Recovering Access to Primary Care

Baroness Winterton of Doncaster Excerpts

Tuesday 9th May 2023 Commons Chamber

[The Secretary of State for Health and Social Care (Steve Barclay)]

With permission, I would like to make a statement on the primary care recovery plan. For most of us, general practice is our front door to the NHS. In the last six months, over half the UK population has used GP services, and GPs in England carry out around 1 million appointments every single day. They are doing more than ever. General practice is delivering 10% more appointments a month than before the pandemic—the equivalent of the average GP surgery seeing about 20 additional patients every working day. There are more staff than ever, with numbers up by a quarter since 2019, and we are on track to deliver our manifesto target, with an additional 25,000 staff already recruited into primary care. We are investing more than ever, too, with the most recent figures showing that funding was around a fifth higher than five years before, even once inflation is taken into account.

But we know that there is a great deal still to do. Covid-19 presented many challenges across the health service, leaving us with large numbers of people on NHS waiting lists, which need to be tackled. In general practice, patient contacts with GPs have increased between 20% and 40% since before the pandemic. As well as recovering from the pandemic, we face longer-term challenges, too. Since 2010, the number of people in England aged 70 and above has increased by a third, and this group attends five times more GP appointments than young people. Not only that, but advances in technology and treatments mean that people understandably expect more from primary care systems.

Today I can announce our primary care recovery plan, and I pay tribute to the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien), for his work on this plan. I have deposited copies of the plan in the Libraries of both Houses. Our plan will enable us to better recover from the pandemic, to cut NHS waiting lists and to make the most of the opportunities ahead by focusing on three key areas: first, tackling the 8 am rush by giving GPs new digital tools; secondly, freeing up GP appointments by funding pharmacists to do more, with a “pharmacy first” approach; and thirdly, providing more GPs’ staff and more appointments. NHS England and my Department have committed to make over £1.2 billion of funding available to support the plan, in addition to the significant real-terms increases in spending on general practice in recent years. Taken together, our plan will make it easier for people to get the help they need.

The plan builds on lots of other important work. Last year, we launched the elective recovery plan, which is making big strides to reduce the backlog brought by covid-19. We eliminated nearly all waits over two years by last July, and 18-month waits have now decreased by over 90% since their peak in September 2021. By contrast, in the NHS in Labour-run Wales, people are twice as likely to be waiting for treatment than in England. They still have over 41,000 people waiting over two years and nearly 80,000 waiting over 18 months. In addition, this January, I came before the House to launch our urgent and emergency care plan, which is focused on how to better manage pressures in emergency departments, with funding to support discharge to improve patient flow in hospitals. Today’s plan is the next important piece of work.

Turning to the detail of the plan, our first aim is to tackle the 8 am rush. We will do that by providing GPs with new and better technology, moving us from an analogue approach to ways of working in the digital age. An average-sized GP practice will get around 100 calls in the first hour of a Monday morning. No team of receptionists, no matter how hard-working, can handle such demand. About half of GPs are still on old analogue phones, meaning that when things get busy, people get engaged tones. We are changing that by investing in modern phone systems for all GPs, including features such as call-back options, and by improving the digital front door for even more patients. In the GP practices that have already adopted those systems, there has been a 30% improvement in patient feedback on their ability to access the appointments they need. That also reflects the fact that online requests can help find the right person within the practice, such as being directed to a pharmacist for a medicine prescription review or to a physio for back pain.

In doing that, we will make the most of the 25,000 more staff we now have in primary care. Today’s plans fund practices without this technology to adopt it, while also providing them with staff cover to help them manage a smooth transition to the technology. Indeed, many small GP practices in particular find it hardest to fund new technology, or to manage the disruption that comes with transitioning to new ways of working, so we are funding locum cover alongside the tech itself. Notwithstanding that, people will always be able to walk in or ring if they prefer; if someone wants to ring up and see someone face to face, these investments will make that easier, too.

We also want to make sure that patients know on the same day that they make contact how their request is going to be handled. Clinically urgent issues will be assessed on the same day, or the next day if raised in the afternoon. If the issue is not urgent, an appointment will be scheduled within two weeks, but crucially, people will not be asked to call back the following day. Instead, they will get their appointment booked on the same day or be signposted to other services.

The second area of the plan is Pharmacy First. As well as giving GPs new technology, I know that we need to take pressure off GPs where possible by making better use of the skills of all clinicians working in primary care. We saw the incredible role that pharmacists played during the pandemic—their capacity to innovate and deliver for the communities that they served, freeing up GP appointments in doing so—so the second part of our plan is to introduce a new NHS service, Pharmacy First, on which we are already consulting with the Pharmaceutical Services Negotiating Committee.

Some 80% of people live within a 20-minute walk of a pharmacy, so making it easier for pharmacists to take referrals can have a huge impact. Referrals might be from GPs, NHS 111 or, from next week, urgent and emergency care settings. Community pharmacies already take referrals for a range of minor conditions, such as diarrhoea, vomiting and conjunctivitis, but with our Pharmacy First approach we can go further still. We will invest up to £645 million over the next two years so that pharmacists can supply prescription-only medicines for common conditions, such as ear pain, urinary tract infections and sore throats, without requiring a prescription from a GP.

One of the most significant shifts we are making is on oral contraception. Pharmacists can already manage the supply of contraception prescribed elsewhere; from later this year, they will also be able to start women on courses of oral contraception. This is another way in which, in light of our women’s health strategy, we aim to reduce the barriers to women accessing contraception. Pharmacists will also be able to do more blood pressure checks, which is one of the most important risk factors for cardiovascular disease. Not only will those kinds of steps make it easier for people to get the care they need, we expect them to release up to 10 million appointments a year by 2024-25.

The third part of our plan is about providing more staff and more appointments. We are making huge investments in our primary care workforce, and are on track to meet the manifesto commitment of 26,000 more primary care staff by next March, meaning that we have more pharmacists, physios and paramedics delivering appointments in primary care than ever before. In 2021, we hit our target of 4,000 people accepting GP training places, and our upcoming NHS workforce plan will set out how we will further expand GP training. We are also helping to retain senior GPs by reforming pension rules, lifting 9,000 GPs out of annual tax changes. These are the pension reforms that the British Medical Association welcomed, describing them as “significant” and “decisive” changes and citing them as “transformative for the NHS”.

