NHS Dentistry

Catherine West Excerpts

Tuesday 9th January 2024 Commons Chamber

[Wes Streeting]

I agree with the hon. Gentleman about the urgency of the situation. There is a different path available to us. We can revive our public services and give our country back what we used to take for granted. Labour’s plan would take immediate steps to rescue NHS dentistry, with 700,000 more urgent appointments and the recruitment of new dentists in the areas most in need. We would also take the necessary steps to rebuild NHS dentistry over the long term, including reforming the dental contract and introducing supervised toothbrushing for three to five-year-olds in primary schools, so that poor oral health is prevented and demands on the service reduced.

In fact, some of my Labour colleagues are not even waiting for the general election to start making a difference. Labour’s candidate in Stroud, Simon Opher—himself a GP—has spearheaded a campaign working with local dentists and the integrated care board. From opposition, he has more than trebled the number of emergency appointments available each day across Gloucestershire, pioneered a new dental stabilisation scheme for people not known to a local practice, opening up more than 130 appointments a week, and introduced supervised toothbrushing in 14 local primary schools. If that is the difference Simon is making in opposition, imagine what he will be able to do as a Labour MP working with a Labour Government. That Government cannot come soon enough.

[Catherine West (Hornsey and Wood Green) (Lab)]

My hon. Friend is making an excellent speech. Does he agree with me and my constituent in Crouch End who has not had a check-up since 2019 that the link between poor oral health and oral cancer is serious? That could be contributing to the terrible problem we have with cancer waiting times.

[Wes Streeting]

I totally agree with my hon. Friend. Prevention is better than cure. It is a truism, and it is also the foundation pillar of what would be Labour’s 10-year plan for reform and modernisation of our national health service. A part of that plan is before the House today, and Government Members will have to explain to their constituents, only months, if not weeks away from a general election, why they are refusing to support it.

The Government’s amendment to the motion promises that the dental recovery plan is coming soon, but it was due last summer; now, they cannot put a date on when the plan will arrive, when it will be implemented or even say what it is. Conservative Ministers have taken a look at the state of NHS dentistry, at the millions of people across the country who cannot get an appointment to see a dentist and at children in their own constituencies whose teeth are rotting, and their conclusion is: what is the rush? Let me tell them why they should get their skates on.

A 17-year-old boy in Plymouth had to undergo emergency surgery on an abscess in his mouth last year. He spent two months trying to book an NHS dentist—he said that he was on hold for about three hours per day. According to figures on the NHS website, no dentists are taking on new NHS patients in the Plymouth, Moor View constituency. It was left too late, and when he finally got the healthcare he needed, he required emergency surgery, which has left him scarred for life.

In Worthing West, Labour’s candidate Dr Beccy Cooper told me of an 82-year-old great-grandfather on pension credit who told her that he will not be going back to an NHS dentist before he dies. He tried to get an NHS dentist in Worthing, but no one will take him on the NHS to receive low-cost treatment. Dr Beccy Cooper also tells me that residents who cannot get a dentist are being told to look for one in Hampshire, more than 60 miles away from where they live.

--- Later in debate ---

[Victoria Atkins]

I am going to make some progress.

I am very pleased that, subject to a public consultation which will be published shortly, we have secured funding to expand water fluoridation schemes across the north-east of England. [Interruption.] The hon. Member for Ilford North may be interested to know why we have identified the north-east, given that he read out so many constituency names in his speech. The north-east was chosen because natural fluoride levels there are among the lowest in the country, and the proportion of five-year-olds with teeth extracted because of tooth decay is among the highest. We have wanted to address that very real health inequality to ensure that more than 1.6 million people in the area can benefit from this expansion, subject, as I have said, to a public consultation.

Supervised tooth brushing has been raised. That has indeed been proven to drive down oral health inequalities, which is why we have already introduced a toolkit that local authorities are using to introduce supervised tooth brushing across schools, nurseries and family hubs. We have been clear that we want to see that happening in more areas. I would encourage any colleague who is concerned about that, rather than waiting for some mythical date in the future, to ask our local authorities whether they are using these toolkits, because they are freely available, and they can and should put them in place.

[Catherine West]

The Secretary of State rightly talks about prevention, but what about the opposite, where rates of oral cancer have gone up because prevention has not been in place? What assessment has she made? If she does not have the data to hand, will she write to me with the assessment that the Department of Health and Social Care has made of the link between failure on prevention and cancer?

[Victoria Atkins]

I thank the hon. Lady, and particularly for the constructive tone of her intervention, because she is right. This is not simply about teeth health; it is also about the conditions that dentists check for—probably without anyone quite realising that they are doing so. I will take the hon. Lady up on her invitation to write to her on the figures, but that is why we are looking at health inequalities across the country and, importantly, focusing on encouraging dentists to re-register with the NHS if they have left, because it is vital for tackling much wider health conditions in addition to the pain and discomfort that tooth decay can bring.

Oral Answers to Questions

Catherine West Excerpts

Tuesday 5th December 2023 Commons Chamber

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. You won’t get your turn if you shout from there.

[Catherine West (Hornsey and Wood Green) (Lab)]

4. What steps her Department is taking to reduce pressure on NHS services in winter 2023-24.

[The Minister for Social Care (Helen Whately)]

We know that winter is hard for the NHS, as it is for other health systems. That is why we started planning for this winter earlier than ever before—back in January, when we published our urgent and emergency care recovery plan, which funds more beds and new ambulances for our NHS, funds more social care in our communities, joins up care, and makes the most of technology, so that more people can get the care they need when and where they most need it.

