Countess of Chester Hospital Inquiry
Diana Johnson Excerpts(3 years ago)
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Steve Barclay
I absolutely agree with my hon. Friend’s sentiment in putting families and their wishes central. I hope he will understand that as part of an independent inquiry, it will be for the judge to decide which hearings are held in public and which are in private. In essence, part of the initial discussion on a non-statutory inquiry and my discussion with the families was about balancing privacy concerns versus the more adversarial and public nature of a statutory enquiry. I know that Justice Thirlwall will be sensitive to the families’ wishes and what is the appropriate balance between hearings held in public and those held in private.
Dame Diana Johnson (Kingston upon Hull North) (Lab)
After all that has happened, it was surely a mistake not to implement recommendation 5 of the Kark review. Why does the Secretary of State not just get on with it and bring it in to disbar senior managers in the NHS?
Steve Barclay
The Kark recommendations that were accepted, which cover events since those covered at Chester, are believed to have addressed the concerns about the revolving door, but given the issues that have come to light through the case in Chester, I have asked NHSE colleagues to revisit that decision without waiting for the inquiry to look at that. Of course, the inquiry will also look at what is the right balance of regulation for managers.
Recovering Access to Primary Care
Diana Johnson Excerpts(3 years, 4 months ago)
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Steve Barclay
My hon. Friend is right about the opportunity that tech offers to deliver changes at scale and the fact that this is proven technology that is working and already up and running in many primary care settings. So often within the NHS the challenge is not the initial innovation—we get pockets of wonderful innovation—but how we industrialise it across the wider NHS. This recovery plan focuses on that, looking at how we scale the case studies to which he refers. About half of primary care does have digital telephony. The opportunity here is to target that funding at the other half; that is often the smaller GP practices, as well as those in coastal communities, because they find the transition to tech more difficult. That is why a key part of this recovery plan is about the investment in not just the tech, but in locums, to provide cover so that staff can make the transition to that new way of working.
Dame Diana Johnson (Kingston upon Hull North) (Lab)
The NHS workforce plan has been promised for years. Meanwhile, as my hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy) says, we are short of GPs, pharmacists and dentists in Hull. Will the Secretary of State answer the question she put to him: can we please build on the excellent work of the Hull York Medical School to set up a dental training school there, and a school of pharmacy and one for ophthalmologists? That would help in the longer term, but we need a proper workforce plan and the Government need to get on with it.
Steve Barclay
As I have said several times, we will publish a workforce plan shortly. We are committed to that and the Chancellor set that out in the autumn statement. Of course, when he was doing this job and when I was previously in the Department, we expanded medical undergraduate places by a fifth, so there was an increase then. I have said that we will also set out a dental recovery plan in due course.
Reforms to NHS Dentistry
Diana Johnson Excerpts(3 years, 4 months ago)
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Dame Diana Johnson (Kingston upon Hull North) (Lab)
I congratulate my hon. Friend the Member for Bradford South (Judith Cummins) and the hon. Member for Waveney (Peter Aldous) on their persistence. Let us hope it starts to pay off and they do not need that fourth debate on the subject.
As my hon. Friend the Member for Bradford South has said, NHS dentistry is in crisis. There is a recruitment and retention crisis, which the Government have allowed to develop and grow to the point that many of my constituents in Hull North have been left with no access to an NHS dentist. We all know what needs to be done to fix the problem, but the Government have continued to drag their feet over the need for a new dental contract, for new dental schools and for expanding the number of dentists that we have in this country. It is almost like they have hoped that those who can afford to do so will go private, and those who cannot will just sit and let their teeth rot.
Right now, people in Hull North are paying for the Government’s time wasting with their dental health. One constituent has told me of waiting lists at a local NHS dentist of more than 1,500 people, and another has tried to call every NHS dentist within 30 miles, but the earliest appointment they have available is January 2025. A concerned parent tells me that their 11-year-old has not seen a dentist since they were six years of age, and their four-year-old has never seen a dentist, despite being on several waiting lists across Hull since they were a baby. I have had headteachers tell me that children do not go to school because of dental pain and being unable to get access to a dentist.
