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.

--- Later in debate ---

[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?

--- Later in debate ---

[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.

--- Later in debate ---

[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.

Covid-19: Government’s Publication of Contracts

Chris Bryant Excerpts

Tuesday 9th March 2021 Commons Chamber

[Edward Argar]

I am grateful to my hon. Friend. I have set out in my answers that what I think is most important for this country is that we work together— the public, private and voluntary sectors, and the Great British public—as we did, in this context. We have pulled together and done everything we can, including, as he alludes to, building that capacity for UK businesses to meet more of our need for PPE. That is a great success for those businesses and I pay tribute to them.

[Chris Bryant (Rhondda) (Lab)]

The Minister is adorable, but I am not falling for that old trick. The truth of the matter is that the Government did not even get PPE out fast enough to people who really needed it, especially in our care homes, which is why so many people died and we have the highest excess death rate of any country in the world. So I am not taking any of this nonsense about how, “We had to focus on that, which meant we could not deal with transparency.” The truth is that they set up a VIP track for some people to be able to get massive contracts, and some people enriched themselves phenomenally during this pandemic, many of whom, surprise, surprise, happen to be Conservative party donors. I have to say that it looks like corruption, and the only way the Government can wipe that slate clean is if they come clean with all the contracts. Otherwise, it just looks like a cover-up.

[Edward Argar]

I will take the hon. Gentleman’s first comment as a compliment, I think, from a colleague I know well. Having said that, I do not recognise his characterisation of what happened. He is right that challenges were faced not just in frontline NHS situations, but in social care. He is absolutely right to highlight that, and I alluded to it earlier, and that is why we increased the number of organisations that we were able to supply centrally from 226 to 58,000. That is why we massively ramped up the purchases of PPE and the stocks of PPE that were available to get to the frontline to ensure that staff could access what they needed to keep them safe. He mentions the assessments of the contracts and how they were awarded. I merely take him back, very gently, to the point that I made to my right hon. Friend the Member for Gainsborough (Sir Edward Leigh), which is that these contracts, as set out to the Public Accounts Committee, went through an eight-stage assessment process undertaken by civil servants. I know the hon. Gentleman well, that he would not be impugning the integrity of those civil servants and that he has great respect for them. But I say very gently that there has been no evidence cited and no findings in court of any Minister in terms of conflicts of interest or having behaved inappropriately.

Oral Answers to Questions

Chris Bryant Excerpts

Tuesday 23rd February 2021 Commons Chamber

[Matt Hancock]

I think my hon. Friend has just made his heartfelt plea and it has certainly landed with me, but I am not surprised because he has made this case to me on behalf of his constituents over and over again and he is quite right to. We are in the process of considering which hospitals will be in the eight additional, on top of the 40 that we committed to in our manifesto. I am grateful for his representations and we will certainly consider Airedale and its full needs for the local community.

[Chris Bryant (Rhondda) (Lab) [V]]

I wonder whether the Health Secretary would agree with me that coronavirus has not only changed many of the ways that we have to do our lives, but it is fundamentally going to have to change the whole structure of the NHS re. That means we are going to have to recruit more pathologists in this country for ourselves; we are going to have to have far more intensive care unit capacity; we are going to have to have UK manufacture not only of PPE but of vaccines if we are to be able to be self-reliant; we are going to have to have much better long-term rehabilitation for people with brain injuries; and we are going to have a complete review of our care homes, aren’t we?

[Matt Hancock]

We will need to draw many lessons from the pandemic. For instance, my brilliant team who have done all this procurement of PPE have also built an onshore PPE manufacturing capability. With regard to almost all items of PPE, 70% of it is now made onshore in the UK, up from about 2% before the pandemic—likewise for vaccines, where we did not have large-scale vaccine manufacture and we now do, and for a host of other areas, including some of those that the hon. Gentleman mentioned.

Covid-19 Update

Chris Bryant Excerpts

Tuesday 9th February 2021 Commons Chamber

[Matt Hancock]

Yes. Stoke-on-Trent has been ably and effectively represented in this discussion, and everybody across Stoke deserves praise for the work that they are doing to drive up the vaccination rate. The higher the vaccination rate, the more quickly and safely we can all come out of this together.

