Health and Social Care

Maria Caulfield Excerpts

Friday 24th May 2024 Written Corrections

The following extract is from the urgent question on Measles on 22 January 2024.

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

… NHS figures show that almost 3.5 million children under the age of 16 are unprotected and at risk of catching this serious and preventable disease.

—[Official Report, 22 January 2024; Vol. 744, c. 33.]

Written correction submitted by the Under-Secretary of State for Health and Social Care, the hon. Member for Lewes (Maria Caulfield):

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

… NHS figures show that around 3.4 million children under the age of 16 are not fully vaccinated and may be at risk of catching this serious and preventable disease.

Contingencies Fund Advance

Maria Caulfield Excerpts

Thursday 23rd May 2024 Written Statements

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

I hereby give notice of the Department of Health and Social Care’s intention to seek a Contingencies Fund advance to make the recently announced interim infected blood payments.

The Minister for the Cabinet Office was absolutely clear in his announcement on 21 May that additional interim payments of £210,000 will be delivered within 90 days, starting in summer, to all UK living infected beneficiaries of the UK infected blood support schemes.

The Department of Health and Social Care’s capital annually managed expenditure ambit does not provide cover for compensation payments already approved by Parliament through legislation. While this will be received through the main estimate, this advance will enable interim payments to be made ahead of Parliament formally approving the ambit and the associated expenditure through an estimate, in line with the Government’s commitment.

Parliamentary approval for additional capital of £837,000,000 for this new expenditure will be sought in a main estimate for the Department of Health and Social Care. Pending that approval, urgent expenditure estimated at £837,000,000 will be met by repayable cash advances from the Contingencies Fund.

[HCWS498]

Crisis Houses

Maria Caulfield Excerpts

Wednesday 22nd May 2024 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

It is a pleasure to serve under your chairmanship, Ms Fovargue. I thank the hon. Member for Enfield, Southgate (Bambos Charalambous) for bringing forward the issue. I offer my deepest condolences to his constituents on the loss of their daughter Jess.

Improving mental health crisis services has been a key priority for the Government for the past few years. We very much recognise that we need to support people better in their communities, rather than wait for someone to go into crisis when the only option is admission into a mental health in-patient unit. If we can get to people earlier, the outcomes are better, particularly for certain groups, depending on age, gender and ethnicity. We know that recovery is possible if the right treatment and early intervention can be given. That is why we have invested heavily in crisis services over the past few years. We see the difference that that can make, with people not ending up in detention in police cells, A&E or other inappropriate settings.

Before I touch on crisis houses specifically, I want to mention the range of crisis support available. We have provided more than £150 million of capital investment in urgent and emergency care infrastructure, £7 million of which has gone into new specialist mental health ambulances, which have mental health teams on board, rather than a traditional ambulance crew. Also, £143 million has gone into a range of alternatives—crisis houses are one of them, but we also have crisis cafés, step-down services and other crisis centres—which provide healthcare for people at a difficult time. More than 160 projects have been allocated funding and 137 of them are completed. We now have our crisis 24/7 helplines, so that around the country, in every area, a call will go through to the local crisis team. They are now linked through the NHS 111 service to provide a consistent route, so if a person is not aware of their crisis helpline number, dialling 111 will get them to that crisis line and their local mental health crisis team.

Crisis houses are a key part of that provision, and the early evidence shows that even crisis cafés can be associated with an 8% lower admission rate to hospital. Telephone services are associated with about a 12% lower admission rate. Overall, there is a 15% lower rate for detention under the Mental Health Act, which is all to the benefit of patients going into crisis. Crisis houses specifically are part of that crisis support team, and they provide accommodation for those who need such help and support, perhaps as a step towards more intensive crisis support, although sometimes that is just enough that someone is able to return home.

The hon. Gentleman is right that there is a mix in the provision of crisis houses. Some provide specialist care and regulated activity, including for those going through drug and alcohol addiction, some of whom might need their medication assessed and changed. Those crisis houses that do not provide such activities are not regulated by the CQC—he is absolutely right about that—and, to date, there have been no plans to expand the list of CQC-regulated activities to capture crisis centres that do not provide the more intense support. I hear his concerns, however, and as part of our work on the suicide prevention strategy, through which we are trying to reduce the number of suicides in England, we know that those suffering with pre-existing mental health illnesses are a high-risk group. I hear his concerns about Jess and the fact that she was in a place of safety that did not safeguard her needs, in particular as a vulnerable woman needing that help.

Crisis houses play an important role. They help mental health support teams, allowing them to deal with the most serious cases. They can also become a familiar setting for those patients who may use them regularly if they are going into crisis; they will know that that is a place where they can get help and support. Through our work on the suicide prevention strategy, in all the accommodation that people come into—crisis houses, police cells, prison cells, A&E or mental health in-patient settings—a key piece of work is on trying to eradicate ligature points, so that if someone is thinking of such a method of suicide, we have made it as difficult as possible for them to do that.

I am also concerned by the hon. Gentleman’s point about staff training. These staff members are looking after very vulnerable patients and they need training to know to whom they can signpost more quickly, whether that is the crisis team or other support avenues. Crisis houses are about more than just accommodation. Although they are not a regulated activity, they are more than just a roof over someone’s head. They are about assessing someone and getting them more intensive support if needed or getting them back home if possible.

Although I cannot commit today to including crisis houses as a regulated activity, I want them to meet the same standards as other places in which people going into crisis are often accommodated. Our motto for the suicide prevention strategy is “Suicide is everyone’s business”, so if crisis houses are not going to be a regulated activity and therefore not the business of the CQC, there must be more safeguards in place to ensure that they are as safe as possible, particularly for those at risk of suicide and for the staff, who have a difficult enough job at the best of times without having to deal with the fallout of a young person taking their own life under their care.

What I can commit to today is discussing the issue of crisis houses with Professor Louis Appleby, the Government’s adviser on suicide prevention, with whom I am working on the suicide prevention strategy and the suicide prevention oversight group. I am not sure whether regulation falling under the CQC is the answer, but I agree with the hon. Gentleman that there are clearly some gaps in training and development for staff. They must be able to better assess risk. There is also the issue of ligature points in crisis houses and gaps in their assessment as a place of safety for those staying in them.

