Independent Review into Maternity and Neonatal Services in East Kent: Government’s Initial Response

Maria Caulfield Excerpts

Tuesday 7th March 2023 Written Statements

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

I wish to inform the House of the Government’s initial response to the report of the independent review into the maternity and neonatal services at East Kent University NHS Foundation Trust that was published on the 19 October 2022. NHS England commissioned Dr Bill Kirkup CBE to undertake this review following concerns about the quality and outcomes of care.

I would like to place on the record my gratitude to the families who came forward to contribute to this review, and to express my deepest sympathies for the loss and harm that Dr Kirkup discovered in the maternity and neonatal services at East Kent. I am also grateful for Dr Kirkup and his review team for his report. Taking each of the recommendations in turn:

The Government already has work underway to establish a taskforce with appropriate membership to drive the introduction of valid maternity and neonatal outcome measures capable of differentiating signals among noise to display significant trends and outliers, for mandatory national use.

Those responsible for undergraduate, postgraduate and continuing clinical education will be commissioned to report on how compassionate care can best be embedded into practice and sustained through lifelong learning.

Relevant bodies, including royal colleges, professional regulators and employers, will be commissioned to report on how the oversight and direction of clinicians can be improved, with nationally agreed standards of professional behaviour and appropriate sanctions for non- compliance.

Relevant bodies, including the Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives and the Royal College of Paediatrics and Child Health, will be charged with reporting on how teamworking in maternity and neonatal care can be improved, with particular reference to establishing common purpose, objectives and training from the outset.

Relevant bodies, including Health Education England, royal colleges and employers, will be commissioned to report on the employment and training of junior doctors to improve support, teamworking and development.

The Government will consider in parallel with other relevant inquiries the duties placed on public bodies to share information with families.

Trusts will be required to review their approach to reputation management and to ensuring there is proper representation of maternity care on their boards.

The Government will continue to work with NHSE on its approach to poorly performing trusts and their leadership.

The trust has already made a statement accepting the reality of these findings; acknowledging in full the unnecessary harm that has been caused; and embarking on a restorative process addressing the problems identified, in partnership with families, publicly and with external input.

We continue to work with NHS England and the Care Quality Commission regarding patient safety concerns at the Trust. Further information on how the recommendations are being implemented will be outlined in spring 2023. The Department of Health and Social Care will also closely monitor progress on these recommendations alongside the recommendations of other maternity and neonatal service inquiries to improve standards of care for mothers and babies.

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Covid-19 Vaccine Update

Maria Caulfield Excerpts

Tuesday 7th March 2023 Written Statements

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

His Majesty’s Government are committed to protecting people most vulnerable to covid-19 through vaccination as guided by the independent Joint Committee on Vaccination and Immunisation.

On the 25 January 2023, the JCVI published interim advice on the covid-19 vaccination programme for 2023. The JCVI has now provided final advice for a covid-19 vaccination booster programme in spring 2023. HMG has accepted this advice and I am informed that all four parts of the UK intend to follow the JCVI’s advice.

Covid-19 spring booster programme

The JCVI advises that a covid-19 vaccine spring booster dose should be offered to:

adults aged 75 years and over;

residents in a care home for older adults; and

individuals aged five years and over who are immunosuppressed, as defined in tables 3 or 4 in chapter 14a of the UK Health Security Agency’s (UKHSA) Green Book.

NHS England has asked covid-19 vaccination providers in England to begin the main spring 2023 booster campaign vaccinations from 17 April, with the national booking system opening beforehand. Vaccination of residents in older adult care homes will start ahead of this from 3 April. Eligible individuals will be offered the vaccine around six months after their previous dose.

The JCVI has advised the following vaccines may be used in the 2023 spring programme:

Pfizer-BioNTech bivalent;

Moderna bivalent;

Sanofi/GSK monovalent—beta variant;

Novavax monovalent—wild-type variant—only for use when alternative products are not considered clinically suitable.

The vaccine offered will depend on a person’s age and local supply considerations. Children under 12 years of age will be offered a children’s formulation of the Pfizer-BioNTech vaccine.

In addition, the JCVI’s interim advice remains that individuals at higher risk of severe covid-19 are expected to be offered a booster vaccine dose in autumn 2023 in preparation for winter 2023 to 2024.

Moving primary course covid-19 vaccine to a targeted offer

Currently the covid-19 vaccine primary course offer—first two doses—is available in the UK to everyone aged five and over. The JCVI’s interim advice in January set out that this offer, should move over the course of 2023 towards a more targeted offer during vaccination campaigns to protect those persons at higher risk of severe covid-19. This would include:

residents in a care home for older adults and staff working in care homes for older adults;

frontline health and social care workers;

all adults aged 50 years and over;

persons aged five to 49 years in a clinical risk group, as set out in chapter 14a of the UKHSA’s Green Book;

persons aged 12 to 49 years who are household contacts of people with immunosuppression;

persons aged 16 to 49 years who are carers, as set out in out in chapter 14a of the UKHSA’s Green Book.

I am now updating the House that the ongoing primary course vaccination offer will be moving to a more targeted offer available during campaign periods only for those at higher risk of severe covid-19 from July. Otherwise healthy five to 49-year-olds who have not come forward for their primary course covid-19 vaccination will no longer be able to access this offer following the close of the 2023 spring booster programme, planned to end 30 June 2023.1 would encourage those who have not taken up the offer to come forward in good time to access it before the offer ends.

Notification of liabilities

I am now updating the House on the liabilities HMG have taken on in relation to further vaccine deployment via this statement and accompanying Departmental Minutes laid in Parliament containing a description of the liability undertaken. The agreement to provide indemnity with deployment of further doses increases the contingent liability of the covid-19 vaccination programme.

