(2 years, 8 months ago)
Commons ChamberMy hon. Friend, along with many right hon. and hon. Members, is doing his bit to push the cause of his local hospital investment bid. As I said to the hon. Member for Weaver Vale (Mike Amesbury), I commend that, but it would be wrong for me to be drawn while the process is still under way.
I thank my hon. Friend for his statement on health and social care planning. The worry is, of course, that the omicron variant will put a lot of pressure on that planning. Will he update the House on where the Department has got in crunching the data on how dangerous or not omicron will be?
The latest statistic I have on the number of cases in this country is, I believe, 42. That work is still being done. We have seen various news reports today on things that might be encouraging, but I encourage everyone to wait and see while that analysis is done. It will take two to three weeks for the scientists to do their amazing work in understanding whether this new variant is more infectious and more virulent as well as how it responds to therapeutics and vaccines, and I am afraid that we will have to be patient while they do that work. Hopefully, they will come back with positive news, but it is too early to say.
(2 years, 8 months ago)
Commons ChamberI have given way a lot, and lots of other hon. Members are waiting to speak.
As for the Leader of the House’s nonsensical claim that people cannot catch covid from their friends, I have to say that words fail me—and as Members can well believe, that is not a common occurrence. It is clear that the most common spread is within households. If the Leader of the House thinks that husbands, wives and children are not friendly with one another, I really worry about his home circumstances.
It is early days, but we should be following a precautionary approach. As Dr Ryan of the World Health Organisation has always said: go early and go hard. In the last three waves, the Government often delayed making decisions until the problem was proven. I welcome the changes that they are making to try to get ahead of the curve this time, but as well as taking action on masks, they should advise those who can easily work from home to do so. They should promote “hands, face, space” again, to push it to people who may have got a little complacent.
The Government should also look at how to support the installation and improvement of ventilation. Covid is airborne. Hon. Members will remember how smoke used to hang in a pub before the smoking ban. Any Member who has ever worked in pubs, as I did as a student, will know that smoke would still be hanging there the next morning. That is the issue with poorly ventilated spaces, as we have seen from the outbreaks associated with Committee Rooms in the House.
The arrival of such a variant was inevitable. Last spring, we heard warm words about a global response to a global crisis, but while more than 85% of adults in the UK have been double-vaccinated, the figure is less than 4% in low-income countries, including many that have not been able to vaccinate their healthcare workers.
Does the evolution of an immune escape variant, which omicron may be, occur because of a vaccinated immune population or because of a naive population?
I think that its emergence in southern Africa would suggest that it is from a naive population. One of the issues with our complacency here and reliance on vaccination while allowing very high case numbers is that through Darwinism it can pre-select for vaccine-resistant variants and mutations. Those are the ones that will get a grip; the ones that are vaccine-susceptible will not, because we are so vaccinated.
Allowing high spread, which means common mutations, is a problem wherever it happens, but in the naive populations in the global south there is a real danger. They do not have testing, they do not have the materials, they do not have genomics and they do not have vaccines, so the danger is that they will therefore get a variant that builds up and eventually comes to Europe and to the UK. Sending occasional batches that are almost out of date, as was reported recently to us in the all-party parliamentary group on coronavirus, does not allow Governments in the global south to prepare and use vaccines within date.
The UK is still among the countries blocking a TRIPS waiver. We must realise that it is not a matter of just sharing some leftover doses. We need to massively increase global population, which means sharing intellectual property and sharing technological expertise. If anything, this variant should be a reminder that no one is safe until everyone is safe.
It is always a pleasure to follow such a powerful speech from my hon. Friend the Member for Wycombe (Mr Baker).
Today’s debate is fundamentally about uncertainty—uncertainty about omicron. It looks spooky, and it seems to be out-performing other variants in Africa. Why? Who knows. We do not know whether it is going to be more harmful or less harmful; we just do not know.
The problem with these restrictions is also uncertainty. Their direct effect is certainly not trivial. They are going to batter the international travel sector, which has already taken an absolute battering over the past two years. They will yet again have a disproportionate impact on children, when we see the collapse of bubbles in schools because of omicron and our children having to wear face masks at disproportionately high rates compared to adults; yet again, children are going to be the most affected. Sadly, that has been the story of the pandemic thus far.