[Catherine West]

Two accident and emergency departments serve patients in Hornsey and Wood Green. One is now serving double the number of visits by patients and is buckling under the pressure; and the other has seen 4,000 extra patients this year compared with last. What are the Government going to do about overcrowding in accident and emergency?

[Helen Whately]

The hon. Member is right that our hospitals are busier; we are seeing more patients in A&Es. That is why we are doing two things with our work on urgent and emergency care. One is providing more capacity—more hospital beds, more hours of ambulances on the road, and more capacity in social care to help with discharges. We are also doing things differently by seeing more people out of hospital, avoiding people coming to hospital unnecessarily, and providing more care at home; for instance, our 10,000 “hospital at home” beds are helping people recover at home, which is better for them and better for the system.

NHS Workforce Expansion

Catherine West Excerpts

Tuesday 28th February 2023 Commons Chamber

[Catherine West (Hornsey and Wood Green) (Lab)]

Does the shadow Secretary of State agree that it is not just about cash; it is also about the huge recruitment issues? For example, the North Middlesex University Hospital has 800 patients a day into accident and emergency, and it is suffering because even if there is the budget, there simply are not the staff to employ to put on the frontline?

[Wes Streeting]

My hon. Friend is absolutely right, and it is why current staff in the NHS are right to say that retention is urgent and that we need measures from the Government immediately to deal with retention. By definition, if we have a shortage of staff, retention is not enough, and that is why Labour has put forward a fully costed, fully funded plan for the biggest expansion of NHS staff in history.

--- Later in debate ---

[Wes Streeting]

Well, I need the help of the hon. Gentleman and Conservative Members, because my pleas seem to be falling on deaf ears. That is why I have taken the trouble to circulate this email to every Conservative Member, so that they can collar the Chancellor in the voting Lobby this evening—no doubt when he is voting with us, because he agrees with us—and I look forward to their assistance in helping him to see the error of his ways. In all seriousness, it is time that the Chancellor put his money where his mouth is, abolished non-doms and used the proceeds to train the doctors and nurses that the NHS needs.

We know the consequences of the current NHS crisis. Earlier this month, I met Samina and Minnie Rahman, who lost their loving husband and father on Christmas eve after calling for an ambulance three times. The family were initially told a nurse or paramedic would call them back, as it was deemed Iqbal did not require an ambulance. Forty minutes later, when his condition worsened and his family were unable to lift him into their car to drive him to hospital, they phoned 999 again. This time an ambulance was sent, but was then diverted to a higher-priority call. When Iqbal stopped breathing an hour after the first call, his family called 999 a third time, and an ambulance eventually arrived 24 minutes later. The paramedics spent 90 minutes attempting to revive Iqbal in front of his family, but they were unable to. That story is tragic and awful for the family who lost a husband, a father, and a grandfather. Perhaps most depressing is that this case is no longer surprising. The hour and a half that Iqbal waited for an ambulance was the average amount of time that patients with conditions such as heart attacks and strokes waited in December.

The West Midlands Ambulance Service has apologised to Mr Rahman’s family, but they want the Government to take action. They are calling for change to ensure that no other family must endure what they have been through, and they have three asks. First, they want an independent review to establish the number of deaths and serious harms caused by ambulance delays. The Government have rejected figures from the Royal College of Emergency Medicine that claimed that up to 500 people a week were losing their lives this winter due to long waits for emergency care. They also rejected figures from the Office for National Statistics on the number of excess deaths suffered in the past year. Well, Mr Deputy Speaker, “ignorance is bliss” is not a responsible approach to the crisis in emergency care. Sunlight is the best disinfectant, so I hope the Minister will commit to establishing the true scale of the harm caused by the crisis in the NHS.

Secondly, Minnie and Samina ask the Government to instigate Cobra-style meetings to deal with the public health emergency of ambulance delays. That is already happening to deal with the fallout from industrial action, but we need the same level of action for non-strike days. Thirdly, Minnie and Samina have asked to meet the Health and Social Care Secretary, so that he can hear at first hand about their experience, and see the trauma it has caused. The Secretary of State is not able to be here this afternoon, but I hope the Minister will convey that request to him. I gently remind her that I passed on Zaheer Ahmed’s request to meet the Secretary of State after his five-year-old nephew passed away following multiple failings by the health service, but that meeting is yet to be arranged. I think the least we can do as public servants is listen to those we serve, especially those who have suffered in the most unimaginable way. I hope the Secretary of State will meet those families, and that they are able to spur the Government into taking the action we need.

One promise of the NHS is that it is there for us when we need it. That has been completely fundamental in this country for as long as many in the Chamber can remember, but that promise is now broken. People are frightened that the NHS will not be there for them in an emergency. It is not hard to understand why. Look at the news today that more than 1.5 million patients waited for more than 12 hours in A&E last year, which is estimated by the Royal College of Emergency Medicine to have seen 23,000 people lose their lives.

This is not just about emergency care. Patients in need of an operation or even a GP appointment do not know whether the NHS will be there for them when they need it. That is why so many people are voting with their feet, and with their wallets, and going private. Of course most people in this country cannot afford to pay, so they have no choice but to wait and worry. Restoring that promise of an NHS that is there for us when we need it should be a basic task for any Government, but this Government do not even have the ambition, let alone a plan to get there. Instead, the Health and Social Care Secretary said last month that a world where patients are seen within four hours at A&E is “too ambitious” and “not achievable”. But it was achieved until 2015. It was certainly achieved under the last Labour Government.

