Health and Care Bill (Twenty First sitting)

Alex Norris Excerpts

Committee stage
Thursday 28th October 2021 Public Bill Committees

Brought up, and read the First time.

[Alex Norris (Nottingham North) (Lab/Co-op)]

I beg to move, That the clause be read a Second time.

It is a pleasure to resume our consideration with you in the Chair, Ms Elliott. The new clause is in my name and those of my colleagues. If we think about the pandemic and the last 18 months, we will have various views on all sorts of things that have gone on during that period, but I think that one thing that we would be of one mind on is how well our nation’s directors of public health have performed in this crisis. They have been incredible, pulling together the local response and bringing to bear their unique combination of training, relationships and local soft power in order to ensure that the local approaches to dealing with the pandemic in aid of the community have been strong ones. I think we would all say that they have done absolutely superbly.

The new clause seeks to codify a little more formally the place of directors of public health in the system. As we are authoring a new system in the Bill, this is no bad time to do that. The purpose of the new clause is to clarify the roles, powers and duties of directors of public health and to put them on a statutory footing. Whatever structures DPHs sit within, their major role—the reason why as a country we need them and why we invest in them as we do—is that they act as an independent advocate for the health of the population, for system leadership and for the improvement of the system for the population. They are already responsible within their area for a broad range of things, such as measurable health improvement, health protection, public health input, planning, commissioning, reducing inequalities and more. There is a strong reason to put them on a statutory footing. They of course provide an independent advisory function for a wide range of organisations, including the NHS. My local DPH is very good indeed. She often reminds colleagues that she is the system’s DPH rather than just the local authority’s. She may well be hosted by the local authority, but her remit goes much broader, and that is a very good thing. Putting DPHs on a statutory footing would recognise the system leadership role that they have.

The new clause would use a corporation sole model to ensure that directors of public health have scope for independent action; it would ensure that special arrangements are made for them, as officers of the Crown, to bring certain things to the attention of the Attorney General and the chief medical officer, and to ensure public health representation on NHS managing, regulating or commissioning bodies where necessary; and it would guarantee their professional independence in these wider functions. In the vast majority of cases across the country, most of these functions and roles are operating very well indeed, but the new clause would give statutory underpinning to that.

Together, these changes would allow DPHs to have influence across the entire place that they work for and across all policy areas, including budgetary and allocative decisions, and ensure that they have a chance to play their part across all decisions being made in the local community that impact on public health. This proposal would hardwire links between DPHs and the NHS public health workforce who enact public health policy. For place-based officials, having strong links with local and regional NHS employees is not only a benefit but a necessity. It would help to strengthen our response to health inequalities and hence the prevention of ill health—we have spoken at length about that during these proceedings—as well as enhancing relationships for emergencies, which we have seen in recent months.

Where this is done best, it is a strong model. I know that some directors of public health have consultants within their local NHS trust. That is something that the Association of Directors of Public Health is very keen on. If the Bill and the direction of travel are about an integrated system, those kinds of integrators are a very good model of doing that.

These are critical roles. We have seen that in challenging times, but in more general times, as we push on in order to have a healthcare system that is more preventive, that closes inequality gaps and which delivers excellent services to our population, directors of public health will be really key players in it, so I hope that this attempt to put them on a slightly stronger and more consistent footing will be welcome.

[The Minister for Health (Edward Argar)]

It is a pleasure to see you in the Chair once again, Ms Elliott.

My understanding, in the light of what the shadow Minister has said, is that one of the underlying aims of the new clause is to ensure that the public’s health is at the fore as we reform the health and care system. I have the utmost sympathy with that an aim

The Government recognise the importance of a robust public health system that works to improve the health and wellbeing of the nation and to prevent disease. That is why we have taken decisive steps to reshape our national public health bodies so that we are well equipped to face future challenges. Furthermore, we agree that directors of public health and their teams should have a crucial role at the heart of the new system.

The shadow Minister is absolutely right to say that although directors of public health are hosted by local authorities, they represent the whole system, and we owe them a debt of gratitude. In our past lives, he and I would have worked with DPHs in our local authority contexts, and of course, as Members of Parliament, we have all seen what our local DPHs have had to do over the past year and a half. I suspect that Members who did not know their local DPH have probably got to know them and their work in the community a lot better, which is no bad thing.

This fits naturally with the strategic emphasis on population health that we expect of integrated care systems. Both the Department of Health and Social Care and NHS England have set out in published policy and guidance documents our expectation of directors of public health having an “official role” in integrated care systems. Officials in the Department are working closely with the Association of Directors of Public Health and others to help describe further the place of these roles, the outcomes that we hope collectively to achieve, and the ways in which they can best add value to the system’s impact on health overall.

Although we entirely understand the motivation behind the new clause, I am not sure that it is strictly necessary. It seeks to clarify the roles, powers and duties of DPHs, but their roles and responsibilities are already clearly and accurately set out in legislation and current guidance. The requirement for the recruitment to the role of director of public health, for example, is already clear on professional qualifications, and the registration and regulation requirements are clearly laid out. The new clause may have the effect of reducing the flexibility of the post, although I am sure that the shadow Minister would say that that concern is unfounded.

Furthermore, the current system already provides independence and influence for directors of public health, and that is strengthened by several provisions in the Bill, which includes, for instance, a duty on ICBs to seek advice from persons with the appropriate expertise on prevention and public health, including directors of public health, complementing the existing duty, in the section 6C regulations of the National Health Service Act 2006, for local authorities to provide the NHS with public health advice.

Additionally, we do not believe it necessary to make directors of public health officers of the NHS, as the Bill already provides opportunities for DPHs to link into and influence NHS bodies in their current guise. Integrated care partnerships, for instance, must develop an integrated care strategy to which integrated care boards must have regard in drawing up their commissioning plans. The intended result is to create a plan to meet the health—including public health—and social care needs of the population within their defined geography. That will provide directors of public health with the opportunity to influence NHS commissioning plans to meet wider public health aims.

It is also possible that the new clause would create a number of undesirable consequences—I suspect that the shadow Minister will allay some of those fears in his response. Rather than bringing clarity, the new clause could create confusion and complexity in a system that is already functioning effectively with a clear understanding of the role and how it operates.

The new clause would put a host of prescriptive new requirements on DPHs, including a requirement for them to be officers of the NHS, NHS consultants in public health, and officers of the Crown, while retaining independence of thought and action.

While we certainly understand the motivation of wanting to knit together the system through an individual post, that approach would add a layer of complexity. I believe that it would be challenging for an individual holding that office to seek to balance those complex responsibilities, accountabilities and potentially competing priorities within various organisations. That would also complicate the lines of accountability

My concern is that the new clause is overly prescriptive about the status and nature of the role, which would go against the overall aims of the Bill in terms of permissiveness. Although we hope and expect that directors of public health will act as a nexus for bringing coherence to the local system’s focus on population health, we are not convinced that this level of prescription over permissiveness is appropriate. That reflects a thread of the debate throughout the passage of the legislation on where the appropriate balance should be struck.

Proposed new paragraphs (e) and (h) would weaken the ties that directors of public health have with local authorities. Since the 2012 reforms, there has been widespread consensus that local authorities are best equipped to deal with a wider range of public health matters for their population’s needs. In that context, I pay tribute to local authorities for their role in tackling the pandemic, including those in elected roles. If I recall correctly, the wife and partner of the shadow Minister, the hon. Member for Ellesmere Port and Neston, is active as an elected councillor in a local authority. Many Members of this House will have served in that role, too, and will recognise what local authority councillors and officers do in that space.