I commit to following up on Jess’s case. We are going to get those suicide rates down. It is no one’s fault, but if there is extra work we can do to make crisis houses not just places of crisis, but places of safety, we should leave no stone unturned in doing that. I am very grateful to the hon. Gentleman for raising his constituent’s case as an example of what can happen. Crisis houses are not a regulated activity at the moment, but I am sure that there is more we can do to improve the safeguards that are in place. Following the debate I will speak to Professor Louis Appleby to see what more we can do for crisis houses to ensure that when a person going into crisis reaches out to get the help they need, they are as safe as they can be.

Question put and agreed to.

Mental Health and Long-term Conditions

Maria Caulfield Excerpts

Thursday 16th May 2024 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

It is a pleasure to serve under your chairmanship, Sir Robert. I am grateful to the hon. Member for Bootle (Peter Dowd) for securing this debate about mental health for those with long-term conditions, especially during Mental Health Awareness Week.

I thank everyone who contributed, including the hon. Member for Blaydon (Liz Twist) who does great work on mental health with her all-party parliamentary group on suicide and self-harm prevention. If other hon. Members do not mind me saying so, the standout speech was from the hon. Member for Birmingham, Perry Barr (Mr Mahmood), who talked about his own experience of going through a long-term condition and needing dialysis for renal disease. He highlighted not only the physical impact but the effect on his mental health, and the uncertainty that organ donation and transplant can bring.

I know that this is a debate on mental health for those with long-term conditions, but I will touch on what the hon. Member for Birmingham, Perry Barr said about the opt-out system for organ donations in England, which we brought in in May 2020. I recognise that even when someone has consented themselves, there are still issues with families refusing organ donation. In February 2023, we committed to implement the recommendations of the Organ Utilisation Group, which highlighted issues relating to opt-out and to the use of donated organs—we must ensure they go forward for donation—so I absolutely recognise the hon. Gentleman’s comments.

I want to reassure hon. Members about our commitment to improving mental health and wellbeing, particularly for those with longer-term conditions. Over the past 14 years, the stigma surrounding mental health problems and mental illness has been removed. People are much more willing to talk about their mental health and discuss issues that they face; we are breaking down those barriers.

We have also made progress on parity of esteem between physical and mental health, and the funding that we have made available to mental health in the past few years is the most significant ever in England. That is not to say that it has met all the challenges we face, but through funding, infrastructure and staff recruitment we are getting mental and physical health on the same level.

When I spoke at the Mental Health Foundation event in Parliament yesterday, I said that our challenge now was to ensure that we do not just silo people into having a mental health problem or a physical health problem. The hon. Member for Birmingham, Perry Barr expressed that so well. We cannot just treat people in isolation; we know that people who suffer with mental illness have significantly poorer health outcomes for major conditions including cancer and heart disease, and likewise people with long-term conditions struggle with their mental health. That is why we put mental health in our major conditions strategy. We got some criticism when we announced that we would not have a stand-alone mental health strategy, but it was because people’s conditions cannot be treated in isolation: their physical and mental health must be treated together. That is why, in the major conditions strategy, mental health is one of the major conditions that we will focus on.

That is also why, through the NHS long-term plan, we have provided record levels of funding to increase our mental health workforce across England. Our target is 27,000 mental health workers and we are on track to meet it. Our NHS forecast shows that since 2019 our spending on mental health services has increased by £4.7 billion in cash terms, compared with our original target of £3.4 billion. We invest almost £16 billion in mental health, enabling 3.6 million people to access mental health services.

Significant investment and resources are going in, but I recognise that there has been a tsunami of demand and we are struggling even to tread water. We have had a 46% increase in the number of referrals across the United Kingdom, not just in England. In Wales they have had a similar experience: child mental health waits were up 14% in July 2023, compared with December 2022. Overall, in Wales there are 30,000 people on the waiting list who have been waiting for more than two years. The challenges that we face in England are exactly the same as those in Wales, and I think it would be more appropriate to take the politics out of this and deal with the causes.

I am really pleased that the types of mental health services we are investing in are not just for people with a mental illness. It is really important that we not only provide bespoke services for people with specific mental illnesses, but improve the mental health of the country overall. One of our biggest successes is the flagship NHS talking therapies programme, which is for adults everywhere across the country. It is accessible on our NHS website. People can access the Every Mind Matters website, and can self-refer. Anyone can access those services, including people with diabetes, Parkinson’s, cancer, MS or renal conditions. So far, more than 1.2 million people have done so in the past year—an 11% increase since the start of the long-term plan in 2019.

We are expanding those services further to help people with mental ill health and long-term conditions. Colleagues in the Department for Work and Pensions are working with people who are struggling to find work because of a long-term condition and the mental health effects that that has had.

We do recognise that two thirds of people with common mental health problems also have a long-term physical health problem. One of the key issues we do need to overcome—which was not mentioned in this debate—is that if someone has a mental illness they may also have cancer, diabetes or renal problems, and sometimes there is diagnostic overshadowing that assumes that it is someone’s mental health problems when they are complaining about pain or describing other symptoms. They are not taken as seriously as someone who does not have a mental illness. That diagnostic overshadowing is sometimes responsible for the poorer clinical outcomes. There is a piece of work to do, across the board, that is not just about providing services. It is about changing that culture so that people with mental illness and long-term conditions get the help that they need.

On the talking therapies point, all integrated care boards are expected to expand their services locally by commissioning NHS talking therapies into physical healthcare pathways. I know the hon. Member for Bootle talked specifically about some of the work on renal disease. NHS England has published a series of service specifications covering renal services, developed by specialist clinicians and commissioners and patients with experience, to set out expected standards for specialised renal care. That does include clinical psychologists, although I recognise that is not happening everywhere. There are regular review meetings between regional commissioners; I am very happy to follow those up with the hon. Gentleman, to update him on where there may perhaps be gaps in service provision. However there is a service specification that should include those services for renal conditions as well.

I will move on to talk about suicide prevention. We released our strategy fairly recently and we have put in it that people with a physical illness or a long-term condition are more at risk of suicide. That is why physical illness is now included as a key national risk factor for action in our five-year suicide prevention strategy. I am very happy to update Members about the progress we are making. There are 130 actions that we believe will address some of those common risk factors and make swift progress.

In terms of the support we are giving to people with long-term conditions and the ability to live better with a long-term condition, we are providing support across the board here as well. It is important that teams that are looking after people, whether with cancer or diabetes, are aware of the emotional and psychological support needed. It has historically been the case that these patients are often referred to the mental health team. That is not always what is needed. Some basic support can do a huge amount to improve the psychological wellbeing of patients.

