Auditory Verbal Therapy

Maria Caulfield Excerpts

Tuesday 12th December 2023 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Dame Maria. I start by congratulating my constituency neighbour and hon. Friend the Member for Hastings and Rye (Sally-Ann Hart) on securing the debate on this important topic. I reassure her and all Members today that the Government are committed to improving outcomes and experiences for all children and young people with special educational needs and disabilities, including children with hearing loss.

As I am sure colleagues are aware, figures from the National Deaf Children’s Society show that there are more than 50,000 deaf children and young people across the UK. Between one and two babies in every thousand are born with permanent hearing loss in one or both ears, and we know that early and effective support is crucial for these children and their families. My hon. Friend pointed out how important it is that help and support is there as soon as possible. She also pointed out that, without intervention, children with speech and language needs are at higher risk of facing longer-term challenges, including in education. It is vital that we intervene at birth, which is why we are investing in hearing screening for newborns to identify babies who have permanent hearing loss as early as possible, so that we can intervene as quickly as possible.

We know that language is linked to social, emotional and learning outcomes. From birth through to childhood, children and young people with hearing loss might need a range of therapy, such as speech, language and auditory verbal therapies. As we have heard today, however, those children are not always receiving the help they need. It is important that we start by pointing out that the commissioning of many of these services, including the provision of therapies for children with hearing loss, happens at the local level. This now sits with our 42 integrated care boards, which means that the responsibility for meeting the needs of a local community of non-hearing children lies with local NHS commissioners.

The National Institute for Health and Care Excellence has issued guidance on the topic of cochlear implants for children and adults with severe to profound deafness. When it comes to commissioning and providing services for children with hearing loss, we have been crystal clear with those ICBs and NHS trusts that they must take those relevant guidelines into account. As yet, however, there are no NICE guidelines on hearing loss for children in general, and until now NICE had not made any specific recommendations on auditory verbal therapy.

I am pleased that NHS England has met with Auditory Verbal UK this year and discussed the need for more high-level research evidence, for the intervention and for evaluations of impact to be developed. NICE will not make recommendations without that evidence base, and getting that information absolutely must be the priority now, so that decisions and recommendations can be made. It is right that Auditory Verbal UK was invited to join the chief scientific officer’s audiology stakeholder group; I am sure it will have a lasting impact on the decisions being made. I am very happy to work with my hon. Friend and Auditory Verbal UK to ensure that progress is happening.

The Government will continue to prioritise investment into the NHS, and we have seen record levels in cash terms, rising to £165 billion in the coming year. We are using that money to support ICBs to make informed decision about the provision of hearing loss services, so that they can provide consistent high-quality integrated care to children with hearing loss. In 2016, NHS England published “Commissioning Services for People with Hearing Loss: A framework for clinical commissioning groups”, which also supports NHS commissioners to address inequalities in access and outcomes between hearing services.

With input from the National Deaf Children’s Society, NHS England produced a guide for commissioners and providers who support children and young people with hearing loss. That guide provides practical advice on ensuring that children with hearing loss receive the necessary support. More recently in May, the NHS service specification for cochlear implant services for adults and children recognised AVTs as part of multidisciplinary teams’ decision-making processes, enabling them to provide rehabilitation services alongside a range of healthcare professionals providing other services.

I fully recognise my hon. Friend’s point that we are not where we want to be in improving access to therapies for children with hearing loss. The limiting factor, as she pointed out, is the number of therapists working in the NHS—the SNP spokesperson, the hon. Member for Motherwell and Wishaw (Marion Fellows), also raised that issue in Scotland. We are increasing the numbers and have seen a 17% increase in speech and language therapists since 2018.

That is also why we are undertaking the biggest nursing, midwifery and allied health professional recruitment drive in decades with our long-term workforce plan, which includes the recruitment of speech and language therapists. AHP training places will increase by 13% to 17,000 in the next five years, with an 8% increase just next year, and by 25% to over 18,800 in the next 10 years. I am very happy to speak to the Minister responsible for the long-term workforce plan to particularly focus on the AVT element of that. Recruiting speech and language therapists is important, but I have clearly heard the point in this debate about the added training required to ensure that more therapists are available across England.

As committed to in the SEND implementation plan, we are exploring options to commission research to understand the health needs of children and young people through the National Institute for Health and Care Research. As I said previously, without NICE recommendations and the evidence base to inform those recommendations, we will not make progress as quickly as we would like. We are therefore working to improve access to speech and language therapy through service innovations.

We are including Early Language and Support for Every Child projects in our £70 million change programme, in partnership with NHS England. That programme is funding innovative workforce models to identify and support children and young people with speech, language and communication needs at an early stage. That will reduce exacerbation of need that might lead to a referral for specialist speech and language therapy or for an education, health and care plan. I welcome the work of Auditory Verbal UK on its plans to upskill health professionals to deliver AVT. Whether that is through speech and language therapists or upskilling other healthcare professionals, I am very keen to hear about its work and to see what more we can do to get those skills in place to help children and young people.

My hon. Friend the Member for Hastings and Rye spoke powerfully about the importance of early identification and intervention for children with hearing loss. The shadow Minister, the hon. Member for Dulwich and West Norwood (Helen Hayes), touched on schools in particular. She will know that teachers of deaf children have to hold the mandatory qualification in sensory impairment. There are currently six providers of that, and a seventh will come on stream next year. I am working closely with the Minister for children, and I will absolutely take her points to him to make sure there is a joined-up approach. This issue is not just about health, but about education—it is a cross-Government issue. We are committed to joining up the dots and working together to get children help and support wherever they need it, whether in healthcare or in school.

