NHS: Long-term Strategy

Clive Efford Excerpts

Wednesday 11th January 2023 Commons Chamber

[Steve Barclay]

As so often, my right hon. Friend raises an extremely important point about how we best use the resources and significant investment being put into the NHS. He will recognise that a key part of delivering value for money is looking at the interfaces on the patient pathway through the healthcare system. Handover points are often when we have the most difficulty.

I am sure my right hon. Friend will welcome that I recently visited Maidstone to see how we track the patient journey through a hospital and into care—residential care or domiciliary care. We are putting control centres in place through the 42 ICBs, and our reforms are bringing health and social care closer together. An area of common ground across the House is on the need to bring social care and healthcare closer together, and the ICBs, which were operationalised from July 2022, are a key part of that.

I suspect that one issue on which my right hon. Friend and I strongly agree is that it has to be underscored by data, so that we can see where the blockages are and prioritise the use of technology, such as machine learning, artificial intelligence, virtual wards and other innovations.

[Clive Efford (Eltham) (Lab)]

Will the Secretary of State give way?

[Steve Barclay]

I am being pretty reasonable on interventions, so if the hon. Gentleman will give me a moment.

[Clive Efford]

rose—

[Steve Barclay]

The Opposition want to hear what the Government are doing, and then they tell me that they do not want to hear.

[Clive Efford]

The Association of Directors of Adult Social Services surveyed English local authorities back in 2019, and it found that they had endured cuts of £6.3 billion in adult social care, resulting in a drop since 2014 of 425,000 beds. How much does the Secretary of State think that has contributed to today’s crisis?

[Steve Barclay]

I am delighted that the hon. Gentleman raises the additional funding that the Government are putting into social care. In his autumn statement, the Chancellor made the biggest social care spending increase of any Government in history: an extra £2.8 billion next year and £4.7 billion the year after. That is £7.5 billion over two years, on top of the £6.6 billion he put into the NHS over two years. At a time when, as a consequence of the pandemic and the war in Ukraine, inflation is extremely high and there are acute cost of living pressures for constituents across the country, the Chancellor prioritised spending not just on health but, as the hon. Member for Eltham (Clive Efford) helpfully highlighted, on social care. Bringing health and social care together is exactly what I set out in my statement to the House on Monday.

NHS Winter Pressures

Clive Efford Excerpts

Monday 9th January 2023 Commons Chamber

[Mr Deputy Speaker]

My apologies to the Secretary of State. I now call Clive Efford.

[Clive Efford (Eltham) (Lab)]

Thank you, Mr Deputy Speaker; I was as enthusiastic to make a contribution as you were for me to make it. What contingency did the Secretary of State put in place for a spike in flu cases? He speaks as if it took the Department by surprise, but it was widely predicted that there would be a spike in flu cases following on from the lockdowns during covid. He has announced 4,500 places to ease pressure, but in his statement he said that in 2020 there were just 6,000 cases of delayed discharge per day—“just” 6,000, as if that is not significant—whereas last year it was between 12,000 and 13,000 cases per day. What he has announced is roughly one third of what he said was the average per day for the last year. Is this not just too little, too late?

[Steve Barclay]

First, the central announcement at the autumn statement was the additional capacity to deal with domiciliary care and further support for social care. That £500 million announcement was part of the £2.8 billion next year and the £4.7 billion the year after. The autumn statement recognised the fact—I would have to go back and check the transcript, but there were many comments around that period pointing to it—that this was likely to be the worst-ever winter because of the combination of pandemic pressure, covid admissions and the risk of flu, which has transpired to be the worst for 10 years. That is why, for example, we expanded the cohort eligible for the flu and covid vaccine to the over-50s and invested in the bivalent vaccine. It is why NHS England put in place an additional 7,000 beds. It is why we have been rolling out virtual wards of the sort used at Watford General Hospital, which is able to address the equivalent of an extra ward. Additional measures have been taken but, over the Christmas period, in line with what happened in Wales, in Scotland and internationally, we saw a rapid spike in flu, with a sevenfold increase in cases over a short period, on top of the pressures already in the system.

