Hospice Funding
Chris Green Excerpts(7 months ago)
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Chris Green (Bolton West) (Con)
It is a pleasure to follow the hon. Member for Strangford (Jim Shannon). I congratulate my hon. Friends the Members for Hastings and Rye (Sally-Ann Hart) and for Darlington (Peter Gibson) on securing this incredibly important debate.
Members have been so positive in talking about the contribution of their local hospices, which ought to be regarded as a very positive, uplifting thing, even though they sometimes have a negative association. When we speak about our hospices, we ought to reflect more on their huge positive contribution to the community. That is certainly the feeling I have had when visiting Bolton Hospice, Wigan and Leigh Hospice and Derian House Children’s Hospice. It is not just the institutions themselves but the staff, including the doctors, the nurses and the volunteers—so many people make a positive contribution right across the organisation. That really drives the fundraising; the vast majority of the hospice movement’s funding is from the charitable sector, with people giving of themselves because they believe in their local hospice. That is immensely important and we ought not to be challenging that relationship with the local community. That takes us immediately on to the other aspect of the funding: the part that local authorities and the NHS give.
When we are going through a difficult time in the economy, it is more difficult for people to give money. Some parts of the country are wealthier and perhaps find it easier to donate to the local hospice, whereas other parts of the country are poorer and perhaps have been hit harder in recent years. Covid and the lockdowns hugely disrupted the ability of hospices to fundraise. We hear of colleagues doing a marathon, skydiving or undertaking all sorts of other activities that so many people around the country do to contribute to their local hospice, but such things were not possible for such a long time. It takes a while for coffee mornings and so many other activities that hospices do to be organised again and for people to get back into that routine of coming along to support their local community events.
That is why it is especially important for national and local government, the NHS and, since 2022, when the Health and Care Act 2022 put them on a statutory footing, the integrated care boards to play their part—this is their responsibility. As was pointed out earlier, the ICBs not supporting the hospice movement in the way they ought to in the short term, because they are under immense financial pressures themselves, will create problems for the wider system. It will create problems for not only the hospices, but the local NHS if hospices cannot continue in the short, medium and longer-term to support their local communities.
A big question that has come out of this debate is about the NHS, which is immensely important, and something that is at the heart of the creation of the ICBs: the ability to have the right care for the community that is represented by the ICB. How do we bridge that divide between the NHS and that local responsibility of the ICB—how do we meet that challenge? Can the ICBs do this or does the Minister have to intervene?
Oral Answers to Questions
Chris Green Excerpts(10 months ago)
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Andrew Stephenson
The NHS long-term plan commits to a number of key ambitions to improve care and outcomes for individuals suffering from cardiovascular disease, including enhanced diagnostic support in the community, better personalised planning, and increasing access to cardiac rehabilitation. Those ambitions will support the delivery of the aim to prevent 150,000 heart attacks, strokes and dementia cases by 2029.
Chris Green (Bolton West) (Con)
The single biggest concern my constituents raise about healthcare is access to GPs, especially in Blackrod and Westhoughton. What more can my right hon. Friend do to ensure we have better GP access?
Dame Andrea Leadsom
I am pleased to tell my hon. Friend that our NHS long-term plan sets out a real-terms increase of at least £4.5 billion a year for primary and community care by 2023-24. We now have over 2,000 more full-time equivalent GPs working in our NHS, and we have had the amazing achievement of more than 50 million more appointments per year, beating our target several months early. Things are improving significantly, and there are many more measures I would be delighted to talk to him privately about.
Oral Answers to Questions
Chris Green Excerpts(1 year, 4 months ago)
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Neil O'Brien
We talk all the time. I am conscious that there are 60% more full-time patient-facing staff in the hon. Lady’s constituency than there were in 2019, which of course puts pressure on premises. The capital allocation for her local ICB between 2022-23 and 2024-25 was £200 million, so the money is there, but I am happy to continue the conversation about how we get the premises in the places where we need them.
Chris Green (Bolton West) (Con)
The Parliamentary Under-Secretary of State for Health and Social Care (Neil O'Brien)
We have already been growing the range of NHS services available in pharmacies: we have set up the community pharmacist consultation service, the discharge medicines service, the new medicine service, the blood pressure check service, smoking-cessation services and the contraception service. We are now investing £645 million to go further through the new Pharmacy First scheme for common conditions.
Chris Green
I thank my hon. Friend for his answer, but does he agree that the services offered by pharmacies can be made more efficient? For example, 62 million prescription items are subject to “split and snip” per year. That is where, to get the right number of pills, a pack has to be manually opened up for a couple of pills to be snipped out, then repackaged and relabelled before being reissued. The spare pills are often thrown away. Can that system not be better?
Neil O'Brien
My hon. Friend is completely correct. That is why at the end of last month we laid a statutory instrument before the House to fix the system, so that pharmacists can spend more time using their skills to provide high-end clinical services and less time snipping blister packs.
Hospice Services: Support
Chris Green Excerpts(1 year, 5 months ago)
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Chris Green (Bolton West) (Con)
It is a pleasure to serve under your chairmanship, Ms Nokes, and to follow my constituency neighbour the hon. Member for Bolton South East (Yasmin Qureshi), who champions the cause of Bolton Hospice so effectively. I congratulate my hon. Friend the Member for Eastleigh (Paul Holmes) on securing this timely debate; the fact that it is so well attended demonstrates how important the hospice movement is, right across the land.
The service that Bolton Hospice, Wigan and Leigh Hospice and Derian House Children’s Hospice provide to my constituents is an immensely important part of the community. The charitable and fundraising aspect represents their importance to so many people in the community. When we are going through very difficult economic times, whether they are caused by war in Europe, by covid or by lockdown restrictions, that makes it very difficult to fund hospices, so they have relied for many years on simple things such as sponsored walks and other events and activities. They value that relationship with the community. I have never had a sense from the hospice movement that it wants to be dependent on the national health service. They need that healthy relationship, but they also need certainty of funding from the national health service.
