Winter Preparedness

Edward Argar Excerpts

Wednesday 18th December 2024 Commons Chamber

[Edward Argar (Melton and Syston) (Con)]

I am grateful to the Minister for early sight of her statement—as I have said before, it is typically courteous of her. I echo the gratitude that she expressed to those in our NHS, and also those in the social care workforce who will be working hard throughout the festive period. As she alluded to, the NHS is already feeling the pressure this winter. We know that winter is always tough for the NHS, irrespective of who is in government, but services are feeling the strain even earlier than in previous years. A tidal wave of flu infections has led to a 70% increase in hospital cases in just seven days, and the national medical director of the NHS has warned of a “quad-demic” of health emergencies as cases of covid, norovirus, RSV and winter flu are all on the rise.

Meanwhile, in October, the longest A&E waits of over 12 hours increased by over a quarter in just one month, reaching the third highest monthly figure since comparable records began in 2010. Of course, all that has come before the cold weather really hits and before more vulnerable pensioners are left in freezing homes, unable to put the heating on after the winter fuel payment was scrapped for a large number. What assessment has the Minister and the Department made of the potential impact of that on hospital admissions this winter?

In government, we recognised that the NHS faces unique challenges in winter. We also recognised, as I know the Minister does from our previous discussions, the importance of flow in the NHS, with all parts of the system working together. That is why last year we provided £200 million to boost NHS resilience specifically during the peak winter months, which was accompanied by £40 million to bolster social care capacity and improve discharges from hospital. That followed the £1 billion announced earlier that year to boost capacity by delivering 5,000 additional beds, 800 new ambulances and 10,000 virtual ward places.

The Secretary of State himself has admitted that there will almost certainly be a winter crisis. There have been warnings from the Royal College of Emergency Medicine, the Royal College of Nursing and directors at NHS England. Yet in today’s statement, in contrast to the steps we took, we heard a lot about data, meetings and co-ordination, but very little in concrete terms to increase capacity specifically over the winter period. That will give scant reassurance to those working in the system or patients needing the system. In fact, earlier this year, the Secretary of State suggested that there would not be any specific new funding for the NHS to cope with winter pressures.

The Minister will know that I have tabled a number of written questions in recent days, met in many cases by what seems to be the standard DHSC response for named day questions of a holding answer. As the pressure continues to grow, I have a number of specific questions for the Minister while she is at the Dispatch Box. Will the NHS receive more resources specifically to increase bed and A&E capacity this winter? Are there enough hospital beds and ambulances for this winter, or is she taking steps to increase them? As of the 1st of the month, how many people who were medically fit to be discharged had not been, for a variety of other reasons?

I am grateful for the update that the Minister provided on winter vaccinations. What assessment has she made of the supply of the flu vaccine? There are some suggestions that pharmacies and others have run out and are waiting for more deliveries. How many additional 111 and 999 call handlers have been recruited specifically for this winter?

We talked briefly about the need for the system to work as a whole. In that context, what is the impact of national insurance contributions on hospices, social care and GPs? The Secretary of State told the Health and Social Care Committee this morning that hospices would get an update from him before Christmas, but at Prime Minister’s questions in response to the Leader of the Opposition, the Prime Minister appeared to say that it will be after Christmas. Can the Minister clarify that for the House, because it is an important point?

Finally, what meetings has the Secretary of State personally had with Julian Redhead and Sarah-Jane Marsh, the NHS winter leads, and when was the first of those meetings specifically on this subject? I am very happy for him to write to me if that is easier, given the complexity.

As seasonal flu piles yet more pressure on NHS systems, it is more important than ever that it gets the resources and support that it needs. There are many promises of reform, but the NHS needs an immediate capacity boost in beds over winter. So far, the Government have kicked reform into the long grass in favour of yet more consultation, and their preparations for winter have lacked the urgency and focus that patients and NHS staff demand. In government, the Conservatives always put extra support in place to keep the NHS going through the tough winter period, boosting capacity and increasing support. This Government need to get a grip and do the same.

[Karin Smyth]

I will do my best to address that range of questions. First, as even a stopped clock is right once—[Interruption.] Yes, twice. On that basis, I agree with the right hon. Gentleman. On correspondence and answers to parliamentary questions, again, the situation we inherited is not satisfactory. I apologise to all Members who are waiting for correspondence—it is something we are taking a grip of. We want to respond positively to questions. The Conservatives did not; we will make sure that starts to happen.

On capacity in the system, again, I remind Members that we came into office in July, which is one quarter of the way through the planning and financial year. We very rapidly looked at the plans that were baked in by the previous Government—I appreciate that the right hon. Gentleman was in the Ministry of Justice at the time, not the Health and Social Care Department—to see whether they were fit for purpose. We wanted to make sure we brought stability to the system. There are, in fact, more beds currently available in the system than last year. If there is a need to increase capacity due to a likely cold snap, the system is absolutely ready to respond in its usual way. That is why we are meeting weekly.

On meetings with clinical and managerial colleagues at NHS England—who, frankly, I see more often than many members of my own family—I can tell the right hon. Gentleman that we started those meetings immediately. I would have to check the exact date, but it was certainly in the summer. I have had fortnightly meetings since September, which, as I said, we can move to monthly meetings, chaired by the Secretary of State. We began getting a grip from day one, knowing that winter was coming, which is why I am monitoring the situation weekly. It is also why we visited the operational centre, to understand in real time what is happening across every single system and every single trust—be that ambulance issues or problems at the front end and in A&E. The one question I do not directly have the answer to is what the daily figures are; I will try to get those figures to the right hon. Gentleman later.

We all know that waiting for discharge to assess is a massive problem. That is why, as I said in my statement, we want to take a grip of the better care fund, to ensure it works better and to stabilise the social care system. I am not particularly versed in issues on supply, so I apologise if that is wrong. We will certainly get back to the right hon. Gentleman on that matter, because we want people to be taking the vaccinations where necessary.

I can confirm that we want an announcement on hospices before Christmas. On winter fuel and its impact, as Opposition Members know, we will continue to monitor the impact of all situations on individuals to ensure they are supported in the community. We urge people to make sure they access pension credit. [Interruption.] I have just addressed that, but if I have missed anything, I will come back to it.

Puberty-suppressing Hormones

Edward Argar Excerpts

Wednesday 11th December 2024 Commons Chamber

[Edward Argar (Melton and Syston) (Con)]

I thank the Secretary of State for advance sight of his statement, and for his courtesy in coming to the House to make an oral statement, which gives hon. Members the opportunity to ask him questions.

When the Secretary of State is wrong, we will challenge him robustly and hold him to account, but when he is right, we will support him. That is responsible opposition. In what he sets out today, he is right, and he has my support for what he is doing. Protecting children is one of the most important priorities that a Health Secretary can have. My predecessor, my right hon. Friend the Member for Louth and Horncastle (Victoria Atkins), worked tirelessly to do just that. She set out that it was her priority to protect children and young people from risks to their safety from the prescription of puberty blockers, given the lack of an evidence base. I welcome the Secretary of State’s continuing the work started under the previous Government, and I welcome his support at the time and all that he has done since, including in his statement on 4 September. I associate myself with the three principles that he enunciated when he opened his statement.

With increasing numbers of young people questioning their gender identity, NHS England, with the support of previous Conservative Health Secretaries Matt Hancock and Sir Sajid Javid, commissioned Dr Hilary Cass to examine the state of services for children questioning their gender. That historic review cut through the noise and ideology to lay bare the clear facts, so that we as policymakers can seek to make decisions based on evidence, safety and biological reality, and create a service that better serves the needs of children, as the Secretary of State set out. In the review, Dr Cass made it clear that not enough is known about the lifelong impacts of using puberty blockers on young minds and bodies to be sure that they are safe, and that the robust evidence base was simply not there. In March, NHS England made the landmark decision to end the routine prescription to children of puberty blockers for gender dysphoria. With the support of the then Government, it announced that it was stopping children under 18 from being seen by adult gender services with immediate effect.

As one of the final acts of the previous Government, my right hon. Friend the Member for Louth and Horncastle used emergency powers under section 62 of the Medicines Act 1968 to extend the ban to private clinics selling puberty blockers to young people questioning their gender. It was the right thing to do, and I agree with and pay tribute to her, as I do to the Secretary of State for what he has subsequently done. The safety and wellbeing of children and young people must come above any other concern. I welcome the fact that the Secretary of State renewed the order; his saying that he will make the ban indefinite, given the absence at present of an evidence base; and his seeking to better understand and build that evidence base.

