A Plan for the NHS and Social Care

Chris Bryant Excerpts

Wednesday 19th May 2021 Commons Chamber

[Madam Deputy Speaker (Dame Eleanor Laing)]

I inform the House that Mr Speaker has selected the amendment in the name of the Leader of the Opposition, which will be moved at the start of the debate, and amendments (j) and (g), which will be moved at the end.

[Chris Bryant (Rhondda) (Lab)]

Not amendment (e)?

[Madam Deputy Speaker]

No. I can assure the hon. Gentleman that his amendment was not selected.

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

I beg to move an amendment, at the end of the Question to add:

“but respectfully regret that the Government has provided insufficient information for its proposals properly to be scrutinised; and therefore beg leave that she will be graciously pleased to give directions that the following papers be laid before Parliament: the DHSC internal review of their operation during the pandemic as referenced by the Prime Minister’s official spokesman on 12 May.”

May I take this opportunity to note that although amendment (e) in the name of my hon. Friend the Member for Rhondda (Chris Bryant) has not been selected, its contents, which relate to brain injury, are important and welcome? I hope that Ministers take on board its recommendations.

[Chris Bryant]

It is all too tempting to intervene; I have never objected to temptation. On brain injury, I just want to say that I really want us to think about legislation now. The United States of America has made dramatic changes—it has introduced legislation four times now—and I think it is time we went down that route.

[Jonathan Ashworth]

I completely agree. I hope that Ministers on the Treasury Bench have listened carefully. If they are prepared to bring forward legislation, we would work constructively across the House to ensure its speedy passage. May I thank my hon. Friend for the reference in his amendment to the impact of alcohol abuse on children? He knows that it is a subject very close to my heart; on behalf of the children of alcoholics community, I am grateful that he referred to it in his amendment.

Although we have often said this in the House, I still think that the whole House will want to remember today the 127,691 people so far who have lost their lives to covid-19, this awful disease, including the 850 health and care workers. Although repeating the numbers has become almost routine in this House, that does not make the scale or gravity of the loss any less shocking. We grieve as a nation and we all pay tribute to our healthcare workers, our social care workers and our public sector workers.

I am sure that the whole House will want to dedicate itself in good faith to learning lessons for the future. Sadly, we are in an era when, according to the experts, pandemics are becoming more predictable and will become more regular because of climate change and biodiversity loss, so learning lessons is about preparing better for the future rather than settling scores.

We know that the B1617.2 variant is spreading. From the data that I have seen, it appears to have a growth rate advantage of about 13% over the B1117 variant. It could well become the dominant strain in the United Kingdom. Although vaccination should mean that many are much safer and ought to avoid hospitalisation, the Government still have a responsibility to do all they can to contain its spread, minimise sickness and ensure that the 21 June target is not disrupted, if at all possible.

That is why I said on Monday that we need more surge vaccination in hotspot areas. We know that with vaccination there are always pockets where rates are lower than necessary, and we need to drive those rates that up. We have seen that throughout history—with measles, for example. So we urge the Government again to do all they can to drive up vaccination rates in Bolton, Bedford, Blackburn and other areas where we know there is an issue. We also need the Government to do more to contain the virus through test, trace and isolate. We need more surge testing. We need more enhanced contact tracing locally, with local authorities given the resources to carry it out. We need sick pay and isolation support fixed as well.

For those who are going in to work, or for those who are now socialising in premises, those buildings and premises need proper air filtration systems. There are experts now who can easily fix filtration systems in buildings to make them much more covid secure, and we should be inspecting workplaces in all these areas to ensure that every workplace is covid secure.

We need transparency in decision making as well. For the first time in my life, I think, I find myself agreeing with Mr Dominic Cummings. I know the Secretary of State does not often agree with Mr Dominic Cummings, but I find myself agreeing with Mr Dominic Cummings, who tweeted yesterday:

“With something as critical as variants escaping vaccines, there is *no* justification for secrecy, public interest unarguably is *open scrutiny of the plans*”.

Mr Cummings, on this occasion, is correct. [Interruption.] A wry laugh from the Secretary of State. Mr Cummings may well have been saying something different when he was in government; I do not know, but at least his public statement yesterday is correct. That is why our amendment calls for the publication of a Government lessons-learned review; not so that we can try to undermine the Government or find some hole to use across the Dispatch Box, but so that we can learn the lessons in our efforts to contain variants, and ensure that we are better prepared for the future. I hope the Secretary of State looks sympathetically upon that request, and perhaps joins us in the Division Lobby this evening.

