Inequalities in Dementia Services

Debbie Abrahams Excerpts

Thursday 16th May 2024 Westminster Hall

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

I beg to move,

That this House has considered inequalities in dementia services.

It is a pleasure to serve under your chairship, Ms Rees. I thank the Backbench Business Committee for granting me this debate to discuss the huge inequalities in dementia diagnosis and other services across the country. I also thank the Alzheimer’s Society for providing the secretariat to the all-party parliamentary group on dementia and for supporting our many inquiries, including the inquiry we conducted into dementia diagnosis last week, which was published in our “Raising the Barriers” report. My particular thanks go to Lewis and Connor for their briefings and for helping me to prepare for this debate.

It is a real honour to have recently been re-elected as co-chair of the all-party parliamentary group on dementia, a position that I have held since 2015. My other co-chair is Baroness Angela Browning, and like Angela I became involved in the APPG because I became a carer of a loved one who developed one of the brain diseases that cause dementia. In my case it was my mum, who was also called Angela. She was diagnosed with Alzheimer’s disease in 2002, when she was just 64, and I cared for her along with my stepfather and brother. After she died in 2012, I became the first MP to train as a Dementia Friends champion and was subsequently elected as co-chair of the APPG on dementia in 2015.

This debate could not be more timely. As you know, Ms Rees, this week marks Dementia Action Week. Yesterday I had the pleasure of sponsoring the Alzheimer’s Society’s reception in Parliament for Dementia Action Week, where we welcomed many Members to hear about the importance of a dementia diagnosis and the transformative potential of new treatments for dementia. Back in January, I spoke in another Westminster Hall debate looking at the advent of new treatments, particularly lecanemab and donanemab. Those drugs have caused huge excitement, as they mark the first ever treatments for people in the early stages of Alzheimer’s disease and could change the way that we see dementia forever. However, even in that debate I highlighted the barriers to those drugs being delivered to patients and sounded a note of caution that they are neither a cure nor a quick fix. I was really reassured that the approval of lecanemab and donanemab is going through the regulatory cycle at the moment, and we hope to hear when they will be available in the next couple of months.

The fact of the matter is that dementia is a monumental pressure on our health and social care system, but it is all too often an afterthought in commissioning. It is not commonly known that dementia is the leading cause of death in the UK. Nearly 1 million people have dementia, but of those one in three currently live without a diagnosis. Dementia costs the economy more than £40 billion each year, and more than 60% of that cost is borne by individuals and families. Those facts may come as a surprise to many, including many commissioners, but I will focus today on two important inequalities in dementia: the inequality in dementia diagnosis rates between different parts of the country and different groups of people, and the inequality between those who do and do not have access to post-diagnostic support.

First, I will share some information that hon. Members will hopefully find useful. When we talk about dementia, we are using a collective term covering the common symptoms associated with a range of brain diseases. Alzheimer’s disease is the most common of those, but they also include vascular dementia, which my mother-in-law had, Lewy bodies, frontotemporal dementia and many others. Each of those brain diseases has different pathology and as a consequence will have different therapies.

Right now, more than 900,000 people live with dementia in the UK, as I mentioned. Due to our ageing population, that figure is set to rise to 1.6 million by 2040, but I need to stress that dementia is not an automatic part of ageing, although it is more prevalent in older populations. People with dementia account for more than 70% of the residential care home population over the age of 65 and 60% of people receiving home care. Meanwhile, as revealed by NHS performance data published earlier this year, it is estimated that a quarter of NHS beds are occupied by people with dementia. They remain in hospital on average twice as long as people who do not live with the condition. Unfortunately, that reflects the crisis in our social care system and not being able to safely discharge people back into the community or to residential care.

I reflect on where we are in relation to our social care system and the opportunities that we have had, for example through the Dilnot proposals back in 2015, and I really do hope that focused the minds of all of us in what we do. I certainly will be supporting, and have for many years been supportive of, a national care service.