My hon. Friend the Member for Hastings and Rye and I share the same ICB. I recommend that all local MPs lobby their ICBs on the importance of commissioning these services. I recognise that we have to do more nationally to train practitioners who teach AVT, but we need local commissioners to commission those services and upskill their own local workforce. I have heard that message very powerfully and look forward to working with my hon. Friend and all Members across the House to deliver for children with hearing problems in the months ahead.

Coronial Investigations of Term Stillbirths: Summary of Responses to the Consultation

Maria Caulfield Excerpts

Thursday 7th December 2023 Written Statements

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

I wish to update the House on the responses received to a joint consultation by the Department of Health and Social Care and Ministry of Justice on coronial investigations of stillbirths in England and Wales.

Over the years, there have been calls from bereaved families, charities and others for a more transparent and independent process for determining the causes of, and learning from, stillbirths. Some of those calling for change identified coronial investigations as the way to deliver an improved process.

Under current legislation, coroners cannot investigate a death when it is known that the baby was not born alive. If there is doubt whether a baby was born alive, a coroner can investigate (which could include holding an inquest) but must halt that investigation if they determine that the baby was stillborn.

The consultation sought views on proposals on whether, and if so how, coronial investigations of stillbirth cases could take place in England and Wales.

The objectives of the proposals, which were co-developed with stakeholders, were to:

bring greater independence to the way stillbirths are investigated;

ensure transparency and enhance the involvement of bereaved parents in stillbirth investigation processes, including in the development of recommendations aimed at improving maternity care; and

effectively disseminate learning from investigations across the health system to help prevent future avoidable stillbirths.

Some 334 people responded to the consultation and 63 people attended our stakeholder workshops. I and my ministerial colleague at the Ministry of Justice are extremely grateful to those who responded and shared their views, particularly families who have experienced stillbirth and shared their personal and often tragic experiences. This was so important to us in considering our response.

Work to respond to the consultation was paused during the pandemic. Today I am sharing a factual summary of the consultation findings. The findings of the consultation were complex: there were mixed views about proposals that coroners should have a role in stillbirth investigations and where they were supportive, about the way in which coronial investigations would be carried out.

In addition, the landscape of maternity investigations has changed significantly since the consultation. The maternity and new-born safety investigations programme is now in place, which aims to provide independent, standardised and family focused investigations for families; to provide learning to the health system via reports at local, regional and national level; analyse data to identify key trends and provide system wide learning; be a system expert in standards for maternity investigations; and collaborate with system partners to escalate safety concerns. Additionally, the perinatal mortality review tool supports standardised perinatal mortality reviews across NHS maternity and neonatal units in the UK. Going forward, my officials are working to improve the information available to families regarding these investigative processes that may be taken forward following a stillbirth. I wish to reassure the House that a further statement will be issued in due course, which sets out whether, and if so, how the Government intend to take action.

The factual summary of consultation responses is available online at: https://www.gov.uk/government/consultations/coronial-investigations-of-stillbirths. The document has also been placed in the Library of both Houses.

[HCWS105]

Draft Equality Act 2010 (Amendment) Regulations 2023

Maria Caulfield Excerpts

Wednesday 6th December 2023 General Committees

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

I beg to move,

That the Committee has considered the draft Equality Act 2010 (Amendment) Regulations 2023.

It is a pleasure to serve under your chairmanship, Mr Hollobone. This statutory instrument will reproduce select interpretive effects of retained EU law, in order to maintain equalities protections against discrimination. These protections are reproduced by making amendments to the Equality Act 2010.

It is important to make clear from the outset that the overwhelming majority of our equality law is contained in domestic legislation. The Equality Act 2010 was approved and voted on by our own Parliament, and so the interpretive effects of retained EU law have a bearing on our equality framework in only a limited number of areas.

This instrument uses the powers of the Retained EU Law (Revocation and Reform) Act 2023 to ensure that necessary protections are put into our statute. This will end the inherent uncertainty of relying on judicial interpretation of EU law and instead ensure that strong and clear equality law protections are set out in our domestic legislation. To be clear to hon. Members, this instrument applies just across Great Britain.

This statutory instrument safeguards and enshrines key rights and principles across a range of areas. First, it protects women’s rights by maintaining equal pay protection where employees’ terms are attributable to a single source but not the same employer; protecting women from less favourable treatment at work because they are breastfeeding; and protecting women from unfavourable treatment after they return from maternity leave, where that treatment is in connection with a pregnancy or a pregnancy-related illness occurring before their return. It ensures that women are protected against pregnancy and maternity discrimination where they do not have a statutory right to maternity leave, but have similar rights under alternative occupational schemes. It also ensures that women can continue to receive special treatment from their employer in relation to maternity; for example, ensuring that companies can continue to offer enhanced maternity schemes.

I am sure that all of us in the House will agree that women should not face discrimination for being pregnant or taking maternity leave, should continue to receive equal pay for work of equal value, and that they should not receive less favourable treatment in the workplace because they are breastfeeding. This instrument reproduces these principles in domestic law to ensure that women can continue to rely on these protections.

This instrument also maintains protections for disabled people in the workplace, so that they are able to participate in working life on an equal basis with other workers. It is, of course, important that disabled people have the same opportunities as everyone else to start, stay and succeed in work, and this amendment will mean that disability protections continue to apply where someone’s impairment hinders their full and effective participation in working life on an equal basis with other workers.

