(2 years, 6 months ago)
Written StatementsFollowing the increased prevalence of cases of monkeypox in England, and transmission within the community for the first time, I would like to inform the House that as of Wednesday 8 June 2022, the following amendments have been laid and come into force:
The Health Protection (Notification) Regulations 2010 have been amended to include monkeypox as a notifiable disease in Schedule 1 and monkeypox virus as a notifiable causative agent in Schedule 2.
The National Health Service (Charges to Overseas Visitors) Regulations 2015 have been amended to include monkeypox in Schedule 1.
The public health assessment remains that the threat to the public is low. These amendments will support the UK Health Security Agency, or UKHSA, and our health partners to swiftly identify, treat and control the disease, and reduce potential financial barriers to overseas visitors in England who require NHS-funded secondary care services in relation to monkeypox.
Health Protection (Notification) Regulations 2010
From today, 8 June 2022, monkeypox is a notifiable disease and there is now an explicit legal duty on doctors to notify the “proper officer” of the relevant local authority if they see a patient they suspect of having the monkeypox virus in England. While we believe cases have been reliably notified to date, this amendment puts beyond doubt the legal obligation of doctors to report cases of suspected monkeypox. Placing a legal duty on doctors to report suspected monkeypox cases, and provide the relevant patient information, will strengthen our understanding of the virus and its transmission within the UK and, if required, support the implementation of timely prevention and control measures.
We have also placed a legal duty on laboratories to notify the UKHSA if they identify monkeypox virus when they test a sample in England, by listing the virus as a notifiable causative agent. Positive laboratory samples will be an important core dataset, strengthening surveillance and helping to inform our understanding of outbreak progression and trends to underpin action. Laboratory notification will also help to identify the links between cases and act as an important contingency if case notification by doctors has not occurred.
National Health Service (Charges to Overseas Visitors) Regulations 2015 (“the charging regulations”)
The charging regulations require providers of NHS-funded secondary care to make charges to people not ordinarily resident in the UK (“overseas visitors”) except where an exemption category applies.
We have taken swift action to ensure that, should an overseas visitor in England need NHS- funded secondary care services in respect of monkeypox, they will not face any charge for them. Providing such services without charge removes a potential financial barrier to overseas visitors presenting for NHS-funded secondary care, therefore ensuring that the risk to the public’s health from infected visitors is minimised. This brings monkeypox into line with most other infectious diseases, such as tuberculosis and covid-19.
The inclusion today of monkeypox in Schedule 1 of the charging regulations will mean that overseas visitors will not be charged for the diagnosis and treatment of monkeypox. The charging regulations have also been amended so that if any charges have already been incurred during this outbreak, they must be cancelled, or, if paid, they must be refunded.
[HCWS82]
(2 years, 6 months ago)
Written StatementsFollowing announcements made by the UK Health Security Agency on 7,14,18 and 20 May, I am writing to inform the House that—as of 12 pm on Monday 23 May 2022—a total of 56 monkeypox cases, in three unlinked incidents, have now been confirmed in the UK. Further cases have been identified worldwide, outside the endemic regions of west and central Africa.
Monkeypox virus in the UK is extremely rare and the detection of monkeypox in unlinked cases indicates community transmission. Prior to May 2022, there were three previous domestically acquired cases—two household transmissions related to an imported case and one healthcare worker related to a separate imported case.
In the coming days, I expect that further cases will be detected by the UK Health Security Agency’s expert diagnostic capabilities, working with NHS services to ensure heightened vigilance among healthcare professionals.
The UK was the first country in the world to identify and report this recent emergence of non-endemic cases to the World Health Organisation, which continues to receive reports of further cases in other countries across the globe.
The infection can be passed on through direct contact with monkeypox skin lesions or scabs; contact with clothing or linens—such as bedding or towels—used by an infected person; and potentially by close respiratory contact via coughing/sneezing by an individual with a monkeypox rash. Monkeypox has not previously been described as a sexually transmitted infection, though it can be passed on by direct contact during sex. A notable proportion of cases have been among gay, bisexual and other men who have sex with men.
The virus does not usually spread easily between people without close contact and the risk to the UK population remains low.
World-leading experts at the UK Health Security Agency, working in partnership with health protection agencies in Scotland, Wales, and Northern Ireland, are providing the latest scientific, clinical and public health advice. They are also providing testing capability at the Rare and Imported Pathogens Laboratory at UKHSA Porton Down and have stood up additional capacity at UKHSA Colindale. They continue to contact trace, rapidly investigate the source of these infections, and raise awareness among healthcare professionals. Any close contacts of the cases are being identified and provided with health information and advice.
UKHSA, and its partner public health agencies in the devolved Administrations, will continue to keep the scientific and clinical evidence under review to ensure that decisions are made on the best available evidence despite the fast-moving situation.
Individuals, especially gay, bisexual and other men who have sex with men, who develop an unusual rash or lesions—such as scabs—on any part of their body, but particularly their genitalia, should contact NHS 111 or a sexual health service. Individuals should notify clinics ahead of attendance and avoid close contact with others until they have been seen by a clinician. They can be assured that discussion will be treated sensitively and confidentially.
UKHSA has set up a dedicated helpline to support clinicians dealing with monkeypox cases.
Vaccination and treatment
The smallpox vaccine, Imvanex (MVA-Bavarian Nordic), although not specifically licensed for the prevention of monkeypox in Europe, has been used in the UK in response to previous incidents. This vaccine has a good safety record; it is made from a smallpox-related virus that cannot replicate and has been demonstrated to be highly effective at preventing infection—when given within four days of exposure—and reducing severe illness, if given between four and 14 days of exposure.
The vaccination of named close contacts of cases is under way, with vaccine eligibility being kept under close review. As of 10 am on 23 May 2022, over 1,000 doses of Imvanex have been issued or are in the process of being issued, to NHS trusts. There remain over 3,500 doses of Imvanex in the UK.
We are also exploring procurement options in case any specific antiviral treatment is shown to be effective against this virus; further details will be provided in due course.
I can confirm to the House that it will be kept abreast of updates as the situation evolves.
[HCWS49]
(2 years, 6 months ago)
Written StatementsMyalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) affects the lives of children and adults across the country. It can be an incredibly disabling condition with fluctuating symptoms, making it difficult to take part in everyday activities, enjoy a family or social life, access services and engage in work or education, especially for the estimated 25% of people who have severe or very severe symptoms. Whilst there are currently no known cures or treatments for the condition, people with ME/CFS can be supported to manage their symptoms and maximise their quality of life.
Today, on World ME Day, I have two announcements to make to show that the Government are committed to better care and support for people living with ME/CFS and their families.
Firstly, I am pleased to welcome today the publication of the top 10 (plus) research priorities for ME/CFS, published by Action for ME and agreed by the James Lind Alliance Priority Setting Partnership on ME. This partnership included people with lived experience and clinicians working together to reach a consensus. I want to thank Action for ME and everyone who took part in this important work, recognising that for many this would have taken considerable effort.
To support these research priorities, I will co-chair a roundtable with my Department’s chief scientific adviser, Professor Lucy Chappell, to bring together experts on ME/CFS, including people with lived experience, to discuss what needs to happen next. The chief scientific adviser has asked the UK clinical research collaboration to convene a subgroup on ME/CFS to work with funders, researchers, charities, and people with ME/CFS to drive high-quality applications for research into ME/CFS and support the research community to build capacity and capability in this field. We are committed to funding research into this important area. Funding for high-quality research into ME is available through existing commitments of HM Government to research and development. The National Institute for Health and Care Research (NIHR) will work with the research community to respond to the priorities as set out in the Priority Setting Partnership, alongside other funding partners.
Secondly, I am announcing the Government intention to develop a cross-Government delivery plan on ME/CFS for England, aligning with other devolved nations as appropriate. In particular, we are engaging with the Scottish Government to explore areas of potential shared interest and learning, especially in terms of research into ME/CFS.
This will build on the recommendations of the priority setting partnership, the recently updated guideline for ME/CFS from the National Institute for Health and Care Excellence, and the comprehensive work of the All-Party Parliamentary Group on Myalgic Encephalomyelitis to date.
At the heart of the delivery plan will be two core principles: firstly, that we do not know enough about ME/CFS, which must change if we are to improve experiences and outcomes; secondly, we must trust and listen to those with lived experience of ME/CFS.
Following this announcement, officials will work with stakeholders ahead of publishing the delivery plan later this year.
[HCWS23]
(2 years, 7 months ago)
Commons ChamberI know that my hon. Friend has long been a passionate advocate for a smoke-free England, and I read his recent Westminster Hall debate with interest. Some 64,000 deaths a year are attributed to smoking and it is one of the greatest drivers of health disparities in our country. I am personally determined that we should do everything we can to reach the Government’s ambition of a smoke-free 2030. That is why, in January, I asked Javed Khan to lead an independent review into tobacco control. Once that review is complete, the Government will set out their next steps.
To get to a smoke-free 2030, for every 100 people smoking today we need to reduce that figure by eight, because “smoke-free” actually means 5% or less of the adult population smoking. Can I ask the Secretary of State to ruthlessly target the barriers that stop people stubbing out their last cigarette? We need to get the numbers of smokers down; otherwise, 2030 will be an ambition that is not achieved.
My hon. Friend is absolutely right. The smoking rate is currently 13.5%, which is the lowest on record. However, smoking remains the largest driver of health disparities in our country. The new tobacco control plan, which will be informed by the new independent review, will be looking to do exactly what my hon. Friend says.