Children were raised in the debate and I want to update the House on that because children have long-term conditions too. We are putting in significant support. Only a few weeks ago, we put forward funding for 24 early support hubs—support hubs for children who want to get mental health support. No referral is required. They are local, with services provided to suit the needs of the local community, and £8 million has gone towards the funding of those 24 projects. We are evaluating them to see whether they are making the difference we need them to make. We are also rolling out mental health support teams in schools to over 4 million children via 400 mental health support teams which are providing support to just under 50% of our schools. I think that is making a significant difference. If a child has a long-term condition in school, they will have within their school a team able to provide emotional and psychological support to them as appropriate.

I hope I have given a bit of a whistle-stop tour—although perhaps not a Cook’s tour, as the hon. Member for Bootle did. I absolutely share some of the concerns that hon. Members have raised in this Chamber, and I hope that I have highlighted that there is some exciting, groundbreaking work happening in this space.

In Mental Health Awareness Week, it is really important that we talk about mental health problems for people with long-term conditions and recognise how being unwell over a long period—whatever the cause—affects a person and their family. That is why it is so important that we have whole-person treatment and support to improve both the physical and mental wellbeing of individuals.

Inequalities in Dementia Services

Maria Caulfield Excerpts

Thursday 16th May 2024 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

It is a pleasure to serve under your chairmanship, Ms Rees. I thank the hon. Member for Oldham East and Saddleworth (Debbie Abrahams) for securing this debate and for her collaborative work on the issue, which brings everyone together. She is right to point out that dementia is not an automatic part of ageing—there is still a stereotype that does not recognise that—but early onset dementia is also an issue. Young people with dementia often struggle to get the help and support they need because it is seen as a disease of old age.

It was incredible to hear the hon. Lady describe her own experience of caring for her mother, Angela, which must have been so difficult. I think most of us have been affected by dementia in some way. My mother-in-law died from dementia last year. It is just terrible seeing people we know and love change in often such a dramatic way. Even with the best care and support available in the world, it is still difficult.

The hon. Member for Halifax (Holly Lynch) talked about her good experience with local services and the importance of dementia-friendly communities. She is absolutely right. My hon. Friend the Member for Romford (Andrew Rosindell) contributed with his own experience, and spoke about the changes he would like to see to improve the care and experience of those who suffer with dementia.

The all-party parliamentary group on dementia does fantastic work. In her role as chair, the hon. Member for Oldham East and Saddleworth is doing groundbreaking work, particularly on reports and surveys to flag issues based on the experience of those who provide dementia services and look after loved ones. In Dementia Action Week, I thank everyone involved in supporting people with dementia, particularly unpaid carers, as the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), said.

I want to reassure hon. Members that this Government are passionate about improving care, and we have a clear mission to make our NHS and social care system much more responsive to people’s needs. The hon. Member for Halifax pointed out the important work of the former Prime Minister, Boris Johnson, in setting up the Dame Barbara Windsor dementia mission. The previous Prime Minister, David Cameron, instigated a lot of research in this space as well.

I say this with my Minister for Women hat on: the leading cause of death among women is dementia. We also know that one in three people will be diagnosed with dementia in their lifetime, and that by 2040 1.6 million of us will be living with the condition, so it has to be a priority for diagnosis, treatment and support. I welcome the research this week from the Alzheimer’s Society, which highlights the economic impact of dementia and further outlines why it must be a priority.

The theme of today’s debate is the inequalities that exist across the country, and the wide variety of people’s experiences in getting a diagnosis and the support and care that they need. Yes, we can put more money and resources in, and I will outline some of the funding we are providing, but we also need a cultural shift. Although dementia is seen as a natural part of ageing, given diagnostic overshadowing other health conditions affecting people with dementia are often completely ignored because they are taken as part of the dementia diagnosis. When someone with dementia has a urinary tract infection, they will often be confused and agitated or even crying out in pain. It is seen as part of their dementia, when actually they could improve considerably with some simple antibiotics to treat that UTI. Sometimes we need to look at the culture around dementia across the system.

I want to highlight some of the work and research that we are already doing to look at diagnosis and treatment. I take the point made by the hon. Member for Oldham East and Saddleworth about the central database. Each ICB holds its own individual database, but I will go back to colleagues in the Department of Health and Social Care to see whether we can bring data together to look at disparities across the country.

Last year we announced our plan to publish a major conditions strategy. Dementia is one of the six conditions covered by the strategy, alongside cancer, cardiovascular disease and other major conditions. It is important that dementia is seen as a major condition and not just a part of ageing. Part of the work that we need to do is around the timely diagnosis of dementia, to ensure that anyone with dementia can access advice, information, care and support.

Our ambition is for two thirds of people living with dementia to receive a formal diagnosis. The shadow Minister probably knows what I am going to say. Absolutely —what he said sounds wonderful. However, Labour is in charge of healthcare in Wales and its ambition in the dementia action plan there is to increase diagnosis by 3% a year. We all want to see an increase in diagnosis rates, but we also need to be realistic and in some of the ambitions elsewhere that has not always been the case.

[Andrew Gwynne]

May I point out to the Minister that I seek to be the Social Care Minister for England, not Wales? As she is the current Social Care Minister for England, not Wales, can she please be a bit more ambitious for England?

[Maria Caulfield]

I think it is ambitious for two thirds of people living with dementia to receive a formal diagnosis, because we are not there yet. We are putting some building blocks in place to improve things.

We know that the pandemic had a significant effect, because we shut down routine care for just over two years. It was very difficult then for someone to see their GP with concerns about potential symptoms of dementia, so the treatment of conditions such as dementia suffered as a result of lockdown. However, we are recovering diagnosis rates and a lot of work is going into that. Nevertheless, I absolutely recognise that some parts of the country have made a better recovery than others. Addressing that must be a focus of our work going forward.

NHS England has committed to recover dementia diagnosis rates to that national ambition and is providing clear guidance to integrated care boards, particularly where performance is not where we want it to be, to make sure that that happens. As part of the spending review in 2021-22, £17 million was allocated to the NHS to address dementia waiting lists and increase the number of diagnoses, which, as I say, was adversely impacted by the pandemic.