Finally, this instrument maintains two protections that apply more broadly. The first of these maintains the status quo whereby employers and their equivalent for other occupations may act unlawfully if they make a discriminatory public statement relating to their recruitment practices, including when there is not an active recruitment process under way. This ensures that groups that share certain protected characteristics are not unfairly deterred from applying for opportunities in an organisation. The second maintains protections against indirect discrimination for those who may be caught up and disadvantaged by indirect discrimination against others, so that they are also protected when they suffer substantively the same disadvantage.

We intend that there will be no time gap and no break in protections between this law coming into effect and the removal of the special status and EU-derived features of retained EU law at the end of this year. By maintaining these important protections, we will ensure that our domestic equality framework has continuity. Importantly, these amendments do not add any regulatory burdens on business, as the legislation reproduces the status quo, meaning that the regulatory environment will not change. I hope that colleagues will join me in supporting these draft regulations and I commend them to the Committee.

[Sir William Cash (Stone) (Con)]

On a point of order, Mr Hollobone. I want to be quite clear, as Chairman of the European Scrutiny Committee, that, as some may know, we are having a full inquiry into the implementation of arrangements regarding the revocation and reform of retained EU law. We are actually having inquiries on a continuing footing. Am I right in saying that, while this Committee will consider the issues concerned, the ultimate decision will be taken by the House? That would be very helpful indeed.

I say this very respectfully: is it possible for those of us who were not nominated for this Committee—my Friend the Member for Aberconwy and me—to speak but not vote? We will be as brief as we can, because I suspect that our hon. Friend the Member for Penistone and Stocksbridge has something that she would like to say. We just have a few thoughts that we would like to offer to the Committee as well. Is that all right?

--- Later in debate ---

[Maria Caulfield]

I am grateful to all hon. Members who have spoken. Britain has a proud history of justice and fairness and has some of the world’s strongest and most comprehensive equalities legislation, thanks to the Equality Act 2010. By setting out these EU-derived protections in domestic law, we will ensure that our equality framework provides clarity and continues to protect the fundamental rights and freedoms of people in this country.

I assure the shadow Minister, the hon. Member for Ellesmere Port and Neston, that there is a cross-Government approach to retained EU laws. A publication on progress on that work is planned for January as part of the statutory six-month reporting requirement. The EU law dashboard on gov.uk, which was last updated on 8 November, sets out the laws that we are retaining. I take his point that more information on that would be helpful to Members across the House. I reiterate that the retained EU law powers are available until June 2026, so we can continue to review the EU laws, and even if we do not retain them now, we have the potential to do so in future.

On the comments by my hon. Friends the Members for Penistone and Stocksbridge and for Aberconwy, I reiterate that the CHEZ ruling is already the basis of law across Great Britain. Whether or not we agree with the judgment, it was made in 2015, before the implementation period, and therefore falls under section 4 of the European Union (Withdrawal) Act 2018. Because of that, it falls under section 12(8) of the Retained EU Law (Revocation and Reform) Act 2023, which enables the Government by regulation to reproduce to any extent the effect of anything that was retained EU law by virtue of section 4 of the European Union (Withdrawal) Act. That is why it comes under the Retained EU Law (Revocation and Reform) Act, and why we have been able to table these regulations.

Section 3 of the Retained EU Law (Revocation and Reform) Act gives Ministers powers not just to replicate but to amend laws as they are put on the statute book. That is not specific to this instrument. That power was voted on in Parliament.

[Sir William Cash]

On a point of information, regardless of what happens with these regulations, which are only for consideration in this Committee and will be subject to final approval on the Floor of the House after fuller consideration, does the Minister agree that if the argument is made as clearly and thoroughly as it can be—thanks to my hon. Friend the Member for Penistone and Stocksbridge, the case has been made more clearly and more explicitly—it could be included in the Government’s list of items for revocation in their entirety?

[Maria Caulfield]

My hon. Friend is suggesting that we revoke the legislation that we are considering, which provides the protections that I set out in my opening speech. It is certainly the Government’s view that it is important that we retain those protections, whether they relate to discrimination against women going through pregnancy, disabled people or others with protected characteristics. To clarify, the way the instrument interprets the CHEZ ruling is not new legislation. As I set out, the CHEZ judgment was before the implementation period, so it is already a basis on which judgments are made. Because it falls under the Retained EU Law (Revocation and Reform) Act, this statutory instrument just puts that on a domestic footing.

[Robin Millar]

I fully acknowledge the challenge of debating such a detailed subject in this setting, but given that the ruling exists, why do we need to enact the measure through regulations now? There is provision in place.

[Maria Caulfield]

The reason is that the provisions currently fall under section 4 of the European Union (Withdrawal) Act 2018 and that if we do not replicate them under the Retained EU Law (Revocation and Reform) Act, they will fall. That would mean that protections for women who are pregnant or breastfeeding fall at the end of the year. That is why we need to replicate them.

Let me touch on the point about whether the measure provides expanded powers—I think “power on steroids” was the phrase that was used. The legal advice is that CHEZ can be interpreted as already giving horizontal rights, so we are not introducing such rights through this statutory instrument. Even if it did not give such rights, section 13 of the Retained EU Law (Revocation and Reform) Act, which Parliament voted on, gives Ministers powers to resolve ambiguities and remove doubt or anomalies to facilitate the improvement of the law. That is the power that that Act provides. We believe that the CHEZ ruling already gives horizontal rights, but even if it did not, the Act gives leeway to Ministers to tidy up those provisions.

[Miriam Cates]

Is the Minister saying that she believes that the legal probability is that the CHEZ judgment already has direct effect in UK law? On my understanding, that is the only situation in which the power can be used to reproduce the judgment in primary legislation. It is not clear to me that it did have direct effect. At the moment, there is clearly no case in the UK courts to suggest that.