As one of the original campaigners for a ban on smoking in public places, I fully support what has just been suggested, but can I go further and beg the Secretary of State to come up very soon with a plan so that every child, every person and every family in this country can breathe clean, fresh air away from the pollution coming from diesel vehicles and other sources?
The hon. Gentleman has long been a campaigner on this issue and I commend him for that. He is right to continue pushing. I do not want to pre-empt the outcome of the independent review because it is just that, a review fully independent of Government. However, once it is complete—I hope to publish it in May—we can set out our plans.
The past few years have shown that we are strongest when we work together. Earlier this year we published the integration White Paper, drawing on our experience of the pandemic to develop a plan that will bring together the NHS and local government to deliver jointly for local communities. We have also created integrated care partnerships, such as the programmes in mid-Nottinghamshire and Northamptonshire, through which we are already showing how we can bring together health and local social care services.
As covid regulations come to an end, I understand that the discharge fund is also set to end. This could leave local government vulnerable where there are no formal procedures locally to pass funding from the NHS to local government services and local authorities. Particularly as we seek to reduce hospital backlogs, it is vital that we get people out of hospital and into appropriate care settings. Will my right hon. Friend assure me that, where local authorities seek to tackle such backlogs, they will have access to appropriate funding?
I can give my hon. Friend that assurance. Of course, we are already putting in record funding for local authorities and the NHS to deal with backlogs. I believe the plan we set out earlier this month for the integration of NHS and local authority care services will make a real difference.
I thank the Secretary of State for referring to the work in Northamptonshire to integrate health and social care. Can he assure me that the central role of local government in ensuring that health and social care services work together to make the most efficient use of local resources will continue? And will he give me a clear guarantee that adult social care will not be taken over by the NHS?
I am pleased to give my hon. Friend the assurance he seeks. The integration White Paper signals our intention to go further and faster on health and care integration, building on the work already being done by the NHS, adult social care and local government to deliver services jointly. The plan will lead to better collaboration, and we want to make sure that overall responsibility is still shared between local authorities and the NHS.
The Secretary of State will know that Walsall Manor has been merged with the Royal Wolverhampton—they share a chief executive and chairman—without consultation with local people. How on earth can integration take place when Walsall Manor does not have a full-time chief executive to ensure that it happens? Will the Secretary of State please ensure that Walsall Manor gets its own chief executive?
I understand the right hon. Lady’s point, but it is about what works on the ground. My understanding is that what is happening in her area is about a shared management team that shares best practice and tries to address challenges together, rather than any kind of formal merger.
Across the country, tens of thousands of people sitting in hospital are medically fit to go home but cannot do so due to a lack of social care. The Health and Care Bill should have addressed that, but it does not. Rather than making us wait for more legislation, will the Secretary of State at least concede that local health leaders, be they in clinical commissioning groups or in integrated care systems in shadow form, should be driving this locally as a matter of urgency?
That is exactly what the new integrated care systems are all about. My understanding is that the hon. Gentleman sat on the Health and Care Public Bill Committee, which made it a reality.
I call the shadow Secretary of State, Jake Berry. [Laughter.] Sorry, Wes Streeting.
Thank you, Mr Speaker. You have clearly had a happy Easter.
The fact is that the Government’s failure to fix the social care crisis is causing huge pressures on the NHS. As of last week, more than 20,000 patients were fit to leave hospital but could not be discharged because the care was not available, which means that 22,000 patients each month are waiting more than 12 hours in A&E and that heart attack and stroke victims have to wait more than an hour for an ambulance. We are used to hearing about winter crises, but is it not the case that, after more than a decade of underinvestment in the NHS, a failure to fix social care and the absence of a plan even to address the staffing challenge in the NHS and social care, we have not just a winter crisis but a permanent crisis in the NHS?<
That is not the case at all. The hon. Gentleman knows, although he pretends not to, that the NHS and social care are facing unprecedented pressure because of the pandemic. He will know that as a result of the pandemic, both in NHS settings and in adult social care there has been a necessity for infection and protection controls. He will know that, sadly, staff absences are higher than they have been in normal times. But the NHS is stepping forward, with its colleagues in adult social care, to provide whatever support it can bring, especially with the record funding the Government are providing, both to the NHS and to adult social care.
My hon. Friend the Member for Hyndburn (Sara Britcliffe) and I have been working with east Lancashire local authorities and our GP services to see whether we can increase the number of face-to-face GP appointments. Will the Secretary of State say what action he and the Government are taking to ensure that people in east Lancashire can see their general practitioner face to face?
My right hon. Friend is absolutely right to raise this issue. We have heard time and time again in this Chamber about the pressures our constituents are facing in order to get that kind of face-to-face access to their GPs. We all know why the situation was particularly bad at the height of the pandemic, but we expect it to improve rapidly. The percentage of people being seen face to face is increasing substantially, in large part because of the measures the Government have taken, including the £250 million access fund that was announced a few months ago.
Thank you, Mr Speaker.
Integration and service improvement cannot be delivered without sufficient staff, and the only way to attract people to a career in social care is by valuing them. In Scotland, they are already paid better than those in England and Wales, and through the national care service the Scottish Government will improve terms and conditions for care workers, through the introduction of national pay bargaining. Have the UK Government considered following the Scottish Government’s approach and commitments?
Integration between the NHS and social care requires the right level and quality of workforce, both in the NHS and in adult social care. In the NHS in England, we have more doctors and nurses—more people working than ever before. In adult social care, we are recruiting at high levels, not least because of the huge recruitment campaign we ran with the sector, and some of the other changes we made, including the £400 million- plus of retention funding over the winter period. In addition, the support for the workforce more generally is making a real difference.
In north Northamptonshire, integration is getting on very well, with Councillor Helen Harrison heading the adult social services. However, going back to what my hon. Friend the Member for Northampton South (Andrew Lewer) said, there is the worry that because the NHS is so big it will overwhelm local government. I have told the Secretary of State that they do not want to mess with Helen Harrison, but can he ensure that there is a mechanism for reviewing that?
I know that my hon. Friend knows Helen Harrison extremely well, but he is right to talk about the importance of the NHS and the adult social care sector and local authorities working together. We must make sure that it is a true partnership, where one does not overwhelm the other and they work together towards their shared interests.
One key cause of the urgent care crisis in Shropshire, in the Shrewsbury and Telford Hospital NHS Trust, is the inability to discharge patients who are medically fit to go home into social care in the community. Shropshire Council’s resource challenges in that area are well known. Will the Secretary of State commit to putting extra resource into social care in Shropshire so that the medically fit can be discharged into the community when they are ready?
The hon. Lady is absolutely right to raise this issue, and the whole House heard just before the recess the results of the independent work done by Donna Ockenden. The hon. Lady is right to talk about that and the pressure that has been faced locally. I understand that she has already reached out to my hon. Friend the Minister for Health and that he will be meeting her to discuss just that.
I am determined to tackle unfair disparities in health outcomes. That is why I launched the Office for Health Improvement and Disparities. OHID’s regional directors of public health will work with local government and the wider health system to empower local partners with the tools they need to respond to disparities in their regional and local areas. We will also publish a health disparities White Paper later this year, with a strong focus on prevention, to improve health for the whole population.
I thank the Secretary of State for his answer, but a decade of under-investment and mismanagement have left 4.5 million people on waiting lists and staff shortages of more than 100,000 people even before we entered the pandemic, which exacerbated health inequalities. I welcome the work his Department is doing, but the reality is that people who live in a constituency such as mine are twice as likely to end up on a waiting list for treatment for more than a year as those in better-off areas. While I welcome what he has announced today, may I ask that he puts in appropriate investment to go along with tackling those appalling health inequalities?
The hon. Lady is right to talk about the importance of tackling health inequalities; on that we absolutely agree, and I hope she will contribute to the health disparities White Paper that I mentioned a moment ago. However, it is wrong of her to suggest that some of the current challenges we face are because of under-investment or because of a smaller workforce than otherwise. We have the largest investment ever going into the NHS. Its budget this year is bigger than the GDP of Greece. It is the highest amount ever, rising by billions each year. We also have more going to social care than ever before, and the highest level of workforce that the NHS has ever seen in its history.
Surely one of the cruellest health inequalities is in fertility treatment. Of the 106 CCGs in the country, only six limit the age at which women can have in vitro fertilisation treatment to 35, and two of those are in Hampshire. Will the Secretary of State meet me to discuss how we can end that most devastating of postcode lotteries?
My hon. Friend is right, and of course I will be happy to meet her and discuss this further, but I can also tell her that that is one of the key things we will be covering in our upcoming women’s health strategy.
Warm words from the Secretary of State, but people in the most deprived parts of England are almost three times as likely to lose their lives from an avoidable cause as those in the least deprived areas. With the cost of living soaring and the Resolution Foundation estimating that 1.3 million people will be pushed into poverty as a result of the Chancellor’s spring statement, those inequalities will worsen. Why will the Secretary of State not just admit that his Government have failed the poorest communities, and start doing something about it?
The hon. Gentleman acts as though health inequalities are something that has just emerged under this Government. There have been long-running health inequalities in this country over decades under successive Governments, and this Government are putting in record investment and coming up with the ideas to deal with them. As ever, the Labour party has no idea how to deal with the challenges this country faces.