NHS England is funding an evidence-based improvement project for two trusts in each region, with 14 sites in total, to pilot the diagnosing advanced dementia mandate tool in order to improve diagnoses rates and so that people know what they should be doing when they are trying to get a diagnosis. That includes people in care homes and those who may not have relatives or friends to advocate on their behalf and help them to get a diagnosis in the first place.

We touched a little on research. I pay tribute to charity partners working with the National Institute for Health and Care Research, or NIHR, to try and find diagnostic tools to provide better diagnoses at an earlier stage, including things such as the blood biomarker and the blood biomarker challenge, which seeks to produce the clinical and economic data to make the case for a blood biomarker test in healthcare across the UK—so including our friends in Wales—to improve dementia diagnosis. That is how we will really find out who is at most risk and get them diagnosed earlier.

We are committed to supporting that research and will double funding for dementia research to £160 million a year by the end of this current financial year. That will be around not just diagnosis but treatment and other research elements. The Dame Barbara Windsor dementia mission is deeply embedded in that work and I thank it for its work in that regard.

I turn to the prevention of dementia. The NIHR is investing £9 million into the three schools dementia programme. There must be risk factors for dementia that we are unaware of at the moment and that vital research could be a game-changer in the future. The NIHR is also supporting the Promoting Independence in Dementia or PRIDE study, which aims to identify how social and lifestyle changes could reduce the risk of developing dementia at any stage of someone’s life—I was going to say “later in life”, but dementia can affect any age group.

That takes me on to treatments. Drugs are currently being appraised by the National Institute for Health and Care Excellence to determine whether they should be made available on the NHS. I know that many, many people are waiting for those appraisals and hope that they will be positive. We expect NICE to publish guidance in July and September respectively, and we want to make sure that if the decision is positive, we are able to provide fair and equitable access to any licensed and approved medication. We will hopefully hear very soon about that.

I want to touch on post-diagnostic support, which is a key part of people’s experience with dementia. Everyone should have access to meaningful care. I want to talk about the work of Admiral nurses, who do a tremendous job but are not available everywhere. It is down to individual ICBs to commission those services. The additional roles reimbursement scheme that is available to primary care networks and GP practices allows for enhanced nurses in dementia care to be employed. I encourage MPs to check with their ICBs, PCN and GPs to see whether that is something being used.

Admiral nurses do a fantastic job. It is not just about supporting people with dementia and their families. One critical area is continuing care applications. Very often people with dementia are turned down for continuing care, and Admiral nurses will often get those decisions overturned. I am not commenting on that, but they do have that experience. Sometimes dementia care may appear on the surface to be social care, but it actually is clinical nursing care, so that NHS/social care divide can be bridged.

Local authorities have a duty under the Care Act 2014 to provide or arrange services that meet the needs of the local population. My hon. Friend the Member for Romford talked about various conflicts between neighbouring local authorities. The reason we brought in integrated care boards was to bridge the gap between not only the NHS and social care but neighbouring local authorities. I encourage my hon. Friend to speak to his ICB to see whether they can do anything to better commission services for patients, so that it does not matter which edge of a borough someone lives in and to ensure that care is more joined up.

[Andrew Rosindell]

What if someone’s local borough is on the edge of a region? Havering is on the edge of Greater London, and down the road is Essex. We would rather be Essex, to be honest, but we are stuck where we are. Are authorities able to work with local authorities beyond the boundary of their region?

[Maria Caulfield]

ICBs should be looking at care in their local population. If there is an issue between regions and across borders, they should have informal conversations, even with a neighbouring ICB, to try to join up the dots. That is why they are called integrated care boards. They are there to integrate health and social care as well as geography in terms of logistical local authority boundary issues. If there is a significant issue across the boroughs on the Essex border, I would happily meet local MPs to discuss it, because we want joined-up dots and better-connected care. Good local relationships can improve local services. We will be publishing ratings of how well local authorities are delivering adult social care, and we will support them to improve their performance, so I am particularly interested in any geographical boundaries preventing that work.

Coming to the social care workforce, the social care setting is integral to supporting families, particularly unpaid carers. Our workforce must be equipped with the skills it needs. We have commissioned and funded the dementia training standards framework, developed in partnership with the sector. The framework sets out the required essential skills that we expect to be applicable across the health and care spectrum, and we expect social care to train its staff according to the framework.

We have also launched the care workforce pathway, which is the first ever national career structure for the adult social care workforce. That is really important as it will cover the complexity of conditions that social care workers now care for and give them a career pathway, so that their option is not just to work for a bit in social care and then go and do something better-paid. We want social care to have career progression and pay progression and help people stay in the job that people love. We have created a new care certificate qualification to end the current practice of care workers having to retrain every time they work for a new employer. Work is being done in this space. To echo the point made by the shadow Minister, the hon. Member for Denton and Reddish, about unpaid carers, we know that the vast majority of care is given by people who are looking after loved ones and friends, and they do an amazing job. Local authorities are required to undertake a carer’s assessment for any unpaid carer.

[Andrew Rosindell]

I mentioned the Dementia Music and Social Club Romford. It meets at the United Reformed church and does a magnificent job. I hope the Minister would commend its work. It struggles because it does not have any direct funding. Would the Government consider having some kind of community chest to support local groups that are organised by volunteers and families of those who are suffering with dementia, so that they can have some funding for special events, day trips or social activities? That is so important, and they make the lives of those who are suffering with dementia so much better. They bring families and local people together to ensure that they have the best possible life with the condition that they are living with.

[Maria Caulfield]

I absolutely recognise that. I will take away my hon. Friend’s suggestion, but I would say that integrated care boards can commission those sorts of services because, despite not being medical services as such, they provide a valuable service to those patients. Local GPs can also fund such activities through social prescribing. If someone goes to those events weekly or on a regular basis, social prescribing is there to help with exactly that sort of activity, because they are health and wellbeing activities, which make such a difference. I am very happy to follow up on my hon. Friend’s suggestion.

[Andrew Rosindell]

I invite the Minister to visit the club. She would be very welcome, and she could see how effective the local group is in providing community support.

[Maria Caulfield]

Absolutely. I am very happy to take my hon. Friend up on his offer. It is important to remind people of the funding avenues available, which are not always used. For example, social prescribing has funding attached to it, and it is important that we remember that. Funding pots must be sustainable. We often give one-off grants, as Government; they make a big difference, but they do not always lead to sustainable funding routes.

[Andrew Rosindell]

Would the Minister write to Members with details of the funding streams available, so that we can disseminate them to groups in our constituencies?