From their home in local government, DPHs have been able to maintain an independent mindset while playing a critical role in improving and protecting the public’s health. Although it may well evolve in future, that system is working, and we have a strong and solid base that is understood by all system players. I therefore encourage the shadow Minister to continue to work with me and others to make that system work, rather than seeking to press the new clause to a Division.

[Alex Norris]

I certainly did not intend to add complexity; I was hoping for clarity and consistency. Nevertheless, as the Minister says, those roles are currently functioning effectively, so I will not divide the Committee.

I would say to the Minister and his colleagues, however, that we need a real watching brief on this matter, because assuming that the Bill continues its onward journey and establishes those ICS footprints, there will be a range of different outcomes and organisational cultures. The stronger systems will be those in which the DPHs are at the heart of insight and decision making, and the reverse will be a defining characteristic in systems that are not as good. I certainly hope that we consider the Care Quality Commission reviews that were included in an earlier new clause, and any sector-led improvement, as well as the work those systems do to reflect on what they do and do not do well.

One of the criteria for both streams of improvement ought to be what the DPH does, how central they are, and how sighted they are on decision making. As I have said, in good systems that will be good, and in weak systems it will be weak. Those criteria would be a bellwether of how good the local ICS footprint is. I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

New Clause 45

Duty on integrated care boards to have regard to net zero commitment

“(1) The National Health Service Act 2006 is amended as follows.

(2) After section 14Z43 (inserted by section 19 of this Act) insert—

“14Z43  Duty to have regard to net zero commitment 

When procuring or commissioning goods and services on behalf of the NHS, integrated care boards must have regard to NHS England’s commitment to reach net zero by 2040.””—(Justin Madders.)

This new clause would place a duty on integrated care boards to have regard to NHS England’s commitment to reach net zero by 2040.

Brought up, and read the First time.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

I beg to move, That the clause be read a Second time.

It is a pleasure to see you in the Chair, Ms Elliott. I will be brief in speaking to the new clause. What we are seeking to achieve is pretty clear: for integrated care boards procuring or commissioning goods and services on behalf of the NHS to have regard to NHS England’s commitment to reaching net zero by 2040.

We can assume that the Government fully support the commitment made by NHS England. We were all transfixed by the goings-on in Committee yesterday, so we may have missed the part in the Chancellor’s statement about investment in net zero and in the NHS, but perhaps the Minister will say a little more on that. I suspect that although he will accept that ICBs should have regard to the overall commitment, he will say that the new clause is unnecessary as NHS England already has a commitment that will percolate down to ICBs. We would say that NHS England can achieve that target only by working through ICBs, which will, of course, have the ability to commission more than £100 billion-worth of services.

We may end up yet again in the realms of the permissive versus prescriptive debate, but the power of public sector procurement is a massive issue, and there is no bigger part of the public sector than the NHS, which is the responsibility of the Minister’s Department. We should be very much on the front foot in using that to deliver the commitment to net zero.

Of course, we have yet to see what will replace the public contracts regulations in Government procurement as a whole. It is hoped that the same commitment to green issues will be in the mix somewhere, but until we know what that looks like, the new clause presents an opportunity to enshrine in law a commitment that I think most if not all Members want to see delivered.

--- Later in debate ---

[Justin Madders]

I am grateful to the Minister for his positive comments. We were probably pushing our luck with getting a formal commitment from him, but it sounds like we are probably as close as we are going to get to progress on the matter without pushing the new clause formally to a vote. We will keep a close eye on the issue and will, no doubt, come back to it if progress is not made in orderly time. I beg to ask leave to withdraw the clause.

Clause, by leave, withdrawn.

New Clause 50

Access to innovative medicines and medicinal products review

“(1) The Secretary of State must undertake and publish a review of the use by the NHS of innovative medicines and medicinal products.

(2) The review must—

(a) conclude before 31 December 2022;

(b) consider ways to improve the use of innovative medicines and medicinal products within the NHS in England.

(3) The review may consider—

(a) the creation of a specific pathway to assess medicines and medicinal products for rare and less common conditions;

(b) improvements to the way in which patient and clinical experience is accommodated when considering the adoption of new medicines and medicinal products.”—(Alex Norris.)

This new clause would require the Secretary of State to carry out a review of the assessment and use of innovative medicines and medicinal products, and to consider how to improve access to medicines and medicinal products for people with rare and less common conditions in particular.

Brought up, and read the First time.

[Alex Norris]

I beg to move, That the clause be read a Second time.

The new clause would put a helpful requirement on the Secretary of State to undertake a review of the assessment and use of innovative medicines and medicinal products, which I believe would be a positive step forward. Medical innovation, including new drugs and cutting-edge treatments, produces life-saving and life-changing results, and those benefits are particularly felt by those with rare and genetic diseases.

--- Later in debate ---

[Dr Whitford]

I wonder whether the hon. Gentleman shares my concerns after leaving the European Union about access for clinicians, and indeed their patients, to the European reference network, which helps to provide advice and treatment and has co-ordinated research, through the European Medicines Agency, into these rare, often childhood, diseases? They can be studied much more easily in a population of 500 million than one of 60 million.

[Alex Norris]

I am grateful for that contribution. It is axiomatic that, if we are talking about diseases that affect small populations in this country, growing the field of people who are affected so that we can undertake better research, trials and treatment can only be a good thing. I hope that the Minister might touch on how he is ensuring that we are not disadvantaged in that way. When we add up the nearly 8,000 diseases, we are talking about 3.5 million people—one in 17, so one person on the Committee, basically—who will in their lifetime be affected by a rare disease. So actually they are not so rare at all. It is really important that we are meeting that group of people’s needs, but access to medicines and medical devices remains a problem, which is why such reporting for rare conditions is so important.

At the moment, approved medicines are available for only 5% of rare diseases and, even where licensed treatments exist, patients can face an uphill battle in accessing them on the NHS. I am sure that most of us will have at least one case of a young constituent who desperately needs medicinal cannabis to treat epilepsy. There is a political consensus that this is the right thing to do, and we ought to do it. That has been a settled matter for at least three years now, but frustratingly it is still not getting through, and that is a pattern across rare diseases. Perhaps that points us to the conclusion that the current assessment process is not quite accounting for the unique challenges presented by rare and ultra-rare diseases.

I do not think that the Minister will want to be drawn on the National Institute for Health and Care Excellence methods review, because we are in that process. I have spoken in multiple debates about my enthusiasm for NICE, and its processes and expertise, but clearly something is missing. My working theory is around evaluation. Again, if we have a small patient population, the data is noisy and there are higher degrees of uncertainty due to the small sample sizes. That leads us nicely to the point that the hon. Member for Central Ayrshire made about trying to grow those pools. At the moment, we are unable to get first-in-class treatments in many cases, which we should want to do something about.

Herein lies the squeeze, as the medicines for rare and ultra-rare diseases are often assessed by processes that were designed for drugs with larger target populations. The statistics are a bit of an apples-to-oranges comparison, which creates a severe disadvantage. The purpose of the new clause is to get the Secretary of State to report generally on how we are ensuring that we are world leading and meeting population need, and then to drill down within that on how we are ensuring that the system for rarer conditions is fit for purpose. As I say, I am conscious that the methods review is ongoing, but I hope that the Minister might at least give us a sense of the general policy direction in this area, and what we might look to do differently in the future.