As well as freeing up more staff time, our plan cuts bureaucracy, too, so that GPs spend less time on paperwork and more time caring for patients. We will remove unnecessary targets, improve communication between GPs and hospitals, and reduce the amount of non-GP work that GPs are being asked to do. For example, patients are often discharged from hospital without fit notes, meaning that they then have to go to their GP to get one. By the end of this year, NHS secondary care services, which understand those patient conditions better, will be able to issue fit notes, and we have streamlined the number of targets on primary care networks from 36 down to just five. Taken together, this work will free up around £37,000 a practice.

Today’s primary care recovery plan funds and empowers our GPs and pharmacists to do more, so that we can prevent ill health, keep cutting NHS waiting lists and improve that vital front door to the NHS for many millions of people. I commend this statement to the House.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I call the shadow Secretary of State for Health and Social Care.

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[Steve Barclay]

The hon. Member started with the message to the public, and the message to the public can be seen by what key figures in the sector say about this recovery plan. Let me just share that with the House. The Pharmaceutical Services Negotiating Committee says that the plan is

“the most significant investment in community pharmacy in well over a decade”.

The Boots chief executive says that this is

“great news that they’ll be able use their clinical expertise more widely”.

The Company Chemists Association says that it is a

“real vote of confidence for the future profession”.

The message to the public from the industries in this sector is clear that this is a well thought through plan which will have a beneficial impact for patients. I will give one final quote: the chair of the Royal Pharmaceutical Society says that this plan will be

“a real game-changer for patients”,

and that is what our focus has been.

The hon. Member raised the issue of our delivery against the 18 months target. It is very generous of him to give me the opportunity to share once again with the House the contrast with Wales, but perhaps he missed it first time around. We have reduced the wait for 18 months by over 90%, yet Wales still has vastly more—over 80,000 waiting there—and that is from a much smaller population. Wales still has over 40,000 waiting more than two years, a target that we virtually eliminated as long ago as last summer. Those who want to see what a Labour Government would mean for the NHS can see it with the performance against the two-year waiting list and the 18-month waiting list in Wales, so it is very generous of him to give me the opportunity to share that once again with the House.

The hon. Member talks about what the recovery plan is for. Clearly, the pandemic has placed huge pressure on primary care, and we can see that just from the increased volumes of appointments that primary care faces. Again, I touched in my opening remarks on the fact that GPs and primary care are seeing more than 10% more appointments than before the pandemic—1 million appointments a day. It is clear why we need to invest in new forms of working, online booking technology and cutting bureaucracy: it is so that GPs can focus on the aspects of their role that apply purely to GPs and we can better use the 25,000 additional roles that are being recruited into primary care.

The hon. Gentleman talked about his direct referral policy. We actually announced our policy guidance in December, a month before his announcement, so it is something of a stretch to say that we are following his approach. He again kindly raised the issue of mental health, which gives me the opportunity to remind the House of the increased funding that this Government are making in mental health. That was a key priority when my right hon. Friend the Member for Maidenhead (Mrs May) was Prime Minister and a cornerstone of the long-term plan, with an extra £2.3 billion going into mental health. But we did not stop there. At the Budget, the Chancellor further prioritised mental health—for example, mental health digital apps were a cornerstone of the measures for economically inactive people. We are recruiting an additional 25,000 roles into primary care in recognition that specialists are needed, whether physios, pharmacists, paramedics or specialists in mental health support.

The hon. Gentleman spoke about other aspects of primary care such as dentistry. We have said frequently that we have a recovery plan for dentistry that we will announce shortly, so that should not be news. On funding, it is slightly bizarre that, although this plan announces more than £1 billion of new funding for primary care, investment in tech, new ways of working, additional staff and empowering our pharmacists, who bring great clinical expertise that we can better harness, the hon. Gentleman, rather than welcoming that, went back to the hackneyed non-dom funding. We have heard that so much before and it has been spent so many times. We have set out ways of best using the skills of our GPs and of the additional roles, where we are delivering on our manifesto with an extra 25,000 already recruited. Above all, we have set out ways of best using our pharmacists, who are a huge resource that we can better use. That is why we are targeting more than £600 million additional funding into pharmacists, which will allow people to better access the care they need in a timely fashion.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I call the Chair of the Health and Social Care Committee.

[Steve Brine (Winchester) (Con)]

I welcome the plan, which I note the Government have released at the first possible moment after the local election purdah period. Members of the Health and Social Care Committee and I will study it carefully, and I know the primary care Minister has already agreed to come before us so that we can give it a good going over. My question is about timing. How quickly can investment in the 8 am scramble part of the policy make a difference to those practices that do not have it? The Secretary of State said that they were already negotiating with the Pharmaceutical Services Negotiating Committee, so how quickly can that very welcome new investment get to the frontline of community pharmacy?

Junior Doctors’ Strikes

Baroness Winterton of Doncaster Excerpts

Thursday 30th March 2023 Commons Chamber

[Steve Barclay]

The urgent question was on the junior doctors—[Interruption.] I am sure I will quote—[Interruption.] There is a rare point of agreement between us. The hon. Gentleman is chuntering, but let me go through the list of things that he did raise pertaining to the junior doctors’ dispute. He said that the Government should get the junior doctors committee in for talks; we have done so—his third question made reference to the fact that we have. We have had the junior doctors in for discussions—[Interruptions.] I will run through the questions.

The hon. Gentleman questions whether there are preconditions attached to those discussions. I have checked the minutes of the meeting and there was a list of conditions —a pay restoration of 35%, and a range of other factors that were put on the table— that were preconditions that the Government had to commit to. The point is that he has said in the media that he does not support those preconditions. He says that 35% is unaffordable, so what is his position? One minute he says that he supports the junior doctors and that they should not go on strike, yet the next minute he says that he does not actually support the precondition that the junior doctors have said is the requirement for them to enter into discussion.

The reality is that the Government have taken a constructive and meaningful approach to trade union negotiations. That is why we have reached agreement with the “Agenda for Change” trade unions. It is why the Royal College of Nursing, Unison, the GMB and the Royal College of Midwives are all recommending the agreement that has been reached, covering more than 1 million staff across the NHS, to their members. The junior doctors have set a precondition on those talks which the hon. Gentleman does not agree—[Interruption.] That is a precondition. He does not seem to understand the terms the junior doctors—[Interruption.] He asked the question, he is getting the answer and the fact that it points to the contradiction in his own position is one that he seems to be having trouble with. Conservative Members are used to contradictions from those on the Opposition Front Bench. He supports the use of the independent sector, whereas his deputy does not. He wants to nationalise the GP estate, but his shadow Chancellor does not. The Opposition are full of contradictions. The reality is that there is a position in terms of the—[Interruption.] The right hon. Member for Islington South and Finsbury (Emily Thornberry) chunters again. There is a position in terms of precondition. The shadow Secretary of State asked me to confirm at the Dispatch Box whether it was a precondition of the junior doctors. Ahead of the urgent question, I checked the minutes—[Interruption.]