I have a few questions that I hope the Secretary of State can offer clarifications on in a constructive spirit. I hope—I think he alluded to this—that he will confirm that he intends to implement the Cass review’s recommendations in full. Of course, support must be available to children and young people who are questioning their gender identity, and that support must be holistic, multidisciplinary and evidence-led. The Tavistock clinic closed earlier this year, and as he set out, three new regional NHS children and young people’s gender services have opened to provide better, tailored gender services for children and young people—again, that is based on recommendations in the Cass review. Can the Secretary of State provide more detail on the delivery of the remaining regional centres, and say what order they are due to open in, so that children and families can see what is happening in their region? Again, that is about putting the best interests of young people first.

Can the Secretary of State reassure the House that these measures will be UK-wide and that he is working in tandem with the devolved Administrations? Will he advise on what progress has been made thus far—I appreciate that it is early days—on further research into patient care and increasing that evidence base? Can he update the House on the steps taken to continue the work of his predecessor, my right hon. Friend the Member for Louth and Horncastle, when she announced to the House in May the decision to work to close any online loopholes to the regulations put in place? Finally, will he commit—I suspect I know the answer to this one—to keeping the House updated in the months and years ahead on developments in this space?

Our children and young people deserve healthcare that is compassionate, caring, careful and led by the evidence. I associate myself with the Secretary of State’s concluding remarks on the need for the debate to be conducted in a respectful and sensitive way, with the needs of children and young people at its heart. We will support measures that protect children, and support him in bringing forward such measures; we want to work constructively with the Government to give the next generation access to the right healthcare to meet their needs. I look forward to working with him in the months ahead.

[Wes Streeting]

I thank the shadow Secretary of State for the constructive way in which he has responded to the statement, and for the tone with which he has approached the issue. It is worth everyone bearing in mind that every word of statements in this House, and indeed online, are often hung upon by a particularly vulnerable group of children and young people. Many of them feel afraid about the environment in which they are growing up, as do their families. Establishing an environment in which we can discuss issues with their welfare and wellbeing at its heart is therefore the right way to approach these issues. As I have said many times before—and I am sure the shadow Secretary of State agrees—we need less heat and more light, and we can show leadership together in trying to provide that climate.

I am absolutely committed to the full implementation of the Cass review. The shadow Secretary of State asked about the implementation of new children and young people’s services on gender incongruence. As I said, the north-west London and Bristol services are now open. A fourth service is planned in the east of England for spring next year. We want a specialist gender service in every region by 2026, and of course I will keep him and the House updated on that.

I am working closely with my counterparts in the devolved Governments. I particularly welcome the engagement I have had with my counterpart in Northern Ireland and his predecessor, the hon. Member for South Antrim (Robin Swann), who is within my line of sight. I appreciate the way we have been able to work together on this and many other issues. The shadow Secretary of State asked about loopholes. I will keep the matter under close observation and review.

With regard to sanctions, penalties and enforcement, it is worth pointing out that breach of the order is a criminal offence under the Medicines Act 1968. It is a criminal offence to supply these medicines outside the terms of the order. That means pharmacists who dispense medicines against prescriptions that are not valid may be liable to criminal prosecution. It is a criminal offence to possess the medicines where the individual had responsible cause to know the medicine had been sold or supplied in breach of the terms of the order. There are fines and penalties associated with that, including case-by-case and regulatory enforcement by the General Pharmaceutical Council.

We have approached the matter in an evidence-based and considered way, and with the welfare and interests of children and young people at the heart of our decision making. I urge everyone else involved in the provision of health and care to do the same.

Tobacco and Vapes Bill

Edward Argar Excerpts

2nd reading
Tuesday 26th November 2024 Commons Chamber

[Edward Argar (Melton and Syston) (Con)]

I do not always do this, but I express my gratitude to the Secretary of State for the tone he has adopted in this debate and for recognising the strongly and sincerely held views of right hon. and hon. Members on both sides of it. I am also grateful to him for being typically willing to share with the House in support of his points something as personal as what happened to his grandmother. Sadly, it will not surprise him that no one asks me for my ID these days—I will have to take some tips from him on the moisturiser that he uses. [Interruption.] I will ignore the unkind comment that he has just made.

In many ways, this Bill is like the curate’s egg: it is good in parts—indeed, it is good in many parts—and started from a place of good intentions. As the Secretary of State set out, smoking has a huge cost to society and to individuals. We know that smoking is the single biggest entirely preventable cause of ill health, death and disability in this country, and we see in our NHS the impact of smoking every day. It is responsible for around 80,000 deaths in the UK each year and is estimated to cost the NHS and social care more than £3 billion a year, including 75,000 GP appointments every month. As the Secretary of State said, almost every minute someone is admitted to hospital because of smoking. It substantially increases the risk of many major health conditions throughout people’s lives, such as stroke, diabetes, heart disease, stillbirth, cancers, dementia and asthma.

As the Secretary of State has alluded to in the past, it is often people in more deprived areas who have higher smoking rates, lower healthy life expectancy and higher mortality rates linked to smoking. Some 230,000 households are estimated to live in smoking-induced poverty, and children of smokers are three times as likely to start to smoke, potentially perpetuating the cycle. Over 80% of smokers started before they turned 20—many started as children—yet more than half of current smokers want to quit; as the Secretary of State said, three quarters say that they would never have started smoking if they had the choice again. Let me be clear: reducing smoking, giving people the information and support to quit, and helping to protect children in particular are worthy ambitions.

Among all the doom and gloom, there is some positive news: smoking rates are falling anyway. While around 6 million people in the UK smoke, the number of smokers has been falling for decades. In 2023, just 10.5% of people aged 16 and over smoked, compared with 20.3% in 2010, 20.7% in 2000 and 30% a decade before that in 1990. Likewise, the number of children who smoke is falling. While this trend is welcome, it is understandable that there is a strong desire to see continued action to further drive down the prevalence of smoking and tackle the recent rise in vaping among non-smokers, especially among young people, and to protect future generations.

As was evidenced by the interventions that the Secretary of State kindly took from many hon. Members, I am sure that many of us in the House have been alarmed by the surge in youth vaping, which has doubled in the past five years. Despite it already being illegal to sell nicotine vapes to under-18s, a quarter of children tried vaping in 2023. While nicotine vapes can and do play an important part in helping adults to quit smoking, we are clear that children who do not smoke should not take up vaping. The nicotine content makes those products highly addictive, while the long-term impacts of the colours and flavours being inhaled are highly unlikely to be beneficial. Of course, the full effects may not be known for some years yet.

The uptake in youth vaping has been driven in part by the branding and promotion of products clearly aimed at children, with vapes, packaging, descriptions and marketing all designed to appeal specifically to young people. Grown adults trying to quit smoking are unlikely to see the appeal of cartoon characters on their vapes, but of course, children and young people will. Likewise, the bright colours and fruit flavours are far more likely to appeal to children than to those looking to quit tobacco smoking.

For those reasons, the last Government introduced a Bill that primarily targeted our interventions at young people. It would have restricted who could purchase tobacco products without impacting current adult smokers. It sought to tackle youth vaping by restricting flavours, introducing plain packaging and changing how vapes are displayed in shops so that they do not appeal to children. It would also have prohibited the sale of non-nicotine vapes and vaping alternatives such as nicotine pouches to under-18s, just as it is already illegal to sell nicotine vapes to children. In parallel, it would have introduced new fines for rogue retailers in order to tackle the illegal market, seeking to make sure that the law—such as age restrictions on purchasing vapes—was properly enforced.

That approach was targeted at the next generation of young people and aimed to prevent the take-up of smoking and vaping and break the cycle of nicotine addiction before it had even started. That Bill was not about demonising people who smoke or curtailing current smokers’ rights or entitlements in any way. None the less, it had challenging practical implementation impacts.

I have a lot of respect for the public health Minister, the hon. Member for Gorton and Denton (Andrew Gwynne)—I think that is his new constituency name—and know him well. I hope that when he winds up the debate, he will address some of the points I am about to make. My first point is about the impact on shopkeepers, particularly small shopkeepers, of enforcing and operating within increased restrictions, and the extent to which those restrictions are practically enforceable. In the context of what the Bill sets out to do, how does one avoid the existence of, or an increase in, a black-market economy in vapes or cigarettes?