On 20 December 2022, the Sanofi/GSK covid-19 vaccine, VidPrevtyn Beta, was authorised by the Medicines and Healthcare products Regulatory Agency (MHRA). The JCVI has provided deployment advice on VidPrevtyn Beta as part of its advice on the spring programme.

The agreement to provide an indemnity as part of the contract between HMG and Sanofi/GSK creates a new contingent liability on the covid-19 vaccination programme. Deployment of effective vaccines to targeted groups has been and remains a key part of the Government’s strategy to manage covid-19.

I will update the House in a similar manner as and when other covid-19 vaccines or additional doses of vaccines already in use in the UK are deployed.

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Norfolk and Suffolk NHS Foundation Trust

Maria Caulfield Excerpts

Tuesday 7th March 2023 Commons Chamber

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

I thank my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) for bringing forward this important debate about the Norfolk and Suffolk NHS Foundation Trust, and for highlighting the progress that has indeed been made. The difficulties at the trust have been well documented, and there have been performance and quality issues for many years. Those have been highlighted on behalf of their constituents by many Members of the House, including my hon. Friends the Members for North Norfolk (Duncan Baker), for Bury St Edmunds (Jo Churchill), for Waveney (Peter Aldous) and for Ipswich (Tom Hunt), many of whom are here this evening. However, all the MPs in Norfolk and Suffolk have worked constructively to make progress and to support the trust, patients and staff.

To understand the root causes and to ensure that effective plans are in place to improve patient outcomes, I and many of my ministerial predecessors have met right hon. and hon. Members from Norfolk and Suffolk collectively on several occasions, alongside NHS England, the CQC and representatives from the trust and the newly formed ICBs, to review progress and to ensure that there was an effective plan to achieve the quality of care that patients and families clearly deserve.

I am pleased that the latest CQC report recognises some key progress in areas that need improvement. The leadership team and staff across the trust should be congratulated on their hard work on that, and on the fact that the trust’s overall rating has moved from “inadequate” to “requires improvement”. Many elements of the report were found to be “good”, however, which indicates that things are moving in the right direction. The CQC also reports that

“the trust had moved at pace to make the necessary changes and…significant improvements could be seen at all levels”,

which is encouraging.

I understand that my hon. Friend the Member for Central Suffolk and North Ipswich and other hon. Members from Norfolk and Suffolk were invited to attend a briefing on 23 February, prior to the publication of the inspection. I hope that those who could attend found that session constructive; it sounds as though there is collective agreement that progress has been made. I had a similar session with the CQC the day before and I found the progress encouraging. I was reassured that many of the issues raised previously are being addressed, but there are clearly still significant challenges at the trust that must be addressed, which my hon. Friend outlined well this evening.

I welcome the progress that the trust and its leadership team have made and the fact that they have set out a realistic improvement delivery plan and a commitment to take it forward. I am pleased to hear from the CQC that the trust and all its partners are clear that they cannot take their foot off the pedal. Now is the time to double down on their efforts and not just assume that the progress of the last few months will continue.

I am pleased to confirm that NHS England will continue to provide the existing level of support to the trust. A full-time improvement director is in place, with representation at the trust’s governance meetings, so they have full visibility of the latest data and improvements needed. They will continue to work closely with the trust and key stakeholders to ensure that they continue to build on the recent progress. As part of the next steps, a rapid quality review meeting between the trust and its partners will take place on 27 March.

I will continue to watch closely and to ensure that any concerns that arise are dealt with quickly and at pace. Alongside NHS England, I am keen to ensure that the joint meetings that we were having continue to take place. I intend to hold a follow-up meeting with the relevant Members of Parliament and our system partners in early May, once the rapid quality review meeting has taken place on 27 March and the options review work has concluded. I hope that gives my hon. Friend some reassurance about how seriously we are taking the issue.

On mental health more generally, on 23 January I announced that we were commissioning a rapid review into mental health in-patient settings, with a focus on how we use data and evidence to look at the quality of in-patient services in mental health across England more broadly, including complaints and whistleblowing alerts, to identify risks to safety. The review is being chaired by Geraldine Strathdee and will run for eight weeks. We will shortly get her report and I am keen to implement her findings. That relates to the point that my hon. Friend the Member for North Norfolk made about the culture in mental health and how we change that to improve outcomes for patients. NHS England recently announced a new in-patient quality transformation programme to support cultural change in mental health and to develop a new, bold, reimagined model of care for all NHS-funded mental health services, particularly in an in-patient setting.

In the minute or so I have left, I will touch on a couple of key asks. Capital funding is available for mental health services. A few weeks ago, we announced funding for crisis centres, community support teams and mental health ambulances, so that they can respond more quickly to those going into crisis, in order to try to avoid admissions. More generally, record levels of funding are going into mental health—£2.3 billion extra each year. I encourage the local trust to speak to its integrated care board, which has access to that funding, if it is interested in capital programmes. That is a whistlestop tour of the support that we can give.

[Dr Poulter]

Will the Minister give way?

[Maria Caulfield]

I have only a few seconds left.

In conclusion, I hope that reassures all hon. Member across Norfolk and Suffolk that we take the issue seriously. I am delighted that progress is being made across the trust.

Question put and agreed to.

Oral Answers to Questions

Maria Caulfield Excerpts

Tuesday 7th March 2023 Commons Chamber

[Matt Warman (Boston and Skegness) (Con)]

2. What assessment he has made of the implications for his policies of the report by the UK Commission on Bereavement entitled “Bereavement is everyone’s business”, published in October 2022.