--- Later in debate ---

[Maria Caulfield]

Absolutely. I am very happy to take that away as an action point.

I thank everyone for taking part in this debate. We recognise how difficult it can be for people diagnosed with dementia and their friends and family. We know that we have work to do on improving diagnosis rates. We are seeing improvements, but there is a lot more work to do. It is research and development that will really transform the way we manage dementia, find out who is at risk, diagnose them early and get treatments in place. There will be game changers, I am sure, over the next few years that will make a difference, but in the meantime we have to support people with dementia and their families better. I hope that I have demonstrated that the Government are absolutely supportive, and that we see this as a top priority. Once again, I thank all Members across this Chamber for taking part in the debate.

Gamete Donation Regulations

Maria Caulfield Excerpts

Wednesday 15th May 2024 Written Statements

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

In a parliamentary debate on 23 October 2023, I announced the Government’s intention to update the UK’s gamete donation regulations. The first change would allow people living with HIV with an undetectable viral load to donate their gametes. The second change would update the definition of partner donation to include female same-sex couples, therefore reducing costs for those undergoing reciprocal IVF.

Today, we will lay the necessary regulations to make these changes, which will benefit patients across the whole of the UK, supported by scientific advice from the Advisory Committee on the Safety of Blood, Tissues and Organs.

First, this will allow people living with HIV to donate their gametes to family, friends and known recipients provided that:

 They have a sustained viral load of less than 200 per millilitre—“undetectable viral load”;

they have been receiving antiretroviral treatment for at least six months prior to donation; and

the recipient knows of their HIV diagnosis and provides informed consent.

These changes will benefit hundreds of couples, including same-sex male couples using a surrogate where one or both have HIV, and those seeking known donation from a friend or relative with HIV. This legislative update reflects the advances made in preventing HIV transmission through fertility treatments and is a significant step in further reducing stigma around HIV.

Prior to donation, people living with HIV will undergo a series of tests to ensure their gametes are safe to donate. There is currently a requirement for a post donation HIV test for sperm donations, which is not clinically necessary due to the pre-donation tests. We were unable to rectify this issue in this statutory instrument without causing significant delays. Our priority is enabling people living with HIV to donate their gametes and start a family, and I will look to bring further legislative changes to remove this requirement in due course.

Secondly, the regulations will include an updated definition of partner donation. Under current rules, female same-sex couples hoping to conceive via reciprocal IVF must first go through screening for additional infectious diseases and genetic diseases, which can cost over £1,000. Heterosexual couples are not required to undergo this testing.

This legislation will seek to rectify this disparity in testing requirements and therefore lower costs for treatment. Reciprocal IVF is an increasingly popular way for female couples to have families and this change will help many more couples to afford this treatment.

We hope that these changes will help to create a fairer health system by removing barriers to accessing fertility care, in line with our commitments in the women’s health strategy.

[HCWS467]

Antimicrobial Resistance National Action Plan 2024 to 2029

Maria Caulfield Excerpts

Wednesday 8th May 2024 Written Statements

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

This is a joint statement with the Minister for Biosecurity, Animal Health and Welfare.

Today we are publishing the 2024 to 2029 UK anti-microbial resistance national action plan. This reaffirms the Government’s commitment to preserving the effectiveness of critical medicines for generations to come.

The ability of bacteria—and other pathogens—to develop resistance to the medicines, particularly antibiotics, used to treat them is a significant and growing threat. Antimicrobials underpin modern medicine, enabling critical healthcare, including hip replacements, cancer treatments, and caesarean sections, to be undertaken safely.

The UK is leading the way in the global fight against AMR, both at home and abroad. This is in line with our 20-year vision for AMR to be contained, controlled and mitigated by 2040. This national action plan has been developed through cross-UK working between the UK Government and the devolved Administrations in Northern Ireland, Scotland and Wales. In recognition of the shared challenge of AMR—infectious diseases do not respect borders—the four nations of the UK will work together to deliver this plan.

This five-year national action plan for AMR is the second in a series to support achievement of the 20-year vision. It sets out our comprehensive “One Health” approach to confronting AMR, across humans, animals, food and the environment. It sets out an ambitious course of action, strengthening the existing UK commitment to preventing infections, optimising the use of antimicrobials, and investing in research and innovation to address AMR. The plan includes commitments that will help to protect people and animals from drug-resistant infections.

I am proud of the progress the UK has made in tackling AMR over the past five years, with significant achievements in reducing the use of antibiotics in animals, revolutionising the way we pay for antibiotics on the NHS in England, and investing in world-leading research. Without the efforts of the past 10 years, there would have been much higher rates of infection and antimicrobial usage. This Government are committed to continuing to act to mitigate the threat posed by AMR, which requires action across the whole of society.

The next five years mark a critical period in which to confront the threat of AMR. In September 2024, the United Nations General Assembly high-level meeting on AMR will be the most significant global moment on AMR since the 2016 high-level meeting, which secured a landmark political declaration on AMR. The UK will continue international advocacy for AMR, which is essential to solve this global threat. Looking forward to 2028, the centenary of the discovery of penicillin, the Government have committed £5 million in seed funding to help launch the Fleming Centre, a collaboration led by Imperial College London and Imperial College Healthcare NHS Trust. The centre will support the next generation of world-changing health discoveries.

The publication of this national action plan is a significant milestone in confronting the threat of AMR, one of the most pressing challenges humanity faces this century. The national action plan has been published on gov.uk.

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Covid-19: Response and Excess Deaths

Maria Caulfield Excerpts

Thursday 18th April 2024 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

Apologies for my croaky voice. I will try to respond to all the points that I can.

I thank the hon. Member for North West Leicestershire (Andrew Bridgen) for securing this important debate. As the Opposition have rightly said, it is important that we have the debate in a measured way, because there are strong feelings on all sides. Those who have concerns about vaccines, lockdowns and the way pandemics are managed are right to raise them, but it is also right and proper that people express the view that vaccines protect people and that difficult decisions had to be made. As the hon. Member for Blackley and Broughton (Graham Stringer) highlighted, it is much easier to come to different conclusions with hindsight. It is really important that as we go forward, still living with covid, we continue our discussions in a measured debate on all sides. In recent weeks, we have seen the impact of people not being able to speak freely about their concerns regarding the Post Office or the Tavistock centre.