Diagnosis is the key that unlocks vital care and support for people living with dementia, particularly those who are struggling to manage their symptoms alone. It helps people to understand their condition. It allows them and their loved ones to start planning for the future but, as I mentioned earlier, currently just one in three people estimated to have dementia receive a formal diagnosis. The benefits to receiving a diagnosis are massive—access to new treatments and to the care and support that is needed. Alzheimer’s Society reported earlier this week that 91% of people with a dementia diagnosis saw real benefits to having received one. However, the dementia diagnosis rate in England dropped from 67.6% to 61% during the covid pandemic. Currently it is 64.8% in England—below the national target of two thirds.

[Andrew Gwynne (Denton and Reddish) (Lab)]

I am very grateful to my hon. Friend for giving way and I commend her, not only for securing this debate but for the powerful work she does in this area of policy. She raises the national target for two thirds of people with dementia to be diagnosed. That is not nearly ambitious enough. Is she also concerned that there are huge variances across the country? How can it be that a place like Stoke can get 90% diagnosis and a place like Swindon 50%?

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[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

I am very grateful to my hon. Friend for his intervention. This is the absolute crux of the issues we are facing. First of all the target is not ambitious enough, but as he rightly says there are these inequalities. I prefer calling a spade a spade, so these are inequalities and we need to call them what they are. Although the national picture is poor, if we dig further into the data we can see that there is a huge regional inequality in dementia diagnosis rates. In my Oldham constituency, for example, the rate is above 75% and in Devon it is just 40%. Where you live has a massive impact on whether you get a timely, accurate and high-quality dementia diagnosis. A postcode lottery on this scale for a condition that will affect one in three of us is not acceptable.

The APPG’s dementia diagnosis inquiry revealed several issues. There are significant differences in the dementia diagnosis rates between integrated care system areas in England. The report referred to a recent Alzheimer’s Society survey of clinicians, clinical commissioning groups—the predecessors of the ICSs—and dementia support workers. Poverty and health inequalities were identified as major barriers to getting a dementia diagnosis. This was also borne out by analysis by the Office for Health Improvement and Disparities. I have to say I do not particularly like the title of that organisation; I think it should be the “Office of Health Improvement and Inequalities”.

Similarly, there were lower rates of diagnosis in ethnic minority populations. For example, the City of Wolverhampton has an overall diagnosis rate of 70%, but just 35% for people from an ethnic minority community.

Alzheimer’s Research UK also undertook an analysis and published a report last October—“Towards Brain Health Equity: Tackling Inequalities in Dementia Risk”—and this highlighted research identifying vulnerable groups and the dementia risk that they face. That is also an inequality. It referred to research in England and Wales that showed that socioeconomic deprivation and ethnicity are linked to increased dementia mortality, younger age at death from dementia and poorer access to specialist diagnostics. A number of recommendations were made around that. We know that there are 12 modifiable risk factors associated with dementia, and the report focused on action around reducing air pollution, lowering smoking rates, healthy eating, tackling higher blood pressure and identifying and treating hearing loss.

Returning to our APPG inquiry, we received input from more than 2,300 people and I thank them sincerely. Those people have gone through—either themselves or with a loved one—a dementia diagnosis process. They shared their experiences in our survey and we found that every part of the country produced different experiences of the diagnosis system. In Somerset, for example, people were most likely to report that they were satisfied with the time it took for them to receive a diagnosis but were least likely to say that they received satisfactory post-diagnostic support. In London, respondents had the best access to brain scans but found it most difficult to access GP appointments. I know that £17 million was invested in dementia diagnosis by the Government in 2021-22 and that part of that money was to develop best practice advice.

[Andrew Rosindell (Romford) (Con)]

I commend the hon. Lady for calling this debate and for her work through the APPG. I say to her, and to the Minister, that today we are seeing more people being diagnosed with dementia and dying than is the case with other conditions, such as heart disease and cancer. Why does the hon. Lady think we are not investing more resources in research and support for people who suffer from this terrible condition?