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

I thank the UK Commission on Bereavement and everyone who contributed their experience of bereavement for their input into the report. We are working across Government and with the bereavement sector to consider how the wide range of findings from the report can inform future policy and make a difference to those who are bereaved.

[Matt Warman]

When my parents died just six weeks apart from each other, I know I would have benefited from practical and emotional support. The UK Commission on Bereavement has a number of excellent recommendations. Does the Minister agree that, among those, the idea of integrating support and information about bereavement into palliative care and end-of-life care is one that the Government should look at taking up?

[Maria Caulfield]

I absolutely agree with my hon. Friend, who has done so much work in this space campaigning for others to have a better experience than he had with the tragic loss of his parents. I can give him an absolute commitment that we are working with partners across health and palliative care to ensure that bereavement support is an integral part of palliative and end-of-life practice. The new Health and Care Act 2022 means that integrated care boards must commission those services, and NHS England has published new statutory guidance on palliative and end-of-life care to give ICBs the information they need, which includes giving bereavement support to those facing a loss.

[John Stevenson (Carlisle) (Con)]

3. What steps he is taking to increase the number of doctors.

--- Later in debate ---

[Kirsten Oswald (East Renfrewshire) (SNP)]

12. What steps he is taking to help reduce the cost of hormone replacement therapy for people with menopause symptoms.

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

This is a great opportunity to remind the House that, from 1 April, women will be able to apply for an HRT prepayment prescription for less than £20 a year to pay for all their HRT, whether they are on patches, gels or dual hormones.

[Kirsten Oswald (East Renfrewshire) (SNP)]

Although these cost reductions are welcome, England is still the only UK nation not to offer free prescriptions. Instead, the UK Government are penalising those who are experiencing menopause who need these medications to improve their symptoms. Will the Minister not consider following Scotland’s lead and scrap prescription charges to better provide accessible menopause support?

[Maria Caulfield]

I remind the hon. Lady that about 60% of women in England who are on hormone replacement therapy are already exempt from prescription charges, but we are reducing the cost by hundreds of pounds a year for the remaining women who do pay. We respect the Scottish Government’s decision to provide free prescriptions, but it would cost us in England £651 million a year to provide free paracetamol to millionaires and we do not think that is the best use of taxpayer money.

[Mr Speaker]

I call the shadow Minister.

[Liz Kendall (Leicester West) (Lab)]

With International Women’s Day tomorrow, I want to pay tribute to the menopause warriors—all the amazing individual women and organisations who have forced this issue up the agenda, including my hon. Friend the Member for Swansea East (Carolyn Harris). It was her private Member’s Bill that made Ministers finally agree to cut the cost of HRT prescriptions, but questions remain. Will all products that help with menopause symptoms be eligible for the prescription prepayment scheme? What are Ministers doing to end the ongoing and unacceptable shortages in HRT that are causing women such anxiety, and if this issue is such a priority for the Government, why has not the menopause taskforce met since June last year—let me warn the Minister, the warriors do not want to wait?

[Maria Caulfield]

It is a shame that, on International Women’s Day, the shadow Minister cannot welcome the progress we are making on the menopause. Labour could have done this. We are the first Government to reduce the cost of HRT for women. [Interruption.] The shadow Secretary of State, the hon. Member for Ilford North (Wes Streeting), wants to listen because this is important for women. All licensed HRT products will be available on the prepayment certificate. On the issue of shortages, over 70 products are available to women. Last year, 19 of them were facing a shortage. Thanks to the work of this Government, that is down to five products, and Utrogestan, a product widely used by women, is now back in stock and is being distributed to pharmacies. We are passionate about making HRT more available. There has been a 50% increase in the number of women getting HRT prescriptions. That is a tremendous success for women and we are reducing the cost.

[Esther McVey (Tatton) (Con)]

14. When he plans to reply to the letter of 24 January from the right hon. Member for Tatton on non-covid excess deaths.

--- Later in debate ---

[Angela Crawley (Lanark and Hamilton East) (SNP)]

21. What recent assessment he has made of the potential impact of the cost of living crisis on long-term trends in levels of mental ill health.

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

Last year, £50 million was invested through the promotion of the better mental health fund in 40 local authorities that have the most deprived parts of the country. That is to boost prevention and early intervention and to support those hardest hit by the pandemic and the cost of living.

[Angela Crawley]

The Royal College of Psychiatrists in Scotland found that 52% of Scots are concerned about the impact that rising prices are having on their mental health. Poverty is a key driver of poor mental health, and those already struggling with poor mental health and money worries are likely to be the hardest hit. What discussions has the Minister had with her Cabinet colleagues on the consequences of policies, such as the punitive sanctions regime, that are shown to increase anxiety and harm to people’s mental health?

[Maria Caulfield]

This Government have been supporting people with the cost of living through the £37 billion package, and £15 billion of targeted support for those most in need. That includes £150 of help with council tax, £400 for electricity, the 8 million people supported by the £1,200 payment and paying towards half of people’s energy costs. This Government are serious about helping people with the cost of living at this time.

[Theo Clarke (Stafford) (Con)]

I welcome the Government’s commitment to tackling mental ill health, in particular the recent funding that we have received in Stafford for a new crisis assessment centre at St George’s Hospital. What further steps are the Government taking to improve access to mental health support, especially in our schools?

[Maria Caulfield]

I thank my hon. Friend for her hard work securing that funding for the crisis centre in her constituency. These centres make such a difference, because they are based in the community and can intervene at an earlier stage when someone is facing difficulty. They are on top of measures such as our mental health ambulances, which will also respond to people in crisis, and supporting our local communities to deal with mental health as well as those with a mental illness.

