NHS Dentistry: Recovery and Reform

Baroness Keeley Excerpts

Wednesday 7th February 2024 Commons Chamber

[Victoria Atkins]

My right hon. Friend raises an interesting point. Indeed, that is exactly the sort of discussion I am having with my right hon. Friend the Levelling Up Secretary, because I am really interested in having that connected and joined-up approach between planning and health. I think it could bring dividends for us all.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I do not believe that what the Secretary of State has described will deal with the complexity of dental problems out there. I have a constituent who was referred to the Manchester Dental Hospital for a possible abscess and was told that even an urgent referral would take a month. In fact, the dental hospital did not get back to her for five months after the referral; it offered her a telephone consultation. The amount of pain and infection meant that she had to seek private treatment at a cost of £4,000, but many cannot afford that, including the young man wheeled into Royal Bolton Hospital in great pain, leaking blood on the floor after trying to remove a painful tooth with pliers. What does the Health Secretary say to patients who have long-standing and complex dental problems and are paying the price by waiting in pain, paying for private treatment or trying to remove their own teeth?

[Victoria Atkins]

I take that constituency case very seriously. I am really keen to urge the hon. Lady that if a constituent contacts her in future with that level of discomfort and pain, she should advise that constituent to contact 111 and, if necessary, go to accident and emergency—[Interruption.] Labour Members are shaking their heads, but what she has just described is a serious situation. That constituent needs medical attention, and the NHS is there, ready and willing to help. That is the advice that she should be giving her constituents, and I hope that she takes it as seriously as I do. [Interruption.]

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 23rd January 2024 Commons Chamber

[Victoria Atkins]

I thank my hon. Friend for her interest and, of course, her many years working as a clinical psychologist. She brings that experience to the Chamber. National commissioning guidance to integrated care boards was published in November. It sets out that a mental health in-patient stay for a person with a learning disability

“should be for the minimum time possible, for assessment and/or treatment which can only be provided in hospital”.

In overseeing implementation of the action plan going forwards, the “Building the right support” delivery board will maintain focus on quality of care and on reducing long stays.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

It is vital for the Government to do more to move autistic people and people with learning disabilities out of in-patient units and back to their communities. Recently, in the trial of staff at Whorlton Hall, we saw staff who were cruel and uncaring. Delivering sentences, the judge said that Whorlton Hall was an

“unpredictable and…frightening place to live”.

Is it not time for the Government to close down those units and move the majority of people into the community?

Draft Anaesthesia Associates and Physician Associates Order 2024

Baroness Keeley Excerpts

Wednesday 17th January 2024 General Committees

[Barbara Keeley (Worsley and Eccles South) (Lab)]

It is a pleasure to serve on this Committee with you in the Chair, Dame Caroline. I am pleased to be able to speak in our discussion of this very important area of legislation, as the right hon. Member for Suffolk Coastal just called it. In my view, this issue is so important that we should be debating it in the Chamber; perhaps we could have found a way to do that.

Schedule 1(3)(a) to the order states that the regulator

“has the objective of promoting and maintaining—

(i) public confidence in, and

(ii) proper professional standards and conduct for members of, the anaesthesia associate and physician associate professions”.

I hope that the regulator takes those duties very seriously, because public trust in physician associates has already been damaged by the very sad death of Emily Chesterton, who died after being seen twice and diagnosed by a physician associate at a local GP practice. Emily was the daughter of my constituents, Marion and Brendan Chesterton, and I raised her case at an Adjournment debate on 6 July 2023. I would like to give details of Emily’s case, because it illustrates the need for the greatest clarity in the distinction between doctors and staff in the medical associate professions.

Emily Chesterton died in November 2022 after suffering a pulmonary embolism, after being seen twice by a physician associate, rather than a GP. She was just 30 years old when she died. Emily was a budding actor in musical theatre. She and her partner had moved to London from Boothstown, in my constituency, to pursue their careers in the arts. They registered with their local GP surgery, the Vale Practice in Crouch End, north London. Emily had been diagnosed with polycystic ovary syndrome and had also contracted covid-19 in late summer 2022. Marion Chesterton, her mother and my constituent, said that Emily had been feeling unwell for a few weeks before she made an appointment at the Vale Practice on 31 October 2022, as she had calf pain and was breathless. Emily believed that this appointment was to see a GP, but the person she was booked to see at the practice was a physician associate.

Physician associates and doctors have a very different depth of expertise. Physician associates have to complete just two years of clinical training, following a biosciences undergraduate degree. Doctors, on the other hand, must complete a five-year medical degree, as well as several years of foundation training and specialism training, interspersed with national exams. As both the Minister and my hon. Friend the Member for Bristol South on the Opposition Front Bench have said, physician associates are intended to support and assist more medically qualified staff, not replace them.

In Emily’s case, after a short appointment, the physician associate diagnosed Emily with a sprain and possibly long covid. Emily was told to rest and take paracetamol. At no point during the appointment at the GP surgery was Emily made aware that the person who had diagnosed her was not a doctor.

A week later, on 7 November, Emily began to feel very unwell. Her leg was swollen and hot, and she struggled to walk a few steps without becoming out of breath. She made another appointment at the Vale Practice and saw the same physician associate. It appears that this was a short appointment, and that Emily’s legs were not examined. The physician associate suggested that Emily’s breathlessness was due to anxiety and long covid. She prescribed propranolol. In messages that Emily sent to her family on that day, it appears that she described seeing “the doctor”, and that she was never told that the person she was consulting for medical assistance was not a fully qualified GP.

In its serious incident report after Emily’s death, the Vale Practice stated that patients should not see a physician associate twice for the same condition. The guidelines make it clear that physician associates cannot prescribe; any prescriptions need to be signed off by a supervising GP. It appears that the oversight of prescribing medication was missing, and the system failed in Emily’s case.

Later in the evening of that same day, 7 November, Emily’s health deteriorated, so she took a propranolol tablet, as advised by the physician associate. She then became drowsy, and then very ill. Her partner Keoni recalled to the inquest that she lost her pulse, and he had to perform CPR on her, which recovered the pulse. He then called an ambulance.

Emily suffered a cardiac arrest on the way to the hospital. Her family had to say their goodbyes to her while she was still on the machine that was pumping her heart for her. Keoni recalled that staff at the A&E department at Whittington Hospital, where Emily died, told him that the propranolol tablet “definitely would not have helped” Emily’s condition, and staff had to give her an antidote to the drug.

The circumstances that led to Emily Chesterton’s death were investigated by a coroner, and there was a hearing at St Pancras coroner’s court on 20 March 2023. Messages from Emily to her partner and family at the time of her appointments were shared at the inquest. These messages provide evidence that Emily believed that she was seeing a doctor. They also provide evidence that the appointments with the physician associate were short, and that Emily was not examined fully.

The coroner’s conclusion was as follows:

“Emily Chesterton died from a pulmonary embolism, a natural cause of death. She attended her general practitioner surgery on the mornings of 31 October and 7 November 2022 with calf pain and shortness of breath, and was seen by the same physician associate on both occasions. She should have been immediately referred to a hospital emergency unit. If she had been on either occasion, the likelihood is that she would have been treated for pulmonary embolism and would have survived.”

That heartbreaking statement lays out clearly the failings in the health system, which should have supported Emily with appropriate care.

Sadly, further failings were evidenced in the incident report that the Vale Practice provided to the coroner. In particular, it was noted that the physician associate who saw Emily did not introduce herself and her role to Emily during the appointment. The practice said that the physician associate had failed to explore the causes of Emily’s symptoms, failed to refer Emily for clinical investigations, and failed to consult a doctor after seeing a patient who had presented twice in one week with significant risk factors for pulmonary embolism. The practice also raised concerns about the physician associate’s overconfidence and lack of insight into the limitations of her clinical knowledge and practice. Although the physician associate’s contract at that practice was later terminated, Mrs Chesterton was upset to learn that she was still practising in the NHS in London, but I understand that that changed after I raised concerns in the Adjournment debate.

I must add that Emily’s is not the only case like this. Sadly, Ben Peters, a previously healthy 25-year-old, died from a heart haemorrhage after being diagnosed with a panic attack by a physician associate. A freedom of information request sent to Scottish health boards found that there have been at least 12 “never events” linked to physician associates in Scottish health authority areas.

These cases demonstrate the urgent need for this profession to be regulated in a way that avoids further confusion among patients, their families and medical staff. To patients, associates and doctors may look the same—they appear to be doing a similar job—but the fact is that the associates do not have the same qualifications or expertise as doctors. I understand that it was originally envisaged that physician assistants would be vital members of multidisciplinary teams, assisting with the workload and contributing to a high quality of care, but the regulator must ensure that there are now clear guidelines for associates to make their role clear to patients when they introduce themselves. As I have described, that did not happen in the case of Emily Chesterton.

There is a bigger question around the titles of associate. At the time of my Adjournment debate, Marion Chesterton raised with me the point that the title sounds

“extremely grand, even grander than a General Practitioner”.

Some have suggested changing the title back to the original title of physician assistants and anaesthesia assistants to avoid that confusion. There may be other solutions that the Minister could consider.

Getting the approach to associates right will become even more urgent as the profession grows in line with the proposals set out in the NHS long-term workforce plan. There is certainly a need to tackle workforce shortages in the NHS, as my hon. Friend the Member for Bristol South said. A lack of qualified professionals is the root cause of many of the challenges that our health service faces. We must be careful that any adaptations to the workforce to fix those issues do not push existing professionals out.

I had many GPs write to me after my Adjournment debate about Emily’s case. One told me,

“There is much talk amongst GP locums of work drying up, possibly due to the increasing use of Additional Roles Reimbursement Scheme staff (including the associate roles) to fill vacancies (and these are much cheaper than employing locum GPs), and last week there was considerable disquiet about the Surrey practice that made its salaried GPs redundant due to ‘new ways of working’.”