The real harm from these restrictions is the, “Here we go again.” That is how I felt when the 5 pm press conference on a Saturday was announced again. In the click of a finger, I was back to 2020. I think that everyone at home watching was starting to worry and think, “What is going to come next? Here we go—is this the start of the ratchet again, moving monotonously and inexorably towards higher and increasing restrictions?”. My hon. Friend the Member for Winchester (Steve Brine) was exactly right when he said that it is this chilling effect that does, and is doing, the most harm.
Immediately, I started thinking, “Shall we hold off on ordering the booze for my 40th birthday party in a couple of weeks? Shall we just wait and see what happens?”. There are stories of countless events that we already anticipate will be cancelled, thinking, “Let’s hold off on making clear arrangements about seeing our parents at Christmas” and “Let’s just hold off on ordering the goose or the turkey”. All this has a snowballing impact.
I remember, as I think many people do, when it was just three weeks to flatten the curve. Heaven forbid that because of this chilling effect, people at home say to themselves, “You know what, actually? That lump I found? Let’s not bother the GPs. They’re too busy—too much to deal with, with covid.”. That is a serious and severe concern.
There is a final uncertainty that gives me the most trouble: how much we will really know in three weeks’ time. We know that it takes three weeks to get from infection to hospitalisation and three weeks from hospitalisation to get to death. We have only just started finding our domestic omicron cases. Will we really know from our domestic data in three weeks’ time what on earth omicron looks like: what it is doing, how transmissible it is, and the impact it is having on our NHS? Can we really compare international data with ours? We have had a phenomenal vaccine roll-out. We celebrate the impact of our vaccine roll-out and the booster: it is far better than many other nations’. Are we really comparable in those terms, whatever data ends up coming out across the world? I am really uncertain that we will know in three weeks’ time what is going to happen and what our next steps, if anything, should be.
In the face of the uncertainty that all of us are feeling, where can we find confidence? I would argue: here. Here is where the public find confidence, because they see us standing here debating and scrutinising, raising their points and concerns, chewing over in the most minute detail the SIs that are coming forward, and challenging the Minister on why we are doing what we are doing—having a great debate across the House on these issues. They see this and they have confidence that whatever we do in going forward, and whatever impact we are having on people’s day-to-day lives, we have scrutinised it—that we are here representing them and making sure that we make the best possible decisions.
We have some big decisions to take in three weeks and I do worry about what is going to happen then. Will the data from omicron be bad, will it be good, or will it be “not sure”? Parliament must be able to debate this, being recalled if necessary or, better yet, not going into recess until we have the data so that we know what our next steps should or should not be. For me, in terms of ending uncertainty, I would be grateful if the Minister gave certainty that Parliament will have its say whatever happens in two or three weeks’ time in terms of our response to the omicron variant or wider variants that may pop up between now and then.
(2 years, 9 months ago)
Commons ChamberThe Department already had contingency plans in place for countries being rapidly added to the red list. I believe that more than 600 rooms were made available on Sunday morning, and that will rapidly increase during the next few days. I think it has already increased since then. I believe that most of the information is available on the Government website.
I thank my right hon. Friend for his statement. Clearly the problem here is uncertainty. I welcome the analysis, along with the three-week review and the ambition to do it sooner, but following on from the question from my hon. Friend the Member for North West Leicestershire (Andrew Bridgen), does he agree that if the review takes place after the House has risen, we should be recalled to debate its findings?
That is a decision we will have to make closer to the time.
(2 years, 9 months ago)
Commons ChamberI agree with the hon. Lady that surgeons work incredibly hard. What I am talking about is operating at the top of the licence and for our consultants to be able to do the things that we want them to do. She is absolutely right; they are doing vital work in other areas running clinics and so on, but ultimately what we have is an elective challenge, and we need to ensure that we spend as much time addressing that elective challenge.
Does my hon. Friend agree that one of the challenges for primary care is that general practitioners have absorbed a great deal of the role of social advocacy in our society? People are trying to get a face-to-face GP appointment, and it is sometimes being suggested to them that such things as getting a fitness note or a letter to go to a school might be better served by someone else in the wider multi-disciplinary team. People are getting frustrated, because our messaging about how to use the health service and the different range of roles and responsibilities offered is sometimes getting a bit diluted.
