Community Pharmacies

Steve Brine Excerpts

Thursday 14th September 2023 Westminster Hall

[Steve Brine (Winchester) (Con)]

It is nice to see you in the Chair, Sir Mark. Well done to my hon. Friend the Member for Waveney (Peter Aldous), my dear friend with whom I entered Parliament in 2010: as always, he has set out the issues beautifully, with the forensic ability for which he is known. The people of Waveney are very lucky to have him, as is this House. It was my hon. Friend who inspired me to speak in this debate: he collared me in the corridor, as he often does. I am only too pleased to do so, both as MP for Winchester and Chandler’s Ford and as Chair of the Health and Social Care Committee.

When I was pharmacy Minister, I spent many happy hours where the Minister is sitting today, answering debates on the subject. We have moved on a lot, and I give credit to the Minister, the Secretary of State and this Prime Minister of all Prime Ministers—if they had not understood community pharmacy, we were never going to get there. All credit to them for the investment and the work that has gone on. As somebody once said, “Much done, more to do.”

My fellow Committee members, one of whom is here today, and I are all too aware of the challenges facing community pharmacies in all our constituencies. Nevertheless, there is great cause to be positive. In my opinion, pharmacies have huge untapped potential to transform the way patients access and receive healthcare services, and to support the building of a preventive healthcare approach, which the Minister knows I am passionate about and which I suggest is central to the future sustainability of the NHS itself.

Earlier this year, the Select Committee launched an inquiry into pharmacy. It will look broadly at pharmacy services including hospital pharmacy, which is often overlooked but is very important, but community pharmacy will form the largest part of it. The terms of reference include specific questions about funding, which my hon. Friend the Member for Waveney and the right hon. Member for Knowsley (Sir George Howarth) both mentioned; the commissioning arrangements for community pharmacy, which I know we will come on to; the locations of community pharmacies; and, of course, achieving the ambitions of Pharmacy First in the primary care recovery plan. I trialled Pharmacy First in the north-east when I was pharmacy Minister; I am a great believer in it, so it is great to see how the Minister has taken it forward.

A key question that our inquiry seeks to answer is, “What does the future of pharmacy look like, and how can the Government ensure that it is realised?” We will be very forward-looking, considering how the challenges of today can be addressed to ensure that the potential is realised. However, we will also look at the services that community pharmacies are already offering or are set to offer through the pharmacy-first approach. Crucially, we will also consider the areas in which there is a chance to go further.

Community pharmacists are highly trained clinical professionals. They are not retailers; they are clinical professionals. They want to do more, they can do more and we should trust them to do more. We will also consider some of the innovations in the sector—for example, how automation and hub-and-spoke arrangements, which we have not talked about much today, will come in and help. We will also look at the workforce challenges, which we have heard about, including issues around the retention of pharmacists in the community pharmacy sector and around training.

The inquiry will be wide ranging. We are looking forward to getting started with oral evidence, hopefully in November. There is no shortage of enthusiastic people in the community pharmacy sector who are willing to share their experiences with us. We are incredibly grateful to all those organisations and individuals who sent in their written evidence, and we hope to continue seeing that positive engagement from the sector when we start the oral evidence sessions.

The Committee has the benefit of drawing upon the work of our expert panel, which is chaired by Professor Dame Jane Dacre, whom the Minister will know. The panel, set up by my predecessor, now the Chancellor of the Exchequer, evaluates the Government’s progress on meeting their commitments on an area that I ask it to look at. It delivers a Care Quality Commission-style rating as to where we are, which can range from “outstanding” to “inadequate”. I asked the panel to look at the pharmacy sector, based on its own members’ expertise and research and submissions by stakeholders, as well as some roundtable events with patients, people in receipt of social care, and pharmacy professionals.

