Women’s Health Strategy
Victoria Atkins Excerpts(10 months, 1 week ago)
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The Secretary of State for Health and Social Care (Victoria Atkins)
After a successful first year implementing the women’s health strategy for England, I am pleased to update on our priorities for 2024.
Improving care before, during and after pregnancy
We will continue to deliver NHS England’s three-year plan for maternity services and empower women with information on the improvements that they should expect and deserve during pregnancy and after giving birth.
We will work to prevent and improve support for women who have experienced physical and mental birth trauma. By March, new services to avoid tears during childbirth and to improve maternal mental health will be rolled out across England, alongside updated guidance for GPs.
We will improve post-natal contraception provision and awareness of hyperemesis gravidarum during pregnancy. We will also continue to support for women and their partners who have experienced pregnancy loss, including through the baby loss certificate service that will be available shortly.
Improving care for gynaecological conditions and menstrual problems
Guidance will be updated this year for gynaecological conditions such as endometriosis and we will work to improve women’s experiences of gynaecological procedures including hysteroscopy. Access to contraception will also be improved through Pharmacy First, which will play a vital role in managing menstrual problems.
The Office for National Statistics will carry out work to improve our understanding of endometriosis diagnosis times and the impact on women in the workforce.
Expanding women’s health hubs
We are investing £25 million in women’s health hubs to improve women’s access to care, improve health outcomes and reduce health disparities.
We are working closely with NHS England and the network of women’s health champions to support the establishment of women’s health hubs, and we expect all 42 local systems in England—each integrated care system—to have at least one hub operating this year.
Tackling disparities and improving support for vulnerable women
We will focus on improving support for patients and staff who are victims of domestic abuse and sexual violence. NHS trusts and local systems will review their policies, training and support systems for domestic abuse and sexual misconduct this year.
The new acquired brain injury strategy coming later this year will consider the needs of victims of domestic violence with acquired brain injuries. We will implement the recommendations in the NHS England and HM Prison and Probation Service joint national women’s prison health and social care review.
We will also work to reduce maternal disparities, given that data continues to show that black women are almost three times more likely to die during or shortly after pregnancy than white women. Women of Asian ethnic backgrounds are 1.67 times more likely to die than white women.
Boosting research on women’s health
Through the first ever National Institute for Health and Care Research—NIHR—challenge fund of its kind, we will provide £50 million to unite researchers, policy-makers, and women, to tackle maternity disparities. The NIHR will continue to encourage bids for better representation of women in research and more research into under-researched women’s health issues such as lobular breast cancer as well as conditions that affect women and men differently, such as heart attacks.
The NIHR recently published a statement of intent for developing policy and practice which sees sex differences fully accounted for in research.
Continuation of existing priorities
Since my the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield) wrote to parliamentarians in summer last year outlining the significant achievements made so far, we have made further progress in other areas:
We have published a tool to help people find local fertility commissioning policies in England. We have recently announced changes in the law to remove financial barriers to female same-sex couples accessing IVF, and will continue to work with NHS England to improve access to NHS-funded fertility treatment.
We launched our new women’s health area on the NHS website, a new HRT hub and for the first time new pages on conditions such as adenomvosis.
NHS England announced its aim to eliminate cervical cancer by 2040 by making it easier to get the lifesaving human papillomavirus—HPV—vaccination and increasing cervical screening uptake.
The NHS England Pharmacy Contraception Service relaunched to enable community pharmacies to initiate oral contraception. Almost 3,000 contractors have already signed up to the expanded service.
Between its launch on 1 April and 31 December 2023, 484,082 hormone replacement therapy prescription prepayment certificates were purchased, saving women millions of pounds in ongoing prescription charges.
NHS England will continue its work to improve menopause care by piloting new guidance for nurses, GPs and other staff in the midlands to better recognise and treat symptoms.
Helen Tomlinson, the Government’s Menopause Employment Champion, published a plan for the next six months in her role. The Government also launched online resources for employers.
In autumn we ran a reproductive health survey, which received 52,000 responses from women telling us about their experiences across all areas of reproductive health.
The upcoming major conditions strategy will consider the differences between men and women in conditions such as osteoporosis and dementia.
I am delighted to announce the reappointment of Professor Dame Lesley Regan as Women’s Health Ambassador for England for a further two years to December 2025. She will provide expert clinical leadership and support implementation of the strategy.
[HCWS192]
NHS Dentistry
Victoria Atkins Excerpts(10 months, 2 weeks ago)
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The Secretary of State for Health and Social Care (Victoria Atkins)
I beg to move an amendment, to leave out from “House” to the end of the Question and add:
“recognises the impact of a once-in-a-generation pandemic on NHS dental services, with 7 million fewer patients seen in England across 2020 and 2021; notes these challenges were reflected in both Scotland and Wales; acknowledges the steps already taken to recover services in England including the introduction of a minimum rate and increased payments for complex dental activity to better reward dentists for their work; welcomes the publication of the Long Term Workforce Plan which committed to expanding dental training places by 40 per cent; and supports the upcoming publication of the Government’s plan to further recover and reform NHS dentistry and promote good oral health throughout life.”
It is a pleasure to update the House on the work the Government are doing to strengthen NHS dentistry across the country. We are reforming our NHS and social care system to make it faster, simpler and fairer. Dentistry is a vital part of our NHS and improving dentistry is one of my top priorities. The hon. Member for Ilford North (Wes Streeting) represents a deeply urban seat, so I am pleased that he has presented me with an excuse to boast about the fact that I represent, and am very proud to represent, a rural and coastal constituency. That is why fairness is one of my three priorities for our NHS. I know the challenges that rural and coastal communities face when it comes to accessing an NHS dentist appointment, and the disparities in health that we see between rural and coastal communities and city centres. I will come to some statistics in a moment.
I am determined to fix these issues, and the other problems facing NHS dentistry, so that anyone who needs to can always see an NHS dentist, no matter where they live. Indeed, one of my very first acts as Secretary of State was to respond to the Health and Social Care Committee’s recommendations on dentistry. We agreed to the majority of those recommendations, and we stand firmly behind the ambition that NHS dentistry should be accessible and available to all who need it.
Victoria Atkins
I am going to make a little progress, but I promise to give way later.
The whole House understands that the pandemic placed a long-lasting and heavy burden on NHS dentistry. [Interruption.] I hear groans from Opposition Members, but they cannot ignore the fact that some 7 million people did not come forward for appointments during that long period of the pandemic because dentists had to shut, and we were unable to accommodate those needs within the system because of the severe strictures under which we were all placed as a society. We shepherded the sector through the pandemic with £1.7 billion of direct support to compensate for NHS activity that could not be delivered. As we recover from the pandemic there are no quick fixes, but our recovery is well under way. Let me give the latest statistics, because the hon. Member for Ilford North missed them out in his speech. The Government delivered 6 million more courses of NHS dental treatment in 2022-23 than in the previous year. [Interruption.] In the two years to June 2023, the number of adults seeing a dentist increased by 1.7 million compared to the number in the previous year, and 800,000 more children saw a dentist in the year to June 2023.
Opposition Members cannot have it both ways. While I was reading out those statistics they were saying, “You cannot make those comparisons because of the pandemic”, but that is the point: people did not come forward during the pandemic, so, as we must all know from experience in our own constituencies, there is a backlog that dentists around the country are having to work through—and they are making progress.
Victoria Atkins
In fairness, I will give way to the hon. Member for North Shropshire (Helen Morgan) first, because she rose earlier.
Helen Morgan
Like the Secretary of State, I represent a rural community, and the reason dentists are handing back their NHS contracts where I live is that they cannot recruit another dentist to come and help them. They have not had a day off, they cannot meet their commitments under their contracts, and they cannot recruit. They have offered golden hellos of 25%, but they have not been able to get anyone to come and work with them. What will the Secretary of State do to recruit the dentists whom we need to see the people in dental deserts such as North Shropshire?
Victoria Atkins
As I have explained, in relation to dentistry but also in relation to wider healthcare, the long-term workforce plan, which was requested by NHS England and by clinicians, is the means of laying those foundations for the future of the NHS. I will now give way to the hon. Member for Wallasey (Dame Angela Eagle).
Dame Angela Eagle
I thank the Secretary of State. I wanted to intervene earlier when she was talking about the pandemic. In my constituency many people were thrown off their dentists’ lists during the pandemic, often with no notice, and then found that they could not register anywhere else. That is what happened, I believe, all over the country. Can the Minister explain what she is going to do about it? It was not that people were not visiting their dentists; they were denied access.
Victoria Atkins
The hon. Lady has raised an interesting and important point, because, of course, dentists are independent contractors to the NHS, and I have to work with the levers that are available to me. As I have said, we have already invested £1.7 billion to try to help with the recovery, and the House will, I hope, look forward to our dentistry recovery plan when it comes to other ways in which we can improve that. The important point, however, is that because those dentists are independent contractors, we must work with the profession to encourage them back to the NHS to offer the services that we all want to see.
Sir John Hayes (South Holland and The Deepings) (Con)
Is not the root of the problem the contracts that the NHS has with dentists? The roots of that, of course, lie with the previous Government, a Labour Government, rather as they do with the GP contracts. Does my right hon. Friend not need to revisit the genesis of this problem, as well as training more dentists here in the UK?
Victoria Atkins
I thank my right hon. Friend, and indeed my friend, my Lincolnshire neighbour, who knows as well as I do the pressures that we face in ensuring that our constituents receive the same quality of care that we expect across England. He was right to draw attention to the—I would argue—badly drafted contract of 2006, but he also touched on the complexity involved in finding systems that would work better.
Victoria Atkins
I cannot wait to reach the part of my speech that will deal with the hon. Gentleman’s suggestions, but first I will allow him to intervene, because I enjoy this back and forth.
Wes Streeting
So do I. The Secretary of State is far more entertaining than her predecessor. Given that she is painting a picture of improvement, how does she explain the story in The Times which revealed that NHS dentistry activity is now falling in 2023-24 compared with 2022-23? Is it not the case that things are going backwards rather than forwards? How does the Secretary of State explain that, and when are we going to see her plan?
Victoria Atkins
I am grateful to the hon. Gentleman for raising that point, because according to the latest statistics available to me, 18.1 million adults were seen by an NHS dentist in the 24 months up to 30 June 2023. That is an increase of 10%, and what does it mean in reality? It means that over 1.7 million more adults were seen than in the previous year. I know that we are all concerned about the health of children; some 6.4 million children were seen by an NHS dentist in the 12 months up to 30 June 2023, an increase of 14%, which means, in real terms, an increase of 800,000 on the previous year.
I accept, of course, that there is more to do, and we will be setting that out in our dental recovery plan shortly, but this is not just about big numbers. [Interruption.] The hon. Gentleman asks when “shortly” will be. As he knows full well, “shortly” is a little shorter than “in due course” and a little longer than “imminently”.
We have introduced several simple and effective measures to improve the nation’s dental health. The Health and Care Act 2022 made it simpler to expand water fluoridation schemes, because raising the fluoride level to 1 mg per litre is a straightforward way to prevent tooth decay. It has proved effective in parts of England as well as Canada, the United States, Ireland and Australia, and the chief medical officer has concluded that there is “strong scientific evidence” that water fluoridation can drive down the “prevalence of tooth decay”.
Anthony Mangnall
I congratulate the Secretary of State on the progress that has been made, while, obviously, recognising that there is more to be done. I wonder if she will help me to ask the shadow Minister to correct the record. He said that in 2010 and 2015 Labour had a plan for dental practice, but there is no mention of that in the Labour manifestos. I will come back and correct that if necessary, but the hon. Gentleman is out there stating that Labour has had a plan for dental recovery since 2010, and that is not in those manifestos.
Victoria Atkins
My goodness me! My hon. Friend has identified a “cavity” in the shadow Minister’s so-called plans.
Several hon. Members rose—
Victoria Atkins
I am going to make some progress.