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. We cannot have this constant chuntering.

[Steve Barclay]

The Opposition do not seem to like their question being answered. The shadow Secretary of State asked me to confirm the position, for the avoidance of doubt, at the Dispatch Box. That is exactly what I am doing. I have checked the minutes. I have spoken this morning with officials to confirm, before I made the statement to the House, that it was a precondition of the talks. We were told, in terms of the pay erosion of 26.1%, that that needed to be restored at 35%, alongside other things. The reality is that he does not support that. He is facing both ways, wanting to support the junior doctors, but not actually willing to support the pay that they are demanding.

Future of the NHS

Baroness Winterton of Doncaster Excerpts

Thursday 23rd February 2023 Commons Chamber

[Margaret Greenwood]

The right hon. Member is being generous. I completely disagree with him about charging people for missing appointments. I remind him that 7 million adults in this country are functionally illiterate and huge numbers of people have dementia, so if a letter comes through the door, they may not understand it. Does he not agree that it would be much better to put resources into understanding why people do not come to appointments?

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. The right hon. Gentleman has been generous in taking interventions, but I am conscious that there are quite a lot of speakers, and if everybody takes nearly half an hour, we will not get everybody in.

[Matt Hancock]

I apologise; I have tried to be generous in taking interventions. It has been a positive and good-natured debate, which is valuable. I entirely recognise the point made by the hon. Member for Wirral West (Margaret Greenwood), and it has to be done sensitively, but the point made by my hon. Friend the Member for The Cotswolds (Sir Geoffrey Clifton-Brown) about the sheer quantity of missed appointments is a problem that must be resolved.

My final point is that too often, the NHS is a national hospital service that fixes people after they get ill—that happens in this country far more than elsewhere. The effective prevention of ill health is central to ensure that the NHS can continue to thrive in decades to come. The gap across the country is huge and it needs to be addressed. For example, the gap between the life expectancy of 74 years for a man in Blackpool and 81 years for a man in Buckinghamshire is far too high. About half that gap, however, can be put down to the difference in smoking rates—it is not about the NHS service in Blackpool at all, which is excellent.

We have to support people to prevent ill health in the first place; hitherto, the NHS has not put nearly enough effort and attention into that. I hope that the Minister will confirm the importance of prevention. I know that the Select Committee is about to launch an inquiry into prevention policy. I was delighted to set up the National Academy for Social Prescribing when I was the Secretary of State to try to drive the agenda further, but there is clearly much more to do.

The NHS is our national treasure. For those of us who care deeply about a service that is free when people need it, where the nation collectively comes together to look after those who are ill, it has deep moral force and is efficient and effective. If people care about its future, however, we need to reform it and ensure that we bring it into the modern age—only then can that promise to the nation continue to be fulfilled for the rest of our lives.

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[Rob Roberts]

It has—although if Opposition Members want to argue with the King’s Fund, that is fine. But if NHS funding was okay under Labour and has increased in real terms since then, how is it not okay now? I agree that it is not okay now, but that is because of all the reasons I have already mentioned: we are keeping people alive longer, and sicker, there are more of them, and it is more expensive to diagnose and treat them. They are not political issues.

To draw my remarks to a conclusion, I am not familiar with the machinations of how to go about these things, but it seems perfectly reasonable to have, finally, some kind of royal commission—some kind of massive public engagement exercise—on the future of health services in the United Kingdom. We must tackle it head-on. We must not be afraid to go wherever that debate takes us in search of better outcomes for people. I just wish we would keep in mind that we are here for people. We are here to serve them and give them the best outcomes we possibly can, not to get caught up in form and process, or dogma and ideology. We are trying to make people better. We have to do whatever we can to get to the root causes of the issue, because as my former NHS and now private sector nurse partner tells me all the time—I quote—“You could fix so much if you’d just stop politics getting in the bloody way.”

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. I call Paulette Hamilton.

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[Rob Roberts]

On a point of order, Madam Deputy Speaker. I apologise to the House for interrupting the debate. At the end of my speech, I may have used a little bit of intemperate language, which was not necessarily in best keeping with the traditions of the House. I apologise to you, Madam Deputy Speaker, and to the House.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I thank the hon. Gentleman for his apology. As he said, it is important that we use moderation in our language.

Draft Mental Health Bill 2022

Baroness Winterton of Doncaster Excerpts

Thursday 26th January 2023 Commons Chamber

[Dr Poulter]

I thank the hon. Member for his question. As part of our work, we looked at elements of reform that are being considered across the devolved Administrations. The fusion of mental health law and mental capacity law is already well under way in Northern Ireland, so it may be a question of the UK Parliament learning from the Northern Ireland Assembly, rather than the other way round. We in this place will continue to watch with interest how the proposed changes to legislation in Northern Ireland progress, as they may improve what we do when we look in the future, I hope, at a fusion of mental health law and mental capacity law.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I thank the hon. Member for his statement and all colleagues who participated.

NHS: Long-term Strategy

Baroness Winterton of Doncaster Excerpts

Wednesday 11th January 2023 Commons Chamber

[Madam Deputy Speaker (Dame Rosie Winterton)]

I inform the House that amendment (a), tabled in the name of the Prime Minister, has been selected.

NHS Dentistry: Salford and Eccles

Baroness Winterton of Doncaster Excerpts

Monday 19th December 2022 Commons Chamber

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

rose—

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. I gently say to the hon. Gentleman that if he wanted to intervene, he ought to have been here right at the beginning, because it is the hon. Lady’s Adjournment debate, and it is about Salford and Eccles? I leave it to him to decide whether he wishes to intervene.

[Neil O’Brien]

I am happy to take whatever interventions are appropriate.

We know that there are still further improvements to be made. Although I am pleased that over 75% of the patients who tried to get a dental appointment over the last two years were successful, this is not back to the level that we were seeing pre-pandemic, which was 92%. That is why in July and in our plan for patients, which the hon. Lady mentioned, we announced some improvements to the 2006 contract to ensure that patient access was improved, although I want to reassure her that we do not regard those as the end of the story; they were a stepping stone.