My hon. Friend speaks with much experience and makes a powerful point. I think he would agree that that core admin function is not what he went into medicine to do. He went into medicine to treat patients. I am grateful that the Minister laid out some of the plans that the Government have to deal with this issue. It is right that we should be looking to the long term, and the 15-year framework for future workforce is to be welcomed, but there also needs to be a much more regular reporting mechanism attached to that to ensure that we as Members are informed, but more importantly the NHS is informed, about how that challenge is going. The integration between NHS England and Health Education England—aligning the delivery arm and the workforce capacity arm—is probably also the right thing to do.
I end with this point: the challenges around workforce will be addressed not only by employing and training more NHS staff, although that is crucial—that is why I have some sympathy for amendment 10—but by ensuring that we work more productively by asking clinicians to operate at the top of their licence. It is also about ensuring that the NHS works smarter. We have created organisations such as Getting It Right First Time and NICE and asked them to go away and do the hard work of coming up with the most cost-effective and efficient ways of delivering care. If we ask those organisations to come up with the pathways and the ways of doing these things, surely it is only right that the NHS then adopts them instead of sitting there and saying, “These things will not necessarily work here.” We ask experts to come up with the right way of performing procedures; I suggest we go ahead and adopt them.
(2 years, 9 months ago)
Commons ChamberThe UK’s covid-19 vaccination programme has been a recognised success story. It is the largest vaccination programme ever undertaken by the NHS. We are working at speed to get people their covid-19 booster vaccines. Our vaccination programme is making great progress, with over 15.3 million people across the UK already having taken their covid-19 booster or third jab.
I think my hon. Friend might be wearing a booster badge, because I understand that he has taken his own boost this morning. What more encouragement would the people of Milton Keynes want than their very own Member of Parliament getting boosted? I can tell him that the Bedfordshire, Luton and Milton Keynes clinical commissioning group is in regular dialogue with Healthwatch and the local authority to see what more it can do to encourage local people to take up their booster jabs, and the national “Boost your immunity” campaign is helping to encourage more and more people to come forward, not just for their booster jab but for their vital flu jab.
I thank my right hon. Friend for his answer and for the speed of the booster roll-out. In fact, it is so speedy that the criteria for getting a booster are changing all the time, and many constituents have contacted me confused about exactly what the criteria are. I have spoken to my CCGs to try to get them to improve the public engagement that they are doing, but will my right hon. Friend lay out what the criteria are for getting a booster at the moment, and what support he is giving to CCGs so that they can get the message out to people and get them into walk-in centres or booking their appointment for a booster?
My hon. Friend will understand that there is often good reason to change the criteria. They might be changed, for example, on the latest advice from the Joint Committee on Vaccination and Immunisation; the Government must of course consider that advice and take it seriously. As was mentioned earlier, we are extending the booster jab to 40 to 49-year-olds. NHS England has issued guidance to CCGs on the covid-19 vaccination programme, which includes guidance on eligibility for booster vaccines and how to manage those appointments. We encourage everyone to visit the NHS website on gov.uk for the very latest information on the programme.
(2 years, 10 months ago)
Commons ChamberI join Members from across the House in paying tribute to the hon. Member for Swansea East (Carolyn Harris) for bringing forward this very important debate and for the campaign she has been running.
I have a different experience of the issue. Obviously, I have not been through the menopause, but as a doctor working in mental health I have looked after several women who have come to me where their depression has been misdiagnosed as the menopause. So I have seen the issue the other way around. I completely get the point that has been made across the House by several Members that understanding and recognition in this area by clinicians is something that people have many concerns about and needs to be improved. One thing that I have really taken notice of is the strength of feeling around that and the medical profession needs to think about that. I should make some declarations. I am still a member of the medical profession. I am a member of the Royal College of Physicians and the Royal College of Psychiatrists, but, as I would say if I was a member of the Scientific Advisory Group for Emergencies, I am here speaking in a personal capacity today.