I am very pleased that, subject to a public consultation which will be published shortly, we have secured funding to expand water fluoridation schemes across the north-east of England. [Interruption.] The hon. Member for Ilford North may be interested to know why we have identified the north-east, given that he read out so many constituency names in his speech. The north-east was chosen because natural fluoride levels there are among the lowest in the country, and the proportion of five-year-olds with teeth extracted because of tooth decay is among the highest. We have wanted to address that very real health inequality to ensure that more than 1.6 million people in the area can benefit from this expansion, subject, as I have said, to a public consultation.
Supervised tooth brushing has been raised. That has indeed been proven to drive down oral health inequalities, which is why we have already introduced a toolkit that local authorities are using to introduce supervised tooth brushing across schools, nurseries and family hubs. We have been clear that we want to see that happening in more areas. I would encourage any colleague who is concerned about that, rather than waiting for some mythical date in the future, to ask our local authorities whether they are using these toolkits, because they are freely available, and they can and should put them in place.
Catherine West
The Secretary of State rightly talks about prevention, but what about the opposite, where rates of oral cancer have gone up because prevention has not been in place? What assessment has she made? If she does not have the data to hand, will she write to me with the assessment that the Department of Health and Social Care has made of the link between failure on prevention and cancer?
Victoria Atkins
I thank the hon. Lady, and particularly for the constructive tone of her intervention, because she is right. This is not simply about teeth health; it is also about the conditions that dentists check for—probably without anyone quite realising that they are doing so. I will take the hon. Lady up on her invitation to write to her on the figures, but that is why we are looking at health inequalities across the country and, importantly, focusing on encouraging dentists to re-register with the NHS if they have left, because it is vital for tackling much wider health conditions in addition to the pain and discomfort that tooth decay can bring.
Ashley Dalton (West Lancashire) (Lab)
Will the Secretary of State give way?
Victoria Atkins
No, I will give way to my hon. Friend the Member for North West Norfolk (James Wild) and then I will make some progress.
James Wild (North West Norfolk) (Con)
My right hon. Friend mentioned levers. One issue facing recruitment in North West Norfolk is the time involved in getting on to the NHS performers list. Newly in post, will she look at that issue and bring forward proposals as part of the plan to speed up that process and boost recruitment?
Victoria Atkins
I am extremely grateful to my hon. Friend. His intervention shows the level of detail that colleagues on the Conservative Benches have gone into in trying to address the understandable concerns that local NHS providers are voicing. I will look into that. I am very keen on my three words: faster, simpler, fairer. I want to make it as simple as possible for dentists to rejoin and join the NHS. I will say more on that later.
The choice of whether patients are offered NHS exams and treatment lies with the dentists, who are independent contractors to the NHS. As well as making simple, common-sense changes, in July 2022 we announced a package of far-reaching reforms to make NHS work more attractive to dentists. We have created more bands for units of dental activity, so that dentists are properly rewarded for taking on more complex care, and the best-performing practices can see more NHS patients.
Previously, regardless of the amount of time the dentist took on each patient, they received the same payment for every individual treatment package in band 2, which covers fillings and tooth extraction. Perversely, that meant they received the same payment for doing one filling as for three. That left many dentists unable to afford to take on patients who had not seen a dentist for some time and therefore needed extensive treatment. That needed to be put right for the sake of both patients and dentists. Thanks to our reforms, dentists now receive five units of dental activity when they treat three or more teeth, which is a significant increase from the old maximum of three. Root canal treatment on molar teeth is now rewarded with seven units of dental activity, as opposed to three, meeting one of the British Dental Association’s key demands.
We also recognise the barriers that too many communities have faced when accessing NHS dentistry, with people left phoning around practices to see who was taking on NHS patients. That is why we have made it a contractual requirement for dentists to update the NHS website regularly, making it clear whether their practices are taking on new patients, as well as explaining the services that they offer, thus making it easier for patients to find a dentist that can deliver the care they need. These reforms have improved access to dentistry and ensured that the system better supports dentists and their teams, so they were well received by dentists, their representatives and patient groups across England, with Healthwatch’s national director recognising that these reforms show that the Government are listening to patients and taking action, and these reforms can help ensure that dental care is accessible and affordable to everyone who needs it.
Wera Hobhouse
I am pleased to hear about some of the reforms that we have raised in this Chamber many times, particularly on changing the dental contracts and units of dental activity, but may I raise another point? In official workplace data, dentists who do just one NHS check-up a year are counted the same as an NHS full-timer. Does the Secretary of State recognise that that is a problem, because that workplace data hides the scale of the problem?
Victoria Atkins
I am extremely grateful to the hon. Lady, who makes a fair point about measuring within the system how much work NHS dentists are doing. As I say, we are looking at all of this in the work that we are doing on the dentistry recovery plan. I repeat that I want to make it as simple as possible for dentists to register with the NHS, to continue offering the care that we all want them to, so I am grateful to the hon. Lady for her intervention.
Victoria Atkins
I am going to plough on, I am afraid.
Earlier, Labour Front Benchers—perhaps not understanding that they were doing so—set out the philosophical difference between our two parties on how to grow the economy. As our economy grows, we on the Conservative side of the House want to attract the best and the brightest from around the world to work in our NHS, in our tech sector, in our life sciences industry, in our movie industry—hon. Members may know that it filmed “Barbie” this year—and in many other thriving industries. Labour, however, apparently wants to shut the door by taxing such people on earnings they make outside the UK. I speak, of course, of non-domiciled tax status.
If I may correct the hon. Member for Ilford North, because I appreciate that he has not spent any time on the Front Bench, last year alone non-domiciled taxpayers paid £8 billion in UK taxes on their UK earnings. That is equivalent to more than 230,000 nurses. Labour wants to put that at risk and put the UK at a disadvantage in the highly paid, highly competitive, highly mobile international labour market. This really is yet another branch of the magic money tree that Labour has always been looking for, to which they apparently want to add £28 billion a year of taxes or increased borrowing and increased inflation.
How they want to spend this money is interesting as well, because in 2022 Labour promised that their non-domiciled taxation would fund a workforce plan. Last September, it became breakfast club meals. Then, by October, it had morphed into 2 million hospital appointments and MRI and CT scanners. Now, apparently, it is funding a dentistry plan. One wonders how all these magic branches on the magic money tree will add up to all the promises made so far.
Victoria Atkins
I will resist, but only because I am going to ask the hon. Gentleman to intervene in a moment—he should be careful what he wishes for. I also notice that he talked about reform of the dental contract but did not give any detail. Government is not as easy as selling a book. It cannot be cut and pasted from Wikipedia, as some on the Labour Front Bench seem to like to do. It is about being clear on what you would do differently. Now, Labour in Wales is of course running the Welsh NHS. They do like to do things differently. People there are almost twice as likely to be waiting for health treatment as in England.
Virginia Crosbie (Ynys Môn) (Con)
The Leader of the Opposition states that the Labour Government in Wales is a blueprint for what Labour can do in the UK. Given that 97% of high street dentists in Wales state that Labour’s reforms are not working, does the Secretary of State agree that NHS dentistry is being destroyed by Labour in Wales, and that if Wales is their blueprint for UK dentistry, we should all be very afraid?
Victoria Atkins
I thank my hon. Friend, who represents a Welsh constituency. The chair of the British Dental Association wrote to the Labour Welsh Government to complain about their plan and, I understand, used words such as “toxic mix of underinvestment” and “untested targets.” The picture in Wales, if it is the Leader of the Opposition’s blueprint, is perhaps not as convincing as the shadow Health Secretary would have us believe.
The fundamental difference between the current systems in England and Labour-run Wales is that Wales has a capitated list system for dentistry. I am willing to give way so that the shadow Health Secretary can clarify whether he wants to bring in that system.
Wes Streeting
I cannot believe that is meant to be the right hon. Lady’s big “Gotcha.” She cannot even tell us when she will bring forward her plan, let alone what is in it. They have had 14 years to come up with a plan. This is absolutely astonishing. As much as I enjoy these partisan knockabouts at the Dispatch Box, the sight of the Health Secretary giggling and laughing at her own jokes will be of small comfort to people who are literally pulling out their own teeth.
Victoria Atkins
Just to cut through all the froth, the hon. Gentleman has not, in fact, answered my invitation. Does he wish to have a capitated list system, as they have in Wales, or does he have other plans? Could he please answer?
Wes Streeting
Like any responsible Government, we would consult the dentistry profession, the BDA, and come up with a serious programme for dentistry reform. If the right hon. Lady wants to ask me questions and have me answer them, the Government should call a general election and I will happily oblige.
Victoria Atkins
Again, cutting through the froth, the hon. Gentleman called this debate and has not set out his plan. He knows full well that this is an Opposition day debate and I am responding to Labour’s motion by moving an amendment. He has no plan on dentistry. When I asked him to clarify whether he will follow the capitated system in Wales, he declined to answer. I assume that is because he knows we tested a prototype system based on the Welsh capitation approach here in England, and the results were clear. It worsened access and widened oral health inequalities.
The hon. Gentleman quoted the Nuffield Trust, placing great emphasis on it, in his opening speech. As he agrees so much with the Nuffield Trust’s report, does he also agree with its former chief executive who said that his ideas on general practice represent
“an out of date view”
and “will cost a fortune”?
It is becoming increasingly clear that the Labour party’s approach to our NHS is empty words about reform followed by the phrase “funded by non-doms.” We are very lucky in this country—on this side of the House we consider ourselves blessed—to have incredible dentists working across the NHS.
Here are some facts for Opposition Members. There are now 1,352 more dentists working in the NHS than 14 years ago, thanks to the stewardship of this Conservative Government. I thank them and their colleagues for everything they do, and we are backing them to build a brighter future for NHS dentistry by taking concrete steps to improve recruitment and retention. That is why our long-term workforce plan, the first in NHS history, will expand dentistry training places by 40%, providing more than 1,100 places by 2031, which will be the highest level on record under any Government.
Over the same period, this Government’s plan will also increase training places for dental therapists and hygiene professionals to more than 500. The importance of the long-term workforce plan to dentistry’s future was recognised across the sector, and Professor Kirsty Hill, who chairs the Dental Schools Council, backed our plan:
“Expansion is a significant and positive development, and we commend the government for recognising the importance of increasing dental hygiene and dental therapist positions. These roles play a vital role in enhancing capacity and improving care.”
Debbie Abrahams (Oldham East and Saddleworth) (Lab)
I find it absolutely extraordinary that the Health Secretary lectured the shadow Health Secretary on calling a debate to hold this Government to account. Twelve million people are not able to access dental care, including thousands in my Oldham constituency.
Madam Deputy Speaker (Dame Rosie Winterton)
Order. The hon. Lady knows that she must not refer directly to other Members.
Victoria Atkins
I think the hon. Member for Oldham East and Saddleworth (Debbie Abrahams) was raising her voice at me, but it was not me who heckled her. I recognise the passion she brings to her intervention, and I simply made the point that this is an Opposition day debate. The hon. Member for Ilford North understandably set out some of his plans, which is his job, and I was merely questioning him on the detail of those plans. Sadly, he was not able to provide that detail.
The long-term workforce plan is about not just training more staff but delivering value for hard-working taxpayers. Currently, around a third of dentists do not carry out any NHS work. This simply is not fair on the taxpayers who fund their training, which is why, through the long-term workforce plan, we are exploring the introduction of a tie-in period that encourages dentists, after they graduate, to spend a minimum proportion of their time delivering NHS care. We have also made it easier for experienced dentists from around the world to come to the UK to ply their trade, which is apparently something with which Labour Members do not agree.
Last year, we brought forward legislation to give the General Dental Council greater flexibility in administering the overseas registration exam. The Government welcome its decision to triple the capacity of the next three sittings of part one of the ORE, from August last year, and to increase the number of sittings of the second part of the exam from three to four, creating an additional 1,300 places. Ministers will continue to meet the GDC to discuss how we can make these flexibilities as effective as possible, to get more dentists into the NHS workforce delivering care for patients.
Seema Malhotra
I thank the Secretary of State for giving way. It is worth repeating that the Nuffield Trust has warned that NHS dentistry is at its most perilous point in its 75-year history. That goes alongside recent Healthwatch polling suggesting that one in 10 people in England have ended up paying for private dental treatment in the last 12 months because they could not find an NHS dentist. It has been the same in my constituency, where the majority of dental surgeries are not taking on new patients. Can the Secretary of State explain how on earth things have got this bad?