Mental health is a serious challenge of our time. It is totally unacceptable that waiting times, average number of sessions and minimum number of sessions differ according to which part of the country someone lives in. Sadly, recent statistics show that in Stoke-on-Trent people are taking their own lives at double the national average. That is why I am proud to support the cross-party “No Time to Wait” campaign, led by James Starkie with the backing of The Daily Telegraph and the Royal College of Nursing, for the provision of mental health nurses in GP surgeries, which could make a real difference to those who bravely come forward asking for help. Will my right hon. Friend meet me, hon. Members of this House who are supportive, and James to discuss how we can make that possible?
Yes, of course; I would be delighted to meet my hon. Friend and others to discuss the campaign. He speaks with passion and I know this is something he has long campaigned on. I have had time to look at some of the content of the campaign, but I would certainly be happy to discuss it further.
Personalised healthcare is a key priority in my reform agenda. I recently set out a new ambition: that as many as 4 million people benefit from personalised care by 2024, covering everything from social prescribing to personalised support plans. We are also on track to deliver 200,000 personal health budgets and integrated personal budgets by 2023-24.
I welcome the Secretary of State’s answer. My constituents are still telling me that they are experiencing some delays beyond the NHS guidelines on diagnosis for special treatment. What plans does my right hon. Friend have to address the lack of capacity and need for capacity in specialty-trained doctors and specialist diagnostic equipment, to make personalised care a reality?
My hon. Friend is absolutely right to mention the importance of the workforce and medical equipment. He will be reassured to know that the NHS has more doctors and nurses working for it than ever before, with more in training than ever before. We are investing record amounts of capital for new medical equipment, including investment in some 160 new community diagnostic centres, which will all include the latest, state- of-the-art diagnostic equipment.
Our healthcare system is standing at a crossroads, and sooner or later we will have to make a choice between endlessly going back to the taxpayer to ask for more money and reforming the way in which we do healthcare in our country. Last month, I unveiled an ambitious new programme of reform, setting out how we are going to prioritise prevention, offer more personalised care, deliver improvements in performance and back the people making the difference in the NHS. The objective of this agenda is simple: to bring about the biggest transfer of power and funding in decades from our ever-expanding state to individuals, their families and their communities.
In Gloucestershire Hospitals NHS Foundation Trust, 30% of patients do not medically need to be in hospital; they are waiting for discharge. That figure is twice the national average. Will one of the Ministers contact the relevant people in the health service in Gloucestershire to ask them for ways in which the Government could help them to reduce that figure, because as it stands lives are being put at risk?
My hon. Friend is right to raise this. We are already in contact with the acute trust in Gloucestershire and some of the other trusts that are finding delayed discharge a particular challenge. My hon. Friend will know that, because of the pandemic, what has been a long-term challenge has become much more acute, not least because of the lost beds due to infection protection control and staff absences both in healthcare and in social care. Our delayed discharge taskforce is making a difference—the numbers are coming down overall—but we will be working with Gloucestershire.
Why does the Health Secretary think he has any licence to lecture the British people on their moral duty to pay taxes when he spent so many years avoiding his own?
Order. I am not quite sure that is relevant in topical questions.
I am very happy to answer if you will allow me, Mr Speaker. The hon. Gentleman could have asked me a question on anything to do with health and care—anything he wanted—but instead he chooses to talk about my personal affairs before public life. That was his choice. He could have asked me about the covid backlogs that he pretends he cares so much about. He could perhaps have given me suggestions—
Order. Secretary of State, I have got it. These are questions about your responsibilities. Now we can have another try—Wes Streeting.
Mr Speaker, you have been very generous to the hon. Gentleman: you gave him another try, but that was another failure to ask a question. Again, the hon. Gentleman is not asking about the serious issues, which again shows that he will play petty party politics and that Labour has no plan for the challenges this country faces.
May I just reassure the Secretary of State for Health that I was not being generous? The shadow Secretary of State had two questions, so I have not been generous in any shape, way or form.
Like many across the House I have been deeply disturbed by the reports we have all seen from Shanghai and my thoughts are with the people affected. It shows what a dangerous fallacy this whole idea of zero covid was, and it also shows that we are the most open country in Europe and that we have got the big decisions right. We did not listen to the Opposition when they said we should not open up in the summer, and we did not listen to them when they again called for restrictions in the winter. We are showing the world how to live with covid.
As the hon. Gentleman is aware, I know his constituency well; it is my birthplace. He might also know that just a couple of months ago I visited his constituency and met members of the local community at the Deeplish community centre to talk about exactly what he has rightly raised today: the importance of tackling inequalities in Rochdale and beyond. We will set out our plans in our upcoming health disparities White Paper.
I share my hon. Friend’s concerns, which is why the NHS commissioned this review from one of our top paediatricians. It is already clear to me from her interim findings and the other evidence I have seen that NHS services in this area are too narrow; they are overly affirmative and in fact are bordering on ideological. That is why in this emerging area, of course we need to be absolutely sensitive, but we also need to make sure that holistic care is provided, that there is not a one-way street and that all medical interventions are based on the best clinical evidence.
The Secretary of State will have read the scandal exposed in The Sunday Times this weekend that six babies are born every month after being exposed to sodium valproate, which has been known for many years to cause disabilities. Last year the Government consulted on putting warning labels on valproate. Is it not time to go much further and ban the prescription of sodium valproate to epileptic pregnant mothers?
My right hon. Friend is right to raise this, and many of us will have seen the recent reports, especially from the families affected. It is right that we reconsider this and make sure that sodium valproate, and any other medicine, is given only in the clinically appropriate setting.
I would be pleased to have the meeting that the hon. Lady has suggested. She should know that we just closed the consultation on the 10-year cancer plan. There has been a fantastic response. She may also have seen the announcement that we made today about lung cancer health checks. With improvements like that, we intend to do a lot more.
One of the best ways to maximise NHS capacity is to increase people’s access to GP appointments and treatments such as mental health services and physiotherapy in their own communities. Will the Minister join me in backing our bid for a new health centre in East Leake and in calling on Nottinghamshire’s clinical commissioning group to prioritise funds for this vital service?
I welcome all that my right hon. Friend is doing to address health inequalities. However, could I ask him to look carefully at public health funding for my borough of Bexley, as we are seriously underfunded compared with similar boroughs in London?
I would be very pleased to meet my right hon. Friend to discuss that further. I am sure he will welcome the publication of the upcoming health disparities White Paper.
In a recent survey by Carers UK, almost half of unpaid carers said that they are currently unable to manage their monthly energy bills and expenses, and that any further increases would negatively affect their own physical and mental health, or that of the person they care for. What steps are being taken, along with the Secretary of State for Work and Pensions, to support those hard-working exhausted unpaid carers with the cost of living?
(2 years, 8 months ago)
Commons ChamberWith permission, Mr Speaker, I would like to make a statement on the Ockenden report. The independent review was set up in 2017 in response to concerns from bereaved families about maternity care at Shrewsbury and Telford Hospital NHS Trust. Its original scope was to cover the cases of 23 families, but since it began, sadly, many more families have reported concerns. Due to this tragically high number of cases and the importance of this work to patient safety, early conclusions were published in an initial report in December 2020. We accepted all the recommendations of the first report, and the NHS is now taking them forward.
Today, the second and final report has been published. This is the one of the largest inquiries relating to a single service in the history of the NHS. It looks at the experiences of almost 1,500 families from 2000 to 2019. I would like to update the House on the findings of the report, and will then turn to the actions that we are taking as a result of it.
The report paints a tragic and harrowing picture of repeated failures in care over two decades, which led to unimaginable trauma for so many people. For these families, their experience of maternity care, rather than being of moments of joy and happiness, was one of tragedy and distress. The effects of these failures were felt across families, communities and generations. The cases in the report are stark and deeply upsetting. In 12 cases where a mother died, the report concludes that in three quarters of them, the care could have been “significantly improved”. It also examined 44 cases of HIE—hypoxic ischaemic encephalopathy—a brain injury caused by oxygen deprivation. Two thirds of the cases featured “significant and major concerns” about the care provided to the mother. The reports also states that of almost 500 cases of stillbirth, one in four was found to give rise to major concerns about maternity care that, if managed appropriately, “might or would” have resulted in a different outcome.
When I met Donna Ockenden last week, she told me about basic oversights at every level of patient care, including in one case where important clinical information was kept on Post-it notes, which were swept into the bin by cleaners, with tragic consequences for a newborn baby and her family. In addition, there were repeated cases where the trust failed to undertake serious incident investigations; and where investigations did take place, they did not follow the standards that would have been expected.
Those persistent failings continued until as late as 2019, and multiple opportunities to address them were ignored, including by the trust board accountable for these services. Reviews from external bodies failed to identify the substandard care that was taking place, and some of the findings gave false reassurances about maternity services at the trust. The Care Quality Commission rated maternity services inadequate for safety only in 2018, which is unacceptable given the huge deficiencies in care that are outlined in the report.
The report also highlights serious issues with the culture in the trust. For instance, two thirds of staff who were surveyed reported that they had witnessed cases of bullying, and some staff members withdrew their co-operation on the report within weeks of publication. The first report has already concluded that
“there was a culture within the Trust to keep Caesarean rates low because this was perceived as the essence of good maternity care”.
Today’s report adds:
“many women thought any deviation from normality meant a Caesarean section was needed and this was then denied to them by the Trust”.
It is right that both the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives have said recently that they regret their campaign for so-called normal births. It is vital, across maternity services, that we focus on safe and personalised care, in which the voice of the mother is heard throughout.