My principal question to the Minister, because so many of the key arguments have been made so compellingly, is what she can do with the integrated care systems and integrated care boards, as well as with the national health service, to maintain and shore up their relationship with their local hospices. That point is not necessarily recognised, because the hospice movement is independent of and separate from the national health service. When the NHS is going through a difficult squeeze, it is perhaps those other services, which are so important to the local community and which have such fantastic staff and so many superb volunteers doing amazing work, that are not necessarily recognised by the local system in the way they should be. The Minister must encourage and support integrated care systems and integrated care boards to deliver.
Several hon. Members rose—
Draft Water Fluoridation (Consultation) (England) Regulations 2022
Draft Health and Care Act 2022 (Further Consequential Amendments) Regulations 2022
Chris Green Excerpts(2 years, 1 month ago)
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Chris Green (Bolton West) (Con)
The fact that this power is being taken from the local authority level up to the Secretary of State would suggest that the Secretary of State, or the previous Secretary of State, believes that the decisions on—or progress of, as it might be seen—the fluoridisation of England’s water have not gone far enough. The Government clearly start with an intent to fluoridise more of England’s water. The intent is already there and the direction is being pushed in regardless of what consultation there is. It is not clear that local voices will be represented, as opposed to the establishment will that currently exists.
Will Quince
I note my hon. Friend’s concerns. I will come on to address them, and if I do not do so immediately—because I am going to talk about the consultation and how we propose to undertake it—I will do so in my closing remarks about the duty of the Secretary of State. My hon. Friend is right that it is important that localities have a say on such things as water fluoridisation.
Chris Green
The question of localities is important. I am a Greater Manchester MP; will Bolton be the local authority that makes the decision for my area? How much influence will the integrated care board have? Will it be a Greater Manchester Combined Authority decision, or will it be a mayoral decision?
Will Quince
My hon. Friend is right to push us on those issues. I will touch on them all, because it is about not just local authorities, metro Mayors and others having a say, but all those who live, work and study in an area. No doubt they will have strong views, notwithstanding me as a Health Minister having a view when it comes to tooth decay and the difference that fluoridation will have in that respect.
We launched a public consultation on 8 April that ran until 3 June. We sought views on whether future water fluoridation consultations should be restricted only to people affected locally and bodies with an interest, such as those referenced by my hon. Friend the Member for Bolton West—incidentally, that had been the case under legislation—or whether we should move to a model in which consultation would open to all, especially given the shift of responsibility from local authorities to central Government. Some people with strong views on water fluoridation may not live in a particular area but may have certain expertise or a particular interest.
We received 1,228 responses to the consultation; of those, 94% came from individuals and 6% came from organisations. The majority of respondents favoured a consultation open to all. The draft regulations will not restrict who can respond to any future consultation on water fluoridation, which I hope my right hon. Friend the Member for East Yorkshire and my hon. Friend the Member for Bolton West agree is the right approach.
To come to the crux of my hon. Friend the Member for Bolton West’s points, we understand that the views of those who are directly affected and living, working and studying in an area in question are incredibly important. For that reason, the regulations also provide for consideration to be given, as part of the decision-making process, to whether additional weight should be given to consultation responses from those who may be particularly affected by any future proposals.
Public opinion and the extent of support for a water fluoridation proposal will continue to be important but, as my right hon. Friend the Member for East Yorkshire rightly pointed out, consultations are not referendums. It is right that regulations provide for a range of other factors to be taken into account when considering a water fluoridation proposal.
Will Quince
The honest answer is that I am not aware of any, but no doubt my officials will look that up and I will be able to respond in my closing remarks.
The wider factors that have to be taken into account in the consultation include but are not limited to the strength of evidence underpinning an argument made by the respondents. It is absolutely right that due regard is given to those arguments and that they are properly supported by sound evidence.
On evidence, a point that my right hon. Friend the Member for East Yorkshire alluded to, we are committed to scientific evidence on water fluoridation. It has to underpin any proposal that we put forward. The Department continues to review scientific papers published both in this country and internationally as part of the continuous monitoring of the evidence. That includes papers on the epidemiology and toxicology of water fluoridation. Every four years, the Department will continue to publish a summary report on our knowledge, in line with the Secretary of State’s responsibility for monitoring the effects of the water fluoridation arrangements on the health of the populations that are served by existing schemes.
Chris Green
What is the Government’s view of side effects? As far as the Government are aware, are there zero side effects from the fluoridation of water?
Will Quince
I will come to that point. The common finding of several authoritative scientific reviews is that there is no convincing scientific evidence that fluoride in drinking water, at levels used in fluoridation schemes, is a cause of adverse health effects. Let me provide further assurance that if the balance of evidence in favour of water fluoridation as a public health measure were to change, a review of the current water fluoridation policy would take place.
I am conscious that I was not the Minister when the Act was passed, but this same point was made during the passage of the 2022 Act. We have 57 years of experience in England and 75 years of experience internationally of water fluoridation schemes. There continues to be no convincing evidence of health harms associated with the levels of water fluoridation use in this country. In fact, what we have seen internationally is more countries moving in that direction because of the benefits of tackling tooth decay, particularly in children.
Vaccination: Condition of Deployment
Chris Green Excerpts(2 years, 9 months ago)
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Sajid Javid
I will say two things to anyone involved in NHS trusts, especially those who were leading the campaign to encourage their colleagues to get vaccinated. First, I say a huge thanks for what they have done and what they have achieved so far. I mentioned earlier that, since we consulted on the original regulations, 127,000 more people across the NHS have been vaccinated, which represents in total some 19 out of every 20 employees in the NHS. That is a phenomenal achievement. My thanks go to all those working in the NHS who have helped to make that happen and are still helping to make that happen.