[Mrs Paulette Hamilton (Birmingham, Erdington) (Lab)]

22. What steps he is taking to improve patient access to primary care.

--- Later in debate ---

[Lee Anderson (Ashfield) (Con)]

T8. Sean Lynk, aged 30, in Ashfield, took his own life just before Christmas. No one saw it coming. Male suicide takes the lives of 12 young men every day in this country. It is the biggest killer of young males under the age of 40. Sean’s father Graham is coming next week to watch me speak in a Westminster Hall debate on male suicide, so could somebody from the Health team please meet Graham and me next Monday?

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

I thank my hon. Friend for raising this important issue. We are launching a prevention of suicide strategy, and male suicide will be a particular focus, as it is a high-risk group. The debate next week will be answered by a Minister in the Department for Education, because it relates specifically to the national curriculum, but I am very happy to meet my hon. Friend and his constituent.

[Mr Speaker]

I call the SNP spokesperson.

--- Later in debate ---

[Jeff Smith (Manchester, Withington) (Lab)]

T5. Every day, the families of women who took the drug Primodos in the 1960s and ’70s continue to suffer the consequences of a lifetime of disability. Baroness Cumberlege’s review made it clear that Primodos caused avoidable harm and that the families should be given redress, so why have the Government recently refused three mediation requests on behalf of those families?

[Maria Caulfield]

The hon. Gentleman will know that we have huge sympathy for those affected by Primodos. He will also know that there is a legal case at the moment so I am unable comment at this time, but I am happy to discuss it with him further.

[Richard Fuller (North East Bedfordshire) (Con)]

Over the past year or so, Bedfordshire’s fire service and ambulance service have taken innovative steps to co-operate to bring response times down. They are now working on a plan to deepen that co-operation. Will my right hon. Friend facilitate a meeting with the leaders of the fire service and ambulance service in due course when that plan is ready?

Eating Disorders Awareness Week

Maria Caulfield Excerpts

Tuesday 28th February 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, Ms Harris. I thank the hon. Member for Bath (Wera Hobhouse) for securing this important debate. Both as an MP and as chair of the all-party parliamentary group, she has long been a champion of those with eating disorders.

Improving treatment for eating disorders is a key priority for the Government and a vital part of our work to improve mental health overall. We have heard from right hon. and hon. Members from across the political divide about how urgent this issue is and how many of our constituents are affected by it. It is national Eating Disorders Awareness Week, and raising awareness is an important part of improving the outcome for those suffering with this serious and often life-threatening condition. It can affect anyone of any age, gender or background.

As has been mentioned numerous times, Beat has done tremendous work in this space. It estimates that 1.25 million people live with an eating disorder in the UK. Of those, one in four is a man. I am really pleased that this year’s national Eating Disorders Awareness Week is focusing on eating disorders in men. I think that every Member who spoke in the debate covered the fact that men are often reluctant to come forward and ask for help. There is a stigma around eating disorders, particularly for men. It is important that healthcare professionals recognise that this is also an issue for men, so that if a man or a young boy seeks help, that is taken seriously.

It is vital that we recognise that these issues affect men, so that we can break down the stereotypes and help men to speak up and get help, because having an eating disorder is devastating, and not just for the individual. As the hon. Member for Strangford (Jim Shannon) highlighted, it can also be devastating for those around them, whether family or friends. We know that recovery is possible, which is why it is so important that people come forward to ask for help and support, and get timely access to the right treatment that can save their lives. That is why, under the long-term plan for the NHS, we are investing £1 billion extra in community mental healthcare for adults with severe mental health illness, which includes treatment for eating disorders. The extra funding is being used to enhance capacity for new and improved community eating disorder teams, covering the whole of England.

Hon. Members have raised concerns about long waiting times in their communities. Integrated care boards, which were set up in July, now commission services. We will hold them to account for their timelines, but hon. Members can also hold their local commissioners to account. The funding is given to them for mental health services. We do not dictate how it is spent, because that will be different for different communities, and the prevalence of eating disorders will be different in different parts of England. We expect commissioners to commission those services and to ensure capacity and timeliness for their local population, but if Members of Parliament feel that is not being done, we are happy to meet them to discuss how we can improve things locally.

Since 2016, investment in children and young people’s community eating disorder services has risen every year; there has been an extra £53 million per year from 2021. As my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) highlighted, the pandemic continues to have an impact on the mental health and wellbeing of many people, and has caused a large increase in demand for eating disorder services. Services were almost closed, or certainly severely reduced, for nearly two years during covid, and covid itself had an impact, and there is now a tsunami of people coming forward. Data shows that the number of children and young people entering urgent treatment for an eating disorder in 2021 increased by 11% on the previous year, to over 2,600, and in the year before that it increased by 73%, from around 1,300 to close to 2,400, so there are more referrals than ever before.

A number of Members, particularly my right hon. Friend the Member for Romsey and Southampton North, mentioned online safety. I reassure colleagues that we are working with Ministers from the Department for Culture, Media and Sport on the online safety legislation, but also on other issues, because there is so much work that needs to be done to ensure that online influence is reduced where it is causing significant harm.

To return to the funding being made available, this is the first Government to really put mental health on the same footing as physical health. I am proud that we are creating parity of esteem, not just in planning services but in funding services. As part of the £500 million covid recovery plan funding for the mental health recovery action plan, we have invested an extra £79 million to expand young people’s mental health services, which has allowed 2,000 more children and young people to access eating disorder services. We have delivered this, with over 4,000 more young people entering treatment for an eating disorder than did in the previous year.