[Chris Bryant (Rhondda) (Lab) [V]]

The roll-out of the vaccine programme has been absolutely commendable. Brilliant! Well done! Locally, it has been really encouraging to see the mass vaccination centres working alongside the GP surgeries, but I am really worried that from this Friday onwards all the local mass vaccination centres will have to close because there will not be any more Pfizer vaccine except for the delivery of second doses, which will not start for another fortnight. On top of that, the number of AstraZeneca doses available locally will fall from 24,000 a week to 8,000 a week, so I am really worried that the next cohort of people are not going to get their vaccinations soon. Is there anything the Secretary of State can do to ensure that we get more vaccines locally by this weekend?

[Matt Hancock]

I am not aware of the closure of any vaccination centres. Of course, it is a matter for the Welsh Government if they are going to close vaccination centres, but I speak to the Welsh Health Minister regularly and this has not been raised as an issue of concern. Supply is of course the rate-limiting factor, as it has been throughout the roll-out. Supply continues, but we have to start ensuring that we have those second jabs ready for people. I am not aware of the issue that the hon. Gentleman has raised. It is certainly not a problem across England, where I am directly responsible for the roll-out. So far, this programme has been going so well across the whole United Kingdom, and we have all been working so hard together to make it happen.

Covid-19 Update

Chris Bryant Excerpts

Monday 14th December 2020 Commons Chamber

[Matt Hancock]

Yes, and I strongly commend my hon. Friend’s leadership locally. These are tough decisions, but let us get this testing going, get everybody coming forward to get a test if they can, to find those cases and ask and require people to isolate to break the chains of transmission and get Essex and Thurrock back out of tier 3 as soon as we possibly can.

[Chris Bryant (Rhondda) (Lab)]

One of my closest friends, Dan Lass, who I had known for more than 30 years, died of leukaemia last Thursday morning. He was in the United States of America, but I want to ask the Secretary of State about the cancer recovery plan in this country because cancer carries on killing people and many people have ended up not presenting this year. I know we have got things going again—even during the second wave—which is an amazing job by all the oncologists and doctors, but we must ensure we get clinical trials up and running again. We must be able to save lives and we must ensure that people go into hospitals to get the treatment they need. Otherwise, there will be more people who have lost someone like Dan.

[Matt Hancock]

The hon. Gentleman is quite right to raise this issue. My condolences to him and to all the family and friends of his friend, who is sadly no longer with us. I pay tribute to the way in which the NHS has kept cancer services going during the second peak. It has not been easy, but it has saved lives. The NHS has worked hard at it, and we must keep that going for the remainder of this time until we can get through and beyond.

Coronavirus Vaccine

Chris Bryant Excerpts

Wednesday 2nd December 2020 Commons Chamber

[Matt Hancock]

Absolutely, and my hon. Friend gives the lie to this idea that we should somehow split public and private. I want to pay tribute, on behalf of all those in the House who believe in private enterprise, to everybody: the major global pharmaceutical companies such as Pfizer and AstraZeneca, the small entrepreneurial start-ups such as BioNTech and all those who have come to the aid of the nation. If they do it and make a profit, if they do that to save lives, that is fine by me.

[Chris Bryant (Rhondda) (Lab)]

Advent always starts with the prospect of good news, so this is a really good Advent. [Interruption.] Says the former vicar. Yes, quite.

Can I add one element to this issue of the prioritisation of vaccination? Covid has savagely exposed the health inequalities across the whole country. The poorest communities have suffered most, and the poorest communities often have the fewest health services and the least additional capacity to be able to deliver vaccination. As part of the mix, can we make sure that equality, real equity, across the whole country means that the poorest communities may need additional support?

[Matt Hancock]

Yes. The hon. Gentleman raises a point that is important for the vaccination programme but also important thereafter, because if levelling up means anything, it means trying to level up health and make sure that the health inequalities of which he speaks are addressed.

Covid-19: Acquired Brain Injury

Chris Bryant Excerpts

Tuesday 24th November 2020 Westminster Hall

4.2 pm

[Chris Bryant (Rhondda) (Lab)]

I beg to move,

That this House has considered acquired brain injury and covid-19.