--- Later in debate ---

The Government published the new United Kingdom rare disease framework in January 2021, outlining the key priorities for rare diseases in the UK over the next five years. One priority area, identified through the national conversation on rare diseases, is to improve access to specialist care, treatments and drugs. Development of nation-specific implementation plans for this priority are under way across the four UK nations and will involve further engagement with the rare disease community. I believe these are the right steps to take, and I therefore encourage the hon. Gentleman not to press his new clause to a Division.

[Alex Norris]

I am grateful to the Minister for his full answer. He mentioned reviews around the innovative medicines fund and NICE methods, and it is probably wise for us to let those processes play out before looking at anything else, so I do not intend to press the new clause to a Division. However, I will leave the Minister with some final thoughts on NICE methods.

First, I hope there will be a parliamentary moment for us to engage with that and have those conversations. The process has independence for a very good reason, but we should still have views on its overall direction. I want to flag ahead of that—with a focus on combination therapies, particularly in the cancer space—that we are understanding better every day how different therapies used together can have an incredible aggregate impact on the individual.

I do not think it is breaking any great state secrets to say that the problem is that the way we pay for drugs in this country is an imperfect market. Do not get me wrong; it has found a balance, but one problem is that the treatments are—funnily enough—often priced to what we can afford to pay for. That is fine until we need to combine two different treatments from different providers, when it becomes really challenging to work out how to apportion that. If we are to achieve the innovations that we need, particularly in cancer, we will need a good answer to come out of that review.

I hope that the Minister has a watching brief on that review, and that when NICE has finished, we can have a good conversation about the outcome to ensure that it supports the goals that I think we all have. I beg to ask leave to withdraw the clause.

Clause, by leave, withdrawn.

New Clause 51

Duty on integrated care partnerships to prepare and deliver a Best Start for Life strategy

“(1) The Local Government and Public Involvement in Health Act 2007 is amended in accordance with subsection (2).

(2) After section 116B (substituted by section 20 of this Act) insert—

‘116C  Duty on integrated care partnerships to prepare and deliver a Best Start for Life strategy 

(1) Each integrated care partnership must—

(a) assess the needs of expectant parents, infants and young children in its area;

(b) prepare and publish a strategy to improve outcomes and reduce inequalities among expectant parents, infants and young children;

(c) consult parents and carers in the area when developing the strategy;

(d) monitor and evaluate the effectiveness of the strategy.

(2) Local authorities, NHS bodies and other relevant partners must—

(a) cooperate on delivering the strategy;

(b) have regard to the strategy when exercising their functions.’”—(Alex Norris.)

This new clause would require each Integrated Care Partnership to prepare and deliver a “Best Start for Life” strategy, in cooperation with relevant bodies.

Brought up, and read the First time.

[Alex Norris]

I beg to move, That the clause be read a Second time.

I cannot quite remember on what day this new clause was submitted; it is towards the end of the new clauses but not at the very end, so that probably carbon dates it by 10 days or so. Nevertheless, we had some news in this space from yesterday’s Budget. We are in the strange situation of having seen effective early intervention services, such as Sure Start, take a clobbering for a decade, and then getting paid back pennies on the pound and being supposed to feel grateful for it. We are not. Nevertheless, there needs to be a commitment at all levels of Government and local government—and, in this case, integrated care boards—to have a real focus on early years.

The first 1,001 days of a child’s life, from conception to age two, are crucial. Getting things right in this period can determine what kind of life a child has and their health, wellbeing, cognitive function and psychological make-up. During those early years, a baby’s brain grows rapidly, and it doubles in size within the first year of life. As is so well established, child development is influenced by early experiences and environment, which means that it is so important to ensure that little ones in our communities get what they need—care, nurture and support—while ensuring that they are protected from neglect, harm and stress.

As the Government’s strategy in this space recognises, getting things right impacts not just on the lives of our children, but on our entire society. By ensuring that children get what they need at an early age, we can target some of the big issues that we have talked about for the last two months in this Committee: physical and mental health issues, pressures on the NHS, crime and antisocial behaviour, and drug and substance abuse. So much of that leads back to the early stages in life, and this is a matter of established science. There is no doubt that in this country, we are not very good at doing something about that. Six months or maybe even a year ago—time flies—we had a fantastic Westminster Hall debate, led by the right hon. Member for South Northamptonshire (Dame Andrea Leadsom), who chaired a very good review in this space.

There is barely a leaf’s width of disagreement on this issue between right hon. and hon. Members of all political persuasions. The common diagnosis for why we have not made more progress is that we know that such things save public services money in a generation’s time, but we cannot demonstrate that in a cashable savings way that passes Treasury processes. I am afraid that I did not see anything yesterday to suggest that that fight is yet being won, and I hope the Minister and his colleagues are doing everything in their power to argue for early interventions. Frankly, I would argue that for pretty much all Members present, the bulk of the returns will come when someone else is sitting in our seats and our roles are somebody else’s dreams, but that should not stop us acting, because it is so significantly in the national interest and in the interests of our communities.

There are huge inequalities. The most basic health statistic is that a child born in my city will live for seven fewer years than one born in the City of Westminster—never mind the yawning chasm of almost twice that in healthy life expectancy. That is the result of smaller inequalities that all add up to different life paths: family income, financial stress, smoking and alcohol use, and access to care and services. We know that the 1,001 critical days from conception are the moment to offer really good-quality support. Families receive support from a wide range of services, including maternity, health visiting and early years, and perhaps children’s social care, mental health and paediatrics.

As well as the inequalities, there is complexity. I have mentioned five different organisations with five different uniforms, five different organisational plans and five different organisational cultures. Someone has to pull that together. We have been told throughout proceedings on the Bill that that is exactly what integrated care partnerships are here to do, so let us put a responsibility on them to do so, and to have a plan. I dare say—the Minister might say this himself—that they are more than likely to want to do that themselves, and that would be a very good thing, but I do not think we can allow variance. This should be important for everybody and all footprints should be doing it, so that the first 1,001 days are given priority in new health systems. That would have a significant impact on the long-term health and wellbeing of our country.

[Dr Whitford]

I rise in support of the new clause. It is important to shift the narrative from what is often a structural focus on the NHS, and catching people when they fall, to looking at wellbeing and population to allow people to be healthier and live higher-quality lives for longer.

The hon. Member for Nottingham North mentioned the slowing down of improvement in life expectancy and the variation in life expectancy, but the bigger issue is the failure to improve healthy life expectancy. The 20 years of unhealthy life expectancy faced by many across the UK, particularly in more deprived areas, put pressure on the NHS, and we have seen that come home to roost over the last decade.

A lot of those health issues, or unhealth issues, are laid down in childhood. I am vice-chair of the all-party parliamentary group for health in all policies, which conducted an inquiry into the impact of child poverty. A figure from the Faculty of Public Health that has stayed with me is that the UK loses 1,400 children a year as a direct result of poverty, including by immature birth, small birth weight, foetal alcohol syndrome, fires, road traffic accidents, alcohol and drugs, violence and suicide. That is the number of students in a large secondary school, and if the roof of a large secondary school were collapsing every single year, we would do something about it.

Often, the time to do something about that is in the 1,001 days from conception forward, as the hon. Gentleman said. That means looking at maternal health and nutrition, which is why the early years collaborative in Scotland led to the Best Start grants to mothers and children at birth, on entering nursery and on entering school.

One internationally used measure on the health of our youngest children is infant mortality—death perinatally or in the first year. In 2014, England and Scotland had the same rate of 3.6 per 1,000 live births. In Scotland, we have managed to drive the rate down to 3.2, but in England, it is currently at 3.8. In some poorer areas of the UK, the rate is worse than in parts of the global south and the developing world. That is a brutal statistic.