Oral Answers to Questions

Clive Efford Excerpts

Tuesday 6th December 2022 Commons Chamber

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

My hon. Friend makes an important point. The NHS is strongly encouraging local vaccination teams to vaccinate staff, as well as residents when they visit care homes. That should be normal practice. I am happy to look into it, if that is not happening in her area. I take this opportunity to encourage any health or social care worker who has not had their covid or flu jab this winter to please go ahead and get one.

[Clive Efford (Eltham) (Lab)]

T5. Parents are becoming increasingly worried about the current prevalence of strep A. It is a time of year when parents are going to have children with high temperatures and sore throats, so concern is likely to be very high. There are also concerns about the availability of antibiotics. Does the Secretary of State believe that this is a moment where the Government need to make a statement and show clear leadership to calm people down and reassure them about the situation?

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

We held a cross-party briefing last night on strep A. We want to reassure parents, and if their children have symptoms and they are concerned, please seek help. GPs are ready and A&E departments are ready, and we have directors of public health proactively going into schools where there are cases. There is no shortage of antibiotics—we want to reassure people on that—and we are keeping an eye on that on a daily basis.

Covid-19: PPE Procurement

Clive Efford Excerpts

Thursday 24th November 2022 Commons Chamber

[Clive Efford (Eltham) (Lab)]

I heard what the Minister said earlier about the process and how meticulously it was followed for every company that applied for contracts during covid. What is it about the individuals or companies that had associations with the Conservative party or Ministers that made them so adept at getting through the process?

[Neil O'Brien]

As I said, 90% of them did not get a contract, so it was not that they were being given some sort of guarantee of a contract. That scheme was a way of managing the contacts that were happening with Ministers. They were being directly contacted by MPs from across the House and all sides of it. There had to be a way of understanding what was happening with each of those bids, because otherwise it would have been completely overwhelmed. To reiterate: all the bids went through exactly the same process—not done by Ministers, but by civil servants—of checking the quality, the price and whether they could realistically deliver. There was no difference in the process that they went through.

Oral Answers to Questions

Clive Efford Excerpts

Tuesday 1st November 2022 Commons Chamber

[Clive Efford (Eltham) (Lab)]

11. What progress his Department has made on recruiting 6,000 more GPs by 2024.

[The Secretary of State for Health and Social Care (Steve Barclay)]

We are making progress on increasing numbers. The number of doctors in general practice has increased over the past three years, from 34,729 in September 2019 to more than 37,000 in September this year.

[Clive Efford]

I am grateful for that answer. I recently met representatives of the local GP network in my constituency who described to me their difficulties in employing GPs. What can the Secretary of State do to ensure that people choose to go into general practice and to make the job much more attractive, so that he hits his target of recruiting 6,000 more GPs, which he is woefully way off doing?

[Steve Barclay]

I touched on that exact point in an earlier answer. There are parts of the country where it is more difficult to recruit GPs; that is why we have a targeted fund to attract people into those areas, with grants of up to £20,000. Alongside the appointment of GPs, we are also looking at using the wider primary care skills workforce, so that people can get to the appointment that they need.

East Kent Maternity Services: Independent Investigation

Clive Efford Excerpts

Thursday 20th October 2022 Commons Chamber

[Dr Johnson]

I know that my right hon. Friend shares the House’s desire to ensure that such events do not reoccur, and that his constituents are safe. He asked about failures over time. In fact, there were signs as early as 2010 that problems were being raised with the trust. The failure was not so much to find those problems, but that they were not properly dealt with when they were found. Yesterday, I received assurances from the regional director of NHS England, as I described a few moments ago, and I will meet her regularly to receive updates to ensure that the process is not just put in place but followed through.

[Clive Efford (Eltham) (Lab)]

The stories of the families are harrowing to read. I hear what the Minister says: that staff shortages cannot be used to excuse the poor practice that has taken place. None the less, it is disturbing that NHS England has abandoned its safety targets under the midwifery continuity of care model. When more midwives are leaving the profession than coming into it, as a matter of urgency to avoid such occurrences in other places, what are the Government going to do to turn around that loss of midwives?

Ambulance Pressures

Clive Efford Excerpts

Monday 18th July 2022 Commons Chamber

[Steve Barclay]

I do not know the specific circumstances of the case my hon. Friend highlights, but in general good consultation and engagement with stakeholders will of course lead to better and more informed decision making. Where decisions have been taken and the outcomes proceed in a sub-optimal way, I know from my knowledge of my hon. Friend that he will make such a case in the strongest terms.