He wrote on,

“For GPs—salarieds, locums, and trainees—who have been working in an over-stretched, high-stress system, and [who have] been told that there is a national shortage of GPs—this leaves many wondering about the security of their career and exploring other options. I am seriously concerned that the many intelligent, enthusiastic and valuable people in training and working as GPs are looking at options outside the NHS, outside medicine, and outside the country.”

I am sure the Minister would agree that this is deeply concerning when the UK already faces intense competition from other countries to retain our doctors. While multidisciplinary teams with a diversity of roles are vital, doctors must still be valued. Most importantly, patients and clinicians must have a clear understanding of the skills, qualifications and limitations of those providing care.

I want to acknowledge that there have been many tragic cases leading to avoidable deaths of patients that have involved other roles. We could look at the case of Connor Sparrowhawk, an epileptic teenager who had a seizure and drowned in a bath at a hospital unit run by Southern Health. Connor was just 18. Dame Caroline, you will know well the case of Oliver McGowan, who died in Southmead Hospital at the age of 18. Oliver was prescribed the anti-psychotic medication olanzapine by a consultant in the hospital, despite his notes saying that he had reacted badly to it previously. Oliver died as a result of the brain injury caused by the medication.

Those are tragic cases, but in neither of them was it the role and the limitations of an NHS professional that caused the problem. The issues I have raised are about the safety of patients and the accepted standards of knowledge, training and experience that we should expect from our medical professionals in order for them to provide a high quality of care. I hope that the Minister notes the points raised in this debate, and takes steps to ensure that the NHS workforce delivers for patient safety.

--- Later in debate ---

[Andrew Stephenson]

I thank my right hon. Friend the Member for Suffolk Coastal and the hon. Members for Bristol South, for Leicester East, for Worsley and Eccles South, for York Central, and for Wirral West for their contributions to today’s debate.

I would like to turn first to the contribution by the hon. Member for Worsley and Eccles South, who spoke movingly on behalf of her constituents Marion and Brendan Chesterton about the death of their daughter, Emily. I know that the hon. Lady also did so in a very moving fashion during an Adjournment debate, which was responded to by my predecessor, my hon. Friend the Member for Colchester (Will Quince). Ahead of today’s debate, I was very keen to listen to that debate, so I watched it back and I am keen to see what more we can do to learn lessons.

No family should ever have to endure the loss of a child, and no words from me will assuage the family’s grief. However, I hope that by passing this order we are helping to ensure that some lessons have been learned and that we can deliver improved patient safety through better regulation of these roles. I recognise that there have been delays to the previously published timescale for the regulation of AAs and PAs. Although that is in part due to the pandemic, it is important to reiterate that this work is being taken forward as part of a broader package of reforms of regulators, governing a whole range of medical professions. That work is significant and complex. On that basis, a huge amount of work and input from all the regulators and a range of stakeholders has contributed to the draft legislation for AAs and PAs, which will be used as a template for reforms to other regulatory bodies.

Throughout this process, officials from my Department have met the BMA and other stakeholders to develop the policy behind this legislation. On the basis of feedback received through public consultation and additional targeted engagement, officials have made a number of amendments to the draft order to ensure that the legislation is fit for purpose and delivers the flexibility and autonomy required to empower regulators to be able to introduce new regulatory processes that would better serve patients and their registrants. That engagement has been crucial in shaping both our policy intention and the resultant legislation to ensure that it remains a practical piece of legislation that can be used by regulators.

The forthcoming GMC rules consultation, which will follow the passage of this order, represents a further opportunity for the BMA and others to have input into the regulation of these roles. When I met the GMC, I was assured that they were confident that they could bring forward this consultation quickly so that there are no further delays to the timetable of implementing these regulations.

Turning to the AA and PA titles, which quite a few Members have raised today, the physician associate title has been well established in the UK since 2014, and the Government have no plans to change the titles of PAs or AAs. As set out in the National Institute for Health and Care Excellence guidelines, all healthcare professionals directly involved in patient care should introduce themselves and explain their role to the patient. AAs and PAs are not and should never be referred to as medical practitioners, doctors or consultants.

The GMC has published interim standards for AAs and PAs in advance of regulation that make it clear that professionals should always introduce their role to patients and set out their responsibilities in the team. Ahead of regulation by the GMC, the Faculty of Physician Associates has issued guidance for PAs, supervisors, employers and organisations that helps to provide a structured and standardised way of using the title. In addition, NHS England has produced patient-facing materials that have been shared widely with GP practices to support patient awareness and understanding of the PA role.

[Barbara Keeley]

I thank the Minister for his words of sympathy; I will pass them on to Mr and Mrs Chesterton. On patient-facing advertising, I think a couple of months ago, I raised with the previous Secretary of State for Health, the right hon. Member for North East Cambridgeshire (Steve Barclay), a post from Norfolk and Waveney integrated care system that read, “Got abdominal pain that isn’t going away? A Physician Associate based in your GP practice can help…They are highly skilled at diagnosing conditions”. That was marketing material related to the role, which does not help. We have had tragic cases like Emily’s, and it does not help to have over-egged advertising like that. Can the Minister can say anything about that?

[Andrew Stephenson]

I completely agree. Things like that do not help, and that is why bringing forward these regulations will help. The GMC is obviously very keen to start its consultation and have the regulations introduced. As soon as this is set out in statute, it will be very helpful, not just for PAs but everybody, particularly employers and others, in ensuring that they never oversell the abilities of a PA and are clear about the role of a PA or AA in an integrated health team.

Turning to the shadow Minister, the hon. Member for Bristol South, I thank her for her contribution and join her in paying tribute to the PAs and AAs already working in our NHS. She asked about the impact on training opportunities for junior doctors, which leads me on to addressing quite a few of the points about why we have decided to go with the GMC as the regulator. The assessment of the most appropriate regulatory body for AAs and PAs was completed in 2019 following a public consultation. The majority of respondents were in favour of the GMC taking on regulation, including the professional bodies representing the two roles and the medical royal colleges. For the record, from a total of over 3,000 responses, 59% of respondents felt that the GMC was the most appropriate, while 20% thought it should be the HCPC.

Regulation of the associate roles by the GMC will allow it to take a holistic approach to the education, training and standards of associate and doctor roles. That will enable a more coherent and co-ordinated approach to regulation, hopefully ensuring that concerns around training places for junior doctors, for example, are addressed appropriately. I am happy to reassure the shadow Minister that I will continue to work with all stakeholders to ensure that we get the regulations right.

I thank the hon. Member for York Central, who spoke knowledgeably about these roles. We would all agree that it has been long recognised that we need to reform the legislative framework for the regulation of healthcare professionals to make things faster and more flexible. The current UK model needs to change to better protect patients, support our health service and help the workforce to meet future challenges.

Successive Governments have considered such reforms, but they have never come to fruition until now. While it is our intention to work as swiftly as possible to deliver reform for each regulator and profession, we will prioritise delivery based on criteria including the size of the registrant base, the need for reform, and our assessment of regulators’ readiness to implement the changes. Based on those criteria, we intend to start working with the regulators to develop reform legislation for their professions over the next couple of years.

The hon. Lady asked about fee levels. I believe the GMC’s current plan is to charge AAs and PAs a fee of £221 per annum, adjusted for inflation. That is what PAs are currently paying the FPA—of course, AAs do not currently pay a fee. The GMC, like the NMC and other regulators, works on the basis of their activities being funded by the fees from registrants, which is an important way of keeping them independent from Government.

This draft order represents a vital step forward to improve patient safety by ensuring that PAs and AAs meet the standards that we expect of all regulated professionals and that they can be held to account if serious concerns are raised. I hope that I have addressed as many of the points raised by the Committee as I can, but I am more than happy to continue dialogue with the Opposition Front-Bench team and others to ensure we get the changes right. I commend the draft order to the Committee.

Building an NHS Fit for the Future

Baroness Keeley Excerpts

Monday 13th November 2023 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

I congratulate the Minister on being the great survivor of the Department of Health and Social Care. She must surely be due a carriage clock or the long service medal by now. The only long-term decision for a brighter future seems to be that she is still in her place, although she did not offer much of a brighter future.

More positively, I see far more than one nervous face on the Government Benches—I see lots of nervous faces among those contemplating the next general election—but one is undoubtedly that of the hon. Member for Uxbridge and South Ruislip (Steve Tuckwell). I congratulate him on his election and wish him well for his maiden speech, which I can confidently say will be the best speech we hear from those on the Conservative Benches all day.

At a time when patients cannot get a doctor’s appointment, families are struggling to pay the mortgage and major conflicts are having an impact on our economy and security, the Prime Minister has spent the past five days deciding whether to sack his Home Secretary for publicly disobeying him, undermining the police and inflaming tensions on our streets. Finally, having had the sheer poor judgment to have appointed someone to such high office when she had already been forced to resign for a serious national security leak, he has summoned up the guts to sack the worst Home Secretary in history. Yet, as we see, the merry-go-round of the Conservative clown show continues. After 13 years, the Conservatives have run out of names at the bottom of the barrel, so they are starting all over again. May I offer my sympathies to the Conservative Members who did not get the call from No. 10 today? What kind of message does it send to their constituents that their own party leader cannot find a suitable candidate for Foreign Secretary among the 350 Conservative MPs who sit in this House?

The arsonist has today returned to the fire, because when it comes to the national health service, Lord Cameron has quite a lot to answer for as the architect of austerity and the biggest top-down reorganisation in the history of the NHS—a £3 billion disaster that has led straight to the biggest crisis in the history of the NHS. That is before we even begin to take into account his record of ushering in the “golden” age between Britain and China; taking 20,000 police officers off our streets; and having food bank Britain leave more than 1 million people dependent on charity to feed themselves and their families. That is Lord Cameron’s legacy and as the current Prime Minister admits, “some mistakes were made”. Who is he trying to kid when he tells us that this recycled Conservative Government offer the change our country needs?