The target for ambulances reaching patients with strokes or heart attacks has almost doubled to half an hour. If someone wants to see a GP, there is an “expectation”, not a guarantee, that they will be able to do that in two weeks. Two weeks! I remember Tony Blair being attacked because people were forced to see a GP within two days—what people wouldn’t give to be in that position now. Millions wait longer than a month. The Government missed the goal so they moved the goalposts. They have accepted that the NHS will not be there for all of us when we need it. That is what managed decline looks like. That is what brings about the end of the NHS. It is not calls for a different model from the right hon. Member for Gainsborough and others; it is this: slow, irreversible decline. That is what the end of the NHS will look like, and that is why we desperately need a change in Government.

[Catherine West]

Does my hon. Friend remember when the NHS had an 80% approval rate among UK citizens back in 2008? Now look at it—approval is under 50%, perhaps 38%.

[Wes Streeting]

I wholeheartedly agree with my hon. Friend. We delivered the highest levels of patient satisfaction in the history of the national health service. Now patient satisfaction is at its lowest level since at least 1997. There is a second basic promise of the NHS which, if it is not broken, is under attack today like it has not been for years. When I went through my treatment for kidney cancer I had lots to think and worry about—every cancer patient does—but the one thing I never had to worry about was the bill. That is the thing that people love most about the national health service, but those who have never believed that healthcare should be provided to all, regardless of their means, are using this crisis to attack that principle. The right hon. Member for Gainsborough called the NHS the

“the last example of collective planning and socialist central control”—[Official Report, 22 September 2022; Vol. 719, c. 840.]

and even today called on the Health and Social Care Secretary to look at insurance based systems instead.

The hon. Member for Christchurch (Sir Christopher Chope) has a Bill before the House this week that would extend user charging. The Prime Minister himself pledged last summer to charge patients who miss GP appointments, although he has since ditched that pledge—indeed, he has ditched an awful lot since he became Prime Minister. Two former Health Secretaries have joined in. The right hon. Member for West Suffolk (Matt Hancock) has proposed charging for missed GP appointments. The right hon. Member for Bromsgrove (Sajid Javid) went further and suggested charging patients to see a GP, or even to attend A&E. If he were here, I would happily give way to hear an explanation as to how that would work. The most deeply cynical thing about this, is that the right hon. Members for West Suffolk and for Bromsgrove are the people who bear much of the responsibility for the mess we are in today. They ran down the NHS. They refused to train the staff needed to treat patients on time. Now they say that timely care, free at the point of use, as we enjoyed 13 years ago, and as we have enjoyed for much of the past 75 years, is no longer possible—that we cannot afford it any more, that it is not achievable. That regressive, miserabilist argument cannot be allowed to win. Not only is it unjust, but it is wrong, so let us take it on in its own terms.

Why do patients who are ill enough to need to see a doctor miss appointments? Very often it is because the appointment clashes with work, they are unable to travel, they did not receive the letter, or it arrived too late. The answer is to change the archaic and maddening way that patients are forced to book appointments, and build a new system around patient convenience. If patients could choose whether to have an appointment face-to-face or over the phone, if they did not have to wait on hold at 8 am to book an appointment, then wait for a call back that can come at any time of the day, fewer appointments would be missed. Why is it that those who attack NHS managers as being wasteful bureaucrats want to install far more of them? Because that is what an insurance-based system would mean. One-third of US healthcare costs go to insurance company overheads and providers billing patients. Is that really what the proponents of an insurance system want—more administration, more bureaucracy, and less money spent on delivering healthcare?

What would happen if we charged patients to see a GP? People would stay away. In some cases, yes, that would mean people who did not need to see a GP would not take up an appointment. But it would also mean that many people who needed to see a GP but could not afford the price stayed away. More conditions would go undiagnosed, and left to become more serious until the patient had to go to hospital instead. It would mean worse outcomes for patients, a less healthy society, and greater cost to the taxpayer. While we might save £39 on a GP appointment, it costs far more for patients to go to A&E, which costs £359 on average. Not only are those proposals unfair, but they would mean more bureaucracy, more late diagnosis, more expensive and less effective hospital treatment—exactly the opposite of what the NHS needs. Such proposals are wrong on fairness, wrong on efficiency, and wrong on health outcomes. Those in government have no plan for the NHS, and there are even worse ideas sitting on their Back Benches.

Oral Answers to Questions

Catherine West Excerpts

Tuesday 6th December 2022 Commons Chamber

[Helen Whately]

My right hon. Friend makes an important point, and this is exactly why work is going on to increase the number of defibrillators across the community, for instance, in villages such as his. Many villages will already have them. We are also supporting the NHS to train community first responders to make sure that there are people all across the community who have the skills to do CPR— cardiopulmonary resuscitation—and use a defibrillator. I look forward to being able to announce shortly a new initiative that will mean further defibrillators across our communities.

[Catherine West (Hornsey and Wood Green) (Lab)]

11. What progress he has made on delivering social care reform.

[The Minister of State, Department of Health and Social Care (Helen Whately)]

We are already putting social care reforms into practice. For instance, we want care providers to adopt digital care records, and more than 50% have already done so. I am determined to shine more light on our social care system, so our new Care Quality Commission-led assurance of local authorities’ social care duties will start in April.

[Catherine West]

One of the worst vacancy rates across the NHS is that of geriatricians. What urgent action is the Minister putting in place to ensure that people either at home with domiciliary care or in social care settings are seeing a geriatrician consultant regularly? If there is a shortage, which I believe there is, what action is she taking to have more doctors train as geriatricians?

NHS PPE Supply Chains: Forced Labour

Catherine West Excerpts

Thursday 14th July 2022 Westminster Hall

[Catherine West (Hornsey and Wood Green) (Lab)]

It is a pleasure to contribute to this debate under you chairmanship, Ms Rees. I thank the hon. Member for Strangford (Jim Shannon) for securing it. He is, of course, well known in the House for his commitment to the defence of human rights and the freedom of religion or belief. Given the ongoing Conservative party leadership election, and the comments made by some candidates in recent days regarding policies and views relating to China and human rights, this debate is particularly timely.