[Debbie Abrahams]

The hon. Member is absolutely right; there is less money going into research. On why there is not more done about it, the hon. Member really needs to direct that question to the Minister. I have set out all the evidence that says it should be a priority for the families and individuals affected and a priority for our society, and it should also reflect how we organise our care system, given that predominantly the people in the care system are those living with a diagnosis. The hon. Member will therefore have to direct that question to the Minister.

Going back to my point about the investment made in 2021-22, can the Minister update us on how that is going and the improvements that she may not see immediately but which she hopes to see? Clearly, that is something we need to see as part of the levelling-up agenda.

As I said before, 2,300 people filled out our online survey and shared their stories to inform our work. Sadly, just 5% of people’s stories were positive. Five per cent: that is awful, is it not? After a constituent came to see me regarding concerns about the delay for her mother’s diagnosis—it took her 15 weeks to get an appointment for her mother to attend for a dementia diagnosis, during which time she noticed a considerable decline in her cognitive health—I tabled some written questions on the proportion of people waiting more than 15 weeks for an initial dementia diagnosis and the average waiting time for an assessment. I was told in response on 22 January 2024 that those data were “not held centrally”. I find that extraordinary. National strategies should not just reflect the evidence and data for a national profile around dementia, so we should agree that that needs to change.

[Andrew Rosindell]

My constituency is in the London borough of Havering, with the second highest number of older people in the whole of Greater London. At the moment, on average it takes over 16 weeks to get a diagnosis. Of course, the quicker the diagnosis the better, so it is important that we reduce the length of time that people have to wait to know the condition they are suffering from. Consequently, I fully support the hon. Lady in urging the Government to make earlier diagnosis a greater priority.

[Debbie Abrahams]

I am very grateful to the hon. Member for that intervention, and I absolutely agree.

All of that underlines the importance of improving the dementia diagnosis pathway and making it work better for people living with dementia and their loved ones. The APPG has developed a series of recommendations across the core themes of dementia diagnosis, data, workforce, and public health messaging. Collectively, these recommendations outline how dementia pathways can be strengthened to enable access and quality care across all settings, communities and regions in England. I would be grateful if the Minister could say what work the Department is undertaking in those areas to reduce inequalities in the experience of dementia between localities and population groups.

I turn now to the inequality between those who have post-diagnostic support for dementia and those who do not—or, perhaps more insidiously, the gap between what people with dementia are supposed to receive and what they actually receive. Guidance states that people living with dementia should be offered a review with a healthcare professional at least once a year. However, just 25% of people with dementia who were polled by the Alzheimer’s Society said that they or their loved one had had an annual dementia review within the last 12 months, and only 16% said that they had received enough support from local services in the last 12 months. In addition, more than half said that, even if they had received an annual dementia review, it did not help them feel more able to manage their condition.

This trend continues outside primary care and in allied health professions. Over half of people with dementia who have been signposted to mental health services report having to wait up to a year for treatment. Evidence shows that mental health treatments can be effective in treating depression and anxiety symptoms associated with dementia, but just 0.002% of referrals to NHS talking therapies are for people with dementia—that is 2,000 people out of 1 million referrals.

A quarter of people with dementia wait for up to a year for occupational therapy after referral. Occupational therapy can help people to avoid dangerous falls and to live well in their own home for as long as possible. The average time spent in hospital for a hip fracture is seven days, but patients with dementia stay in hospital for up to four times longer a hip fracture. The additional cost—I know it should not be just about cost, but there is an associated cost—is almost £6,000 per patient, which is far more than the cost of an occupational therapy appointment. I have to say that I just do not get why we are prioritising things in this way.