Victoria Atkins
I trust that the hon. Lady has been listening to the whole debate, because I set this out in some detail at the beginning of my speech. I will not repeat the impact of the pandemic, but I hope she has taken on board the £1.7 billion of investment that has already seen a sizeable increase in the number of adults and children being treated by NHS dentistry.
I do not pretend that this is the full stop at the end of the sentence. We have a plan and I look forward to our debate when that plan is published, because I suspect it will be welcomed across the House.
Dominic Raab (Esher and Walton) (Con)
I commend my right hon. Friend for her powerful speech. The plan will improve financial incentives for NHS dentists and support practices to take on new patients, but to what extent will she and the plan take on board high operating costs and, indeed, the high cost of living in areas where there is high demand for NHS dentistry?
Victoria Atkins
I thank my right hon. Friend for his intervention. I can imagine that the concerns he outlines are very pressing in his constituency, and one important priority behind the dental recovery plan work is addressing health inequalities. Although I have spoken about rural and coastal areas from a constituency perspective, we also understand, of course, that there are differing cost of living pressures in different parts of the country. He makes an important point about the costs for NHS dentists operating in very expensive parts of the country, such as his constituency, and I thank him for doing so.
Our workforce is not just made up of dentists; dental care in England could not function without the vital contribution of dental and orthodontic therapists, dental hygienists, dental nurses and clinical dental technicians. We recognise the importance of harnessing the skills and knowledge of all those professionals. They can support dentists to carry out first-class care, and we must empower them to take on more responsibility and to work at the top of their licences. That is why last year we issued guidance to NHS practices, supporting them to make the most of everyone in the dental team and make a difference to patient care. Since then, NHS England has made it clear that dental therapists and dental hygienists can provide patients with direct care, provided they are appropriately qualified, competent and indemnified. We have also run a consultation to enable dental therapists and hygienists to deliver more treatments. That will boost access to care for patients and support dentists, and we will be setting out our next steps shortly.
Victoria Atkins
I am conscious that Opposition Members will want time today, so I am going to bring my remarks to a close. It is my mission, as Health and Social Care Secretary, to build an NHS that is faster, simpler and fairer, and of course I include dentistry in that work. We have taken the long-term decisions that will improve access to dental care. Delivering 6 million more courses of treatment, expanding dentistry training places by 40% and making it easier for patients to find a dentist to deliver the care they need are just some of the ways in which we are going to achieve that. Of course, we must make sure that dentists are properly rewarded for all the work they do. Through our soon-to-be-published dentistry recovery plan, we will go further, to make NHS dentistry accessible and available for everyone who needs it, no matter where they call home in this great country.
Several hon. Members rose—
NHS Winter Update
Victoria Atkins Excerpts(10 months, 2 weeks ago)
Commons ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
The Secretary of State for Health and Social Care (Victoria Atkins)
With permission, Mr Deputy Speaker, I would like to make a statement on the winter pressures facing the national health service and social care, as well as the impact of the ongoing junior doctors’ strikes. The NHS employs 1.3 million people and the social care system a further 1.5 million people. Together, they treat and care for tens of millions of people every day. We all know that winter is the most challenging time of the year for the NHS and social care, as our workforce have to tackle the pressures created by cold weather and seasonal viruses.
To put our health and social care system in a strong position heading into winter, this year we started preparing earlier than ever before. In January last year, we published our recovery plan for urgent and emergency care and provided £1 billion of dedicated funding to boost emergency capacity. The plan committed to delivering 5,000 new permanent staffed beds. I am pleased to update the House that more than 3,000 were already in place in December, and in the coming weeks NHS England will meet the 5,000 pledge and make sure that it has almost 100,000 core beds ready when covid and flu peak.
Our recovery plan also pledged 10,000 virtual ward beds so that more patients can be monitored safely at home, away from hospital. I am pleased to update the House that we have delivered more than 11,000 virtual ward beds, and they have been a vital service for eligible patients over the festive period.
We have boosted our ambulance service with £200 million of additional funding, putting new vehicles on the road, improving response times and getting crews out and about for more hours. In recognition of the importance of patients being discharged promptly from hospital when it is safe to do so, we have made sure that every acute hospital in England has access to a care transfer hub, bringing together teams from the NHS and social care to speed up discharge, backed by an extra £600 million for social care. To help prevent the spread of winter viruses, we brought forward flu and covid vaccinations, protecting the most vulnerable and making them less likely to require hospital treatment.
But no matter how thorough our preparations are, winter will always be the most challenging time of the year for our NHS. That is why it is extremely regrettable that the British Medical Association’s junior doctors committee has chosen to strike not once, but twice at this time of year. It has also chosen to strike for an unprecedented length of time, putting profound pressure on hospitals and GP surgeries throughout the country.
Before Christmas, the BMA’s strike caused the cancellation of almost 90,000 appointments, some of which will have to be rescheduled for a second or even third time. That is in addition to the 1.1 million appointments that have already been affected since strikes began in December 2022. This is not just another statistic; there is a person behind every one of these appointments, who may be in pain or distress and who now must wait longer for the care they deserve.
Last week, a member of the BMA leadership said
“strike action benefits absolutely nobody.”
They were absolutely right on that. The ongoing strikes are causing more appointments to be cancelled and more worry for patients, and are putting a significant strain on staff.
During December’s and this week’s strikes, the NHS’s priority has been to protect patient safety. Resources have been channelled into urgent and emergency care, including vital neonatal and maternity services. Huge efforts were made to make the most of the working days between Christmas and new year, because throughout any strike action, it is crucial that every patient who needs urgent medical care comes forward as normal. We continue to face challenges, and strikes have stretched emergency care, but thanks to the meticulous hard work in local trusts in preparing for strikes, as well as to the huge personal sacrifices that clinicians and staff are making to pick up the slack, emergency care has largely held up and the system has coped under the circumstances.
Staff across the NHS deserve our sincerest thanks for the heroic efforts they have made throughout the unprecedented strikes. I thank the doctors, nurses, paramedics and all frontline staff who have come into work to support each other, deliver care and protect patients; the consultants, including Members of this House, who are working extra hours, cancelling their holidays or even coming out of retirement to safeguard patient safety; the managers, administrators and NHS leaders who are working day and night to make sure that the right staff are in the right place to protect patient safety; and all those working in social care, from local authority staff to care workers and carers, who have rallied round to support hospitals.
I know that work does not stop when the strikes stop. NHS staff will begin turning their attention to recovering from the impact of the industrial action, restarting elective treatment and improving the flow of patients through emergency departments. The junior doctors committee’s choice to strike at this time of year means that that work must now be done under additional pressures, as staff move to catch up from industrial action as well as tackling the impacts of cold weather, covid, flu and norovirus.
I want to find fair and reasonable solutions to industrial action. One of my first acts as Health and Social Care Secretary was to bring in the British Medical Association for talks to end these long-running disputes, as well as meeting representatives for Agenda for Change unions who speak for frontline staff, including nurses. We have reached agreements with unions that represent consultants and specialty doctors on offers to be put to their members. Those offers will modernise contracts, realign pay scales and improve doctors’ career progression, while delivering value for the taxpayer and protecting the hard-won progress we have made to halve inflation. Consultants and specialty doctors are pausing strike action while members vote on the offers, with the results of both ballots expected shortly. The Government and BMA agree that they are the best deals available to us, and I very much hope that members will vote in favour so that those positive changes can be made and we can move the NHS forward.
On junior doctor negotiations, the talks that began in November had been progressing with the BMA junior doctors committee. The talks were constructive, exploring a range of proposals that would improve the working lives of doctors across the NHS. I was therefore extremely disappointed when the BMA turned its back on the negotiations before they had concluded to call the damaging strikes that we face today. The Government will not negotiate with the BMA while strike action is under way and patient safety is at risk. Every strike is hugely disruptive for our NHS. The NHS and patient safety cannot be switched on and off on a whim. I do not believe it right to negotiate with unions while they are being unreasonable and some of their members are walking out of hospitals at the busiest and most challenging time of year for patients.
I remind the House that the junior doctors committee’s headline demand of a 35% pay rise is simply unaffordable for taxpayers. Last summer, we accepted the recommendations of the independent pay review body in full. That meant that junior doctors received average pay rises of almost 9% in their September pay packets—some of the most generous increases across the entire public sector. Meeting the 35% demand would stoke inflation just as we as a country have halved it, burning a hole in the pockets of families up and down the country, and it would be totally out of step with the pay rises awarded to other dedicated public servants and employees throughout the private sector. Staff across the public sector have agreed fair and reasonable deals on pay; only the junior doctors committee has repeatedly walked away from talks.
Let me address the issue of NHS leaders asking some junior doctors to return to work when patient safety is at risk, in what are known as patient safety mitigations or derogations. As of 9.30 this morning, 40 patient safety mitigations have been submitted during the current round of strikes, and two have been accepted by the BMA. NHS leaders, many of whom are themselves members of the BMA, have decades of combined experience. They know their patients and they know their rotas, and they would ask for mitigations only if they were absolutely necessary—in, for example, a children’s emergency department. They are wholly independent of Government: it is for them to make those decisions. I trust them and I trust their judgment. That is the reality, and that is the truth about patient safety mitigations.
One of the reasons why I came into politics was the NHS and what it had done for me and my family. That is also one of the reasons why I am a Conservative. This is a Government who have delivered record NHS funding, the first ever NHS long-term workforce plan, and 50,000 more nurses for our NHS. We are providing the NHS with the doctors it needs for the future by doubling the number of medical school places, opening five new medical schools and pioneering one of the world’s first medical apprenticeships. We have also supported doctors by making changes to pensions for those at the very top of their career path—at that point, that was the BMA’s No. 1 ask, and a policy that the Opposition seemed to oppose.
Those are not the actions of a Government who are turning their back on the NHS, as some have declared. They are the actions of a Government who are building a health and social care system that is sustainable for the long term. To do that, we must put the strikes behind us and move forward together, because the NHS belongs not just to the junior doctors committee: it belongs to us all. It belongs to the millions of people who rely on its being there when they need care, as well as the millions of taxpayers who pay for it. For their benefit, it is time for the members of the junior doctors committee to show that they are serious about doing a deal. They have legitimate concerns about their working lives, and a fair and reasonable deal can be reached, but calling damaging strikes is not the way in which to achieve that. Earlier this week I said that if they called off their damaging strike action, I would get round the table with them in 20 minutes. I am, of course, extremely disappointed that they refused my offer, and continue to refuse it—the strikes are ongoing as we speak—but if they come to the negotiating table with reasonable expectations, I will sit down with them.
This Government have a clear, long-term plan for the NHS. Our recovery plans in elective, emergency and primary care can improve access to treatment, transform services, and give patients more choice in and control over their care. Our long-term workforce plan will give the NHS the staff it needs to thrive for decades to come, our social care reforms will build a better care workforce to support our growing number of older people, and by creating the first smoke-free generation we will reduce long-term pressure on our health service. We have eliminated the longest waits, but we have not yet made a significant enough reduction in waiting lists. To do that, we need the junior doctors committee to come to the table and do a deal that is in the interests of patients, in the interests of our NHS, and in the national interest. Then we can build an NHS that is not only stronger today, but stronger for our children and grandchildren.
I commend this statement to the House.
Wes Streeting
Patients are sick and tired of waiting—waiting for ambulances, waiting for a GP appointment, waiting for their operation and waiting for a general election that cannot come soon enough. Why do the Conservatives not get out of the way and let Labour fix the mess they have made?
Victoria Atkins
I welcome the hon. Gentleman back from his world tour promoting his book. It is very nice to meet him for the first time across the Dispatch Box. While he was away in sunnier climes, he may have missed what is actually happening in Wales, which interestingly has been described by the Leader of the Opposition as the “blueprint” for how Labour will run the NHS, were it ever to come into government. Interestingly, in the Labour-run Welsh NHS, people are almost twice as likely to be waiting for treatment, and they are waiting an average of five weeks longer for NHS treatment under Labour in Wales than they do in England. Indeed, the number of patients in Wales seeking treatment in England has increased by 40% in two years because of the experiences that people are having in Wales.