Secondly, I say to those people that their work, with our support—the support of the Government and my Department—continues. Despite the changes today, for the reasons that I have set out, it is still hugely important to get vaccinated. We must keep reaching out positively to those who have not yet, for whatever reason, chosen to do so by helping them to make the right decision.
Chris Green (Bolton West) (Con)
I welcome my right hon. Friend’s statement. He made several references to conditions of employment and he finished by asking regulators, “to urgently review current guidance to registrants on vaccinations”.
What will he do to ensure that that does not become a compulsion for vaccinations by other means?
Sajid Javid
The regulators I referred to are independent, so all I can do is ask them to review their regulations. My hon. Friend might be aware that some regulators, such as the General Medical Council, already have requirements for vaccinations in certain settings, which is a decision for them. As he will know, however, the independent regulators usually set out guidance and allow some flexibility in how it is interpreted in certain settings.
Oral Answers to Questions
Chris Green Excerpts(3 years ago)
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Maggie Throup
As I said earlier, we have already vaccinated over 1.1 million 12 to 15-year-olds since the roll-out began, which to me is a huge success. We have opened up the national booking service, and provided more opportunities for youngsters to come forward whether within the school environment or outside the school environment. We always look at every opportunity to ensure complete accessibility for people to get their vaccine.
Chris Green (Bolton West) (Con)
Bill Esterson (Sefton Central) (Lab)
The Minister for Care and Mental Health (Gillian Keegan)
We recognise the considerable challenges the adult social care sector faces in recruiting and retaining staff. We have put in place a range of measures to support local authorities and care providers to address workforce capacity pressures. These include a new £162.5 million workforce recruitment and retention fund, and the latest phase of our national recruitment campaign, launched on 3 November, which highlights adult social care as a rewarding and stimulating place to work.
Chris Green
I thank my hon. Friend for her reply. The latest figure I have for the vacancy rate for carers in August was significantly worse than those from before the pandemic, and it is likely to worsen still further due to the requirement for compulsory vaccination. When does my hon. Friend believe the vacancy rate will return to pre-pandemic levels?
Gillian Keegan
The first thing to say is that obviously the vaccine saves lives, and it is our responsibility to do everything we can to reduce the risk for vulnerable people. As of 14 November, 92.5% of care home staff have had their second dose. We have put in place measures, as I said earlier, to support workforce capacity, which have only just gone to local authorities. The Department continues to closely monitor workforce capacity, bringing together the available data, including the vacancy rate, with local intelligence. Longer term, we have committed at least £500 million to support and develop the workforce, and that will go some way to addressing the barriers to people taking up work in adult social care, which has been an issue for a number of years.
GP Appointment Availability
Chris Green Excerpts(3 years, 1 month ago)
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Joy Morrissey
I thank the hon. Lady for her comment. In my constituency we have GPs who have worked tirelessly throughout the pandemic and have done so much to roll out the vaccine—I commend them for everything they have done in such an incredible way. This is not to disparage the wonderful work of the majority of GPs and GP’s surgeries. I am looking for the correct terminology. There are certain GP’s surgeries that have struggled to even respond to constituents with phone calls. Many would be satisfied with just a phone call, but they cannot even reach their GP to schedule a phone call appointment.
Chris Green (Bolton West) (Con)
Does my hon. Friend share the concern of many of my constituents that there is to some degree a postcode lottery in the national health service and the GP service? Different GP surgeries and different areas provide very different levels of service, whether that is face-to-face or there is a lack of that.
Joy Morrissey
I would agree with that. Some GP surgeries, in certain parts of my constituency, are excellent—they were excellent with the vaccine roll-out; they are excellent now; they have done everything in their power to see as many constituents as possible—and then there are certain others, in the Iver and Burnham areas, where we continually have complaints, where constituents come to me in desperation because they have nowhere else to go.
We need to find a way of giving health access to everyone in a fair and reasonable way. I promised my constituents that I would raise their concerns at the highest level, and I have done that today, both in Westminster Hall and with the Minister directly. I thank Members for their time today, and I hope that this issue will continue to be considered and debated within Parliament and by the Minister.
Chris Green (Bolton West) (Con)
It is a pleasure to serve under your chairmanship, Mr Robertson. It is a pleasure to follow the hon. Member for York Central (Rachael Maskell), who makes important points in her speech. I congratulate my hon. Friend the Member for Beaconsfield (Joy Morrissey) on securing the debate and making many compelling arguments. I congratulate my hon. Friend the Minister on taking her position on the Front Bench. She is one of a small number of individuals in Parliament who has recent frontline experience and I am sure she will bring that to bear in her role.
GP appointments are an important issue about which there have been concerns for many years. The principal concern at the moment relates to coronavirus and the lockdown. We cannot avoid that or simply touch on the subject, then concentrate on a wealth of other concerns. We have to focus on that issue as the prime driver of the current problems in the sector.
The Chancellor has put forward substantial resources, but more are always needed to make sure that resources are available for the national health service and for general practitioners. More needs to be done, and I am sure that, in the coming months and year or so, more resources will come forward.
I am here to raise the concerns of my constituents who are increasingly worried. At the beginning of the coronavirus lockdown, many people chose not to take up available GP or hospital appointments, but many of those conditions that have not been investigated or checked in the last 19 months are now far worse. The pressure and demand on hospitals and GPs are more severe. People are increasingly less frightened of coronavirus but more frightened about when they will get to see their family doctor, who is now difficult to see.
People are told by their GP receptionist to call at 8 o’clock, or earlier in some areas, but they have to make call after call after call for half an hour or 45 minutes. They cannot get through until it is too late and they are told to do the same tomorrow. That is happening day in, day out. Many people are now going to accident and emergency. For a long period at the beginning of the pandemic, A&Es were quiet because people were worried about going and getting coronavirus, but the situation has changed radically. People cannot access their GP surgeries and they are going to A&E, but it is far more difficult to get the service there too.