We introduced our Bill before the general election. Since then, the new Government have introduced a Bill that may have the same name, but is not quite the same Bill that was introduced back in March. The Bill before us today gives the Secretary of State new, or significantly modified, powers under the Health Act 2006. It runs the risk of piling an unknown number of regulations on to retailers through a new licensing scheme, and it creates a whole new registration scheme. The challenge is that right hon. and hon. Members will not be told in detail what those schemes will look like, the specific impact they will have on businesses, or the detailed impact they will have on smoking and vaping rates until after the legislation has been passed. A hefty impact assessment—all 294 pages of it—has been produced. Given that the public health Minister has signed it, I fear he had to read every one of those pages before doing so. However, even with that impact assessment, the detailed impact of the individual regulations that may follow is unclear.

For example, clause 136 amends the Health Act 2006 to give the Secretary of State the power to extend smokefree places to some outdoor spaces. Of course, adults should be mindful and thoughtful about where they smoke or vape to be considerate to those around them, especially in areas with children or vulnerable young people, but the Bill risks giving the Secretary of State expanded powers to expand smokefree areas with minimal oversight. I acknowledge that the affirmative resolution procedure will be used, but as we in this House know, a statutory instrument and the procedures that accompany it are not as rigorous in their scrutiny as primary legislation.

Unlike previous laws, which banned smoking in confined areas such as pubs and bars, the Secretary of State is talking about bans in open spaces where the risks of second-hand smoking may be more limited. Page 64 of the delegated powers memorandum states:

“Under Section 4 of the 2006 Act, the Secretary of State could make regulations to designate additional places as smoke-free provided that they were of the opinion that there was a significant risk persons present in such a place would be exposed to significant quantities of smoke without a smoke-free designation…Section 5 of the 2006 Act gave the Secretary of State powers to make regulations for vehicles to be smoke-free.”

It goes on to say:

“Clause 136 amends the existing power in section 4 of the 2006 Act by omitting the risk condition.”

I would be grateful if the public health Minister could explain in his winding-up speech—I suspect he will be able to do so—why that condition is being removed. It was there for a reason: to give a sense of proportionality to anything that was done and to ensure that a particular bar had to be met, given the impact. Its removal effectively gives the Secretary of State much greater discretion to do as he wishes at a future date. I note that the Secretary of State has said today that he changed his mind on banning smoking in pub gardens or outside hospitality venues. I know him well, and he is an honourable man, so I take him at his word on that, but there is nothing in this proposed legislation to prevent a future Secretary of State from coming back, consulting and expanding beyond the areas where he proposes to restrict smoking to other venues and settings at a future date. Under clause 136, that could be done without the crucial risk criteria being applied. I would be grateful if the Minister could address that point, because it is hugely important. Members are being asked to decide now whether they support expanding smokefree places to an unknown list of outdoor spaces in the future, so it genuinely raises significant challenges and concerns if that gateway is not in place.

[Peter Swallow (Bracknell) (Lab)]

I am listening very carefully to what the right hon. Gentleman has to say. Some 13% of adults in Bracknell smoke, but we know that more than half of smokers would like to give up, so what I and my constituents are listening for is a commitment that his party will back concrete measures to end the public health epidemic of smoking once and for all—or are they just going to wrap up their objections in sophistry?

[Edward Argar]

I am grateful to the hon. Gentleman for most of what he just said. I will address precisely his point in a few paragraphs, but I say to him that my party brought forward legislation in March, which was debated in April, that did not have the mission-creep that I fear the Secretary of State is demonstrating with clause 136 and various other measures in this proposed legislation.

I must also challenge the Government on how they anticipate this measure being enforced. Will members of the public be encouraged to call the police if they see a parent smoking in a prohibited place? If there are no children in a park or playground, will it still be prohibited?

Concerns are also raised by the new licensing and registration schemes. While it is right that we had planned to expand the existing notification scheme to include non-nicotine vapes and nicotine products involved in the supply chain, this Bill goes a number of steps further. The Secretary of State will be able to create a new licensing regime for retailers for tobacco, vaping and nicotine products. Over 70% of convenience stores selling vapes and tobacco products are independent shops. How will they fare and how will they be assisted with the layers of added bureaucracy and cost that will be associated with the Bill? Do local authorities, which are already under pressure, have the capacity and additional funding allocated to administer such a licensing scheme in their areas?

Again, my fear is that we are unable to make a fully informed decision about the impact because the regulations will be set out only after the Bill has passed. The impact assessment states:

“A more restrictive licensing scheme would be expected to have a greater impact on public health and a greater economic impact on businesses.”

However, we simply do not know if that is what the Secretary of State has in mind or what the regulations will look like. Likewise, there is no detail on the impacts of a new registration scheme for all tobacco, vaping, nicotine and herbal products, as well as tobacco-related devices.

In the few months that the Government have been in office, they have sadly shown that they are not particularly a friend of business and have broken a number of their pre- election promises. Although I have confidence in the Secretary of State as an individual and as a right hon. Member of this House, I ask him to forgive the cynicism of those on the Opposition Benches over any attempted reassurances from the Government that they will take businesses’ concerns into account as they consult on their plans.

To the point made by the hon. Member for Bracknell (Peter Swallow), if a Division is called, in line with the precedent set last time this will be a free vote; each Conservative Member may vote as they choose. The Bill, as I have said, comes from a good intention to keep the population healthy, to ease costs for the NHS and to prevent children from taking up addictive habits that may follow them for the rest of their lives. I support those objectives, but I call on the Minister for public health, when he winds up, to give the reassurances I seek and roll back the additional measures that have been put in place, over and above what we were proposing.

It is important that information is available so that people can make informed decisions and that support is available for those who choose to stop smoking. Adult individuals are best placed to make decisions about their own lives, but we recognise that the same is not true for children. I look forward to the responses from the Minister for public health, which I hope will be constructive. I welcome the Secretary of State’s offer to be collaborative and constructive in his approach to the legislation.

[Dr Beccy Cooper (Worthing West) (Lab)]

Will the shadow Secretary of State give way?

[Edward Argar]

I will briefly, because I have one sentence to go.

[Dr Cooper]

I thank the shadow Secretary of State. As a public health doctor, I am delighted to hear him speak so freely, openly and positively about all the great things that this legislation will bring, but I remain unclear whether he will be voting in support of this generation-defining public health Bill this evening.

[Edward Argar]

That will depend on whether the Minister for public health gives the promises I seek that he will withdraw a number of the measures that the Government have added to the Bill. I am grateful to my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson), who will take the Bill through Committee on behalf of the Opposition, and I know that she looks forward to constructive and collaborative engagement with the Minister. I hope he can offer reassurances when he gets up to the Dispatch Box in a few hours’ time.

Oral Answers to Questions

Edward Argar Excerpts

Tuesday 19th November 2024 Commons Chamber

[Mr Speaker]

I call the shadow Secretary of State.

[Edward Argar (Melton and Syston) (Con)]

The Secretary of State knows that every year, irrespective of which party is in government, winter is challenging for the NHS. Possibly, it will be all the more so this year with the potential impact on older people’s health of the loss of the winter fuel allowance by many. What winter preparedness steps has he taken, like previous Governments, to increase A&E capacity and to increase the number of beds this winter, and can he say by how many?

[Wes Streeting]

It is thanks to this Government and the action we have taken that, for the first time in three years, we go into winter without the spectre of national strikes looming over the NHS, and with NHS staff on the frontline not the picket line. It is thanks to the priority this Government have given to prevention that we have already delivered almost 15 million covid-19 and flu vaccinations, alongside the new RSV—respiratory syncytial virus—vaccination to help vulnerable groups for the first time. The shadow Secretary of State mentions the winter fuel allowance. This Government are protecting support for the poorest pensioners to protect them not just this winter, but every winter, and over the coming years the value of the pension will of course rise with the cost of living.

[Edward Argar]

I am grateful for that response but, just as my hon. Friends have highlighted in respect of the damaging impact of increases in employer national insurance contributions on GPs, hospices and care providers, I fear it was another example of the Government simply not answering the question and not having a plan yet. Either the Government have not done their homework and, as with the impact of NICs increases, they have not thought this through and do not know, or worse, they do not care—which is it?

[Wes Streeting]

This Government are prepared for winter and we are already standing up the operational response to winter pressures. On funding, the right hon. Gentleman was in government just before the general election. Is he saying that his Government did not provide enough funding for the NHS this winter? If not, why not? If he does accept that it is enough money, he will surely welcome the extra investment that the Chancellor is putting into the NHS from next year.