I will just correct the hon. Gentleman on a couple of other things, too. Just to help him understand, we are delivering the 800 new ambulances—those are new ambulances—at pace at the request of the NHS, just as we are putting in 5,000 extra beds in hospitals across England, because we understand the point about capacity and we want to help the NHS look after people in a timely and efficient manner.
I will also just correct him again on the doctors in training point. I am surprised he has come on to that at this point, but had he spoken to his friends in the BMA, he would have understood that that is the phrase that the BMA is using. It has passed a motion to stop using the phrase “junior doctors”. [Interruption.] Yes, the BMA passed a motion. The hon. Gentleman referred to doctors, but he perhaps does not understand the complexities of contractual negotiations. The phrasing is used to denote those professionals who are still on formal training pathways who are not specialty doctors or consultants. That terminology has been agreed with the BMA.
In terms of the strikes themselves, I note—I know that those sat behind me on the Government Benches noted it, too—that the hon. Gentleman did not condemn the strikes. I am happy to give way, if he would like to confirm whether he condemns the strikes. Unfortunately, he has missed his chance to do so, but I suspect that everybody, including the patients at home waiting for appointments, will see the Labour shadow Minister’s failure to condemn these strikes. That is because, in line with public sector strikes more generally, the Labour movement will always prioritise union harmony over patient safety. That is not what we as Conservatives do; we will always put patient safety first.
Mr Deputy Speaker (Sir Roger Gale)
I call the Chair of the Health and Social Care Committee.
Steve Brine (Winchester) (Con)
Happy new year. The Secretary of State will know that it is far from all doctors in training who have taken part in this strike. In my trust, Hampshire Hospitals, it was just over 60%, and the average across the south-east was little more than 50%. Many doctors were hard at work this past week caring for their patients. Does my right hon. Friend share the concern of many in the health service that the longer this dispute drags on, the more we lose the good will of the consultants who have been filling in and the more we do serious damage to the career pipeline that sees today’s doctors in training become tomorrow’s consultants?
Victoria Atkins
I thank my hon. Friend for asking that question and for noting the enormous efforts that clinicians across the NHS have gone to in order to cover these strikes. We are conscious of the personal impacts that has had for many, and clinicians have had a very tough few Christmases. We were all collectively hoping that this Christmas would be just a little bit easier for them, but sadly these strikes have a real impact on people who are working to pick up the slack from junior doctors not turning up. I am grateful to everyone who has gone into work, who has worked extra shifts and who has cancelled time off with their families. We must find a fair and reasonable solution to this industrial action, which is precisely why I was so very disappointed that the BMA junior doctors committee chose to walk away from these discussions.
Mr Deputy Speaker (Sir Roger Gale)
I call the Scottish National party spokesperson.
Amy Callaghan (East Dunbartonshire) (SNP)
A very happy new year to you, Mr Deputy Speaker. Our NHS faces an unprecedented winter of pressure, with inflationary costs, increasing viral infections and staff shortages. While the SNP Scottish Government have acted with £300 million to cut waiting lists and negotiated with NHS staff, preventing even a day of strike action, NHS England is undergoing a junior doctors strike—the longest in the history of any NHS in the UK. No one wants strike action, but it works, which is exactly why the Tories want to ban it. In fact, this Tory Government appear to be working to make this winter harder by cutting NHS capital funding, undercutting attempts to recruit new staff and not getting round the table with trade unions, instead blaming the BMA and junior doctors. Is the decision to underpay NHS staff and stoke strikes the policy of this Health Secretary, or is she being forced down that path by a Chancellor who is continuing his decade-long war on junior doctors?
Victoria Atkins
I imagine that the hon. Lady has seen that we accepted in full the pay review body’s recommendations last year and, as of September, junior doctors and doctors in training have received on average an 8.8% increase on their basic salaries—they also earn money on top for antisocial hours, working overtime and so on. In addition, they have pension contributions of some 20%, which is a rare employment benefit across both the public and private sectors. In the future, I want to find a fair and reasonable settlement with the junior doctors, as we have been able to reach with consultants and specialty doctors, but we cannot do that if junior doctors are on strike. That is why it is so very disappointing that they walked away from the discussions.
Mr Deputy Speaker
I am sure that we all wish to welcome Sir David Evennett back to the House in rude health.
Sir David Evennett (Bexleyheath and Crayford) (Con)
Thank you, Mr Deputy Speaker. I welcome my right hon. Friend’s factual statement on the state of the NHS in her winter update. Will she confirm that she would return to the negotiating table immediately were the BMA to call off these very damaging strikes?
Victoria Atkins
I welcome my right hon. Friend back. I have said throughout this that I was extremely disappointed that the committee chose to walk away from discussions. I also think that there is a lot more to discuss apart from pay—I have made it clear that I would like to look at other aspects of their working conditions—but, unfortunately, the junior doctors committee walked out. The strike action has had a real-terms impact on patients. We need to find a fair and reasonable solution, but I will not do that while the junior doctors committee maintains strikes. It will have to come to the table with reasonable expectations and change their minds on the validity of strike action.
Rachael Maskell (York Central) (Lab/Co-op)
We have had 14 Tory winters. One would have thought that they would learn by now that the real crisis in our NHS is that social care is not up to scratch. A quarter of patients in my local hospital are waiting for social care. As a result of jamming the back door, the front door becomes inaccessible to so many patients. After all these years, when will the Secretary of State publish a proper plan for social care, or will she leave it to my right hon. Friend to take over?
Victoria Atkins
I am so sorry, I do not know who the hon. Lady is referring to. On the Conservatives’ plans, at the 2022 autumn statement we announced up to £7.5 billion of additional funding—an historic increase—and we did not stop there. This summer, we announced an additional £600 million, which brings it up to £8.1 billion of additional funding over two years. That will support our care workforce, and the majority of the funding will end up in the pockets of the amazing people who provide care and support to the patients we are all concerned about.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
I declare my interest as a member of the BMA and an NHS consultant who has worked during the industrial action. Let us make no mistake that these strikes are causing suffering to patients, both adults and children. The derogation process has not worked because, as the Secretary of State said, the BMA has not returned junior doctors to work when they have been asked to—where there has been a risk of dangerous harm to patients. The first duty of any Government is to protect their citizens, so when will the Secretary of State bring forward the minimum service levels to protect patients from these dangerous strikes?
Victoria Atkins
First, I sincerely thank my hon. Friend. I was in contact with her over the weekend when she had come off a very long shift in emergency care, looking after patients locally. I have nothing but admiration for her and the many, many other people who stepped in at short notice to cover urgent and emergency care in our NHS during the strikes. On minimum service levels, she will know that we have already introduced them for ambulance services—something that was opposed by the Labour party—but we have just closed the consultation on minimum service levels in hospitals and we are, of course, carefully analysing the responses. Again, the point that 40—four zero—patient safety mitigations were made by NHS leaders yet only two were granted by the BMA, is very, very worrying when it comes to how seriously the BMA is taking concerns about patient safety.
Daisy Cooper (St Albans) (LD)
A few weeks before Christmas, NHS bosses were here in Parliament briefing MPs that, notwithstanding their preparation for the winter crisis, the one thing that would push them to the brink would be a rise in respiratory illness. Now here we are: cases of flu, covid, RSV—respiratory syncytial virus —and whooping cough are all rising rapidly. A strong public health intervention by the Government could have prevented that from happening. When will the Government get serious about public health interventions such as vaccine uptake, air filtration and protecting the immune compromised to stop people getting so ill so often for so long?
Victoria Atkins
I thank the hon. Lady for re-emphasising the critical timing of the strike actions and the impact it has on patients. We know that winter is difficult. It is not just difficult for our healthcare system. Around the world, when cold winter strikes, it has physiological impacts on people with underlying health conditions. We also have a rise in infectious conditions, too. As she will appreciate, that is precisely why, on the advice of clinicians, we brought forward the flu and covid vaccination programme to try to protect the most vulnerable in our society. But again, the timing of the strikes is so very cynical, because their impact and tail will, I am sorry to say, have consequences beyond tomorrow’s stop date.
Dr Thérèse Coffey (Suffolk Coastal) (Con)
I was really concerned when my right hon. Friend mentioned the number of requests made to the BMA for certain duties in hospitals and that only two had been responded to positively. That is really concerning for patients. Contrast that with the behaviour of Nick Hulme, the acting chief executive at Norfolk and Norwich University Hospital, who has transformed its A&E in terms of waiting times. We need to promote such leaders, but we also need to unreservedly condemn the actions of the BMA junior doctors committee and get the strikes over and done with.
Victoria Atkins
I thank my right hon. Friend for her work in the Department. She knows only too well the difference an inspirational leader can make to a local NHS trust, and at regional or national level. Managers who are good and committed to their local area, who work with their clinicians and other healthcare staff to try to look after patients all year round, have been put under the most enormous pressure over the last few weeks because of the strikes. I thank every single one of them for doing what they can to safeguard patient safety. As I say, I trust their judgment. If they have put patient safety mitigations in, it is because they consider, in their professional judgment, that they are needed.
Dame Diana Johnson (Kingston upon Hull North) (Lab)
The public health director in Hull published her report recently. She talked about the double jeopardy that my constituents face: from the most disadvantaged communities, they have shorter lives in far poorer health. At the end of last year in A&E, patients were less likely to be treated within the four-hour target than anywhere else in England. Why is that after 14 years of a Conservative Government who are committed, apparently, to levelling up?
Victoria Atkins
I am extremely grateful to the right hon. Lady, who will know that our constituencies, albeit not necessarily in the same region, nevertheless share similarities, being relatively close to each other. The work and the progress made on urgent and emergency care is precisely because we were concerned about, for example, ambulance response times and hospital discharges. We worked with NHSE to bring together the urgent and emergency care plan and, for example, bring about 800 new ambulances on to our roads and about 5,000 more core beds into the NHS to try to address those needs. Unfortunately, the strike action that we have seen over recent days has very much militated against those efforts. We all accept that winter is a very difficult time for the NHS, and through the urgent and emergency care plan we have worked with NHSE to try to meet the demands that she so rightly puts forward.
Mr Robin Walker (Worcester) (Con)
I welcome the Secretary of State’s commitment to reaching a fair and reasonable solution to the strikes. Worcester went into this winter with the delivery of a new emergency department and was able to deliver 21 beds-worth of extra capacity over the winter, but I have heard from the hospital today that it is still facing intense pressure. Will the Secretary of State join me in paying tribute to the staff who are working around the clock to meet that pressure, and will she support the South Warwickshire University NHS foundation trust as it works to address some of the key transport bottlenecks on its site, in the interests of patients and staff alike?
Victoria Atkins
My hon. Friend sets out clearly the many pressures and factors at play in running emergency departments and hospitals at the best of times, when we are not in the middle of winter and facing the pressures that it always brings on the healthcare system. I thank not only staff in his trust, but staff throughout the country for the work they have done over recent weeks to support the NHS and to bring treatment to patients. We are working hand in glove with NHSE regional and local leaders to see whether there are practical measures that can be taken to improve the flow through hospitals.
Tim Farron (Westmorland and Lonsdale) (LD)
NHS winter pressures are having a huge impact on cancer surgery and other cancer interventions. In Cumbria, in the south of the county 25% of those with a cancer diagnosis are waiting more than two months for their first intervention, and in the north of the county 47% are waiting more than two months. We know that every month’s delay in treatment means a 10% reduction in people’s chances of surviving. Some 123 cancer operations have been cancelled in the last year in our area. One reason is the lack of investment by this Government, and their predecessors of all colours, in radiotherapy. Will the Secretary of State agree to meet me and Conservative and Labour members of the all-party parliamentary group for radiotherapy, which I chair, to look at solving the problem by investing in the kit that Britain desperately needs to save lives?