I would welcome the Secretary of State for Health and Social Care, the hon. Member for Louth and Horncastle (Victoria Atkins) to her position, but of course she is not here this afternoon, having just been appointed earlier today. She is the fifth Secretary of State for Health and Social Care that I have faced in this job in less than two years, although, to be fair, two of those appointments were the right hon. Member for North East Cambridgeshire (Steve Barclay). The Government said they would make

“Long-term decisions for a brighter future”,

but they cannot even deliver a long-term Secretary of State for Health.

We know where the Secretary of State is—she will be in the Department being briefed about the challenges of the job and being brought up to speed. No doubt she and new Ministers will want to review the decisions she is inheriting and to start to think afresh about whether she wants to proceed with those decisions as they have been working through the machine. That is why it is so grossly irresponsible to change Ministers every five minutes and constantly churn from one face to another, when it is clear to everyone but the Prime Minister that it is not just a change of faces around the Cabinet table that we need, but a change of Government.

As the Secretary of State sits in the Department being briefed by her civil servants, I will help them out with the induction by offering her a primer on what she inherits: millions of patients a month unable to get a GP appointment when they need one; 24 hours in A&E—not just a television programme, but a reality for far too many; ambulances not arriving on time, if they arrive at all; the 12th month of the worst strikes in the history of the National Health Service; NHS dentistry in managed decline, to the point where people are forced to pull out their own teeth—DIY dentistry in 21st century Britain; a generation of young people who have paid the price for lockdowns with their mental health, forced to wait years for the support they need; the longest waiting lists and the lowest patient satisfaction in history. That is the record of the Secretary of State’s seven predecessors: failure, upon failure, upon failure, upon failure, upon failure, upon failure, upon failure.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

My hon. Friend is absolutely right about that list of failures—it is shocking. I would like to add to the list that over 2,000 autistic people or people with learning disabilities are detained in inappropriate units, when this Government promised over 10 years ago to close them all down.

[Wes Streeting]

I thank my hon. Friend for her intervention. As I make progress through my speech I will come back to the breath-taking complacency about mental health we heard from the Minister a moment ago.

Given the scale of the crisis and given that the Prime Minister has made fixing waiting lists one his five priorities, hon. Members might have expected something in the King’s Speech to deal with it. Instead, we got nothing on the NHS as it heads into its most challenging winter yet and we got nothing on social care, just kicking the can down the road and delaying reforms until after the election. There was nothing on dentistry, despite even Conservative Back Benchers crying out for a rescue plan, and nothing on mental health, despite the Conservative party committing to reform, not just in its last manifesto but in its last two manifestos.

It was the longest King’s Speech in almost a decade, with the fewest Bills. Does that not just sum up the modern Conservative party? Plenty of slogans, but no solutions. What we got was a Bill that will not come into effect until after the general election and a sack-the-nurses Bill. On the tobacco and vapes Bill, the question is not whether Labour will support it, but whether the Conservative party will support it. Government Members will remember that I first proposed that smoking ban back in January. I say they will remember, because they made their feelings known in newspapers at the time. They called it “nanny state” and

“an attack on ordinary people and their culture”.

They accused me of “health fascism”. Well, they can now make their considered and nuanced views known to the new Secretary of State—I am sure she is looking forward to receiving them. It just demonstrates that where Labour leads, the Government follow.

The Prime Minister may be too weak to whip his Back Benchers to vote that crucial measure through, but on the Opposition Benches we will put country first and party second. Labour MPs will go through the voting Lobby and make sure that the legislation is passed, so that young people today are even less likely to smoke than they are to vote Conservative.

I am afraid to disappoint the Government, but we will not be supporting the other Bill in the King’s Speech that relates to health. Most people look at the crisis in the NHS and think it needs more doctors and nurses. The Conservative party looks at the health service and concludes that we need to sack more doctors and nurses. The Government are saying that public servants should be sacked for failing to provide minimum standards on strike days, but the Government have not met the four-hour A&E standard since 2015; they have not met the standard for treatment within 18 weeks since 2016; and they were doing so badly on meeting cancer waiting time standards that they have simply got rid of the standards altogether. If the Conservatives are proposing to sack doctors and nurses for failing to provide minimum service levels, can we now sack Ministers for failing to meet minimum standards on non-strike days?

The new Health and Social Care Secretary has an opportunity to break with the past year. Strikes are crippling the NHS and they are putting patients in harm’s way. Her predecessor may have thought that they were a useful excuse for his failure, but they were, and are, a misery for patients and staff alike. The Government must stop the scapegoating of NHS staff, go into these negotiations with good faith, work at finding a solution, and, finally, bring these strikes to an end. There will be no progress on turning around our national health service until the Government make some progress.

When summing up I hope the Minister will explain why action was not taken on the Mental Health Act 2007, because, I am afraid, the Minister’s opening remarks were entirely unsatisfactory. The Bill has gone through Committee. It has cross-party support. It is ready to go, so where is it? The treatment of people with learning disabilities and autism under the current Act shames our society. The disproportionate impact on black people, who are four times more likely to be sectioned than white people, is appalling. Prisons and police cells are no place for people with mental ill-health. Surely that is not controversial in 2023. It is, as the former Prime Minister, the right hon. Member for Maidenhead (Mrs May), said, “a burning injustice”. I cannot understand why the Government have broken their promise to address that matter finally.

It is long past time that mental health was treated with the same seriousness as physical health. Labour will not only reform the Mental Health Act in our first King’s Speech, but recruit thousands more mental health professionals, provide hubs in every community, and set up mental health support in every school, so that young people can get the help they need when they need it. [Interruption.] The Minister says that they have done that. What planet is she living on? This is the problem with these Ministers. Even when the faces change, the lines remain the same. The Minister has not changed, but she is still reading from the same failed script. This is the problem with the Conservative party. Its message to the country is simple: “You have never had it so good. Everything is going really well. The reason we are churning all the Ministers in our Cabinet is that they are doing such a good job. It is job done and time to give someone else a chance.” I am afraid that that is why these Conservatives are so out of touch and will struggle at the next general election if their message to the country is that it has never had it so good.

Furthermore, unlike this Government, who crashed the economy in the most reckless way, we will pay for our policies, making sure that they are fully costed and fully funded—in this case, by ending tax breaks for private schools and private equity fund managers. Politics is about choices: Labour chooses the wellbeing of the many, not the interests of the few, and we will fight the election on those lines any time. I say call the election tomorrow, because we are ready.

When it comes to dentistry, I should also say farewell to two former Ministers, the hon. Members for Colchester (Will Quince) and for Harborough (Neil O’Brien). As the hon. Member for Harborough departs Government, I hope that he does not take with him his pledge to bring forward a recovery plan for NHS dental services. It has been seven months since he announced that such a plan would be forthcoming, yet it is now nowhere to be seen. Indeed, last week, integrated care systems were given permission to raid their dentistry budget underspends and to remove the ringfence. That follows a pilot in Cornwall, trialling making NHS dentistry available only to children and the most vulnerable. It is the managed decline of NHS dentistry before our eyes. If people want to know what the future of the NHS would look like with five more years of the Conservative Government, they need only look at the ghost of Christmas past in NHS dentistry. The Conservatives blame the previous Labour Government, but they have been in power for 13 years. In 2010, we stood on a manifesto committed to reforming the NHS dental contract. They have had 13 years to do it, and they have failed again and again, leaving us in the situation that we are in today, with Dickensian stories of desperate people performing DIY dentistry and tooth decay being the most common cause of children aged six to 10 being admitted to hospital. It did not need to be this way.

I say to the new Secretary of State and her team that she may not have a plan, but Labour does, and she is more than welcome to nick it. We will deliver 700,000 more urgent appointments a year, recruit dentists to the areas most in need, introduce supervised toothbrushing in schools to prevent children’s teeth from rotting, and reform the NHS dental contract so that everyone who needs an NHS dentist can get one—

--- Later in debate ---

[Barbara Keeley (Worsley and Eccles South) (Lab)]

The shadow Health Secretary, my hon. Friend the Member for Ilford North (Wes Streeting), raised the fact that there have been five Health Secretaries in two years. The Conservatives have also had 12 Culture Secretaries since 2010, so perhaps it should not surprise us that, among the many glaring omissions in the Gracious Speech, there was an absence of any measures to support those who work in Britain’s cultural sector, and particularly musicians. I want to focus on that.

Music industry leaders tell me that their sector feels left behind. Freelancers feel left out in the cold without the financial stability they deserve. In too many communities, cultural provision is now dependent on the good will of talented individuals who are prepared to manage on shoestring budgets with low income levels. We can do so much better in this country. As a music leader recently told me:

“The warning bell has been ringing for years, and this Government seems to have taken for granted the drive, passion and sacrifice which has somehow kept the industry alive.”

I have been told repeatedly that the problems faced by creatives come back to this: a decline in arts education, which is leading to skills shortages; falling funding levels; and the challenges to touring caused by the Government’s failure to get a visa waiver for touring in the Brexit deal. The Government choose to ignore those problems and pretend that they are supporting the sector adequately—even today they are setting ambitious growth targets for the creative sector. I want to begin by looking at the squeeze on arts education, and in particular the decline in music education.

We know that state-funded schools are increasingly unable to provide strong music education—or in some cases any music education. Policies such as the English baccalaureate, combined with the crisis in music teacher recruitment and squeezed school budgets, have led to a reduced provision of music education for young people in state schools. On average, music provision in state-funded schools is only 47 minutes a week. That is significantly below the Government’s target of one hour, which is a bare minimum. Compare that paltry target with parts of Germany, where secondary school students study music for at least two hours a week, or Finland, where music is studied for eight hours a week. Meanwhile, the uptake of music at A-level has fallen by a catastrophic 45% since 2010. There is a similarly worrying picture when it comes to studying music at GCSE.