Having a new Prime Minister and a fresh ministerial team this autumn will give us a real opportunity to do the right thing, not only in purchasing PPE but in applying pressure on Governments and in legislating to ensure that private sector organisations do their bit to promote human rights. The number of human rights staff in overseas posts has been cut back severely since 2010. I sincerely hope that the Foreign, Commonwealth and Development Office will replace them, because that is how we know exactly what conditions are like in manufacturing and overseas supply chains.

We know that there are many concerns about supply chains that arise from the Xinjiang province of China, with the Chinese Government being routinely accused of using the Uyghur minority population as slave labour. As the hon. Member for Strangford has said, at least 20% of all global cotton and 80% of Chinese domestic production, has its provenance on the Xinjiang region. The scale of the problem is why this issue is so important.

It is vital that the NHS, as one of our proudest national achievements and a large purchasing unit, is not implicated, either directly or indirectly, in forced labour or questionable supply chains. But we know, sadly, that that is often the case. Pre-pandemic, PPE global supply chains were already known to be riddled with trade union and human rights violations, but it has worsened in the past 28 months. However, many of the companies supplying PPE have vastly increased their profits.

Forced labour has increased but this is not just a story about forced labour. Authoritarian Governments have used the pandemic to further restrict workers from organising into trade unions. All over the world, in all sectors, collective bargaining agreements have been ripped up and thrown away. In a number of countries in the Asia-Pacific area, wage theft is sadly a feature of the production of PPE basics such as rubber gloves, gowns and surgical masks.

I acknowledge the ongoing work of the trade union movement, not least Unison, which has been campaigning on this issue for some time. Labour’s position has always been clear and consistent—that we must remove any suggestion of forced labour from the NHS’s PPE supply chain.

My hon. Friend the Member for Ilford North (Wes Streeting), the shadow Health Secretary, has spoken clearly about Labour’s support for legislative measures during the passage of the Health and Care Act 2022, particularly given the significant amount of public money that has been wasted through crony contracting. The Government should resource adequately the checks on procurement and bring to book any companies that fail to follow guidelines on supply chains. We cannot allow public money for our NHS to pay for questionable contracts, to enable forced labour, or to be part of our entering trade deals that contradict the spirit of the UK’s obligations under the genocide convention.

The issue is not new and today is not the first time that it has been raised. As we are aware, there is a requirement on Governments that are signatories to the genocide convention to act even when there is only a suspicion that genocide might have occurred, and not to turn a blind eye to human rights infringements.

As the hon. Member for Strangford mentioned in his opening remarks, the House has voted that the evidence that has been brought to light about slave labour in the People’s Republic of China amounts to evidence of a genocide. There is some debate in wider terms around that issue, but the genocide convention bypasses that point and that debate about definition by saying that even when there is just a suspicion that there could be some form of genocide, Governments who are signatories to that convention ought to take action. Consequently, I am pleased that following the passage of the Health and Care Act 2022, there has been some movement by the Government.

I urge the Minister to respond to the points that have been made in this debate, to clarify the position today; the 2022 Act completed its passage only a short time ago. What cross-departmental work is being undertaken to apply the guidelines that we have discussed across other Government procurement practices? What guidelines have been issued to local government, for example? The average local authority in inner London has a £1 billion turnover. Other large purchasing units at Government level also ought to be aware of the duty to prevent potential human slavery or potential genocide. What discussions has she had with the trade union movement to ensure that its views, expertise and research are integral to the formation of any strategy to clean up our supply chains?

--- Later in debate ---

[Maria Caulfield]

Absolutely. We have secondary legislation coming forward that will enact what was agreed in the Health and Care Act 2022, which will look at some of this issue. The Procurement Bill is also passing through the House of Lords and will come to our Chamber. It will look at procurement more generally, not just NHS procurement. If he and other hon. Members with a keen interest in the subject, such as my hon. Friend the Member for Congleton, have specific questions on NHS procurement, I am happy for them to write to me and we shall see whether we can look at them as part of scrutiny of the Bill as it progresses. He is right that we want to ensure that we are learning lessons and sharing best practice across the board. I cannot speak for other Departments, but we are keen to get that right for the NHS where possible.

We are taking steps to achieve greater supply chain visibility, particularly where risks are highest, with the recognition that workers in the lower tiers of supply chains are often the most vulnerable. In line with that, we ensure that all contracts placed by the Department adhere to standard terms and conditions that include clauses requiring good industry practice to ensure that there is no slavery or human trafficking in supply chains.

Suppliers appointed to NHS supply chain frameworks must also comply with those standards or they can be removed from consideration for future opportunities. All the suppliers of PPE frameworks let in conjunction with the Department were registered and required to complete a modern slavery assessment and a labour standards assessment. Our purchase process includes safeguards to strengthen due diligence and to terminate a contract should there be substantiated allegations against a provider.

We are not content to rest on the status quo, which is why the Health and Care Act contained a regulation-making power that will come into force, designed to eradicate the use in the NHS of goods or services tainted by slavery or human trafficking. The regulations will set out the steps that the NHS should be taking to assess the level of risk associated with individual suppliers and the basis on which it should exclude them from a tendering process. Those regulations will help to ensure that the NHS, the biggest public procurer in the country, is not buying or using any goods or services produced by or involving any kind of slave labour. It represents a significant step forward in our mission to crack down on the evils of modern slavery wherever they are found. We are grateful to the work of modern slavery campaigners, who hailed the regulations as

“the most significant development in supply chain regulation since the Modern Slavery Act 2015”.