It is a great delight to serve under your chairmanship, Ms Eagle, as I have never done so before, as far as I can remember. Some have greatness thrust upon them and I have always waited for this moment.

As hon. Members will know, the issue of how brain injury is treated and dealt with in society has been close to my heart for some considerable time. My hon. Friend the Member for Blaydon (Liz Twist) and I have been running the all-party parliamentary group for acquired brain injury for the past few years. It is frustrating that we have not been able to hold as many meetings this year as we would like to, but I am determined that we are going to move forward on this.

Most hon. Members will have had moments when they have visited a Headway group, a local hospital, a local trauma centre, or perhaps one of the day care centres run by their local authority, and met individuals who have had traumatic brain injuries—perhaps people who have suffered carbon monoxide poisoning, or who have had a stroke, or any one of the many different ways in which the brain can be injured. They will know of the great joy that many families feel that somebody’s life has been saved, and of the great sadness that their quality of life is not what they would want it to be.

I praise the Government for setting up the major trauma centres, because in the last few years, despite lots of controversy locally in many parts of the country, those centres have undoubtedly saved many lives. Probably in the region of 800 to 900 lives are saved every year because of those centres. However, many of those people come out with brain injuries, and the pain for the individual and the family surrounding them can be phenomenal.

I want to say up front to the Minister the things that I want out of this, just to be absolutely clear. I want a national neurorehabilitation strategy, because there is not one at the moment—there are lots of bits and pieces of strategies, but no national neurorehabilitation strategy. I want a national neurorehabilitation lead—a single person who is in charge. I have heard rumours that somebody might have been put in charge, but I am not sure, so I hope the Minister will be able to respond to that.

I want a mandatory system, not a casually achieved system, for commissioning neurorehabilitation, particularly within the community. It is far too patchy up and down the country, and I am not even referring to the differences between England, Wales, Scotland and Northern Ireland; even within England, it is far too patchy and insecure. I have a real fear that, after covid, we will not reinstate all the neurorehabilitation services that we had before covid came to these shores. I have a real fear of that, so I want a guarantee from the Government that all those services and more will be reinstated, and that all the posts that have been furloughed, suspended or not appointed throughout this year will be kept and will be restored.

[Liz Twist (Blaydon) (Lab)]

Does my hon. Friend agree that our report, “Time for Change”, which was produced by the APPG with the help of the United Kingdom Acquired Brain Injury Forum, actually demonstrates the importance of neurorehabilitation, both in acute settings and in community-based cases?

[Chris Bryant]

My hon. Friend is absolutely right, and I pay tribute to her for the work that she has done on this issue in lots of different debates, particularly on the relationship between neurorehabilitation and education. It is about the individual in the acute setting, perhaps after a traumatic brain injury in a car crash or something like that, and then it is about that person being given enough neurorehabilitation so that they do not need an enormous care package when they go out into the community, but it is also making sure that there is enough ongoing neurorehabilitation in the community so that they do not fall back on requiring even more of a care package—not because I want to deny care packages, but because I want people to live independently and have the freedom that we would all want for every individual.

I will add two other things that I really want. I am sorry that I am sounding like a popular beat combo from a previous generation—my husband will be proud of me. Neurorehab should be one of the 12 specialities protected during covid. I have made a similar argument about cancer, and cancer has quite rightly had lots of coverage in the country. I hope that very soon we will see the cancer recovery plan, which we have been awaiting for some time, but we also need one for neurorehabilitation. I will come to some of the reasons for that.

The final thing that I really want is a coherent, consistent and tidy arrangement of community neurorehabilitation across the whole country, so that whether someone is in Wells, in Winchester or in the middle of Manchester, they and their family or loved ones have the same right to access ongoing community rehabilitation. Otherwise, it just seems terribly unfair. One of the things that so many families have said to me time and again is that they feel as if they are pushed from pillar to post. They hear a story of somebody getting rehabilitation sorted in one part of the country, and then they find that it is simply not available in their part.