The system is coming under significant and increasing pressure, which is piling up as we head into winter. It is not just coronavirus. There is an expectation that the pressure from other respiratory viruses will mount up along with, as I mentioned, conditions that have not been checked or investigated for all those months such as cancer and other life-threatening conditions.
We have heard about elective care for issues such as cataracts and hip replacements. In the scheme of things, when we are thinking about life and death, they may seem relatively minor but they have a dramatic impact on people’s standard of living. The situation has negatively affected all those discretionary care items, but they have to be addressed too.
Margaret Greenwood
The hon. Gentleman is talking about rationing and what is happening in the wider system. With the Health and Care Bill, we are moving away from a national health service to 42 integrated care systems that will all have to balance their books every year under tight financial controls and will all have different strategies. Does he share my concern that that will embed the postcode lottery and increase the rationing of care? Have his constituents commented on that and do they share those concerns?
Chris Green
The hon. Lady makes some important points about the Bill, but the postcode lottery is already there. Most people view the national health service as a one-size-fits-all service that provides the same service wherever they are in the land, but that is not true and perhaps never has been. Access to medicines is very variable and IVF is a good example of something for which different areas have different agendas, policies and accessibilities. We all know that there is already a postcode lottery.
I do think that NHS England is too large an organisation. I was not intending to talk about this, but I was hopeful about health and social care devolution in Greater Manchester. The Mayor could have taken that up and championed it, but he has not made a single speech on the subject—he has not touched it. Having seen the failure of that devolution, the Government are now looking at other mechanisms to champion the cause of better accountability—
Chris Green
I am sorry, I have very little time—where local leaders may be able to champion the cause of better delivery, with organisations in a sufficiently large area in which they can make a difference, but which are close enough to people that local needs can be respected and identified. Different areas are often so very different.
About 5.5 million people are on hospital waiting lists. That is an extraordinary figure. However, there have been about 7 million fewer GP to hospital referrals during the pandemic. If we extrapolate from those figures, we have roughly 13 million people on the hospital waiting list. We need to get the GP service sorted out as soon as possible. It is appalling. I am disappointed in the British Medical Association for threatening strikes. The health system, the unions and the Government need to get together and deal with those problems as soon as possible.
I was concerned about the renewal of the Coronavirus Act 2020 because I know what that will symbolise to the civil service, the health system, the education system and wider society: that we have not and should not yet return to normal. As long as the Coronavirus Act is in place, I can see that the wider system of state, including GPs’ surgeries, will not return to normal. That has to be changed and normal service must resume as soon as possible.
Dr Rosena Allin-Khan (Tooting) (Lab)
It is a pleasure to serve under your chairmanship, Mr Robertson. I thank all hon. Members for their contributions this afternoon and the hon. Member for Beaconsfield (Joy Morrissey) for securing this debate on an extremely important issue as we recover from the pandemic. This issue is close to all our hearts and to the hearts of the people whom we service.
GPs play an essential role in our communities. They are often the first port of call for people accessing a wide variety of health services, and their hard work and dedication to serving their communities ensure that we can always obtain advice, medicine and referral to other services.
When we discuss GPs, it is important to remember that they are more than just nameless public servants doing a job. They do not just serve communities; they are an integral part of them. I myself have had the same GP for my whole life, if people can believe that. I am slightly giving my age away to say that she has been my GP for over 40 years.
GPs are the foundations of our national health service, and without access to them our whole health system would collapse. Chronic illnesses would not be caught in time, mental illnesses would go unchecked and life-saving medication would simply not be prescribed. From our birth to our death, a GP is there for us all, and everyone in this country should have access to their GP.
However, like much of the NHS, GPs are overstretched and under-resourced. Even prior to the pandemic, GP surgeries had to contend with a double hit of fewer doctors in the workforce and a rising ageing population. Demand simply outweighs supply. We need more GPs, pharmacists, physiotherapists and community health workers. But instead of supporting GPs during this challenging time, the Government prefer to blame them, making their jobs even more difficult at the time of greatest pressure for our NHS.
We have looked for virtual solutions so often during this pandemic, and for the most part their effectiveness cannot be disputed. They have allowed our economy to keep going and our public services to continue functioning, and also allowed a small degree of normality in what has been an extremely challenging and turbulent 20 months. I know from my own experience on the A&E frontline, especially early on in the pandemic, that infection protocols and social distancing made many elements of delivering compassionate care very challenging.
Digital solutions have worked well, but we know that they are not appropriate in every setting and they do not work for everyone; we have heard ample example of that today in this debate. However, we need to be careful not to conflate two separate issues. Digital solutions in practices were not just necessary for infection control. The sheer demand for appointments is through the roof. GPs have been offering telephone consultations and online appointments for some time now, even prior to covid. There were 2.2 million more appointments in August this year compared with August 2019. The percentage of appointments being delivered face to face is also rising. That shows that GPs are striving to see as many patients as they can, but to increase that number even further they need more support from the Government.
The Conservatives have promised more GPs in every one of their manifestos since 2015. However, we have approximately 2,000 fewer GPs now than we had in 2015. It seems like a simple fix for Government—deliver on manifesto commitments and expand the GP workforce. That will allow for even more appointments and it will help to reduce the burden on existing staff, leading to less burnout and less fatigue.
The British Medical Association conducted a survey of GPs in July. Half the respondents said that they are currently suffering from depression, anxiety, stress, burnout, emotional distress or other mental health conditions. I repeat—half the respondents said that. That is a huge percentage. Around the same proportion of respondents said they now plan to work fewer hours after the pandemic. When a workforce are supported, their absence rates come down and their productivity goes up; it is pretty basic. Ensuring that staff are supported not only benefits the workforce but the patients, through more effective and timely care. It is a virtuous cycle, which surely even the cynics would support, as it ultimately leads to more patients being seen and better care being provided.
