pleased to assure them that rebuilding our NHS and delivering world-class cancer treatment and prevention services for every person will always be a top priority for this Government.

Question put and agreed to.

RAAC in the NHS Estate

Karin Smyth Excerpts

Tuesday 5th November 2024 Written Statements

[The Minister for Secondary Care (Karin Smyth)]

Today I wish to update the House on the presence of reinforced autoclaved aerated concrete (RAAC) in the NHS estate. RAAC is a type of concrete that is prone to collapse and needs replacing.

As the Chancellor announced on 30 October, over £1 billion will be invested to tackle dangerous reinforced autoclaved aerated concrete (RAAC) and make inroads into the existing backlog of critical maintenance, repairs, and upgrades across the NHS estate. This Budget will begin delivering on our promise of change for the NHS. It will take time, but we are beginning to rebuild the health service to make it fit for the future.

We are committed to removing RAAC from the NHS estate as a priority. The NHS has been surveying hospital sites to identify the presence of RAAC since 2019. As of 3 October 2024, there are 47 hospital sites in England with confirmed RAAC, a reduction of seven since February of this year. To date, RAAC has been completely eradicated at 13 hospital sites and further sites will have eradicated RAAC this financial year. The published list of sites on gov.uk has been updated accordingly and can be found here: https://www.gov.uk/government/publications/reinforced-autoclaved-aerated-concrete-raac-in-hospitals-management-information The full list of sites with RAAC as well as eradications can also be found in the table below.

Once the presence of RAAC is confirmed at a hospital site, the trust joins NHS England’s national RAAC programme. This programme has delivered mitigation, safety, and eradication works across all hospital sites with confirmed RAAC to keep facilities safe and open and is working to remove RAAC fully from the NHS estate.

The Chancellor reiterated in her autumn Budget statement that the seven identified hospitals in England constructed wholly or primarily from RAAC in the new hospital programme will proceed at pace, due to substantive safety risks associated with these. These schemes were out of scope of the recent NHP review and have continued to their existing delivery timeframes.

These seven hospitals continue to receive funding and support to ensure patient and staff safety from NHS England’s national RAAC programme ahead of the delivery of replacement hospitals. Keeping capacity open but being scrupulous about RAAC monitoring and mitigation until the RAAC can be removed is fully in line with the current evidence and recommendations of the Institution of Structural Engineers.

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]