As I said, we have had a number of debates on this issue, including in January, when I acknowledged that the hon. Member for North West Leicestershire was correct to say that we have seen excess deaths in recent years. However, excess deaths are not new; they were happening before covid and have happened since then as well. It is important to look at the figures, because the Office for National Statistics indicates that the number of excess deaths has been reducing, year on year, since the high in 2020, when there were 66,740 excess deaths in England. I can only talk about England because health is obviously devolved and the Governments in Scotland, Wales and Northern Ireland will have their own data. In 2022, that number went down to 37,701, and in 2023, there were just 10,206 excess deaths in England. It is important to remember that every single one of those is a person, a family member, and a loved one, but it may reassure hon. Members greatly, as it does me, that the ONS has reported negative excess deaths for every week so far in 2024.

[Andrew Bridgen]

After a pandemic, which we have been out of for quite some years, we would expect a deficit in deaths, so why have we not had a deficit for the past two years, in which we have not had the covid pandemic?

[Maria Caulfield]

The hon. Gentleman may have missed my last sentence before his intervention. I said that the ONS data shows that in every week in 2024 so far, we have had negative excess deaths. That goes specifically to his point.

We are not complacent, though. As I set out in previous debates, when we have seen those rises in excess deaths—and we have seen significant excess deaths—we have looked at that data to see the cause behind it, whether it is the vaccine, covid, or other factors. We have been working so hard, and I am really pleased that we are now starting to see negative excess deaths.

Let me highlight some of the work that we have been doing in looking at those figures. We had an incident of high flu prevalence in 2022, with a peak of 31.8% of flu tests being positive. That is highly likely to be because we locked down the country for two years and people’s immune systems were not used to flu. That is why, last winter, we brought forward our flu vaccine, and extended it the year before to the over 65s; we recognised that people’s immunity to flu and respiratory illnesses was low because we had locked them down. I think that we need to be honest about that. This winter, as a result, we have seen fewer admissions and fewer deaths from flu and respiratory illnesses.

We have also seen challenges with other health conditions, such as diabetes and cardiac disease, for which people would routinely have come forward for checks. Routine treatments and access to appointments are difficult even now, given the backlog of examinations and tests that need to happen. When we looked at this, we saw that last year, the rate of deaths from cardiovascular disease was 2% higher than expected, with there having been more than 2,200 excess deaths.

That is why we are reinvesting in our NHS health check. It was on pause during covid, when people could not get their blood pressure or cholesterol checked and could not go on smoking prevention programmes. We restarted those, and as a result, excess deaths from cardiac disease are starting to fall. We want to use the opportunity to roll out our new digital health checks. We recognise that access to GPs is sometimes difficult, but this roll-out is expected to deliver an additional 1 million checks in the first four years. We also have a £10 million pilot to deliver cardiovascular checks in the workplace. Again, that is about making it as easy as possible for people to get checked. We have our Pharmacy First roll-out as well. That is all for general health purposes. We know that all these things contributed to excess death rates.

I want to touch on the crux of the matter, which is the covid vaccine; that has come through in all these debates. I was not a Health Minister at the time, so I did not have to make these difficult decisions, but the hon. Member for Blackley and Broughton is absolutely right: as the pandemic preparedness Minister, I want the findings of the inquiry. I have to make difficult decisions now about potential future pandemics that may never happen, but could happen tomorrow—we just do not know. The results of the inquiry with regard to lockdowns, face masks and vaccines will all be really useful information, and at the moment, I am not much the wiser on those results.

On module 4, I want to see any evidence about vaccine safety, because that is how we learn. I think we are all singing from the same hymn sheet. We want to do the best, but during the pandemic, when we watched TV footage from around the world, and the media were often pushing us to lock down harder, faster and longer, we had to make difficult decisions without the benefit of hindsight.

I went back to the wards during covid, and I looked after covid patients who were being treated for cancer. We lost many of them, and we lost a number of staff, too. I have seen this from both sides of the fence.

[Dr Mullan]

Of all the concerning points that the hon. Member for North West Leicestershire (Andrew Bridgen) made in his opening speech, particularly abhorrent was the suggestion that people who were not eligible for a ventilator were essentially condemned to death. That is a deeply disturbing thing to say, and it does not reflect my experience. I was privileged to volunteer on the frontline, as the Minister did, and I saw staff battling as best they could to save people, using all the medical treatments available, whatever the patient’s age. Will the Minister join me in paying tribute to those staff who worked so hard to save as many lives as they could?

[Maria Caulfield]

Absolutely, and I thank my hon. Friend for his work during those difficult times. We did not have a vaccine in those days, and we did not know how long covid was going to last. I reassure the relatives who are listening to this debate that we treated every single patient in the best way we could. If they needed a ventilator, we often had to ship them out of hospital to get them to a ventilator, but they got one. If they did not need a ventilator, we treated them. We did not leave people to die, and I reassure relatives who might think that we did that it certainly was not my experience of looking after patients.

It is important to look at the data on covid vaccinations. The Office for National Statistics published data last August showing that people who received a covid-19 vaccination had a lower mortality rate than those who had not been vaccinated. Given that 93.6% of the population has been vaccinated with either one or two doses, or multiple does, it is almost impossible to determine correlation versus causation. Vaccinated people will feature highly in excess death numbers because most people have been vaccinated, which is why we need to go through the data really carefully and not just take the first data at face value.

The covid virus continues to circulate, and we are now living with covid. Some people are still very vulnerable to covid, although the current variant is obviously less severe than the initial variant. We have just had our spring vaccine roll-out, and those who are invited should please go to get their vaccine. We know that it makes a difference to the most vulnerable. Over this winter, after both the flu and covid vaccine roll-outs, we have seen a significant reduction in hospital admissions.

[Sir Christopher Chope]

When will the immunosuppressed have access to Evusheld? Will it be this week, next week, sometime or never?

[Maria Caulfield]

That is a clinical decision, but now that we have the omicron variant, the evidence for Evusheld’s effectiveness is not as compelling.

Returning to the crux of the matter, there are risks and benefits to every single medicine when the regulator or NICE is weighing up whether to license or fund a product. If the advice coming to us is that, with omicron, the benefits of Evusheld do not outweigh the risks, we have to take that advice. People are not currently being advised to shield, but I recognise that people are very nervous, particularly when they cannot have the vaccine. We are in constant touch with NICE and the MHRA on this, but we have to respect their decision if it is felt that a product will not benefit patients.