I now turn to the contents of the Gracious Speech more generally. This should have been the Queen’s Speech that unveiled a new NHS plan to bring down the elective waiting list, which now stands at 5 million. This should have been a Queen’s Speech that outlined proposals to tackle the backlog of 436,000 people waiting over 12 months for treatment—many of them waiting in pain and anxiety, many of them facing permanent disability as a consequence of those waits.

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[The Secretary of State for Health and Social Care (Matt Hancock)]

I start by thanking the right hon. Member for Leicester South (Jonathan Ashworth) for his comradely advice, and I just correct the record because, thanks to his steadfast support for the Government’s action through the pandemic and the very grown-up approach he takes to these exchanges, Her Majesty the Queen was pleased to invite him to join the Privy Council, which we on the Government Benches welcome.

I am grateful to the right hon. Gentleman for describing the bond that has grown between us. It is true that, even while challenging each other from time to time in times of pandemic, sometimes relationships are strengthened in the heat of responding to something so serious. That is absolutely true. I think he is a wonderful man. I know that occasionally he has to criticise, because he has to please his Back Benchers, but I know he does not really mean it.

Throughout these great challenges and these difficult months, we have protected the NHS and protected and supported the amazing people who work in it, and we are determined to give the NHS all it needs as we emerge from this pandemic. The Queen’s Speech underlines that commitment, first, with a total focus on beating covid through our unprecedented vaccination programme, and then through an ambitious programme of support for our whole health and care system to tackle the backlogs caused by the pandemic, which the right hon. Gentleman rightly described, and a health and care Bill to set the NHS fair for the future—a Bill whose ideas and central propositions come from the NHS itself—alongside social care reforms to tackle injustices that have remained for far too long, public health reforms to learn the lessons of the pandemic and to promote the health of the nation, mental health reforms to bring that legislation into the 21st century and digital health reforms to harness all the opportunities that modern technology provides. That is our mission, a mission to ensure that, in support of all this, we also turn our nation into a life sciences superpower.

The last year has proved beyond measure the value of the NHS across Britain, the importance of social care and the strength of feeling that people rightly have for these cherished institutions. Our task in this Parliament is to help them further strengthen and build back better, and that is what this Queen’s Speech will allow us to do.

I turn first to the immediate task of tackling covid. With more than 70% of adults now having had a first dose and almost two fifths already double vaccinated, we have much to celebrate. Vaccination underpins our road map, which means we can now have pints in pubs and hugs in homes. Yet, as I updated the House on Monday, the race between the virus and the vaccine has got a whole lot closer. I can tell the House that 2,967 cases of covid-19 with the B1617.2 variant have now been identified. We are protecting the progress we have made and the progress that everybody has worked so hard to achieve, with the biggest surge in local resources of this pandemic so far. That means surging vaccines and testing. In the last week across Bolton and Blackburn with Darwen, we have given 26,094 jabs, as well as delivering 75,000 extra tests.

But this challenge is not restricted to Bolton and Blackburn. We have used the extensive biosecurity surveillance system that we have built and new techniques to identify the areas we are most concerned about, where we will now surge testing and vaccinations further. We, of course, look at the data on cases, variants and hospitalisations, all of which we publish, but we are now able to use further tools. Mobility data shows how often people travel from one area to another, and we look at that in deciding where the virus is likely to spread. We now analyse waste water in 70% of the country, and we can spot the virus and the variants in the water to identify communities where there is spread.

As a result of all that analysis, I can tell the House that we will now surge testing and vaccinations in Bedford, Burnley, Hounslow, Kirklees, Leicester and North Tyneside, and we are supporting the Scottish Government, who are taking similar action in Glasgow and Moray. In practice, this means that we are putting in place more testing and more testing sites, and we are making more vaccinations available to everyone who is eligible. We are not yet opening up vaccinations to those who are 35 and younger, because across the whole country, the message is crystal clear. This episode shows just how important it is that every single person who is vulnerable to covid-19 gets not just one but two doses, because the vaccine offers the best possible protection against this disease.

Turning to our programme for the future, we must learn from the success of this vaccine roll-out, which shows how we can deliver huge projects with huge flexibility at huge pace. We must apply these lessons to how we tackle the backlog, and I want to set out clearly to the House the sheer scale of the challenge left by the pandemic. I agree very much with the analysis that the right hon. Member for Leicester South set out in respect of the scale of the challenge.