Those changes included: making sure that dentists were remunerated more fairly for complex work, which will improve access for patients; implementing a minimum value of £23 for each unit of dental activity, boosting incomes in the places where the UDA value is lowest; and enabling dental practices to deliver up to 110% of their contract levels, to increase activity and allow those practices that are delivering NHS care most effectively to deliver more. This effectively takes away the cap that has been in place since the 2006 contract, which the hon. Lady mentioned.

This package will increase and improve access to dental care for patients across the country. We have already taken action to implement these changes, including through regulations that came into effect on 25 November. The changes have all been decided with careful consideration, working collaboratively with the dental sector. The Department has worked with the General Dental Council on legislative proposals that will make registration processes for dental professionals qualified outside the UK more proportionate and streamlined, making the process to join the UK workforce more efficient for dentists from overseas. These changes are another way in which we are seeking to improve access for patients.

Finally, to make it easier for patients to find dentists taking on new patients, we have made it a requirement for NHS dentists to update their information on the NHS website, which has historically been out of date, but of course we are looking to go further to ensure that those appointments are there. These changes are just the beginning. They are the necessary first steps of our work to improve NHS dentistry. These are the measures that we can take immediately, and they will have a noticeable impact, but we will go further.

Looking forward into the new year, we have been working with NHS England and the sector on further changes to improve access. Our priorities for this next phase of reform include: improved access to urgent care for patients who need to see someone immediately; better access to care for new patients; and further workforce and payment reform. We aim to take the necessary steps to implement these changes next year, but I am keen to seek every opportunity to take action wherever I can, and ahead of those reforms we are also actively considering what support we can offer to help patients who do not currently have access to the dental system and those who are not attached to a practice, who have the worst access. We are also considering how the recruitment and retention of dentists can be improved, particularly in the parts of the country where the need is greater. We are also thinking further about how overseas qualified dentists can be supported to start working in the NHS more quickly.

I am strongly committed to improving our NHS dental system wherever I can for all those who need it. The hon. Lady has set out a powerful case today on why we need to go further, and we will go further. I thank her for raising this important debate, and I hope that she will be reassured that although the reforms we have made so far will make a difference, they are far from being the end of the story, and that we will continue to take action to improve access to NHS dentistry across the nation.

Question put and agreed to.

Cancer Services

Baroness Winterton of Doncaster Excerpts

Thursday 8th December 2022 Commons Chamber

[Several hon. Members rose—]

[Madam Deputy Speaker (Dame Rosie Winterton)]

We have a further debate this afternoon. In order to ensure equality of Back-Bench contributions across the afternoon, I advise colleagues to speak for no more than about 10 minutes, which will enable remaining Back Benchers to get in later.

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[Several hon. Members rose—]

[Madam Deputy Speaker (Dame Rosie Winterton)]

I call shadow Minister Liz Kendall.

Government PPE Contracts

Baroness Winterton of Doncaster Excerpts

Tuesday 6th December 2022 Commons Chamber

[Madam Deputy Speaker (Dame Rosie Winterton)]

Before we begin this debate, I would like to remind Members that the motion gives general reasons why the House might agree to the Humble Address. The normal rule that reflections must not be cast upon Members of either House of Parliament, except on a substantive motion, remains in force. I am sure right hon. and hon. Members will ensure that that rule is stuck to in their speeches. I call the Deputy Leader of the Opposition.

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[Angela Rayner]

The Chair of the Public Accounts Committee is absolutely right. It is absolutely eye-watering and astonishing that 176 contracts remain in this situation. The public can see that and they are frustrated, because it is not acceptable and not okay to govern in that way. The public rightly want answers, and they want them now.

The links between the company Medpro and the Tory peer in question were never publicly disclosed. In fact, they were denied repeatedly by the lawyers acting for those involved. We now know that the money ended up in offshore accounts directly linked to those individuals. By their own admission, this was for so-called tax efficiency. It seems that they even dodged paying their own taxes on the profits they made from ours. Only after a long legal battle was it revealed that there was active lobbying from ministerial colleagues for access to the VIP lane and substantial contracts were won by those companies. They said that the peer in question did not benefit from these contracts. That denial has been rather undermined by the latest revelations of The Guardian, rather than any disclosure of Ministers. It was only some time after The Guardian exposed those links that a Minister, the right hon. Member for Charnwood (Edward Argar), finally told me in answer to a parliamentary question:

“Departmental records reflect that a link between Baroness Mone and PPE Medpro was clear prior to contracts being awarded.”

But Ministers have, for months, refused to show us those records or tell us the nature of that link and whether it was declared or discovered in due diligence.

This was the subject of an investigation by the Standards Commissioners in the other place, yet it appears that Ministers sat on the information that they had. The question is very simple: what have Ministers got to hide? Did they know all along who was behind PPE Medpro, or was due diligence so poor that they did not realise the problem? If they had nothing to hide and no rules or laws were broken, Ministers will surely be happy to make the details of the meetings and correspondence available. While they are at it, will the Minister give us clarity about allegations made by the former Health Secretary in his new book about a separate bid for business connected to Baroness Mone?

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. The right hon. Lady is venturing rather too far into the territory that I urged her to avoid. I am afraid that those are the rules, so I have to pull her up if she is actively criticising a Member of the other place. I am sorry about that, but those are the rules.

[Angela Rayner]

I was not criticising Members from the other place. I am just quoting what a Member from this place, who was a Health Minister at the time, said. I am asking this Minister today if he can give us clarity on what was said, because that is now on the public record. That is all I am asking the Minister for. I have not said that about any person from the other place—that is what a former Minister said in his diaries, so it would be nice if this Minister can give us some light on this whole murky affair.

Let us turn to the numbers because, as they say, the numbers don’t lie. Ten: how many times more likely to get a contract a company was if it was in the VIP lane. One in five: the proportion of emergency contracts handed out by the Government that have been flagged for corruption. Three and a half billion: the value, in pounds, of contracts given to the Tory party’s mates—that we know of. Three billion: the value, in pounds, of contracts awarded that warrant further investigation. None, zilch, zero: the number of times this Government have come clean about this dodgy Medpro scandal. A cover-up, a whitewash, events swept under the carpet—and now they have been dragged kicking and screaming to the House today to give an honest account of their shameful dealings. The public are sick of being ripped off and taken for fools. They want to know the truth.