Income Tax (Charge)

Edward Argar Excerpts

Tuesday 5th November 2024 Commons Chamber

[Edward Argar (Melton and Syston) (Con)]

It is a pleasure and a privilege to be working once again in health and social care, although a disappointment to be doing it from the Opposition Benches. It is a privilege because, like the Secretary of State for Health and Social Care now, I had the privilege in government of working with the amazing and dedicated people who work in our NHS and in social care up and down the country. It is a pleasure to be back. It is a pleasure to be opposite the Secretary of State, as he now is. I remember our tussles back in the day, when I was sitting over there and he was sitting here.

I am sufficiently fond of the right hon. Gentleman to encourage him not to get himself fired out of a cannon, as he alluded to. Although I will say one thing for it: it would not only draw attention to his day job, but possibly even aid him in his ambitions to secure his boss’s job in due course. In respect of his comments about the Leader of the Opposition, my right hon. Friend the Member for North West Essex (Mrs Badenoch), I would only say very gently that she should probably take that as a compliment. When the right hon. Gentleman attacks someone in that way, it probably means that they are somewhat frit of her. I think he will see in the coming weeks and months why that is so.

We have already seen and heard over the previous days of debate that this is unequivocally a Budget of broken promises. Despite the pledges made over the course of the election and the commitments given to the British people, in reality those words meant nothing to the Labour party once it secured the keys to No. 10. Instead, we have seen taxes hiked on working people: the people who provide food security and food every day, our farmers, hit hard by the changes that have been made. We see living standards set to fall and mortgage rates likely to rise. We see taxes up, we see borrowing up, we see debt up, and we see that growth will be down on where it could and should be. Unfortunately, I fear, that pattern of broken promises also applies to the NHS and our social care sector.

[Mr Perkins]

I am grateful to the right hon. Gentleman for giving way and congratulate him on his new appointment. He is obviously very critical of the Government’s attempt to alleviate the appalling financial legacy that his party bequeathed to the nation. Does he support the extra investment for the health service, and is it just the ways of paying for it that he is against? Or is he actually opposed to it?

[Edward Argar]

I am very grateful to the hon. Gentleman. In his allusion to the Labour party’s inheritance, he missed the fact that the Office for Budget Responsibility singularly failed to back up the assertions made about the quantum of challenge the incoming Government faced.

Time and again, the right hon. Member for Ilford North (Wes Streeting), both in opposition and now as Secretary of State, has promised that any more money for the NHS has to be linked to reform. He has done that again today. The week before the Budget, he said that

“extra investment in the NHS must be linked to reform”.

In September, the Prime Minister himself said:

“No more money without reform”.

They are right on that. The Opposition support that condition, because it is only with reform that the NHS can sustainably continue to look after us for years to come. Yet I fear that this risks being another broken promise. I say to him now that where he is bold and provides genuine reform to benefit patients, he will have our support. Equally, if he bows to internal pressure and backs away from the radical reform that is needed, we will hold him to account.

[Joe Powell (Kensington and Bayswater) (Lab)]

Will the right hon. Gentleman give way?

[Edward Argar]

I will make a little progress before giving way to the hon. Gentleman.

I congratulate the Health Secretary on winning round 1 with the Treasury—I look across the Chamber and see the Chief Secretary to the Treasury on the Government Front Bench—in securing extra investment. He has secured more than £22 billion announced for the NHS, but without, as yet, any detailed indication of where that funding will go. I look forward to him returning to the House to set out the detail—I think he said that would be next week. What it must do is genuinely improve outcomes for patients and our NHS, rather than simply be focused on the headline figure of the inputs to it. There are, as yet, no clues as to whether it will be spent on wages, recruiting more staff, medicines or equipment; no clues as to how it will deliver the 40,000 additional appointments that have been promised; and no conditions linking the funding, as yet, to productivity improvements, modernisation or better outcomes for patients.

What we need to hear next week from the Secretary of State is an actual plan. As he mentioned, the right hon. Gentleman became shadow Health Secretary three years ago. I hope that in that time he has had an opportunity to think about what he wants to do and that he will actually set that out to the House next week.

[Joe Powell]

I welcome the right hon. Gentleman to his new position. On the theme of broken promises and capital investment, and in the spirit of a fresh start, I wonder whether he will extend an apology to my constituents who were promised a new hospital under the new hospital programme, which was never funded in any forward-looking Budget document?

[Edward Argar]

I am grateful to the hon. Gentleman. If he pauses for just a moment, I will turn to capital investment and seek to address his point.

[Paul Holmes]

Will the shadow Secretary of State give way on that point?

[Edward Argar]

I will make a little progress, but then I will happily give way to my hon. Friend.

Apart from the press releases and the reviews, where is the action? We need to see where the £22 billion will be spent. What plans does the Secretary of State have for additional investment for the NHS this winter? He knows, as I knew when I was a Minister, that winter in the NHS is always challenging. I look forward to him setting out what additional investment he plans.

[Wes Streeting]

On that point.

[Edward Argar]

I will give way to my hon. Friend the Member for Hamble Valley (Paul Holmes) in a second. Nice try, Secretary of State.

Is the right hon. Gentleman directing where that NHS funding goes himself, or will it be for his officials or NHS England to set the priorities for that, and who will be held accountable for ensuring that it is prioritised in the right places?

[Paul Holmes]

I thank my right hon. Friend for giving way and congratulate him on his appointment as shadow Secretary of State. Does he share my concern that, although the extra investment in the NHS is welcome, the lack of clarity from a Budget in which growth has actually been revised down means that in future years we could see additional investment in the NHS actually being cut back, because the Budget does not deliver the growth for public service investment?

[Edward Argar]

My hon. Friend is absolutely right. You cannot tax your way to growth and you cannot invest in public services without that growth. If the predictions we are seeing about growth are borne out, there is a real risk to our public services’ sustainability in future.

The Chancellor said that the funding would help to deliver 40,000 more NHS appointments a week, but again we see no reference to specific actions by which that will be achieved. The Government seem not to know the difference between a target and a plan, and simply restating their ambition while throwing money at the challenge will not be enough to deliver on that commitment.

As I have said, elements of the Budget relating to the Department of Health and Social Care were welcome, one of them being the Secretary of State’s one-nil win over the Chief Secretary in respect of funding. An additional £2 billion to drive productivity is important. I fear that it is a slimmed-down version of the £3.4 billion NHS productivity plans that we announced and funded, but I will study it closely, and, similarly, the Secretary of State’s plan for mental health is deserving of serious study. On both sides of this Chamber, we recognise the importance in mental health investment of not only parity of esteem but parity of services, and it is therefore right for us to scrutinise very carefully how the right hon. Gentleman intends to build further on the success that we had in driving that agenda forward.

Let me now turn to the subject of capital investment, which was touched on by the hon. Member for Kensington and Bayswater (Joe Powell). It concerns me that, as far as I am aware, the Secretary of State has still not told us exactly when his review of the new hospital programme will report and set out the future for each and every one of the hospitals that he committed himself to delivering during the election campaign—the programme to which the previous Chancellor had committed funding, building on the original £3.7 billion allocated in 2019. The question for the Government, and the question for the Chief Secretary to answer when he winds up the debate, is: “When will that review report, and when will each and every one of those colleagues and communities who are looking forward to a new hospital know whether it will be delivered in line with the Secretary of State’s pledge, or whether the programme will be cut?”

Nearly a week after the Budget, Members will be familiar with the verdict of the Office for Budget Responsibility: namely, that the £25 billion assault on businesses risks lower wages, lower living standards and lower growth. And let us not forget what this tax hike will mean for those providing essential services across primary, secondary and social care—the general practices, care homes, adult social care providers, community pharmacists on our high streets, hospices and charities such as Marie Curie and Macmillan which provide additional care for patients alongside the NHS.

I was deeply disappointed that the Secretary of State did not take the opportunity offered by my hon. Friend the Member for Hinckley and Bosworth (Dr Evans) to state clearly that all those groups would be exempt and would not be hit by this hike, and I hope that when the Chief Secretary winds up the debate he will be able to give that reassurance. The Royal College of General Practitioners has warned that the extra costs of the employer’s national insurance hike could force GP surgeries to make redundancies or close altogether, and the Independent Pharmacies Association has warned that community pharmacies will have to find an extra £12,000 a year, on average, to pay for the hike.