A number of Members talked about setting targets for children. We have indeed set targets for children’s eating disorders services. For adults, NHS England has consulted on setting a target for mental health services. I am particularly keen for that to be introduced as quickly as possible. I am meeting NHS England’s clinical lead for mental health services in the coming days and hope to be able to update Members on progress on that, because what gets measured gets done. While we may not be meeting the target for children yet, because of the sheer scale of demand, at least we have a target, and we know which parts of the country can and which cannot meet it, and I am keen that we do the same for adults.

The issue of BMI was raised, and I take the points made extremely seriously. Let me be clear: rejection for treatment on BMI grounds should not occur. If there are instances where that has happened, I am happy to address them; that practice is not in line with any guidance, including National Institute for Health and Care Excellence guidance, so it should not be happening. If there are examples of it happening, we are very keen to hear about them. If it is happening at a local level, I urge hon. Members to contact their local commissioners to find out why, because the guidance does not recommend that practice at all.

The hon. Member for Sheffield, Hallam (Olivia Blake) raised the issue of restraint, which I was concerned to hear about. We introduced new legislation in 2018 on restraint in mental health in-patient settings. If there are loopholes in that legislation, I am very keen to look at them. Restraint should not be happening at in-patient mental health settings, but if someone is outside of that setting and it is happening, we need to look at that. The rapid review across in-patient mental health settings is looking at the safety of those services. We will be looking at the results of that review in the coming weeks. I am clear with hon. Members that this Government sees mental health services as a priority.

[Sir George Howarth]

The Minister may recall that I intervened on the hon. Member for Bath (Wera Hobhouse) about the problem of type 1 diabetics with eating disorders. Is the Minister aware of the two trials taking place, one in London and the other in Bournemouth in the west country? Once an evaluation of the success of those integrated approaches is available and published, will she undertake to look at it, because it could have some indications as to how to treat other kinds of eating disorders as well?

[Maria Caulfield]

Absolutely; I will look out for the results of those trials. I am keen that we use evidence-based medicine, and if something has proven to be effective in clinical research, it absolutely needs to be rolled out. An hon. Member touched on the lack of research into eating disorders. The National Institute for Health and Care Research does have funding available, so I would encourage clinicians, researchers and charities that want to undertake research into eating disorders to apply for funding for those trials. We need more research into eating disorders, particularly around men and high-risk groups, such as diabetics.

[Wera Hobhouse]

Will the Minister respond to the concern raised that Government money had been made available but did not reach the frontline, as a freedom of information request by Beat showed? How do the Government intend to tackle that and ensure that money reaches frontline services?

[Maria Caulfield]

The Government have made huge amounts of funding available, for both mental health and eating disorders. More funding than ever before has gone into those services, but that funding needs to reach the frontline. That speaks to my point about local commissioners: where funding is given to a particular area, commissioners are supposed to use that money to commission services at a local level. If that is not happening in some parts of the country, then I am happy to meet with those commissioners and Members of Parliament to find out why.

We want to ensure that funding is going to the frontline to make the difference that we need it to. We are the first Government to prioritise mental health, and the first to set targets for eating disorder referrals. We are the first Government to set a standard of recruiting 27,000 additional mental health workers. We have started to roll out mental health teams in our schools, and when I spoke to the Royal College of Psychiatrists yesterday, for the first time it said that it had filled all its training posts in the last year.

We are making significant progress, but patients need to feel that. That is the next step. I am happy to work with the hon. Member for Bath and the APPG on eating disorders to make sure that is happening on the ground, because, as someone said, it is great to talk about it, but we need to see the impact for patients.

I hope that reassures right hon. and hon. Members about how seriously we take this issue. I look forward to working with everyone across the House to make eating disorders a bigger priority for clinical work. Good progress has been made, but there is a lot more to do.

NHS Workforce Expansion

Maria Caulfield Excerpts

Tuesday 28th February 2023 Commons Chamber

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

Let me first pay tribute to all the wonderful staff across the NHS who day in, day out give their all for their patients. I should mention doctors and nurses but also cleaning staff, porters, receptionists, radiographers, physios and many others who make such a difference to patients’ experience.

It is disappointing that, once again, the Opposition have used the debate to talk down the NHS and not to recognise the incredible achievements and progress made: treating more patients than ever before; working on our plans to eradicate cervical cancer; progress for people with HIV, who are now able to have a normal life expectancy; reducing stillbirths by 21%; and reducing neonatal deaths by 17%. Those are just some of the achievements of our incredible staff for patients in this country.

Anyone listening to Opposition Members would think that life under the previous Labour Government was a health panacea. When we came into government, MRSA was rife across the NHS, with wards and hospitals closed, operations cancelled and patients dying from infection. Clostridium difficile was the same—in 2008, there were 8,300 deaths. Deep cleaning was needed across hospitals to keep them open and try to prevent infections. The Labour Government’s pledge to end mixed-sex wards failed; the then Health Secretary, Alan Johnson, announced that they had “got it wrong” when they could not manage it. Elderly women were sharing bays with young men, separated by just a curtain—there was no dignity for patients at all.

Then there was the PFI scandal, as my hon. Friend the Member for Newcastle-under-Lyme (Aaron Bell) pointed out, with £300 billion of debt for the taxpayer for projects worth just £54.7 billion. There was a £26 billion IT scheme that never saw the light of day. Undeterred, the Labour leader is now doubling down on his “fit for the future” plans for the NHS. When Labour was last in government, its “fit for the future” plans closed hospitals up and down the country, with plans to close the Princess Royal in Haywards Heath in my constituency. Between 2003 and 2010, in the last six years of the Labour Government, 26,000 beds were closed. That was the legacy of the last Labour Government for the NHS.