We now have 4.7 million people in England waiting for care and more in Scotland, Wales and Northern Ireland. Before the pandemic, we had succeeded in getting the 12-month waiting list down from 18,700 in 2010 to just 1,600 in the months leading up to the pandemic. Now, 380,000 have waited more than a year for care, but these figures do not yet include the returning demand of those people who have a problem but have not yet come forward during the pandemic, often because they have been trying to reduce the burden on the NHS, but are now rightly regaining the confidence to approach the NHS. So the real waiting list is far larger than those figures, and as people re-present with problems that they might not have wanted to bother the NHS with in the past year, we will see the waiting lists go up.

We know that, during the pandemic, 6.9 million fewer patients were added to the waiting list for diagnosis and treatment. The scale of the pent-up demand that will come forward is unknowable, but to give the House a sense of the scale of the challenge, since the start of the pandemic, the NHS performed 70% fewer electives than in a normal year. Some of those will have been resolved without the need for hospital treatment, and that is fine, but some will return. We do not yet know how many will present themselves and add to the waiting lists, but we do know that the NHS needs to operate at a scale never seen before across the whole United Kingdom to clear the backlog, so we are working hard to support the NHS to accelerate the recovery of services.

[Chris Bryant]

The Secretary of State will know that people with traumatic brain injury might well have been treated because they have been in a car crash or something like that over the last year, but then the ongoing neurorehabilitation simply will not have been made available to them. On top of that, we have a new set of people who have neurocognitive problems because of covid. May I urge him to think of putting a single person in charge of the whole sphere of neurorehabilitation and brain injury, to try to get this back on course?

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[Matt Hancock]

My hon. Friend has enormous expertise and wisdom in this area. He is right to make the argument that we need to support everybody’s mental wellbeing, but that we also need a specific focus on very serious mental ill health, much of which has been, in many cases, exacerbated by the privations that have been necessary during the pandemic. He says that this is a process that happens once every 20 years, but it is almost 40 years since we had a new mental health Act. We want to do this with stakeholders on a consensual basis—I am very glad to hear the reiteration of cross-party support just now from the right hon. Member for Leicester South. Our goal is to bring forward a draft Bill in this Session and a Bill potentially in the next Session, so that we ensure it is legislated for during this Parliament. That is a timetable on which we have worked with the many experts who have informed the process, led by Sir Simon Wessley, of course, whose report sparked off this work. I look forward to working on that with him and the Minister with responsibility for mental health, my hon. Friend the Member for Mid Bedfordshire (Ms Dorries).

[Chris Bryant]

I think the Secretary of State just said that we have not had a mental health Act for 40 years, but I remember sitting on the Public Bill Committee for the Mental Health Act 2007. I know that everybody is against lobbying, but my experience as a member of that Committee was that the lobbyists from the mental health charities, the British Medical Association and the pharmaceutical companies were absolutely invaluable in ensuring that we got the legislation right. Will he make sure that is available again this time?

[Matt Hancock]

Yes, I am absolutely happy to stress that point. This is a consensual process taking into account all the expertise from those who rightly want to influence. The hon. Gentleman almost made a joke about lobbying. The truth is that listening to people who have an expertise and an interest is absolutely critical to getting such a sensitive piece of legislation right. The legislation that this will replace was introduced in the early ’80s, so it is essentially 40 years old. There have been some updates, but there are still some extraordinarily antiquated things in our current mental health legislation. For instance, if someone does not declare then it is automatically assumed, if they are unmarried, that their father should take decisions on their behalf, rather than them choosing who might take those decisions—not their mother and not just one of their parents, but their father. That is just one example of the antiquated practices in this area that we need to address.

Finally, turning to our digital reforms, the pandemic has shown that one of the greatest allies we have in our battle for the nation’s health is data and technology. Digital health has truly come of age over the past year. There is no doubt about it: data saves lives. As we reshape health and social care, we will do it underpinned by a modern data platform, so we can get the most out of this powerful new technology. I am glad, again, that this is an area of cross-party consensus. Telemedicine has taken off. The NHS covid-19 app has been downloaded almost 24 million times and the wider NHS app, on which we can now demonstrate our vaccine status, was downloaded more times on Monday this week than on any previous day. If Members have not downloaded it yet, I recommend that they do. They can see their medical records and show somebody when you had the jab. NHSX committed to delivering the app by the ambitious schedule of 17 May, and it delivered. I am grateful to everybody who worked on this incredibly important project. The lesson of our data-driven vaccine roll-out must be applied everywhere. As citizens, we value the ability to see our data—after all, it is about us and it effectively belongs to us—and we want to see it used to drive better decisions, better research, better treatment and better support for colleagues on the frontline.