[Maria Caulfield]

The legal advice is that it is arguable that it can be interpreted as giving horizontal rights, and that is why the instrument reflects that.

The basis of this argument was that we believed that, in leaving the EU, it was fundamental that Parliament made decisions about which laws we retained, repealed or amended. That is exactly what we are doing today. We may differ over whether we believe that the protections are needed or whether they go too far, but it is now Parliament that is making that decision.

[Sir William Cash]

The Minister is making an interesting case, and I understand that she prepared her notes and thoughts before she came to the Committee. At the same time, questions have been raised with regard to matters of ambiguity or uncertainty in interpretation that could apply in this instance. It is possible for the Government to consider their position on the merits of the issue—on the basis of another understandably important opportunity to look at the legal implications of the instrument—after the Committee has finished its consideration. They cannot make the decision now. There is an opportunity for these matters to be looked at more carefully and with great legal analysis in a way that I am quite sure will throw up some further points, which can then be taken into account when the final decision is about to be made. I am sure that the Minister would agree with that. Otherwise, there would be very little point in the procedures.

[Maria Caulfield]

I take my hon. Friend’s point, but if we had not left the EU, the CHEZ ruling would still be the basis of the way in which decisions are made right now on discrimination cases. Any law can be challenged in courts and precedents can be set, but that does not mean that we should not set out the law as we determine it should be interpreted. Obviously, case law can change that, but the CHEZ case was back in 2015, so it falls under the European Union (Withdrawal) Act. We have decided as a Government to retain those protections. Let me set them out for hon. Members: they are around maintaining equal pay for pregnant women; protecting women from less favourable treatment because they are breastfeeding; and helping pregnant women facing discrimination with being able to return to work.

[Miriam Cates]

I completely agree with the Minister about the need to protect equal pay, pregnant women and so on; I do not think there would be any disagreement on that. The problem is the unintended consequences.

I will come back to the example of the hon. Member for Cumbernauld, Kilsyth and Kirkintilloch East. At the moment, let us say that a group of people were thrown out of a pub because of a homophobic landlord who thought that they were all LGBT. Let us say that they were not LGBT; the people who were not would currently, under UK law, have a case for discrimination, and rightly so.

The problem is that the effect of this legislation would be that if someone else walked into the pub who was not LGBT, and the landlord did not think he was LGBT but still threw him out, he would be able to claim that he suffered the same effect of discrimination, even though he did not have the protected characteristic. That is the impact. The lady who won the CHEZ case was not Roma, and nobody thought that she was Roma. She experienced the same discrimination as Roma people, but she was still able to claim. That is the difference between existing law and what this legislation potentially puts into practice, and that is the unintended consequence.

[Maria Caulfield]

That is open to interpretation, and that is exactly what the courts are there for: to decide how existing laws are interpreted. However, the CHEZ judgment is part of existing case law. It is the basis of how discrimination is determined right now. If we did not have this instrument and we had not left the EU, that would continue to be the case. At the end of this month, if we do not retain the law, those protections for pregnant women, disabled people and those with protected characteristics will fall completely. The CHEZ judgment is actually the basis of case law.

[Stuart C. McDonald]

Will the Minister give way?

[Maria Caulfield]

I do not wish to test your patience, Mr Hollobone, but I will take a final intervention.

[Stuart C. McDonald]

I am trying to be helpful to the Minister here. Putting aside all those arguments, I am not an employment lawyer, and I did not prepare on this particular case in advance. However, a more fundamental point is that that judgment is part of UK law just now. It would be outrageous if, through the statutory instrument procedure, we just decided to dump it overnight. If people have a beef with that particular case, they should promote a private Member’s Bill or encourage the Government to bring in another bit of legislation. Today is about a statutory instrument preserving the status quo. Any other course of action from the Government would be completely unacceptable.

[Maria Caulfield]

Absolutely; I agree with the hon. Gentleman on that point. I hope that in debating the statutory instrument, colleagues will realise that whatever we think about which laws we retain or revoke, it is based on the CHEZ ruling of 2015. That will not change after the statutory instrument is approved on the Floor of the House. There is no change: it is still based on the exact same principles since the CHEZ ruling of 2015. It is really important that we retain those protections, because without them vulnerable groups will be left without protection and face discrimination. I hope that colleagues will join me in supporting the regulations, which I commend to the Committee.

Question put and agreed to.

Resolved,

That the Committee has considered the draft Equality Act 2010 (Amendment) Regulations 2023.

Health and Care Settings: Duty of Candour

Maria Caulfield Excerpts

Wednesday 6th December 2023 Written Statements

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

I wish to inform 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 review will formally commence early in the new year.

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 about people’s right to openness and transparency from their health or care provider. It means that when something goes wrong during the provision of health and care services, patients and their families have a right to receive explanations for what happened as soon as possible and a meaningful apology.

Since its introduction, there has been variation in how the duty has been applied in some settings. To that effect, the review will look at the operation and enforcement of the existing duty, with a focus on delivering recommendations that can improve its application.

The terms of reference will be published on www.gov.uk and I will deposit a copy in the Libraries of both Houses.

[HCWS100]

Women and Equalities

Maria Caulfield Excerpts

Wednesday 29th November 2023 Ministerial Corrections

The following is an extract from the Westminster Hall debate on International Men’s Day on 21 November 2023.

[Maria Caulfield]

The theme of this year’s International Men’s Day is zero male suicide. The latest data we have from the Office for National Statistics tells us that men account for around three quarters of all deaths by suicide. As many Members have said, that is the biggest cause of premature death in men under 35, but middle-aged men are also a significant risk group, and that is why they are a priority group in our recently published suicide prevention strategy. Over 4,500 men die by suicide in England alone every year. My hon. Friend the Member for Don Valley noted that is 13 deaths a day.