In Yorkshire and the Humber, as my hon. Friend referred to, in the year ending 2022, 4,560 children under the age of 10 were hospitalised for tooth extractions. That shocking figure includes more than 1,500 babies and toddlers under five with cavities so bad that they have had to have their teeth removed. The situation is shocking and considerably worse in Yorkshire, the Humber and the north-east than elsewhere in England.
What we need are more NHS dentists. We need to recruit more NHS dentists, and if we want to tackle the dental recruitment problems, we obviously need to train more NHS dentists. Years ago, the University of Hull, in partnership with the University of York—I am very pleased to see in her place my hon. Friend the Member for York Central (Rachael Maskell), who represents that university—put in a joint bid for a dental school.
It was to go alongside the brilliant Hull York Medical School, which had been established under the Labour Government when there was a real need for more doctors to be trained. The idea was that we would “grow” our own doctors from the area where the medical school was based. Let us imagine what would have happened and the situation we would be in today if we had been allowed to have that Hull York dental school.
After all the dither and delay that we have been talking about, we can correct our course today. There is plenty of existing support and the capability to deliver a high-quality training facility in the Humber area, which could directly serve one of the worst affected regions in the country, but we need the Government to step up to give us the resources and provide the funding for places.
I am, however, grateful to the Under-Secretary of State for Health and Social Care, the hon. Member for Harborough (Neil O’Brien), for agreeing to meet me after I raised this issue in Tuesday’s Health questions. I also commend him for the speed with which his office contacted mine to arrange that meeting. Getting a ministerial meeting that quickly is unusual these days, so I thank him for that. A Hull dental school could be part of a long-promised workforce plan for the NHS. It could mean that we have sufficient UK-trained, highly qualified dentists and, with the necessary changes to the dental contract, a decent reward for their hard work. We also need to remember that we are competing in a global market for dentists. I was struck by the fact that if a dentist goes to Canada, they receive a £63,000 golden hello and the offer of residence. That is clearly tempting for many dentists who train in this country and feel they are overworked and get too little pay.
To date, the Government have been missing in action, dentists have been voting with their feet and patients in Hull have been paying with their teeth. We need more NHS dentists. Let us train them. Let us get on with it and do it now, and let us do it in Hull.
Oral Answers
Diana Johnson Excerpts(3 years, 4 months ago)
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Will Quince
My hon. Friend is right to raise this issue. Over 12,000 more participants a month are recruited into clinical trials than before the pandemic, but we recognise that there is much more to do in order to be internationally competitive, including around regulation and speed of approval. I am pleased to say that in the coming weeks, Lord O’Shaughnessy will publish his independent review into UK clinical trials, and I very much look forward to receiving his recommendations.
Dame Diana Johnson (Kingston upon Hull North) (Lab)
NHS Strikes
Diana Johnson Excerpts(3 years, 5 months ago)
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Steve Barclay
I very much agree with my hon. Friend, and he is right to highlight the wider issues that we want to discuss. The previous negotiation with the junior doctors included, for example, setting up a higher pay band, which has meant that there has been a cumulative increase of over 24% over four years. It included targeted action such as a £1,000 a year allowance for junior doctors who work less than full time, and targeted action around unsocial hours and weekend work. Those are the meaningful discussions that we want to enter into with junior doctors, but that has to be on the basis of a realistic and deliverable discussion, and 35% is not that.
Dame Diana Johnson (Kingston upon Hull North) (Lab)
I am not sure the Secretary of State understands just how angry people are. My constituents are absolutely furious with the Government’s stewardship of the NHS. Hull is the most under-doctored area in the country; we have the longest waits in A&E in the country; and we have had a very poor Care Quality Commission report on our local hospitals. On the junior doctor strikes, when will the Secretary of State start to put patients first? I want to make sure that he goes away from this Chamber and gets ACAS involved, so that we can get the junior doctors back at work, with no further delays and cancellations for my constituents and patients in Hull.
Steve Barclay
The rather odd thing is that we have a larger cash offer on the table for 2022-23 than the Labour Government in Wales, and we have reduced our longest waits far more than they have in Wales. We have a deal that the trade union leaders themselves have recommended, that the majority of staff councils have recommended and that the largest health union has voted emphatically in support of. It is right that we allow time for that deal to go through, and we stand ready to have similar meaningful and constructive engagement with the junior doctors once they move from what is an unrealistic position.