The panel recently published a report on its evaluation of Government commitments in the pharmacy sector. It was assisted by several pharmacy professionals and leaders who steered its decision on which commitments to evaluate. Community pharmacies were an obvious area to focus on. The panel looked at two specific community pharmacy-related commitments, rating the position on both as “requires improvement”. I take a glass half-full perspective. There are good things in the report; I know that the Minister will look carefully at it. The first commitment was to maintain the pharmacy access scheme, which aims to protect access to local, physical NHS pharmaceutical services in areas where there are fewer pharmacies. The chemist may be the only shop in town—that is often the case in coastal communities.

The second commitment was to review the community pharmacy funding model and the balance between the spend on dispensing and new services within the community pharmacy contractual framework, which is negotiated between Community Pharmacy England—formally the Pharmaceutical Services Negotiating Committee—the Government and NHS England. The panel concluded that community pharmacies are struggling to meet increased demand. It is a good thing that demand is increasing, because it means that people are increasingly turning to the chemist, but they are struggling to meet that demand, to deliver services, and even to remain open with the current funding model, which was set in 2019 for five years and has not been reviewed significantly during that time.

As my hon. Friend the Member for Waveney suggested, pharmacies are also struggling as their staff are encouraged to take up roles in primary care, funded by the additional roles reimbursement scheme. The right hon. Member for Knowsley touched on the fact that IT systems can make it difficult for patient information to be shared between community pharmacies, hospitals and general practices. Taken together, those challenges can negatively impact community pharmacies’ ability to deliver services and support other parts of the health and care system.

The National Pharmacy Association does great work in this space and has been in touch with us. It commissioned an EY report, which found that almost three quarters of pharmacies in England face a risk of closure if a serious funding shortfall is not addressed, with 72% of them forecast to be loss-making within the next four years. The Minister will be aware of that report. It is sober reading, but it would be wrong to overlook it. It is a serious piece of work.

Going back to the expert panel, members also raised concerns about the lack of data collected on the performance of schemes designed to improve community pharmacy services, especially whether they were delivering the positive outcomes that we want for patients and people in receipt of social care. There is a lot for the Government to consider in the panel’s report. We still await their response, which, I hasten to add, has not timed out yet. We look forward to that.

I want to touch on a couple of other points. First, I co-chair the all-party parliamentary group on HIV and AIDS. We are calling for the HIV prevention pill, PrEP—pre-exposure prophylaxis—to be available through community pharmacies, with clear financial accountability for its provision. I think that would be a game changer for HIV prevention. It would be a critical part of ending new cases of HIV by 2030, urged by the HIV Commission, which I commissioned as the Minister and, after leaving Government, became a commissioner on, along with the shadow Secretary of State, the hon. Member for Ilford North (Wes Streeting). The Opposition Front Benchers have signed up to that 2030 ambition, and the Government have committed to it too.

Community pharmacies are well placed to prescribe PrEP. They carry out medicine use reviews for patients, and I think that they would be well placed to counsel on PrEP and to manage the prescriptions alongside other medications, because it is critical that medicines are prescribed in conjunction with each other. Community pharmacies are well connected to other parts of the health service, where integrated care boards have ensured that the IT is right and that the relationships are right. Furthermore, services provided by pharmacies act as a bridge between secondary and primary care, so that would complement sexual health prevention and treatment services and the advice that goes on. Will the Minister, in his summing up, touch on what progress has been made towards the commitment to make PrEP available beyond sexual health services and when it will be available in community pharmacies?

On the supply side, we have talked a lot about the bricks and mortar and the workforce, but the medicines supply chain, also mentioned by both previous speakers, is in need of serious love from Ministers. Pharmacies often have no idea of the prices being charged by wholesalers for some key generics, so they have no idea what is short, while pricing of products is often much higher compared with other European countries; consequently, margins in community pharmacies are often being eroded by uncertainty in the supply chain. I urge the Government to look at a robust system to plan for future pandemics and address shortages of key pharmaceuticals, because that undermines the sector and some of its great work.