There are three precious elements of the NHS. There is the building infrastructure, which we are putting £10 billion of capital funding into this year—that is part of the 40 hospitals that we are now building to create better infrastructure for the future. We are also introducing state-of-the-art facilities, with over 90 rapid diagnostic centres and over 90 surgical hubs now open. We are eliminating our two-year wait for procedures, and are on track to eliminate our 18-month wait from April.

Of course, our staff are the most precious element of all. We are not pretending that things are perfect. As the hon. Member for Bristol South (Karin Smyth) said, there are pressures, backlogs and delays in England, Wales and Scotland. It is pointless to play politics with the issues; those are the facts.

Let me list exactly what we are doing now to invest in our staff. We are on track to deliver 50,000 more nurses across the NHS by next year. We have 38,000 more nurses than in 2019. We have record numbers of staff in the NHS, with more than 1.25 million members of staff—41,800 more than a year ago. We have 4,800 more doctors and 10,900 more nurses. Last year, we had 72,000 people training to be a nurse, 9,000 people training to be a midwife and 30,000 people training to be an allied health professional. We had a 16% increase in students accepted on nursing and midwifery courses. We had 3,400 people starting a degree nurse apprenticeship, earning while they are learning and not accumulating student debt. We had student nurses supported with a student bursary of £5,000 a year.

Last year, we had over 19,400 non-UK nurses and health visitors joining the NHS. We had 11,600 non-UK doctors. We have funded 1,500 more medical places each year—a 25% increase over three years. We have five new medical schools, which are in Tyne and Wear, Essex, Kent, Lincolnshire and West Lancashire. We have 7,630 new entrants to undergraduate medical courses. We have introduced medical degree apprenticeships. With regard to retention, we have suspended until 2025 the rules on nurses who retire and the restricted hours that they can do, and we are consulting on removing pension barriers.

We are developing a workforce plan, as set out by the Chancellor. We are working with midwives, with Birthrate Plus, on staffing ratios in maternity units. We are on track to have 27,000 more mental health workers. We are rolling out mental health support teams in our schools. We are introducing Oliver McGowan training on autism across healthcare. We have had 3,000 undergraduate student dentists over the past few years. We had an increase of 5,039 dentists providing NHS services in the past year. In England, we have 2,500 pharmacists entering training each year. We have had a net increase of 1,400 pharmacists a year since 2016, and we are increasing the number of pharmacy technicians.

I could go on, because that is just the tip of the iceberg when it comes to our investment in our staff. I will take no lectures from Opposition Members, because RCN statistics show that Labour-run Wales has 2,900 nurse vacancies and is spending £140 million on agency nurses. In fact, the emergency medicines workforce census this year says that there is one consultant in Wales for every 7,784 patients at A&E. [Interruption.] Opposition Members may laugh, but in Wales there are simply not enough staff to cope.

I will finish by addressing Labour’s non-dom tax plan, which is as much use as an ashtray on a motorbike. Labour Members’ non-dom tax plan for transforming the health service would raise just £3.2 billion. Not only have they spent that 10 times over, but their flagship policy—the shadow Secretary of State wants to scrap GP partnerships—will cost more than £7 billion, and buying them out and tearing up GP contracts will cost £1.7 billion a year. The Opposition are economically illiterate. [Interruption.] The shadow Secretary of State has said on the record that he wants to abolish GP partnerships. Perhaps he wants to clarify that and say it is not what he wants to do, but I do not see him rising to intervene.

This Government will not fall for the fairytale Labour party policies. As I have said, we are delivering now—not in the future—the many ways in which we are increasing our NHS workforce. We are focused on tackling covid backlogs, improving our services for patients, and increasing our NHS workforce in England. Let us see what happens in Wales with the Labour plans, but we value each and every one of the members of the NHS who deliver for patients day in, day out.

Question put:

NHS Hormone Replacement Therapy: Prescriptions

Maria Caulfield Excerpts

Tuesday 21st February 2023 Written Statements

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

Around 400,000 women enter the menopause each year in the UK. Around three quarters of women will experience menopause symptoms, and around a quarter of women will experience severe symptoms. Symptoms can affect a person’s physical and mental health as well as their participation in the workplace and personal lives.

Hormone replacement therapy (HRT) is the main treatment for menopause symptoms. Around 15% of women aged 45-64 in England are currently prescribed HRT, this has increased rapidly in the last two years from around 11% and continues to increase.

To ensure that women can access the treatment they need, this Government made a commitment to reduce the cost of HRT prescriptions for menopausal women.

I am pleased to announce today that from 1 April 2023 women will be able to apply for a HRT prescription prepayment certificate (HRT PPC).

The HRT PPC will cost the equivalent of two single prescription charges, currently £18.70 and will be valid for 12 months. The HRT PPC can be used against a list of HRT prescription items, and a patient can use this against an unlimited number of HRT items during its validity.

The HRT PPC will offer savings to patients currently paying for their HRT medicines through individual charges, and for many patients the HRT PPC will also be more cost-effective than a three or 12-month PPC if they only require HRT medicines.

It is estimated that the HRT PPC will benefit approximately 400,000 patients who do not qualify for an existing prescription charge exemption.

Menopause is a priority area within the women’s health strategy for England. The strategy was published last summer and sets out an ambitious new agenda for improving the health and wellbeing of women and girls and improving how the health and care system listens to women. The introduction of the HRT PPC delivers one of our year one priorities for the women’s health strategy for England.

Reducing the cost of HRT medicines is just one part of our ongoing programme of work to improve support for menopause and access to HRT.

The Government have accepted the recommendations of the HRT taskforce, including encouraging and supporting manufacturers to boost supply to meet growing demand and continuing to issue serious shortages protocols when needed. The Department closely monitors the supply of HRT and regularly meets with individual suppliers, as well as hosting quarterly roundtables with industry to ensure a continuous supply of HRT.