[Official Report, 21 November 2023, Vol. 741, c. 33WH.]

Letter of correction from the Minister for Women, the hon. Member for Lewes (Maria Caulfield):

An error has been identified in the speech I gave in the debate on International Men’s Day. The correct statement should have been:

[Maria Caulfield]

The theme of this year’s International Men’s Day is zero male suicide. The latest data we have from the Office for National Statistics tells us that men account for around three quarters of all deaths by suicide. As many Members have said, that is the biggest cause of premature death in men under 35, but middle-aged men are also a significant risk group, and that is why they are a priority group in our recently published suicide prevention strategy. Over 4,500 men died by suicide in England, Scotland and Wales in 2021. My hon. Friend the Member for Don Valley noted that is 13 deaths a day.

Fuller Inquiry Report

Maria Caulfield Excerpts

Tuesday 28th November 2023 Written Statements

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

Today the report of the independent inquiry into the issues raised by the David Fuller case has been published. Sir Jonathan Michael updated the victims’ families earlier today.



This report follows two years of work by the independent inquiry, led by Sir Jonathan, investigating David Fuller’s shocking and depraved actions in the mortuaries of Maidstone and Tunbridge Wells NHS Trust.



I am very grateful to all those who provided evidence to the independent inquiry, especially the families who found the courage to share their experience of what happened to their loved ones.



The report makes for harrowing reading. It sheds a light on the circumstances surrounding David Fuller’s abuse, which regrettably meant that his crimes went undetected for a long period of time.



I want to profoundly apologise on behalf of the Government and the NHS and commit that lessons will be learned. We fully welcome the report, and will ensure that there is a full response to the recommendations in spring 2024 and that lessons are learned across the wider NHS so that no family has to go through this experience again.



A lot of work has already been done to review mortuary safety since these crimes were first revealed. NHS England required all NHS trusts with either a mortuary or a body store to review practices and ensure they are compliant with the requirements set out in the Human Tissue Authority’s standards and guidance. NHS trusts were asked to take action to ensure all access points to mortuaries or body stores are controlled by swipe card security access, ensure there is effective CCTV coverage monitoring access to and from mortuary areas, undertake risk assessments of mortuary security and ensure consistent application of appropriate levels of Disclosure and Barring Service checks for all trust and contracted employees.



However, we should not be complacent. It is important that the whole system remains alert and accountable at all levels and that any concerns are swiftly identified and escalated through the appropriate governance processes.



The report will be published on www.gov.uk and is available in the Vote Office (HC 310).

[HCWS73]

Tattoo Artists, Body Piercers and Cosmetic Clinics: Licensing

Maria Caulfield Excerpts

Tuesday 28th November 2023 Commons Chamber

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

I congratulate my hon. Friend the Member for Winchester (Steve Brine) on securing this important debate and reiterate the Government’s commitment to improving patient safety in this area. We recognise that for some time, there have been concerns about the lack of regulation of these procedures, both here and abroad, the dangers they can pose to consumers and the long-term impact when they go wrong. As my hon. Friend pointed out, we have heard many horrific stories, both in this Chamber and in Westminster Hall, about what can go wrong when procedures are done poorly or consumers or patients experience side effects that they were not expecting.

As my hon. Friend pointed out, there are existing regulations for body piercing and tattooing, which I will touch on in a moment. However, we take this area so seriously that the Health and Care Act 2022 gave the Secretary of State powers to introduce a licensing scheme for non-surgical cosmetic procedures in England. The scheme we intend to introduce in England will be more extensive than the Welsh scheme that my hon. Friend mentioned; it will cover more than the four areas outlined in the Welsh Government’s recent piece of work. Obviously, we have just held our consultation, and at the moment we are looking to see whether the scheme will also cover some of the existing powers around tattoos and piercings that are enforced by local councils.

We want the licensing scheme that we intend to introduce to support people in making an informed choice, and to ensure that when they make their choice, they experience safe care for any non-surgical cosmetic procedure. We want the scheme to address three areas, the first of which is to ensure that services are administered by suitably trained and qualified practitioners. That does not necessarily mean regulated healthcare professionals, but it does mean that anyone who undertakes procedures must be trained and qualified to do so. We also want practitioners to hold appropriate indemnity cover, so that they and the patients they are treating are covered should something go wrong, and to be operating from premises that have appropriate standards of hygiene and cleanliness.

As my hon. Friend said, we have been working closely with many professionals from a variety of backgrounds to start the process of introducing the licensing scheme. The cosmetic procedures sector includes a vast and expanding range of treatments and techniques. We want to future-proof regulation so that we cover as many emerging techniques, treatments and procedures as possible—we do not want to be revising regulations on a regular basis—and cover a wide range of practitioners and businesses. We want those businesses to thrive—they contribute to our economy and provide a very popular service—but we need to make sure that they are safe and well regulated, so that those undergoing procedures are safe and can make informed choices about treatments.

In introducing the licensing scheme, we need to make sure that we consider all eventualities. There are a number of factors to consider, from who undertakes the procedures to the types of procedures that are covered and who undertakes inspections once the regulations are introduced. Through our engagement, we have developed proposals on which treatments are to be included, who should be permitted to perform them, and whether age restrictions need to be introduced for certain procedures.