[Pete Wishart (Perth and Kinross-shire) (SNP)]

I welcome the right hon. Gentleman to his place. I was waiting for the Health Secretary to turn to devolution issues, but he never quite did. We have a particular issue in Scotland: up to £500 million of extra costs will be forced on to the NHS there because of that national insurance hike. We have heard no commitment from the Secretary of State that he will meet those costs in full, and we look forward to hearing such a commitment. I am sure the right hon. Gentleman will share my concern about what this is doing to devolved services across the United Kingdom.

[Edward Argar]

The hon. Gentleman is right to highlight the ill-thought-out consequences of this hike for hospices and general practices, both in Scotland and elsewhere. I would dearly love to be able to respond to his question. Sadly, however, I am on this the side of the House and not the other side, but I am sure that the Chief Secretary will attempt to do so.

The Nuffield Trust has said that without additional financial support, the tax raid is likely to force social care providers to pass higher costs on to people who pay for their own care, or potentially collapse financially. Charities are not exempt either. As a result of the increases in the national living wage and employer’s national insurance contributions, one of the UK’s largest social care charities says it is facing an unfunded increased wage bill of £12 million a year, and Marie Curie has warned that the rises in employer’s NI contributions will only serve to put the services that it delivers on behalf of the NHS under further pressure. Those charities will be looking to the Chief Secretary to say what succour he can offer them in the form of an assurance that they will not be hit.

[Ms Polly Billington (East Thanet) (Lab)]

I welcome the right hon. Gentleman to his place, but before throwing stones, will he just remind the House that under his Government’s plans, there would have been £15 billion less for the NHS, leaving it broken?

[Edward Argar]

I welcome the hon. Lady to her place as well. I think this is the first opportunity I have had to respond to a intervention or question from her.

In fact, we put record funding into the NHS—£164.9 billion per year—and on top of that we recruited more doctors and more nurses. We did not do that by piling tax hikes on hospices and general practices, among others. I am not sure how hitting primary care, social care or charities supporting NHS services will help the Secretary of State to deliver his aim of cutting waiting lists. I hope that the Chief Secretary will tell the House what steps the Treasury is taking to ensure that those organisations are not hit by these changes.

Let me take a moment to consider what was not included in the Budget.

[Josh Fenton-Glynn (Calder Valley) (Lab)]

Will the right hon. Gentleman give way?

[Edward Argar]

I will make a bit of progress, if I may.

There were no plans for social care reform after the Chancellor broke Labour’s promise to deliver the cap on social care costs. I hear what the Secretary of State says about a willingness to work on what is a challenge facing our whole country and society: with an ageing population, how do we address the challenge of social care? There were no further detailed plans for NHS dentistry, despite the election pledge to deliver more dental appointments. There was no support for pharmacies or for the day-to-day running of general practice, and there were still no additional resources for the NHS this winter—or, indeed, the details of reform to go with them.

[Lizzi Collinge (Morecambe and Lunesdale) (Lab)]

The right hon. Gentleman speaks about the investment that the last Conservative Government put into the NHS. Can he tell me what the outcome of that investment was? From my point of view, the outcome was longer waiting lists, poorer health and bad patient care.

[Edward Argar]

We increased investment significantly, not only to tackle the inevitable consequence of a global covid pandemic—which, as we all know, hit our NHS hard—but to build back better subsequently, which is the task that we began to perform. We have always said that investment in the NHS must be married to reform in order to deliver better patient outcomes and value for money, building on the reforms that we introduced in the Health and Care Act 2022 and ensuring that the NHS will be there to look after us for decades to come. The Secretary of State has worked with me before, and we will work with any party, including his.

[Mr Perkins]

Will the right hon. Gentleman give way?

[Edward Argar]

I gave way to the hon. Gentleman earlier. I am afraid I want to conclude my remarks, because I am keen for others to have a chance to speak.

That offer to the Secretary of State stands. I am always happy to work constructively with him when he is willing to work constructively with me. He knows that we have done that before, not least as we emerged from the pandemic, when I was still a Minister in the Department.

Unfortunately, despite the rhetoric, I fear that the Budget was a missed opportunity that will not achieve the ambitions the Government have set out. As I have said, we cannot tax our way to growth, and without growth we cannot sustainably fund public services. I urge the right hon. Gentleman to be brave, to stand up to those in his party who would have him back down or water down reform, and to deliver a genuinely radical plan for the future of our NHS and for social care that works for those who work in it, but also, crucially, for all the people who rely on it. Our constituents deserve nothing less from him.

[Madam Deputy Speaker (Caroline Nokes)]

I call Kate Osamor.

Oral Answers to Questions

Edward Argar Excerpts

Tuesday 19th July 2022 Commons Chamber

[Maggie Throup]

The hon. Lady continues to be a loud voice for those who are immunosuppressed, and I commend her for that. As she is aware, Evusheld was awarded conditional marketing authorisation by the Medicines and Healthcare products Regulatory Agency, which outlined some remaining questions, including about the amount of protection and the dose needed. My Department has been conducting an assessment of Evusheld, looking at the data available and the options for the NHS. We have asked clinicians to look at what we can do for future patient cohorts; we are considering their advice and will update the House shortly.

[Edward Argar (Charnwood) (Con)]

One of the great privileges of the three years that I spent at the Department of Health and Social Care was seeing at first hand the amazing work of our NHS workforce; I put on record once again my gratitude to them. Growing that workforce is vital to meeting the future health needs of our population, so will my right hon. Friend the Secretary of State, whom I welcome to his post, reconfirm the Government’s commitment to the target of 50,000 more nurses, and update the House on progress towards that target?

[Steve Barclay]

May I take the opportunity to thank my hon. Friend for his service as Minister of State? I think he was one of the longest-serving Ministers in that role; in fact, I think he took over from me, or shortly after me. He carried out the role with great distinction, as I am sure the whole House recognises.

I am very happy to reconfirm our commitment. I think the number is at about a third of a million, and great progress is being made. That enlarged measure is down to my hon. Friend’s work as Minister of State.

Ambulance and Emergency Department Waiting Times

Edward Argar Excerpts

Wednesday 6th July 2022 Westminster Hall

[The Minister for Health (Edward Argar)]

I am happy to do so, Mr Stringer.

It is a pleasure to be here on the Front Bench responding to this very important debate. If I am still in this role on Sunday, I think I will be the third longest-serving Minister for Health since 1970, which says something about either longevity or churn in this role. It is a genuine pleasure to respond to the hon. Member for Bath (Wera Hobhouse), and I congratulate her on securing this debate.

As hon. Members across the House have acknowledged, the NHS has faced extraordinary pressures over the course of the pandemic and continues to face them. Although I suspect that not everything I say will meet with agreement from Members from both sides of the House, I join them in expressing our gratitude to all those who work not just in our NHS and health services but in social care.

I will start with a couple of words of caution about the use of history and statistics. Hon. Members made a number of points. I have been doing this job for almost three years, and I have often found that assertions are made with statistics or other facts from the history of the NHS, and I want to provide a counter-narrative to three or four before turning to the specifics of the hon. Lady’s debate.

First, I urge a little caution from Opposition Members when raising bed closures, not least because between 1997 and 2007, about 32,000 beds in the NHS were closed, which is more than double the number that were closed between 2010 and now. I say that simply to caution hon. Members that statistics can be used in different ways. There has been a long-term trend under Governments of both parties as the nature of care has changed.

[Karin Smyth]

Will the Minister give way?

[Edward Argar]

I just want to make a few more points, and then of course I will give way to the shadow Minister. She and I spent many happy hours in the Health and Care Bill Committee over many days.

On engagement with the private sector, again I would urge a little caution. It was of course the Labour Government in 2004 who first introduced the private sector into the provision of frontline clinical services with the out-of-hours contract. A Nuffield Trust blog in 2019 highlighted the fact that the increase in the use of the private sector in the NHS began before 2010 under that Government. I do not think the hon. Member for Jarrow (Kate Osborne) was asserting anything other than that, but it is important that I put that on the record.

Of course resources are hugely important. One of the first pieces of legislation that we introduced following the 2019 general election was the NHS Funding Act 2020, which will increase funding by £33.9 billion—a record amount—by 2023-24. As the hon. Member for Weaver Vale (Mike Amesbury) would expect me to say, we introduced the health and care levy to bring more funding into our NHS and social care. It was disappointing that Opposition Members voted against additional funding for the NHS when that was put to a vote.

[Karin Smyth]

The Minister talks about the bed reduction, but that was in the context of massively increasing primary and community care, and the private sector capacity was brought in to reverse the horrendous waiting lists following 18 years of Conservative government. We decided to govern. The point that hon. Members are making is: why does the Minister not govern?