The report shows a systemic failure to listen to the families affected, many of whom had been doggedly and persistently raising issues over several years. One mother said that she felt like a
“lone voice in the wind”.
Bereaved families told the report that they were treated in a way that lacked sensitivity and empathy. Appallingly, in some cases, the trust blamed the mothers for the trauma that they had been through. In the words of Donna Ockenden, the trust
“failed to investigate, failed to learn and failed to improve”.
We entrust the NHS with our care, often when we are at our most vulnerable. In return, we expect the highest standards. I have seen in my family the brilliant care that NHS maternity services can offer, but when those standards are not met, we must act firmly, and the failures of care and compassion set out in the report have absolutely no place in the NHS.
To all the families who have suffered so greatly: I am sorry. The report clearly shows that you were failed by a service that was there to help you and your loved ones to bring life into this world. We will make the changes that the report says are needed, at both a local and national level.
I know that hon. Members and the families who have suffered would want reassurances that the individuals who are responsible for these serious and repeated failures will be held to account. I am sure that the House will understand that it is not appropriate for me to name individuals at this stage. However, I reassure hon. Members that a number of people who were working at the trust at the time of the incidents have been suspended or struck off from their professional register, and members of senior management have been removed from their posts. There is also an active police investigation, Operation Lincoln, which is looking at around 600 cases. Given that this is a live investigation, I am sure that hon. Members will recognise that I am not able to comment further on that.
Today’s report recognises that since the initial report was published in 2020, we have taken important steps to improve maternity care. That includes providing £95 million for maternity services across England to boost the maternity workforce and to fund programmes for training, development and leadership. The second report makes a series of further recommendations. It contains 66 for the local trust, 15 for the wider NHS and three for me as Secretary of State. The local trust, NHS England and the Department of Health and Social Care will accept all 84 recommendations.
Earlier today, I spoke to the chief executive of the trust, who was not in post during the period examined in the report. I made it clear how seriously I take this report and the failures that were uncovered, and I reinforced the message that the recommendations must be acted on promptly, but as the report identifies, there are also wider lessons that must be learned, and it sets out a series of actions that should be considered by all trusts that provide maternity services. I have asked NHS England to write to all of those trusts, instructing them to assess themselves against these actions, and NHS England will set out a renewed delivery plan that reflects those recommendations.
I am also taking forward the specific recommendations that Donna Ockenden has asked me to. The first is on the need to further expand the maternity workforce. Just a few days ago, the NHS announced a £127 million funding boost for maternity services across England. That will bolster the maternity workforce even further, and fund programmes to strengthen leadership, retention and capital for neonatal maternity care.
Secondly, we will take forward the recommendation to create a working group, independent of the maternity transformation programme, with joint leadership from the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists.
Finally, Donna Ockenden said that she endorses the proposals that I announced in January to create a special health authority to continue the maternity investigation programme that is run by the Healthcare Safety Investigation Branch. Again, we will take her proposals forward, and the SHA will start its work from April next year.
I thank Donna Ockenden and her whole team for the forensic and compassionate approach that she has taken throughout this distressing inquiry. The report has given a voice at last to those families who were ignored and so grievously wronged, and it provides a valuable blueprint for safe maternity care in this country for years to come.
Finally, I pay tribute to the families whose tireless advocacy was instrumental to the review being set up in the first place. I cannot imagine how difficult it must have been for them to come forward and tell their stories, and the report is a testament to the courage and fortitude that they have shown in the most harrowing of circumstances.
This report is a devastating account of bedrooms that are empty, families that are bereft and loved ones taken before their time. We will act swiftly, so that no families have to go through the same pain in the future. I commend this statement to the House.
The Secretary of State is quite right that this is a very important statement, so I will offer the shadow Minister, Feryal Clark, six minutes.
I thank the hon. Lady for her remarks. It is not often that we get to say this in this Chamber, but I agree wholeheartedly with what she has just shared with the House. She is absolutely right to talk about this as a fight for justice and to say that if these brave families had not been so persistent in coming forward with what was done to them and what went wrong, the inquiry might never have happened. She is also right to talk about institutional failure at the trust, which the first report set out in some detail and which we are seeing in much more detail today.
The hon. Lady talked, rightly, about patient safety. She will know that the Government have already set out plans to appoint a patient safety commissioner; that appointment will be made soon, but we need to do much, much more. That is why it was right to accept all the interim report’s recommendations, including seven immediate and essential actions and 27 local actions. I can tell the House that the trust has implemented all the actions set out in the interim report; that was backed at the time by £95 million in extra funding. As I said a moment ago, the final report quite rightly makes many more recommendations, which have all been accepted and which are backed by funding of at least £127 million, much of which will go to workforce.
The hon. Lady is right about the need to increase the size of the workforce, especially with respect to midwives. Last year’s acceptance figures for student nurses and midwives were, I think, the highest that the country had seen in decades, but clearly there is much more to do.
We now come to the Chair of the Health and Social Care Committee.
I very much agree. I want to acknowledge that the report ultimately took place because of my right hon. Friend’s decision to ask Donna Ockenden to do the independent review, but he is absolutely right that he, in turn, did so because of the bravery of Rhiannon Davies and Richard Stanton, of Kayleigh and Colin Griffiths and of the many other families who came to see him.
My right hon. Friend asked about the immediate and essential actions. The interim report sets out seven such actions; the trust has implemented them all, and across the NHS they are either fully or partially implemented. The final report also recommends such actions; their implementation has already begun. Of course, we have just received the report, but I have asked for a timetable of when it will all be done. I want to see it done as quickly as possible.
My right hon. Friend’s point about workforce is very important. I hope he welcomes the fact that, for the first time, the NHS has been asked to set out a 15-year workforce plan.
I join colleagues across the House in thanking all the families who have bravely come forward to share their experiences, particularly Kayleigh, Colin, Rhiannon and Richard, whose persistence has led to the review. I hope that women and babies in Shropshire, Telford and the Wrekin and across the UK will be safer in future as a result of their bravery.
I thank Donna Ockenden and her team for their thoroughness in reviewing so many tragic cases. I am sure that the Secretary of State agrees that this can never be allowed to happen again and that the deaths of these 201 babies must not be in vain. This must be a turning point for maternity services in England.
Donna Ockenden has endorsed the findings of the Health and Social Care Committee and recommended that an immediate investment of £200 million to £350 million per annum is required to keep women safe. I welcome the Secretary of State’s guarantees that the immediate and essential actions will be implemented, but may I ask whether he can commit the additional resources recommended by Donna Ockenden today?
I thank the hon. Lady for her comments. I assure her that constituents throughout Shropshire, Telford and the Wrekin, and indeed families across England, will be safer as a result of those brave families coming forward and this report.
On resources, the hon. Lady will have heard me talk about the £95 million given at the time of the interim report, plus the £127 million given for maternity services in the past few days. We will keep that under review.
I thank the Secretary of State for his very welcome statement and the Under-Secretary of State, my hon. Friend the Member for Lewes (Maria Caulfield), for her excellent work. I pay tribute to my right hon. Friend the Member for South West Surrey (Jeremy Hunt) for everything that he has done for patient safety; he has led the way, and I am so grateful.
Does the Secretary of State believe that what we have seen at Shrewsbury and Telford Hospital NHS Trust is indicative of a culture in which senior management were unaccountable, no one felt responsible, failings were minimised, poor care was normalised and women’s voices were not heard? Will he do everything he can to increase the accountability of senior management across the NHS so that that institutional blindness can never again cause such harm to those who put their trust in the NHS?
Let me first thank my hon. Friend for her approach and her role in helping to make the report happen, and for the way in which she has worked with me, and with Ministers in my Department, on this most important of issues. She is right to talk about the importance of culture, especially given that, as the report makes clear, the voices of women were not heard time and again. I want to reassure her that we will implement all the report’s recommendations, but, more broadly, that women’s voices will be at the heart of the upcoming women’s health strategy.
Today is an important day for maternity safety, and we rightly pay tribute to the families directly affected, so many of whom have given evidence to the Ockenden review.
James Titcombe, who lost his baby son Joshua during the Morecambe Bay maternity scandal, has said that one of the most harmful experiences for the Morecambe Bay families was
“seeing influential people in the maternity world diminish… the…findings”
of the investigation report. I join James Titcombe in saying that we must not allow that to happen with this report. I urge the Secretary of State to ensure that the bereaved families are allowed a process of truth, reconciliation and healing, rather than any denial of the truth of what took place.
I agree with the hon. Lady, and she is right to raise the importance of the Morecambe Bay investigation. That report, which I believe was completed in 2015, contained 44 recommendations. Eighteen recommendations that were specifically for the trust have been implemented, and the 26 for the wider NHS are in the course of being implemented.
I thank my right hon. Friend for both the tone and the substance of his response to this devastating report. Let me also add my voice to the consensus throughout the House that the way in which this is handled is vital, and that we must ensure that the NHS takes Donna Ockenden’s recommendations on board. She and her team of more than 90 experienced clinicians are properly being thanked for the work that they have done. They have painstakingly reviewed these cases going back some 20 years, which must have been harrowing for them, as of course it has been for all the families so tragically affected who have had to relive their tragedy.
In particular, I want to praise the courage and tenacity of Rhiannon Davies and Richard Stanton, who were my constituents when they lost their baby Kate in truly awful, and tragically avoidable, circumstances. It was they who kept pressing for answers from Shrewsbury and Telford Hospital NHS Trust. That led me to take them to see the then Health Secretary, my right hon. Friend the Member for South West Surrey (Jeremy Hunt), who agreed to launch this review five years ago. They are no longer my constituents, and I understand that they are now understandably keen to focus their attention on their family, having been living with this trauma since 2009.