My view is that for years the health system has shied away from the modern use of data, and struggled on with paper forms, fax machines and clunky systems that do not talk to each other—but no longer. The pandemic has proved without doubt the incredible value to patients and clinicians alike of the modern use of data. Because of the gift of a universal NHS, we have the opportunity to have the best data-driven healthcare in the world, and I am determined that we seize it. Our health and care Bill and our new data strategy will drive a whole new approach to unleash that potential.

In addition to all those changes, we must, throughout, support all those who improve our health, including those in our life sciences and those who work in the NHS. Last week, I attended with colleagues a service to commemorate the life of Florence Nightingale. In his bidding, the Dean of Westminster reminded us that in Florence Nightingale, compassion and care had the power to deliver not just healing, but change. That must be our mission too: not just to heal, but to change. I am proud to be a member of a Government who deliver on our commitments. We delivered on our commitment to Brexit. We delivered on our commitment to protect the NHS. We are delivering on our commitment to vaccinate all. This Queen’s Speech is a commitment for healing and for change, for a United Kingdom that is stronger, healthier and more prosperous together, and I commend it to the House.

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[Chris Bryant (Rhondda) (Lab)]

Alison was 68 when she fell down a long flight of stairs and hit her head. She was bright as a button until that moment but the damage has left her feeling befuddled and trapped.

Heather was seven when she was hit by a car as she turned a corner on her scooter. Thank goodness she survived, but she suffered a terrible blow to the head. She is now 13 and she still struggles to concentrate.

Gareth played rugby from the age of 10 until he retired as a professional rugby player in his 30s. He took blow after blow to his head in the game and was repeatedly concussed, and kept on going back on the pitch. He now suffers from panic attacks, depression and anxiety. He thinks of taking his life every day. He fears dementia.

Rhys is in his 80s. He gets terribly confused and forgetful. He half-remembers that he has been diagnosed with dementia, but sometimes, paranoia sets in and he gets very angry with those who are looking after him.

Kate is 19. She was in a car with three friends when another car suddenly appeared on the wrong side of the road and crashed into them. The ensuing crash left her paralysed from the neck down and with significant cognitive impairment. She feels completely trapped.

Mark is now 19 and lives on his own. He finds it difficult to control his emotions and perform normal executive functions such as turning up on time. His doctor thinks that that is because the boiler in his childhood home was pumping out carbon monoxide for years without being spotted.

Richard and Jane adopted Kia when she was three months old. She suffers from foetal alcohol spectrum disorder.

Nick is a former fusilier in the British Army. He was caught by an improvised explosive device in Iraq, but because there was no physical sign of an injury, he was never checked for brain damage. He, too, suffers from depression, anxiety and suicidal thoughts.

Faisal had covid last year. He has never shaken it off. He suffers from terrible fatigue and brain fog all the time.

Maria is 42. She was in a horrible abusive relationship for a decade, but never dared go to the doctor when her partner smashed her head repeatedly against the kitchen worktop. She suffers from terrible paranoia and has just been sent to prison for possession of illegal drugs.

These people—I have changed their names—and the 1.4 million people like them really need legislation now. A brain injury Act would do five things. First, it would guarantee neuro-rehabilitation for all, bridging the gap between acute services and community services, which so many people miss out on. Secondly, it would put proper protocols in place on concussion in all sports, both professional and grassroots, and make them identical so that children who play more than one sport do not end up terribly confused. Thirdly, it would help to prevent brain injury by legislating on carbon monoxide poisoning and employers’ duties towards their staff, including in the British armed forces.

Fourthly, the Act would ensure research into the causes, effects and treatment of brain injury. It seems remarkable to me, as the child of an alcoholic mother and as somebody who has seen various forms of brain injury in my own family, that we still do not really understand how the mind sits inside the brain. We really need to invest much more dramatically in research in that area.

Finally, the Act would require that all public bodies, including schools, the police, Department for Work and Pensions assessors and the courts, be trained in brain injury. One thing that repeatedly comes back to me is that people know that their injury is not visible to everybody else. The strength of the internal agony that they might be suffering changes from day to day and from week to week. To banish some of the taboos in this field, it is essential that, when they deal with somebody in our public services, they know that that person fully understands. Amendment (e) has not been selected today—I never thought it would be—but I hope that one day we will have proper legislation in the field.

I end by paying enormous tribute to the people in the Rhondda who have been doing the mass vaccination programme. I have seen the work that they do every Friday afternoon when lots of people have not turned up: they are so desperate not to waste a single dose that they ring anybody they know to get them in. That is an enormous tribute to them.