Victoria Atkins
I hope the hon. Gentleman will be interested to know that we have made cancer treatment waiting times a key focus of our elective recovery plan, which has been backed by an additional £8 billion in revenue funding across the spending review period. We have made progress by delivering record numbers of urgent cancer checks, with more than 2.9 million people seen in the 12 months to October last year. Of course there is more to do, and I would be very happy to meet him and colleagues across the House to discuss the practical ways by which treatment can reach our constituents. He will not be surprised to know that cancer is a priority not just for me personally, but for the Government as a whole.
Will Quince (Colchester) (Con)
I welcome my right hon. Friend’s statement; there is a lot in it to welcome, but I particularly welcome the additional 11,000 virtual ward beds. Hospital at home is hugely popular and we know it takes pressure off our hospital. I thank all of the clinicians who helped to make that possible. Can she confirm that it is her intention now to go further and roll it out to more hospitals and more specialties, so that more patients can recover at home?
Victoria Atkins
I thank my hon. Friend for all his work in making that happen. He worked very hard on virtual wards when he was a Health Minister, and they represent a real step change in how we treat people with long-term conditions who can be monitored safely at home. They mean that people do not have to spend time in hospital, with all the pressures that can mean for us as individuals. Importantly, that also frees up beds for other patients who need them. I am keen to roll the scheme out further. Indeed, we have not just met but exceeded our initial ambition, which is why I can confirm that we have delivered 11,000 places in the virtual bed ward category.
Clive Efford (Eltham) (Lab)
The BMA says that junior doctors’ pay has been cut in real terms by 26% through consistent below-inflation increases. If the Tories really cared about this strike and about the NHS, would they not have avoided creating the circumstances that made junior doctors so angry that they felt the need to go on strike? Does that not just show that you cannot trust the Tories with the NHS?
Victoria Atkins
The figure that the BMA relies on is in fact from 2008, when the Labour party was in government for the first two years. The BMA cites a 35% pay rise. Just to clarify, independent organisations such as Full Fact and the Institute for Government rely on the consumer prices index measure, which shows a difference of 11% to 16%. I am sure that the hon. Gentleman will take into account the fact that we have already given graduate doctors, in their first year out of medical school, a rise of 10.3%, and I was willing to negotiate further and consider additional settlements that are fair and reasonable to the taxpayer.
Steve Double (St Austell and Newquay) (Con)
Is the Health Secretary aware that the impact of these strikes on the Royal Cornwall Hospitals NHS Trust has seen more than 7,000 appointments and operations cancelled and several million pounds in extra costs to the trust—and that is before the most recent strikes. Does she share my concern that the junior doctors are pursuing an unreasonable pay demand and causing lasting damage to patients and the finances of the NHS?
Victoria Atkins
My hon. Friend is a brilliant advocate on the challenges facing his rural and coastal community. We all know that geography is a factor in the difficulties of delivering healthcare in his corner of England, but everything the trust and clinicians do is about trying to improve healthcare for his constituents. I cannot be the only one who felt uncomfortable at the image of some on the picket lines last week singing while our constituents were struggling with cancelled appointments and worried about urgent and emergency care times. I am very keen that we should reach fair and reasonable settlements with junior doctors, but in order for that to happen they must act reasonably, change their minds and call off the strikes.
Sarah Edwards (Tamworth) (Lab)
Recently, Tamworth had clarification that mental health provision at the George Bryan Centre would not be invested in. From now on, patients must travel to Stafford for crisis care. Labour has pledged to recruit 8,500 more staff for community-based talking therapies in order to reduce waiting times and crises. Why have the Government not put in place a plan to recruit more NHS mental health staff?
Victoria Atkins
We have—in the NHS long-term plan. We have set an ambition to grow the mental health workforce by an additional 27,000 staff between 2019-20 and 2023-24. That is in addition to the at least £2.3 billion of additional funding a year by March this year.
Holly Mumby-Croft (Scunthorpe) (Con)
We are delighted to have our new community diagnostic centre, and of course our new A&E, under way in Scunthorpe. However, my right hon. Friend will know that we are fighting incredibly hard to prevent the loss of some of our hospital services. Of the hundreds of local residents who responded to my survey, over 98% agreed with me that we must not lose those services. Does my right hon. Friend agree that, in order for the NHS to provide resilience during the winter and the services that it wishes to provide to patients, hospital bosses need to listen carefully to what patients think?
Victoria Atkins
Indeed. I thank my hon. Friend for all the hard work and advocacy she puts in on behalf of her constituents. If I may, I will ask the Minister for Health and Secondary Care to visit my hon. Friend’s hospital to discuss with her the concerns of local residents and to ensure that the trust is aware of them.
Richard Foord (Tiverton and Honiton) (LD)
Two GPs from Seatown, in my part of Devon, moved to Australia to practise a little over two years ago. Both are working as full-time GPs, with no gaps in their career, and they now wish to return to east Devon to help ease winter pressures. Retesting someone who returns to England is lengthy, costly and bureaucratic, and it does not take into account practice in similar primary care settings. Can NHS England not make it easier for UK-trained GPs working in Australia, New Zealand or Canada to return to general practice in England?
Victoria Atkins
That is a very fair challenge, and I will look into it, given that the hon. Gentleman has raised it.
Alun Cairns (Vale of Glamorgan) (Con)
The Labour party has been running the NHS in Wales for the last 27 years. The shadow Secretary of State, the hon. Member for Ilford North (Wes Streeting), highlighted that he was frustrated with waits for ambulances, GPs and operations. I politely point out to him, and to other Members, that my constituents in the Vale of Glamorgan, and people across the whole of Wales, are waiting much longer for ambulances, GPs and operations. In fact, a quarter of my constituents, and a quarter of people across the whole of Wales, are on an NHS waiting list. I advise my right hon. Friend the Secretary of State that junior doctors and GPs are also in disputes in Wales, despite the claims made by Opposition Members. I therefore ask her to show some caution before taking advice from her shadow.
Victoria Atkins
I will follow that advice with great enthusiasm. I have another statistic for my right hon. Friend: the Labour-run Welsh Government were hiding 45,000 patients from their A&E waiting figures in the first half of 2023, and falsely claiming that they perform better than England. If that is the blueprint for how it runs things, we should all be very worried if Labour ever again forms a UK Government.
Alison McGovern (Wirral South) (Lab)
Further to the question from my hon. Friend the Member for Tamworth (Sarah Edwards), it was disappointing that the Secretary of State did not mention mental health in her statement. Given the rising levels of destitution and chronic bad housing in our country, mental health services have winter crises too these days. What progress is she making in developing proper waiting times for people in need of mental health services?
Victoria Atkins
I reassure the hon. Lady that the impact of mental health patients remaining in A&E for any length of time, let alone beyond 72 hours, is genuinely a metric and factor that we look at very carefully, as we have done throughout the strikes. We appreciate that A&E is not the right environment for most people who are suffering from a mental health illness or a psychotic episode, and we want to move them into appropriate care as quickly and safely as we can. With that in mind, I hope that she will welcome the fact that we are spending some £7 million for up to 100 mental health ambulances over the next two years, to try to ensure that people get the right care they need, when they need it. More than 160 projects are being allocated funding in the community, including crisis cafés and safe havens, so that hopefully people are caught before the crisis happens and they end up in A&E.
Alberto Costa (South Leicestershire) (Con)
I welcome the winter update from the Secretary of State. There is actually a winter update going on in South Leicestershire. Will she join local NHS stakeholders there, and me, in encouraging South Leicestershire’s constituents to respond to the consultation on the future of the Feilding Palmer Hospital? The deadline is 14 January.
Victoria Atkins
I would be happy to do so. I am pleased to hear of local NHS leaders actively seeking the views of the patients and communities they serve, in order to ensure that their services are what the public expect from their local hospitals, and from primary and secondary care services.
Justin Madders (Ellesmere Port and Neston) (Lab)
I remember a former Conservative Prime Minister promising to fix social care, yet I am still hearing of too many patients who are medically fit for discharge being stuck in hospital. This time last year we had a record high of about 14,000 patients stuck in hospital who were fit for discharge. Will the Secretary of State tell us what the figure is at the moment, and whether she expects it to go up or down before the end of the month?
Victoria Atkins
We are making progress. The hon. Gentleman will appreciate that that figure alters not just day by day, but hour by hour. We have been investing in social care packages precisely because we understand the importance of being able to discharge people promptly and safely into the appropriate social care setting, which can have a huge impact on flow through the hospital.
Other factors can also have an impact on flow, such as practical measures for people who perhaps do not need social care help when they leave hospital. We are looking at what we can do to improve those local factors as well. The hon. Gentleman is right to make the point that the social care system goes hand in hand with our NHS and hospital care. That is why we have been so keen this year to inject extra investment into social care—to try to alleviate some of the issues that he rightly raises.
Andrew Percy (Brigg and Goole) (Con)
The shadow Secretary of State seemed to forget the 50,000 hospital beds that Labour closed when they were in government—the thousands of mental health beds and the large number of wards they closed, including at Goole and District Hospital. But I digress.
I spent Christmas on duty as a first responder at the Yorkshire Ambulance Service—as the Secretary of State knows, the Minister for Health and Secondary Care performs the same role at the North West Ambulance Service—so I can attest to the professionalism and dedication of our ambulance services and of our 999 dispatch centres and the clinical hub that supports us at scene. Ambulance crews bear the strain not only of winter pressures year in, year out, but of this doctors’ strike. I urge the Secretary of State to pay tribute once again to their work and, as I have said before in this place, to consider what we can do to expand community paramedicine, so that, as demography changes and more older people are cared for at home, more people can be treated at scene rather than being taken to A&E.
Victoria Atkins
I pay tribute to both my hon. Friend and my right hon. Friend the Minister for Health and Secondary Care for their work as first responders. I would get into a lot of trouble in my own constituency if I did not mention the wonderful LIVES—our community first responders, who get to the scene of road accidents or emergency calls before ambulances and conduct the most extraordinary and complex procedures very safely on patients when they need it.
Recently, I was pleased to visit the London Ambulance Service to see for myself what team work can achieve across an ambulance service and how these highly qualified and experienced individuals can make a real difference to people’s lives and health after recovery. I send my sincere thanks to everyone who has been working in those capacities in recent weeks and over the festive period.
Janet Daby (Lewisham East) (Lab)
We have gone from no winter crisis when Labour left office to an annual winter crisis—and now a crisis all year round under this Conservative Government. Patient satisfaction with the NHS is at a record low. Instead of there being a blame culture, when will the Secretary of State accept responsibility for that appalling record?
Victoria Atkins
I think the hon. Lady was claiming that there was no winter under Labour, but perhaps that is yet another thing that does not quite stack up. I fully endorse her call for an end to blame culture, but point her to the real and practical measures that we have taken to improve urgent and emergency NHS care. I assume that she joins those on the Government side in condemning the unprecedented strike actions that the junior doctors committee has called at this particular time of year.
Richard Graham
Having chaired more than 150 meetings between Gloucestershire MPs and our NHS leaders, this week I am handing over the baton to my neighbour, my hon. Friend the Member for Tewkesbury (Mr Robertson). My two thoughts are, first, to share the Secretary of State’s immense gratitude to everyone in the Gloucestershire Royal Hospital and our other services for all their continuing, amazing work; and secondly, to highlight that the biggest single impediment to reducing the elective surgery backlog—the hips, knees and much more of many of our constituents—is this continued strike by doctors in training. I am sorry, but the continued failure of the shadow Secretary of State to highlight whether he supports patients or strikers shows an absence of leadership. Will my right hon. Friend confirm that the doctors in training, the doctors on strike, have already received, in 2023, a pay rise of between 8.1% and 10.3%?
Victoria Atkins
I most certainly can confirm that—those doctors have already received the rise. As I said, I wanted to continue discussions on more fair and reasonable settlements for junior doctors, recognising as I do how tough their job is and the conditions under which they work. May I thank my hon. Friend for the leadership he has shown with his local trusts and clinicians? I agree with him that the one thing we have not heard from the Opposition is that they condemn the strikes. They seem to prioritise union harmony over patient safety.