I do not want to reduce health and social care decisions purely to finance, but the fact of the matter is that early intervention for people with dementia saves so much money. The Alzheimer’s Society reported on Monday that the cost of dementia to the UK economy is £42 billion a year, and that figure will skyrocket to £90 billion by 2040 because of our ageing population. The cost of dementia rises significantly as the condition progresses. The average cost of care for someone in the early, or milder, stages of dementia is about £28,000 a year; in the later, severe stages of dementia, it rises to well over £80,000 a year. Caring well for people with mild dementia can prevent falls and infections, which cause unnecessary hospitalisations and deconditioning, which increase the speed of deterioration in people with dementia. Early identification and increased spend in the early stages of dementia pay dividends further down the pathway.

I would like to end by putting three questions to the Minister, and I would be grateful if she could address them in her response or in writing at a later date, if that is easier for her. First, what will the Department do to ensure that where someone lives, their socioeconomic status or their ethnicity do not negatively affect their likelihood of getting a dementia diagnosis? Secondly, what will the Department do to ensure that everyone with dementia has access to high-quality, post-diagnostic care, regardless of where they live? Thirdly, it was two years ago this week that the right hon. Member for Bromsgrove (Sir Sajid Javid) announced a 10-year plan for dementia, which was then folded into the major conditions strategy. However, we still do not know when that strategy will be published. Can the Minister update us on when we can expect publication of the strategy?

Dementia is a monumental health and social care challenge, and will be the defining test of our system in the decades to come—I have absolutely no doubt of that. We have spoken in this place about planning for the next generation of dementia care in the context of the new, potentially transformative drugs that are currently under appraisal, but almost 1 million people are living with dementia in this country today, and much more can be done to get them the care and support they need and deserve at the earliest possible moment.

I would like to thank the Backbench Business Committee and those who have joined us on a Thursday afternoon when a lot is going on in Parliament. I look forward to the Minister’s response.

[Christina Rees (in the Chair)]

May I remind Members that they should bob if they wish to be called to speak?

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[Debbie Abrahams]

I will be very quick because I know that people have trains to catch, but I want to reiterate the Minister’s thanks to everybody for taking part. This has been a particularly nice debate in its collaborative approach, and I thank her also for saying that she will follow up on the data and whether it could be retained centrally. I also hope that there is evidence that has been supplied here and elsewhere that will help to strengthen the dementia aspect of the major conditions strategy. We have not spoken about type-specific diagnoses, so I ask the Minister to ensure that that is included, because access to the therapies will not be available without that.

Question put and agreed to.

Resolved,

That this House has considered inequalities in dementia services.

Post Office Governance and Horizon Compensation Schemes

Debbie Abrahams Excerpts

Monday 19th February 2024 Commons Chamber

[Kemi Badenoch]

I knew that someone would ask that question. I in fact have evidence to show that I asked Sky News not to run the story. Of course I did not leak it—because if I had, that would have created legal risk if Mr Staunton had found out on the news before I had had a chance to speak to him. We have no idea how Sky News found out the information—several thousand people work in the Department for Business and Trade, and many more work at the Post Office and UK Government Investments. [Interruption.] The hon. Member for Rhondda (Sir Chris Bryant) is heckling, but the point I am making is that leaks are incredibly damaging and harmful; they create legal risk for the Department. I did not do so; I made multiple efforts with at least two media outlets to make sure that they did not create problems for Mr Staunton, and it is one of the reasons why it was very disappointing to see what he did in The Sunday Times at the weekend.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

To be honest, I am afraid I do not think that the Business Secretary and her statement have helped us to get closer to the truth in this situation; it is a question of the Secretary of State’s version of events and the former chairman’s version of events. For clarity, and to try to draw a line under this and get to the truth, is the Secretary of State willing to refer herself to the ethics adviser?

[Kemi Badenoch]

I think that is a ridiculous assertion, and from someone who clearly did not listen to the statement. The difference between what I am saying and what Mr Staunton is saying is that I have officials who will back me up, I have members of the Post Office board who will back me up, and I have newspaper and media outlets that know that I tried to stop the story. The fact is that the hon. Lady just wants to believe Mr Staunton’s allegations because that helps Labour politically, but they are not true. They need to listen to the truth and stop hoping for lies; that is not what our job is in this House.