I have some questions for my right hon. Friend the Secretary of State. Does he recognise that the Ockenden review has raised fundamental questions for maternity services across the NHS over the culture of so-called normal birth, and that a focus on targets, under successive Governments, rather than on patient outcomes, can distort clinical best practice and, tragically, patient safety? Following his discussion with the trust’s current chief executive, which he has mentioned, is he satisfied that the current management and clinical teams have accepted the “local actions for learning” recommendations in the initial Ockenden report, and are committed to studying and rapidly implementing all further recommendations specific to the trust? Finally, what reassurance can he give the thousands of expectant mothers in Shropshire, Telford and Wrekin that the maternity services there are safe, and that patient safety is paramount?
I thank my right hon. Friend for the way in which he has worked with the Department and with my predecessor in representing his constituents throughout this investigation. He referred to “so-called normal birth” in his question, and he was right to do so: the only normal birth is a safe birth, which is what the NHS should be working towards, but that did not happen in this trust. The report has made that absolutely clear. Just as important are its recommendations, including some for my right hon. Friend’s local NHS trust. I can reassure him—partly as a result of my conversation earlier today with the current chief executive—that all the recommendations in the interim report have been implemented by his local trust, and all those in this report have been accepted.
Let me start by paying tribute to all the families affected, and thanking Donna Ockenden and her team for their recommendations.
More midwives are leaving the profession than are joining it. We cannot run equally safe services in all NHS trusts without appropriate staffing levels. I therefore hope that the Secretary of State will be able to give further details of what the Government are doing to ensure that there are safe staffing levels in all trusts to provide care for pregnant women.
The hon. Lady is right to talk about the importance of having the right workforce, and certainly more midwives. I can tell her than last year there were 30,185 acceptances for nursing and midwifery courses, the highest number in a decade. Recruitment is being supported by some of the extra funding that I have talked about today. The Government have established grants enabling students to take courses, and, where appropriate, are also focusing on international recruitment.
This courageous report makes clear that keeping caesarean section rates artificially low contributed to babies dying. I am pleased that, following a recommendation from the cross-party Health and Social Care Committee, NHS trusts are no longer being assessed on performance for their caesarean rates, but will the Secretary of State go further? Will he ensure that we look at where caesarean section rates remain artificially low in trusts, so that this dangerous “normal births” ideology is eradicated from the NHS once and for all?
I, too, pay tribute to the families named in what is a truly shocking report.
I am sorry, but I have not read all the recommendations, so may I ask the Secretary of State whether, as well as identifying issues relating to the culture in this particular trust, the report includes recommendations concerning governance for boards? Boards have a key role in holding their executives to account. Will he be writing to them to make them aware of their responsibilities in that regard? May I also ask him what the implications are for the national clinical audit of the confidential inquiries into maternal and infant deaths?
If I may, I will write to the hon. Lady about the national clinical audit. As for her important point about boards, the report refers to their importance and the importance of ensuring that the people on them are vetted, understand their responsibilities, and have the information that they need in order to fulfil those responsibilities. In, I think, 2014 or thereabouts, the Care Quality Commission changed the rules relating to NHS trust board members, requiring them to meet a new “fit and proper” test.
It is impossible to think about these lost babies, lost lives, and damaged families without becoming very upset and then very, very angry. However, I know from the work I have been doing with midwives and families, mums and dads, in the last six months or so that this does not involve just one trust. We have thousands of midwives marching on the streets. During the pandemic, mums were taking to social media, feeling that they were being marginalised and their voices were not being heard. Midwives tell me that they did not want to speak out before because they did not want to frighten the mums and dads in their charge, and that is why they often feel that they are not heard themselves. So we have to help them. How will the NHS and the Government reassure pregnant women and help the midwives to reassure them, given that all this is in the news at the moment, and how can we prevent other maternity services from failing?
My hon. Friend has raised a very important point. Hundreds of thousands of births are delivered through the NHS each year, and the vast majority are completely safe, as I myself have found and as many other Members have found, including my hon. Friend. What we have heard about today is what happens when it goes wrong, and goes tragically wrong, but especially when that was avoidable.
My hon. Friend was right to talk about the importance of considering other trusts. This report focuses on one trust, but we know that there was a problem in Morecambe Bay and that an independent investigation is taking place in East Kent. There is action to be taken by all trusts. That is why I think it is so important for the NHS to act on the recommendations for the wider NHS, and for me to act on the recommendations for my Department. We will certainly be taking action and so will the NHS.
I thank the Secretary of State for his statement. Not one person could help but be moved by that account or by his sincerity in dealing with this horrific situation. I also want to commend all those involved in the Ockenden report for their work on this issue. Our hearts break for the little babies, the mums and dads and the family units who have been impacted by these horrendous practices, and today we remember and commend the bravery of the families who had the courage to speak out. Given the findings and the negative cloud that will hang over all those who work in maternity services, will the Secretary of State take this opportunity to thank the maternity teams throughout this United Kingdom who, day in and day out, bring new life into this world in a compassionate and professional manner? I am thinking of the wonderful services at Craigavon Area Hospital in my own constituency. I know that those who work there will be saddened today by what they are hearing in the report, so I trust that the Secretary of State can commend them for the work that they do.
I join the hon. Lady in warmly thanking and commending the work of maternity teams throughout the United Kingdom for what they do, day in and day out, especially over the last two years of the pandemic, which has probably made it even harder than normal. I know that they will all welcome this report because they will want to see the very changes that are set out in it.
I would also like to thank the families for shining a spotlight on this. One of my children suffered from oxygen deprivation at birth, through what I now know were failings in my care. I was lucky, though, in my third pregnancy. By sheer fluke, the GP practice I was registered with had a wonderful community midwife. She was with me through my pregnancy and through the birth of my daughter and she took care of me afterwards. I was listened to, I was supported and I felt safe. I thank my right hon. Friend for taking on board these recommendations, but would he agree that every woman deserves that continuity of care? It can make a profound difference in outcomes for families, because they will have somebody by their side who understands them and they will not have to go through their medical history over and over again, often missing out vital pieces. We should have loftier ambitions. Will my right hon. Friend try to make sure that every woman has the opportunity to have their own midwife with them all the way?
Yes, I agree very much with my hon. Friend and I thank her for sharing with the House her own valuable experiences. She is right to talk about the importance of continuity of care, and that is part of our maternity transformation plan.
I thank the Secretary of State for the report, although it is sad that we have to have a report such as this in front of the House. I want to highlight a point and check whether we can do something about it. There are many good people working in our NHS, and the majority of people are probably there for the right reasons, but, unfortunately, due to the culture of institutional blindness that has been mentioned, or to bullying, they cannot whistleblow, and whistleblowers are not being protected. As a consequence, more and more of these types of reports are going to be required, not only on maternity services, because whistleblowers are being targeted and put down. I would ask that whistleblowers be protected and given the opportunity to have their concerns understood and heard.
The hon. Gentleman is absolutely right. One of the reasons we are creating the special health authority that I referred to earlier is to provide that independence, and also more protection for members of staff to come forward. For example, members of staff will be able for the first time to report things they are concerned about directly to the SHA, and it will have the right to investigate.
Many members from across the House have mentioned the incredible bravery of all the parents who fought for their babies, particularly Rhiannon Davies. Rhiannon is originally from mid-Wales, although she now lives in a constituency across the border. There are many women who live in mid-Wales who need to access the Shrewsbury and Telford Hospital NHS Trust, and I am concerned that they will hear about today’s report and be worried about the care that they will be receiving over the next few days. So, as well as implementing the Ockenden review in full, will the Secretary of State please give his reassurance to those women in Wales who need to travel across the border for maternity services?
Yes, I can give my hon. Friend that reassurance. I can add that Donna Ockenden, in doing her work, looked at cases from Wales as well. The issue that my hon. Friend has raised has also been raised by my hon. Friend the Member for Montgomeryshire (Craig Williams), and I can give them both that assurance.
I thank the Secretary of State for his statement, for the obvious compassion that he has for all those involved, and for his support of the Ockenden report. I want to place on record my sympathy with all those parents who still grieve their loss, and for whom no report will never, ever soothe the pain. Will the Secretary of State confirm that the report into this dreadful spate of deaths will be made available to all hospital trusts across the United Kingdom, including Northern Ireland, to ensure that lessons are learned and that the 84 recommendations of the Ockenden report and any mechanisms of prevention can be understood and put in place UK-wide?
Yes, I can give the hon. Gentleman that assurance. We are more than happy to reach out to the Northern Ireland health service and to work proactively with it on improving maternity services in Northern Ireland.
I thank my right hon. Friend for his statement, and all the many Members present who have contributed to the process that has led to this report. Following the remarks by my hon. Friend the Member for Brecon and Radnorshire (Fay Jones), I have been working with my hon. Friend the Member for Montgomeryshire (Craig Williams), who sadly cannot be here today as he has important constituent business, to look at the cross-border nature of this inquiry in relation to his constituency, my constituency of Clwyd South, my hon. Friend’s constituency of Brecon and Radnorshire and others on the Welsh borders. Will my right hon. Friend reflect on the fact that there will be many concerned residents in Wales, alongside the victims outlined in this report, who need representation on this important issue?