There are so many things we could talk about, such as the ill-health prevention inquiry by the Select Committee, where I see pharmacies playing a key role. Much has been achieved. When I walked into the Department, I asked the special advisers what should be on my worry list, and they said: “General practice, Minister.” Some things never change. However, I passionately believe that community pharmacies are part of primary care, or pre-primary care as I used to call it. When I talked to parts of the primary care sector as the Minister, they would say to me: “We want to do more. We can do more. We are trained clinical professionals who can be trusted to do more.” The Government have picked up the mantle of that through the reform of, and new investment in, the contract, with the Prime Minister putting his personal authority behind the sector.

There is therefore much to be proud of, but we have to be careful that we do not end up losing community pharmacies. If we lose them, once they have gone, they will not come back, and we will have a supply-side problem in the bricks and mortar, as well in some of the pharmaceuticals. I thank my hon. Friend the Member for Waveney for securing the debate—it is, as always, an excellent subject for the House to discuss—and thank you, Sir Mark, for calling me to speak.

Countess of Chester Hospital Inquiry

Steve Brine Excerpts

Monday 4th September 2023 Commons Chamber

[Madam Deputy Speaker (Dame Eleanor Laing)]

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

[Steve Brine (Winchester) (Con)]

I place on record my sympathy to the families, who have conducted themselves with the utmost dignity throughout this process and who remain in my thoughts and prayers as well. I welcome the judge-led statutory inquiry that my right hon. Friend has announced. It is the right thing to do, as are the phases of the inquiry, which prevent stuff from taking too long to move fast. As that work moves forward, and the debate rightly continues to touch on how we regulate managers working in the NHS, and remove them, I ask that Ministers remain alert to any “us and them” thinking between managers and clinicians. Surely any successful hospital trust is one team working together, so that defensive medicine is all but impossible.

[Steve Barclay]

I very much agree with the Chair of the Select Committee on the need for a one-team approach, and on looking at how we encourage more clinicians into management roles. We need to be clear-eyed that often some of those in management positions were already regulated, because they were in medical or nursing regulatory positions, but it is important that we consider the right approach to ensure accountability for the families. That is why NHS England will look at this further.

Health and Social Care

Steve Brine Excerpts

Wednesday 12th July 2023 Ministerial Corrections

[Steve Barclay]

I am pleased to see those services going into Scunthorpe. That underscores the investment we are making now while preparing for the long term, through the largest ever expansion in workforce training in the NHS’s history. My hon. Friend is right about the importance of tie-ins. Let me explain why that matters in particular for dentists: around one third of dentists do not do NHS work. That is why the plan has looked at tie-ins for dentistry, which we will explore in the weeks and months ahead.

Topical Questions

The following is an extract from Health and Social Care topical questions on 11 July 2023.

[Steve Brine (Winchester) (Con)]

Back to NHS dentistry, I am afraid. Later this week, the Select Committee will publish its report on NHS dentistry services. Spoiler alert: it will be uncomfortable reading for some. Will the Secretary of State tell us when and how he plans to bring forward plans for the tie-in of newly qualified dentists? Could that go hand in hand with a “return to the NHS” campaign for dentists who have already left that part of the service?

[Steve Barclay]

It is characteristically astute of my hon. Friend to zero in on the tie-in, which is an important part of the long-term workforce plan. Around two thirds of dentists do not go into NHS work after training, so having a tie-in is more pertinent there than it might be elsewhere in the NHS workforce.

[Official Report, 11 July 2023, Vol. 736, c. 174.]

Letter of correction from the Secretary of State for Health and Social Care, the right hon. Member for North East Cambridgeshire (Steve Barclay):

An error has been identified in my response to my hon. Friend the Member for Winchester (Steve Brine).