We have heard about the trickle-down effect of not being able to see GPs and the knock-on impact that has on the rest of the NHS. Yet instead of delivering on their manifesto pledges, this Government would rather stoke the flames of division, by attempting to shift the blame to GPs and encouraging local residents to vent their frustrations at them rather than at the Government. The Health and Social Care Secretary has resorted to attempts to name and shame GP practices that were unable to guarantee face-to-face appointments. The Government will then deny additional essential funding to the practices they deem to be performing poorly. That provocation does nothing to improve patient care; it serves only to deflect anger away from the Government and towards the health service. I know from colleagues in GP surgeries across England that it has already resulted in abuse both online and in person. That leaves so many practitioners considering their career choices, and will lead only to further shortages in future.
Fundamentally, the Government need to make good on their manifesto pledge of an additional 6,000 GPs. Without that, there will be a detrimental impact on the workforce and, crucially, on patient care. That has a knock-on impact on how much time GPs are able to spend with patients. Patients are understandably frustrated, as the backlog of care due to covid continues to pile up, with a knock-on impact on waiting times throughout the NHS. At a time when case numbers are soaring again and the booster programme is faltering due to Government inaction, people are anxious about their health and the health of their local community.
Dr Allin-Khan
No; I want to make some progress. The imminent arrival of winter is also a great cause for concern. Winter is always an extremely challenging time for the health service. GPs will be the first point of contact for the majority suffering from winter respiratory illnesses. However, GP surgeries cannot be blamed for being unable to fill vacancies as a result of wider workforce and funding issues. It is simply not acceptable. The Government are purposefully turning communities against one another, risking the health and wellbeing of patients and staff simply because they are unwilling to put forward a sustainable plan to support GPs to manage their workloads. GPs’ needs and patients’ needs are one and the same. It is a failure of Government that has led us here.
Chris Green
The Labour party voted against compulsory vaccination in the care setting, presumably because they sensed that it would have an impact on carers and their ability to carry on in the sector. Does the hon. Lady think that it would also have an impact on the NHS, with perhaps up to 100,000 people leaving, and GP surgeries?
Dr Allin-Khan
That is beyond the scope of this debate, but I am very happy to have a discussion with the hon. Gentleman afterwards. I do not believe it is appropriate to mandate vaccinations for NHS staff, forcing them to leave their jobs if they do not accept vaccination, as I put forward in the Labour party’s position on the care sector.
Let us be clear: GPs are being scapegoated for a failure of this Government to act and put people’s health first. The war against GPs that is being propagated by the Government does nothing to serve patient needs or to serve GPs, who are exhausted and unable to fulfil the commitments that they trained hard to carry out, because of a failure of this Government. I see that the hon. Gentleman feels rather pleased with himself for his intervention on me. Forcing people to have vaccinations in the communities that have been hardest hit, for whom trust has been completed eroded by this Government, does nothing to serve our collective aim, which is to ensure that the communities that we all serve have the treatment that they need and timely and respectful surgeries and appointments. That is the very thing that will keep our communities alive and well this winter.
Will the Minister, whom I welcome to her place, please outline what steps the Government will take to tackle the workforce shortages in GP surgeries? Will she outline what resources will be provided to ease the intense workload that GPs are already contending with? Will she outline why additional funding is all directed to secondary care, while our primary services are left to crumble?
I thank all the GPs out there serving our communities. I hope that the Government have listened to our points on the support that GPs, patients and communities need.
The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
It is a pleasure to serve under your chairmanship, Mr Robertson. I thank the hon. Member for Beaconsfield (Joy Morrissey) for bringing forward the debate. As we have heard from MPs from across the political parties, their postbags show that this is a big issue from the perspective both of constituents, who are trying to access appointments, and of GPs, who are reaching out to their local MPs to highlight the pressures and difficulties that they have faced recently.
I want to start off by thanking general practice teams and GPs in particular. It is disappointing to hear what the shadow Minister, the hon. Member for Tooting (Dr Allin-Khan), had to say. There is no war on GPs. We are all in this together, including GPs, reception staff and nurses. On 14 October the Secretary of State announced a GP support package precisely to support GPs in supporting their patients. We have been listening long and hard to the difficulties faced in primary care. The range of measures I will talk about are there to help GPs as much as patients. If we do not support GPs, the patients will struggle.
I wish to put on the record my thanks to all in general practice during the pandemic. They have gone above and beyond—and often under the radar—by continuing to see patients during the crisis. They have also helped support and in many cases run vaccination programmes in their local areas, and have been a key factor in supporting community teams to help patients be discharged from hospital more quickly and to prevent readmission. That was key during the crisis. Without their hard work and dedication, much of that would not have happened.
There is, however, an issue. We all know that there are problems with accessing GP appointments, but there is also some good news. My hon. Friend the Member for Barrow and Furness (Simon Fell) described the situation perfectly when he called it a perfect storm. So many patients did not come forward during the pandemic, as advised in the main, and many issues, symptoms, conditions and worries are now coming to the fore. The pent-up demand is such that GPs are overwhelmed by the number of people who now need to be seen, often with symptoms and conditions that are far worse than if they had been able to come forward at an earlier stage.
The physical set-up of many GP practices—infection control measures had to be put in place to protect GPs and their staff and patients—means that they have struggled to see patients. My hon. Friend the Member for Bracknell (James Sunderland) asked about those measures. They have been relaxed: social distancing has been reduced from 2 metres to 1 metre. Face masks are still required, but it is now safer for GPs to open their doors and get more patients into their waiting and consulting rooms. Some infection control measures have been relaxed and we should see an improvement.