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[Angela Rayner]

My hon. Friend is absolutely right, and I would go further. I know from the correspondence I have been receiving that the public feel that way, and that many Conservative voters are absolutely shocked by what they have seen this Conservative Government do. They do not believe that the Government speak to their values, yet this has happened and we have a Procurement Bill going forward where this could happen again. So for today at least, the question before the House is simple: clean-up or cover-up?

I know that Members across this House care about our democracy, and although we disagree on many things, I hope we agree on the importance of trust in politics, the values of integrity, professionalism and accountability in public office and the public’s wish for more transparency and accountability within these four walls. Put simply, a vote for this motion is a vote in favour of the truth. This Government have presided over scandal after scandal engulfing their party. They appear to have benefited from dodgy lobbying, left, right and centre. Voting today for yet another cover-up will send another clear message to the public that this Prime Minister cares more about protecting vested interests than putting things right, and that his own promise of “integrity, professionalism and accountability” is just more hot air. After what they have put the British people through, this surely cannot be the message that Conservative Members want to send.

Labour has a plan to turn this procurement racket on its head and tackle the obscene waste with an office for value for money, to ensure that public money is spent with the respect that it deserves. It is about time that Conservative Members got with that programme. So I say today—I hope Conservative Members are listening—let us end the cover-up and begin the clean-up, and let us start it now. I commend this motion to the House.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I know that hon. and right hon. Members heard what I said previously. I just want to add that while these matters are not sub judice, they are under investigation by law enforcement agencies and the Lords Commissioners for Standards, and nothing should be said to prejudge or prejudice any investigations. I am sure that that will be borne in mind.

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[Neale Hanvey]

At the beginning of the pandemic in one of my first Prime Minister’s questions, I asked the then Prime Minister if he would ensure that profiteering would have no place in this Government’s response to the covid pandemic. Now, when we fast-forward to all these years later, that seems to have been at the very heart of it. The British people were told that this Government were helping them. British industry was told that it was going to be supported. I have persisted in my questions about how the domestic diagnostic industry has been promised work by this Government, yet it is being charged for doing the right thing. Will the Minister apologise—

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order.

[Will Quince]

I will come on to many of the points the hon. Gentleman has raised, but I will just say this about UK supply chains. At the beginning of the pandemic, only 1% of PPE used in the UK was produced here. At present, three quarters of the FFP-3 masks provided to the NHS and social care are now manufactured in the United Kingdom and contracts were signed with around 30 UK-based companies to manufacture around 3.9 billion items of PPE.

Colleagues will recall those early days, with planes being turned around on the tarmac, countries imposing export bans, huge inflation in global prices and the price of crucial items such as glass increasing sixfold. These were the conditions under which tough decisions were taken, and these were the decisions under which PPE was procured. These were the conditions under which we stepped up to protect our most vulnerable and to save lives.

--- Later in debate ---

[Karl Turner]

rose—

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. The hon. Gentleman must allow the Minister to answer. It is not fair to shout back as soon as he starts answering.

[Will Quince]

The hon. Member for Kingston upon Hull East (Karl Turner) will know that civil servants had to take decisions about speed, pace and quantity. They were looking at contracts that would get the most amount of PPE for the best value for money as quickly as possible.

--- Later in debate ---

[Several hon. Members rose—]

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. The Minister has indicated that he will give way shortly. Let him make a bit of progress.

[Will Quince]

I have given way equally to both sides so far in this debate. I have some reluctance to give way to Members who tell others to sit down while they are speaking or making interventions.

NHS Workforce

Baroness Winterton of Doncaster Excerpts

Tuesday 6th December 2022 Commons Chamber

[Caroline Ansell (Eastbourne) (Con)]

I thank the hon. Lady for advising me ahead of the debate that she might mention the hospital in my constituency. I am not sure of her particular interest in Eastbourne, although it was named by Time Out as its place to visit in 2023. For the benefit of those in my constituency who may be following this debate, am I pleased to share that, in relation to the workforce—the matter before us today—there has been a 25% increase in full-time staff over the past 10 years. That is a 10-year increase in nurses and midwives, a 10-year increase in doctors and dentists, and a 10-year increase in allied health professionals. They also report £20 million—[Interruption.]

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. It is important to have fairly short interventions.

[Caroline Ansell]

Thank you, Madam Deputy Speaker. Is the hon. Lady therefore pleased and relieved to hear that, despite staff concerns that there would not be a new hospital, there has been a run of incredibly positive meetings and we are assured that, in the words of the chief executive, “once-in-a-generation” investment is coming?

--- Later in debate ---

[Margaret Greenwood (Wirral West) (Lab)]

It is clear that we have a crisis in NHS staffing. For the very first time in its 106-year history, members of the Royal College of Nursing have voted for strike action in their fight for fair pay and safe staffing. I express my solidarity with them. They do not do this lightly. Consecutive Conservative Governments have brought them to this situation.

Staff shortages are putting immense pressure on the NHS. There were more than 133,000 vacancies in the NHS in England in September 2022, up from around 103,000 the year before. There were more than 47,000 registered nursing vacancies in September, about 8,500 more than in March, and there were more than 9,000 medical staff vacancies in September, over 1,000 more than in March.

We all know things were bad before the pandemic, but an already extremely serious situation has got worse. This staffing crisis is a direct result of the failure of Conservative Governments to plan and deliver the workforce we need, and it is leading to very high levels of stress for staff and extraordinarily long waiting lists for patients.

Two weeks ago, I led a Westminster Hall debate on NHS staffing. Numerous organisations provided briefings in advance of that debate, and I will share some of their concerns about staff shortages, the pressures on the NHS and the impact they are having on workers and patients. Their observations reflect the depth of the crisis in the NHS, along with the complexity of medicine and the immense level of expertise in this country. The Government really should listen to them.

Research by the British Medical Association points to a lack of doctors in comparison with other nations. The average number of doctors per 1,000 people in the OECD’s EU nations is 3.7, but England has just 2.9. Meanwhile, Germany has 4.3.

Parkinson’s UK has said:

“People with Parkinson’s are facing huge waiting times for diagnosis, mental health support, check-ups and medication reviews. This is due to critical shortages of NHS staff across England who are available to see people with Parkinson’s. Problems with finding healthcare professionals who understand the condition and accessing the right specialist services have been exacerbated by the pandemic. Waiting times for a consultant after diagnosis are up to two years in some areas.”