NHS Winter Pressures
Diana Johnson Excerpts(3 years, 8 months ago)
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Steve Barclay
First, integrating health and social care through the integrated care boards. That is what we put in place from July, recognising that actually the pressures on the NHS are often as much about pressure on social care as they are about pressures in the NHS itself. In particular, if we look at ambulances, we see that often it is the delay in domiciliary care that is driving the blockage on the wards, which in turn applies there. Secondly, it is recognising that there are workforce pressures, which is why NHS England has been working on the workforce plan that has been set up.
Thirdly, we have already set out our elective recovery plan. Over the summer, the longest waits—those of over two years—were largely cleared. [Interruption.] Opposition Front Benchers chunter, “How’s it going?” Let us look at how it is going, compared with the Labour Government’s two-year clearance in Wales. Before Christmas, there were about 60,000 people in Wales who had been waiting for more than two years; in England there were fewer than 2,000. We are making progress on the longest waits through the work of Jim Mackey, Professor Tim Briggs and Getting It Right First Time. We are innovating with the surgical hubs and the community diagnostic centres. That, in turn, gives greater resilience to the electives that used to be cancelled when there was winter pressure. With hot and cold sites, they are much more resilient.
Finally, I must take issue with what my right hon. Friend says. In France, Germany, Canada and many other countries, the massive spike in flu and covid pressure, combined with pressures from the pandemic, has placed similar strains on healthcare systems. It is simply not the case that the issue affects England alone.
Dame Diana Johnson (Kingston upon Hull North) (Lab)
I am really not clear how, despite all the warnings, the Government have got themselves into this position after the biggest crisis in the NHS. We all know that it is a no-brainer to invest in social care to reduce bed blocking, so what exactly is the purpose of the pilot that has been announced for Hull and the Humber? It will tell us what we already know: that what we need is investment in social care and reform of social care.
Steve Barclay
We recognised very early—in fact, NHS England recognised it in the summer—that this winter was likely to be extremely hard, both because population resilience to flu would be lower as a consequence of the pandemic and because of the combination of pandemic backlogs with the ongoing level of covid admissions. As I have said, we have more than 9,000 patients in hospital with covid and a further 5,000 with flu; that comes on top of the other strains from the pandemic that we have seen. The measures taken, such as boosting the vaccination programme, extending it to the over-50s and being the first place to have the bivalent vaccine, were part of the package in NHS England’s operational plan.
We also recognised—this point goes to the heart of the right hon. Lady’s question—that social care is central. That is why, notwithstanding the other economic pressures that the Government faced, health and education were prioritised in the autumn statement, with an extra £6.6 billion in funding for the NHS over the next two years and an extra £7.5 billion in funding for social care. That was recognised with a clear prioritisation in the autumn statement. The reality is that we have had a massive spike in flu cases, meaning that there have been 100 times as many hospital admissions for flu as there were last year.
Women’s Health Strategy for England
Diana Johnson Excerpts(4 years, 1 month ago)
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Steve Barclay
I know from my own involvement in the mesh campaign just how central the hon. Lady’s role was in it, and I pay tribute the work that she has done on that and a number of other campaigns over recent years. In respect of mesh, she will be aware that an annual review is published. On the workplace issue, a key thing that comes out of the report is the significance of the time off work that many women are experiencing, with the difficulty, quite often, in having these conversations with employers. It is very welcome that the civil service has taken a lead, as has the NHS, in certain aspects of that, but there will clearly be more to do, and the point she raises will be part of that wider conversation.
Dame Diana Johnson (Kingston upon Hull North) (Lab)
I welcome the appointment of the women’s health ambassador, Dame Lesley Regan. It is an excellent appointment to that role.
The 2020 report on access to contraception by the all-party parliamentary group on sexual and reproductive health found that the current fragmented commissioning arrangements have a severe impact on women’s access to contraception due to a lack of joined-up services. With 45% of pregnancies in England being unplanned, what specific plans does the Secretary of State have to remove the barriers to co-commissioning of reproductive healthcare to require different parts of the system to work together to meet women’s healthcare needs?