Alongside those regulations, the Health and Care Act also requires the Secretary of State to carry out a review into the risk of slavery and human trafficking taking place in NHS supply chains and to lay before Parliament a report on its outcomes. That review will focus on NHS supply chain activity, as well as supporting the NHS to identify and mitigate risks with a view to resolving issues. The review and the regulations will send a clear signal to suppliers that the NHS will not tolerate human rights abuses in its supply chain; they will create significant incentives for suppliers to review their practices; and they will block, if necessary, any suppliers that are found to be using human trafficking or slave labour.

I was moved to hear the cases of the Uyghurs that the hon. Member for Strangford raised. He is right that that goes far beyond the NHS, which is why the Procurement Bill, currently passing through the other place, is an important piece of legislation. I am sure that he and other hon. Members, such as my hon. Friends the Members for Wealden (Ms Ghani) and for Congleton, and my right hon. Friend the Member for Chingford and Woodford Green (Sir Iain Duncan Smith), who are assiduous campaigners on the issue, will take a keen interest in that.

I conclude by thanking all hon. Members for their contributions. Modern day slavery is a deplorable practice that causes irreversible harm to those affected. We all have a responsibility to call it out. As a Department, we take it extremely seriously. I hope that, by sharing what is happening, I have given hon. Members confidence that we will do all we can to root it out and take out of our supply chains any affected pieces of equipment.

[Catherine West]

The Minister is being generous; I recognise that she is speaking from a health perspective. Will she undertake to write to hon. Members present about the Government’s progress on cross-departmental best practice sharing from her Department?

[Maria Caulfield]

I am very happy to do that. While I have been able to highlight what the NHS is doing, some good cross-departmental work is also being done on procurement and on identifying where slavery is happening both globally and domestically. I highlighted the evidence from Mo Farah this week. We must not take it for granted that slavery is not happening in this country. I am happy to write to the shadow Minister and those who have taken part in the debate to highlight the work that is happening across the Government. It has to be a cross-Government initiative to make sure that we are all working together to root this out. Much remains to be done to ensure that we deliver the message that modern day slavery is completely unacceptable. I look forward to working with MPs across the House to make sure that we all do our bit.

Access to GP Services and NHS Dentistry

Catherine West Excerpts

Tuesday 21st June 2022 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

I beg to move,

That this House notes that primary care is in crisis, with people across the country struggling to access GP services and dental treatment; believes that everyone should be able to get an appointment to see a doctor when they need to and has the right to receive dental treatment when they need it; is concerned by the Government’s failure to remain on track to deliver 6,000 additional GPs by 2024-25; and therefore calls on the Secretary of State for Health and Social Care to urgently bring forward a plan to fix the crisis in primary care, meet the Government’s GP target and ensure everyone who needs an NHS dentist can access one.

Mr Speaker, thank you for the opportunity to open this debate on the future of primary care, access to GPs and access to dentists. It is a particular delight to see the Secretary of State here. I so enjoyed our exchange of letters last week that I cannot wait to repeat the exchange in real life.

Primary care is the front door to our NHS—for most of us, the general practitioner is the first port of call when we are worried about our health—but after 12 years of Conservative mismanagement and underfunding of our health service, the front door is jammed. Patients are finding it impossible to book GP appointments, serious conditions are going undiagnosed, patients are waiting longer than is safe for treatment, with backlogs building up and greater pressure placed on the rest of the health service, and millions of people are waiting more than a month to be seen, often in pain and discomfort.

[Catherine West (Hornsey and Wood Green) (Lab)]

My hon. Friend has made an excellent beginning to his speech. What is his view of my local hospital, where, instead of 350 people daily, we have 710 people coming into accident and emergency at the North Middlesex Hospital? What response does he have to that kind of demand? Where is it going to lead if people cannot see a GP? They are going to end up in A&E.

[Wes Streeting]

My hon. Friend is absolutely right to highlight that problem. If the front door of the NHS in primary care is jammed, people end up presenting in A&E. As I shall outline in my speech, this is not only a great inconvenience and burden to patients; it comes at an additional cost to the NHS and we all pay the price for that in every respect.

--- Later in debate ---

[Sajid Javid]

I will take some interventions in a moment.

The hon. Gentleman has had every opportunity to do the right thing, to put patients first and to condemn these unjustified and reckless transport strikes, yet at every turn he has chosen to back his union paymasters.

[Catherine West]

rose—

[Sajid Javid]

I hope the hon. Lady will condemn the strikes.

[Catherine West]

The Secretary of State speaks about opportunities. In this House, we had a number of opportunities to get workforce reform, workforce numbers and a plan for our health service into the Health and Care Act 2022. Why did he miss those opportunities?

[Sajid Javid]

We are seeing record investment in the workforce, and we are seeing record increases. For the first time ever, the NHS is also coming up with a 15-year long-term workforce strategy, which I hope the hon. Lady welcomes.

The Government have always been on the side of patients and the people who care for them. I pay tribute to everyone working in primary care and dentistry for the difference they make day in, day out to their patients’ lives. I know that the pandemic has brought some unimaginable pressures, and equally I know that many of those pressures have not gone away now we are living with covid.

The hon. Member for Ilford North talks as though he does not know where the pressures have come from—as though he has had his head under a rock for two years. The NHS has said it believes that between 11 million and 13 million people stayed away from the NHS, including their GPs and dentists. Rightly, many of those people are now coming forward for the treatment they need—and I want them to come forward.