[Clive Efford (Eltham) (Lab)]

It is worth remembering that the 2010 to 2015 Conservative Government took £6 billion out of social care, so it is no wonder that we are facing a logjam. Since 2015, not once have the Government hit their four-hour target at A&E, and it is down to less than 72% on average right now. This logjam is created by the Conservative Government’s mismanagement of our national health service, so what is the Secretary of State going to do to get back to the four-hour target for A&E?

[Steve Barclay]

This Government are investing in our NHS. That is why the resource departmental expenditure limit, which in 2010 was £99 billion, went up last year to £150 billion. It is why we are investing more than £10 billion in capital this year alone. It is why the NHS will get an uplift of about £38 billion over the five years from 2019-20 to 2024-25, and it is why this Government have invested in our 40 hospitals programme as part of a £22 billion commitment.

Access to GP Services and NHS Dentistry

Clive Efford Excerpts

Tuesday 21st June 2022 Commons Chamber

[Wes Streeting]

Thank you, Mr Speaker.

I was about to quote the great political philosopher, Jonn Elledge, who, in response to what the Secretary of State said, commented on Twitter that we are

“all as ants before the might of the all powerful shadow health secretary”.

When is the Health Secretary going to wake up to the fact that he is in government, he has responsibilities, he is discharging the greatest crisis in the history of the NHS and he is doing nothing about it? Instead of lecturing the Opposition, when is he going to show some leadership and get on with governing?

[Clive Efford (Eltham) (Lab)]

The “Panorama” programme also exposed the fact that GP practices are being hoovered up by the private sector. Operose Health now owns 70 practices, with more than 600,000 patients. That exposes the fact that there is now a value to GP patients lists and that they are being sold on. They are collected by GPs, free of charge and then, as they are amassed in great number, they are sold to the private sector. Is my hon. Friend, like me, concerned about that practice?

[Wes Streeting]

I wholeheartedly agree with the point my hon. Friend makes. It is simply not good enough for the Minister to keep on talking about what the last Labour Government did. If she does not agree with the situation described by my hon. Friend, which is happening on her watch, why does she not legislate? If she is incapable of governing, she should make way for people who can govern.

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[Sajid Javid]

We are putting record amounts of investment into the NHS, including more funding into dentistry—I am about to come on to that right now—which will help with those pressures.

[Clive Efford]

Covid is just a pathetic excuse, because even if it was the sole reason, the Secretary of State should have been planning for when we came out of it, but nothing he has said explains why we had record numbers of patients on waiting lists even before covid started.

[Sajid Javid]

I think that many people working across the NHS will be listening to the hon. Gentleman and realising that he has no idea about the pressures that covid has created for everyone working there, especially those on the frontline.

Health and Social Care Leadership Review

Clive Efford Excerpts

Wednesday 8th June 2022 Commons Chamber

[Sajid Javid]

This is a very important issue for my hon. Friend. I would be happy to meet him to discuss it further.

[Clive Efford (Eltham) (Lab)]

NHS staff are exhausted and demoralised, and now we are asking them to deal with the growing waiting lists. We still have a huge vacancy problem within our NHS. Where is the plan to deal with that issue? If we are to improve our NHS going forward and have anything there for these managers to manage, we need to deal with that problem within the workforce.

[Sajid Javid]

That is exactly why I have commissioned a 15-year workforce strategy from the NHS.

Breastfeeding: Government Support

Clive Efford Excerpts

Tuesday 8th March 2022 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady for bringing forward this debate. She has certainly been a champion on this issue—that word is used often in this House, but it is applicable to her. Following on from my work with her in the all-party parliamentary group on infant feeding and inequalities, I met a lady called Claire Flynn—a Breastival board member from Belfast—who I think the hon. Lady knows. She said that breastfeeding strategies and plans vary across Scotland, Wales, England and Northern Ireland. Does the hon. Lady agree that there is a real need to reinstate the infant feeding survey? We understand that work on that is under way at Public Health England. Northern Ireland must be included and funding must be made available to enable that. Through the hon. Lady, I ask the Minister to consider a UK-wide approach.