As my hon. Friend said, we rolled out an initial consultation, which closed at the end of last month. We received over 12,000 responses from across England, which is a pretty significant number of responses to a Government consultation; we do not normally get so many. To reassure my hon. Friend, 43% of those responses were from aesthetic practitioners and about 40% were from the various regulated health professionals, so there was an even mix of practitioners and regulated healthcare professionals. We received a fair balance of views, and we are working through the responses at speed. I thank everyone who responded, because the consultation will inform how the regulations are developed.

Over the next 12 months, we will work through the consultation responses and set out exactly which procedures will be covered by the regulations; the education and training standards that will be required of practitioners; the types of premises that will be allowed; the types of licence fees that will be introduced, if any; and who will enforce the regulations to ensure that they are complied with.

That will take time—we estimate that it will take most of next year—but I can assure my hon. Friend that it is crucial. Like him, I thought that we would be able to get this done pretty swiftly, but once we start to unearth which procedures should be covered, who should be doing them and the types of premises they should be operating from, it is a can of worms. It is really important that we take the time to get this right, so that we have a really robust, extensive and safe regulatory licensing scheme in operation across England.

My hon. Friend touched on tattoos and piercings. As he said, those are regulated by measures such as the Local Government (Miscellaneous Provisions) Act 1992 and the Local Government Act 2003, as well as legislation specific to geographical areas of England. The existing legislation gives local authorities the power to register practitioners and their premises, and to take enforcement action if practitioners are not abiding by byelaws. He is right that that varies across England, but the measures local authorities undertake do reduce the risk of transmission of blood-borne viruses such as HIV and hepatitis B and C. The Department has a model byelaw template—if local authorities want to introduce that in their local area, they can contact us for it—to try to get as much consistency as possible.

We are looking at whether tattoos and piercings should also come under the non-surgical cosmetic procedures regulations. We are engaging with those sectors to see whether we should have one wide piece of legislation and regulation, or a dual system, because many tattoos and piercings practitioners feel that that works quite well for them right now. We have not ruled out a change, but it is important to note that, as the legislation stands, there are already regulations for tattoos and piercings, which should be being enforced by local authorities up and down the country.

I want to touch on cosmetic procedures abroad, because that is becoming more of a topical issue. As costs rise and procedures are often cheaper abroad, it is so important that we make sure that people from the UK travelling for non-surgical cosmetic procedures are informed about the risks and do their research before they travel. While excellent healthcare is available internationally, we are aware of tragic cases—even cases in which people have lost their lives—arising from treatments outside the UK. Our team are actively engaging with international partners to consider how best we can support people considering travelling abroad for such treatments. Having a safer, regulated system in England will help inform people that, if they are travelling abroad, the country involved should be operating to the same standard as the licensing scheme we are intending to introduce in England.

I absolutely understand the urgency with which my hon. Friend wants to see the licensing scheme come forward. That is why we introduced the power in the Health and Care Act, but this is a complex area. We need to decide who will undertake these procedures and which procedures will be covered, and to future-proof so that we cover as many as possible. We also need to look at the premises that practitioners are operating from and who the regulator will be. It could be the Care Quality Commission, local government, the Nursing and Midwifery Council or the General Medical Council, which all have a role to play in this. There is a lot to decide before the legislation and regulations come before us.

I can assure my hon. Friend that we will be working to respond to the consultation early in the new year, and we will then set out the framework for the legislation. We will conduct a further consultation on that before finally announcing it, because, as he said, there are concerns across the sector. There will also be an interim period so that, if we introduce mandatory training for practitioners, there is time for those operating in this space to take on qualifications and training, to upgrade their premises or to look at which procedures they undertake. We want to ensure that those who can practise safely have the time to develop their skills and upgrade their premises accordingly. I assure my hon. Friend we will consult again so people will be fully aware of the changes coming through.

I look forward to working with my hon. Friend and his Select Committee to make sure that we have an extensive scheme of regulation across England as quickly as possible, but also that it is robust and meets the needs, most importantly of patients, but of the sector as well.

Question put and agreed to.

Draft Health Protection (Coronavirus, Testing Requirements and Standards) (England) (Amendment and Transitional Provision) Regulations 2023

Maria Caulfield Excerpts

Wednesday 22nd November 2023 General Committees

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

I beg to move,

That the Committee has considered the draft Health Protection (Coronavirus, Testing Requirements and Standards) (England) (Amendment and Transitional Provision) Regulations 2023.

It is a pleasure to serve under your chairmanship, Mr Paisley. I will begin by setting out the policy context for the regulations, and then explain the effects of the proposed changes. We all remember that during the covid-19 pandemic the Health Protection (Coronavirus, Testing Requirements and Standards) (England) Regulations 2020 focused on enabling providers who met appropriate quality standards to rapidly enter the private covid-19 testing market. At the time, the right balance was struck between protecting public health and growing the market quickly, both of which were necessary public health outcomes. Now that the threat of covid-19 is reduced and there is no longer an urgent need to grow the testing market quickly, the Department has reviewed the 2020 regulations and proposes that all private providers must be now be fully accredited before they provide testing services.

The 2020 regulations introduced a three-stage accredit- ation process for organisations providing covid-19 testing commercially, to speed up entry to the market. Stage 1 required a private provider to make an application to the United Kingdom Accreditation Service for accreditation, and to make a declaration to the Department that it met and would continue to meet certain minimum standards. Stage 2 required an applicant to demonstrate within four weeks of applying for accreditation that it met the requirements published by UKAS. Between January and June 2021, stage 3 required providers to complete their application within four months.

In June 2021, we passed legislation to update stage 3, thereby requiring applicants to achieve a positive recommendation from UKAS within four months of completing stage 2. As long as a provider received that recommendation, it then had a further two months to achieve accreditation. Providers that failed to meet those deadlines, or failed to satisfy UKAS that they met the relevant standards, had to stop supplying tests. At the time, our approach ensured that enough providers were able to enter the market to meet the public’s demand for covid-19 testing, while still putting providers through an appropriate approvals process.