Helen Morgan (North Shropshire) (LD)
Shrewsbury and Telford Hospital Trust has one of the most challenged A&E departments in England, for a number of reasons. In August last year, the Government awarded a grant of £21 million to provide extra beds to ease some of the issues in A&E, but those beds are not online and operational yet. What assurances can the Secretary of State give us that the measures that have been taken to ease winter pressures will be in place to help people before the winter is over?
Victoria Atkins
I will ask the Minister for Health and Secondary Care, my right hon. Friend the Member for Pendle (Andrew Stephenson), to liaise with the hon. Lady directly. As I say, the latest figures I have from NHS England, working with local trusts, is that more than 3,000 of the extra 5,000 beds were in situ in December, and we expect the 5,000 deadline to be met very shortly. I hope she will see that at local level in her hospital very soon.
James Wild (North West Norfolk) (Con)
Is not the rejection by the BMA of derogation requests made on the basis of patient safety dangerously irresponsible? Rather than Dr Laurenson, co-chairman of the junior doctors committee, saying that the NHS hates doctors, it is past time that they called off this damaging strike action and put patients first.
Victoria Atkins
Very much so—the NHS belongs to us all, as I say repeatedly. It goes without saying that doctors are a critical part of our workforce. That is why, since becoming Secretary of State, I have wanted to have a good, constructive working relationship with all of the representatives of doctors and the wider workforce. That was why I called in the BMA and “Agenda for Change” as soon as I possibly could, and I am pleased that I have been able to find fair and reasonable settlements with consultants and specialty doctors. I very much hope that junior doctors will call off their strikes and come back around the table so that we can find solutions for them too.
Samantha Dixon (City of Chester) (Lab)
The latest period of strike action by junior doctors has been the longest in the NHS’s history. We have seen trusts declaring critical incidents and A&E departments telling patients not to come in unless their lives are under threat. Can the Secretary of State tell me why the Prime Minister has not stepped in to resolve the dispute? Does he think it is not serious enough?
Victoria Atkins
As I said earlier, strikes have very serious consequences for the NHS. We cannot pretend that the NHS can be switched on and off at whim. My one ask of the junior doctors committee was that it stop the strikes so that we can return to the table. As the number of patient safety mitigations has revealed—by the way, it is the highest number of patient safety mitigations that local NHS leaders have ever asked for, because of the unprecedented length and timing of the strike—and because the BMA has refused even those derogations, with the exception of two, we have to get to a place where it returns to a more reasonable frame of mind and comes back to the table with more reasonable expectations, so that we can try to find a solution. I will not put patients’ safety at risk: I have to enable NHS England to make preparations and continue the work it is doing day by day, hour by hour, to safeguard hospitals and patients during this very damaging strike action.
Mr Philip Hollobone (Kettering) (Con)
My right hon. Friend the Secretary of State will be as concerned as my constituents in Kettering that, for every three days of junior doctor strikes, the cost to Kettering General Hospital is a staggering quarter of a million pounds, with hundreds of operations cancelled or delayed for patients in pain. In confirming that the 35% pay demand is both unrealistic and unaffordable, will she call for junior doctors to return to their posts so that that money can be better spent on reducing waiting lists and improving patient outcomes?
Victoria Atkins
My hon. Friend puts it eloquently; there is a real human cost to these strike actions. It is why I did everything I could when we were in negotiations to try to find fair and reasonable settlements for junior doctors. I was very disappointed when they walked out, but we have to find solutions for the sake of our patients and of all 1.3 million people working in our NHS across England. There have been some brilliant examples of local trusts, local clinicians and other members of staff working really hard and pulling together to cover these damaging strikes, but all we ask of junior doctors is to come back to work, do their jobs and look after our patients.
Mr Tanmanjeet Singh Dhesi (Slough) (Lab)
NHS waiting lists have trebled since the Conservatives came to power almost 14 years ago. The Prime Minister’s pledge to cut waiting lists has effectively been abandoned, with the Government choosing to blame NHS staff instead of fixing the problems. Is it not the case that the longer we give the Conservative Government in power, the longer patients in Slough and across our country will, sadly, have to wait?
Victoria Atkins
Waiting lists are coming down, but they are still too high. Towards the end of last year, we had a period without any strikes in the NHS. We saw the waiting lists fall by tens of thousands—indeed, by 65,000—over the period of October, which shows the impact of the industrial action. Sadly, we know that more than 1.1 million appointments have been rescheduled in the last 12 months. It is having an impact on waiting lists and, for the sake of patients, we ask the junior doctors to come back to work.
Jack Brereton (Stoke-on-Trent South) (Con)
May I first thank Tracy Bullock, the chief executive of University Hospitals of North Midlands NHS Trust, who has announced her retirement today due to ill health.
We have been making significant progress in north Staffordshire with improvements to health services. Nursing vacancies have declined significantly over the last year and £13.4 million has been invested in improving urgent and emergency care services, freeing up some beds, but what puts all that at risk are these reckless strikes. Some 867 appointments at the Royal Stoke have been cancelled, as have 38 operations. Does my right hon. Friend agree that all the progress we are making is put at risk by these reckless and unprofessional strikes?
Victoria Atkins
First of all, I join my hon. Friend in thanking Ms Bullock for her work and public service, and I wish her a speedy recovery.
On the progress made in my hon. Friend’s local area, he is right: there are some really encouraging signs for the future of the NHS. All the work that we have been doing across all the recovery plans—whether it is for urgent and emergency care, primary care or elective recovery plans—is about embedding progress in the future of our NHS in this year of all years, as we celebrate 75 years of its establishment.
On the impact of the junior doctors’ strikes, my hon. Friend is right to refer to the number of new nurses and the progress that has been made locally. In fact, this year we have been able to announce that we have met a manifesto commitment to recruit 50,000 more nurses. We made that promise in 2019. We have met it early, as well as the commitment to have 50 million more GP appointments than in 2019—two manifesto commitments made, and two manifesto commitments kept.
Alex Sobel (Leeds North West) (Lab/Co-op)
Happy new year, Mr Deputy Speaker.
More and more of my constituents are waiting longer and longer for emergency care. In 2010, the target for emergency care was 95% of patients within four hours. The Government watered down that target to 76%, and are not meeting that. When will they meet their own target, and when can we expect to see 95% of my constituents being seen within four hours?
Victoria Atkins
I hope the hon. Gentleman is injecting the same anguish into the conversations that I imagine he is having with his local junior doctors, asking them to come back to work. Of course, having junior doctors not working in hospitals across the NHS has an impact—of course it does; they are a vital part of our NHS. The attention of NHS leaders, medical directors and clinicians over past weeks has had to be diverted towards covering the strike action rather than making the sorts of improvements and progress we all want to see across urgent and emergency care, in line with our recovery plan.
Anna Firth (Southend West) (Con)
Happy new year, Mr Deputy Speaker. The majority of NHS staff at Southend Hospital are working incredibly hard. Despite winter pressures and industrial action, they have used winter money to open a new ward, adding extra bed spaces. However, the chief executive has written to tell me he is extremely concerned that approaching 40,000 out-patient and in-patient appointments across the Mid and South Essex NHS Foundation Trust have been postponed since this industrial action started. This afternoon, we learned from the Secretary of State that doctors in training have received above inflation average pay rises of 9%, so is it not time that they simply got back to work, delivering the care my constituents deserve and pay for?
Victoria Atkins
I thank my hon. Friend. We know the figures for previous strike actions, but sadly we will hear the true extent and impact of the strike action over the last six days later this week, and I suspect we will have even more missed and cancelled appointments to add to the list she rightly sets out.
On the point about pay, the basic pay of a foundation year one doctor has risen by 10.3%. Once one takes into account factors such as overtime and unsocial hours payments, that means the average salary is £40,800, a figure that I hope begins to reflect the importance we put on doctors and their role in the NHS. As doctors progress with their careers, there is a good package of development and progress, culminating in the pay settlement, currently out to ballot with the BMA, that I hope consultants, who are at the end of their career and do so much to help train younger doctors, will vote for. There is much work to be done, but progress has already been made on pay. That is why the decision by the BMA junior doctors committee to call strikes of such length at this time of year was so disappointing.
Mr Deputy Speaker (Sir Roger Gale)
I thank the Secretary of State for her statement and for responding to questions, and my thanks also go to those on the Opposition Front Bench.
Government Offer to NHS Specialist, Associate Specialist and Specialty Doctors
Victoria Atkins Excerpts(11 months, 1 week ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health and Social Care (Victoria Atkins)
After seven weeks of constructive negotiations with the British Medical Association specialist, associate specialist and specialty doctors committee, I am pleased to inform the House that on 16 December, I made a formal reform-based offer that the BMA SAS committee has agreed to put to its members for a vote.
No strikes will be called by these doctors while the deal is being put to members.
SAS doctors are a vital part of the NHS. They focus predominantly on providing direct patient care by providing clinical expertise in their specialist area and taking responsibility for a full range of patients within their area of practice, making them essential to our efforts to cut waiting lists and deliver the highest quality service to patients.
In 2021, the Government agreed a multi-year deal with the BMA SAS committee. If accepted, this offer will: address the unintended imbalances in the pay scales for these doctors on the 2021 contract and pre-2021 contracts to ensure consistency and fairness across the workforce; speed up the delivery of some of the key objectives of the 2021 deal, such as the roll-out of the new specialist grade; and encourage more existing doctors to take up the new contracts, which offer modernised terms and conditions.
The offer includes plans to set up a £5 million funding pot to encourage and support NHS employers to create more permanent specialist roles where there is a need. This will fund a significant increase in the number of specialist doctors, improving patient care and access, and will create further opportunities for doctors to progress in their careers.
A joint piece of work will also be undertaken to consider how locally employed doctors—doctors who are employed on local terms and conditions as opposed to national—can be better supported to progress in their careers, including the development of a potential process whereby such doctors operating at specialty level for 24 months could be transferred to a specialty contract.
The Government have made further commitments on career development, including the promotion of job planning for all such doctors; the development of guidance to support the career development of SAS doctors; the development of guidance for employers to encourage, establish and embed specialist roles in their organisation; and a research project to understand why specialist roles are not being created.
Both the Government and the BMA SAS committee engaged constructively and in good faith to identify fixes and reforms that address important concerns for SAS doctors. This offer is independent of the headline pay uplift that SAS doctors have already been awarded in 2023-24 through the Government’s acceptance of the independent pay review body’s recommendations.
The BMA SAS committee will now make arrangements to put this offer to a vote of its members in the coming weeks. I encourage them to accept this offer, and I will update the House in due course.
[HCWS162]
Oral Answers to Questions
Victoria Atkins Excerpts(11 months, 3 weeks ago)
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Layla Moran (Oxford West and Abingdon) (LD)
The Secretary of State for Health and Social Care (Victoria Atkins)
May I, through you, Madam Deputy Speaker, wish Mr Speaker a very speedy recovery?
As Secretary of State for Health and Social Care, I want to reform our NHS and social care system to make it faster, simpler and fairer. Dentistry is a critical part of that. Integrated care boards are responsible for identifying areas of local need and determining the priorities for investment. NHS England published guidance in October this year to help ICBs use their commissioning flexibilities within the national dental contractual framework, and I will be looking carefully at how the boards are identifying need and investment across England, including for vulnerable people.
Kim Johnson
I am glad that the Minister mentioned ICBs. Liverpool has a very high percentage of children with dental decay, and tooth extraction is the most common hospital procedure for five to nine-year-olds at Alder Hey Children’s Hospital, yet there was a £10 million underspend for primary care dentistry, and instead of investing it in preventive care, NHS England gave permission to all ICBs, including NHS Cheshire and Merseyside, to use the balance to balance their budgets. Will the Minister agree, here and now, to reinstate the ringfenced funding to commission extra capacity for the most vulnerable patients?
Victoria Atkins
I am delighted to be able to inform the hon. Member that NHS England has provided guidance for ICBs that requires dental funding to be ringfenced, with any unused resources redirected to improve NHS dental access in the first instance. Interestingly, ICBs will report their expenditure against the dental ringfence to NHS England as part of their in-year financial planning, which will happen at the end of this financial year.