In this difficult environment for schools and teachers, the role of music education hubs is all the more important, yet those hubs have had their funding reduced by 17% in real terms since 2011, and Government plans to reduce the number of hubs risk a further deterioration of the music offer. The Government’s failed education policies mean that the opportunities to gain the skills necessary to be a musician are becoming increasingly the preserve of those young people whose families who can afford to pay privately, either through attending independent schools or through private music tuition. As a result of those Conservative policies, less than a quarter of the music and performing arts workforce now come from a working-class background.

As well as fewer opportunities in schools, there are now barriers to both budding and established musicians touring beyond the UK’s borders. The failure of the former Culture Secretary to obtain a touring agreement with the European Union for cultural workers resulted in an appalling mess of red tape and extortionate fees for bands and orchestras looking to perform in EU countries. Agents, promoters, record labels and musicians have all told me that this is proving devastating for artists, particularly those trying to break into the industry. The freelance opera singer Paul Carey Jones said:

“As ever, it’s those at the start of their careers, without the backing of an established reputation, who will suffer the most…the consequent long-term damage to the UK’s position as a global force in the performing arts is incalculable.”

In a recent interview on LBC, the Culture Secretary implied that sorting out the mess of visas for touring musicians is not under the control of her Government, but it is up to the Government to renegotiate it and to find a solution for touring musicians.

Then there are the financial challenges that many musicians face. A recent survey by the Musicians’ Union found that musicians earn, on average, just £20,700 a year from music. Nearly a quarter of musicians reported that they did not earn enough to support themselves or their families, even after their lengthy training. There is a direct link between the working conditions of musicians and decisions to cut arts and culture budgets. Local authorities are the biggest funders of culture in the UK, but, as we know, they have suffered a 40% real-terms reduction in central Government spending since 2010. That has meant a £1.4 billion shortfall in spending on culture, heritage and libraries. Meanwhile, Arts Council England had its per capita budget reduced by 13% between 2009-10 and 2021-22. It is therefore no surprise that the number of filled jobs in music is falling.

In the last year alone, the number of filled jobs in music performing and visual arts fell by a tenth—a drop of 35,000 roles. That reduction is even greater in roles relating to instrument manufacture, sound recording and the operating of music venues. How can we expect children and young people to aspire to work in the music industry if there are no jobs for them to go into?

Funding shortfalls may also sadly have an impact on the important work undertaken by music organisations in health and care. For example, the Liverpool philharmonic has just celebrated 15 years of its music and health programme, which works with the NHS to help people access music to support their recovery and their wellbeing. Another brilliant health initiative is the English National Opera’s “Breathe” programme, where ENO chorus members have used singing techniques to aid recovery from covid-19 or long covid. There is also a great deal of work involving musicians bringing joy to people with dementia and those living in care homes.

The failure to support musicians and other creatives is not a peripheral issue, because expression in all its forms is central to the task of recreating a sense of community, identity, pride and hope, and our creative workers are at the heart of that potential. We will never achieve the diversity needed for the arts sector to thrive under the Tory policies I have discussed. The systemic failure to protect creative workers under this Conservative Government has led to working-class representation in the creative industries halving since the 1970s.

Today, the Culture Secretary is in Manchester, praising the creative industries as a driver of economic growth. At the same time, she is presiding over the cutting of the funding streams that feed them, and expects them to run on empty, doing more with less, year after year. It is time for this Government finally to accept that their policies have failed, and that Britain’s culture sector would be better off under a Labour Government.

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 17th October 2023 Commons Chamber

[Steve Barclay]

I very much welcome my right hon. Friend signalling that we are ahead of the manifesto commitment not just in nurses being recruited, but in key additional roles in primary care, where the target was 26,000 and actually 31,000 have now been recruited. He is right about the importance of clinical research. The O’Shaughnessy review speeds that up and reduces the cost. It better leverages the taxpayer pound in investment from the private sector, and standardises contracts across NHS trusts to bring the time down. We are also looking at innovation in areas such as the NHS app to better empower patients to take part in clinical research trials. That ensures they are at the front of the queue in getting the latest medicine, which is exactly where we want the NHS to be.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

The Secretary of State did not mention the increase planned in the number of physician associates. The Norfolk and Waveney integrated care system has posted:

“Got abdominal pain that isn’t going away? A Physician Associate based in your GP practice can help…They are highly skilled at diagnosing conditions”.

After the tragic case of Emily Chesterton, who was misdiagnosed after seeing a physician associate twice at a GP practice and no GP at any point, when will the lesson be learned that the NHS workforce cannot be safely expanded by this route of associates with only two years’ medical training?

[Steve Barclay]

All clinical roles need to have the right regulation around them, and we need to ensure that patient safety is to the fore. The hon. Lady gives a very good illustration of how the Labour party talks about reform, but not when it comes to the reform of new roles, having new roles in the NHS and having a ladder of opportunity for people to come into the NHS. Physician associates are people with masters’ degrees: these people are highly skilled. Of course, we need to get the regulation right. However, the Labour party talks about reform, but when it comes to standing up to the trade unions, it is not willing to do so, which is why, when there is an innovation such as physician associates, it wants to block it.

Countess of Chester Hospital Inquiry

Baroness Keeley Excerpts

Monday 4th September 2023 Commons Chamber

[Steve Barclay]

A number of steps have already been taken; I am thinking, for example, of the role of medical examiners working in conjunction with the role of the coroner. Those are the sort of areas that the inquiry will look at: the roles of the coroner, the medical director, the Royal College of Paediatrics and Child Health report in 2016, who had sight of that and what action was taken, and the role of the board, including the non-exec lead, in terms of issues around patient safety. So a range of areas will be looked at, which is the whole purpose of having this inquiry. A number of steps have already been put in place, but it is important that we learn the lesson where clinicians have raised concerns and those concerns were not acted on.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I co-signed a letter to the Health Secretary from Salford MPs and the Salford City Mayor detailing that two senior managers from the Countess of Chester Hospital who were accused, as we have been discussing, of repeatedly ignoring warnings about Ms Letby’s actions then left that hospital and were employed or seconded to NHS trusts in Greater Manchester, including Salford Royal NHS Foundation Trust and the Northern Care Alliance. The two managers were re-employed well after the police had launched their investigation into Lucy Letby. This raises serious questions about NHS governance, HR processes, safety, risk assessment and the role of regulators, as already raised by the Labour Front Bench and my hon. Friend the Member for Weaver Vale (Mike Amesbury). I want to join our concerns from Salford with the concerns the Health Secretary says are already being expressed about the governance issues raised by the re-employment of managers at that time and ask for assurances that this will be fully explored in Justice Thirlwall’s inquiry.

[Steve Barclay]

The hon. Lady raises extremely important issues and I am happy to give her the assurance that these issues will be explored. NHS England is looking at that. On the concerns expressed around the regulation of managers, the chief exec of NHS England hosted a meeting last week with key stakeholders to discuss these very issues and I will of course relay to the chief exec the points she has raised.

Under-age Vaping

Baroness Keeley Excerpts

Wednesday 12th July 2023 Commons Chamber

[Andrew Gwynne]

The hon. Lady makes a powerful case. Those are precisely the reasons why we have called this debate. It should shock each and every one of us. The ease of access to e-cigarettes for children, many younger than the ages she gave as an example, just cannot be allowed. We must be doing all we can on e-cigarettes, as we did to tackle the packaging and advertising of actual cigarettes, to ensure that children are weaned off their nicotine addiction and that other children do not start vaping in the first place.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

My hon. Friend is making a very effective speech to open this debate. He quoted the figure of 30% for Yorkshire and the Humber. The figure for the north-west is 29%, which shows very little difference. Those figures are twice that for London, so it may be that some hon. Members are not aware of how bad the problem is getting. The Royal College of Paediatrics and Child Health has warned that youth vaping is fast becoming an epidemic. Worryingly, the number of children admitted to hospital as a result of vaping has almost quadrupled. Is my hon. Friend, as a fellow Greater Manchester MP, concerned about how many more children might suffer those health impacts before the Government take the action that is needed?

[Andrew Gwynne]

I am very grateful to my hon. Friend. As a Greater Manchester MP, I see the problem in my constituency and she will see it in hers. It concerns me greatly, because within our city region there are already communities that have some of the worst health inequalities. A lot of those health inequalities have been exacerbated by a higher than average prevalence of smoking. Even now, as smoking rates have declined, there are still communities in the areas we represent that have an abnormally high number of smokers. I do not want, in tackling smoking and reducing some of the health inequalities that are caused through smoking, to be storing up future problems with a new generation caused as a direct consequence of vaping or, more sinisterly, as a gateway to smoking later on in life. She is absolutely right.

--- Later in debate ---

[Neil O’Brien]

I completely agree with the hon. Lady on that point; this is exactly what our enforcement squad is doing, and I completely agree about the importance of doing it.

On the call for evidence, we will be producing our response in early autumn, identifying and outlining areas where the Government will go further. The key point is that we need evidence to take effective action to stop children vaping. While that call for evidence has been running, we have already taken further steps. At the end of May, the Prime Minister announced several new measures to support our efforts to tackle youth and kids’ vaping. That included closing the loophole in our laws that has been allowing companies to give out free samples of vapes to under-18s, which ASH estimates could total as many as 20,000 a year. He also announced that we will overhaul the rules on selling nicotine-free vapes to under-18s and on issuing fines to shops selling vapes to the under-18s.

The Prime Minister also announced that we will update the school curriculum, to emphasise the health risks of vaping within relationships, sex and health education lessons, just as schools currently do for smoking and drinking, so that kids understand the risks of vaping. We will be writing to police forces to ensure dedicated school liaison officers across the country are using the new resources available to keep illegal vapes out of schools.