The correct response should have been:

Under-age Vaping

Steve Brine Excerpts

Wednesday 12th July 2023 Commons Chamber

[Steve Brine (Winchester) (Con)]

As the Chair of said Committee, I am very conscious of the importance of these issues, and I am pleased to see them debated in the House. I welcome the debate, but anywhere I have seen this issue debated, including in my cross-party Select Committee—many of its members are here—I do not see an awful lot of politics in it. I have a lot of time for the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), but I thought that he was uncharacteristically partisan in his remarks—a Labour Government this and a Tory Government that. I thought that that was misplaced, but maybe that’s just me.

Our Committee heard from the chief medical officer back in February at the start of our major inquiry on prevention. Professor Whitty highlighted then what he called “an appalling situation” whereby vaping, which he described as

“an addictive product with…unknown consequences for developing minds”,

is being marketed to children. I absolutely agree with him that that is totally unacceptable and out of control. As a parent of secondary school-age children, I see, hear and read letters home about the subject in a way that I never imagined I would only a couple of years ago, let alone when I started in this House 13 years ago.

Professor Whitty noted that

“rates of vaping have doubled in the last couple of years among children”,

which is consistent with what we are all hearing as constituency MPs. That situation cannot be allowed to continue, which is why I agree with the part of the Opposition’s motion that calls for plain packaging for vaping. The record will show that I most certainly did not vote against new clause 4 to the Health and Care Act, tabled by the hon. Member for City of Durham (Mary Kelly Foy), in November 2021. I support that part of the motion—it is consistent and in line with what happens for cigarettes. I do not think anybody would argue that we should go back to the days of the Marlboro Man and branding on cigarette packets, so I urge my hon. Friend the Minister to take that point away.

[Kirsten Oswald]

I am grateful to the hon. Gentleman for giving way as he is getting into the meat of his speech. Does he share my concerns about the impact that advertising on sports kits could have on any attempts to bring down the number of children vaping?

[Steve Brine]

Yes, I do. I suspect that point may be raised later in the debate by one of my fellow Committee members, if she catches your eye, Mr Deputy Speaker. The Blackburn Rovers issue has been raised, and it is not a historical sports deal, either: some may think that it was something that happened last season, but they have renewed it for the new season, which in my opinion is the opposite of “totally wicked”. I have young children who use that expression, and I can see why that would be attractive to a company wishing for Blackburn Rovers to carry its advertising on their shirts—I can only think that is the company’s motivation. I would ask Blackburn Rovers to look themselves in the mirror about that deal as much as the company that is doing the advertising, because it takes two to tango. Yes, I am concerned about that.

A couple of weeks ago, the Health Committee held one of our topical oral evidence sessions on youth vaping. We did so because we are very concerned about increasing media reports of children taking up vaping, as well as what we are hearing in the House and from our own constituents. During that evidence session, we heard from representatives from the health policy world and the medical and education sectors about the impact of the rising trend in child vaping. As was mentioned by the shadow Minister, the hon. Member for Denton and Reddish, we heard directly from a headteacher from the constituency of my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson)—a fellow Committee member—about the disruption that vaping is causing in her school. She did indeed talk about the impact on education of students vaping in the toilets and setting off the fire alarms.

We heard about the cost associated with putting heat sensors on top of fire alarm sensors—teachers have got enough to be doing! We heard about the disruption, which has an impact on education. During exam season recently, there were examples of exams being impacted by alarms being set off. As the headteacher told us,

“I became really concerned about interruptions to the exam season, so I had to change the smoke sensors to heat sensors really quickly to prevent us being in and out while students were sitting GCSEs and A-levels.”

That beggars belief. Young people have suffered enough in the past few years, their education has been disrupted enough, and now this—an epidemic of vaping that we are allowing to happen.

I raised the same point with the children’s doctor who gave evidence to the Select Committee. The issue of toileting in schools has wider impacts than just the disruption of education: children do not want to use the toilets, because they do not want to walk into an environment where people are vaping. They are worried about that, so toilets have become off-limits places. There is a much wider issue around toileting in schools and schools closing toilets. There is a very good charity called ERIC that works in the area of children’s bowel and bladder health, and without getting into too much detail, there is an impact on the retentiveness of children who do not use the toilet when they are at school. That can have serious medical implications, so once again, it beggars belief that we find ourselves in this situation because of vaping.