Future of the NHS

Catherine West Excerpts

Monday 31st January 2022 Westminster Hall

[Catherine West (Hornsey and Wood Green) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Gray. I am proud that so many of my constituents in Hornsey and Wood Green signed this important petition about funding for the national health service, and about keeping it in the public sector.

There is no doubt that the national health service is the most popular public service in my constituency, but there is a basic lack of staff, whether we are talking about primary care, GPs and other practice staff—they always seem to be looking for more staff—the 40,000 nurses of whom we are in desperate need nationally, or the thousands more doctors who are needed. Compared to other European countries, we simply do not have the correct ratio of patients to doctors. For example, in psychiatry there are increasing numbers of patients, particularly following the stresses and strains of coronavirus, waiting days and days in a hospital bed to see a consultant. I heard a story this week about a patient who waited 10 days to be seen during doctors’ rounds. That is a very long time to use a bed without getting the correct medical attention.

Many Members have mentioned the insufficient funding for dentistry. Sadly, my constituency of Hornsey and Wood Green, and the London Borough of Haringey, has some of the worst rates of caries in children’s teeth in Europe.

As my hon. Friend the Member for Wansbeck (Ian Lavery) said, 77% of NHS staff believe that they are worse off this year than last year. We know that they are working in excess of their hours, and that since 2010, hourly pay has been frozen or increased by a tiny increment. That does nothing to help staff cope with the challenges of the Tory-driven cost-of-living crisis, be it domestic fuel bills, the cost of food, children’s clothing, basic travel to work, or petrol to drive to work.

The Health and Social Care Levy Act 2021 has recently passed through Parliament. Social care is crucial to fix bottlenecks in the health service. We need a properly funded care system in which the hourly rate is correct in the light of the needs of the people working in it, and we need better overall management to get people into the right sort of care as quickly as possible, so that we can free up the national health service to look after people coming into hospitals through accident and emergency. That is a basic point that every Member in Westminster Hall has made on a number of occasions, but it still seems as if this Government are sitting on their hands and failing to address the crucial question of how we get the flow through the system. The problem also comes down to the terrible cuts to local government. If local government was adequately funded, we would have a much better, more proportionate system. I will stop there, Mr Gray, as other Members wish to contribute.

--- Later in debate ---

[Kim Johnson (Liverpool, Riverside) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Gray. The future of the NHS hangs in the balance, and the petition is entirely correct in calling on the Government to renationalise the NHS, scrap integrated care systems and end private finance contracts.

The Health and Care Bill threatens to open the floodgates to further privatisation by implementing a healthcare model that incentivises cuts and closures and rations funding to health boards while welcoming private profit-driven companies such as Virgin and Serco on to the boards of integrated care systems, giving them a say on where NHS money gets spent. The new legislation will further dilute the voice of patients and the public, with the new boards covering populations of up to 3 million people that will be remote and centralised, with no obligation to be open, transparent or accountable to ordinary people.

[Catherine West]

My hon. Friend is making an excellent speech. Does she agree that if we have that lack of transparency we might see a repetition of the Government’s wasting £4 billion during covid? There is a fear about related-party transactions, where people know exactly where the money is going—into their pockets.

[Kim Johnson]

I fully support what my hon. Friend says. The boards will be remote and centralised and will seriously restrict the power of local authorities to protect local services. With these changes, private healthcare giants will not only have a bigger say over the NHS but will be granted contracts with even less scrutiny than now.

By opening the door to private healthcare providers to take decisions on NHS budgets and services, the Bill makes it easier for public health contracts to be distributed to private providers, with less transparency and accountability. Safeguards in the Public Contracts Regulations 2015 will be excluded, watering down protections for employment and environmental provisions in procurement processes. There is no doubt that the Bill will put on steroids the cronyism we have seen during the pandemic while our NHS heroes have worked day and night, putting their lives on the line. The Government have cut real pay for nurses while handing out billions of pounds of contracts through an illegal VIP system to their mates and donors and to the failed track and trace system.

The NHS is the jewel in the crown of our public services—our proudest achievement. However, 12 years of Tory austerity, and now the pressures of the pandemic, have stripped it to the bone. An unbelievable £100 billion has gone to private healthcare providers in the last decade alone. The last thing the NHS needs right now is a dangerous overhaul that puts the private sector at its heart. We must take this and every opportunity to support amendments to the Bill that establish the NHS as the default option for all NHS contracts, to mitigate the worst parts of it. We must stand up to these new attacks or risk losing the NHS to privatisation by stealth. We must go further in our demands to roll back the damage done, reinstating the NHS as a truly national service and establishing a fully integrated national care service with staff and patients at its heart.

--- Later in debate ---

[Edward Argar]

As the hon. Lady will know, the former chief executive of the NHS, Lord Stephens, was clearing in saying that the

“overwhelming majority of these proposals are changes that the health service has asked for.”

We should do the right thing by them and by patients. It is the right time for the Bill: it is the right prescription at the right time.

The substance of the petition, which has framed many speeches by hon. Members today, calls for the Government to renationalise the NHS. I have to say that it has never been denationalised. The NHS is and always will be free at the point of use. The Government are committed to safeguarding the principles on which the NHS was created. The hon. Member for Denton and Reddish set that out very clearly. We have no plans for privatisation.

[Catherine West]

Will the Minister give way?

[Edward Argar]

I will make a little progress; if I have time, I will give way to the hon. Lady, with whom I sat on a committee of London councils when we were looking at social care reform way back in 2010.

We all recognise the importance of preserving this great national asset for the future and ensuring that the NHS remains comprehensive and free at the point of use, regardless of income, on the basis of need. The Government remain steadfast in their commitment that the NHS is not, and never will be, for sale to the private sector.