Steve Barclay
I welcome the hon. Lady’s acknowledgement of the expertise that Professor Dame Lesley Regan brings as ambassador. I think she will be fantastic in that role. A key part of this strategy is addressing the fragmented health system and how that impacts on areas such as contraception. That is why we are having, for example, the women’s health hubs to provide a one-stop shop and centre of expertise so that we can better identify the services that people need.
Ambulance Services and National Heatwave Emergency
Diana Johnson Excerpts(4 years, 2 months ago)
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Maria Caulfield
I am not sure whether that means the hon. Gentleman is now supportive of the social care levy, which is there to pay for improvements to social care. This Government are making those changes and bringing forward the integrated care boards that are bringing health and social care together to deliver on those delayed discharges. I have been very honest: delayed discharges are having an impact on bed capacity and a knock-on effect on our ambulance services. If the hon. Gentleman has changed his mind and now supports the social care levy, I welcome that news.
Dame Diana Johnson (Kingston upon Hull North) (Lab)
With the greatest of respect to the Minister, I cannot fathom why the Secretary of State for Health and Social Care is not at the Dispatch Box when we are facing such a perfect storm. Given that the Home Secretary failed to turn up to the Select Committee on Home Affairs this morning, may I ask the Minister whether this is the Government’s new approach: that members of the Cabinet no longer turn up to be accountable and so that scrutiny can happen in this House?
Maria Caulfield
I can reassure the right hon. Lady that I am the Minister responsible for ambulances, which is why I am standing here at the Dispatch Box. The Secretary of State has been out on visits this morning, meeting clinical teams; it is important that he hears at first hand from those who are on the frontline. I got into politics to make sure that those of us who work on the frontline—[Interruption.] The right hon. Lady rolls her eyes; maybe she does not have much respect for those of us who worked on the frontline. We are dealing with this situation, and will be supporting the ambulance service over the coming months. The right hon. Lady’s response is extremely disappointing.
Health and Care Bill
Diana Johnson ExcerptsWednesday 30th March 2022
(4 years, 5 months ago)
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Jess Phillips
I absolutely agree. It is difficult to be dispassionate. I have never been accused of being dispassionate about anything. I am passionate about what I eat for my breakfast. I am just not a dispassionate sort, but the right hon. Lady is absolutely right that we must look at column A and column B in this instance. Column A is full of experts—medical experts, women’s rights experts, and women themselves—and a huge amount of evidence.
Dame Diana Johnson (Kingston upon Hull North) (Lab)
I just wanted to add to the list that the right hon. Member for Basingstoke (Mrs Miller) just read out the World Health Organisation, which also says that telemedicine is safe, and the National Institute for Health and Care Excellence, based in the United Kingdom, which made a recommendation in 2019 about the safety of telemedicine for abortion.
Jess Phillips
I totally agree with my right hon. Friend. Actually, if people are against telemedicine for abortion, they might have very strongly held views about not liking telemedicine for anything. By that virtue, they should be against it for everything. For all the people who are desperately worried about vulnerable women—victims of domestic abuse and victims of sexual violence—not being able to access healthcare, I say come on and join me. They are absolutely right: there is zero availability of most mental health support. There is zero chance of getting a GP appointment any time soon, but somehow, people are against telemedicine only on this issue.
Often in debates, we do not stand up to seek to convince others. That only happens when there is a free vote—when actually the debate is really important. To people who are unsure, I say that I understand it—I totally get it—especially if they do not necessarily have so much skin in the game have but a huge load of emails in their inbox. The reality is that if they are not sure, they should either try to be convinced by the debate and the evidence, or they should simply abstain on the issue.
This is not particularly difficult for me. As I have said, I am not a dispassionate sort. I have stood in this House before and said that I have had an abortion. I do not feel devastated by that fact. I think we need to be clear about this. In this place, we only deal in hard cases, because they tell the argument much better. One thing I would say about when I had an abortion is that the worst process of having an abortion is the waiting. I had made the decision about what I was going to do with my body. I had made it the second that I saw I was pregnant on a pregnancy test, because I am an adult woman, completely capable of handling my own body and knowing my own mind, and that is how we should treat every woman in this country.
Dr Johnson
I can only absolutely agree with my hon. Friend’s intervention.