We talked yesterday about maternal and infant deaths, but this also relates to the attainment gap and other issues faced throughout life by those who struggle in childhood. Investing in early years saves money in the long term. That might be the pitch to the Treasury: if we gave more children a decent start in life, fewer would struggle in the education system, fewer would struggle to get jobs, and fewer would be trapped by addiction or caught in the criminal services system. Instead of picking up the pieces later through the NHS or other public services, surely we should be investing in the best start in life for all our children.

--- Later in debate ---

[Alex Norris]

The point that the hon. Member for Central Ayrshire made about the UK losing 1,400 children a year is sobering. Whatever comes out of the process that the Minister mentioned must to be different from what we have today, or we will keep repeating that mistake. I shared the hon. Lady’s view about the pitch to the Treasury, but we will have to demonstrate that planning cycles in this country are mature and flexible enough to reflect the fact that not everything can be delivered, and show immediate returns, before the next general election. It is a challenge, and we will have to do better in that space. I am grateful for the Minister’s response, and he addressed my concerns very well. I beg to ask leave to withdraw the clause.

Clause, by leave, withdrawn.

New Clause 52

Plan for implementing recommendations of the Independent Medicines and Medical Devices review

“The Secretary of State must, within six months, publish a report containing a plan for the implementation in full of the recommendations of the Independent Medicines and Medical Devices review that have hitherto not been implemented.” —(Alex Norris.)

This new clause would require the implementation of any remaining recommendations from the IMMDS report.

Brought up, and read the First time.

[Alex Norris]

I beg to move, That the clause be read a Second time.

In February 2018, the noble Baroness Cumberlege was asked to carry out the independent medicines and medical devices review into the experiences of people—generally women—who had been treated with Primodos, sodium valproate or pelvic mesh implants. In very many cases, they had to battle for decades to be heard. They were gaslit, belittled and ignored at every turn. Some of the ways in which they were treated were just astonishing, and so upsetting. However, through that report they got their deliverance. They were vindicated: what they said had happened to them had happened to them—even though they had not been believed—and it should not have done. Acknowledging the pain that had been caused to these families was a big start in helping them come to terms with what they had experienced.

The excellent review team set out nine ways in which things would be made better, or at least a little bit easier, for those people now, and to try to prevent future incidents. Those nine recommendations should have been accepted in full. Instead, we have seen from the Government a pattern of accepting things that I suspect they were already keen to do, but otherwise taking the families for a long walk when it comes to the harder and more significant things that the Government clearly do not want to do. In aggregate, it has become a refusal to do right by these families, and that is a really poor decision.

This new clause seeks to attend to that by saying that within six months, the Secretary of State must publish a report containing a plan for the implementation of the recommendations in full. Of the nine, only four are being implemented in full and, frankly, that is not good enough. I am pleased that there has been an apology, and the families were too. I was also pleased to see legislation for a patient safety commissioner. We were lucky that the Medicines and Medical Devices Act 2021 was in front of us at that time, because it gave us a moment to introduce that and a devices database, which the hon. Member for Central Ayrshire and I pursued during proceedings on that Bill. Those things have a bit further to go, but they were significant, as were the promises of cultural reforms at the Medicines and Healthcare products Regulatory Agency. We will wait to see meaningful change there. With the remaining five recommendations, there has been a mixture of in-principle acceptance, partial acceptance and, in some cases, outright denial. I do not think that is good enough, and the new clause seeks to change that.

These are the bits that we are still missing. Recommendation 3 calls for:

“A new independent Redress Agency for those harmed by medicines and medical devices”.

The Government responded that they did not accept that. The problem is that families are therefore left to rely on conventional civil and legal routes. Those are expensive and long, and who do the families sit against in the courtroom? Very big companies with very big legal teams, so there is a significant imbalance. The whole point is that, as recommendation 3 goes on to state:

“The Redress Agency will administer decisions using a non-adversarial process with determinations based on avoidable harm looking at systemic failings, rather than blaming individuals.”

That would have been really significant, but we do not have that. Instead, families are left stuck in the court system for as long as they can stick at it.

Recommendation 4 states:

“Separate schemes should be set up for each intervention—HPTs, valproate and pelvic mesh—to meet the cost of providing additional care and support to those who have experienced avoidable harm and are eligible to claim.”

Again, the Government do not accept that. These families meet exceptionally challenging needs day after day. Some have lost their house; some have had failed relationships; and all struggle with mental health, or certainly distress, as a result of what has happened, and we are not doing enough to help them. This should have been done, if not on day one, at the very first possible moment for support, rather than us expecting them to fall back on the conventional system, as they did. What have they gained by their vindication?

Recommendation 5 states:

“Networks of specialist centres should be set up to provide comprehensive treatment, care and advice for those affected by implanted mesh; and separately for those adversely affected by medications taken during pregnancy.”

The Government accept that only in part; it is particularly with regard to valproate that those affected will not get those centres. I will listen carefully to the Minister’s justification for that. I understand that valproate is different, in the sense that its use is ongoing in certain situations where that remains medically appropriate. However, the lack of specialised knowledge is a real issue. If there is not specialisation, we need a real sense that there is a universal step change in knowledge and experience in this area to give us greater comfort.

Recommendation 8 states:

“Transparency of payments made to clinicians needs to improve. The register of the General Medical Council (GMC) should be expanded to include a list of financial and non-pecuniary interests for all doctors”.

That is very basic. There were relationships between clinicians and big drug companies that were unknown to the families when certain treatments were suggested. The Government accept the recommendation in principle, but will not use the General Medical Council model, preferring to go practice by practice. That is big mistake. Our constituents can go to one easy, obvious place—our website—to find out our exact financial interests if they have concerns or just want to know them. We ought to be able to do the same, through the GMC, when it comes to doctors. Again, there is an unwillingness to move quickly enough to resolve these issues.

Finally, it remains surprising that the Government have not availed themselves of recommendation 9. I will listen carefully to the Minister’s response on this point. It states:

“The Government should immediately set up a task force to implement this Review’s recommendations. Its first task should be to set out a timeline for their implementation.”

Of course there should be a taskforce, including families and the broader aspects of the state, to do that. Again, the Government say they accept the recommendation in part, but the reality is that they have no plans to establish an independent taskforce. There is a patient reference group, and we of course support its work, but it is not in control; it is not at the table. The problem is that these things were done to families; they had no agency and no say. The solutions that come out of this cannot follow that same model. Once again, families are having things done to them, rather than being worked with.

I meet representatives of these groups frequently, as I know colleagues do. I like meeting them. These are good people who have been through incredible things and have extraordinary dignity and courage, not to mention that they are brilliant campaigners. They are probably sick of seeing me, and I would rather see them in happier circumstances. When I ask them what is next, they say that they are campaigning again. They campaigned over many years to be listened to, and were proven right in the most absolute terms, but they feel they have to campaign again to get the justice that should flow from that report and from their vindication. What an extraordinary demonstration of how we have let them down. They fought for too long. It is time that we stood up for them and did right by them by implementing the recommendations in full; otherwise we fail them again. I hope to hear of significant progress from the Minister.

[Dr Whitford]

I support the new clause. For a surgeon, knowing that an operation that they were trained to carry out, and performed in good faith, has caused harm is one of the worst things that can happen. I remember how I felt in the mid-1980s when we began to realise the impact of contaminated blood. It had a huge impact on how I operated. I used special diathermy techniques to avoid blood transfusion in all elective circumstances, and that is something I carried on throughout my time doing breast cancer surgery.