Yes, I can give my hon. Friend, and my hon. Friend the Member for Montgomeryshire, who cannot be with us today, the reassurance that they seek.
My right hon. Friend said in his statement that the Care Quality Commission rated these maternity services inadequate for safety only in 2018, which is unacceptable. Can he assure the House that the CQC inspections are now rigorous enough that failings are picked up much earlier to prevent this type of thing from happening again?
I can assure my hon. Friend that there have already been a number of changes in the CQC’s approach, but I cannot give an assurance that it has changed enough, because this report has only just been published and it is important to me to follow through and ensure that, where relevant, the independent regulators are also making the changes set out in the report. To respond to an earlier question from the hon. Member for Enfield North (Feryal Clark), she was right to suggest that there should be an update from Ministers on progress following this report, and I will ensure that that happens. That picks up on this question about the CQC as well.
This House is united in our heartache over the lives lost and the lives destroyed, and over the women who were silenced and told that birthing had happened for centuries so they should shut up, or that it should happen as though in some sort of movie. I am afraid that, as an MP, I have concluded that NHS bureaucracy has a systemic problem of sexism, and I ask the Secretary of State to keep an eye on this nationally. I remember, after 36 hours of labour, being rushed to the operating theatre and being denied a C-section, then being rushed back an hour later and having a C-section, but only because my husband had noticed that my son’s heart rate had plummeted to almost non-existent. We must also prevent the unforgivable and unscientific locking out of loved ones across all health services. It compromises care and it is still happening in hospitals around the country across different types of care.
I thank my hon. Friend for saying what she has said in the way that she did, and also for talking about her own experience. She is absolutely right to emphasise the point that the NHS is there to care for anyone regardless of their gender, but when it comes to women in particular, I hope she agrees that this is precisely why the Government are right to want to set out—as we will do shortly and for the first time ever—a detailed women’s health strategy.
(2 years, 8 months ago)
Written StatementsOn 21 February 2022, the Government published, “Covid-19 Response: Living with Covid-19” which set out the Government’s plan for living with covid-19. This included removing remaining legal domestic restrictions while continuing to protect people most at risk of serious illness from covid-19 and maintaining resilience.
The Government’s objective in the next phase of the covid-19 response is to enable the country to manage covid-19 like other respiratory illnesses, while minimising mortality and retaining the ability to respond if a new variant emerges with more dangerous properties than the omicron variant. As a result, the Government now assess that it is time to transition their response towards guidance and encouraging responsible behaviours, while targeting protection towards those individuals most at risk from the virus. I have today set out the future approach in England to testing beyond April.
The “Living with Covid-19” strategy is already being implemented. Individuals are no longer legally required to self-isolate, and instead are advised to stay at home and avoid contact with other people if they test positive. This advice will be updated further as set out below. The Government have removed their advice for staff and students in most education and childcare settings to undertake routine twice weekly asymptomatic testing. The Government have started the process of reducing their testing and tracing infrastructure, in preparation for the end of free universal testing from 1 April. We are now reconfiguring our services to target Government testing provision to enable treatment and protect our most vulnerable settings.
Symptomatic Testing
The Government will continue to provide free symptomatic testing for:
Patients in hospital, for whom a test is required for clinical management or to support treatment pathways.
People who are eligible for covid-19 treatments, because they are at higher risk of getting seriously ill from covid-19. People in this group will be contacted directly and sent lateral flow tests to keep at home for use if they have symptoms as well as being told how to reorder tests.
Individuals who live or work in high-risk closed settings, for example in some NHS, social care and prison—and other places of detention—settings where infection needs to be identified quickly to minimise outbreaks.
NHS England will be writing to those eligible people to inform them of the new process.
DHSC will continue to fund some asymptomatic testing in NHS services, during periods of higher prevalence, including for staff and patients.
For ASC services and hospices, DHSC will also continue to fund some regular asymptomatic testing for staff in periods of high prevalence. Asymptomatic testing of care home and hospice residents will be provided on admission and during an outbreak, not routinely.
In addition, in some closed or semi-closed settings, for example: parts of the prison estate, places of detention, and some refuges and shelters, where individuals are at high risk of severe disease outcome and infection can spread rapidly, asymptomatic testing will continue to mitigate risk during higher prevalence periods.
Most visitors to adult social care settings, and visitors in the NHS, prisons or places of detention will no longer be required to take a test.
Contingency
UKHSA will maintain critical surveillance capabilities to provide insight into emerging threats and retain contingency capabilities to enable a rapid response . This includes genomic sequencing to identify a variant of concern and the ability to scale up a national response, should that be warranted. It will retain the ability to enable a rapid testing response should it be needed, such as because of a new variant of concern. UKHSA will also retain critical lab and contingency infrastructure, delivery channels, mobile testing units, and accompanying digital infrastructure. Altogether, this will ensure we retain critical resilience—giving rapid, reactive capability to respond to a future health threat, while a more comprehensive response can be scaled.
Guidance
Guidance will be published on 1 April that sets out the actions that those with symptoms of covid-19 or respiratory illness should take to reduce risk of infection to others.
Devolved Governments
UKHSA is committed to working with devolved Governments to take forward the testing programme in each nation in 2022-23.
Funding
The Government have provided significant additional funding, through additional borrowing, to respond to the pandemic, the cost of living with covid-19 will be met within existing funding streams, including the additional funding allocated at SR21. The Government will reallocate resources as necessary to pay for the maintenance of our pharmaceutical defences against covid-19 and preserve hard-won freedoms.
Free parking in hospital car parks for NHS staff introduced during the pandemic will also come to an end on 31 March. However, over 93% of NHS trusts that charge for car parking have implemented free parking for those in greatest need, including NHS staff working overnight.
Conclusion
Finally, on behalf of the Government, I would like to record my thanks to everyone who has worked tirelessly to keep people safe over the last two years and whose efforts have enabled us to move to the next stage of the covid-19 response.
The Government will continue to work together with our partners to keep all these measures under review.
[HCWS740]
(2 years, 9 months ago)
Written StatementsI wish to update the House on my vision on health reform, “Our Health System: the Government’s reform agenda”. In today’s address, I outlined our intention to take bold action on healthcare reform, setting out our agenda for transforming the healthcare system. This agenda addresses the enduring issues facing the system, and recognises the challenges and opportunities arising from the pandemic—building on our recent elective recovery plan and the publication of the integration White Paper.
The NHS has many strengths and is rightly regarded as a national treasure. However, it faces long-term challenges, including an ageing population and people increasingly living with multiple long-term conditions. All of these have been exacerbated by the covid-19 pandemic, which has added extra pressure on the system, highlighted existing issues, and created new challenges.
At this critical moment, we must now seize the opportunity to put our healthcare system on a more sustainable path for the future while meeting the immediate recovery challenge we face as we emerge from the pandemic.
The Health and Care Bill will, subject to Parliament, create the structures for the future, but we need to consider how we will work within those structures. I recognise waiting time recovery is a significant challenge. However, this is not a reason to back away from those changes, but to double down and ensure we deliver the full benefits.
In the face of growing demand, we will focus on taking a more prevention-centred approach to healthcare, where the emphasis is on preventing needs from arising in the first place—prevention; putting people in control of their own care—personalisation; and driving up the quality of care by working smarter—performance.
As we do this, we must build on existing progress and work with the brilliant individuals and teams in our healthcare system who are already making change happen on a daily basis—which will include continuing to invest in the workforce.
We will build on the announcements made during my speech and set out wider Government policy in this area in due course.
[HCWS666]
(2 years, 9 months ago)
Ministerial CorrectionsFirst, I wish a happy St David’s day to the hon. Member and all those celebrating. I would be happy to meet her on this issue. The Government greatly value the role of physician associates. She knows that they bring new talent to the NHS and act in an enabling role, where they can help healthcare teams with their workload. Physician associates will be regulated by the General Medical Council, and the Department has consulted on draft legislation on just how to do that.
[Official Report, 1 March 2022, Vol. 709, c. 900.]
Letter of correction from the Secretary of State for Health and Social Care, the right hon. Member for Bromsgrove (Sajid Javid).
An error has been identified in my response to the hon. Member for Newport East (Jessica Morden).
The correct response should have been:
First, I wish a happy St David’s day to the hon. Member and all those celebrating. I would be happy to meet her on this issue. The Government greatly value the role of physician associates. She knows that they bring new talent to the NHS and act in an enabling role, where they can help healthcare teams with their workload. Physician associates will be regulated by the General Medical Council, and the Department plans to consult on draft legislation later this year on just how to do that.
(2 years, 9 months ago)
Commons ChamberWe are committed to ensuring that everyone with mental health needs has timely access to support and treatment. We remain committed to the expansion in mental health services in the NHS long-term plan, which should see 345,000 more children accessing services by 2023-24. To accelerate that expansion, we have provided an additional £79 million this year in recognition of the impacts of the pandemic.
The NHS long-term plan promises a
“new approach to…mental health services for people aged 18-25”.
Could the Secretary of State set out in detail how university mental health and wellbeing services will work seamlessly with NHS mental health services so that students in need of support do not fall through the cracks?
The hon. Lady raises a very important point, especially as this week is Eating Disorders Awareness Week. Sadly, as she and many other hon. Members will know, eating disorders have increased significantly over the past couple of years.
Last year, during the pandemic, we published a mental health recovery action plan with an additional £500 million of funding, a minimum of £13 million of which was dedicated to young people between the ages of 18 and 25, particularly to help with the transition from children’s to adult mental health services. My hon. Friend the Minister for Care and Mental Health has been in talks with the Department for Education and has a meeting soon to discuss what more action we can take collectively.