I also want to talk about coercion, because we know that some women may be coerced into having an abortion.
Dame Diana Johnson
Before the hon. Lady moves on, I want to raise something with her. Obviously she has a clinical background, and she will know jolly well about the range of safeguarding measures that all clinicians, the royal colleges and all those involved in abortion care have to follow. She makes it sound as though no safeguards are in place. For instance, if a 14-year-old telephoned a clinician to seek advice around abortion, that clinician may well say, “I want to see you face to face.” There is nothing to stop that happening, and that may well be a proper safeguard that would carry on, irrespective of whether telemedicine carries on today.
Dr Johnson
With respect, the right hon. Lady makes my point for me, because that is right: there is nothing to stop that happening, and it may be that the doctor would say that they wanted to see the patient, but they do not have to do so. We know that abortions are being prescribed by telemedicine to children under the age of 18. If this measure had been looked at properly by the House as a single issue, rather than as this amendment to something else, we would have stipulated that children under the age of 18 should not be receiving abortions over the telephone without proper appointments, as I think they should and as the right hon. Lady, if I understand her correctly, also seems to be saying that they should.
We know that sometimes women and girls can be coerced into having abortions that they do not want, perhaps because the baby is of a gender or sex that the father does not want, perhaps because they are being abused, or perhaps they are being trafficked or sexually assaulted. It is very difficult for a woman to tell someone about that over the telephone, whereas if a woman is seen in clinic, she has that one-to-one opportunity.
Dame Diana Johnson
I rise to speak to amendment (a) tabled by the Government in lieu of Baroness Sugg’s amendment—Lords amendment 92—which would continue the telemedicine service for early medical abortion that was introduced during the covid pandemic. First, I pay tribute to the noble Baroness Sugg for her persistence and her work in the other place.
This is about how we best provide essential healthcare to women, and remember that one in three women will have an abortion during their lifetime. It is about making access as straightforward and women-centred as possible. The Secretary of State recently made a pledge in his speech to the Royal College of Physicians when he talked about the need to
“empower patients and fulfil the promise of the technological leaps we’ve seen throughout the pandemic.”
Scrapping telemedicine abortion at this stage goes completely against what the Secretary of State was talking about. This is also about trusting women, as the Chair of the Women and Equalities Committee, the right hon. Member for Romsey and Southampton North (Caroline Nokes), has talked about and as my hon. Friend the Member for Birmingham, Yardley (Jess Phillips) has said today.
Such is the strength of the evidence that the Welsh Government recently announced that they will be making telemedicine for abortion permanently available. This sends a clear message that, while women in Wales can be trusted to use a healthcare service in a way that meets their needs, women in England cannot. Not only will there be unequal abortion access between the devolved nations, but this decision will lead to health inequalities within England for the most vulnerable and marginalised. I struggle to see how the decision to bring this service to an end after August is in line with the Government’s commitment to put women at the centre of their own healthcare, as detailed in the vision for the women’s health strategy.
Telemedicine has already enabled an estimated 150,000 women to access abortion care at home. Its removal means that every woman, regardless of her personal circumstances and health needs, will be forced to attend a clinic. Lords amendment 92 would ensure that women can continue to access a consultation with a clinician by telephone. To make it crystal clear to everybody, very importantly, face-to-face consultations will still be available. We have heard concerns about younger people, and face-to-face consultations will be available—
Dame Diana Johnson
I am going to carry on because I know time is short.
Those consultations will be available if the clinician feels that that is appropriate or the woman wants to see somebody face to face. Let us all be clear: this is about choice. The continuation of telemedicine means that a woman would not have to travel long distances to attend a clinic if, for example, she lived in a remote area or had to make arrangements—
Dame Diana Johnson
I am talking about women’s experience, so I will continue, if the hon. Gentleman does not mind.
The woman may have to make arrangements if she has childcare or caring responsibilities, or she may have to take time off work. In the case of a coercive and controlling relationship, she would have to explain where she is going to a perpetrator, such as the Mumsnet user who said she had to visit a hospital to access abortion care and was “terrified” of her abusive ex-partner finding out where she was. She spoke of having to construct “various lies” about where she was that day and why she had to have someone look after her children.