The NHS England national menopause care improvement programme is improving clinical care for menopause and training for healthcare professionals, and we are also working across Government and with employers to improve workplace support, and boosting menopause research and evidence.

[HCWS572]

Indemnity for the Liverpool Community Health Independent Investigation

Maria Caulfield Excerpts

Thursday 9th February 2023 Written Statements

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

It is normal practice, when a Government Department proposes to undertake a contingent liability in excess of £300,000 for which there is no specific statutory authority, for the Minister concerned to present a departmental minute to Parliament giving particulars of the liability created and explaining the circumstances; and to refrain from incurring the liability until 14 parliamentary sitting days after the issue of the minute, except in cases of special urgency.

I have today laid a departmental minute proposing the provision by NHS England of an indemnity that is necessary in respect of an NHSE non-statutory independent investigation into patient safety incidents and deaths at the former Liverpool Community Health NHS Trust.

This investigation follows an independent review chaired by Dr Bill Kirkup CBE into widespread failings by Liverpool Community Health NHS Trust. The review report, published on 8 February 2018, found that there were significant failings in the trust from November 2010 to December 2014.

It is important that these failings are investigated and that lessons are learnt to improve services. In response to the serious patient safety incidents described in the report, the Secretary of State for Health and Social Care commissioned Dr Kirkup to conduct an independent investigation into patient safety incidents at the trust. The investigation’s terms of reference cover patient safety incidents that occurred in the same period as the initial independent review addressed—namely, November 2010 to December 2014. The investigation was originally intended to submit its report at the end of 2021, but a number of factors have come together to delay its work, including challenges related to information governance and electronic document management. We now expect the investigation to have reported by spring 2024 at the latest.

NHSE is able to obtain indemnity cover from NHS Resolution through the liabilities to third parties scheme—LTPS. The scheme applies to any liability that a member of the scheme owes to any third party in respect of loss, damage or injury arising out of an act or omission in the course of the carrying out of any relevant function of that member which is a qualifying liability.

The NHS resolution indemnity will cover any sums—including any legal or other associated costs—that members of the investigation team are liable to pay in relation to legal action brought against them by a third party in respect of liabilities arising from any act done, or omission made, honestly and in good faith, when carrying out activities for the purposes of the investigation. The indemnity will apply to any work carried out in accordance with the investigation’s terms of reference from the commencement of the investigation to its completion in 2024. The indemnity will cover the contingent liability of any legal action up to and following the publication of the investigation report.

The liability of the scheme for any proceedings brought against the member by virtue of section 13 of the Data Protection Act 1998, or any subsequent updating or replacement legislation (the “data protection legislation”), for all compensation payable to any claimant or any number of claimants in respect of or arising out of any one event or series of events consequent on or attributable to one source or original cause shall not exceed £50,000. Further, the maximum sum payable for such cases in any one membership year shall not exceed £500,000.

However, in view of the substantial fines that it is possible for the Information Commissioner’s Office to impose in the unlikely event of a data breach, NHSE considers it prudent for the £50,000 cover available under the NHS Resolution LTPS scheme to be “topped up” with a specific NHSE indemnity to £500,000. If the liability is called, provision for any payment will be sought through the normal supply procedure.

The Treasury has approved the proposal in principle. If, during the period of 14 parliamentary sitting days, beginning on the date on which this minute was laid before Parliament, a member signifies an objection, by giving notice of a parliamentary question or by otherwise raising the matter in Parliament, final approval to proceed with incurring the liability will be withheld pending an examination of the objection.

[HCWS557]

Healthcare Safety Investigation Branch: Transition Update

Maria Caulfield Excerpts

Thursday 9th February 2023 Written Statements

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

I am making this statement to update Members on the Government’s time- table to establish the Health Services Safety Investigations Body (HSSIB) and the Maternity and Newborn Safety Investigations special health authority (MNSI). The programmes of national investigations and maternity investigations currently sit in the Healthcare Safety Investigation Branch (HSIB).

The Health and Care Act 2022 contains provisions that will, once commenced, establish the HSSIB as a non-departmental public body. On 26 January 2022, by way of a written ministerial statement, the Department of Health and Social Care announced that a separate special health authority would also be established to continue the independent maternity investigation programme, and that both bodies were expected to be operational in April 2023.

I am today announcing a delay of six months until October 2023 to the expected establishment of both bodies. I believe this further period will enable all the necessary work to be completed to ensure a smooth transition of these investigation programmes.

In the meantime, I remain committed to ensuring that the important work of the HSIB continues, both investigations and the maternity investigations programme.

[HCWS554]

Children's Mental Health Services: Lincolnshire

Maria Caulfield Excerpts

Tuesday 7th February 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, Sir Christopher. I thank my hon. Friend the Member for Grantham and Stamford (Gareth Davies) for securing this debate and for the way he continues to champion children’s mental health services. I recently discussed many of the issues with him and some of his constituents. The experience that they brought to me has helped to influence the work we are doing. I reassure my hon. Friend that there is a huge focus on improving children’s mental health services, both nationally in terms of funding and, as he indicated, in terms of staffing. In his local area, much of the work will be in the major conditions strategy, which includes mental health, and also in our suicide prevention strategy—[Interruption.]

[Sir Christopher Chope (in the Chair)]

Order. There is a Division in the House, so the sitting is suspended. If there is one vote, it will be for 15 minutes; if there are two votes, it will be for 25; and if there are three votes, as expected, it will be for 35 minutes. I look forward to seeing Members back here then.