In my opinion, the industry has not gone anywhere near far enough in ensuring that its products do not appeal to the young demographic, and it is disingenuous for it to claim otherwise. Shops are able to display wide ranges of vapes in colourful, flavoured varieties and in locations that do not usually sell similar products: for example, we heard about vapes being sold in chicken shops and pound shops. That is in sharp contrast to tobacco products, which must be locked away and packaged in standardised plain packaging containing health warnings.

Evidence given to us by ASH from its surveys shows that flavour is a reason but not the main reason why young people who have never smoked start vaping. The most common reason for trying vaping among young never smokers is “just to give it a try”, at 54%, followed by “other people use them so I join in”, at 18%, and then there is “I like the flavours”, at just 12%. It is worth putting that statistic on the record, because there was a bit of a debate earlier between those on the Front Benches about flavours.

I have a few other points. Vapes are an age-controlled product; it is not legal for people under the age of 18 to buy them. There are a number of ways that young people obtain vapes anyway—for example, through the lack of age verification in shops or by buying them from other sellers who are often older teenagers who buy in bulk to sell them on, sometimes in school settings. I know schools take a very tough line on that, and rightly so, but teachers have better things to do than play trading standards officers on campus. We are particularly concerned in the Select Committee about online ordering, which is an area I think would benefit from more Government attention in order to avoid the law being circumvented. Overall, there is a need for much better enforcement of the law on not selling the products to under-18s. It is crucial that trading standards officers tackle non-compliant vendors, and of course are resourced to do so. I know the Minister is seized of that, and he rightly put that in his recent tobacco plan. I say tobacco plan, but I mean the tobacco strategy; as someone who has written a tobacco control plan, I was careful about using that word.

Price is another important issue, particularly the price of disposable vapes, as others have mentioned. They are much cheaper than tobacco products—much cheaper—in part because they are not subject to the same levels of excise duty. I understand that that is clearly not a matter for the Minister on the Front Bench, but maybe he could take that up with his Treasury colleagues. ASH told us that there is evidence that children are highly price-sensitive when it comes to buying these products, and that adding an excise charge of £5 on the battery, which is what we have often heard about, would act as a significant deterrent.

There are a lot of young people in the Gallery, and I wonder what they are thinking listening to this debate. I would urge right hon. and hon. Members to talk to young people, as I am sure we all do, either in their own homes or in the schools in our constituencies, and to ask them their motivation for vaping and what story they know about vaping, because their stories are interesting. I dropped into a vape shop in my constituency just the other day. I made a full disclosure: I told them who I was and that I chair the Health and Social Care Committee. High street vape shops are often very responsible in what they do, and this shop was very clear about how it approaches young people who come in. It told me about a product that basically looked like a bag of Skittles—other nice sweets are available. Skittles took the producer to court and the producer then had to withdraw that product. It does not take a genius to understand why someone might want to brand a vape to look like a bag of Skittles. Popping into vape shops and talking to them about how they do their business is time well spent on a constituency Friday.

To conclude, I have so many serious concerns about disposable vapes and the way they are marketed to children. However, I have to say that I do not support a total ban because, as ASH told the Select Committee in evidence, they can play an important part in helping people to quit smoking. We have to be very careful about a broad-brush ban, but the Government need to step forward even more than they already have, and this debate may help the Minister to form his views. I know he is personally very seized of this issue; he has spoken to me about it on a number of occasions.