Steve Brine (Winchester) (Con)
The Government previously committed to publishing a dental recovery plan, which the former dental Minister, my hon. Friend the Member for Harborough (Neil O’Brien), said that the Government would publish shortly. He also told my Committee:
“We do want everyone who needs one to be able to access an NHS dentist”.
We were surprised, but he said it. We were told that the plan would be published during the summer or before the summer recess. When will the plan be published, if that is still the intention? Presumably it will come alongside the response to our “Dental Services” report, which was due on 14 September.
Victoria Atkins
I thank my hon. Friend and I look forward to being grilled by him and his Committee in due course—at least, I think I do. Perhaps I can assist him, first, on the very important dental report that his Committee published. I am looking through it myself this afternoon and I will be publishing the response and sending it to the Committee imminently. In relation to the dental plan, both the Under-Secretary of State for Health and Social Care, my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom), and I are looking carefully into the needs of communities in rural and coastal areas, as well as in more urban areas, to understand not just the need but the answers that we can provide to help with urgent care and, importantly, preventive care, particularly for our children and vulnerable people in our society.
Justin Madders (Ellesmere Port and Neston) (Lab)
Last week another dentist in my constituency told my constituents that they were no longer able to provide NHS services. These people have literally nowhere else to go nearby. I want to come back to what my hon. Friend the Member for Liverpool, Riverside (Kim Johnson) asked about the underspend, because we had a meeting with the ICB and it was specifically told that the ringfence was being disapplied. Does the Secretary of State agree that that money should be spent on dental services and that that instruction should be given by her today?
Victoria Atkins
I agree, and that is why NHS England has provided guidance, as I set out earlier.
Derek Thomas (St Ives) (Con)
I welcome the guidance that ICBs have received. Cornwall ICB has committed to ringfencing money for dentistry next year, but the truth is that, before it took on that commitment, £4.5 million for unmet units of dental activity was returned to NHS England. What can the Secretary of State do to ensure that Cornwall gets the money that was intended for Cornwall to deliver NHS dentistry?
Victoria Atkins
A theme is emerging of underspend in dental work, which is one of the things that the ministerial team and I are looking at. NHS England emphasised in its guidance to ICBs that the funding should be ringfenced. I very much understand the pressures that my hon. Friend and other south-west Members have been raising over many months on the care that their constituents are getting. To ease pressures in the south-west, NHS England has commissioned additional urgent dental care appointments that people can access through NHS 111.
Abena Oppong-Asare (Erith and Thamesmead) (Lab)
I begin by welcoming the Secretary of State and her Ministers to their posts.
Last year, the Prime Minister pledged to restore NHS dentistry, including a specific promise to protect its budget, yet last month we learned that he will break that promise and allow ICBs to raid dentistry budgets to fill the gaps. Labour has a plan for 700,000 extra appointments, supervised toothbrushing in schools and a targeted dentistry recruitment scheme in left-behind areas. It is all fully funded by abolishing non-dom tax status. We have a plan, but the Government’s plan is four months overdue. Where is it?
Victoria Atkins
I thank the hon. Lady for her warm welcome. I look forward to discussing these matters with her over the Dispatch Box.
Over the weekend, I was rather pleased to see the Leader of the Opposition’s damascene conversion to the Conservative cause. As the shadow Secretary of State is on his world tour investigating what other health systems are doing, the Labour party may wish to bear in mind the words of wisdom from the great lady herself: “The problem with socialism is that at some point you run out of other people’s money.”
Michael Fabricant (Lichfield) (Con)
Debbie Abrahams (Oldham East and Saddleworth) (Lab)
The Secretary of State for Health and Social Care (Victoria Atkins)
I am pleased to reiterate to my right hon. Friend the Member for Witham (Priti Patel) that Essex is receiving funding from the National Institute for Health and Care Research, which is funded by the Department of Health and Social Care, to promote research into health inequalities and support better health outcomes for her constituents and all residents in Essex.
Priti Patel
I thank the Secretary of State for her response and welcome her to her new role; it is a real pleasure to see her in her position today. My Witham constituents have one of the highest patient-GP ratios in the country. That brings many challenges in accessing the NHS, from primary care to dentistry, social care and hospital appointments, some of which have been exacerbated by industrial action. Will she give an update on the work she is leading to address some of those issues and will she support my work and campaign locally to get a new primary health centre in Witham town?
Victoria Atkins
I thank my right hon. Friend very much for her kind words. She will remember how much I enjoyed sitting on the Front Bench alongside her when we were in the Home Office. In terms of her work in Essex, she is a formidable campaigner and she will know that the decision on such a healthcare centre lies with her integrated care board, to which the Government have given some £183 million of capital funding between 2022 and 2025. I am sure she will make a compelling case to the ICB for such a centre in her constituency. Interestingly, the Mid and South Essex integrated care board is one of seven sites receiving additional support and funding from NHS England to address health inequalities, and I know she will pay close attention to how that is spent.
Debbie Abrahams
There were multiple warnings from experts such as Professor Sir Michael Marmot of the widening health inequalities that started in 2015. Covid just exposed and amplified those inequalities, so that in the north there were 17% more deaths, or more than 2,500 avoidable deaths. While I welcome the new Health Secretary to her post and I welcome her announcement this morning, what else is she going to do to address in particular the socioeconomic inequalities that drive those health inequalities?
Victoria Atkins
I thank the hon. Lady for her welcome. Having grown up in Lancashire myself, I very much understand why she is speaking up on behalf of her constituents. There are many different ways that we deal with this, but let me use a couple of headline points. First, we are increasing the public health grant to local authorities, providing more than £3.5 billion this year, so per capita public health grant allocations for the most deprived local authorities are nearly two and a half times greater than for the least deprived.
There is also interesting work going on with family hubs. Indeed, the Under-Secretary of State for Health and Social Care, my right hon. Friend for South Northamptonshire (Dame Andrea Leadsom), who has responsibility for start for life, is leading on that. The family hubs and start for life programme will deliver a step change in outcomes for babies, children and parents in 75 local authorities in England with high deprivation. We believe strongly that if we can give the best start in life to our babies and children, it will bode extremely well for their future years.
Maggie Throup (Erewash) (Con)
A report that is to be published shortly by the all-party parliamentary group for diagnostics, which I chair, has highlighted that community diagnostic centres are essential for tackling health inequalities. I welcome my right hon. Friend to her new role. Will she honour her predecessor’s commitment to meet the all-party group to discuss the benefits of diagnostics in general and the preventive role that they can play in reducing health inequalities across the country?
Victoria Atkins
Not only am I delighted to accept my hon. Friend’s kind invitation, but I am also extremely grateful for her work in that area. Of course, we think that community diagnostic centres are an important and exciting part of healthcare in this country. We have 136 centres operational at the moment, and we know that they have provided 5 million additional tests since July 2021. That is the future and we very much support it.
Kirsten Oswald (East Renfrewshire) (SNP)
We know that socioeconomic inequalities drive health inequalities and that poverty increases adverse health effects. Research by the Trussell Trust shows that one in seven people faces hunger across the UK because they simply do not have enough money. Will the Secretary of State raise with her Cabinet colleagues the Trussell Trust joint campaign with the Joseph Rowntree Foundation calling for an essentials guarantee in universal credit to ensure that the basic rate at least covers life’s essentials so as to ensure that people can afford essentials such as food and heating and to mitigate against health inequalities?
Victoria Atkins
Of course, conversations continue between Ministers across Government in terms of helping not just with health inequalities but with inequality of opportunity. That is why I very much hope that the hon. Lady and her colleagues will welcome the thoughtful focus that both the Chancellor and the Secretary of State for Work and Pensions have put into the back to work plan. We know that getting people into work can have enormous benefits, not just financially but, importantly, for their wellbeing. The idea behind the back to work plan is that we do it by working with people to draw out their full potential and help them to lead healthy lives.
Mr Barry Sheerman (Huddersfield) (Lab/Co-op)
Marion Fellows (Motherwell and Wishaw) (SNP)
The Secretary of State for Health and Social Care (Victoria Atkins)
My priority as Secretary of State is to reform our NHS and social care system to make it faster, simpler and fairer. Since my appointment, we are making progress. To make our system faster, we have hit our manifesto target to recruit and retain 50,000 more nurses for our NHS, and to deliver 50 million more GP appointments, achieving both commitments months ahead of time. We have made an offer to health unions that I hope will end the consultants’ strike, which has disrupted care for the public and put a strain on staff. To make our system simpler, we have announced Pharmacy First, which will make it quicker and easier for millions of people to access healthcare on the high street. To make our system fairer, we have agreed a deal with pharmaceutical companies that will save the NHS £14 billion in medicine costs and give patients access to more life-saving treatment. The NHS is one of the reasons I came into politics—[Interruption.] I know Labour Members do not like to hear that, but I look forward to working with patients and staff across the country—[Interruption.]
Madam Deputy Speaker
Order. I do not need any help, thank you. The Secretary of State has answered the first question at length. I am sure that means she will answer the other questions much more briefly.
Marion Fellows
People with disabilities and serious health conditions already have higher living costs, and the proposals in the work capability assessment activities and descriptors consultation will mean that if they are reassessed they will lose £390 a month. I appreciate that the Secretary of State is new to her role, but will she commit as a priority to taking this up and consulting Cabinet colleagues, to ensure that people who are disabled and have serious health conditions are not pushed even further into dire poverty?
Victoria Atkins
As I said earlier, careful thought has gone into the announcements that were made in the autumn statement, and of course I will work with the Secretary of State and the Chancellor to ensure that the commitments we already have to people living with disabilities are maintained, and that we have their wellbeing at the heart of all our policy making.
Priti Patel (Witham) (Con)
Victoria Atkins
I would be very pleased to meet my right hon. Friend, the families and other Essex MPs to discuss that important inquiry.
Ashley Dalton (West Lancashire) (Lab)
With your indulgence, Madam Deputy Speaker, I welcome the Secretary of State and the new members of her Front-Bench team to their roles. I am honoured myself to stand at the Dispatch Box today for the first time on behalf of the shadow Secretary of State for Health, my hon. Friend the Member for Ilford North (Wes Streeting), who is currently in Australia exploring international best practice in healthcare.
Talking of best practice, on this Government’s watch, people with suspected breast cancer are not getting it. The two-week target from GP referral to a first consultant appointment for breast cancer has not been met since March 2020. I know from my own experience of breast cancer that the waiting is terrifying, wondering whether it has been left too late and the cancer has become incurable. How much longer will patients have to wait before the Government can meet their own targets and deliver the timely care that patients need and deserve?
Victoria Atkins
I genuinely thank the hon. Lady for her warm welcome, and indeed I welcome her to her first outing at the Dispatch Box. As she was describing where the hon. Member for Ilford North (Wes Streeting) is, I had images of “I’m a Celebrity… Get Me Out of Here!” Sadly for citizens in Wales, they are experiencing what it is like to live under a healthcare system run by Labour, and they might fully agree with that sentiment.
The hon. Lady raises the important issue of breast cancer, and the NHS has an ambition to diagnose 75% of cancers as stages 1 or 2 by 2028. In January last year we provided £10 million of funding for 28 new breast screening units and nearly 60 life-saving upgrades to services in the areas where they are most needed, because we understand our constituents’ concerns and also their determination that we continue to improve cancer survival rates.
Ashley Dalton
Unfortunately, the reality is that cancer referrals have only got worse with the Conservatives in government. In September 2023, only 74% of urgent cancer referrals to a consultant met that two-week target. That is the second-lowest rate for two-week referrals since 2009. When can the public expect this performance to improve?
Victoria Atkins
We have in fact made progress by delivering record numbers of urgent cancer checks, and levels of first treatments following an urgent cancer referral have been consistently above pre-pandemic levels, with activity in September standing at 108% of pre-pandemic levels on a per working day basis.
Peter Gibson (Darlington) (Con)
Dr Luke Evans (Bosworth) (Con)
Victoria Atkins
May I thank my hon. Friend for bringing his professional expertise to the Chamber? Of course, minimising “did not attends” is a critical part of ensuring that clinical time is optimised, and I will take his suggestion away and mull it over.