We are determined to embrace innovation and potential where we find it, but that is different from many of the accusations in the speeches we have heard today. I know it is tempting to scaremonger and set out accusations about what this Act does, even when people know better, as I know hon. Members do, but that reflects scaremongering rather than reality. There has always been an element of private provision in healthcare services in this country. Labour Members should know that because, as the Nuffield Trust said in 2019,

“the available evidence suggests the increase”—

in private provision—

“originally began under Labour governments before 2010”.

[Catherine West]

Will the Minister give way?

[Edward Argar]

I will just finish this point and then give way to the hon. Lady. The hon. Member for Liverpool, West Derby (Ian Byrne) made the point, which the hon. Member for Middlesbrough touched on as well, that it is important to look at the extent of the involvement of private sector providers, which accelerated when the Labour party was in power. The hon. Member for Liverpool, West Derby talked about the 2012 legislation and “any qualified provider”, but that was not brought in by the 2012 legislation; it was brought in by the Gordon Brown Government in 2009-10, under the term “any willing provider.” The name was changed, but nothing substantive changed from what the Labour Government had introduced in terms of the ability to compete for contracts.

[Edward Argar]

One more sentence and I will give way to the hon. Member for Hornsey and Wood Green (Catherine West); then I will try to bring in the hon. Gentleman.

One of the key changes allowing private sector organisations to compete for and run frontline health services came in 2004, again under a Labour Government, when the tendering for provision of out-of-hours services by private companies was allowed.

[Catherine West]

The Minister is being very gracious. How is the Act going to ensure that there is no conflict of interest between private providers who sit on integrated care boards and who then provide services? Are we going to end up with another Randox scandal?

Oral Answers to Questions

Catherine West Excerpts

Tuesday 18th January 2022 Commons Chamber

[Maggie Throup]

I reassure the hon. Gentleman that we are talking about patient safety. He is quite right that it is important to have that dialogue, and I know that colleagues across the board in the NHS are having that. It is interesting to note that more than 94% of NHS staff have already had their vaccine, and I commend them for that. As the chief medical officer Chris Whitty rightly said, those looking after other people who are very vulnerable have a “professional responsibility” to get vaccinated.

[Catherine West (Hornsey and Wood Green) (Lab)]

Access to vaccinations in remote areas is incredibly important, but so is a general health strategy for clinically very vulnerable people. Young Lara in my constituency had the organ that she desperately needed for a double organ transplant, but unfortunately there was no bed in intensive care for her to have the operation. What strategy is the Department taking in general for our clinically vulnerable to provide access to operating theatres so that there is a focus not just on vaccination but on the multiple health conditions that so many of them suffer across the board?

Sickle Cell Treatment

Catherine West Excerpts

Wednesday 8th December 2021 Westminster Hall

[Mr Pat McFadden (Wolverhampton South East) (Lab)]

I beg to move,

That this House has considered the treatment of sickle cell.

Thank you for chairing our proceedings, Mrs Miller. I am very pleased to open this debate. I chair the sickle cell and thalassaemia all-party parliamentary group, which works for a better understanding of sickle cell and better treatment for those living with the condition. I am enormously grateful to all hon. Members who have supported the APPG’s work, including our late colleague Sir David Amess, who was one of our officers. I am also grateful to the Sickle Cell Society, which provides the secretariat function for the APPG. I also thank Parliament’s digital engagement unit, and the hundreds of individuals from around the country who have emailed me in advance of today’s debate.

The focus of our debate is the APPG’s recent report, “No one’s listening”, which has a number of findings and recommendations in relation to the care of people with sickle cell. The trigger for our report was the tragic and avoidable death of Evan Nathan Smith in North Middlesex University Hospital in 2019. The coroner’s report into Evan’s death, published in April of this year, found that he would not have died if medical staff had recognised his symptoms and treated him sooner. The report pointed to a

“lack of understanding of sickle cell disease in the medical and nursing staff looking after Mr Smith”

and

“a failure to appreciate the significance of those symptoms by those looking after Mr Smith at the time.”

Evan Smith was just 21 years old; he had his whole life in front of him. His death is not the only one in which a lack of understanding of sickle cell and mistakes in treatment have been contributory causes.

[Catherine West (Hornsey and Wood Green) (Lab)]

I thank my right hon. Friend, my hon. Friend the Member for Edmonton (Kate Osamor) and all the other Members who have done a lot on this topic in the House. Despite this being a long-running disease, we have not paid enough attention to it at an institutional level, be that in primary or secondary care. That needs urgent redress.

--- Later in debate ---

[Mr McFadden]

My hon. Friend makes some very strong points, and I will discuss some of them, including the question of race.

Since the report’s publication, I have continued to receive emails from sickle cell patients all around the country that confirm the report’s findings, and I want to put on the record my gratitude to each and every person who has taken the trouble to write to me, whether it was just after the report was published or in advance of today’s debate.

Let me set out the main findings of the report for the House. Let us begin with a positive: we found a good level of trust among sickle cell patients in the specialist haematology departments of hospitals that look after them on a long-term basis. We found clinicians passionately committed to better treatment and honest enough to tell us when that good treatment was not there. We found that where there is a good level of understanding and knowledge, sickle cell patients are generally well treated and well looked after, but we also found a huge gulf between the good level of confidence and trust in the specialist parts of the system, and treatment in the more generalised parts of the system—specifically A&E and general wards.