However, we are now more than three years on from the start of the pandemic, the living with covid strategy has been in place for over a year and the World Health Organisation has declared that covid-19 is no longer a public health emergency of international concern. It is, therefore, the right opportunity to review and update covid-19 legislation on private providers to bring in requirements and standards to strengthen consistency, safety and high-quality covid-19 testing services.

The proposed changes will empower consumers to choose a private testing service with confidence, while continuing to improve safety and quality.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

I notice that there is no impact assessment associated with the regulations—why is that? Will the changes to the regulations take into account the investigation into Immensa and the errors that resulted in 39,000 covid tests being inaccurately assessed as negative? Will the Minister reassure us that that will be the case, and explain why there was no impact assessment?

[Maria Caulfield]

Certainly. I will come in a moment to the standards we are changing to meet those concerns.

First, under the new regulations, from 1 January 2024, in order to enter the private covid testing market private providers will have to achieve accreditation against the appropriate ISO standard by a signatory of the international laboratory accreditation co-operation mutual recognition agreement. That should give Members confidence that providers will now have to meet an internationally recognised standard. There will be consistent testing standards across the board that meet the ISO standard and are accredited by a signatory of that mutual recognition agreement. The new requirements will replace the three-stage accreditation process required under the existing regulations, which I just outlined, to make sure that providers meet a certain standard.

Secondly, we are removing the requirement for providers to get sign-off from the Department at the start of the application process, because they will have to be accredited before they can enter the market; thirdly, we are shifting the legal responsibility for clinical services to the clinical organisation, rather than it resting with customer-facing organisations; and finally, we are removing the duplicative provision for the validation of testing and ensuring that the regulations reflect the publication of the updated ISO standard, which is 15189:2022.

The changes in the regulations are forward-looking and do not affect private providers that have applied for accreditation before the instrument comes into force. Those providers will still need to complete the application process but can do so using the current staged accreditation system.

On the point made by the hon. Member for Oldham East and Saddleworth, we are moving to a system in which accreditation will have to be achieved against the new ISO standard, and that will apply across the board and be comparable to other countries. We will move away from the three-stage process that we used during the emergency phase of the pandemic, when we had to balance risks and benefits. The risk at that time related to the need to get as much testing out to the public as possible, but that has now reduced, so it is important to set high standards so that people have confidence in the tests they get done.

The regulations will reduce the bureaucracy involved in applying for accreditation while still delivering the rigorous accreditation requirements that are important for public health. I therefore commend the regulations to the Committee.

--- Later in debate ---

[Maria Caulfield]

Let me respond to the questions from the shadow Minister. Currently, we have enough testing capability. Testing providers that are already accredited by the current system will not have to reapply, and those currently undergoing accreditation will be able to continue as planned. The new regulations are for providers that want to enter the market.

More than 100 providers currently hold accreditation, and 18 of them were reporting results to UKHSA as of September. A significant number of providers is currently accredited, so we do not anticipate a huge number coming through the new system, but we will keep an eye on that. Since January we have had very few applications, if any, which shows that the current capacity reflects the demand.

If covid numbers took off or there was a variant of concern, the balance of risk and benefit that I talked about earlier would have to be re-looked at and we would look at the accreditation process in that light. Assuming that the living with covid policy continues as it is, we are confident that the regulations will be appropriate to meet the demand of those wanting to join the private market testing sector. We will keep that under constant review, along with the resources needed to manage the accreditation process.

The shadow Minister touched on the specific issue of the testing at Immensa laboratories. As she said, the UKHSA, the arm’s length organisation responsible for that, looked at the issue and published a public statement in November last year on the serious incident investigation. It found that

“no singular action or process implemented by NHS Test and Trace could have prevented the errors within the Immensa laboratory arising”.

However, although Immensa was going through the three-stage accreditation process, when problems were identified and it failed to achieve a positive recommendation at stage 3, it was not allowed to continue, and neither of the relevant organisations has rejoined the private testing market. So it was identified at the time and the UKHSA, the organisation that oversees testing, looked into it.

Lessons will be learned from the covid experience, which is why an independent inquiry is ongoing. I reassure the shadow Minister that we will do everything we can to learn lessons from that. This is exactly why we have the regulations in front of us: at that time there was pressure to get as much testing out to the public as possible, and the three-stage accreditation process was introduced to do that. That is not the case now, so we are able to take a much more robust approach to assessing organisations that want to take on testing. I hope that gives the shadow Minister some reassurance and that I have demonstrated why the regulations need to come into force now. I hope I have answered the questions. I commend the regulations to the Committee.

Question put and agreed to.

International Men's Day

Maria Caulfield Excerpts

Tuesday 21st November 2023 Westminster Hall

[The Minister for Women (Maria Caulfield)]

It is a pleasure to serve under your chairmanship, Mr Davies. May I start by saying how pleased I am to participate in today’s debate? The theme of this year’s International Men’s Day is “zero male suicide”, which was touched on in many contributions today and is something that I am passionate about in my role as mental health Minister. I will touch on the groundbreaking work that we are introducing in that space, which is absolutely a priority area for this Government.

I thank my hon. Friend the Member for Don Valley (Nick Fletcher) for securing the debate and for his tireless campaigning. He has held my feet to the fire to get men’s health recognised in a way that has not happened before, and pushed the Government to make this a priority area.