Kate Hollern (Blackburn) (Lab)
Imran Hussain (Bradford East) (Lab)
Victoria Atkins
I assume from the hon. Gentleman’s question that he fully supports our efforts to get consultants back into hospitals as well as junior doctors and doctors in training. It is all very well to sit there commenting, but we on the Government side of the House are working with doctors to try to help them look after the NHS for us all.
Selaine Saxby (North Devon) (Con)
While I recognise that money does not grow on trees, neither do teeth. Can my right hon. Friend advise me of how quickly my North Devon constituents will be able to see the NHS dentists they so desperately need?
Patricia Gibson (North Ayrshire and Arran) (SNP)
Victoria Atkins
I will not comment on evidence from the covid inquiry, given that it is an independent inquiry. However, on the general principle of encouraging people back into work, we have the plans set out by the Secretary of State for Work and Pensions and the Chancellor at the autumn statement. We want to encourage people back into work and to support them when they fall ill and need help from the state.
Anna Firth (Southend West) (Con)
Last year, I asked the Government to show me the money with respect to £118 million of long-awaited capital funding for south Essex hospitals. With £8 million now delivered and the other £110 million now confirmed to be on its way, will the Secretary of State please come with me to Southend Hospital and see how that vital money will transform care in Southend and Leigh-on-Sea?
Victoria Atkins
I will be delighted to visit that hospital with my hon. Friend—I suspect that I will be visiting a lot of hospitals.
Paul Blomfield (Sheffield Central) (Lab)
Victoria Atkins
Yes, I was. What is more, we looked carefully at the figures in relation to overseas care workers. We are grateful to all international people who work in our NHS and our care system, but we need to tackle the migration rate, which is too high. The package presented yesterday by the Government is a thoughtful and careful one to tackle legal migration.
Siobhan Baillie (Stroud) (Con)
Stroud Maternity Hospital is doing a great job, but the post-natal beds are still not open. We have been chasing a ministerial meeting about that for some time. Will my hon. Friend meet me and the Gloucestershire NHS scrutiny chair, Andrew Gravells, to discuss the issue? We think that we need some help with the Care Quality Commission.
James Sunderland (Bracknell) (Con)
Would the Health Secretary please agree to meet me to discuss improved access to GPs and dentists in Bracknell Forest and Wokingham boroughs?
Pete Wishart (Perth and North Perthshire) (SNP)
My constituent Air Marshal Dr David Walker, an inspirational leader and academic, sadly died of glioblastoma in June. When diagnosed, he and his wife Catherine were shocked to learn of the woefully low funding for brain and other less survivable cancers and established the charity the Right to Hope with Cancer. Will the Minister show the courage and leadership so epitomised by the life of Air Marshal Walker, and properly resource and fund less survivable cancers, so that everyone living with cancer has some sort of hope?
Public Health: Opt-out HIV Testing
Victoria Atkins Excerpts(12 months ago)
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The Secretary of State for Health and Social Care (Victoria Atkins)
The Government remain committed to ending new HIV transmissions within England by 2030. In order to do this successfully, we must identify and treat more of those who are unknowingly living with HIV.
As part of our HIV action plan, NHS England is currently operating a bloodborne virus emergency department opt-out testing programme for HIV and for hepatitis B and C for 34 emergency departments across London, Manchester, Salford, Brighton and Blackpool, focusing on areas with extremely high HIV prevalence (five or more HIV cases per 1,000 residents aged 15 to 59), in line with National Institute for Health and Care Excellence HIV testing guidance.
This means that anyone aged 16 years and over attending an emergency department in these areas and having a routine blood test will automatically be tested for HIV and for hepatitis B and C, unless they opt-out. Accessible public-facing information about testing, its benefits and how they can opt out allows individuals to make informed choices.
Through their recently published evaluation report, the data from NHS England and the UK Health Security Agency (UKHSA) indicate that the existing opt-out testing programme has been highly successful in areas of extremely high HIV prevalence, helping identify over 2,000 cases of bloodborne viruses, including 550 cases of people living with undiagnosed or untreated HIV.
After careful consideration of the available evidence, I am pleased to announce that the Government are committing to new research, commissioned through the National Institute for Health and Care Research, to evaluate the expansion of HIV opt-out testing to a further 46 emergency departments, in areas across England where there is high HIV prevalence (two or more HIV cases per 1,000 residents). Funding will support 12 months of testing for each emergency department, to begin during the next financial year.
We anticipate that this will be an effective way to reach a substantial proportion of the estimated 4,500 people England who are living with HIV but unaware of their status.
We will continue to keep Parliament updated on our progress to meet our 2030 ambitions as set out in our HIV action plan. We also want to thank our partners across the NHS, in NHS England, UKHSA, local government, and the community and voluntary sector, for their work towards ending HIV transmission in England.
[HCWS79]
NHS Consultants: Pay Offer
Victoria Atkins Excerpts(12 months ago)
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The Secretary of State for Health and Social Care (Victoria Atkins)
After several weeks of constructive negotiation with the British Medical Association and Hospital Consultants and Specialists Association committees, I am pleased to inform the House that, on 27 November, I made a formal offer to both unions, which includes a package of reforms to be applied from January 2024. If accepted by their members, this would end damaging strike action, benefit patients and deliver for consultants by reforming outdated aspects of their contracts.
The Government’s position is that the headline pay uplift for 2023-24 was settled through the pay review body process. This offer builds on that and focuses on reform. All parties strived to find a fair deal for NHS consultants that acknowledges the wider economic pressures facing the UK and the need to continue to bring down inflation. We have heard the concerns consultants have raised about outdated pay scales that have poor equalities outcomes. This offer would invest in modernising the consultant pay scale to reduce the number of pay points and the time it takes to reach the top.
As part of this reform, we would also be introducing more consistent performance gateways so that there is a clearer link between pay progression and evidence of skills, competencies and experience. This would make it faster for consultants to progress and help mitigate the gender pay gap, which was expressly highlighted in the independent review into gender pay gaps in medicine in England. To enable these reforms, unions have agreed to end local clinical excellence awards—an employer-level bonus scheme that has been seen to contribute to pay inequalities.
In addition, the Government will work with the unions to review the operation of the Review Body on Doctors’ and Dentists’ Remuneration. This work will extend to looking at the process for the appointment of members to the DDRB, the timing of the round, the data provided to the DDRB, and changes to remit letters and the panel’s terms of reference.
The Government have listened carefully to the concerns of consultants, their representatives and employers, particularly around retention, motivation and morale. This offer has been carefully balanced to meet those concerns while also ensuring value for the taxpayer. Together, this represents the biggest transformation in the consultant contract in 20 years. This offer, should it be accepted, will improve the working lives of consultants while ending damaging strike action that has had a detrimental impact on patients and the NHS.
The BMA and HCSA will put this offer to their members for a vote in the coming weeks. No further industrial action will be called while this happens.
[HCWS75]
NHS Federated Data Platform: Contract Award
Victoria Atkins Excerpts(1 year ago)
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The Secretary of State for Health and Social Care (Victoria Atkins)
Today, NHS England announced that, following an open and competitive procurement, it has awarded a group led by Palantir Technologies UK, with support from Accenture, PwC, NECS and Carnall Farrar, the contract to provide the new NHS Federated Data Platform (FDP).
The NHS manages data in different systems that do not connect effectively or efficiently. Every day, clinicians and other hospital staff spend time on the phone and in meetings, trying to join this information up themselves—to manage their theatre lists, waiting lists and information on patients ready to be discharged. This time could be better spent caring for patients.
The FDP is software that will sit across NHS trusts and integrated care systems (ICSs), allowing them to connect data they already hold, such as health records, waiting lists, and theatre and staff rosters, in a safe and secure environment, to better manage patient care. The FDP will support key priorities of the NHS, including recovery of elective care and the improvement of discharge processes to get medically fit patients treated and home quicker.
The safety and security of patient data is front and centre of this new system. As happens currently, there will be clear rules and auditability covering who can access this data, what they can see, and what they can do. Only authorised users will be granted access to data for approved purposes—for example, NHS staff and those supporting them, such as administrators, bed managers or care co-ordinators, and staff in social care supporting the move from hospital care. The provider of the software will not hold or have access to NHS data for any purpose, other than as directed by the NHS; they will not control the data in the platform, nor will they be permitted to access, use or share it for their own purposes. The contract makes strict stipulations about confidentiality. No new data will be collected, and GP data will not be part of the national platform.
In addition, NHS England has awarded a contract to a separate provider, IQVIA, for privacy enhancing technology, as an additional safeguard to enhance the security of data used in the FDP. The FDP will not go live at trusts or ICSs until this privacy enhancing technology is in place.
Across England, 26 trusts have been piloting what the FDP will provide. Clinicians have described the results as “game-changing”. It has helped them to better organise their clinics and waiting lists by integrating and consolidating data from different hospital systems or by creating a single list of information used by everyone working in health and care on discharge of patients from hospital. Patients in these vanguard trusts have seen falls in waiting times, discharge delays reduce, and diagnoses speed up. Theatre utilisation has increased by more than 6%, meaning an average of 120 additional patients per month are being treated at each trust. A new discharge tool has allowed one trust to reduce unnecessary days in hospital for long-stayers by 36% and halve the number of patients occupying a hospital bed for 21 days or more, compared with the England average.
It is these real benefits that an FDP will bring for patients and clinicians that have seen the chief executives of all 42 integrated care boards sign up to an open statement of support for the procurement.
Every hospital and integrated care board will have its own version of the platform which can connect and collaborate with other data platforms as a “federation”. In the first contract year, investment is expected to be at least £25.6 million and over the total contractual period of seven years, there will be up to £330 million investment in the Federated Data Platform and associated services. Learning about how to make the roll-out to trusts as efficient as possible will be built in overtime to reduce costs.
Additional funding has been set aside for other organisations to bid in separate, future procurements to build new products on to the platform that are interoperable and provide the opportunity for the NHS to benefit from new innovations from a range of suppliers. This makes it easier for health and care organisations to work together, compare data, analyse it at different geographic, demographic and organisational levels, and share and spread new effective digital solutions.
The contract will not only benefit users of the NHS; it will see investment in the UK-based data industry: the contract includes the creation by the supplier of a hub in the north-west. Data will not leave the UK.
Contract award for the FDP is the first stage of the process. An advisory group made up of expert health and care stakeholders, as well as patients and regional system representatives, will help to shape how the FDP is implemented. NHS England has already carried out engagement on the FDP requirements, including with patient and professional representative bodies. Ongoing public engagement is planned throughout the period of the contract, including as part of a recently announced circa £2 million national programme of engagement on the use of health data.
Further information on the FDP can be found on NHS England’s webpages at:
https://www.england.nhs.uk/digitaltechnology/digitising-connecting-and-transforming-health-and-care/fdp-faqs.
[HCWS57]
Voluntary Scheme for Branded Medicines Pricing, Access and Growth
Victoria Atkins Excerpts(1 year ago)
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The Secretary of State for Health and Social Care (Victoria Atkins)
I am pleased to inform Parliament that agreement has been reached on a Heads of Agreement for the 2024 Voluntary Scheme for Branded Medicines Pricing, Access, and Growth (VPAG). This is an agreement between the Department of Health and Social Care—representing the UK Government, the Governments of Scotland and Wales and the Northern Ireland Department of Health—NHS England and the pharmaceutical industry, represented by the Association of the British Pharmaceutical Industry (ABPI).
This is an important milestone in the agreement of a new scheme. Once the Heads of Agreement has been formalised in a full scheme document, the 2024 VPAG will operate for five years starting from 1 January 2024, when the current scheme ends.
The 2024 VPAG stands to deliver savings to the NHS across the next five years, rapid patient access to new clinically and cost-effective medicines, and a sustainable approach to medicines provision.
The proposals also demonstrate the Government’s commitment to supporting a strong UK life sciences industry to drive economic growth, including through the establishment of a £400 million fund to support investment in the UK life sciences ecosystem, including improved clinical trial capacity.
[HCWS52]