Appointment numbers are returning to pre-pandemic levels. In August the average number of general practice appointments per working day was 1.14 million, which represented a 2.2% increase on August 2019. As GPs will tell us, they are seeing more patients. The proportion of face-to-face appointments is also increasing. Since August, nearly 60% of appointments have been face to face. That shows that things are starting to return to pre-pandemic levels, but the sheer scale of people who now need to be seen means that it often does not feel like that for patients.
I will give my hon. Friend the Member for Beaconsfield some specific figures for Buckinghamshire. In August, practices arranged a total of more than 200,000 appointments with patients, which is an increase of more than 3,000 from August 2019. In addition, practices in Buckinghamshire helped deliver more than 786,000 vaccines. I take her point that there are specific issues with certain practices that are struggling. My advice to her—and I am happy to meet her and discuss this more fully—is to try to broker a meeting between the GPs and the clinical commissioning group, because often additional support can be given locally to those practices that are really struggling. Sometimes GPs are so overwhelmed that they do not have the space to ask for help and support, even though that is what they need.
Many colleagues, including my hon. Friends the Members for Bolton West (Chris Green), for Beaconsfield and for Barrow and Furness, have raised the issue of telephone access. Much of the problem that patients face is that they cannot get through in the first place, whether that is to make a face-to-face appointment, have a telephone consultation or make a virtual appointment. That is an issue. GPs have historically devised their own telephone systems. They may have gone in with primary care networks or the CCG, and many have their own set-up. Given the sheer scale of the numbers, there is a real issue in having two or three receptionists tackle 300 or 400 calls on a Monday morning, most of which will be complex calls rather than quick, five-minute calls to book an appointment.
That is why part of the GP support package that the Secretary of State announced on 14 October will provide telephone support through a cloud-based system, which will do a number of things. First, it will increase capacity so that patients can get through much quicker. Secondly, it will provide an automated queuing system. I know from my own constituency that patients can be 29th in the queue and have to wait for a long time, so providing that extra capacity will take the pressure off GPs. It will also provide an insight into how much admin support GPs actually need. That valuable data will allow us to provide them with support for the long term.
There are a number of other measures in the GP support package and we are working hard on this matter. There is a £250 million winter access package, aimed at helping GPs open up their surgeries for more face-to-face appointments because this is not an either/or situation. Many Members, including the hon. Member for Batley and Spen (Kim Leadbeater), pointed out that many patients like telephone consultations and the virtual appointments, and we are not going back to pre-pandemic face-to-face-only appointments. We need to embrace the changes that technology has brought. It is far more beneficial for busy people who are working or juggling childcare to be able to speak to a GP rather than have to trundle down to the surgery, but there is a place for face-to-face appointments as well.
The access package of £250 million can be used in a number of ways by GP practices. It can be used to take on locum staff if they are available, to take on other healthcare professionals to see patients, to extend opening times, or even to change the layout of a surgery so that it can accommodate more patients. It is for local commissioners and GPs to decide how they would like to use that fund.
There are also significant moves to reduce bureaucracy for GPs. They are often the only people who can sign fit notes or Driver and Vehicle Licensing Agency requests. As has been said, there are other healthcare professionals who are equally qualified to do that. Some of it may need legislative changes, which we are working at pace to introduce, but we want to take that bureaucratic burden off GPs so that they are free to see patients when they need to.
There are also a number of other measures in terms of increasing the general practice workforce. As the hon. Member for Barrow and Furness said, communications is a crucial point because it is not always the GP that patients will see in face-to-face appointments. They might see a nurse, a pharmacist or a physio. We need to get that message out at a general practice level, but also at a national level.
Chris Green
On compulsory vaccinations in the care sector, I have concerns about compulsory vaccination on the NHS sector. Would the Minister do what she can to ensure that there is an impact assessment before this is done on the NHS, if it is done in the future?
Maria Caulfield
My hon. Friend is certainly persistent in his questioning on that issue. It is a decision for the Secretary of State, who is looking at such factors. The vast majority of NHS staff have been vaccinated, for their own protection as much as anything else. I want to highlight that we are increasing the number of primary healthcare professionals across the board, aiming to replicate the model used in hospitals, where a consultant leads a team of multi-disciplinary professionals who will help see a patient and are, sometimes, more expert in dealing with certain clinical situation than GPs themselves.
Coronavirus Act 2020 (Review of Temporary Provisions) (No. 3)
Chris Green Excerpts(3 years, 1 month ago)
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Martyn Day
I thank the right hon. Gentleman for his comments, and I do indeed agree. I wonder whether he has seen an advance copy of my notes, because I was coming to that very point. We are still witnessing too many infections and I worry that, when they are combined with flu, we could yet have a very difficult winter ahead for our health services—a “twindemic”, if you like. The successful roll-out of vaccinations and the protection of the most vulnerable remain essential, so I thank the right hon. Gentleman for that point.
As I have said, the SNP welcomes the four-nations approach to tackling the coronavirus pandemic. However, the UK Government would do well to match Scotland’s science and public health-first approach for the remainder of the pandemic. The Scottish Government have followed the science and done what they can within their power, which is why Scotland retains stronger rules on face masks, for example. As we head into what will likely be a difficult winter, the UK Government must be willing to follow the examples set by the devolved nations and be prepared to introduce measures such as face masks in shops and on transport, to protect people from both coronavirus and flu this winter.
Chris Green (Bolton West) (Con)
Scotland and Wales have national ID cards, and if plan B is triggered in England, there is a possibility that we will have an ID card in England, too. Does the hon. Gentleman feel it would have been better to have a whole-United Kingdom covid ID card, so that each nation is in sync, or does he think it is better for each nation to have individual ID cards?
Martyn Day
I should point that they are not ID cards but vaccine certificates. As I have said, we respect the differences, and although we welcome a four-nations approach we will move differently if things move at different paces.