I want to use this opportunity to outline the work we are doing to successfully reduce smoking, not least because the Opposition Front-Bench spokesperson touched on it. In the 1970s, more than 40% of people smoked, and it was still 21% in 2010. Since then, we have taken a series of steps, including doubling excise duties and introducing a minimum excise tax on the cheapest cigarettes, that have helped to drive down smoking to a record low of just 13% in England.

We have gone from 21% to 13%, but of course we want to go further. In 2019, we announced our ambition for England to go smoke-free by 2030, which is considered to be 5% or less. Over the past decade, we have made significant progress towards making England smoke free. We have continued to invest in local stop-smoking services, to help smokers get the right support for them. We continue to work in support of the NHS. Last year alone, we provided £35 million to the NHS long-term plan commitments on smoking.

Youth smoking rates are now at their lowest rates on record. In 2021, just 3.3% of 15-year-olds were regular smokers, although of course we want to reduce that figure even further. Through the new measures I announced in April, the Government will be supporting many more smokers to quit through the tobacco reduction strategy. Some 1 million smokers will be encouraged to Swap to Stop, swapping cigarettes for vapes under a new national scheme that targets those who are most at risk and gives them free vapes. That is first scheme of its kind in the world. It is based on experience from the successful local pilots, and is an evidence-based initiative.

Likewise, we will offer innovative, but evidence-based, financial incentives for all women to stop smoking in pregnancy. Again, this is based on evidence that has been gathered during local pilot schemes and the strategy will be implemented at a national level. Shortly, we will launch a consultation on cigarette pack inserts to provide further information to support smokers to quit, which is something Canada has done successfully.

Further, those who supply tobacco for sale in the UK must be registered for tobacco track and trace, and obtain an economic operator ID. We brought in that scheme to tackle illegal tobacco, but we now want to use the existing system in a new way, to help strengthen enforcement and to target the illicit market. From now on, when people are found selling illicit tobacco, we will not just seize their products but remove their economic operator ID, so they will no longer be able to buy or sell tobacco. We are exploring how to share information with local partners about who is registered on the track and trace system, so that they know who is and who is not legally entitled to sell tobacco in their areas, helping to drive enforcement.

We are committed to doing all we can to prevent children from starting to vape and we are already taking robust action in a range of areas. We are actively working on ways that we can go further, but it is essential that those methods are evidence based and that we have measures that will be effective.

[Barbara Keeley]

The Minister will have heard the figures given earlier: my hon. Friend the Member for Denton and Reddish (Andrew Gwynne) said that 30% of secondary school pupils in Yorkshire and Humberside have tried vaping and I said that the figure for the north-west was 29%. I quoted the Royal College of Paediatrics and Child Health saying that youth vaping is “fast becoming epidemic”. He is talking about an evidence-based plan, but what is the situation around evidence? My local area still has very high levels of smoking, but we are now seeing the same pattern tracking in vaping among young people as we did in smoking. Does he agree that there needs to be different and further action in those places where the figures are so bad?

[Neil O’Brien]

The theme of my speech is that we have already taken action and we will continue to take action, but that it has to be evidence based. A range of suggestions has been made during the debate, and I am sure there will be more, about different things to do with flavours, packaging, colours and marketing. There needs to be evidence and definition about those things. Some people will probably say that we should ban all flavours; some will say, “Let’s ban all coloured vapes”; some will say that we should have plain packaging or vapes should be hidden from view. We will need to take an evidence-based view on all those issues, rather than just assuming that one knows the answer immediately.

It is not totally obvious to me what the position is of the Opposition Front Bench team on any of those issues—whether they would ban all colours, ban all flavours, demand plain packaging, or want the same kind of restrictions as there are for cigarettes in terms of where they are placed in shops. I am happy to take an intervention if the shadow team have answers to those questions. Is it a yes or a no to those things?

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 11th July 2023 Commons Chamber

[Steve Barclay]

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

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I have received a wave of concern from clinicians on the safety of using physician associates, following my Adjournment debate last week in which I raised the death of Emily Chesterton, the 30-year-old daughter of my constituents Marion and Brendan. Emily died of a pulmonary embolism after being seen twice by the same physician associate at her GP practice. The physician associate failed to refer her to a doctor or to a hospital emergency unit for tests, which the coroner concluded could have prevented her death.

Yesterday, on “Good Morning Britain”, the Secretary of State boasted of increasing the number of people working in primary care, presumably including the workforce plan proposal to triple the use of physician associates. Will he look urgently at the details of Emily Chesterton’s case and ask himself whether lessons can be learned to avoid other preventable deaths?

[Will Quince]

Having responded to the hon. Lady’s Adjournment debate last Thursday, I hear the calls she has made. I know that she has also written to the Secretary of State, and I will ensure that she gets a full response, with answers to all the questions she raises.

Physician Associates

Baroness Keeley Excerpts

Thursday 6th July 2023 Commons Chamber

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I applied for this debate to discuss the use of physician associates in the national health service and I am grateful for the opportunity to bring this important subject to the attention of the House today.

This issue was raised with me following the very sad death of Emily Chesterton, the daughter of my constituents Marion and Brendan Chesterton, who are in the Public Gallery today. Emily died in November 2022 after suffering a pulmonary embolism. She was just 30 years old when she died.

Emily was a budding actor in musical theatre. She studied at the Liverpool Institute of Performing Arts and performed in numerous productions. She was also a winner of the Hammond House poetry prize in 2018. Emily’s mother, Marion Chesterton, describes Emily as active and always willing to help others.

Emily and her partner, Keoni, moved to London from Boothstown in my constituency to pursue their careers in the arts. They registered with their local GP surgery, the Vale Practice in Crouch End, north London. Emily had been diagnosed with polycystic ovary syndrome and had also contracted covid-19 late last summer.

My constituent, Marion Chesterton, said that Emily had been feeling unwell for a few weeks before she made an appointment at the Vale Practice on 31 October 2022 as she had calf pain and was breathless. Emily believed that this appointment was to see a GP, but the person she was booked to see at the practice was a physician associate.

A physician associate does not have the depth of training that a general practitioner would be expected to have, as they are not a doctor. A physician associate can practise after just two years of training. Importantly, physician associates are intended to supplement more qualified staff, not to replace them.

After a short appointment, the physician associate diagnosed Emily with a sprain and possible long covid. She was told to rest and take paracetamol. At no point during the appointment at the GP surgery was Emily made aware that the person who had diagnosed her was not a doctor.

A week later, on 7 November, Emily began to feel very unwell. Her leg was swollen and hot and she struggled to walk a few steps without becoming out of breath. She made another appointment at the Vale Practice and saw the same physician associate. It appears that this was a short appointment and that Emily’s legs were not examined.

The physician associate suggested that Emily’s breathlessness was due to anxiety and long covid and prescribed propanolol for the anxiety. In messages Emily sent on this day, she described seeing “the doctor” and it appears that she was never told that the person she was consulting for medical assistance was not a fully qualified GP.

In its serious incident report, the Vale Practice states that patients should not see a physician associate twice for the same condition, and guidelines make it clear that physician associates cannot currently prescribe, with any prescriptions needing to be signed off by a supervising GP. It appears that the oversight of prescribing medication was missing and that this system failed in Emily’s case.

Later in the evening of that same day, 7 November, Emily’s health deteriorated while she was out for a meal with her partner and parents. She took a propanolol tablet as advised by the physician associate. Emily’s mother, Marion Chesterton, told the coroner’s inquest into Emily’s death that Emily immediately became drowsy and that they all soon left the restaurant, with Mr and Mrs Chesterton driving Emily and Keoni back to their home in Crouch End.

On returning home, Emily became very ill. Her partner, Keoni, recalled to the inquest that she lost her pulse and he had to perform cardiopulmonary resuscitation on her, which recovered the pulse. Keoni then called an ambulance.

Mr and Mrs Chesterton then returned to Crouch End to be with their daughter. Marion Chesterton recalled that, when she saw Emily, she was squatting on the stairs. She sat with her daughter as they waited for the ambulance. Marion said:

“Emily asked me in a quiet voice to please help her, and I tried my absolute best to keep her calm, stroking her hair, holding and supporting her on the step as best I could, reassuring her that all would be well, not to panic, that I loved her…I noticed that she had lost some responsiveness, that she was extremely clammy, and her lips were turning blue. Her breathing had become very laboured, and she was rasping.”

Mrs Chesterton recalled that the ambulance arrived not long afterwards, around 45 minutes after Keoni made the first phone call. Emily suffered a cardiac arrest on the way to the hospital. Her family had to say their goodbyes while she was still on the machine which was pumping her heart for her.

Keoni recalled that staff at the A&E department at Whittington Hospital, where Emily died, told him that the propanolol tablet “definitely wouldn’t have helped” Emily’s condition. Staff had to give her an antidote to the drug.

The circumstances that led to Emily Chesterton’s death were investigated by a coroner, with a hearing at St Pancras Coroner’s Court on 20 March 2023. The coroner heard from representatives of the Vale Practice, Emily’s mother, Emily’s partner and the physician associate who had seen Emily.

Messages from Emily to her partner and family at the time of her appointments were also shared with the inquest. These messages evidence Emily’s belief that she was seeing a doctor. They also evidence that the appointments with the physician associate were short and that Emily was not examined fully.

The conclusion of the coroner was:

“Emily Chesterton died from a pulmonary embolism, a natural cause of death. She attended her general practitioner surgery on the mornings of 31 October and 7 November 2022 with calf pain and shortness of breath, and was seen by the same physician associate on both occasions. She should have been immediately referred to a hospital emergency unit. If she had been on either occasion, the likelihood is that she would have been treated for pulmonary embolism and would have survived.”

That is a heartbreaking statement, making clear the failings in the health system, which should have supported Emily with appropriate care.