Has my right hon. Friend made any specific assessment of the effect of the covid-19 lockdown restrictions on children’s mental health and general wellbeing?
I can tell my hon. Friend that we have and that that assessment continues. Sadly, as he will know, we have seen a significant increase in mental health referrals, especially for young people, over the past two years. The extra support that we have provided through the action plan and the £500 million of funding is helping, but I am afraid that there will be some long-term challenges created by the pandemic. We are very much looking at what more we can do.
I echo the words of solidarity with Ukraine that many colleagues have shared in recent days.
There are stark inequalities in children’s mental health services, from the postcode lottery of whether a child is ever seen after a referral to the luck-of-the-draw results of eating disorder treatment. Children from black and mixed-race backgrounds make up 11% of the population, but account for a staggering 36% of those detained in the highest-level mental health units. However, just 5% of those who access routine children’s mental health services are black. That is unacceptable—something clearly is not working.
Labour will put a mental health support hub in every community and a specialist mental health staff member in every school. What are the Government going to do?
I think we all agree, across the House, about the importance of mental health services, especially for younger people. As for what the Government are doing, before the pandemic there was already a commitment to increase funding for mental health services in the NHS’s long-term plan by an additional £2.3 billion a year. On top of that, there has been the response during the pandemic, with the mental health recovery action plan and the additional £500 million that I referred to a moment ago. When it comes to children’s mental health services, there is £79 million included, which will pay for an extra 22,500 referrals.
We have worked with the NHS to expand virtual wards and establish a new national discharge taskforce to safely maximise patient discharge and free up beds. We have also announced a delivery plan for tackling the covid-19 backlog of elective care, which sets out our clear vision for how an additional £8 billion will be spent over the next three years to help the NHS to recover and expand elective services.
I thank my right hon. Friend for that information. As we look beyond the pandemic, our priority must be tackling the NHS waiting list. Does my right hon. Friend agree that the record number of doctors and nurses working in our NHS shows that the Government are putting the NHS on the best possible footing to meet the challenges ahead?
I absolutely agree with my right hon. Friend. Let me take this opportunity once again to thank everyone who has been working in the NHS, especially for all that they have done during the pandemic. We are continuing to invest in the workforce through our 50,000-person expansion in the nurse programme, and we already have 44,000 more full-time employees in healthcare settings than we had this time last year, including 4,600 more doctors and 11,100 more nurses.
The lack of capacity in accident and emergency departments and other healthcare services is a major contributor to the ongoing ambulance waiting time crisis in my constituency. Will the Secretary of State meet me and representatives of the West Midlands ambulance service—as I have repeatedly asked him to do—to help to resolve the crisis?
The hon. Lady is right to raise this matter. As she will know, owing to the pressures of the pandemic we have seen significant challenges for ambulance services throughout the country. Just a few days ago I met the head of the West Midlands ambulance service to discuss some of the issues, and also how the extra funding that we provided over the winter—some £55 million of support for ambulance services—is helping.
May I press the Secretary of State on how the increases in NHS capacity will be maintained over the medium term? His own Department has forecast that waiting lists may hit 9 million or 10 million in the next couple of years. The Government also have a plan to take the extra funding coming from the increase in national insurance and the health and social care levy out of the NHS to fund our long-term social care plans. How are the two to be reconciled?
As my right hon. Friend will know, when I presented the NHS’s elective recovery plan for the covid-19 backlog in the House a couple of weeks ago, I made it clear that we expect waiting lists to rise before they fall. That is because some 10 million people stayed away during the pandemic, and we want as many as possible of those who want and are able to come forward to do so. At the same time, the NHS will be massively increasing its activity, in new ways and with new funding. It is essential for there to be much greater integration between the NHS and social care, and we set our plans in detail in the White Paper published last week.
The Government seem to think that there is some kind of magic staffing tree, but there is no increase in capacity, no elective recovery and no fixing of social care without an immediate and ambitious workforce plan. We have legislation in this place, and we have seen a tsunami of White Papers, but none of that includes a credible workforce plan. Given the estimated 93,000 NHS vacancies and more than 110,000 vacancies in social care, when will we have that plan?
The hon. Lady has just stood up and said that there is no increase in capacity. I am afraid she was probably not listening a few minutes ago when I said that in the last year the number of people working in the health service had increased by 44,000, and that we had 11,000 more nurses and nearly 5,000 more doctors. As for a plan, the hon. Lady may know that I have already asked the NHS to work on a long-term plan—a 15-year workforce plan. If she really wanted a new workforce plan, she should have thought about how we could fund it, and should not have voted against the increase in spending that the Government proposed.
On the subject of NHS capacity, data released by NHS Digital shows that NHS Bury clinical commissioning group had the lowest number and also the lowest percentage of face-to-face GP appointments in England in January 2022. Only 37% of Bury appointments are face-to-face, which is clearly unacceptable and unfair to my constituents. Will my right hon. Friend agree to meet me to find solutions to this serious problem?
It is a serious issue, and I will of course meet my hon. Friend to discuss it further. He may be interested to know that over the winter the Government provided an additional £250 million in a winter access fund for primary care services throughout the country. That has certainly helped to increase the number of face-to-face appointments, although the omicron wave made the process more challenging. As my hon. Friend suggests, it should ultimately be for patients to choose how they want to be seen.
Addressing the disparities discussed in that report is one of my key priorities. We are already making progress in crucial areas such as increasing covid-19 vaccine take-up among ethnic minority groups. To go further, we also plan to publish a health disparities White Paper later this year that will set out impactful measures designed to address disparities and their causes, including those linked to ethnicity.
I thank the Secretary of State for his response. I hope he will ensure that he implements all the conclusions of that report. He is aware of the McLean review into the senior leadership of the Royal Wolverhampton NHS Trust, who have now annexed the Walsall Manor Hospital. Can he say what he will do to ensure that all those working in the NHS and using the NHS are treated with equality and transparency, starting with the Manor?
The right hon. Lady is absolutely right to raise this issue. This is one of the most important issues and one of the biggest longer-term challenges to face the NHS. I welcome the report and I will be taking it very seriously. She will know that I have commenced action on ethnic disparities in healthcare. For example, I have asked for an investigation, headed by Dame Margaret Whitehead, into potential bias in medical devices. The right hon. Lady is also right to raise the importance of inequality of treatment, and I will shortly have more to say on that.
This report is damning. The evidence shows that, over a decade of Conservative Government, we have not seen any significant change. Ethnic minority patients continue to receive poorer care because of their race at every stage of their life. The Tories have had 12 years to act. Why have they failed to do so?
The reason this report exists is that the Government want to see this kind of work being done by an independent organisation so that we can address these types of disparities and issues. There have been ethnic disparities in our health service for decades, sadly, under successive Governments, and it is this Government who are doing something about it. I have already referred to the medical devices review. Earlier this week, the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield), set out the maternity disparities taskforce, and we will have a lot more to say on this when we publish our forthcoming White Paper.
I share the horror and disgust of almost everyone in this House, this country and the whole world at the unprovoked, unjust and unjustifiable invasion of Ukraine by President Putin last week. That appalling act has created a humanitarian emergency and we are looking at every opportunity to give the people of Ukraine the support that they so urgently need.
On Sunday night we sent almost 50,000 items of medical supplies to Poland via air for onward transport to Ukraine. I can inform the House that another plane departed at 7 o’clock this morning with more supplies, including medical equipment and personal protective equipment. We have all been in awe of the bravery and heroism shown by the Ukrainian people. Rest assured, we all stand with them shoulder to shoulder in their hour of need.
On behalf of my constituents with blood cancer, will the Secretary of State please consider providing free asymptomatic testing for the close contacts of immunocompromised people?
We will keep under review the testing offer that we will provide over the coming weeks and months. We continue to consider whether any changes are necessary, but as we learn to live with covid we will target our free asymptomatic testing offer on vulnerable people. That includes, of course, those who are immunocompromised. Such individuals will also be eligible for antiviral treatments through a free priority PCR test service.
I associate myself and everyone on the Opposition Benches with the Secretary of State’s remarks and warmly welcome the support that the Government are providing to the people of Ukraine and the Ukrainian army. We all stand with the people of Ukraine in their fight for freedom and democracy.
Turning to matters closer to home, the Secretary of State asked the Chancellor for £5 billion to cover essential covid costs—ongoing covid costs—and he came away with nothing, so where will the cuts now fall in the NHS budget?
We must all learn to live with covid. The Government have been very clear about that, and we set out a very detailed plan. As infections fall, cases fall and rates of hospitalisation for covid fall, which means we can now have this type of plan. It is a properly funded plan that focuses on vaccines, treatments and targeted testing, and that builds in resilience should there be future variants of concern. It is right that this plan is funded by the Department because it is our No. 1 health priority.
Hang on a minute. So one minute the Secretary of State is asking for £5 billion from the Treasury, and the next minute he has found the money within the Department. Either he was trying to pull a fast one on the Treasury, because he had the money he needed, or he has not got the money he wanted and therefore the cuts are going to fall within existing budgets. Members do not need to take my word for it; it was reported in The Times that the Health Secretary threatened that, if he did not get the funding, it would mean delaying investment in social care, fewer elective surgeries and cuts to the hospital building programme. Having, I think, not tried to pull a fast one on the Chancellor, is he now pulling a fast one on patients, and is it not really the patients who are going to pay the price for his failed negotiations?