[Edward Argar]

That is exactly what we are doing: we are leading and putting forward measures. Disappointingly, Labour voted against that extra funding.

[Wera Hobhouse]

Will the Minister give way?

[Edward Argar]

I just want to finish this point, but I will give way to the hon. Lady because it is her debate.

My hon. Friend the Member for Broadland (Jerome Mayhew) and others are right in their analysis that this is about patient flows. It is about a whole-system approach and the challenges across the system. My hon. Friend asked what the solution is to making the join-up work better. A key element of the solution is the new integrated care boards and integrated care systems, which genuinely seek to bridge the gap between two parts of the system, to which the hon. Member for Bath—health and social care. They both have, for want of a better way of putting it, different DNA. The NHS, since the legislation in 1946 and its implementation in 1948, has been essentially a vertical system, whereas we have retained local care by local councils on a social care level. This is an attempt to integrate them far more effectively.

[Wera Hobhouse]

It is not very helpful that we are entering into a party political ding-dong. There is a crisis, and we owe it to our constituents to face it. We are asking the Government, who are in charge, to do something about it.

[Edward Argar]

I am grateful to the hon. Lady, but when hon. Members raise party political points, it is incumbent on me as Minister to respond and to put the facts on the record. I will turn to the specific points she has raised. I will also turn, in that context, to the various points that she and the hon. Member for North Shropshire (Helen Morgan) made about various tangible suggestions from the Liberals on the issue.

The hon. Member for Bath is right to have secured and introduced the debate, because this issue is one of growing concern, understandably, and not just for all our constituents but for those who work on the frontline of our NHS. I think it was the hon. Member for Weaver Vale who highlighted the challenges faced by those staff, who want to be there and want to help. When someone rings for an ambulance, it is not a case of making an appointment with their GP; they are deeply concerned for their health, or the health of someone else, in an emergency. All those staff want to do—I have met many of them—is be there for those people, and the hon. Gentleman was right to highlight that issue.

As the hon. Member for Bath will be aware, the pandemic has caused significant strain across the NHS and the social care sector, and emergency care performance, as hon. Members have been open in acknowledging, is recognised as a whole-system issue. The challenges in performance can be traced along the entire patient pathway. Indeed, as I think the hon. Lady acknowledged in her Adjournment debate in the main Chamber on 31 March, although there are elements of that that we need to look at, we also need to look at the issue as a whole. She was right to say that.

For example, as hon. Members have said, the problems and delays in discharging patients home or to community services once they have recovered have a genuine impact on hospital bed occupancy—taking up beds that could otherwise be used by patients who need them. I want to give my hon. Friend the Member for Broadland a slightly more optimistic picture, which is in no way to diminish the challenge that remains. The number of beds taken up by people who are clinically fit to be discharged is not 20,000; it hovers at around 10,000. We have set up a national discharge taskforce, which is working actively with trusts and across local systems, particularly those that are most challenged, to support that discharge work. The situation is not as acute as he suggested, but it remains challenging because every one of those beds could be used to admit patients from an urgent and emergency care setting, or indeed to tackle elective backlogs and waiting lists.

[Margaret Greenwood]

Will the Minister give way?

--- Later in debate ---

[Edward Argar]

I would like to make a little progress before giving way again. I am conscious that I need to leave enough time for the hon. Member for Bath to respond.

That affects how quickly patients can be admitted from A&E, and such delays increase waiting times, as has been said, and lead to that crowding in departments, which has an impact on how quickly new patients arriving in A&E can be seen and treated, including those arriving by ambulance. When this causes ambulance queues to form, the local ambulance resource available to be dispatched to incoming 999 calls is reduced. It is fair to say that although the ambulance queues and delays are often the most visible manifestation of challenge, they are in many ways a symptom of that broader patient flow and the systemic challenge we face.

The root cause of these issues is hospital bed occupancy. That has consistently remained nationally at around 93%—a level usually seen only during winter pressures, as hon. Members have said. The pandemic has played a significant part in driving those pressures, and there are nearly 9,500 in-patients either with covid or for covid in clinical settings, as of 1 July. That is about 10% of all general and acute beds in the NHS.

[Margaret Greenwood]

rose—

[Edward Argar]

I will give way to the hon. Lady, but I want to make a little progress. There are points I want to make before I run out of time, but then I will give way.

That number, as we know, has frequently been higher during the pandemic, and there is the challenge of staff absences during waves.

[Margaret Greenwood]

rose—

[Edward Argar]

If the hon. Lady is brief, I will of course give way.

[Margaret Greenwood]

The Minister will be aware that I have expressed extreme concern and tabled written questions about what happens to those people who are discharged under what was known as discharge to assess and their clinical outcomes. Will he commit to carrying out a review of the patient outcomes of all the patients discharged in that way, to see how many were readmitted to hospital within 30 days of discharge?

[Edward Argar]

I will not commit myself to what the hon. Lady specifically asks for because of the challenge of data collection, but I will say that I see where she is coming from and appreciate the underlying point, which is about understanding the impact of the policy. It has been in use since 2020 as a pandemic measure and is now in statute. The NHS will be monitoring it carefully. We do not agree on everything, but I am always happy to talk to her about these matters because she takes a close interest in them.

With regard to local actions in the patch covered by the hon. Member for Bath, as an illustration of the sorts of measures being put in place across the country, the local integrated care system is working to improve patient flow and reduce handover delays at acute trusts, including the Royal United Hospital in Bath. I join her in paying tribute to the work that her local team there are doing. That hospital is working well with community partners to help patients to return home as soon as they are well. That includes work with the hon. Lady’s local council to develop its domiciliary care provider, which will provide an additional 1,000 hours of domiciliary care a week. A £2 million investment will also be made in the Home First programme, whereby experts from across health and care help patients to get safely back home as soon as possible. The system is also working on opening an additional 20 beds at St Martin’s Community Hospital, while also developing same-day emergency care for frailty to avoid unnecessary admissions to hospital and to care for patients safely in the community.

There is of course nationally a wide range of support in place to improve urgent and emergency care more widely. That includes growing the number of call handlers for 999 and 111, and the investment that we have seen going into our ambulance services and A&Es. It is the case that £450 million of capital investment has already gone into increasing capacity in urgent and emergency care departments. In addition, we have kept, I think, over 155 more ambulances on the road over winter with our investment of £55 million more going into ambulance services. We are investing those resources in the frontline. If I recall my statistics correctly, there has been a 38% increase in the paramedic and ambulance workforce since 2010. The hon. Lady and her party can rightly claim a degree of credit for that, because a degree of that took place between 2010 and 2015. We do continue to grow the workforce.

Turning to workforce issues more broadly, it is absolutely right that, as well as providing the support to which the hon. Member for York Central (Rachael Maskell) alluded—mental health and physical support for the workforce—we continue to grow the workforce in order to ease the workload pressures. We have already witnessed over 30,000 more nurses in the NHS since that pledge was made in 2019. We continue to grow all workforces. In section 41 of the Health and Care Act 2022 we set out a very clear duty on the Secretary of State in relation to workforce planning, and that work is already under way.

I will turn to a couple of further points very briefly, because I want to give the hon. Member for Bath her two minutes at the end. She raised a number of specific points. She called for greater resources to be put in. That has been done. She called for an increase to be made in paramedics and ambulance staff. That has been and continues to be done. None of these are completed works, but they continue to be done. She called for action to stop ambulance station closures or community ambulance station closures. I have to say that those decisions are made clinically by local trusts; the power was not there for the Secretary of State to intervene. In fact, it was the Labour party that argued against giving the Secretary of State and Ministers the power to take action on those things when it voted against and spoke against that measure during the passage of the Health and Care Bill. It is right that clinicians determine what is the best set-up for clinical services in their area. I just gently make that point.

In summary, I think that both sides of the House recognise fully the challenges faced in these unprecedented times by our urgent and emergency care sector, and particularly by patients and those who work in the sector. We have a plan to fix it. We continue to invest in that plan and to support our workforce, and we will continue to do that for the benefit of patients.

Health Services: Southend West

Edward Argar Excerpts

Wednesday 6th July 2022 Commons Chamber

[The Minister for Health (Edward Argar)]

I congratulate my hon. Friend the Member for Southend West (Anna Firth) on securing this important debate. She is a notable advocate for healthcare in her constituency, and a strong champion and voice for her constituents in this place. The NHS has faced extraordinary pressures over the course of the pandemic, and I am sure the whole House will join me in expressing our utmost gratitude to staff for their outstanding work and dedication during this time.