I referred to NICE and the World Health Organisation in an intervention, but we should be aware that since telemedicine was introduced the risk of complications related to abortion has reduced, as women are able to access care much earlier in their pregnancy. I will rehearse the long list of supporters of the measure continuing: The Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives, the Royal College of General Practitioners, the British Medical Association, the Royal Pharmaceutical Society, the Faculty of Sexual and Reproductive Health, the TUC, Women’s Aid, Rape Crisis, Karma Nirvana, the Terrence Higgins Trust, End Violence Against Women, Mumsnet, and many others. What I find most disappointing is that the Government are going against a wealth of robust and widely accepted peer-reviewed evidence from medical professionals and women’s charities, and appear to give greater weight to anecdote, erroneous opinion and misinformation focused on campaign groups with extreme views who bombarded a consultation. Sadly, that further emphasises that this is not an evidence-based policy decision.
Caroline Nokes (Romsey and Southampton North) (Con)
Will the hon. Lady give way?
Dame Diana Johnson
I want to address the issue of safeguarding. Let me be clear: creating more barriers to access does not help women; it helps abusers. The End Violence Against Women coalition and other major VAWG organisations reject the claim that telemedical abortions put women at greater risk of coercive abortions. The fact is that coercive pregnancies are far more common than coercive abortions, and since the introduction of telemedical abortions providers have seen a rise—a rise—in safeguarding disclosures, highlighting that the system provides a safe space for women to come forward if they are being coerced. Nurses are highly trained to assess safeguarding issues, and if concerned they will ask the women to come to the clinic for face-to-face assessment.
Finally and crucially, women themselves strongly favour keeping telemedicine for early medical abortion. A clear majority want it to continue.
As a country, we have an opportunity to be seen to be a shining light for women’s reproductive rights around the globe at a time when those rights are being rolled back elsewhere. The weight of the evidence in favour of maintaining this essential women’s healthcare pathway is overwhelming. I ask Members to support the amendment in lieu.
Mrs Miller
First, I apologise for being late to the debate, Mr Deputy Speaker. I appreciate your calling me to speak, and I will be brief.
Amendment (a) in lieu of Lords amendment 92 is all about increasing women’s choice, not about taking choice away from anyone. The basis on which the amendment can be judged is the evidence we have gathered, not in a short period of time, but during two years in which 150,000 women have used telemedical abortion care. Judge the amendment against that backdrop; it is done not on a whim or a fancy, but after two years of intensive analysis.
While I might want to agree with those of my right hon. and hon. Friends who are calling for a reasoned debate in the House of Commons on the broader issues of abortion, the truth is that we do not have those debates because the Government talk about changes to abortion provision coming from Back Benchers when that provision is now so out of date in our country that we need the Government to look at it more broadly. I will support the amendment because it is the right thing to do. The amendment is backed by a huge range of organisations and a significant body of evidence, and it requires the Government to look more broadly at abortion—to take this as a responsibility and to stop shoving it back on to the Back Benches.
Continuing telemedical abortions will be supported and regulated in exactly the same way as face-to-face abortion care, and to suggest otherwise is to be factually incorrect. Members really need to think about the evidence showing that online sales of abortion pills from unregulated providers have decreased since telemedical abortion was made legally available. Rather than push people back into an unregulated market, let us keep what we have, which has worked for 150,000 women over the past two years. But please, please, Minister, let us have a reasoned look at abortion more broadly. Stop saying that this is an issue for Back Benchers. It is not.
Oral Answers to Questions
Diana Johnson Excerpts(4 years, 6 months ago)
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Edward Argar
My hon. Friend is, as ever, persistent and tenacious in his advocacy of Long Crendon’s surgery plans; not only at the Dispatch Box but whenever he runs into me around this place, it is often the first thing on his lips. I will continue to work with him on the surgery bid and I encourage him to continue to work with his local NHS systems.
Dame Diana Johnson (Kingston upon Hull North) (Lab)
Will the Secretary of State meet me as chair of the all-party parliamentary group on sexual and reproductive health in the UK? Can I bring along the Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives, the Royal College of General Practitioners, the Royal Pharmaceutical Society and the Faculty of Sexual and Reproductive Healthcare to explain why the decision to remove telemedicine is wrong for women in this country?