The Government need to stay on this issue as an urgent case. A number of friends who also have children at secondary school have asked me, “What are the Government doing about this?” because they know what I do. The concern out there in parent land is growing by the day, and we parents are concerned—very concerned—about this. We on the Select Committee are also very concerned about it, and we will be writing to the Minister and the Secretary of State off the back of our session a couple of weeks ago to set out some of our concerns and some of the recommendations we may make. I hope the Government will take that on board, and come back to us promptly as part of the ongoing consultation the Minister has told us about.

I agree with some of the interventions that have been made. The Khan review was commissioned by the Government and it is a robust piece of work containing with lots of evidence. There is an awful lot to be seized of. I appreciate that it is challenging to get grid slots and get stuff through No.10, but the Prime Minister has personally identified himself with this issue and is concerned about it. I therefore say to the Minister that in that regard he would be pushing at an open door if he banged on a black door with a No.10 on it.

Oral Answers to Questions

Steve Brine Excerpts

Tuesday 11th July 2023 Commons Chamber

[Mr Speaker]

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

[Steve Brine (Winchester) (Con)]

Back to NHS dentistry, I am afraid. Later this week, the Select Committee will publish its report on NHS dentistry services. Spoiler alert: it will be uncomfortable reading for some. Will the Secretary of State tell us when and how he plans to bring forward plans for the tie-in of newly qualified dentists? Could that go hand in hand with a “return to the NHS” campaign for dentists who have already left that part of the service?

[Steve Barclay]

It is characteristically astute of my hon. Friend to zero in on the tie-in, which is an important part of the long-term workforce plan. Around two thirds of dentists do not go into NHS work after training, so having a tie-in is more pertinent there than it might be elsewhere in the NHS workforce. I look forward to the Select Committee’s report but, with some of the reforms already in place, we are boosting the number of patients treated. There were a fifth more dental treatments in 2022 than in the previous year. We are also making NHS dentistry more attractive with some of the changes to the previous 2006 contract, but we recognise that there is more to do, which is why we will shortly set out our dental recovery plan.

NHS Long-term Workforce Plan

Steve Brine Excerpts

Monday 3rd July 2023 Commons Chamber

[Mr Speaker]

I call the Chair of the Select Committee.

[Steve Brine (Winchester) (Con)]

This is a serious piece of work, and it is very welcome. Despite calls from people like me to get on with it, it was right for the Government to take their time and get it right. The Select Committee will scrutinise it—as we do—on 12 July.

The training piece is very strong. Doubling the number of medical school places has to be right, and I am glad that the Secretary of State thought of it. On retention, if we are saying—rightly, I would contest—that it is not all about pay, what role does he envisage the integrated care systems and, therefore, the trusts having in supporting staff as he makes the “one workforce” that is mentioned in section 5, with which I agree, come to pass?

[Steve Barclay]

Characteristically, my hon. Friend the Chair of the Health and Social Care Committee makes an extremely pertinent point about the role of the ICSs. As we move to place-based commissioning and look to integrate more, the interplay between the workforces in the NHS and in social care will be a key area where the ICSs will be extremely important.

The ICSs will have a particular role in the apprenticeship and vocational training, which are key retention tools in those parts of the country where it is hard to recruit, as well as in offering more flexibility to staff. When I talk to NHS staff, they often talk about having different needs at different stages of their career—whether for childcare commitments, which relate to the measures the Chancellor set out in the Budget, caring for an elderly relative, or wanting to retire and work in more flexible ways—and the ICSs have a key role to play in that. I welcome my hon. Friend’s comment that this is a serious and complex piece of work, and that it was right that we took our time to get it correct.

Lung Cancer Screening

Steve Brine Excerpts

Monday 26th June 2023 Commons Chamber

[Madam Deputy Speaker (Dame Eleanor Laing)]

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

[Steve Brine (Winchester) (Con)]

I remember dear James Brokenshire saying the words that the Secretary of State repeated today in the House. James made this happen—this is a fantastic prevention announcement. Although this nationally expanded programme cannot prevent lung cancer, will the Secretary of State confirm that we will stick by the principle of making every contact count? When people come forward for a lung risk assessment, we can offer emotional support where a problem has been detected, provide smoking cessation services to those who are still smoking, or just put our arms around people where there are comorbidities. When people come into contact with the health service, will we make every contact count for them?