The Royal College of Midwives has expressed serious concerns that the NHS in England has 800 fewer midwives than it did at the time of the 2019 general election and that

“midwife numbers are falling in every region of England.”

According to the latest census by the Royal College of Physicians

“52%—more than half—of advertised consultant physician posts were unfilled in 2021. That is the highest rate of unfilled posts since records began, and of the 52%, 74% went unfilled due to a lack of any applicants at all.”

The Royal College of Speech and Language Therapists has said:

“Speech and language therapy services across the entire age range are facing unprecedented demand and there are simply not enough speech and language therapists currently to meet the level of demand.”

Last year’s report by the British Society for Rheumatology found that

“chronic workforce shortages mean departments lack sufficient staff to provide a safe level of care.”

This means

“patients are experiencing progressively worse health, leading to unnecessary disability and pain.”

Cancer Research UK has pointed out that

“critical staff shortages impact all aspects of cancer care”—

I would have thought the Secretary of State would like to listen to what Cancer Research UK has to say. It highlights:

“In 2020-21, £7.1 billion was spent on agency and bank staff to cover gaps in the NHS workforce, an increase of almost £1 billion from an already enormous £6.2 billion spent the year before. This is money that could be spent on training and recruiting full-time equivalent NHS staff, but instead is”—

being used—

“in an attempt to mitigate chronic NHS staff shortages.”

Unison has said it is

“very concerned that NHS services are in a dire state due to there being insufficient staff numbers available to deliver safe patient care.”

It points out:

“While the government has belatedly accepted the need for an independent assessment of the numbers of health professionals needed in future, they repeatedly refused to write such plans into the Health and Care Act 2022, despite a broad coalition of more than 100 healthcare organisations calling for this.”

The TUC is calling on the Government to put in place

“an urgent Retention Package, with a decent pay rise at its heart.”

The 2022 pay award is well below current inflation levels, so it amounts to a real-terms pay cut. The TUC went on to say:

“The 2022 pay uplift needs to be set at a level which will retain existing staff within the NHS”,

is attractive to new recruits,

“and recognises and rewards the skills…of health workers.”

In recent weeks, we have seen announcements of industrial action from other organisations representing NHS workers, including Unite the union, Unison and the GMB. In addition, the Chartered Society of Physiotherapy is balloting members and the British Medical Association will ballot next year. As with the Royal College of Nursing, this is not being done lightly. NHS workers care deeply about patients and the service as a whole, but they can also see that the NHS is at breaking point. It is notable that, in a recent poll of 6,000 adults carried out on behalf of Unite, 73% of respondents supported NHS and care workers receiving pay rises that keep up with the cost of living.

The Conservative Governments’ failure to address chronic staffing shortages in the NHS is putting those working in the service under immense pressure and, in some instances, it is putting patients at risk. Since 2010, instead of focusing on and planning and delivering a well-resourced, well-staffed NHS, the Conservatives have focused their energy on not one but two major reorganisations of the NHS, designed to open it up to privatisation. This ideological agenda is causing immense suffering to patients and great stress for staff.

The Health and Care Act 2022 provided for the revoking of the national tariff and its replacement with a new NHS payment scheme. The national tariff is a set of rules, prices and guidance that covers the payments made by commissioners to secondary healthcare providers for the provision of NHS services. Engagement on the NHS payment scheme is ongoing, with a statutory consultation due to begin this month. Given the requirement in the Act for NHS England to consult each relevant provider, including private providers, before publishing the scheme, I am very concerned that this may well be a mechanism through which private health companies will have the opportunity to undercut the NHS. If that happens, one inevitable outcome would be an erosion of the scope of “Agenda for Change”, as healthcare that should be provided by the NHS is increasingly delivered by the private sector. I ask the Minister to give us an assurance that that will not be used in that way.

As I have said, the Conservative Governments’ failure to address chronic staffing shortages in the NHS is putting those working in the service under immense pressure and, in some instances, it is putting patients at risk. Since 2010, instead of focusing on planning and delivering a well-resourced, well-staffed NHS, they have focused on a privatisation. In the second reorganisation, they held a consultation, allegedly, when NHS staff were working incredibly hard during the pandemic. It was very unfair to carry out a consultation while the people to be affected most by it were dealing with the worst public health crisis we have seen.

The staffing crisis has been created by the Conservatives on their watch. The comprehensive workforce plan announced in the autumn statement is due to be published next year. It is long overdue and it will need to be backed up by sufficient resources. In the meantime, the Government bear a responsibility in relation to how the NHS fares this winter. They have the opportunity to avert industrial action and should do all in their power to do so. They must support those who work in the service and make sure that NHS workers receive a fair pay rise.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I call the shadow Minister.

--- Later in debate ---

[James Murray]

I thank the hon. Gentleman for his intervention. I have set out that scrapping the non-dom status would raise £3.2 billion, and that our workforce expansion plan would cost £1.6 billion, so we would be well able to afford that measure from the amount of money that we have raised from scrapping this outdated, unfair tax loophole.

Non-dom status should have no place in our modern tax system. It is unfair. When the Government are making working people pay more tax, it is simply wrong to allow wealthy people with overseas income to continue to benefit from an outdated tax break. It is also bad for UK business: the loophole prevents non-doms from being able to invest their foreign income in the UK, as bringing it here means it becomes liable for UK tax. Abolishing non-dom status would end that barrier to UK investment—and, as I have said, raise £3.2 billion, money we would use to put towards priorities including expanding the NHS workforce.

To be honest, we would have thought abolishing non-dom status, replacing it with a modern system and using the money to strengthen the NHS and economy would be a no-brainer. What is it about this Conservative Government, led by the right hon. Member for Richmond (Yorks) (Rishi Sunak), that makes them so reluctant to close that loophole? Last week, during the rushed debates on the Government’s autumn Finance Bill, I asked Treasury Ministers to confirm whether the Prime Minister had been consulted on the option of abolishing non-dom status and whether it was ever considered as an option for last week’s Finance bill. I also asked whether, when the current Prime Minister was Chancellor, he had ever recused himself from discussions on the matter, for obvious reasons.

I put these questions to Treasury Ministers on three separate occasions last week, but they refused each time even to acknowledge the questions, never mind answer them. For a Minister to overlook a set of questions once might be an oversight, but to ignore them three times looks like something else. Perhaps the Minister will today show that they have nothing to hide by answering the questions I have raised.