Our key findings include the unacceptable variability of treatment, depending on where someone lives or who happens to be on duty at the time; patients having to battle for the pain relief to which they are entitled; and protocols on pain relief—for example, that it be administered within 30 minutes of arrival—being regularly and repeatedly ignored or not being implemented. Witnesses told us of waiting for hours in excruciating pain. Some clinicians spoke of adherence to the pain relief guidelines within their hospital being as low as just 20% or 30%. There is a lack of compliance with care plans that have been agreed for individual patients, including with the hospital where a patient has turned up, and people have been told, “That doesn’t apply here.”

We found a dangerous lack of communication between the general and specialist parts of the system. In Evan Smith’s case, he had been in the hospital for over two days before the haematology unit even knew he had been admitted. That finding was described as “shocking” by one haematologist who gave evidence to the group. Such delays can contribute to mistakes, with the most terrible consequences. As well as deaths, we heard about a number of near misses where care had gone badly wrong and the patient had still survived.

There is a lack of awareness of the condition and a lack of understanding about how to respond to a sickle cell crisis among some NHS staff. Everyone in the healthcare system knows the key symptoms of a heart attack or a stroke, and how to respond to them. With sickle cell, however, the patient experience is often one of being caught in a perpetual loop of trying to teach staff about what is happening to them and what treatment they need, often at the time that they are experiencing excruciating pain.

[Catherine West]

I thank my right hon. Friend for giving way a second time; he is being very generous. Does he agree that that lack of awareness goes all the way through to the research community, whereby sickle cell is one of the most under-researched diseases, despite the fact that research into it has many different and interesting applications through its links to malaria and all sorts of other diseases, and that there is simply not enough research funding going into understanding this disease?

[Mr McFadden]

I very much agree with my hon. Friend. Indeed, the next finding that I was going to cite is a lack of research and innovation in treatment. There has only been one new drug approved in the UK for sickle cell treatment in decades and it was approved just before our report was published.

For each of the findings, we made recommendations: about training; about compliance with clinical guidelines; about reviews of sickle cell treatment in secondary care; about communications change; very importantly, about a stronger voice for patients in all of this; and in many other areas, too.

Underlying all those individual findings and recommendations are some key overarching themes. First of all, the experiences that I have described have contributed to a damaging loss of trust among sickle cell patients in the system that is there to help them. Some patients told us that they avoided going to hospital at all costs, no matter how serious their crisis, because they found the whole experience so exhausting and debilitating, or, as one woman put it,

“to avoid the mental strain of another battle...when she does not have the energy to advocate for herself”.

It cannot be right that people who need help have so little trust that they do not seek that help from the very system of care that is supposed to be there for them.

Secondly, there is the unavoidable question of race. Sickle cell is a condition that predominantly, but not exclusively, affects black people. Many patients told us of being treated with suspicion when they sought treatment, being regarded as troublesome by staff, being thought of as drug-seekers, and encountering negative and sometimes even hostile attitudes.

The principle of racial equality in healthcare is fundamental. No one is seeking to put one group of people above another, but we want to see equality in healthcare treatment and right now with sickle cell we do not have that. That situation is completely unacceptable and, following this report, it must be addressed.

Thirdly, the findings that we cite in our report are not new; these things have been happening for a long, long time. They have been raised time and again, and the fact that this situation is continuing has led to a great deal of anger and frustration among those living with sickle cell and their families.

Yet, even though all of those things are true, this might—just might—be a moment of opportunity. Why do I say that? Soon after the Secretary of State for Health and Social Care was appointed, he spoke about the “disease of disparity” and about how the covid pandemic had exposed a number of long-standing health inequalities, including racial ones. I welcome the Secretary of State’s commitment to address these inequalities and his warm welcome for our report on the day it was published. Perhaps this is a moment when we are more aware of health inequalities than we would have been before the pandemic; maybe this period can be a turning point for change.

There is no need for this to be a partisan issue. No one is pretending that the findings in our report only began in recent years or under one Government. These things have been there for a long time. However, perhaps the experience of the pandemic will give us a new-found resolve; maybe it will mean that this time people listen.

From the Secretary of State and the Department to the NHS in every part of the United Kingdom, we want this report to mark a moment of change in the treatment of sickle cell. We want to ensure that the issues raised in the report are addressed once and for all, and that training is improved so that staff throughout the system understand, and have a knowledge of, the condition. We want to ensure that care plans and pain relief protocols are adhered to by both the generalist and the specialist parts of the system. We want to step up research and innovation in treatment and restore trust among sickle cell patients. Most of all, we want to ensure that there is equal health treatment for everyone, regardless of the colour of their skin. That is not too much to ask for, but we do not have it at present.

Today I appeal to the Minister, the Secretary of State, my own Front-Bench team and the other parties represented here to become our allies in this and to work with us. Please do not let this be a missed opportunity. Let us collectively resolve that we will not have me, or another chair of the APPG, standing here in a few years’ time making exactly the same points as I am making today. Let us make sure that this time people do listen, that we act on these long-standing failures in the care of people with sickle cell and that we improve healthcare for people with this condition once and for all.

Covid-19 Update

Catherine West Excerpts

Monday 29th November 2021 Commons Chamber

[Sajid Javid]

If my right hon. Friend is suggesting that there are mixed views on the efficacy of face coverings in helping to fight the pandemic he would be right, but I would point him to UK work by Public Health England—published, if I remember correctly, last month—referring to a number of reports setting out how in certain settings face coverings could help.

[Catherine West (Hornsey and Wood Green) (Lab)]

What urgent action is being taken to vaccinate people who are bed-bound?

[Sajid Javid]

For those who are bed-bound, home-bound or vulnerable for other reasons and who cannot make it to vaccination centres, vaccinations are primarily carried out by GPs. I do not have the numbers of how many have been done, but recently to encourage more people to be vaccinated more quickly we changed the GP payment system, which seems to have helped as well.