[Andrew Bridgen]

Will the Minister give way?

[Maria Caulfield]

I will give way one more time, as I have only a few minutes left.

[Andrew Bridgen]

I thank the Minister for giving way. She is very generous.

Using her medical experience, can the Minister explain to the House—I am befuddled by this—how a systemic vaccine injected into the arm, into the blood and creating an antibody response, can stop an infection of the airways and lungs by a respiratory virus? It has never happened, and it did not happen this time either, did it? How can it do that?

[Maria Caulfield]

That is actually what antibodies do.

I will answer some of the many questions that have been asked in this debate. I reiterate that no medicine or vaccine is completely risk free. Even simple paracetamol has the potential to kill people if it is not taken properly, and people with certain conditions might not be able to take it at all. We have monitoring systems in place. The MHRA, which I know has come under criticism, took a stand when in April 2021, following concerns raised through the yellow card system, it reduced access for the under-30s and then for the under-40s. When concerns are raised, it absolutely takes action. There are now recommendations about the type of vaccine, and about whom we vaccinate, bearing in mind the current evidence.

I have said that no vaccine is 100% safe, which is why we have the vaccine damage payment scheme. I hear concerns about that, and I have met my hon. Friend the Member for Christchurch (Sir Christopher Chope) to discuss it. We took the scheme off the Department for Work and Pensions and moved it into the Department of Health and Social Care to speed it up and get claims turned around more quickly. We have had more than 4,000 claims, 170 of which have been awarded. Roughly speaking, the majority of claims are decided on within six months, and the vast majority are decided on within 12 months. Of course, we want to speed up on those. We recognise the time limit of three years, which is why we are working as hard as we can to get through as many claims as possible, so that if people have been affected by the covid vaccine, they get some help and support through that funding.

My hon. Friend the Member for South Basildon and East Thurrock (Stephen Metcalfe) raised the issue of research. We are absolutely researching the issue of covid-19 vaccines—not just future types of vaccines, but their safety. There is £110 million from the National Institute for Health and Care Research going specifically into covid-19 vaccine safety, and I encourage all Members to keep an eye on that as the evidence comes forward.

I have to give the hon. Member for North West Leicestershire a few minutes to reply, so I will just say that we take this issue extremely seriously. I know that as a Minister, I will be responsible—

[Danny Kruger]

Will the Minister give way?

[Maria Caulfield]

I will not, as I have to let the hon. Member for North West Leicestershire respond. We take this issue very seriously. I have been as open and transparent as I can be. If there are concerns, we will always look into them, but there is no doubt that covid vaccines save lives. There is no doubt that some people have experienced harm from them—we acknowledge that, and we want to help and support people who have been affected—but the vaccines did get us out of the pandemic and we need to be mindful of that as well.

[Andrew Bridgen]

With the leave of the House, Mr Deputy Speaker, let me thank all the hon. Members who have taken part in a debate that has been robust, as it should be, given the gravity of the issue. I wish this debate were not needed; I wish the experimental covid-19 vaccines were safe and effective, but they are not. The longer we go on not admitting the problem, the bigger the problem that will come, and the greater the harm that will continue to be caused. Those in this House can continue to deny that the vaccines are causing harm and deaths, and the legacy media can continue to censor all reports of vaccine harms and excess deaths, but the people know, in increasing numbers, because they are the ones who are losing their loved ones and relatives. I urge the Government: release the control-level data, and let us sort this out once and for all.

Question put and agreed to.

Resolved,

That this House has considered the covid-19 pandemic response and trends in excess deaths; and calls on the Covid-19 Inquiry to move onto its module four investigation into vaccines and therapeutics as soon as possible.

Antimicrobial Resistance

Maria Caulfield Excerpts

Wednesday 17th April 2024 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

It is a pleasure to serve under your chairmanship, Mr Dowd. I thank my hon. Friend the Member for Colchester (Will Quince) for securing today’s debate, for his contribution to the Department of Health and Social Care during his tenure as a Minister and, in particular, for his work on this issue.

This is a pivotal year for confronting antimicrobial resistance, because the emergence of resistant infections is relentless and, as my hon. Friend eloquently described, the pipeline for new antibiotics is running dry. The evidence is stark, not just domestically but globally: more than 1 million people die every year from infections that have become resistant to treatment. To put that number in context, that exceeds the number of people who die from HIV or malaria.

AMR is sometimes described as an ignored pandemic, but if we do not act, the cost of treating resistant infections could compare to having a pandemic such as covid-19 every five years. My hon. Friend is absolutely correct to say that, if we were to walk outside this place, many of the people we talked to would not understand what AMR is or appreciate the consequences of not dealing with it domestically or internationally. That is why we are committed to addressing antimicrobial resistance.

My hon. Friend is also right that in 2019 we published our vision for antimicrobial resistance to be contained and controlled by 2040, and that date looms ever closer. That vision recognises that it is a complex problem. There are three tiers to the way we are tackling it. First, we must lower the burden of infection in humans and—my hon. Friend touched on this slightly—in animals: if you do not get the bug, you will not need the drug.

Secondly, we must use antimicrobials only when they are absolutely needed, and we should use them correctly. That is also true for both people and animals, as I will touch on in a moment. Thirdly, we must develop new antibiotics or new technologies to treat these infections so that we have more tools in our armoury as resistance emerges.

We can all play our part. I make a public health plea to everyone: we all have a responsibility to finish courses of antibiotics prescribed to us—often, we do not finish our course, because we feel better and think there is no need to take the rest of it, but that is a key way of developing resistance—and not to self-medicate after keeping the strip, which is equally harmful. There are bad practices in other countries, but we all have a responsibility to take our antibiotics as prescribed, and not to self-medicate, should we have some antibiotics looming in our cupboards.

[Richard Foord (Tiverton and Honiton) (LD)]

I am grateful to the Minister for giving way and I pay tribute to the hon. Member for Colchester (Will Quince) for securing the debate. On a brilliant Radio 4 documentary called “Swimming in Superbugs”, Dr Anne Leonard of the University of Exeter Medical School talked about her Beach Bums project and said that people who use the sea are three times more likely to have antibiotic bacteria in their gut. Does the Minister agree that we should not import human sewage sludge to spread on farmland, given that we think traces of antibiotic resistance material might have ended up in the sea?