Oral Answers to Questions

Debbie Abrahams Excerpts

Thursday 25th January 2024 Commons Chamber

[Kevin Hollinrake]

The hon. Lady is absolutely right to raise that point. Yes, the compensation scheme is there to compensate and provide redress for financial loss, but also, quite rightly, for personal loss, loss of reputation, impact on health—those kinds of matters. There are two routes open to compensation: the £75,000 fixed-sum award, which is pretty much an immediate payment, or someone can go for a full assessment of losses, which takes into account all those matters. Interim payments are also available. We have paid out £153 million in total across the schemes. I am happy to help the hon. Lady with that specific case, and we are looking to try to expedite the payment of full and fair compensation to all individuals. I am working on a daily basis to try to do that.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

13. What steps her Department is taking to help tackle late payments to small and medium-sized businesses.

[The Parliamentary Under-Secretary of State for Business and Trade (Kevin Hollinrake)]

The Government are committed to tackling late payments. That is why we launched the prompt payment and cash flow review, which was published alongside the autumn statement. The review includes amending payment performance reporting requirements for large businesses, and providing the Small Business Commissioner with more powers to investigate late payments.

[Debbie Abrahams]

Small businesses are the backbone of our economy, but unfortunately late payments continue to blight the ability of small businesses to trade, with an average of £684 million a year being lost. Unfortunately, that is on the increase, with a 7% increase in 2023. I appreciate what the Minister said about another review— I think we had one a few years ago—but what specific actions are the Government taking to address this appalling abuse of power, which is contributing to 50,000 small businesses going under a year?

[Kevin Hollinrake]

The hon. Lady is right to raise this issue, and earlier I set out specific actions such as giving the Small Business Commissioner more powers, and producing league tables. We work closely with the Good Business Pays campaign, which produces league tables on this issue, and naming and shaming the people responsible is important. The Government are leading the way, and from April 2024 firms bidding for Government contracts worth more than £5 million will have to demonstrate that they pay their invoices within an average of 55 days, tightening to 45 days in April 2025 and to 30 days in the coming years.

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[Mr Speaker]

Please, do not do that. I called the next Member, so I expect you to sit down. It is topical questions, not free statements.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

T5. Will the Post Office Minister meet me and my constituent, who was a postmistress? She lost £250,000 in 2000. It is an unusual case, otherwise I would write to him, but it does need him to meet her, so I would be grateful if he would do that.

[Kevin Hollinrake]

Yes, I would be very happy to meet. There are three compensation schemes and it depends on which one she falls into. If it is the group litigation order, an immediate award of £75,000 can be made; if it is an overturned conviction, the amount is £600,000. I am sure there will be one scheme that the hon. Lady’s constituent will fit into. I am very happy to meet her to help ensure she finds the right one.

Measles

Debbie Abrahams Excerpts

Monday 22nd January 2024 Commons Chamber

[Maria Caulfield]

The Chair of the Health and Social Care Committee is right. That is why we have met with both the west midlands and the London teams to hear from those on the ground what resources they need in order to become more nimble in the vaccine roll-out. The communities that are not coming forward are the ones that are not engaging with the routine MMR vaccine programme, so we need to be more nimble, which is why we are hearing from those vaccinating on the ground about vaccine buses going into communities, pop-up clinics in schools, and GPs putting on extra vaccine clinics. From our data, we have a list of the children who are unvaccinated, and more than a million letters have gone out to their parents to urge them to come forward.

My hon. Friend is right about using pharmacy, with Pharmacy First as a model, to make it even easier for people to come forward, but the real barrier is people’s reluctance to get vaccinated for a variety of reasons, whether it is vaccine fatigue through covid or because they missed their routine appointments and find it difficult to come forward at an extra clinic. We are engaging with local authorities and the Department for Education to try to make it as easy as possible for children and adults to get vaccinated.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

There are clear inequalities in vaccination uptake, including MMR, which reflect various socioeconomic inequalities. What extra support is being given to those areas, and to places such as mine, and why, as the Chair of the Health and Social Care Committee suggests, was the risk assessment of the UK Health Security Agency seemingly ignored by the Government?