I therefore reiterate that I really want a single coherent approach towards brain injury, and not just in neurorehabilitation—although, as I said earlier, we also need a national neurorehabilitation strategy. We also have to bring together all the different elements. I have spoken to the Minister for the Cabinet Office, the right hon. Member for Surrey Heath (Michael Gove), about the need to bring together all the different departmental Ministers into a single committee to look at the interaction between the work of the Department for Work and Pensions, the Ministry of Defence—it deals with many veterans who have had brain injuries during active service—the Departments for Education and for Health and Social Care, the Treasury, the Ministry of Housing, Communities and Local Government, because it looks at the provision in local communities, and, for that matter, the Department for Digital, Culture, Media and Sport. One of the most depressing and upsetting things this year has been hearing the family of Bobby Charlton say that they reckon that the dementia from which he suffers is a result of his experience playing football, and particularly heading the ball. I am not an England supporter, being a Welshman, but how depressing is it that so many of the players in the 1966 team have subsequently been found to have had dementia, depression and anxiety, which were almost certainly related to their playing of football? We put these people on a pedestal, but we are not prepared to protect them. I am still extremely critical of the way the Football Association has behaved around this.

The problem this year, in particular, is that during the first lockdown, a lot of people with brain injuries were discharged early. I understand why it happened, because hospitals had to make beds available for people with covid, but lots of units were closed in the east of England and in the midlands, which are the two areas that have done the most research into this. Between 50% and 100% of the beds that are normally allocated for neurorehabilitation were closed down and simply not available, and people were very swiftly discharged into their community.

The Chartered Society of Physiotherapy has found that 80% of NHS services in this field have not yet resumed—80%. The number of people acquiring brain injuries during this time, in all the different ways that I have mentioned, has not slowed down; if anything, it has sped up. We have always said in our all-party parliamentary group that brain injury is a hidden epidemic. The person standing in front of us in a queue may be slurring their words and we might think that they are doing so because they have been drinking, but it may be because they have a brain injury. Of course, it is not written on their forehead. Lots of the problems associated with brain injury are not visible, so it is all the more important that we dig down into these issues.

The waiting list for community neurorehabilitation is now four to six months. That is a phenomenal length of time for families to be providing care, particularly when covid means that they sometimes cannot even visit the person concerned. There are major comorbidity questions as well. Patients have been discharged into adult social care with no neurorehabilitation at all. We now know that covid itself is causing neurocognitive problems for many people—not just people with long covid, but those with other symptoms as well. I guess that as covid develops and we get more understanding of the disease—and, incidentally, as we are able to treat more people and keep them alive—it is likely that there will be more, not fewer, people who need neurorehabilitation.

[Liz Twist]

Does my hon. Friend agree that we now need to make sure that those rehabilitation services come to the top of the pile, because this is causing a real problem for too many people in their everyday lives?

[Chris Bryant]

Absolutely. This is one of the difficulties in this field. We have worked with the United Kingdom Acquired Brain Injury Forum, and Chloe Hayward is wonderful. Headway is also a wonderful organisation, although like many charities in this field, it is having a really difficult time this year. Despite that, the truth is that because there are many different routes to a brain injury, it does not always acquire the same currency as cancer or other medical conditions, and yet it affects at least 1.4 million people in the United Kingdom. That is one of the things we need to tackle.

Specialist early supported discharge and community neurorehabilitation teams were redeployed in large numbers during the first lockdown earlier this year, and many were furloughed. In some cases, they have still not been brought back, and in lots of parts of the country there simply are no services available in this situation. What happens is that the person with the acute condition—the acute set of problems—is not treated but sent out of hospital, because the bed is needed in this second lockdown. That person is sent directly into adult social care, with a phenomenally expensive care package. I am not against the expensive care package—that is what we have to provide—but the point is that neurorehabilitation would be far more cost-effective; there would be far better outcomes for the individual patient; and it would be far more sensible for Government if we could get the system sorted out. In the second lockdown—who knows whether we are having a third lockdown, or a tier situation, or whatever it is?—the truth is that lots of neuro patients are being discharged early. That is just a fact, and I think that it will give us a long problem, not only for the individuals and their families but in lots of local authorities and community services.