We are clear that more needs to be done to improve outcomes across the board for men, particularly in relation to health. That includes men and boys, whose place in society, as we have heard today, is integral to equality for all, because when men thrive, we all thrive. We all have fathers, brothers, friends, husbands, partners and colleagues. When we improve care for women, that impacts society, but that is equally true when we improve care for men. That is why, as part of International Men’s Day, we have made some significant announcements, which I will touch on.

My hon. Friend highlighted really well that improving outcomes for men is everybody’s business, and I absolutely agree. Whether in relation to economic prosperity for society, delivering education to the next generation, or even politics—or, of course, our own families—it is really important that we support men in every way, and International Men’s Day is an opportunity to highlight the issues that they face.

My hon. Friend the Member for Truro and Falmouth (Cherilyn Mackrory) spoke about the impact of supporting men, particularly around the loss of a child; my hon. Friend the Member for Don Valley gave the example of “Tommy” and talked about how many Tommies there are across the country facing those very issues today; my right hon. Friend the Member for Basingstoke (Dame Maria Miller) touched on life expectancy differences for men; and the hon. Member for Strangford (Jim Shannon) touched on the issues facing veterans. Alongside the NHS, we are rolling out Op Courage for veterans, service leavers and reservists across England, and there is different support in different regions, but I will absolutely take up with the veterans Minister what we can do to help support a similar scheme in Northern Ireland.

The theme of this year’s International Men’s Day is zero male suicide. The latest data we have from the Office for National Statistics tells us that men account for around three quarters of all deaths by suicide. As many Members have said, that is the biggest cause of premature death in men under 35, but middle-aged men are also a significant risk group, and that is why they are a priority group in our recently published suicide prevention strategy. Over 4,500 men die by suicide in England alone every year. My hon. Friend the Member for Don Valley noted that is 13 deaths a day. Every suicide is a tragedy, and we know about the ripple effect that it has for family and friends. We have heard from campaigners what a devastating loss it can be.

Achieving zero male suicide is an ambitious target. In our suicide prevention strategy, we have addressed men as a priority group and addressed the many issues that they face, including alcohol addiction, financial pressures and relationship breakdown. Those are all key drivers of male suicide, so we want to tackle them and put better support systems in place.

Male suicide is everyone’s business. About two thirds of men who take their own lives are in contact with a frontline service, such as primary care, in the three months leading up to their suicide. That is why every Department—whether it is the Department for Work and Pensions, the Department for Environment, Food and Rural Affairs, the Ministry of Defence or the Ministry of Justice—has a role to play in our suicide prevention strategy. We are bringing those Departments together to make suicide everyone’s business, and we want to see a difference—a reduction—in two and a half years.

I do not have a huge amount of time, because my hon. Friend the Member for Don Valley has to respond to the debate, but I want to touch on the announcement we made on International Men’s Day of £16 million funding for a new prostate cancer screening trial. On my right hon. Friend the Member for Basingstoke’s point about life expectancy, we know that cancer is a significant driver of that. That is why we have rolled out our “man’s van” for lung cancer checks, to target men who have previously smoked and perhaps are not as good as they should be in coming forward to get checks done. That is enabling us to detect around 80% of lung cancers at stage 1, rather than at stage 3 and 4 as was the case previously. The prostate research will dramatically change outcomes for men. On the point made by the hon. Member for Strangford, we can look at that on a UK-wide basis, and we will have discussions with the devolved Administrations before that is rolled out in the spring.

We are appointing a men’s health ambassador—work will start on that soon—and we are launching a men’s health taskforce to join up all the dots. In a similar way to what we have done on the menopause taskforce, my hon. Friend the Member for Don Valley, as chair of the APPG, will be invited to that meeting. We will also improve the information on the NHS UK website, to make it easier for men to access help and support. Men often find it difficult to ask for help, but if it is available on the website, they can do that in the privacy of their own home and know that the information is reliable.

We are also now rolling out the HPV vaccine to boys. While we hope that vaccine will help us eradicate cervical cancer, we know that some male cancers—particularly oral cancers—are related to HPV, so rolling out the vaccine to boys will also have an impact on future cancers in men. We also have our major conditions strategy, which will look at things such as heart disease. There is a huge amount of work going on in this space.

I hope that in my whistle-stop tour—

[Karl MᶜCartney]

Will my hon. Friend give way?

[Maria Caulfield]

I will not, because my hon. Friend the Member for Don Valley needs time to respond.

I hope that, in showcasing some of the work we are doing, I have demonstrated how seriously we take this issue. Once again, I thank my hon. Friend for his work in this space.

Equality and Human Rights Monitor Report

Maria Caulfield Excerpts

Thursday 16th November 2023 Written Statements

[The Minister for Women (Maria Caulfield)]

Today the Equality and Human Rights Commission (EHRC) has published its report, “The Equality and Human Rights Monitor 2023.”

The report can be found on the EHRC website later today. The EHRC has a statutory duty—under Section 12 of the Equality Act 2006—to monitor progress on equality and human rights in Britain and publish its findings every 5 years. “The Equality and Human Rights Monitor 2023” outlines the changes the Commission has observed in equality and human rights in England, Scotland and Wales over the last five years, since its last report, “Is Britain Fairer?” (2018).

Based on the Commission’s comprehensive measurement framework, this report analyses outcomes in all aspects of life in Britain, across all nine protected characteristics. It is based on their own robust statistical analyses, a systematic review of research evidence and the responses to a public call for evidence, as well as input from a broad programme of stakeholder engagement.

I would like to thank Baroness Falkner and the Commission for their work on this report.

The report has been published on gov.uk and will be laid in Parliament on Monday 20 November, once the House of Lords returns.

[HCWS42]