Further failings were evidenced in the incident report from the Vale Practice, which was provided by the practice to the coroner. Failings of the physician associate identified by the GP practice include not introducing herself to Emily during the appointment, not allowing Emily’s partner to accompany her into the consultation room despite this request being made and despite Emily being vulnerable because of her illness, not exploring the potential causes of Emily’s breathlessness, not documenting the severity of covid-19 that Emily had suffered from a month earlier, not exploring why Emily felt “clammy”, not documenting whether oxygen saturation readings after exertion or respiratory rate readings were taken, in line with clinical guidelines, and not referring Emily for an electrocardiogram, blood tests or other clinical investigations, also in line with clinical guidelines.

Crucially, the physician associate did not seek medical advice after seeing a patient who had presented twice in one week with significant risk factors for pulmonary embolism, such as polycystic ovary syndrome, recent contraction of covid, calf pain and breathlessness, and she sent Emily home without consulting a doctor. The practice later raised concerns about the physician associate’s knowledge and understanding of what appropriate investigations she should perform in a patient presenting with symptoms post covid, about her ability to recognise an unwell patient and escalate such concerns to a doctor, and about her over-confidence and lack of insight into the limitations of her own clinical knowledge and practice.

Two weeks after conducting the serious incident review, the practice made a collective decision to terminate the contract of the particular physician associate, as she appeared to be unable to co-operate with the practice’s supervision requirements. Then

“a decision was made not to employ physician associates going forward”.

Despite that, Mrs Chesterton tells me that the particular physician associate is still practising medicine in the NHS in London as a locum. She asks, “How is this possible?”

This case raises serious questions about the wider use of physician associates in the NHS, and particularly about allowing the provision of unsupervised one-to-one consultations in general practice. NHS information says that physician associates are graduates who have undertaken relevant postgraduate training and that they work under the supervision of a doctor. They will have been educated on a medical model with basic medical skills, but they lack formal professional regulation and they do not have prescribing rights. Most physician associates work in general practice, acute medicine and emergency medicine.

The physician associate role was introduced into the UK 20 years ago—I have to say that before looking into this case I had never heard of the physician associate role, but it appears it has been around that long—in an attempt to address workforce shortages in underserved primary care practices. The role was based on the physician assistant role in the United States, which dates back to the 1960s.

Physician associates are expected to be under the supervision of a designated medical practitioner, but that does not appear to have been the case with the lack of supervision that occurred in the case of Emily Chesterton. When qualified medical professionals such as GPs are already stretched, it is easy to see how tasks such as checking the notes and work of a physician associate could be missed.

There is also the problem of the title of the role, which Marion Chesterton told me sounds

“extremely grand, even grander than a General Practitioner”.

She suggested that the name should change to “doctors apprentice”, “learner doctor” or “probationary doctor” to avoid confusion, and it should be made very clear who patients are seeing.

Marion Chesterton also told me:

“We only discovered that the medic treating Emily was not a doctor the week before the inquest. This caused us extreme distress.”

She asks:

“Could something be put into place to keep families fully aware earlier on in the process?”

Crucially, it is very concerning that there is no statutory registration system for physician associates. There is only a voluntary register. In July 2019, the Department of Health and Social Care announced plans for the General Medical Council to regulate physician associates, pending the passing of new legislation. After a consultation in 2021, the timetable for regulation has been beset with delays. The Royal College of Physicians and the Faculty of Physician Associates have called these delays “frustrating and disappointing”. It was not until February this year that the draft legislation was published and put out to a public consultation.

When will the Government respond to the consultation and when does the Minister expect the legislation to regulate physician associates to be debated and approved? It has been, as I said, 20 years since the role was introduced. In 2018, as the Minister may know, the hon. Member for Newton Abbot (Anne Marie Morris) promoted the Physician Associates (Regulation) Bill, a private Member’s Bill. In 2019, the Government committed to regulating physician associates. That was four years ago now.

The Royal College of Physicians and the Faculty of Physician Associates have led the RegulatePAsNow campaign since May last year. The Faculty for Physician Associates said:

“We believe that regulation is fundamental to ensuring that physician associates remain a safe and effective workforce in the future.”

We also know that regulating physician associates has public support. A petition calling for the statutory regulation of physician associates was signed by nearly 6,000 members of the public.

It is clear that the legislation underpinning the regulation of medical practitioners is now in urgent need of reform. The Medical Act 1983 is now 40 years old, and the General Medical Council has described it as

“complex, overly prescriptive and slow to adapt to change.”

It has taken the Government too long to recognise that, and progress is happening at a snail’s pace.

What will the Minister do, from today, to ensure the safety of patients being treated by physician associates? What measures will he introduce to ensure that patients know the role and qualification of the person they are seeing when attending appointments in general practice settings? Those questions are becoming increasingly pressing as more people enter the physician associate role. There are currently more than 3,000 qualified physician associates working in the UK. Although the numbers look relatively small at the moment, the General Medical Council expects them to grow steadily in the next few years, with one study estimating a projected growth of 1,000% per year.

Growth in the number of physician associates will be turbocharged by proposals in the Government’s recently published NHS long-term workforce plan. The plan aims to more than triple the number of physician associates in the NHS workforce in the next 12 years. By 2037, they will total 10,000, with around 1,300 trained annually from this year, and 1,500 trained each year in 10 years’ time. In response to the Government’s long-term workforce plan, Latifa Patel of the British Medical Association said that the proposed wider use of physician associates

“must come with clear boundaries around expectations, and not impact on the training of medical students and doctors.”

The coroner concluded that the poor quality of care given to Emily Chesterton by the physician associate at Vale Practice contributed to her death. That concerns me deeply, and it should concern the Minister, too. The Government must now move quickly to regulate physician associates and learn from the events that led to the sad and tragic death of Emily Chesterton.

I want to finish with the words of Emily’s mother, Marion:

“We feel extremely let down by the care provided by the GP practice. We have lost our precious, beautiful, kind, loving, talented and irreplaceable daughter, and this must not be allowed to happen to any other family.”

--- Later in debate ---

[Barbara Keeley]

I take what the Minister has said about the training and voluntary registration aspects, which I did speak to, but could he comment on the situation we seem to have been in? The GP practice had concerns about the physician associate’s knowledge and understanding of what investigations she should perform, her ability to recognise an unwell patient, and her overconfidence and lack of insight into the limitations of her own knowledge. Those are the issues that the GP practice itself reported. Does the Minister share my concern that it is a very serious thing to have had a system like that, and, surrounding that, to have the fact that the reception function in that practice did not realise that it should not refer an unwell patient to a physician associate twice within a short period of time? If these are meant to be safety measures, they are not working, are they?

[Will Quince]

I hear what the hon. Lady says. In response to her questions, we very much need to look into the exact details, and I hope I will be able to respond to her with full answers when I have received both the coroner’s report and further information from NHS England regarding the practice itself. On the face of what she has just said, the situation is concerning and it certainly adds weight to her calls for the register to be non-voluntary and for regulation and legislation in this space. I will come on to that issue in a moment, because it is a case well made.

The physician associate role is in no way a replacement for any other member of the general practice team—that is an important point to make. They work in conjunction with the existing team, and are complementary to it. Physician associates can help broaden the capacity and skill mix within the practice team to help address the needs of patients in response to the growing and ageing population faced by constituencies up and down the country, including the hon. Lady’s constituency and, indeed, mine. However, let me be clear: the employment of a physician associate does not in any way mitigate the need to address the shortage of GPs, nor does it reduce the need for other practice staff.

I will talk, not about the specific case that the hon. Lady described—I do not have those details—but about the generalities of the responsibilities of a supervising doctor, which may be relevant in this case. Physician associates are dependent practitioners: they are working with a dedicated consultant or GP supervisor. They are able to work autonomously but, vitally, with appropriate support, and the General Medical Council has published guidance for doctors who supervise physician associates. The supervision of a qualified physician associate is similar to that of a doctor in training or a trust-grade doctor, in that the physician associate is responsible for their actions and decisions. However, the medical consultant or GP supervisor ultimately retains responsibility for the patient.

The hon. Lady has called for regulation. As she alluded to, the General Medical Council is well advanced in developing regulatory processes for physician associates once the necessary legislation is in place, and regulation will give the GMC responsibility for, and oversight of, physician associates and anaesthesia associates in addition to doctors. That will enable a more coherent and co-ordinated approach to regulation and make it easier for employers, patients, and of course the public to understand the relationship between the roles. The hon. Lady asked specifically when that legislation will come forward. We intend to lay legislation before the House at the end of this year, which will allow the GMC to commence the regulation of physician associates by the end of 2024—legislation by the end of this year, and then a year for it to be put in place.

The General Medical Council has published future professional standards for physician associates. Among other things, that includes working within the bounds of professional competence and knowing when to refer, or indeed to escalate, to a colleague within the practice. Those standards also cover communication with patients, including the importance of physician associates explaining what they do and how their role fits in with other members of the medical team. Once regulation commences, the GMC will be able to investigate concerns raised about physician associates, and in serious cases will be able to prevent a physician associate from practising, either on a temporary or a permanent basis.

[Barbara Keeley]

I want to go back to the point I made to the Minister about the title of physician associate, which I have used a lot and so has he. The point is that it does sound rather grandiose as the name of a role in clinical practice for a person who has trained for only two years, and it is confusing. I have been steeped in health and social care matters in this place—I have been a member of the Health Committee and had Front-Bench responsibility for it—and I had never heard of physician associates, so it does seem confusing. The title itself is confusing.

[Will Quince]

I thank the hon. Lady for her intervention, and I gave careful thought to the point she raised in her speech. Although the terms she used were doctors in training or trainee doctors, physician associates are not doctors in training and they are not doctors. They are very different, but they are a part of a multidisciplinary team. I will take away what she says. She is right that they have been in place for well in excess of 10 years, but nevertheless there is still a relatively small number of them. However, there are plans to significantly grow their number, so I will take that away.