In this case, there may well have been doctors who were dealing with device companies and so on—that regulatory declaration is absolutely needed—but there will be a much greater number of surgeons who were using a device that was licensed and was given to them as the correct, safe device to use.

I find it shocking that although the report was commissioned by the Government, they have accepted fewer than half of its recommendations. The others directly relate to patients who have suffered harm, whether that is the women who had vaginal meshes inserted, or the mothers of children who were harmed by the use of Primodos or sodium valproate.

Sodium valproate is still an excellent anti-epileptic and will not disappear, but it is not a matter for specialist centres. It is so widely used that it is critical that within primary care and on product boxes it is made clear that women who are looking to conceive or who are of child-bearing age should not be left on Epilim; that should be discussed with them right from when they are young teenagers, so they can think about the impact later on.

The recommendations that have not been accepted are not to do with reorganising licensing, or a yellow card system; they are all recommendations that relate to women. That is really disappointing. The redress for them—the setting up of specialist centres to try to repair the damage as far as possible—is what is not being provided. The Government should look at the fact that those are the recommendations they have skirted around and not accepted. These women and the children affected have gone through enough.

--- Later in debate ---

I appreciate that the objective of the amendment is to hold the Government to account for implementation of their response. The Government have already committed to publishing an update on implementation; we intend to do that by summer 2022. I believe that significant progress on the recommendations has been made, but I am conscious that the shadow Minister, with his depth of knowledge in this area, may wish to press further in the coming months. I suspect that he will rightly continue to hold the Government to account.

[Alex Norris]

I am grateful for colleagues’ contributions. The comments of the hon. Member for Central Ayrshire presaged what the Minister said: yes, the Government have been able to do the more strategic aspects of this, but they have done half a job. The half they left out relates to people who have fought for so long just to get a little support, and recognition that they have been badly wronged in a way that significantly changed their life. They really do not ask for much—just a bit of support. It is not a nebulous or open-ended ask; it is just for what was in the report, and that does not seem too much to me.

The Government have been in defensive mode for a long period on this issue, but I desperately hope that they do not think they have done the job, because they really have not. I also hope that they do not think these women will go away, because they absolutely will not, and a lot of right hon. and hon. Members in this place want to help them and give them a platform from which their voices will be heard. A good way to act would have been through the new clause. With that in mind, I intend to press it to a Division.

Question put, That the clause be read a Second time.

--- Later in debate ---

Brought up, and read the First time.

[Alex Norris]

I beg to move, That the clause be read a Second time.

The new clause is a fitting follow-up to new clause 52, in the sense that the theme of the report was that, yes, dreadful things happened, but—as the hon. Member for Central Ayrshire said—largely with a complete lack of knowledge among clinicians, who were just following the guidelines, as they were supposed to and had been trained to. A common theme beyond that is that this happened to women, and when women tried to express their concerns, the system was not geared up to listen. Instead, the response of the system was to write them off—some of the name calling will probably not amaze us, but it should.

The new clause seeks to ensure explicitly that local care boards take into account the views of women on reproductive health. High-quality reproductive healthcare should be accessible and individualised at each stage of a woman’s life, from puberty and through the years of menstruation to the menopause and beyond. This is something that we will discuss tomorrow through the private Member’s Bill of my hon. Friend the Member for Swansea East (Carolyn Harris). She will put the case well, I have no doubt.

The system should enable women to decide whether, when and how often to have children by informing them about, and providing easy and timely access to, the full range of contraceptive methods. Maintaining good reproductive health and wellbeing has profound and positive long-term effects for women and wider society. However, at the moment, inherent system fractures in the commissioning and delivery of reproductive healthcare services mean that many women are left struggling to access basic reproductive care, including contraception and gynaecological cancer screening.

The impact of the current situation is stark. Almost half of British women have experienced poor sexual and reproductive health, and that figure should give us pause. We know that since the Health and Social Care Act 2012—again, this is something in that Act that we should want to change—reproductive healthcare has been compromised by a lack of strategic prioritisation and prevention, a deeply fragmented commissioning landscape, and of course that ongoing theme of significant cuts to public health, which in this case include a 14% real-terms reduction for sexual and reproductive health services. Again, that has been felt more by poorer communities, and all those factors have resulted in gaps in the reproductive care pathway, creating disconnected and disjointed care for women. For example, in many areas of the country, women are not able to access a fitting for an intrauterine device—one of the most effective contraceptive methods—or cervical smear tests in a similar healthcare setting, meaning that they have to go through multiple invasive exams in different settings. Of course, it is important that those tests take place, but we should seek to make it the easiest process that it can possibly be.

Women approaching the menopause are not able to access treatment for heavy menstrual bleeding at community clinics or GP practices, because many are not commissioned to provide that service or lack the funding or trained staff, resulting in those women being bounced around the system while living with obviously debilitating conditions. This Bill is an important moment to tackle long-standing structural challenges in reproductive healthcare. If we are truly moving towards greater integration and collaboration within the healthcare system, this is a really good chance to implement holistic women’s reproductive healthcare services at a regional and local level. Through listening to women and integrating care around the needs of the individual, rather than the institutions, we can deliver holistic care across the breadth of reproductive healthcare.

I know that there is a broader duty in this Bill for integrated care boards to promote the involvement of their patients and carers in decisions about the provision of health and care services, as well as having regard for inequalities. This new clause builds on that by wiring in engagement with women, because it is not happening. Again, if we just keep doing things in the same way, we will get the same outcome, so this is an opportunity to design a healthcare system for women that listens to women and builds in accountability. That will help ensure that reproductive healthcare pathways fully meet the needs of those who they are meant to serve, which would be a very positive outcome.

--- Later in debate ---

[Edward Argar]

The hon. Lady is absolutely right to raise that. We need to get across, loud and clear, to our future clinicians almost right from the start—from their training and early education—the message that everyone’s health concerns matter equally, subject, obviously, to clinical decision making. I hope and believe that HEE and others will engage with that process in the context of the women’s health strategy. We do not want it to be a document that just sits on a shelf, or want it to look at issues in a siloed way; it should look at them across the piece. Over many years, there have been strategies on particular aspects of health. In the strategy, we seek to bring together a whole range of factors, so that we can look at how women interact with the healthcare system, and how to meet their needs holistically.

We want to maximise the independence of ICBs, so that they function in the way that best suits the needs of their patients and their organisations. We are therefore keeping their legislative obligations proportionate; that brings us back to a debate that the Committee has had multiple times about the permissive nature of the legislation. I agree that appropriate representation is essential in healthcare planning. I fear that the new clause is overly specific and not necessarily in keeping with the obligations on ICBs set out in clause 19 on general functions.

The Bill already puts obligations on ICBs that will help to ensure that relevant groups are fully represented and consulted in decision making. In particular, ICBs will need to ensure that they have taken appropriate advice from a broad range of those with professional expertise. As the work of ICBs will inevitably cover reproductive health, that requirement ensures that relevant groups are included in this work. Furthermore, as we discussed in the opening sittings of the Committee, local areas will have the flexibility to determine any further membership of the ICB beyond the minimum for which we have legislated. That discretion will allow local areas to ensure appropriate representation.

On working in partnership with the non-profit sector and local community groups, I recognise the essential role that those organisations and groups play, and agree that they should be involved in strategic decision making where appropriate. Each ICB and their partner local authorities will be required to establish an integrated care partnership. We expect the ICP to bring together organisations from across health, social care and public health, and representatives from wider areas where appropriate. That could include organisations from the voluntary and community sector. The ICP will be tasked with promoting partnership arrangements and developing a plan to address the health, social care and public health needs in its area. As that will include reproductive healthcare needs, we would expect relevant local groups to be represented. The ICB and local authorities will have to have regard to that plan when making decisions. That will enable more joined-up planning and provision, both in the NHS and by local authorities, which will enhance the services that people receive.