--- Later in debate ---

[Maria Caulfield]

Thank you, Sir Christopher, for allowing me to continue what I was setting out to my hon. Friend the Member for Grantham and Stamford, who has been campaigning so eloquently on the issue of children’s mental health, particularly from a constituency point of view. He is quite correct that we are investing record levels of funding into children’s mental health services. We are trying to recruit as many staff as possible to expand those services, which are being extended to support children’s mental health. I will touch on how that is happening, both at a local level in Lincolnshire and nationally across England.

Lincolnshire’s children and young people’s mental health services have always been rated as outstanding by the Care Quality Commission. Pre-pandemic, the average wait for child and adolescent mental health services assessments was 4.4 weeks, and the Healthy Minds Lincolnshire early-intervention service helped to reduce referrals to child and adolescent mental health services by 5%. Lincolnshire has always had an excellent track record in delivering services and supporting young people in particular with their mental health, compared with the figures nationally. I know that is not necessarily much consolation for those parents and children waiting for services, but Lincolnshire mental health services have traditionally been very good.

However, the pandemic has had an impact, as it has across the country. In Lincolnshire, referrals to CAMHS have increased by 15.7%; nationally, the increase was 35%. Although Lincolnshire has not had the same increase in the number of referrals as other parts of the country, it has still had a significant increase. Lincolnshire has had 15% more clinical contacts than the national average, and 92% of children who sought an emergency telephone response received one within four hours as a result. We can see, then, the scale of the pressures that services are facing. Lincolnshire has performed relatively well compared with most other parts of the country but is experiencing challenges. That was very much the point that my hon. Friend made: his constituents are now struggling with waiting times, the sheer scale of the number of referrals is putting pressure on the service, and although a lot of work is going on to improve things, his constituents are feeling the pressures on the service.

The loss of workers in this field is particularly high in my hon. Friend’s area, as it is in other parts of the country. I assure him that we are recruiting more staff, but it takes time to train them up and get them providing services at a local level. Lincolnshire does not have a children’s and young persons’ in-patient unit, and I have heard from his constituents about the impact of that and the difficulty of a child being placed out of area. We fully recognise that and want to work with his local team on it. His local integrated care board is standing up to the challenge—it has increased funding to CAMHS by £1.2 million in this financial year to help to reduce waiting times, which has had a positive impact—but the workforce is probably the single biggest issue in terms of trying to improve services further.

By September of last year, 67% of children and young people who were assessed for CAMHS were assessed within six weeks. If early-intervention and emotional services are included, 72.5% of young people who were assessed were assessed within four weeks, with the national average being 68%. The big concern for Lincolnshire is the length of time that children are waiting for support and the workforce capacity to change that, so I am committed to working with my hon. Friend’s ICB to see how we can address that concern.

My hon. Friend touched on the out-of-hours service. Such services are available throughout the country—there are 24/7 helplines available—but he is quite right that many people do not know how to access those services, and that applies in respect of emergency services as well. We hear from ambulance trusts throughout the country that very often ambulances have to attend to someone with a mental health crisis, and they are not always able to access a 24/7 service. It is not because it is not there but because sometimes it just not clear how it can be accessed. There is, then, a lot of work to do.

Let me reassure my hon. Friend about what we are doing from a national perspective; this will be replicated in Lincolnshire. We are on course to deliver 399 mental health support teams in schools and colleges, and we already have 287 of them in place. They are making a significant difference to children and teachers. They are able to support children who have mental health concerns, mental illnesses or conditions at an earlier stage and get young children into the system much more quickly, before they reach a crisis point, to get them the help and support they need. They also take the pressure off teachers, who until now have done a significant amount of the heavy lifting when it comes to children’s mental health.

We are providing £79 million to boost capacity in children’s mental health services and to help 22,500 more children and young people to access those services. Also, we are specifically expanding access to services that address eating disorders. The funding has increased significantly to try to match our level of ambition, with £53 million of support in 2021-22, which will rise to £54 million in the forthcoming financial year. All that work sits on top of record levels of investment in NHS mental health services in England and the unlocking of support for an extra 345,000 children and young people.

I recognise from the points that my hon. Friend made that where we are making a difference that is great, but for the children and parents who are waiting it is still very difficult. Although Lincolnshire is probably performing better than most parts of England, it is facing some significant pressures with workforce capacity and the lack of an in-patient facility, which also puts pressure on community services.

The Government hope to reform the Mental Health Act 1983 fairly soon. That will support mental health services and make them much more community and crisis team-led, rather than letting people get into crisis and their needing much more extensive services. We have recently announced our major conditions strategy, which includes mental health, and we will also publish our national suicide prevention strategy, in which we will focus on children and young people in particular, because we recognise that significant work needs to be done for them.

It is also about ensuring that we have the workforce capacity in place. The Chancellor and his team will specifically include mental health in the workforce strategy, which is being worked on. We know that when we expand community services to get people seen much more quickly and avoid crisis situations, we will absolutely need the workforce at a community level to meet the demand.

I hope I have been able to reassure my hon. Friend. The Government recognise that there are challenges, particularly with things such as out-of-hours support and rapid access into services. I thank my hon. Friend for the work he is doing by constantly raising the situations his constituents face, because it does make a difference. It means that we are able to assess whether we are making progress in supporting not only children and young people in particular but everyone who wants to improve their mental health or has a mental illness and is in need of support.

Our ambition is that children and young people, wherever they are from in England, whatever their background and whatever their mental health condition, will be able to get the support that they need in a timely manner. I know that my hon. Friend will be holding our feet to the fire to make sure that that happens, particularly in Lincolnshire.

Question put and agreed to.

[Sir Christopher Chope (in the Chair)]

Because the Minister responding to the next debate is not present, I have to suspend the sitting until 5.7 pm. We will then have one hour in which to debate the next motion.