[Maria Caulfield]

That goes back to my first pillar of reducing and preventing infections in the first place. We need to do that domestically, but internationally we are also doing huge amounts of work in that space to improve water sanitation. With animal health, too, we have done a huge amount of work, in particular on antibiotic use in food. Among animals used in food production, the UK has reduced by 59% the amount of antibiotics going into the food chain, which has a knock-on effect.

We are also investing in innovation and capitalising on our world-leading science, including phage therapy, as my right hon. Friend the Member for Tunbridge Wells (Greg Clark) pointed out. I had not heard about the Leamington Spa facility, and I am interested to catch up with him after the debate to see what more can be done. The National Institute for Health and Care Research is investing almost £90 million in that type of research, so if there is potential to develop that further, we are always keen to hear it. Our plan is cross-sectional, a one health approach, recognising the links between the health of humans, animals and the environment, and the spread of resistance between them.

We have a national action plan, which is not limited to activity in the UK. We all know that infections do not respect borders. As my hon. Friend the Member for Colchester said, we are therefore working internationally and taking a lead in many elements of that across the global community, with our UK special envoy on antimicrobial resistance, Dame Sally Davies, spearheading some of the effort. On updating my hon. Friend on the action plan post 2024, we are working it up as we speak and hope to make an announcement soon. There is an ongoing piece of work to drive forward some of the changes across the three sectors.

We are doing our bit here and are leading internationally, but my hon. Friend also touched on what is happening in other countries. Low and middle-income countries have to be part of the change so that we can safeguard ourselves against antimicrobial resistance.

[Jim Shannon]

One of the groups that I speak to reminded me to mention—I quote—

“the need for Group B Strep screening in pregnant women during labour instead of using antibiotics for all routinely.”

The Minister is interested in that subject and has an opinion on it. Does she agree that this is a chance to raise awareness of that particular issue?

--- Later in debate ---

[Maria Caulfield]

The hon. Gentleman is absolutely right. I will touch on how much more we can do with screening to prevent some infections. This cannot just be about developing new antibiotics; it is about preventing infections and screening for them in a range of scenarios.

To touch on some of the high prevalence internationally, 89% of all antimicrobial resistance deaths occur in Africa and Asia, so we have responsibility to ensure that we help out in those countries that struggle most with the issue. We must continue to ensure that people around the world have access to the antibiotics they need, which is why the £40 million in innovative research through the global AMR innovation fund that my hon. Friend the Member for Colchester mentioned is so crucial. It enabled the development of a new antibiotic for drug-resistant gonorrhoea, the first in 30 years.

The hon. Member for Tiverton and Honiton (Richard Foord) touched on the role of water, which requires an international effort. Sanitation is often a leading cause of infection in other countries. That is why we are working hard with other countries and the WHO to improve water sanitation and hygiene to reduce infections occurring in the first place.

In 2022, we made a further £210 million commitment for the second phase of the Fleming Fund to strengthen our surveillance systems. As the hon. Member for Strangford (Jim Shannon) said, it is not just about treatment, but about picking up infections and trends and trying to prevent them in the first place. The Fleming Fund is having an impact. Since 2015, over 240 laboratories have been upgraded with state-of-the-art equipment, training and new systems, and over 75 national action plans on AMR have been developed in Africa and Asia to try to get the death toll from antibiotic resistance down. The Fleming Fund leverages UK expertise, with over 3,000 healthcare workers being trained in antimicrobial surveillance principles through a partnership with the NHS.

Looking ahead, we recognise the risks. We are not being complacent either domestically or internationally. Through the hard work of my hon. Friend the Member for Colchester, we have put some good building blocks in place, but we need to look to the future. Our next five-year antimicrobial resistance national action plan will be published later this year.

[Greg Clark]

I am grateful to the Minister for what she said about phages. She knows that UK science is world-leading, especially in this area. In Imperial College alone, there are 180 researchers working on AMR. One such researcher, Professor Jonathan Cook, has noted the real benefits of point-of-care testing and the fact that other countries, including the Netherlands, have managed to make a big impact. Can the Minister say whether we have plans to accelerate the availability of such testing in this country?

[Maria Caulfield]

My right hon. Friend makes a good point, which I will take away and follow up on. There are some really good examples in primary care where some testing is done. Primary care nurses particularly will do point-of-care testing to see whether someone’s infection will be sensitive to antibiotics or not. I believe there is more we can do in that space, both in primary and secondary care, so I am happy to write to him about how we can roll that out nationally. Importantly, that testing helps to maintain patients’ expectations. I cannot remember who, but someone said that people go along to GPs and expect to be given antibiotics. Point-of-care testing will be able to reassure them that they either do or do not need antibiotics and tell them which type is best suited to their type of infection. That is crucial.

Our plan will set out an ambitious programme of work, learning from covid-19 in testing, surveillance and treatment to prepare for infections of the future. I can reassure my hon. Friend the Member for Colchester that we will continue to collaborate internationally with organisations such as the WHO and use our soft power to help to support in particular African and Asian nations, which are suffering greatly from the mortality of antimicrobial resistance. This is a hidden pandemic that will have consequences for us all if we do not deal with it.

Question put and agreed to.

Duty of Candour in Health and Social Care: Review

Maria Caulfield Excerpts

Tuesday 16th April 2024 Written Statements

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

On 6 December 2023, I informed the House that the Department of Health and Social Care will lead a review into the effectiveness of the statutory duty of candour for health and social care providers in England.

The duty of candour is set out in regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. It has been in place for NHS trusts and NHS foundation trusts since 2014 and for all other providers regulated by the Care Quality Commission since 2015.

The duty of candour is a crucial instrument for promoting an open and transparent culture in health and social care, ensuring patients and service users or their families receive a full account of events, and a meaningful, timely apology when things go wrong during the provision of health and care services. Providers must also provide those affected with reasonable support and details of further enquiries or investigations that need to be made. The duty is about providers taking reasonable steps to ensure they communicate with those affected in a way that is as accessible and supportive as possible.

Today, I wish to inform the House that we are publishing a call for evidence as part of the review. A call for evidence will allow my Department to capture and consider a wide range of views, including expert opinions, about how the duty is being honoured, monitored and enforced, and the extent to which the policy has met its objectives.

The call for evidence will run for six weeks and close on 29 May 2024.

We will consider all responses to the call for evidence and use them to inform our recommendations for better meeting the policy objectives of the duty of candour.

The call for evidence will be published on www.gov.uk and a copy will be deposited in the Libraries of both Houses.

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