Existing and proposed duties already address the concerns underlying the new clause and ensure effective public involvement. We have concerns about imposing additional duties on individual services. Our approach enables local NHS bodies, supported by national guidance, to decide how best to involve patients and the public in the planning of commissioning arrangements, and in developing and considering proposals to change them, so we are not convinced that the additions in the new clause in respect of reproductive healthcare are necessary.

[Alex Norris]

I am grateful for the contribution from my hon. Friend the Member for Bristol South. Many people will be looking with great interest at what happens tomorrow. She spoke about the menopause not having been on the political agenda for such a long time. I think that that has changed, and not before time, so we are all very much looking forward to what will happen.

We have tested the Minister on the permissiveness point quite a lot, so by this, the 22nd sitting of the Committee, I think it is possibly an established fact, and I do not intend to divide the Committee, but I do want to come back on what he said about the sufficiency of the duties as drawn. When we have pushed for individual plans for each ICB—say, on inequalities, on the first 1,001 days and on drugs and health—there has almost been a sense of, “Well, of course these bodies will want to do that. It will be their local decision, but of course the evidence will drive them to do that.” I do not think we can say, on women’s health, that that is an “of course”, because we know that actually, historically, it can be very much an afterthought.

The thought that I might leave colleagues with on this issue is that we are having a growing conversation in this country about misogyny, and one of the things that you will hear men say a lot—I have said this myself, because I mean it—is, “We have to hold one another to account for the things we say and the way we act.” I completely agree with that. In that spirit, we have to understand that if a lot of the basic reproductive healthcare things that we are talking about today happened to men, we would be doing them in McDonald’s drive-thrus. It is as simple as that. Therefore, if we are to have an honest conversation with one another about misogyny in this country, it is that sort of thing that we mean. It is not always about pointing fingers and blaming, or policing jokes, which I think is important; it is actually about saying that services are different because these things do not happen to us and we should be more mindful of that and should want to change. I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

New Clause 54

Enhanced data collection

“(1) The National Health Service Act 2006 is amended as follows.

(2) After section 14Z43 (inserted by section 19 of this Act) insert—

“14Z43A  Duty to develop data collection systems

Integrated care boards must—

(a) develop single whole-system IT systems across the whole of their integrated care system with the explicit purpose of supporting data collection and sharing;

(b) prioritise the use of those data systems for streamlining patient pathways;

(c) establish mandatory standards for patient-initiated follow ups; and

(d) use the data systems developed under paragraph (a) to report on a regular basis performance against improving patient outcomes in line with the standards established under paragraph (c).””—(Alex Norris.)

This new clause requires ICSs to develop digital data collection and sharing systems, and use them to track performance against mandatory standards, with specific regard to patient-initiated follow ups.

Brought up, and read the First time.

[Alex Norris]

I beg to move, that the clause be read a Second time.

I keep going, Ms Elliott. Again, you can perhaps file this under gluttony for punishment. I do not intend to talk for very long about this new clause. I am sure that the Minister will be able to give us comfort easily on the point of new clause 54. It is just to develop the point about data one last time before our carriages turn into pumpkins.

A specific part of the Bill deals with data, and we had some very good conversations at that point. I will not repeat any of that. I will explain what I am chancing my arm at in new clause 54. I talked previously about systems and the problems with systems talking to one another. Here, we are asking integrated care boards to develop

“single whole-system IT systems”.

That is perhaps at the top end in terms of what should be aspirational and what is in fact achievable, but I do want to pursue the point a little.

Data is critical, as we have said before, in driving improvements. NHS England’s own website talks about the need to use it to improve services and decision making, to identify trends and patterns, to draw comparisons, to predict future events and outcomes and to evaluate services. But to do that, we have to have some sense of consistency. I will not repeat the arguments around the General Data Protection Regulation—we had those at length—but that shows the challenges if we do not get it right.

Going down to ICS level, if we are going to have a system that really does harness all the information, we need systems that talk to one another. Therefore, the prescription in proposed new subsection (a) is that it is a single system. As I have said, that is the stretch target. What I am hoping to get from the Minister is a sense of where he thinks this will land. Is it the same organisations using the same systems but trying to find a new way to do them, or will there be some new, novel approach to how we support footprints to do that? It is an established fact that data is going to be really important to local systems, so we want to give them the fairest wind to make the best use of it that they can.

[Dr Whitford]

On new clause 54, I just want to speak to proposed new subsection (d)—the use of data to assess performance against outcomes. Between 2009 and 2019, there was really no significant national audit of quality of breast cancer services in England, even though some of that audit had been carried out in previous years. Part of that was due to the fracturing of the system from the social care Act. There might be only one breast unit within an area, and quality was left to commissioners. How can commissioners measure whether a local breast unit is treating people properly or achieving the aspired-to targets?

In Scotland, 19 of the commonest cancers are audited; I was involved in developing the breast cancer standards in 2000, and they have been updated many times since. They are assessed annually with an annual peer review conference, where clinicians will openly discuss the challenges they face and therefore will share the solutions many of them have come up with. The clinical things that we know will affect the survival and outcomes of our women in the future are all set as national benchmarks. It is important that, while data would be collected locally, it is benchmarked against national standards.

The Getting It Right First Time project was restarted in England a few years ago but, to my knowledge, although the Getting It Right First Time for breast cancer report was completed at the end of 2019, I have not seen it published. That appeared to be due to the election in December 2019; perhaps the Minister can clarify whether the breast cancer GIRFT report has now been published, when it might be published and what other GIRFT reports have come out.

The problem is that, even if that report were published now, two years after its completion, it would largely be based on data from 2018, and therefore clinicians would shrug their shoulders and say, “Out of date.” It is important that data is used in a timeous manner to audit as quickly as possible, so that the audit loop can be closed and services improved. Having led on this process in Scotland, I saw the change in standards between 2001, when we began the first assessment, and 2005, and it is an incredibly satisfying, not frightening, thing for clinicians to see year on year the quality of care delivered by their unit driven up. There must be national standards, but local audit.

--- Later in debate ---

As a result of the above, I do not believe that adding an additional duty to ICBs would be necessary, as the work is already under way.

[Alex Norris]

This is not something that we will be able to resolve with top-down prescription, but I have made the point that I hope we will do everything we can at a national level to model best practice, to demonstrate best practice and to give our local systems access to best-practice systems, because that will be very important. On that basis, I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

New Clause 56

Domestic violence training for GPs

“(1) The National Health Service Act 2006 is amended as follows.

(2) After section 83B (inserted by paragraph 3 of Schedule 3 of this Act) insert—

“83C  Duty concerning domestic violence and abuse

(none) Integrated care boards must ensure that specialist domestic violence and abuse training, support and referral programmes are universally available to all general practitioners.””—(Alex Norris.)

This new clause adds a requirement for specialist domestic violence and abuse programmes to be available universally throughout general practice.

Brought up, and read the First time.

[Alex Norris]

I beg to move, That the clause be read a Second time.

Domestic abuse is an issue of significant interest across this place. We know that two women a week are killed by a current or former partner in England and Wales alone. As we mentioned the other day, a quarter of women will experience domestic abuse in the course of their lifetime, which has devastating effects. It impacts on both the physical and mental health of survivors and their children, and it has a terrible cost in general to everybody, including a financial cost.