[Maria Caulfield]

I can assure the hon. Lady that it was not ignored by the Government. Over the past 12 months, we have been pushing vaccinations to those who have not come forward, and to communities that struggle with vaccination uptake, which is why in the past 12 months there has been a 10% increase. As I say, that is not enough. There are still people who need to come forward for vaccination who have not done so. I emphasise to the House that this is an acute outbreak of measles. If someone has their first dose of the measles vaccine today, within two weeks they will have roughly 92% immunity. If they go on to have the second vaccine, they will have roughly 98% immunity, which will be lifelong.

Horizon: Compensation and Convictions

Debbie Abrahams Excerpts

Monday 8th January 2024 Commons Chamber

[Kevin Hollinrake]

My hon. Friend’s knowledge of history is greater than mine, but the essence of what he says is something we concur with. Whether by means of the route he mentions or other routes, we are keen to ensure that we make it easier to overturn convictions, ideally without the postmaster having to do anything. That is something we are looking at now but, again, we need to have conversations with the judiciary and other elements of the system to make sure that there are no unintended consequences from what we are doing—in terms of precedents, for example. However, our ambitions are exactly the same as my hon. Friend’s.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

Following on from what the hon. Member for Kettering (Mr Hollobone) said, the chair of the independent advisory board, Professor Chris Hodges, is also suggesting that a simple piece of legislation could be introduced to the House, which would ensure pardons en masse and quickly. Will the Minister speak in particular about compensation for bereaved families where former sub-postmasters or sub-postmistresses took their own lives?

[Kevin Hollinrake]

I thank the hon. Lady for her question and again pay tribute to the work of the advisory board, including the chair Professor Chris Hodges, Professor Richard Moorhead, Lord Arbuthnot and the right hon. Member for North Durham. It has done fantastic work and I hope to attend its meeting on Wednesday, where we will discuss some of these issues. It is a further tragedy, of course, for the bereaved families. I have a family in my constituency in exactly that situation. The same amount of compensation should be made available to the family. I know that that is cold comfort for many people in that situation, but it is the least we can do to ensure that at least some compensation is paid to the family, who will also have been affected by this scandal.

Arms Export Licences: Israel

Debbie Abrahams Excerpts

Tuesday 12th December 2023 Westminster Hall

[Zarah Sultana]

I thank the hon. Gentleman for that intervention.

Amnesty International says the

“arms licensing system is not fit for purpose in assessing risk, is riddled with loopholes and is in…need of root-and-branch reform.”

That is why I introduced a Bill this week that would allow us to launch an inquiry into the use of arms sold to foreign states and to suspend arms to any state that might use them in violation of international law.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

I thank my hon. Friend for her excellent speech and for all she is doing on this important issue. I associate my remarks with the personal approach she has taken, because I have a constituent whose partner is being bombed as he tries to evacuate from south Gaza. Does my hon. Friend agree that, in addition to arm sales to Israel, we should think about arm sales to the US, Saudi Arabia and many other countries, and ensure that we tighten the licensing arrangements for arms manufacturers to those countries?

[Sir Christopher Chope (in the Chair)]

Order. This is a debate about arms sales to Israel.

Draft Health Protection (Coronavirus, Testing Requirements and Standards) (England) (Amendment and Transitional Provision) Regulations 2023

Debbie Abrahams Excerpts

Wednesday 22nd November 2023 General Committees

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

I beg to move,

That the Committee has considered the draft Health Protection (Coronavirus, Testing Requirements and Standards) (England) (Amendment and Transitional Provision) Regulations 2023.