Chris Green (Bolton West) (Con)
We are in a profoundly different place from where we were 19 months ago when we entered the pandemic and went through a series of lockdowns. The medicines that doctors use and prescribe and the procedures that are in place are all profoundly improved. The vaccination programme has been a revelation thanks to the quality, the range and the roll-out of the vaccines. We must recognise that, today, we are in a profoundly different situation from where we were right at the beginning. We just have to look at the third wave that we are going through at the moment and at the connection between infections, hospitalisations and deaths. Those rates are fundamentally different from those in the first and second waves, so we should be taking a profoundly different approach to dealing with this virus.
All variants of concern are defeated by our vaccines at the moment, and we have every expectation that that will continue to be the case into the future. By maintaining the Coronavirus Act 2020, but with perhaps a limited number of provisions, we maintain the fundamental approach to dealing with this virus. Society as a whole and the civil service more narrowly are still looking at this challenge in the same way, and there is not, in that sense, a change of mindset.
We are approaching what will be a tough winter. No matter what happens, we will have a very difficult winter. That may be due to the coronavirus itself or to influenza, but it will also be due to the very significant build-up in waiting lists and in conditions that should have been investigated 18 months ago. We know that these cases are building up and that it will create a huge amount of pressure on the national health service.
I want to focus today on the care sector. Some 18 or 19 months ago, we would have had cross-party consensus on the fact that the care sector needed fundamental reform. That is far more true today than it was back then. It is clear that the care sector needs far more resources today than it needed then. There is a shortfall of about 100,000 carers. With the compulsory vaccination approach that has been taken in the care sector, the Government are expecting another 40,000 carers to leave. That will create huge problems not only for the carers, but for the residents themselves.
In my constituency, the care sector is already under tremendous pressure. Some people are leaving because of the pressure that they are under, and some because they choose not to be vaccinated. Some of them are finding employment in the national health service. They are leaving the care sector and going into the national health service to provide care there, but at some point we may be imposing vaccinations in the national health service as well. We do not know how many will leave the NHS at that stage, but if vaccinations in the NHS stand at about 90%, we could be looking at a loss of more than 100,000 people.
We have concerns about people being transferred out of care in the national health service and into the care sector. We know that the situation is going to get substantially worse as we go through the winter and more carers leave the care sector, but we do not yet know when the same approach will be imposed on the national health service. I therefore ask the Minister: what is the Department’s thinking at the moment? When will we impose compulsory vaccination on the NHS, just as has been imposed on the care sector, and what impact will that have?
We need a fundamental reset in our approach to dealing with the coronavirus. The circumstances are fundamentally different now, because of medical advances and so many other things. We have the opportunity to reverse the decision on the care sector. We want to keep carers caring where they want to be caring. We ought not to be imposing this decision now, because in a couple of weeks it is going to be too late. I am concerned about plan B and the possibility of ID cards or covid passes—
Maggie Throup
Covid certification will be brought in under the Public Health (Control of Disease) Act 1984, which, as my right hon. Friend is aware, allows for emergency measures. We will do our utmost to bring forward the vote in Parliament before any enactment of the need for covid certification.
I return to the comments by my hon. Friend the Member for Bolton West. A consultation about making vaccination a condition of deployment in the NHS and wider social care closes on 22 October. We will consider all the responses in due course.
Chris Green
Does my hon. Friend share my constituents’ perplexity and confusion that the Government think it is suitable to have compulsory vaccination in care home settings—that has been their intention for many weeks—yet they are still confused or undecided as to whether that is equally relevant in the NHS? Carers are going from care settings into the NHS at the moment.
Maggie Throup
I reiterate that we are consulting at the moment for the NHS and other social care settings, and we are not moving the dates that we have already set for vaccination as a condition of deployment in care homes.
The hon. Members for Brent Central (Dawn Butler) and for Twickenham (Munira Wilson), my right hon. Friend the Member for Haltemprice and Howden (Mr Davis) and my hon. Friend the Member for Wycombe (Mr Baker) raised the issue of unlawful convictions. I reassure them that since April 2020, the Crown Prosecution Service has reviewed all prosecutions under the Coronavirus Act, and it continues to do so. As such, the issue is primarily administrative, rather than one of the wrongful use of powers provided by the Act. That policy of review by the CPS has provided an effective safeguard. All incorrect charges made under the Act and reviewed by the CPS have been overturned, and updated guidance has been issued to the police.
Future of the National Health Service
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Chris Green (Bolton West) (Con)
It is a pleasure to follow the hon. Member for Leeds East (Richard Burgon). He made a powerful speech, true to his beliefs and values, and he made some powerful points.
It reminded me of my more radical background when it comes to politics, especially in terms of health. I remember attending—not participating in—a demonstration and march in 2011 in Chorlton, shortly after the new Government came in. It was a reasonably left-leaning march and there were a few Soviet Union flags with the hammer and sickle. One of the most powerful contributions was from a trade union rep, who said, “We don’t need change. We don’t need innovation in the National Health Service. The only change you ever needed in the NHS was in 1948 when it was created. We don’t need any change from then.” That was the spirit, and it is the view that too many people have.
The NHS ought to be changing all the time, in different ways, to keep up with the way people work, and with technology and culture. There are so many ways in which the national health service ought to be changing all the time. We need legislation, led by my hon. Friend the Minister, to make sure that we keep up with changes in society. People would be outraged if we had not moved on culturally from 1948.
What does that lead to? Fundamentally, we ought to be focusing on the importance of patients’ values and needs, to make sure that they are at the centre of the national health service. It is not fundamentally about NHS structures, although those are incredibly important, or about maintaining structures as they are forever, but about ensuring that those structures reflect the needs of the national health service so that it is as effective as possible.