New clause 56 would impose a duty at a local level to ensure that GPs have access to specialist domestic violence and abuse training. It is something that would be very welcome, and we are proposing a duty for integrated care boards to provide that. GPs are a credible point of contact for people in violent relationships. Some 80% of women in a violent relationship seek help from health services first. In some cases, that is their only contact. Training for GPs is vital to ensure that such contact is of the best possible quality. A study of women in violent relationships in the Netherlands found that 50% of women who did not speak to their GP about the matter would have done so if the GP had been in a position to approach it. Moreover, 50% of the women who did talk to their GP did so because they hoped to be referred on, so they wanted to have a high-quality conversation with someone who knew the system.

From my time prior to this place and my experience in Nottingham, I have a lot of enthusiasm for the IRIS programme—the identification and referral to improve safety programme. A trial carried out by Bristol University found that the training programme led to up to six times more women receiving the help they needed, and that it boosted the number of referrals to specialist domestic violence agencies. After IRIS training, GPs reported being better able to assess domestic violence risks and a greater awareness of services, while 99% of service users felt listened to and 87% felt safer.

The evidence is that such training works. This is of course not the way in which we should write a new clause, but I am saying that IRIS should be universal or something like it. I would leave the “something like it” to the provider market and to commissioners but, in general, the principle is that all GPs should have training so that they can understand and act on domestic abuse and have the right resources to provide support and make skilful onward referrals, so that the system can wrap its arms around an individual who is trying to get out of an abusive situation. That would be exceptionally important for such women, and I hope the Minister will have some thoughts about how we can get to a universal, IRIS-like level of engagement with our GPs.

[Edward Argar]

The new clause would require ICBs to provide specialist domestic violence and abuse training, support and referral programmes to all GPs, with the aim of strengthening the health response to domestic abuse and improving links between the NHS and voluntary sector support for victims. We have concerns about the new clause, which is why we cannot accept it, but I hope that I can set out to the shadow Minister my reasoning.

Domestic abuse, as we discussed yesterday when considering another proposed new clause, is a terrible crime, and it can have a devastating impact on victims and survivors. It is also important that we remember that children are often just as much victims as the victims themselves, through the experiences that they have of domestic abuse and domestic violence. The Government are clear that there is absolutely no excuse for abuse. Tackling domestic abuse and supporting victims, survivors and their children is a key priority for Government, now more than ever.

The Domestic Abuse Act 2021 and the forthcoming domestic abuse strategy will help to provide a whole-system approach to protect and support victims and their children. The measures in the 2021 Act seek to promote awareness by introducing a statutory definition of domestic abuse, and to recognise children, as I alluded to, as victims in their own right, in order to protect and support both, tackle perpetrators, transform the justice response, and drive consistency and better performance in the response to domestic abuse.

The 2021 Act also sets out the convening of local domestic abuse partnership boards, with healthcare representation. We recognise the key role that healthcare services play within a whole-system approach to tackling domestic violence. Healthcare services must identify signs of risk and harm, enable victims and survivors to come forward, and provide timely integrated care and support. We know how important it is that statutory agencies and professionals properly understand and react to domestic abuse. However, I hope that I can reassure the Committee that placing in the Bill a formal duty on ICBs to ensure that specialist domestic violence and abuse training, support and referral programmes are universally available to all GPs is not necessary.

General practice is delivered by multidisciplinary teams, rather than just GPs, and existing Care Quality Commission registration requirements include a review of practices’ safeguarding processes. In addition, NHSEI’s ICS people guidance sets an expectation that ICBs will foster learning and continuing professional development. Going further, the Bill, in proposed new section 14Z41 of the National Health Service Act 2006, imposes a duty that each ICB

“must, in exercising its functions, have regard to the need to promote education and training for the persons mentioned in section 1F(1)”

of the 2006 Act.

[Edward Argar]

I am grateful to the hon. Lady. In part, the reason is because this is sadly not a well drafted new clause. It is very narrowly drafted to GPs, not recognising the multidisciplinary nature of how healthcare is delivered in GP practices. I suspect that we all have correspondence from constituents—whether happy or unhappy—going to doctor associates, practice nurses and others. That is one of my key concerns, but let me articulate a little more what is already being done. I see where she is coming from. As I mentioned yesterday, I was the Minister with responsibility for victims of domestic violence, and of crime in general, when I was in the Ministry of Justice, so it is something that I am very familiar with. It is about raising awareness not just with GPs, but within the police and a range of agencies. My challenge, just before she intervened, was partly about the way the new clause is drawn, but let me articulate a little further our views on it. I am keen to do so before the business possibly collapses early in the House, and we have to adjourn in order that I can respond to the Adjournment debate.

Section 1F of the 2006 Act defines a wide group of people, covering persons who are employed, or who are considering becoming employed, in an activity that involves or is connected with the provision of services as part of the health service in England. That duty on ICBs would already cover general practitioners, but it goes wider. I appreciate that the new clause goes beyond training, so I will also discuss the support and referral elements that the hon. Member for Nottingham North talked about.

The NHS provides care and support to victims of domestic abuse through a range of healthcare services. This response is centred around ensuring that healthcare professionals are trained to spot the signs of domestic abuse and those at risk; to make safe and sensitive enquiry of the issue; to know where to refer people to get further support, and to know when and how to share information appropriately with colleagues and other organisations.

All NHS staff must undertake annual mandatory safeguarding training, which includes focus on domestic abuse. NHS England, NHS Improvement and Health Education England are reviewing mandatory safeguarding training for all health professionals to ensure that they are fully equipped with the key skills, knowledge and principles to protect all citizens. The Government published an online domestic abuse resource for health professionals and have developed a number of training modules with the Institute of Health Professionals, the Royal College of Nursing and the Royal College of General Practitioners.

From 2018 to 2020, the Department managed £2 million of funding for the domestic abuse pathfinder programme, which created a model health response for survivors of domestic violence and abuse in acute, community and mental health services. The pathfinder toolkit was published in 2020 as the result of emerging promising practice at our pilot sites, coupled with the expertise of the pathfinder consortium of specialist domestic abuse organisations, to encourage best practice across the health system. Pathfinder has given us a model for our response to domestic abuse in healthcare. It is a model for integrated, joined-up and trauma-informed care and support, with healthcare settings and the voluntary sector working together.

As the shadow Minister mentioned, the Department of Health and Social Care has also funded the IRIS programme, to which I pay tribute. IRIS is a training, referral and advocacy model to support clinicians in better supporting patients who are affected by domestic violence and abuse, and to increase the awareness of domestic violence and abuse within general practice. IRIS is recognised by the DHSC as good practice, and via the National Institute for Health Research we funded a study that demonstrated the effectiveness of the IRIS programme at scale. I am delighted to note that the study won the 2020 Royal College of General Practitioners research paper of the year award.

I am proud that the Government have championed the building of that evidence base. I believe that it would not be best or appropriate, however, for the legislation to require local health and care systems to adopt specific programmes. Indeed, such detailed requirements would reduce local health and care partners’ flexibility to meet the needs of their local populations or to engage with particular local organisations and expertise in delivering their programmes.

Beyond ICBs, I see a huge opportunity for integrated care partnerships to support improved services for victims of domestic abuse, sexual violence and other forms of harm, through better partnership working and joint planning of services. The Government have also developed a cross-Government strategy for tackling violence against women and girls, and will develop a cross-Government domestic abuse strategy.