[Clive Efford (in the Chair)]

Order. For those who missed the start of the debate, and so that people do not miss out on their time—we are tight for time—let me just say that we had planned to give Alison four to five minutes, and she has that now. Then the SNP spokesperson will have three to four minutes, Back Benchers two to three minutes and the Minister 10 minutes. I thought it would be worth intervening with that so that Members could work out the timing of their speeches.

[Kirsty Blackman (Aberdeen North) (SNP)]

On a point of order, Mr Efford. I am happy to squeeze my speech if my hon. Friend would like to extend hers.

[Clive Efford (in the Chair)]

Okay.

[Alison Thewliss]

Thank you, Mr Efford. I had a conversation with some of the senior Clerks, and I had thought I would be allowed to slightly extend my time if we could get back quickly from the Chamber after the statement.

I agree with the hon. Gentleman’s comments about Breastival; it is a wonderful event in Northern Ireland and I have been able to participate in it. I agree very much that we need to have consistency and the infant feeding survey.

The World Health Organisation and UNICEF published a report last month entitled, “How the marketing of formula milk influences our decisions on infant feeding”, which found that this $55 billion industry is still doing all it can to target families and to influence their feeding choices,

“undermining women’s confidence and cynically exploiting parents’ instinct to do the best for their children”.

Their data estimates that scaling up breastfeeding globally could prevent the deaths of 800,000 children under five and 20,000 breast cancer deaths among women every single year, which is quite astonishing.

Exposure to formula milk marketing reaches 84% of all women surveyed in the UK. We all know that this advertising works—that is exactly why companies invest so much money, time and effort in it. It influences which brands we choose and how much we spend. The report states that the evidence is strong that formula milk marketing —not the product itself—disrupts informed decision making and undermines breastfeeding and child health. Those who responded to the survey for this debate agreed. Deborah said:

“The aggressive advertising of infant milks and bottles undermines the giving of human milk at every step. It feeds us doubt of our own bodies.”

Stacey said:

“Advertising infant formula basically makes out that breastfeeding should be done for 6 months maximum, then baby should be on ‘proper’ milk. It is completely untrue and it needs to be better regulated as people just assume a baby will be bottle fed formula and advertising does an excellent job of solidifying this belief.”

Much of the marketing in the UK is done through traditional means such as television, but there is also a lot going on in social media, through companies’ advertising and influencers, and through online baby clubs run by formula companies, which are a tool to recruit and to market to families, and are a lot harder to monitor. What discussions has the Minister had with her colleagues at the Department for Digital, Culture, Media and Sport about whether such marketing should be brought into the scope of the Online Safety Bill? After all, this is about the health and wellbeing of parents and the best start for our youngest citizens.

Alongside investing in comprehensive service provision, the Government should do their bit to advertise breastfeeding. There was a brilliant campaign by the Public Health Agency in Northern Ireland called “Not Sorry Mums”. I encourage the Minister to watch it and to see what more her Department can do to protect, promote and support breastfeeding through the means at her disposal. After all, if there can be giant billboards promoting levelling up, there is no reason why there cannot be breastfeeding ones on exactly the same scale. The new mural in Greenock by graffiti artist Smug depicts beautifully a breastfeeding mermaid across a whole gable end. Some have argued that normalising breastfeeding ought to use real women rather than fantastical mermaids, but it is beautiful and we should have a lot more of that.

I repeat that it is crucial to have the service provision there, not just the advertising or the advice; otherwise, we are setting women up to fail. Emma, who responded, said,

“there is a lot of information promoting breastfeeding through the NHS but then very little actual support to help facilitate it. This mixed messaging then causes women to feel like a failure if they are not successful meeting in their breastfeeding goals.”

Donor milk has a crucial role to play in supporting babies in neonatal units. I am proud that Scotland has had a national milk bank based in Glasgow for some years now, but the picture is a bit patchier in other parts of the UK. Professor Amy Brown and Dr Natalie Shenker have been researching the impact that milk banks can have on the mental health of women and their families, in offering both reassurance and support for mums until their own milk comes through. I urge the Minister to engage with that research and see what more can be done to develop and support milk banking.

The provision of tongue-tie treatment is also patchy, but it can make all the difference to parents. Siân contacted me to share her experience, the distress she went through and her heartfelt thanks to her fairy godmother Lisa, a specialist breastfeeding support worker who listened to her and got her the support she so desperately needed. Everyone should have access to a Lisa.