In the autumn statement and last week’s Finance Bill, the Chancellor chose to leave non-dom status untouched, while picking the pockets of working people, including nurses, with stealth taxes such as freezing income tax thresholds and pushing up council tax. Today, the Secretary of State for Health only mounted a brief defence of non-dom status; I wonder whether his colleague from the Treasury will, in her closing remarks, repeat some of the defences that Treasury Ministers tried to set out last week.

Last week, Ministers tied themselves in knots trying to find a justification for the £3.2 billion tax break for non-doms. They tried to pretend that the Government's investment relief is working, when only 1% of non-doms invest their overseas income in the UK in any given year, and last week they tried to win praise for ending permanent non-dom status, while keeping quiet about the new loophole they created, which allows people to use trusts to retain non-dom benefits permanently.

The truth is that, unless the Conservatives vote with us today to abolish non-dom status once and for all, the British people will be clear that no amount of reason or common sense will get this Government to come round. The British people need a fresh start and a new Labour Government that would take those fairer choices on tax to support the stronger NHS we so desperately need.

The NHS is an achievement we share together as a country and one that we all have a personal relationship with. We all want to know that when we have medical symptoms, concerns or needs, the NHS will be there for us. We want to know it will be there as a publicly funded service, free at the point of use, able to provide us with the high-quality help we need. That is what I wanted to know in my early 20s, when I started to notice symptoms of what would later be diagnosed as myasthenia gravis, a rare neurological condition that caused muscle weakness throughout my body.

After the best care I could have hoped for from my brilliant consultant and his team and colleagues at the National Hospital for Neurology and Neurosurgery in Queen Square, I have been symptom-free for many years now, but the memory of first feeling those symptoms and then finding my way towards the right treatment sticks with me. I would never want anyone to feel symptoms like mine and not be sure whether the NHS would be there to help.

We all know stories like that. We all need the NHS to diagnose and treat us when we are worried. We all need to be able to turn to the NHS so that we get that treatment in good time. We all connect with the NHS through our own lives and the lives of our family and friends. That is why the NHS matters so much to us all and why we are so determined to deal with the crisis the NHS is facing and to make sure it is ready for the modern challenges we face.

At the heart of our vision for the country are stronger public services and stronger economic growth. We know that getting public services back on track will support a growing economy, which will in turn support modern, sustainable public services. Before us today we have a chance to end the unfair 200-year-old tax loophole, which lets a small number of people avoid tax on overseas income, and use the money saved to fund one of the biggest workforce expansion plans in the history of the NHS. That is the choice in front of us today, and I urge all MPs to do the right thing by backing our plan.

Royal Assent

[Madam Deputy Speaker (Dame Rosie Winterton)]

I have to notify the House, in accordance with the Royal Assent Act 1967, that His Majesty has signified his Royal Assent to the following Acts:

Identity and Language (Northern Ireland) Act 2022

Product Security and Telecommunications Infrastructure Act 2022

Counsellors of State Act 2022

Northern Ireland (Executive Formation etc) Act 2022

World AIDS Day

Baroness Winterton of Doncaster Excerpts

Thursday 1st December 2022 Commons Chamber

[Chris Clarkson (Heywood and Middleton) (Con)]

It is a pleasure to follow my hon. Friend the Member for West Bromwich East (Nicola Richards). I welcome this debate and I thank the hon. Member for Brighton, Kemptown (Lloyd Russell-Moyle) for bringing it to the House today. I also wish to praise him for his leadership in this area and for the work he has done to educate the public on the realities of people living with HIV. Unfortunately, there are still a lot of prejudices out there, and his speaking openly about his own experience as somebody living with HIV is incredibly powerful and important. When people see that their representatives are representative of society as a whole it makes a real difference. I will not speak at length, because we have heard a series of excellent speeches and I am going to use some of the same facts and figures that have been mentioned. However, I want to say how pleased I am that we are still having these debates, because this problem has not gone away.

The Government committed in December 2021 to achieve zero new HIV infections, HIV or AIDS-related deaths in England by 2030. That is an ambitious target, but I am sure everyone across this Chamber can agree it is essential. The framework for achieving that means ensuring equitable access to and uptake of HIV prevention programmes, scaling up testing in line with national guidelines, optimising rapid access to treatment and retention in care, improving the quality of life for people living with HIV and addressing the stigma surrounding infection and testing.

We must work to address the lazy stereotypes associated with HIV/AIDS, especially those surrounding the LGBT community. I am pleased to see that real progress is being made. The Government have provided £20 million to ensure that HIV opt-out testing is expanded to areas with a high prevalence, including Manchester, London, Blackpool—I pay tribute to my hon. Friend the Member for Blackpool South (Scott Benton) for his dogged determination in getting Blackpool included—and Brighton. That has helped to reduce diagnosis times and improve diagnosis rates.

In Rochdale borough, where my Heywood and Middleton constituency is located, 2.2 in every 1,000 adults are living with HIV. I would particularly like to thank the teams at Middleton health centre and Heywood clinic for their work in providing sexual health testing and support, and I hope we will be able to take advantage of opt-out testing too, as it is essential. The roll-out of opt-out testing saw 128 people newly diagnosed with HIV, 325 people newly diagnosed with hepatitis B, as has been mentioned, and 153 people newly diagnosed with hepatitis C. At a cost of just £2.2 million across 100 days, the opt-out testing paid for itself, saving the NHS an estimated £6 million to 9 million, through early diagnosis and treatment. Opt-out testing also goes some way to addressing health inequalities, with higher proportions of women and people from black African and black Caribbean backgrounds being diagnosed compared with the national average.

In March 2020, the Department of Health and Social Care provided £16 million in funding to local authorities to provide PrEP. I warmly welcome that, but barriers still exist. More than 57% of people waited more than 12 weeks to access PrEP and only 35% who attempted to access PrEP services were successful. It is essential that that changes. PrEP is a game changer for all of us. It is an essential tool if we are to end new infections by the next decade in the UK.