Personally, as part of my own experience of the NHS, I have never seen a physician associate, but when I have been in general practice, I have often seen a paramedic, a physiotherapist or a pharmacist and they have made their position very clear at the outset of the appointment. I think we need to ensure that, regardless of the title— I will take that away and look in some detail at whether it needs to be changed—they are properly introducing themselves and their role, making it very clear to patients that they are not a doctor but are working under the close supervision of one, and making it very clear that they are not able to prescribe but a doctor can. I think that is the most important point, but the hon. Lady raises a very good point about the title and I will consider that very carefully.

[Barbara Keeley]

I think this is actually related to the confidence one has or does not have. The Minister says he takes advice from pharmacists, as do most of us, but we tend to know in that circumstance that it is a pharmacist we are talking to. There are receptionists, physios and all these types of people working in GP practices, but this was a person who to all intents and purposes looked like a doctor. That knowledge of the short period of their training, and of what they can actually do and not do, really ought to be more visible.

[Will Quince]

I hear what the hon. Lady says, and I will certainly take that away and give it considerable thought. If she has any particular ideas in this regard, given her experience on this matter, I would of course be very happy to meet her to discuss this further. It is really important, certainly ahead of legislation, that we get this right.

Before I close, I would again like to reiterate my deepest condolences to the family of Emily, and I thank the hon. Lady once again for bringing this debate to the House. As we develop and progress with changes to the NHS workforce, it is absolutely vital that robust governance and supervision sit at the heart of the multidisciplinary model, because at the heart of everything we do must be patient safety.

Question put and agreed to.

National Carers Week

Baroness Keeley Excerpts

Thursday 8th June 2023 Commons Chamber

[Barbara Keeley (Worsley and Eccles South) (Lab)]

It is good that the hon. Member for Gosport (Dame Caroline Dinenage) has secured this important debate, because opportunities for the House to debate the difficulties faced by unpaid carers and to recognise their contribution are always valuable. However, this cannot be a recognition exercise alone. For too long carers have struggled to get by with little support from the Government, while at the same time providing many hours of highly skilled work. They have been worked to the brink for too long, and many now say that they are fed up with warm words. One unpaid carer, Rachel Adam-Smith, said:

“I cannot believe I am 19 years into my caring role and nothing has changed—other than the fact that I look more exhausted and feel more defeated.

We are given no time to rest, to look after our own health, to take a holiday or even to have a bath. We are all human, none of us are superhuman but unpaid carers are treated as though we are. We aren’t.”

Rachel asks:

“Will it ever change?”

Carers are right to feel disappointed and angry with the Government. As we heard earlier, research by Carers UK shows that a quarter of unpaid carers are cutting back on essentials such as food, and more than three quarters of carers said that the rising cost of living was one of the main challenges they would face in 2023. Gaddum, a charity in Salford, delivers the carers service contract for Salford City Council, which covers my constituency, and it shared with me some insights from a survey of the carers using its services, carried out in February this year. The survey found that 42% of carers’ finances had been negatively affected by their caring commitment, and 84% of carers’ emotional health had been negatively affected. One unpaid carer told Carers UK:

“To date I have sold both of our pensions, shares and insurances to maintain our living standards. They have all gone now so I had to start claiming Universal Credit last year. I have nothing left to sell and I am anxious that we are going to live in poverty for the rest of our lives.”

It is clear that the system of support for carers is not currently working. The financial situation is desperate for too many carers, and the direction of travel for Government policy is deeply concerning. Instead of helping unpaid carers with their unprecedented financial pressures last winter, the Government changed the arrangements for the warm home discount so that nearly 300,000 people with disabilities and their carers were no longer able to claim it. This spring they announced that they would reduce the already pitiful pot of money assigned to social care reform by at least £500 million. Support from the Government is falling away just as more and more carers fear having to cut back on essentials such as food and electricity.

The financial pressures resulting from those and other decisions taken by the Conservative Government have put a real strain on the mental health of carers. Gaddum has told me that carers’ own mental health has been the issue most frequently discussed through casework in the last few years. As the campaigner and unpaid carer Katy Styles recently warned, there is now a risk that carers will become cared for themselves. She said:

“Not only will local authorities and Government bodies be looking after the people that they care for, but also carers who are in a really bad way.”

The We Care Campaign, which Katy founded, does crucial work in amplifying the voices of unpaid carers. We Care is campaigning for more financial support for carers and to secure funding for carers’ breaks. The campaign is also pushing for longer-term solutions, including to the social care crisis, and a crucial national carers strategy.

As the right hon. Lady mentioned, the Government have failed to publish a national carers strategy. They consulted on one in 2016, gaining a lot of responses, yet ultimately the strategy was delayed and then abandoned. Some 6,500 unpaid carers contributed to that consultation, giving up what little time they had to invest their energies in providing details of their day-to-day caring roles. It was dismissive in the extreme for the Government to drop the proposed national strategy. Carers who had contributed to the consultation felt extremely angry. Katy Styles said at the time that:

“Whilst unpaid carers spent precious time informing a Strategy; that time and effort was wasted as that Carers Strategy was apparently scrapped. That’s how much carers’ lives matter.

A national strategy would set the tone on how society should value and support carers. Without a strategy; carers have no hope of being valued and supported.”

Nothing has changed in the past five years to give carers hope of being valued and supported. The 2018 to 2020 “Carers Action Plan” was a flimsy document shamefully void of funding and ambition. We have had nothing of any substance since then.

It is worth remembering that the national carers strategy published under a Labour Government 15 years ago was launched not by a junior ministerial group, as I think is being proposed in this cross-departmental roundtable, but by the then Prime Minister, and signed by all Secretaries of State. That commitment shown by Labour at the time was vital, because I understand that Care Ministers struggle to get that cross-departmental aspect—we have heard about how many Departments are involved.

The other thing is funding. When the strategy was updated in 2008, the last Labour Government pledged £255 million for new commitments to support carers. That included £150 million to increase significantly the amount of money provided by central Government for breaks from caring. The Carers Trust reports that unpaid carers consistently tell it that they value breaks and respite very highly. Carers say that taking a break from caring is beneficial for their health and wellbeing and can allow them to continue in employment. Yet funding for respite care has dried up since Labour’s national carers strategy, with the funding no longer earmarked for breaks as it was up to 2010. The current Conservative Government’s plan in the 2021 social care White Paper for five days of unpaid leave from care is woefully insufficient. It was also disappointing that the Government recently rejected the Lords Adult Social Care Committee’s recommendation on ringfenced funding for breaks. Carers Trust is now calling for a statutory right to respite breaks for unpaid carers across the whole UK.

Carers in Scotland have access to a national scheme giving unpaid carers access to breaks, and Wales will launch a national scheme in June. There should be a national scheme in England too, with local carer organisations as key partners, and it should learn from Carers Trust Wales when designing breaks for unpaid carers. A Carers Trust survey of over 2,500 unpaid carers found that 53% of respondents said a break from caring is what would make the biggest difference. Despite that, research from Carers UK shows that a quarter of carers have not had a single day off from caring in more than five years.

For many, unremitting caring takes a toll on their mental and physical health. Both the GP Patient Survey and 2021 census data show that carers are more likely than those not in a caring role to have a long-term health condition or to have reported “very bad or bad health” and to feel isolated and exhausted. Both studies also showed that the more intense a caring role is in terms of the hours of care provided, the more likely it is that carers will have poorer health outcomes.

The Social Care Institute for Excellence systematic review of evidence on carers breaks found that carers value breaks for a range of reasons: practical, emotional, social and psychological. For some carers, the break has value beyond its allotted time. For instance, looking forward to a break can have the same effect as the break itself. The importance of breaks is to be part of a whole-family approach and as a break from the caring routine, not just having time away from the person. Some carers prefer a break with the person they care for, or as a whole family, but just not when they have to do all the caring.

[Stephen Doughty]

My hon. Friend is making a crucial point. This is exactly what I saw recently at Tŷ Hafan in Sully in my constituency, where there is the option of hotel accommodation for the whole family on site near the person for whom they are caring, but without them having to undertake the full responsibility for care. A pristine natural environment also provides opportunities for the whole family to relax and get some quality family time together while having a break from their responsibilities.

[Barbara Keeley]

I thank my hon. Friend; that will sound very good to other carers.

Breaks can have a vital preventive role, sustaining the caring relationship and preventing carer stress, crisis and breakdown. There are key points where, if practical support and information had been provided, the negative impact of caring may be reduced. Breaks can reduce loneliness and isolation, enabling the carer, and the person they care for, to stay connected to family, friends and the things they enjoy.

We must face the fact that there has been a decline in the funding used to support carers breaks. Analysis by the Nuffield Trust of short and long-term data shows that 24,000 fewer carers were receiving breaks in 2020-21 than in 2015-16—a decline of 42%. It is no wonder that so many unpaid carers are exhausted. Claire, a carer from my constituency, told me that in order to attend the carers networking event in Parliament yesterday, the cost of alternative care for her mother was £33 an hour. She told me that there should be an alternative because the excellent Humphrey Booth Resource Centre in Salford has a four-bed unit for people with dementia. However, it cannot be used to offer respite care for Claire’s mother because it has been taken over to help with hospital discharge issues.

Another major issue facing many carers is that GPs and other NHS staff treating the person they care for often know nothing about their caring role, meaning that carers are not offered the support to which they are entitled, as we have heard. Another carer from Salford called Justine, whom I met in Parliament yesterday, told me that at the start of caring for her mother, who has dementia, she was offered no help or advice and did not know where to turn for support. Even when she asked social services for help, turnover of staff meant that different people were asking her to fill in the same forms again and again and that assessments were being done again and again. Justine said:

“You feel like you are treading water all of the time.”