What am I talking about here? What is the real issue? I will end in a moment, Ms Eagle. As I have said, brain injury comes in many forms. Young brains are often particularly affected. Kids under the age of five from poorer families are four times more likely to have a significant brain injury—as are teenage kids from poorer backgrounds—than those from wealthier backgrounds. There is a knock-on implication for the Ministry of Justice, and so on. Sometimes it is the executive function that is affected, so people may find it difficult to inhibit some of their immediate instincts. Sometimes it is memory that does not work, or it may be language or elements of personality. For some people, the issue is phenomenal fatigue—not just the kind of thing where someone had a big night out the night before and cannot really be bothered to come into a Westminster Hall debate, but a real fatigue that brings people to the point of absolute despair and an inability to feel like living. For many children in particular, sometimes nine or 12 months after the event, there is neurocognitive stall—basically, the brain seems to go on strike and refuse to work as anybody would want it to.

The thing is that neurorehabilitation works. I do not mean just any old rehabilitation; I mean neurorehabilitation, which uses specialist staff who deal with these issues all the time and know about how the brain and the mind work together and how people can be rehabilitated. That works when it is there from the beginning, when it is available consistently for a sustained period and when the connections between acute and community services are absolutely clear. When it works at its best, it is such a joy, because we see kids who were completely dependent on their parents, and on a whole team of people from social services, suddenly able to smile again and able to discover their own freedom and ability to get on with their lives independently of others. We see older people who are able to regain many of the physical and mental skills that they had before, and to regain some of their personality. That is such a beautiful and rewarding thing to behold, and it is why I hope that the Minister will be able to give me everything that I want.

[The Minister for Care (Helen Whately)]

It is a pleasure to serve under your chairmanship, Ms Eagle. I congratulate the hon. Member for Rhondda (Chris Bryant) and thank him for securing a debate on this important matter. I give him so much credit and pay tribute to his passion and his huge knowledge of this subject—I know that he has debated it at length with other Ministers—which he has brought to this debate and other debates on the matter. I also pay tribute to his commitment to this cause and the tireless work that he does. Of course, I know that he speaks on this subject from direct personal experience. I pay a huge tribute to him for all that he brings to these debates.

It is also good to have the hon. Member for Blaydon (Liz Twist) here. I thank her for the work she is doing with the APPG and the hon. Member for Rhondda to campaign for those with acquired brain injury.

I recognise the vital work of charitable organisations such as Headway, the United Kingdom Acquired Brain Injury Forum and the Disabilities Trust. Their work is invaluable not only in raising awareness but in providing hands-on help and support to patients, families and carers. I am aware that acquired brain injury affects not only an individual’s health but their family, work, relationships and education, in the case of children, so it has a huge impact on people’s lives.

I have met people with brain injuries. Shortly after I was elected, I visited Kent and Canterbury Hospital, which has a neurorehabilitation unit, and I spoke to staff and patients and saw the really impressive work that they were doing. I appreciate the points that the hon. Gentleman makes about the importance of effective neurorehabilitation.

As the hon. Gentleman set out, the pandemic has had a real impact on the care and treatment of people with acquired brain injuries. As he said, staff have been redeployed on to frontline covid work, and that has affected people’s care. For instance, some consultations have been moved online, and services are not what we would want them to be. Face-to-face neurology rehabilitation services are being restarted as quickly as possible. Guidance has gone out from NHS England and NHS Improvement and the Association of British Neurologists, and every effort is being made to catch up on delayed care. I will look into the point that the hon. Gentleman made about his concern that services are not yet up and running. I recognise that the pandemic has been a really difficult time for those affected by ABI across a range of areas, not simply access to healthcare services.

This debate and previous debates owe a debt to the all-party parliamentary group and the hon. Gentleman’s leadership. I want to flag the wide-ranging inquiry into the causes, impact and treatment of ABI, culminating in the report published in October 2018, which set out a host of things that we need to address across Government. As he knows, my Department worked with officials across Whitehall to give a response in February 2019. I welcome the fact that the APPG, along with UKABIF, continues to drive the “Time for Change” agenda, most recently in an online summit held on 16 November.