I want to talk about one of the statistics that has been put out, which is that 41% of medical schools do not have formal training on the menopause. I found that astounding—I had formal training on the menopause when I went to medical school—so it is worth unpicking that a little bit. I had a look in the briefing to see where that came from. My reading of it is that it is not that student doctors and GPs are not getting training; they are getting training. They are getting vocational training on placements with senior doctors who are teaching them, but some schools do not have formal modules in terms of didactic sit-down teaching on it. I think we need to be a little careful when we say there is no training on the menopause and to dig in a little bit. The reason that is important—as I say, I totally get the sentiment and agree on the need for improvement and better recognition —is that we need to be careful about issuing diktats for how the profession approaches its training programmes. If we carve off something for one disorder, the question then is, “Well, what about other things?” Eventually, the strength of the argument will start to diminish, because we will have all different campaign groups saying, “This needs to be separately cut out, and this, and this.”
Can I just say, 51% of the population is a huge amount of people who are not getting appropriate care.
I thank the hon. Member for her intervention and for pointing that out, but I would argue that it is maybe not 51% of the population who are in that situation of needing that care and support. Although 51% will go through the menopause, that is different from saying that 51% of the population will therefore need medical intervention and medical discussions around this.
But like I say, I do not particularly want to get into a deep debate on this; I just wonder whether we could ask the profession what it thinks it can do better, rather than us telling it, top-down. Of course, I would say that, I am a doctor—yadda, yadda, yadda; declarations, etc.—but I just wonder what the profession would say in response to the hon. Member’s campaign about how it can improve things and whether we can hear a bit more about that.
My final point is that, in a sense, I find the fact that we are having to have today’s debate deeply depressing. It is a wider indictment of the problems we have in society with the role and position of women. We have got the Equality Act 2010 and lots of legislation and statute, but as we have heard, when it comes to cultures and attitudes, it is just not there. There really needs to be a step change, given the events of the past year and what we have seen with sexual harassment. I have loads of constituents who come to me and tell me about the disrespect experienced by women. I hear the points made by my hon. Friend the Member for Thurrock (Jackie Doyle-Price). It is frankly appalling that women’s health has been left behind. We need to think carefully about what we can do as leaders of our communities and society to change things and increase respect for girls and women and the position of women in society. On that note, I absolutely pay tribute to the hon. Member for Swansea East for bringing this debate forward and the campaign she is running.
May I also add my thanks to the hon. Member for Swansea East (Carolyn Harris) for this amazing debate and Bill?
When I was first in Parliament, I encountered the exact experiences in all the comments read out by the hon. Member for Luton South (Rachel Hopkins). I was incredibly worried about it. I am delighted that so many people are now speaking out about it in public, because none of that was happening when I was first in Parliament and going through the menopause myself. Other than knowing that hot flushes were part of the process, I had no idea about any of the other symptoms until I listened to “Woman’s Hour” in, I think, 2017 and literally everything became clear: the brain fog, the insomnia, which I am afraid has not gone away—it was in the middle of the night that I heard the programme—and the anxiety and weepiness and feeling that you couldn’t cope with what was happening to you. That was very much part of it. Weight gain is common in Westminster anyway, and a lot of men also gain the Westminster stone, so I cannot blame the menopause for that, but it is certainly something that we need to work on.
That is why this conversation is so important. There are 5.1 million women aged between 45 and 55, and it is estimated that 1.5 million will be going through the menopause at any one time, yet we are so embarrassed to talk about it. Husbands and partners are at a loss as to why their wives and partners are struggling, because the symptoms have been hidden from public knowledge. If I had known some of the symptoms before, I could have dealt with them better, and I am sure my husband could have as well. That “Woman’s Hour” programme was a saviour for me, because suddenly I understood what was happening, and if you understand what is happening, you are better able to face it.
Turning to HRT, I never take medication, apart from the odd pain killer, so taking something to control a natural process was something that I did not consider—probably mostly from ignorance, I should add—but I completely understand that others need medical help. The House of Commons Library briefing states that
“16,000 women were admitted to hospital in England in 2019/20 with conditions associated with the menopause.”
I had absolutely no idea, and I am sure that most of the public do not either.
The case on HRT has been well made, so I will not say more on that, but I do hope that we can consider how it can be made affordable, because, otherwise, it will become a postcode lottery. I am very grateful that a Member who represents a constituency in Wales is interested in looking after all of us who live in England.