Analysis by the Nuffield Trust shows that there was an 11% drop in the five years to 2020-21 in the number of carers in receipt of direct support. That is the equivalent of 13,000 fewer carers being given the choice and personalisation that direct support is designed to offer. That downwards trend is reflected in local authority gross expenditure on services for carers, which reduced by 11% between just 2015-16 and 2020-21. That has meant a reduction in the support offer available to carers. Local authorities provided fewer direct support payments and directed 36,000 more carers to information and advice only—that is all they got. Carers have since reported finding it harder even to access adequate advice and support, and satisfaction with carer support services generally is declining—hardly surprising.

Carers organisations know that proper identification of carers by the NHS would mean that carers could be supported much more effectively. Identification of carers is something I have campaigned on for many years. In 2012, I brought in a private Member’s Bill on the identification of carers that would have created a duty on the NHS to identify carers and to promote their health and wellbeing. The then Care Minister in the coalition Government would not support my Bill. Indeed, there is so much that could have been done in the past 13 years to avoid the appalling situation that too many unpaid carers now find themselves in, which has been made worse by the cost of living crisis.

We are here today because this is Carers Week, but care does not stop when Carers Week ends. The Government must urgently bring forward a long-term plan informed by carers and understood at the highest levels of Government. Ministers must learn to listen to unpaid carers—not just this week, but every week—and value their lived experience and insights. The We Care campaigner Katy Styles said that there are so many issues for the millions of carers whose voices she tries to amplify, but only a few of them were able to meet MPs yesterday. Katy told me:

“It’s a battle and a fight for everything. It’s grinding us down.”

We cannot continue to leave carers without proper support.

--- Later in debate ---

[The Minister for Social Care (Helen Whately)]

I thank my hon. Friend the Member for Gosport (Dame Caroline Dinenage) for securing the debate, for her powerful opening speech and for all she does as chair of the APPG on carers. This week is Carers Week—a chance to recognise and focus on carers—but as every carer knows, if you are a carer, every week is carers week. I pay tribute to carers and young carers across the country for what they do, caring for loved ones, whether it is their mum or dad, brother or sister, a neighbour or their child, who will often be grown up, day in, day out, all year round.

Over 4 million people in England are unpaid carers. For some, caring may be a few hours a week helping a relative or neighbour with things they cannot do themselves or providing companionship. For others—in fact, nearly one in three, according to the latest census—caring means over 50 hours each week looking after someone. It is not just a full-time job, albeit unpaid, but how they are spending their lives.

My hon. Friend drew on her expertise, as a former Care Minister, and her personal experience. She spoke about how few families are untouched by caring responsibilities, about the sacrifices that carers make and how they are driven by love, but also the problem of exhaustion and burn-out for carers. She talked about the importance of identifying carers, especially young carers. She spoke powerfully about children with experience of dialling 999 because of a parent needing an ambulance but not telling anyone because of the stigma, particularly due to a parent’s mental health needs.

My hon. Friend asked whether we could build on some of the things we did for carers in the pandemic. I know, as I was Care Minister at the time, how incredibly hard the pandemic was for many carers, how isolated many felt and how many felt they did not have the support they needed. I know how difficult it was to work out how we could support carers during the pandemic, but we managed to do some things, such as identifying carers we prioritise for the covid vaccine. I will take away her request to look at how we can build on the things we did in the pandemic.

I know that the hon. Member for Worsley and Eccles South (Barbara Keeley) is a committed campaigner for social care and carers; we often speak in the same debates. She spoke about some of the financial difficulties for carers, the importance of cross-Government commitment to carers, and carers needing breaks and time off from caring.

My hon. Friend the Member for Cities of London and Westminster (Nickie Aiken) spoke about her personal experience of caring for her father. She talked about the loneliness and isolation but how cricket helped, which made many of us smile. She talked about young carers, how the sacrifices they make are often not appreciated and the long-term effects of being a young carer.

I pay tribute to hon. Member for North East Fife (Wendy Chamberlain) for her very important work in steering the Carer’s Leave Bill through Parliament. She spoke about things that employers can do more broadly to support carers and the opportunity of being a Carer Positive employer. The right hon. Member for Hayes and Harlington (John McDonnell) said that he chairs a local carers group, and I give him credit for that, whether or not it is a Labour group. That is a very important thing to do, bringing carers together to support one another and listening to what help they need. He spoke about the difficulty for carers in getting assessments. The hon. Member for Ceredigion (Ben Lake) spoke about the cost of living and the cost of heating homes for carers, particularly in his constituency, where many carers are off grid and use heating oil.

We also heard briefly from the hon. Members for Strangford (Jim Shannon), for Cardiff South and Penarth (Stephen Doughty) and for Livingston (Hannah Bardell) and my hon. Friend the Member for Henley (John Howell). That level of Back-Bench interest in this topic on a quiet Thursday in Parliament shows how strongly people feel, rightly, about the need for support for carers in our constituencies. We also heard from those on the shadow Front Benches, the hon. Members for Leicester West (Liz Kendall) and for Motherwell and Wishaw (Marion Fellows).

I know, from my own experience and from my family, that caring is something we do because it feels the right thing to do. We might not have a choice or not feel we have a choice, but nor can we imagine not doing it—not caring for the person we love. For many people, it is something that just happens to them: they become a carer without really realising it. Suddenly, they are spending hours caring—perhaps all their waking hours, and often in the night as well—without realising that they have become a carer, and without knowing that they might need support or, indeed, that they could get it. That is why recognising carers and helping them recognise themselves is important in its own right. There is a good reason why recognising and supporting carers in the community is the theme of this year’s Carers Week.

Local authorities, the NHS, schools, universities, all public services, and indeed companies need to continue to improve how unpaid carers are identified, recognised and supported in our communities. This Carers Week, I have had meetings with more than 30 unpaid carers, young adult carers and representatives from unpaid carers’ organisations, and both as Care Minister and in my life outside politics, I meet carers all the time—remarkable carers who have shared their stories with me. Those are so often stories of how hard it is to be a carer, although it is also really good to hear some positive stories. For instance, some employers are really supportive of carers and their caring responsibilities. However, sadly, that is not always the case; in fact, just on Tuesday, one carer told me that she is thinking about giving up her job due to a lack of support. Many hon. Members have spoken about that issue today.

On the important issue of juggling employment and caring, I want to highlight the Carer’s Leave Act 2023, which received Royal Assent on 24 May. Eligible unpaid carers will soon be able to take a week’s flexible unpaid leave each year. I am so pleased to see that Bill pass into law to help carers who are juggling work and caring.

This week, I also spoke to another carer about the challenges they are facing in getting the professional care and support they need. That is one reason why the work we are doing on reforming the adult social care workforce is really important. I say to carers, “Please keep on speaking up. Keep on telling your stories, for other carers and to make sure people know what it is to be a carer. None of you are alone.”

In April, we published our reform plan, “Next steps to put People at the Heart of Care”. The enormous contribution of unpaid carers is reflected in that plan, and in writing it, we were thinking about carers as well as those they care for. This financial year, £327 million of the better care fund has been earmarked to provide short breaks and respite services for carers, as well as additional advice and support. We are finalising plans for how we will deliver the additional sum of up to £25 million that we committed to carers in the White Paper, and I will be sharing those plans shortly. I know it is taking time, but I do really want to get it right.

The Health and Care Act 2022 includes provisions for the Care Quality Commission to assess the performance of local authority delivery of adult social care duties. That duty has gone live as of 1 April with our new assurance framework, which will provide a clear assessment of how local authorities are meeting their statutory duties, including those relating to carers, such as whether local authorities are undertaking their assessment of carers’ need for support and then meeting the needs that are identified. That will address one of the questions asked by my hon. Friend the Member for Gosport, along with other Members: how we make sure carers get the assessments to which they have a statutory right, as well as the support they are identified as needing.

We are working with NHS England to streamline the ways in which unpaid carers are recorded in GPs’ health records, and we have written to all GPs in England to communicate improvements to how that is carried out. Crucially, that identification of individuals with caring obligations extends to young carers. Questions designed to identify children and students caring for family members have been added to the school census, and that important data has been published today. We are also making progress on our plans to transform social care data, better joining up the care to people, including support to unpaid carers as well as those they care for.

Meanwhile, we are taking steps to design a new survey to capture the wide range of experiences and needs of unpaid carers across England, and to commission a valuation of the support provided to unpaid carers through the better care fund, including carer breaks and respite. It might seem obvious, but different carers want different things, so it is right that we take steps to understand and build the evidence base of what works and what matters when supporting carers.

[Barbara Keeley]

Will the Minister give way?

[Helen Whately]

I am really sorry, but I have but a minute left—Madam Deputy Speaker has confirmed that. However, to address the points that the hon. Lady made in her speech, I assure her that not a penny has been taken away from funding for adult social care; in fact, more money is going into adult social care, thanks to the record funding of up to £7.5 billion over two years that we announced in the autumn statement. A crucial part of our adult social care workforce reforms is our reform of the professional care workforce: developing social care as a career for the professional workforce, developing the career pathway and investing in qualifications for that workforce. That is very important to unpaid carers, because the top issue often raised with me by the unpaid carers I talk to is the difficulty of accessing professional care.

To close, I want to say as Minister for Social Care that I care, and I will continue to champion carers’ needs as part of the work I do across Government. I am delighted to announce that I will be convening a roundtable of Ministers to work together across our Departments to identify, recognise and support unpaid carers. I thank all right hon. and hon. Members who have made contributions on this important topic today, as well as Carers UK for its work this Carers Week and its year-round advocating for carers, and the other campaign groups involved in this week, including Age UK, the MND Association, Rethink Mental Illness, the Lewy Body Society and Oxfam. Finally, I say thank you to all carers.