We hear discussions and talk about globalisation, which we know is a reality. Many parts of globalisation are a threat, as highlighted by the hon. Member for Leeds East, who talked about the threats and concerns. However, there are also significant opportunities. We want better access to drugs and medicines, especially innovative drugs and the latest drugs. If we look at figures from the European Medicines Agency about the adoption of drugs, we see that England is behind Germany, Denmark, Austria, Switzerland and Italy. We ought to be at the forefront of the adoption of new drugs and new ways to look after people’s lives.
What do we need to understand when we are thinking about this, especially when we consider treatments and support for people with rare conditions? The UK is often not big enough to provide the innovation for these new treatments, so we need international collaborations. The national health service and other UK bodies need to work with countries around the world, but there is a place for corporations, whether in America, Japan or other places.
We need to ensure that our research and development effort collaborates and works with countries around the world. That cannot be on a Government-to-Government or Government agency-to-Government agency basis only. It has to be right through the system. If we do not have that approach where we need clinical trials at scale to support people or to find new treatments for people with rare diseases, it will not happen. We need to participate in international trials as well.
I would expect these things and I hope my hon. Friend the Minister will articulate that they give more potential to the national health service, because we need more engagement. At the moment, the national health service does not function in the way that many people around the country believe it ought to function. It ought to be far more engaged in clinical trials. Talking to many people from the sector, my sense is that that is down to individual leadership in particular trusts.
Too many trusts do not lead and participate in innovation or the adoption of new drugs, once they have been approved. The system is too slow and it often takes far too long, so patients and patient groups know that their trust or clinical commissioning group does not have the life-enhancing or even life-saving treatment that is available. We need that reform of the system to ensure that it looks after the patients.
There is another aspect that needs changing, which is the way that the NHS is funded or operates. I have a strong sense that it is relatively straightforward for the NHS to adopt a new drug. However, it is far more challenging for the NHS to adopt a new medical device because of the up-front costs and the training needs at the beginning. It is more difficult to adopt a device than it is a drug, and we need to have parity in that. We need the NHS to have the ability to adopt these devices and adapt to them.
That naturally leads on to what devices do. A key part of devices is the generation of data. Data is important for understanding the performance and ability of new treatments to make a difference to people’s lives. The NHS does not operate, to any extent, as a system that works and engages properly and fully with data systems. We need reform of the NHS to do that.
Hannah Bardell (in the Chair)
Order. I hope the hon. Member will wind up his comments shortly.
Chris Green
I will. The integrated care systems ought to be part of this, with local leadership, and hopefully strong accountability, to ensure that leaders in those areas can drive that engagement with medical research technology charities, corporations, institutes and universities, to ensure that the NHS is innovative, adopts new technologies and ensures that patients have the best they can. That is a huge amount of reform, and it must start now.
Edward Argar
The hon. Lady has rightly highlighted the benefits of technology, while my hon. Friend the Member for Bolton West (Chris Green) highlighted the need for us to continue to move with the times and seize those initiatives. I fear that my noble friend Lord Bethell will not be visiting, as he left the Government at the end of last week. However, I have received a very kind invitation from the hon. Member for Central Ayrshire (Dr Whitford) to come and see how the NHS in Scotland is innovating and driving change. I look forward to taking her up on that invitation as soon as I can.
Chris Green
Just as medical devices and drugs innovate change over time, does the Minister agree that the place where the NHS operates and works must also change? Whether those are local surgeries or hospitals, they have to move with the times. In that context, would he also turn his mind to any needs that Bolton Royal Hospital may have in terms of new hospital infrastructure?
Edward Argar
My hon. Friend makes a fair point about the need for us to create the conditions—the physical spaces with the technology—in which the workforce, which is the heart of our NHS, can work. He makes a subtle—or not so subtle—plea for his own local hospital. He will not be surprised that I will not comment on the detail of that.
To finish my response to the hon. Member for Strangford, the Command Paper recognises the challenges posed by the current arrangements in the Northern Ireland protocol around the supply of medicines and other goods, for example. The approach that the hon. Member set out, of removing medicines and medical devices from the orbit of the protocol, is reasonable. I hope that discussions between the European Commission and Lord Frost are productive, and that a consensus can be reached on the way forward.
I have to take issue slightly with the hon. Members who raised the role of Sam Jones, one of the Prime Minister’s advisers. They focused on one particular aspect—that for a brief period she worked for an independent provider. What they did not do, which is extremely unfair to a dedicated public servant, is highlight that she worked for NHS England, running new care models; that she has been an NHS paediatric and general nurse; that she was the chief executive of Epsom and St Helier University Hospitals NHS Trust; that she was the chief executive of West Hertfordshire Hospitals NHS Trust; and that she was the Health Service Journal chief executive of the year for 2014 and was highly commended for her work in driving forward patient safety. I gently say that it ill behoves Members of the House to attack public servants, who cannot answer for themselves in this Chamber, with partial references to their careers rather than recognising that they have contributed a huge amount in the past.
The hon. Member for York Central was absolutely right to highlight health inequalities as one of the greatest challenges—not the only challenge—that we face as a society and as a health system. The measures on integration and change in the Bill will help us tackle those health inequalities. I suspect that on Report and Third Reading she may test and challenge me on those assertions and assumptions, but she is absolutely right to highlight the centrality of health inequalities.
The hon. Member for Liverpool, Wavertree (Paula Barker) spoke about residential care and the link to social care. While I am not the social care Minister, everything that I do in my role as Health Minister must have an eye to social care. I was a cabinet member for adult social care in the dim and distant past, when I had rather more hair, and I also sat on the primary care trust, as it then was, at that time. I recognise the need for those two parts of the system to work together to achieve the best outcomes for our constituents. She makes a valid and important point.
I found what the hon. Member for Wirral West (Margaret Greenwood) said about the US experience of great interest and instructive, but it is utterly divorced from what the Bill and the Government are doing in respect of our NHS. It was an interesting reflection on what is going on in America, but it certainly does not bear any resemblance to what is happening or will happen in this country.