As committed to in the tackling violence against women and girls strategy, the DHSC will continue to work closely with NHS England and NHS Improvement to promote evidence-based approaches to tackling violence and abuse through guidance and engagement with the new system.

[Alex Norris]

I am grateful to the Minister for his response. I am more than happy to wait for the domestic abuse strategy, but I really hope that such measures will feature in it, and that when the strategy goes around various Departments for their comments, the Minister will make a commitment—

[Edward Argar]

May I make the offer to the hon. Gentleman that I or the relevant Minister leading on this—whoever is more appropriate—will engage directly with him?

[Alex Norris]

That is very welcome, and in that spirit, I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

New Clause 57

Cancer strategy

“Within 12 months the Secretary of State must—

(a) publish a new cancer strategy; and

(b) either designate a minister or appoint a national lead with responsibility for enacting its implementation.” —(Alex Norris.)

This new clause requires the publication of a new cancer strategy, with a minister or other person made responsible for its delivery.

Brought up, and read the First time.

[Alex Norris]

I beg to move, That the clause be read a Second time.

[The Chair]

With this it will be convenient to discuss new clause 64—Cancer treatment data reporting—

“(1) Beginning within 6 months of the passage of this Act, the Secretary of State must publish each month data on—

(a) the number of patients awaiting treatment for cancer,

(b) the number of patients with a cancer diagnosis, and

(c) what NHS’s previous estimate was of the number of patients who would have a cancer diagnosis at that point in time.

(2) Six months after the publication of the first report under subsection (1), and every six months thereafter, the Secretary of State must publish a report on the action being taken to reduce the number of patients awaiting treatment for cancer.”

[Alex Norris]

I am conscious of other business, so if I am interrupted, I will not take it as rudeness.

[Edward Argar]

We may be okay.

[Alex Norris]

New clauses 57 and 64 both relate to cancer. It is not quite possible to quantify the damage done by cancer in this country because we end up just throwing big numbers around. In the UK, there are 375,000 new cases and 166,000 cancer deaths each year. Each of those numbers represents a person with a devastated family. I lost my father to cancer in my infancy—35 years ago in January—and that loss is something that lives with a family for the rest of their lives.

We know that one in two people born after 1960 will be diagnosed with cancer. Our investment in cancer services is £5 billion a year, but the cost dwarfs that, at over £18 billion. Nearly 40% of cancers are preventable. Happily—this is something we should be proud of in this country—the developments that we are making in medical and technological areas mean that cancers are increasingly survivable, with the survival rate doubling in the last four decades. Better diagnosis and treatments mean that nearly 50% of those diagnosed with cancer in England and Wales now survive for 10 or more years, and there is no reason for that to stop increasing.

--- Later in debate ---

[Edward Argar]

I am grateful to the hon. Lady, who is distinguished in this field herself, from her previous career. She quite rightly highlights the importance of the workforce. Since 2010, in both radiology and radiography, there have been significant percentage increases in the workforce of those specialist professions. However, she is right to highlight that, while we have seen a significant percentage increase, in absolute terms we still need to do more to grow those professions. We have plans in place to do that, but that is a slow task; it can, in some cases, take up to 10 or 12 years to become an experienced specialist in that field.

On those increases since 2010, the Government would argue that we put measures in place, but it is also important to recognise that the previous Labour Government were working on this as well, hence the pull-through; those radiologists and radiographers did not magically appear immediately after 2010. There were programmes in place before and after that, so it is right that we recognise the contribution of the Opposition when they were in Government.

Finally, the new clause also seeks to place a Minister or national leader in charge of that new cancer plan. My ministerial role includes responsibility for elective recovery and recovery from the pandemic—our plan to tackle those waiting lists. As the shadow Minister knows, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), the former Under-Secretary of State for Health, who briefly sat on this Committee, had responsibility for cancer services specifically, as does the new Under-Secretary. Dame Cally Palmer is the national lead as the national cancer director at NHS England and NHS Improvement. She has a distinguished career as chief executive of the Royal Marsden Hospital in parallel. We are jointly responsible for the current cancer plan. It is therefore unnecessary to include that new duty when we already have those accountabilities.

I will move on briefly to new clause 64, which we are considering with new clause 57. It seeks to legislate for an additional duty on the Secretary of State to publish data on cancer waiting lists, cancer diagnoses and action being taken to reduce the number of patients waiting for cancer treatment in England. Again, I understand the intention behind the new clause. Cancer is one of the greatest challenges to people’s health, as we set out. I would like to highlight first the fact that the Government are already delivering on the request for monthly publication of cancer performance data. Ensuring transparency of data is a priority. Each month, we publish official statistics on waiting list data, including the number of patients who began cancer treatment and waited longer than 62 days for treatment. NHS England also publishes monthly management data on the number of people currently waiting longer than 62 days for diagnosis or treatment. The new clause calls for data that is very similar to what is already published, and we therefore consider that it would be duplicative.

Secondly, on the request to publish predictions—that is not something that is currently done. Doing so would likely result in unhelpful poor-quality assumptions or modelling that could lead to expectations or an understanding that is not reflected in the reality of the data that comes through. While we look at all data sources internally, it would not be in the best interests of scrutiny and, potentially, patients to publish poor-quality predictions with a limited confidence factor.

Thirdly, there is no evidence of need. Following the success of campaigns such as Help Us, Help You, we have seen the public seek medical attention for symptoms that might be cancer, while cancer referrals from GPs have been at record levels since March. At the same time, the NHS has been delivering high-quality and innovative solutions to improve cancer care and treatment. We have announced funding for elective recovery, including cancer services, of £2 billion this year and £8 billion over the next three years, which will increase activity and deliver millions more checks, scans, procedures and treatments. We will continue to publish and review the monthly official statistics to monitor progress.

Finally, on the request for the Secretary of State to publish a report every six months on the actions taken to reduce the number of patients awaiting cancer treatment, I should state that the NHS has already undertaken extensive work to reduce the number of patients waiting for treatment and to continue progress in delivering the long-term plan ambitions for cancer. We will publish the elective recovery delivery plan later this year, which will set out how the NHS will deliver increased elective capacity and how cancer patients will be prioritised for access.

Furthermore, the NHS cancer programme already regularly reports on progress through both NHSEI and DHSC governance structures, through publication of monthly data on cancer waiting times and through regular communications products. We would therefore argue that the new clause is duplicative. While I assure the Committee that we are taking urgent action to reduce cancer waiting lists, we consider the new clause to be unnecessary.

[Alex Norris]

I am grateful for that answer, which reflects the current difference in public policy between the Government and the Opposition. At oral questions to the Health Secretary, I always ask and will continue to ask whether the Government’s position is that the current plans and status will be sufficient to meet the challenges and the backlog—we think they are not. While the system was overheated before the pandemic, it has been distressed by the last 18 months. We do not think that asking that system to meet both emergent and old problems will work. However, that is probably a point for oral questions and future debates, rather than this Public Bill Committee. On that basis, I will withdraw the clause.

As we are coming to the end of the debate, I might gently say to the Minister, on his point that the Government do not make predictions because they might be unhelpful in the future, that it feels as if, every time he goes on the news, the Health Secretary puts waiting lists up by another million in an extraordinary attempt to manage expectations. Was it 13 million last time? It just goes up and up. I do not think it is quite fair to say that Ministers do not do that—the Health Secretary, at least, certainly does. Nevertheless, that is no reason not to withdraw the clause, and I therefore beg to ask leave to withdraw the clause.

Clause, by leave, withdrawn.

Ordered, That further consideration be now adjourned. —(Steve Double.)