I will address a number of my hon. Friend’s points, but, although it is rare to do so at the Dispatch Box, I will come to her main point first and seek to address it head-on. My hon. Friend and my right hon. Friend the Member for Rayleigh and Wickford (Mr Francois)—and, although she may not intervene in the debate, the Lord Commissioner of Her Majesty’s Treasury, my hon. Friend the Member for Castle Point (Rebecca Harris)—have asked whether the Government will provide the £8.4 million of funding requested to improve Southend emergency department to unlock the business case to allow it to proceed to do further work. While I regret that I am not able to give a clear answer to my hon. Friend the Member for Southend West this evening, I hope it will come as some encouragement to her that I can say that, following the tenacity of her campaigning on this issue in the Chamber, and indeed outside it, in pursuing me and other Ministers—that is exactly what Members of Parliament are here to do—I have instructed the Department to convene a meeting to review the submitted business case prior to the summer recess, and I anticipate being able to update her and the trust with the outcome of that before the House rises for the summer. That is, obviously, subject to my new Secretary of State’s decision on the recommendation of officials, but I undertake that I have instructed officials to come back to her with that decision before the House rises in a couple of weeks.

In the meantime, work to improve local services continues, and I am aware that Mid and South Essex NHS Foundation Trust hospitals and the East of England Ambulance Service NHS Trust—EEAST—have a range of actions in place to meet the high levels of demand they are experiencing. For example, EEAST is prioritising emergency cases, and, where clinically appropriate, a team of clinicians in its emergency clinical advice and triage service will advise people who do not need an ambulance to use other services. EEAST has also successfully recruited more call handlers and expanded the network of hospital ambulance liaison officers who help to co-ordinate handovers at hospitals, including by diverting crews to other hospitals where they can be seen more quickly.

EEAST is working with acute hospitals to develop cohorting areas, where patients can be assessed before going into the emergency department, helping to get ambulances back on the road more quickly. In the context of ambulances, I am reminded of an incident that was recounted to me—I could not possibly reveal the source from which I acquired this information. When she was abseiling to raise money for charity while dressed as Wonder Woman, my hon. Friend spotted ambulances queued up. As soon as she got to the ground and across the car park, she pursued the issue to find out what was going on. Such is her commitment to her constituents and her passion for this issue, and I commend her for that.

After a successful trial at Lister Hospital, EEAST is now using a rapid release process with some acute hospital partners, where the handover of patients is fast tracked if an urgent response is required in the community. At busy times, EEAST may also offer enhanced pay rates to encourage staff to complete additional shifts.

These local initiatives are also supported by national actions to reduce waiting times, including continuous central monitoring, support from the National Ambulance Coordination Centre and the allocation of £150 million of additional system funding for ambulance service pressures in 2022-23, supporting improvements to response times through additional call handler recruitment, retention and other funding pressures. My hon. Friend has quite rightly highlighted the additional ambulance service staff and the additional ambulances themselves. She is absolutely right to highlight the fact that while the ambulance service may often be the visual manifestation of the challenges faced, it is a system challenge with a number of complex, interrelated parts.

My hon. Friend has raised an important issue concerning the NHS 111 service and the automatic dispatch of ambulances. I am advised that when a patient calls 111 and the automated call handler assessment concludes that a low-urgency ambulance should be dispatched, a clinician will call the patient back to validate that that is actually required. I understand that that happens about 95% of the time. Where the patient is not able to be contacted within a fixed timeframe, as my hon. Friend has said, the call will be passed to the ambulance service for dispatch. However, it is important to understand that the call may still be scrutinised by the ambulance service as to whether an ambulance is really needed.

Although no remote triage process can be perfect, there is consistent clinical review of these calls to ensure the wise use of resource, and NHSEI does not believe that significant numbers of ambulances are being dispatched unnecessarily. I have already asked officials in the Department to look into the specific issue that my hon. Friend has raised to understand the extent to which that is happening, whether it is happening unnecessarily and what the consequences are in terms of cost and time resource.

We are also building the capacity of NHS 111 to act as the front door to the emergency care system, so that patients receive an ambulance or go to A&E only when needed. This is being supported with £50 million in 2022-23, helping to ensure that people can access urgent care when they need it, increasing the ability to book callers into alternative services or into a timed slot at their local A&E where appropriate.

On general practice, we know that general practitioners are still under huge pressure. I am incredibly grateful for the contribution of GPs and their teams over the past two years. They have stepped up to deliver our world-leading vaccination programme while still providing exemplary care for their patients during a pandemic. We made £520 million available to improve access and expand general practice capacity during the pandemic. That was in addition to at least £1.5 billion announced in 2020 to create an additional 50 million general practice appointments by 2024 by increasing and diversifying the workforce.

GPs and their teams will always be there for patients, alongside NHS 111 and community pharmacy teams, and it is important that people do not delay in coming forward with health concerns. In 2021-22, we saw the highest ever number of doctors accepting a place on GP training—a record 4,000 trainees, up from 2,671 in 2014. GP trainees support fully qualified GPs, helping to ease workloads and increase capacity, and allowing more patients to get the care they need. Just as in hospitals, doctors in training are delivering direct patient care while being safely supervised and supported.

I hope that our exchange today provides a degree of reassurance that there is significant support in place at local and national level to address performance issues, as well as a determination to improve the provision of health services in Southend West and more broadly in the local area. As you alluded to, Mr. Deputy Speaker, I have been a regular at the Dispatch Box in these Adjournment debates, certainly over the past two to three years. I am grateful to my hon. Friend for bringing forward this debate, and it has been a great pleasure and privilege to answer it.

[Anna Firth]

May I thank the Minister very much for the careful way in which he has responded to all my points and for his assurance that there will be some news on the £8.4 million before the recess?

[Edward Argar]

I am grateful to my hon. Friend for her kind words. I will just conclude by saying that it has been a huge privilege to respond to debates such as this, and I am very grateful to her for affording me that privilege this evening.

Question put and agreed to.

Gynaecological Services: Waiting Lists

Edward Argar Excerpts

Wednesday 6th July 2022 Westminster Hall

[The Minister for Health (Edward Argar)]

I would just say that if I am still in post on Sunday, I will be the third-longest serving Minister of State for Health since 1970, but only time will tell. I congratulate the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) on securing this debate about waiting lists for gynaecological services. I know this is a very important subject for her, and I would like to take a moment to highlight her well-known focus in this House on women’s health matters and the work she has done in that space, which reflects the importance many of our constituents attach to these issues.

As has been alluded to, the hon. Member for Kingston upon Hull West and Hessle has done important work on the suspension of the use of vaginal surgical mesh. She has also worked to promote menstrual wellbeing and worked with Endometriosis UK. I congratulate her on that. It is always a pleasure to answer a debate of hers or to respond to her in the Chamber. It is also a great pleasure to be able to respond to the hon. Member for West Ham (Ms Brown), who as ever gave a typically powerful and forthright speech. She highlighted some harrowing examples—as the shadow Minister put it—that illustrate the broader issues around hysteroscopy and particularly the challenges around the NHS listening and acknowledging patients’ genuine concerns and requests. I will return to that in a moment. Normally at this point I would offer to meet with the hon. Member for West Ham to discuss this, but I will instead offer that the relevant Minister meet with her to discuss this matter further and the specific points she raised with her typical forthrightness and expertise.

The covid-19 pandemic has left a large backlog of people needing care. The latest figures show that 6.53 million people are waiting for NHS care, with 1.55 million of these waiting for diagnostic tests. As part of this, the waiting list for gynaecological services has over 28,800 people waiting longer than a year for care. We are working hard to reduce the number of people waiting for these vital services as swiftly as we can. It is promising that activity levels have reached 95% of their pre-pandemic levels in this area, but that is still 5% short of what normal activity would have been pre-pandemic. We recognise that more needs to be done in this space.

We are increasing capacity for gynaecological surgery to tackle long waits in two key areas: first, through surgical hubs, which allow for higher volumes of care to be carried out in protected circumstances, reducing the risk of covid-19 infections; and secondly, through the high-volume, low-complexity programme, which allows increased volumes of surgical procedures to be carried out. To support services further, we have grown the workforce in gynaecology with the addition of 108 consultants this year, bringing the total number working in obstetrics and gynaecology to over 6,400, an increase of 681 since 2019.