[Steve Barclay]

I know that my hon. Friend was a Health Minister at the time that James was raising these points, and that he takes a close personal interest in the issue. He is right about the importance of the point at which people come forward. I was having a discussion this morning about the fact that when most patients come forward for screening, they will not be diagnosed with cancer, but it is still an opportunity for smoking cessation services, for example, to work with them on reducing the risk that continued smoking poses. My hon. Friend is right about using the opportunity of screening to pick up other conditions and to work constructively to better empower patients on the prevention agenda.

Oral Answers to Questions

Steve Brine Excerpts

Tuesday 6th June 2023 Commons Chamber

[Mr Speaker]

I call the Chair of the Select Committee.

[Steve Brine (Winchester) (Con)]

Women living with HIV of course have the right to healthcare on the same terms as anyone else, except that now they do not when it comes to starting a family. Many people living with HIV are currently excluded from accessing fertility treatment, both by law and by the Government’s microbiological safety guidelines. So will the Government now follow the scientific evidence, particularly on undetectable viral load, and remove what are surely discriminatory restrictions on the basis of HIV status?

[Maria Caulfield]

I thank the Chair of the Health and Social Care Committee for his question, as he raises an important point. Last year, we asked the Advisory Committee on the Safety of Blood, Tissues and Organs to reconsider this specific issue. It set up a working group in June last year to look at it and we expect its recommendations this month. We will take them seriously and address them swiftly once we have its advice.

New Hospitals

Steve Brine Excerpts

Thursday 25th May 2023 Commons Chamber

[Madam Deputy Speaker (Dame Eleanor Laing)]

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

[Steve Brine (Winchester) (Con)]

I am grateful for the statement; the Select Committee will want to have a good look at it, and we will start when the Secretary of State comes to see us next month. At the last election, I promised my constituents significant investment in Winchester Hospital. That is already happening, and now with early work in cohort 4 we have the promise of the elective hub to scale the orthopaedic list. Can the Secretary of State be clear with my constituents that, as the new Hampshire hospital comes together as part of the wider cohort 4, it will be for clinicians to make the clinical case on what safe and sustainable services look like in the long term for those people?

[Steve Barclay]

There are different issues around construction and service design. In terms of service design, there will need to be discussions with local clinicians and others. As my hon. Friend knows, with his scheme in North and Mid Hampshire, there are issues around the new site for junction 7 of the M3, where there is significant work on potential land acquisition and what upgrading of the motorway would be required. There is a question about the size of the hospital versus other services offered locally. Those are the issues we are keen to get in discussion with the North and Mid Hampshire trusts on, and that will be part of the rolling programme we take forward.

Patient Choice

Steve Brine Excerpts

Thursday 25th May 2023 Commons Chamber

[Madam Deputy Speaker (Dame Eleanor Laing)]

I call the Chair of the Select Committee.

[Steve Brine (Winchester) (Con)]

This form of patient choice has of course been available for at least 15 years; it just has not been made available to patients. Can the Secretary of State confirm that the referral management centres sitting at integrated care board level will be compelled, not asked, either to change that or to get out of the way altogether? Given that the vast majority of people on the waiting lists are already there with a specific trust, how exactly will they be given the option either to stick where they are, or to twist and exercise that choice to receive treatment sooner?

[Steve Barclay]

My hon. Friend, as ever, makes a shrewd point. Yes, the referral centres are part of this system. The key focus is on the initial GP referral and how we facilitate that with better data, transparency and tech, but the referral centres are a part of this. We want to roll it out to the 40-week waits from October, and to bring waits down to 18 weeks. There is a clear plan to achieve that wider scope, and that is what I have set out to the House today.