Of course, we know that this is not just a problem here at home. The truth is that covid-19 was the second pandemic of our lifetimes and we are still living through the first; this is a global matter. That is why I am proud that the UK provides funds to UNAIDS, the Robert Carr Fund and the Global Fund to Fight AIDS, Tuberculosis and Malaria. I will join the hon. Member for Brighton, Kemptown in saying that I would have liked to have seen the levels sustained, but my hon. Friend the Member for Totnes (Anthony Mangnall) made the important point that there are other things we can leverage as a country to help other countries in their fight against this disease. The UK is a co-founder of Global Fund and the third largest donor historically—my hon. Friend mentioned the figure of £4.4 billion in that regard—and the Foreign, Commonwealth and Development Office announced on 14 November that the UK will contribute a further £1 billion, so at least we are still in the fight. As with covid, the truth is that none of us is safe until all of us are safe, and we have a role to play in supporting those parts of the world less able to tackle HIV/AIDS than ourselves.

As we aim for our 2030 target, I would also like to draw the Government’s attention to the recommendations of the Terrence Higgins Trust and National AIDS Trust, which are calling for the expansion of opt-out testing to all areas of high prevalence—I cannot stress how important that is—the provision of PrEP to all who could benefit from it, which is very important, and a refocusing of sexual health services that have been displaced by the recent mpox outbreak.

There is a huge amount of work to do if we are to reach our 2030 target, and that will rely on adequate funding, access and information across society. It will need those of us in this place to speak openly and honestly about HIV/AIDS and to be collaborative, working across the piece. I am confident that we can get to that 2030 target and I will continue to support everyone working to that endeavour for as long as I have the privilege to be in this place.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I call the SNP spokesperson.

[Steven Bonnar (Coatbridge, Chryston and Bellshill) (SNP)]

. I join all Members in commending the hon. Member for Brighton, Kemptown (Lloyd Russell-Moyle) for leading this debate and for informing us so well on a subject on which he is such a powerful crusader and advocate. I thank him and commend him for his contribution today.

Today, 1 December, is the annual World AIDS Day. From the inaugural World AIDS Day in 1988, the first ever global health day, until today, it has given an opportunity for people worldwide to unite in the fight against HIV, to show support for people living with HIV and to commemorate those who have, sadly, lost their lives as a result of AIDS-related illnesses. More than 105,000 people are living with HIV in the UK, and globally an estimated 38 million people have the virus. Despite the fact that the virus was only identified in 1984, more than 35 million people have died of HIV or AIDS-related illnesses, making it one of the most destructive pandemics ever known.

Each year in the UK more than 4,000 people are diagnosed with HIV. Many people do not know the facts about how to protect themselves and others, and stigma and discrimination remain a reality for so many people who are currently living with this condition. About 6,000 people in Scotland are living with AIDS, according to Health Protection Scotland data, and 98% of those attending HIV specialist treatment and care were receiving antiretroviral therapy—ART. In 95%, the virus cannot be detected in their blood, meaning they have an undetectable viral load and cannot transmit HIV. We know that many within our society are still largely unaware of the disease and the risks of it. A recent survey from the National AIDS Trust found that only 16% of people surveyed knew that if someone with HIV is on effective treatment, they cannot pass on HIV and can expect to live a long, happy, healthy and fulfilling life.

HIV continues to be a major public health crisis both in the UK and across the world, as we have heard today. Although we know that HIV disproportionately impacts segments of the LGBTQ+ community, the two issues should not be conflated; HIV is by no means confined to LGBTQ+ communities or certain black or ethnic minority communities. The fact is that anyone, regardless of sexual orientation, gender, age or any other factor, can acquire HIV or AIDS.

We in Scotland are extremely proud to be the first country in the UK to make PrEP available free of charge to those at a high risk of acquiring HIV. We have made huge progress in detecting and treating HIV, and people with the virus are able to live those long, happy and fulfilling lives. PrEP is free of charge from NHS Scotland for anyone who is more at risk of getting HIV. As we have heard from the hon. Member for Brighton, Kemptown, it is simply an oral medicine, in pill form, comprising two HIV antiretroviral drugs. It is prescribed to HIV-negative people at risk of becoming infected as part of a comprehensive approach to HIV prevention. We know that the drug is highly effective at stopping HIV from being passed on. In clinical trials, PrEP has been shown to reduce the risk of sexually transmitted HIV by between 75% and 86%, so it is hugely successful. Research lead by Glasgow Caledonian University’s Professor Claudia Estcourt shows there has been significant reduction in HIV infections since the implementation of the first PrEP programme in Scotland in July 2017, and that new diagnoses in Scotland have fallen by 20%.

The SNP Scottish Government will continue work to reduce the stigma of HIV, raise awareness of the condition and reduce its transmission. Support is being provided for new research on reducing transmission of the virus, and a separate working group will also look at the clinical utility of PrEP in Scotland.

The SNP Scottish Government have also provided £337,000 to develop a national online service for sexually transmitted infections and blood-borne viruses, which will allow people to request a test online and conduct that home self-sampling that we have heard about today from across the House. Every tool possible will be required in our fight against HIV/AIDS. These are all excellent tools and the Scottish Government remain committed to being on course to reach their target of eliminating HIV transmission in Scotland, and across the rest of the UK, by 2030.

As a fierce defender of minorities in this place, I must also mention the plain fact that many of those living across these nations with HIV are vulnerable. Some experience language, faith and cultural barriers associated with long-standing stigma, while others have complexities, such as mental health and societal issues, that impact their access to health and social care services, leading to poorer health outcomes. As we are all too aware, socio-economic inequalities drive health inequalities. Will the Minister outline the steps being taken by his Government to mitigate the impact of austerity and reduce inequality for all our minority communities?

The Government need to take an intersectional approach to healthcare—an approach that recognises that many people in the United Kingdom will face multiple and often overlapping disadvantages and barriers to accessing good healthcare, and sometimes, as we have heard, a postcode lottery.

Finally, on the matter of funding, the SNP is once again calling on the UK Government to reverse, in effect, the 83% cut to UNAIDS funding, which is a consequence of their decision to cut the aid budget from 0.7% to 0.5% of our GDP. On 31 Oct 2022, the UK Government missed the deadline to donate to the Global Fund to Fight AIDS, Tuberculosis and Malaria. At the time, Mike Podmore, UK Director at STOPAIDS, said:

“The UK is acting as an unreliable partner and preventing the Global Fund from communicating clearly to its grantees about what funding is now available for them to work with, creating uncertainty.”

The consequences of that action could be immeasurable when it comes to the number of lives affected. Although the UK did provide some funding, it was £400 million less than in 2019. Again, we in the SNP call on the UK Government to do the right thing. The aid budget must be restored to its 0.7% level, especially if the UK does not want to be known as an unreliable partner among its counterparts.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I call the shadow Minister.