I wish to comment on the second part of the Bill, because it is very important. I am really pleased that everything has been raised so publicly, but it is extraordinary that it is only in the past four years that people have been bold enough to speak out, when this has been happening to millions of women for centuries. The big change is that more women are in the workplace now than at any time over the past 100 years, and nearly half of all women are over 50. I am really pleased that we have the menopause workplace pledge, with so many employers leading the way. I hope that Parliament has signed up to it, too. Flexible working hours are essential, especially as lack of sleep is a big issue. Another thought is allowing women to come later into work if they travel on public transport, so that they do not have to crowd themselves in when they are feeling incredibly hot. I have come off the tube so many times absolutely drenched in sweat and incredibly embarrassed that I do not have a change of clothes when I get to my office.
The point about training GPs is crucial, too. I listened to what my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer) had to say. I spoke to a doctor about this and found that the issue is barely covered in their initial medical training. For GPs, the clue is in the name—the name is general practice, which means that GPs have to cover a huge area in their curriculum, and it is not mandatory to have additional training for a condition such as the menopause in their professional development. I would very much like to see such training being seen as part of their professional development and it should be taken perhaps every year or every few years, so that they can keep up to date with every aspect, whether it be HRT or anything else on the menopause.
Does my hon. Friend hope that the chair of the Royal College of General Practitioners is listening to this debate today and responds to the hon. Member for Swansea East (Carolyn Harris) on what we are talking about on GP training?
Absolutely, because it is incredibly important that people understand what we are going through—whether we are talking about men or women or people of any age. As someone who does not see the same doctor twice in their practice, although I have not been there very often, I do not have that relationship with a GP, so I would feel embarrassed about going to ask for something that I did not know much about.
On the peer-to-peer point, when I returned to Parliament in 2019, I looked around at the new intake and started approaching women of a certain age—I call them my WOCA group—to form a support group to help those going through the menopause. This has been a lifeline to us, and I hope that everyone else considers that as well. [Interruption.] I can see Madam Deputy Speaker indicating to me.
Finally, may I thank the hon. Member for Swansea East. She truly is a force of nature and I congratulate her on all the things that she is achieving in Parliament, and it is such a joy to work with someone on the Opposition Benches to make a real difference to people’s lives.
(2 years, 11 months ago)
Commons ChamberI do understand the point the hon. Lady makes, but may I suggest that, if she has not yet, she should read the JCVI’s advice on booster vaccines? I think then she might better appreciate the importance of the booster programme.
I thank my right hon. Friend for his statement. I think we all hope that plan B is not activated, but may I follow up the question asked by my right hon. Friend the Member for Tunbridge Wells (Greg Clark) and ask the Secretary of State to lay out exactly what “unsustainable pressure” means? In his assessment of NHS capacity over winter, where does he see the bottleneck? Is it staff? Is it medication? Is it beds? What work is being done to enhance that capacity?
When I talked earlier about unsustainable pressure, it would be things like hospital occupancy, in particular in intensive care units, the admissions of vaccinated individuals versus unvaccinated individuals and the rate of growth in admissions. I know there is a lot there, but I think it is right that there is not one particular trigger and that we take a number of issues into account. I hope my hon. Friend agrees that the Government are right to plan for all contingencies.
(2 years, 11 months ago)
Commons ChamberI will absolutely join my hon. Friend in congratulating St John’s volunteers, who have done a phenomenal job. They really rose to the challenge when we contacted them and said that we needed them. They delivered in spades. I thank my hon. Friend for all his words: this has been a massive team effort involving the health service, the public sector and of course the private sector as well.
I would like to thank my hon. Friend for the incredible vaccine roll-out; many lives have been saved by it. My question is about domestic vaccine passports, and I have to apologise because I get a bit confused by the nomenclature of what is being proposed. On the one hand, we have what I understand to be vaccine-only passports, which say simply that someone has been vaccinated and that that is all that counts. Then we have covid status certification, which can also include negative testing and proof of recent infection. Crucially, this is not just about whether someone has been vaccinated, because as I understand it, a lateral flow test negative result is the best evidence that someone is no longer infectious. Is my understanding correct that the proposal for the end of September is for vaccine-only domestic vaccine passports? If that is the case, why has that moved from covid status certification?