One of the key issues highlighted in the report, as the hon. Gentleman said, is the importance of better Government co-ordination. I absolutely take his point. He mentioned a conversation with the Chancellor of the Duchy of Lancaster. I speak directly for Health, but I am very aware that brain injury cuts across almost all aspects of an individual’s life, from education to work and welfare, and sadly sometimes the justice system, so we need to work on this across Government. I will work with my officials to drive stronger co-ordination for ABI across Government.

On the services available to patients with ABI, the hon. Gentleman will know that since 2012 we have had 22 regional trauma networks across England, and those major trauma centres can provide the specialist care needed by patients with major trauma, including brain injury. Alongside that, timely and appropriate neurorehabilitation is a critical part of care. As the hon. Gentleman set out, that is absolutely crucial for improving the outcomes for people with brain injury. For patients with the most complex need, NHS England commissions specialised rehabilitation services nationally. Trauma unit teams then work to assess and develop a rehabilitation prescription for brain injured patients. RPs are rightly regarded as very important for rehabilitation, as they reflect an assessment of the needs of the patient in the round. That approach is showing results. As the hon. Gentleman knows, the latest data shows that 94% of patients accessing specialist rehabilitation have evidence of functional improvement.

The hon. Gentleman spoke about local commissioning and the differences across the country. The majority of rehabilitation is commissioned locally. To support that, NHS England has produced guidance setting out what good rehabilitation looks like and what services people should expect. Community services clearly play a crucial role.

[Chris Bryant]

I am grateful for the nice comments that the Minister has made, but one of the problems with the guidance is that it does not feel very enforceable, and until the money goes with the guidance, as it were, I think it is unlikely that people will invest in this. It feels sometimes—not to use a cliché—a bit too Cinderella-like. I just wonder whether there is a means of twisting it into enforceability.

[Helen Whately]

I absolutely take the hon. Gentleman’s point, and I have heard the argument made about the service we are discussing and other services that are commissioned locally. There is the holy grail—people want a locally responsive health service to respond to what the community needs, but on the other hand they want consistency. Achieving both of those is hard and, arguably, not entirely possible, because the mere fact of having something locally responsive will involve some variation. However, I will also take away the hon. Gentleman’s point that there are ways to try to achieve a higher overall standard and more consistency without necessarily going all the way and saying that it must be done in exactly that way everywhere. Oversight is one way of doing that, so I shall see whether there is further we can go with regard to the point that he made.

I want to pick up on the list of questions—or the wish list, as we are approaching Christmas—

[Chris Bryant]

Demands.

[Helen Whately]

In that case, demands: I shall see which of them I can answer. One was about a national neurorehabilitation lead. During the period of covid-19 there is indeed a national lead. Suzanne Rastrick has been designated the national clinical director for rehabilitation, co-ordinating clinical advice and leadership in that area. That is for the period of covid. I appreciate that the hon. Gentleman’s demand is that it should go beyond the period of the covid pandemic.

As to whether all neurorehabilitation services will be restored after covid, I have no reason to believe that they will not, but I shall, again, take the matter away, and make sure that we see that happening. The hon. Gentleman asked whether neurorehabilitation is one of the 12 specialties that are protected during covid, and I can broadly answer yes. NHS England has made a specific provision for a subset of services, to ensure that they are protected, and complex rehabilitation services are included in that. I hope that answers the hon. Gentleman, at least on that issue. I shall look at his ask on a national neurorehabilitation strategy and consider whether it is something we can do. It is a clear request.

[Chris Bryant]

Will the Minister give way?

[Helen Whately]

I was just about to conclude, and I believe that the hon. Gentleman has a couple of minutes at the end.

[Helen Whately]

In that case, I shall take his intervention.

[Chris Bryant]

I am grateful. I fully get that one of the dangers of having a postcode lottery is that trying to overturn it can mean ending up with no freedom locally, and all the rest of it; but I just say again that the Chancellor of the Duchy of Lancaster really needs to get everyone together. There are real benefits that we could deliver to people, as well as financial savings across the piece.