First, the hon. Gentleman should not believe everything he reads in the press. We would think he knew that by now. As I said, when it comes to funding our plan for living with covid, it is right that it continues to be the No. 1 priority of my Department to keep this virus at bay and that it is funded by the Department. When it comes to funding, this is the hon. Gentleman who, with all his colleagues, voted against extra funding when he was given the opportunity.
My hon. Friend is absolutely right to raise this. NHS England has already given clear guidance to all GP practices that they must provide face-to-face appointments alongside remote consultations. Patients’ input into the type of consultation they want should be sought by all practices and their preferences should be respected.
The Scottish Government have now confirmed their initial aid for humanitarian support to Ukraine of £4 million, as well as medical supplies. They are keen to work with aid agencies and other UK nations to get support to where it is most needed as soon as possible. What discussions has the Secretary of State had with his Cabinet colleagues on boosting urgent medical equipment provision to Ukraine from the UK and on guaranteeing access for doctors to the country?
The hon. Gentleman raises a very important point, and he will be pleased to know that the UK was one of the first countries in the world to provide medical aid. As I mentioned a moment ago, one flight left on Sunday night and one left this morning, and there will be many more, I hope. I welcome the work of the Scottish Government and their offer, and we will certainly work together in making sure that aid reaches the people who need it.
First, I wish a happy St David’s day to the hon. Member and all those celebrating. I would be happy to meet her on this issue. The Government greatly value the role of physician associates. She knows that they bring new talent to the NHS and act in an enabling role, where they can help healthcare teams with their workload. Physician associates will be regulated by the General Medical Council, and the Department has consulted on draft legislation on just how to do that.
First, I pay tribute to my hon. Friend and to my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) for all the work they have done on this most important of issues. Over the past few months, we have all heard in this House some horrific examples of botched, non-cosmetic procedures scarring people for life. No longer will that be allowed. We will be introducing a licensing regime for such procedures. The details of the regime will be set out in regulations, meaning that it will be flexible, agile and change in response to changes in the cosmetics industry.
Today is the first day of Brain Tumour Awareness Month. The Secretary of State kindly wrote to me in January when my mother died from a brain tumour, and Baroness Tessa Jowell, who was much loved on all sides of the House, also died from a brain tumour. Given that it is the biggest cause of cancer death for the under-40s, and we still do not really know what causes them, does he agree that this should be a priority for research, so that we understand as much about brain tumours as about other cancers?
I once again express my condolences to my right hon. Friend for his loss. He is absolutely right to raise this issue and the need for more research. That is one of the reasons why, back in 2018, we announced £40 million of extra research funding over the next five years. I can tell him that some £9 million of that has already been committed to 10 projects. In addition, the Tessa Jowell Brain Matrix is an exciting new trials platform that will give people with brain cancer access to trials of treatments that are best suited for their individual tumours.
Will the Secretary of State meet me as chair of the all-party parliamentary group on sexual and reproductive health in the UK? Can I bring along the Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives, the Royal College of General Practitioners, the Royal Pharmaceutical Society and the Faculty of Sexual and Reproductive Healthcare to explain why the decision to remove telemedicine is wrong for women in this country?
A dental practice in Shepshed has informed me that its NHS contract has changed little since 2006. Can the contracts and value of units of dental activity for treatment be increased to focus on prevention, rather than treatment alone?
I thank all the Ministers for their responses. What steps have been taken to work with the Education Secretary to provide a higher number of places for medical students containing a golden handshake that allows for no student loan repayment or fees on condition that they stay in the NHS for a set time?
It is an important question on the workforce. The hon. Gentleman will know that over the last two years we have removed the cap on medical places and we have the highest number of doctors and dentists in training ever. It is right to think about what more we can do, however, and we are having active discussions with the Secretary of State for Education to see what can be done.
On the issue of children’s mental health, does the Minister agree that children with ADHD and autism have found the last two years even more stressful than usual? A cross-departmental approach is long overdue to ensure that their needs are adequately met.
The Secretary of State is on record saying:
“Making medicinal cannabis available on prescription will benefit the lives of ill patients currently suffering in silence. There is nothing harder than seeing your loved ones in pain”.
Since he said that, there have been three prescriptions for medical cannabis on the NHS. They are important, because they set a legal and medical precedent that it can happen, and it can happen now. Currently, however, if I can afford it, I can buy it, but if I cannot, I cannot. When will he address that anomaly?
The hon. Gentleman will know that for medicines to be generally available on the NHS, they have to be deemed safe and effective by the independent medical regulator. That requires trials to take place and that is where the focus should be. Those who want those medicines to be more easily available should encourage the companies that produce them to have trials and the NHS will support them in doing so.
Chloe Rutherford and Liam Curry from South Shields were tragically murdered in the Manchester Arena terror attack. Their parents’ pain is unimaginable and constant. After sitting through hours of the inquiry, they have been told that, in just two days’ time, the registration of their precious children’s deaths will be done not by them, but by a stranger. Apparently that is standard practice for mass casualty events. These grieving parents are being denied this final act for their children. Please can the Secretary of State explain why, and urgently intervene?
Of course I would be very happy to meet the hon. Lady. It is a very important issue that she has raised. I also send my condolences to the parents of Chloe and Liam.
The right decision was taken by this Government last week in confirming that the temporary telemedicine at-home abortion pill should cease. I commend the Government for that decision. Given that more than 10,000 women have ended up in hospital in the year 2020 after taking a first abortion pill, can my hon. Friend confirm that the Government will follow through on that decision?
Since the NHS was created, it has been governed by the principle that services are free at the point of use, and, of course, the Secretary of State has a duty to protect that. Many of my constituents want to know whether the Government’s decision to start charging for covid tests marks a departure from that founding principle.
Clearly, that is one of the most important principles of the NHS and it will not change. It is right, though, that when we look at living with covid, we target testing on those who are most vulnerable or who are in vulnerable settings. That is the right, proportionate and balanced approach.
(2 years, 9 months ago)
Written StatementsCovid-19 vaccination as a condition of deployment—revocation consultation response
On 31 January I announced this Government’s intention to revoke the regulations making covid-19 vaccination a condition of deployment in all health and social care settings, subject to consultation and parliamentary procedure.
My statement before the House on 31 January made clear that vaccination as a condition of deployment was the right policy when the original decision was taken, but that it is no longer proportionate in the light of the most recent clinical evidence regarding the current omicron variant of covid-19, which is intrinsically less severe than Delta, and the high rate of vaccination across the population.
On 9 February Government published a consultation document, “Revoking vaccination as a condition of deployment across all health and social care”. The consultation outlined the latest clinical evidence and the proposed way forward, and sought views from all interested parties on whether the regulations should be revoked, as well as what further steps could be taken to increase vaccine uptake.
The consultation received over 90,000 responses from across the health and social care sector, as well as from members of the public. My Department also conducted engagement sessions with sector representatives. I am grateful to all those who have taken the time to respond to the consultation.
My Department’s officials have carefully analysed the consultation responses. The vast majority of the feedback received supported revocation, with 90% of respondents agreeing that the requirement for covid-19 vaccination as a condition of deployment in health and social care settings should be revoked.
I have considered this strong preference for revocation, the relevant equalities assessment, and the scientific evidence. I have concluded that it is right and proportionate to proceed with revocation of covid-19 vaccination as a condition of deployment in all health and social care settings, and have today published the Government’s full response to the consultation on www.gov.uk. I am also laying the regulations to revoke vaccination as a condition of deployment today. These regulations will come into force on 15 March, and will remove the requirements already in place in care homes, as well as those due to come into force in health and wider social care settings on 1 April 2022.
Irrespective of this step, and while we have a number of defences and mitigations in place, such as antivirals and personal protective equipment, vaccination continues to be our most important weapon in the fight against covid-19. I have made it clear that I consider it a professional responsibility for health and care staff, and others who work in the health and social care sectors, to be vaccinated, and I am glad to note that the professional regulators, the Royal Colleges, the chief medical officer, the chief nursing officer, and the chief midwifery officer among others, agree with this. It is encouraging that 92% of the NHS workforce and 95% of care home staff are now vaccinated with two doses, while 89% of home—domiciliary—care staff have so far received at least one dose of the vaccine.
This Government are committed to working with the health and social care sectors to engage with those who are yet to make the positive choice to be vaccinated. In adult social care, the vaccine boosters taskforce has published a paper to support good practice for driving booster vaccination in England. In addition, Government have committed to consulting on updating the code of practice on the prevention and control of infections, which applies to all Care Quality Commission registered providers of all healthcare and social care in England, to strengthen requirements in relation to covid-19, including reflecting the latest advice on infection prevention control.
While we commit to these actions, we also have measures in place to ensure that those most vulnerable to covid-19 remain protected in health and social care settings, as well as across the country. While the shielding programme ended on 15 September 2021, we have made new antibody and antiviral treatments available to people who are at highest risk of becoming seriously ill who test positive for covid-19, to help reduce the development of severe covid-19. On 21 February 2022, Government launched their living with covid-19 plan. The plan confirms that both NHS and adult social care will continue to provide access to free PPE to the end of March 2023, or until the IPC guidance on PPE usage for covid-19 is amended or superseded. Revocation of these regulations plays an important and proportionate role within Government’s approach in ensuring that our entire society, including the health and social care sectors, can learn to safely live with covid-19.
The Government’s response to the consultation is published on www.gov.uk.
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