I would add that it is also important to recognise the other disparities and inequalities that exist. Those living in deprived communities are less likely to breastfeed—although there is some evidence in Scotland of the difference we are making on that. Those who are new to the UK also encounter barriers coming into a bottle-feeding culture and feel pressured to adopt that culture rather than continuing to breastfeed, as their families would have done before. There are also barriers for those who are HIV-positive, who can receive very variable advice, and barriers put in the way of LGBT couples. Laura-Rose Thorogood of The LGBT Mummies Tribe contacted me to highlight the lack of support that she and others like her had experienced. I hope the Minister will meet that group, too, to discuss support further.

I could speak about this for much longer, as I am sure you are aware, Mr Efford. I could give numerous examples and testimony to illustrate what more needs to be done. I would like the Minister to agree to look seriously at the funding of all services and at the full implementation of the international code of marketing breastmilk substitutes, as the World Health Organisation and UNICEF have called for. She has the power to make this change to protect, promote and support breastfeeding now and in the future.

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[Karin Smyth (Bristol South) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Efford.

I thank the hon. Member for Glasgow Central (Alison Thewliss) for securing this important debate, which warrants more time and discussion. I agree that, as we participate in this debate, we are thinking about those women in Ukraine who are either giving birth or are about to give birth in the most extraordinary of circumstances and about the difficulty they face in feeding their children. For those of us who have given birth in normal circumstances, that is a truly horrific thought.

We know that the first few months of a child’s life are crucial for their later development and that parents need support in their choices for their children. I welcome the Minister’s commitment to additional funding for breastfeeding support, but it is clear that the cuts, particularly to Sure Start, were a really bad false economy, with centres having closed, parents lacking support and advice, and children being let down. I was proud to be a governor of a Sure Start early years centre and I know how valuable such centres were.

We have heard that women’s isolation during the pandemic was exacerbated because more services were cut. It was horrific to hear the evidence given by my hon. Friend the Member for Putney (Fleur Anderson) that it was only when she rang up that she found out that the centre she mentioned had closed. We already know that there is a shortage of such venues and that we need more of them.

Disadvantaged mothers are more likely to have babies of low birth weight, and low birth weight is associated with raised blood pressure and coronary heart disease, as well as reduced educational attainment, qualifications and employment. Sure Start centres help to level up and supporting them would be a really easy, quick win for the Government to support women in optimal infant nutrition, particularly breastfeeding.

We know how much breastfeeding increases children’s chance of a better life. According to analysis from the millennium cohort study, by the age of five breastfed children were already one to six months ahead of those children who were never breastfed.

I was fortunate to have three healthy children. I fed them all myself, with variable results; it was difficult with some of them and not with others—I will not say who, because they might at some point watch this debate, and you can never have favourites. When breastfeeding works, it works well, and when it does not work, it is extraordinarily difficult and stressful.

We also know that those households in the lowest socioeconomic groups have significantly worse health outcomes. We know that women in those households need support and that such support yields results in later life. This is an important debate, particularly on International Women’s Day, and I hope that we can have some positive news from the Minister to support women across the country.

[Clive Efford (in the Chair)]

As the Minister knows, we will be suspending the sitting at 4.55 pm, but if she can make a start now perhaps I can give the mover of the motion longer for summing up at the end.

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[Maria Caulfield]

I do not have that information, but I was interested to hear about the experience in Putney. I will take that away because I spoke to midwives who were redirected during covid, but I am not aware of which services have and have not restarted. I am keen to look at that, so I will follow that up. I am happy to conclude, Mr Efford, if that would be helpful.

[Clive Efford (in the Chair)]

The message we are receiving is that the Chamber has been suspended. I was going to suspend the sitting at 4.57 pm, but if the Minister has finished, we can suspend now and come back after.

[Maria Caulfield]

I will just conclude by thanking everyone. There remains a huge amount to be done. I very much take on board the points that have been raised in the debate, and I will follow up with colleagues because we need to put breastfeeding higher up the agenda.

[Clive Efford (in the Chair)]

I am suspending the sitting for 15 minutes, but we will start as soon as people are back in their places.