It is a pleasure to serve under your chairmanship, Mr Paisley. I will begin by setting out the policy context for the regulations, and then explain the effects of the proposed changes. We all remember that during the covid-19 pandemic the Health Protection (Coronavirus, Testing Requirements and Standards) (England) Regulations 2020 focused on enabling providers who met appropriate quality standards to rapidly enter the private covid-19 testing market. At the time, the right balance was struck between protecting public health and growing the market quickly, both of which were necessary public health outcomes. Now that the threat of covid-19 is reduced and there is no longer an urgent need to grow the testing market quickly, the Department has reviewed the 2020 regulations and proposes that all private providers must be now be fully accredited before they provide testing services.

The 2020 regulations introduced a three-stage accredit- ation process for organisations providing covid-19 testing commercially, to speed up entry to the market. Stage 1 required a private provider to make an application to the United Kingdom Accreditation Service for accreditation, and to make a declaration to the Department that it met and would continue to meet certain minimum standards. Stage 2 required an applicant to demonstrate within four weeks of applying for accreditation that it met the requirements published by UKAS. Between January and June 2021, stage 3 required providers to complete their application within four months.

In June 2021, we passed legislation to update stage 3, thereby requiring applicants to achieve a positive recommendation from UKAS within four months of completing stage 2. As long as a provider received that recommendation, it then had a further two months to achieve accreditation. Providers that failed to meet those deadlines, or failed to satisfy UKAS that they met the relevant standards, had to stop supplying tests. At the time, our approach ensured that enough providers were able to enter the market to meet the public’s demand for covid-19 testing, while still putting providers through an appropriate approvals process.

However, we are now more than three years on from the start of the pandemic, the living with covid strategy has been in place for over a year and the World Health Organisation has declared that covid-19 is no longer a public health emergency of international concern. It is, therefore, the right opportunity to review and update covid-19 legislation on private providers to bring in requirements and standards to strengthen consistency, safety and high-quality covid-19 testing services.

The proposed changes will empower consumers to choose a private testing service with confidence, while continuing to improve safety and quality.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

I notice that there is no impact assessment associated with the regulations—why is that? Will the changes to the regulations take into account the investigation into Immensa and the errors that resulted in 39,000 covid tests being inaccurately assessed as negative? Will the Minister reassure us that that will be the case, and explain why there was no impact assessment?

[Maria Caulfield]

Certainly. I will come in a moment to the standards we are changing to meet those concerns.

First, under the new regulations, from 1 January 2024, in order to enter the private covid testing market private providers will have to achieve accreditation against the appropriate ISO standard by a signatory of the international laboratory accreditation co-operation mutual recognition agreement. That should give Members confidence that providers will now have to meet an internationally recognised standard. There will be consistent testing standards across the board that meet the ISO standard and are accredited by a signatory of that mutual recognition agreement. The new requirements will replace the three-stage accreditation process required under the existing regulations, which I just outlined, to make sure that providers meet a certain standard.

Secondly, we are removing the requirement for providers to get sign-off from the Department at the start of the application process, because they will have to be accredited before they can enter the market; thirdly, we are shifting the legal responsibility for clinical services to the clinical organisation, rather than it resting with customer-facing organisations; and finally, we are removing the duplicative provision for the validation of testing and ensuring that the regulations reflect the publication of the updated ISO standard, which is 15189:2022.

The changes in the regulations are forward-looking and do not affect private providers that have applied for accreditation before the instrument comes into force. Those providers will still need to complete the application process but can do so using the current staged accreditation system.

On the point made by the hon. Member for Oldham East and Saddleworth, we are moving to a system in which accreditation will have to be achieved against the new ISO standard, and that will apply across the board and be comparable to other countries. We will move away from the three-stage process that we used during the emergency phase of the pandemic, when we had to balance risks and benefits. The risk at that time related to the need to get as much testing out to the public as possible, but that has now reduced, so it is important to set high standards so that people have confidence in the tests they get done.

The regulations will reduce the bureaucracy involved in applying for accreditation while still delivering the rigorous accreditation requirements that are important for public health. I therefore commend the regulations to the Committee.