[Helen Whately]

The hon. Gentleman makes a good point, and I shall, as I say, take that matter away, as the Chancellor of the Duchy of Lancaster has done as well. In conclusion, I take the matter absolutely seriously. Clearly, covid has put huge pressure on the Department, Ministers and the whole health service, but the hon. Gentleman raises a really important point about how seriously we must take the care, treatment and rehabilitation of those with acquired brain injuries. I thank him again for all that he is doing to campaign on it, and for the impact that he has in doing so.

Question put and agreed to.

DHSC Answers to Written Questions

Chris Bryant Excerpts

Thursday 19th November 2020 Commons Chamber

[Edward Argar]

I am grateful to my right hon. Friend. As a former member of the Procedure Committee, I recall when she kindly appeared before the Committee to answer questions on parliamentary questions at the Home Office. I look forward to the reversal of the position in the coming weeks.

[Chris Bryant (Rhondda) (Lab)]

Was she any good?

[Edward Argar]

I would say that she gave exemplary answers, which fully satisfied the Committee. I have received the letter that she recently sent to my right hon. Friend the Secretary of State. We are grateful for the pragmatic and reasonable approach that her Committee has adopted. She will, quite rightly, want to scrutinise performance, and I look forward to appearing before her Committee to answer detailed questions on the matter.

--- Later in debate ---

[Edward Argar]

I am happy to give my hon. Friend that assurance. Perhaps the best mechanism by which lessons learned can be shared will be through my written response—in due course—to and my appearance before the Procedure Committee, chaired by my right hon. Friend the Member for Staffordshire Moorlands (Karen Bradley). If appropriate, Mr Speaker, I will of course share that response with you and with the Leader and shadow Leader of the House.

[Chris Bryant (Rhondda) (Lab)]

On the plus side, because I have the Minister’s and the Secretary of State’s mobile numbers, when I really want an answer, I just text them. To be fair to them, they have been phenomenally helpful at key moments. I think many hon. Members feel that. At the same time, to be honest, the comms strategy this year has been a complete mess and a disaster. I urge the Minister to go back to the Department and say that Parliament should not be used only for accountability but to try to speak to the people of this country and to get across clear messages in a timely fashion. In that regard, will he tell us when he will publish the national cancer recovery plan, because lots of people have major anxiety at the moment about when their cancer will be treated?

[Edward Argar]

I am always pleased to receive messages and inquiries from the hon. Gentleman. He raises two important points. The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Bury St Edmunds (Jo Churchill) is working on the national cancer recovery plan at pace. I am happy to revert to the hon. Gentleman when I have had an opportunity to speak to her. On his broader point, he is right that it is important that we in this House recognise that, in our democracy, people consent and comply because they are persuaded. It is important that we use this House and all the mechanisms within it to persuade and bring the public with us.

Covid-19

Chris Bryant Excerpts

Wednesday 18th November 2020 Commons Chamber

[Jo Churchill]

If the hon. Member will bear with me, I will continue.

The NAO report examined potential conflicts of interests involving Ministers and the awarding of contracts and found none. It states:

“we found that the ministers had properly declared their interests, and we found no evidence of their involvement in procurement decisions or contract management.”

The report recognises that there are robust processes in place for spending public money, to ensure that critical equipment got to where it needed to go as rapidly as possible while ensuring value for money. I welcome the report, because we can all learn.

[Chris Bryant (Rhondda) (Lab)]

I want to make a very different point, which is about how well prepared we were for this year and how prepared we would be if all this were to happen again. The truth is that we tend to run the NHS at 90% to 95% capacity, and it takes the requirement of only a tiny smidgen of increased capacity for the whole thing to fall over. I am particularly conscious of that in relation to intensive care. We have had to cancel elective surgery just to keep intensive care going. If we had the same number of beds per head of population as France or Germany, we would not have had to do that. Another affected area is neuro-rehabilitation after brain injuries, which was already struggling and will even more so because covid clearly leads to some neuro-degenerative conditions.

[Jo Churchill]

The hon. Member is an incredible campaigner in the area of neural injuries. When elective procedures are stood down, those are clinical decisions. We have ensured that many can keep going in the second wave, but this must be done on a local level. There is surge capacity in the Nightingale hospitals, with an additional 2,000 beds, and we have the ventilator capacity that was built up during the first wave of the pandemic. I recognise what he says, but I do feel that these decisions have to be made locally by the clinicians who are involved in delivering the care.