Order. Just before the Minister answers, I must point out that we need to finish this statement fairly shortly. Colleagues should keep their questions very short, and the answers should be correspondingly short.
(3 years, 1 month ago)
Commons ChamberI ought to conclude the statement here, because we are running way behind time. However, I appreciate that Members have important questions to ask and that the Minister will want to answer them. But I ask for much greater speed and brevity, because otherwise it is not fair to people who are waiting for us to come on to the next item of business. I call Dr Ben Spencer.
Thank you, Madam Deputy Speaker. Before I ask my question, may I declare an interest, in that my wife works in the NHS?
I thank the Minister for her statement, particularly on supporting our workforce. When I speak to local health leaders they tell me that the workforce are tired—they have been dealing with covid for the past 18 months, and they are worried that they will have to lurch from covid into tackling 150% of the covid backlog. What reassurance can the Minister give health staff working in my constituency that there will be a sustainable transition from dealing with the pandemic to dealing with all the backlog and consequences as a result of it?
My hon. Friend makes an important point, and it is why I am working closely with my hon. Friend the Minister for Health, who is leading oversight of the elective recovery work. We are very much discussing how we can make sure that, with the pressure of looking after people with covid, with winter approaching and with elective recovery, we are looking after our workforce through this period. Of course, looking ahead to the winter, it is important that people get not only the covid vaccination, if they are eligible, but the flu vaccination, so we can try to have as little flu as possible in what may be a challenging winter ahead.
(3 years, 1 month ago)
Commons ChamberControversially, perhaps, I think that much of this statutory instrument is uncontroversial. The reason behind that is my own experience of being recruited to go through medical school. As part of the recruitment process, it was made very clear to me that I had to have hep B testing and I had to be vaccinated for hep B, and that going through and getting involved in becoming a medical student just would not happen if that was not the case. I think that is fair enough.
We expect our health staff to have vaccinations for a variety of conditions—not just hepatitis B but things such as chickenpox for people who have not been exposed, and rubella—because we know the impact that those things can have on the patients we look after or the people we care for. We know the huge impact covid has on the most vulnerable in our society. Its lethality—its severity—is linked to frailty, and one of the most frail groups are people living in care. It is important that people are vaccinated so that, when they have asymptomatic covid, they do not unintentionally pass it on. We know that vaccination rates are not high enough to give the protection necessary to protect people in care homes, and on that basis it is an entirely reasonable and sensible approach to bring forward measures saying that people have to be vaccinated to work in that setting. However, although that might be a reasonable approach I realise that it is different from my personal experience as I have just described, because that was a pre-recruitment process that I went through, whereas what we are talking about now is a process for people who are currently in post—people who might have been working for quite some time and have a lot of years behind them—and if they do not go through with vaccination, ultimately they will be without a job. That is a big deal. It is also important to recognise that those who may decide that they do not want to be vaccinated are not evil people who should be shunned; they are people who make decisions for whatever reason about vaccination, and that is important and should be respected.
Fundamentally, this SI is about risk, and I see two risks here. One is the risk of covid to people living in care settings, and that risk is very clear: there is loads of data on that—loads of data on the impact and on fatalities, and also on the protection provided by vaccination for people at risk of covid and protection in terms of reducing transmission. So, that side of the equation is very clear, but the side that is less clear is the risk in terms of staffing, and that is a critical issue. Some people will decide that not being vaccinated is more important to them than working in the care sector. I am completely unclear as to how many people will make that decision and I do not think anyone knows what that population is going to be—what the numbers are going to look like. That is a concern as we already have staffing issues in the care sector and it has been a long-term problem.
Nevertheless, perhaps the only way to test this out is to bring it forward and see what happens. The 16-week run-in makes a lot of sense, but it is critical that it is monitored to see what happens with regard to staffing and retention, and if that is a big issue—if retention pressures start coming through—we will have to change course. When my hon. Friend the Minister sums up I would welcome her saying what she will do over the summer as this is being brought in to work with and engage with people in the social care sector on its impact. If there is a substantial impact, I hope that she will undertake to come back to the House after the summer recess with plans to mitigate this or change course.