[Chris Bryant]

rose—

[Jo Churchill]

I will give way briefly but then I would like to push on.

[Chris Bryant]

I am not having a go at the Minister; I am simply trying to ask a question for the country, in a way. For the future, we will have to have much more capacity in the NHS, won’t we? We will have to nearly double the amount of capacity we have in some areas, particularly in intensive care, in neuro-rehabilitation and, for that matter, in radiotherapy.

[Jo Churchill]

I will come on to the area of cancer, in particular. Strides have been made in different ways of treating virtually, so that fewer people go into the hospital setting, and so on. I take the hon. Gentleman’s point about capacity, but that is why the Government have committed to building 40 new hospitals—because there is a need to ensure that sufficient capacity is available across the country for people.

Dementia: Covid-19

Chris Bryant Excerpts

Thursday 12th November 2020 Westminster Hall

[Chris Bryant (Rhondda) (Lab)]

How the mind sits within the brain is still one of the great mysteries, I guess. I do not know whether Members have seen the ballerina Marta González listening to the music from “Swan Lake” and just beginning to be able to remember the choreography from years before. That inspired in so many a deep sense of that complicated relationship, where there is clearly a mind that has memories, but it cannot quite make the brain do what it wants it to do.

I wanted to speak in this debate because my family has been through quite a lot of that this year. I will talk not about that specifically, but about some of the things that have been common to many people in the country this year. Because many families have been isolated from other parts of their families, they have often not been able to check up on the elderly as frequently as they might want. They may not have been allowed to visit, especially if they are in different parts of the country, and they will not have been able to see the oncoming early signs of dementia. Doctors have sometimes simply been unable to diagnose, because they could not be in the physical presence of the person about whom there are concerns—diagnoses are a third down on normal, as we heard earlier.

The virus itself has, of course, added considerably to levels of anxiety, depression and a sense of paranoia in many people, with a growth in conspiracy theories. That has all added to the complications for families dealing with people who have early-onset dementia or other forms. The virus has direct neurocognitive effects that we are only just beginning to understand.

People have also had dietary issues, because they have not had access to the same kind of food as they might normally. That may well have added to their delirium, which, on top of dementia, can make it more difficult for people to go into care homes. They may need psychiatric support rather than care home support. Yet again, families are finding it terribly difficult during this time.

Families have found it very difficult to get help. The immediate instinct, once the diagnosis has come in, is for people to think about whether they can bring their family member into their own home. If that is not possible, they think about the other support there will be. Care homes have been up against it. There have been terrible anxieties about whether people have other comorbidities that will make it more difficult for them. Many families feel as though they have been bashing their head against a wall.

On top of that, of course, although lots of people had sorted out lasting power of attorney long before, which I would encourage everybody to do if they can, when I rang the Court of Protection, the emergency officer told me that emergency cases might be seen in nine months’ time. Sorting that out for an individual family member may make the difference between whether it is possible to get them into a care home and get them the support they need or not. Nine months—we cannot have that kind of backlog. That is a kind legal misery of the state on top of everything else.

I have done a lot of work on brain injury and some of the things are very aligned. It was terribly depressing to see the family of Bobby Charlton announce the other day that he has dementia, probably from concussion from heading the ball. I am sick and tired of people saying, “Oh well, the ball’s not as heavy as it used to be.” Did nobody do physics at school? It is about the speed of the ball, not the weight of the ball.

There is a lack of neuro-rehabilitation. A quarter of all major trauma centres still do not have a neuro-rehabilitation consultant. Some 57% of patients who have acquired brain injuries still complain that they are unable to get their full support. There is a massive funding crisis for all the organisations that work in that field, such as Headway, the UK Acquired Brain Injury Forum and many others.

My heart goes out to everybody, and my heart sort of goes out to the Minister, because there is a lot to deal with, but I do not think we will be able to do that unless we look at all these issues in the round. The one thing that I beg her to do is to set up a cross-departmental ministerial team that looks at it from Defence, Work and Pensions, Treasury, Health and Social Care—all the different Departments—so that we can really turn this around.