The hon. Member for Kingston upon Hull West and Hessle rightly highlighted a number of key points, one being staffing and another being funding, which is also about facilities and their availability. That is why we increased funding by £33.9 billion in the legislation passed in early 2020 to reach a certain level by 2023-24, plus we provided additional funding throughout the pandemic. We recognise that there is a lot more to do.

The hon. Lady also talked about prioritisation and ringfencing. The only note of caution that I will set out about ringfencing particular parts of budgets is that often it is more effectively done by local clinical systems than by me or another Minister. Often those systems are best placed to work out what their priorities are, based on their waiting lists, population health and population need. I hope that integrated care systems will play an increasingly large role in understanding that, and adapting to the needs of local areas.

Turning to the women’s health strategy, which I know is a central element of the way the Government propose to move forward. Across women’s health we are working to deliver better care through the first women’s health strategy for England, which will reset the way in which the Government are looking at women’s health. That will correct the way in which the health system has in the past been set up—it is fair to say, although hon. Members may disagree—by men and for men. That is the historical evolution of our health service. Huge progress has been made, but there is more to do, which is why that focus is necessary.

Work on the strategy began in December 2021, when we published “Our Vision for the Women’s Health Strategy for England”. We announced in that vision that we are appointing the first ever women’s health ambassador for England. In June we announced the appointment of Dame Lesley Regan to that role. She will focus on raising the profile for women’s health, increasing awareness of taboo topics, and bringing in a range of collaborative voices to implement the women’s health strategy. To reassure the hon. Member for Kingston upon Hull West and Hessle, we do aim to publish the strategy before the summer recess. The relevant Minister will aim to do that.

[Emma Hardy]

When that is published, will it include the point I made about looking at whether there is a gender bias in the prioritisation of health treatment? That was something that the RCOG was really keen to emphasise. Everyone understands that covid meant waiting lists for everything. One of my key points was whether there is a gender bias? Is that partly why gynaecological treatment seems to be delayed more than others?

[Edward Argar]

I do not want to prejudge the specifics of that strategy. In broad terms, I hope that I can reassure the hon. Member that we are seeking to look at all the drivers of the challenges that she and other Members have highlighted, and seek to address improvements. Without prejudging, there are points made by hon. Members that I would expect to see included around information, engagement, guidance and empowerment. The importance of empowering women, believing them and engaging with them came through very clearly in the hon. Member for West Ham’s comments.

[Ms Brown]

I am grateful to the Minister for what he is saying. It is about empowerment, but there is no empowerment when the choice is either to go for it now or to wait for months. Over and over, I have correspondence from women who are being belittled by those in gynaecological services, telling them not to make such a fuss “dear”. That is despite the fact that getting up off the floor after something is often awful. I have had meetings with Ministers; what I really want is some action.

[Edward Argar]

I am grateful once again for the hon. Lady’s typical forthrightness. I have debated with her on a number of occasions—I was going to say “crossed swords” but that is unfair—and I know that she means it with good intentions, even when she is being rightly firm with Ministers in pressing a case. She is absolutely right. When I talk about empowerment, I envisage that encompassing a whole range of things. That includes believing people, treating them with respect and listening to them.

In terms of action, one Opposition Member—forgive me; I do not remember who—mentioned the need for a clear delivery plan. I have been in the Department for almost three years now. Governments of all complexions are often very good at coming up with strategy documents, which are important. However, the key to whether they deliver the outcomes for all of our constituents is how we deliver and implement them on the ground. We have to get the strategy right; that is the first step and we anticipate publishing that before the summer recess. However, it is then important that we focus on delivery, and that we work not just with the NHS but with patients and relevant campaign groups to work out how we deliver on the intentions in that strategy.

More generally, we set out in our elective recovery plan how we intend to build back from covid-19 and reduce waiting times across all elective services, including gynaecology and menstrual health. The plan included our commitment to tackling long waits, eradicating waits of longer than two years by the end of July 2022, and eliminating waits of over one year by March 2025. We will also ensure that 95% of patients waiting for a diagnostic test will receive it within six weeks by March 2025. To support that, we have committed to spend more than £8 billion from 2022-23 to 2024-25, in addition to the £2 billion elective recovery fund and the £700 million targeted investment fund already made available to systems.

That will hugely increase the capacity in the system. However—this also relates to the point made by the hon. Member for West Ham—one of the aims of the elective recovery plan, My Planned Care, and similar, is to increase, not just in the space of gynaecological services but more broadly, the opportunities for patients to exercise choice over whether they want something immediately or would prefer to wait, and potentially where they would prefer to have that procedure performed. We are continuing, through this, to try to build in more choice, not just for the patients—although that is crucial—but to help maximise the capacity within the system, to help avoid people having to wait longer than necessary.

[Ms Brown]

What research, if any, has the Minister done on hospital trusts, for instance, that might have people in a number of different geographical areas being served by a group of hospitals, and whether there is any real choice about which hospitals in those families people can elect to visit?

[Edward Argar]

The challenge that the hon. Lady poses is that if we are talking about, essentially, the multi-hospital trusts or similar, as they have grown up, they have often designed their services in x specialism in one hospital, and moved things around like that. In those cases, there are often only one or two hospitals within the trust that do it. We are seeking to try to create greater choice across the entire system, including regionally, which genuinely builds choice. That is a big challenge—Governments of both complexions have tried it with varying degrees of success—but that is what we are seeking to do here. However, there is a lot of work to do in that space. I hope that when she sees the strategy she will recognise the degree of underpinning research that has been done. It may not necessarily cover every point that she has focused on, but I hope she will recognise the amount of work that has been done.

[Emma Hardy]

I thank the Minister for again giving way. When we see the women’s health strategy, will it respond to all of the recommendations from the Cumberlege review? We had a bit of an interim response to the review, but I am sure the Minister will be aware that there is still a cross-party campaign to ensure that all of those recommendations are fulfilled. If he ever does happen to find himself on the Back Benches, he is more than welcome to join any of my APPGs, and any of those campaigns, from a different side. I would be keen to know whether he is aware of any plans to fully address the report and fulfil those recommendations.

--- Later in debate ---

[Edward Argar]

I am grateful to the hon. Lady. She highlights an issue that I know has exercised Members on both sides of the House. Although progress has been made, I know that a campaign on other elements continues. This makes me sound as I used to occasionally, doing the morning media round and talking to Kay Burley or similar, but I do not want to prejudge what might be said in due course—that was sometimes a wise thing to say when discussing infection rates, restrictions or similar. I do not want to prejudge or predetermine what will be in that strategy, but I genuinely hope and believe that the hon. Lady will be pleased when she sees it. I would not for a moment expect her not to challenge it and seek to improve it, because I have worked and interacted with her before, and that is what Members do in this House. However, I hope that she will see progress in there.

We know that diagnostics are a key area in many gynaecological pathways. As such, we are establishing up to 160 community diagnostic centres across the country by 2025. There are currently 90 such centres operating across the country, including supporting spoke sites, and they have delivered 1 million tests and scans since July 2021. The expansion of the centres will mean that the NHS will have just shy of 38% more MRI capacity, 45% more CT capacity, 26.8% ultrasound capacity improvements, and an increase of around 19% in endoscopy capacity by March 2025, compared to pre-pandemic levels. That will allow more patients to be seen more quickly, meaning they can be diagnosed sooner and then start any treatment they need.

I will turn briefly to general practitioners, who are often key in the treatment of gynaecological conditions. As we all know, general practices are still very busy and are caring for patients in the community who are on waiting lists for secondary care. I pay tribute to the work of general practitioners and their teams throughout the pandemic. We know that some patients have struggled to get through to their GP practice on the telephone, which is why the NHS offered practices an interim telephony solution that enabled them to use Microsoft Teams to free up lines for incoming calls.

We made an additional £520 million available to improve access and expand general practice capacity during the pandemic. I mention this in passing because it is important to recognise that for many the general practitioner is the front door to the system and being able to get access to a general practitioner is a crucial part of being able to get into the care pathway, be that for diagnostic tests or for acute treatment, should that be needed.

I will wrap up now and I hope that will give the hon. Member for Kingston upon Hull West and Hessle a few minutes to respond. In conclusion, I pay tribute to her for securing the debate and bringing it to the Chamber. What this Chamber may lack in numbers, for various reasons this afternoon, is made up for in quality and in the importance of the subject of debate. As ever, I am grateful to the hon. Member for West Ham and to the shadow Minister, the hon. Member for Enfield North (Feryal Clark), who it has always been a pleasure to appear opposite in this Chamber. I hope that I have offered some reassurance to hon. Members about the extent to which the Government take the issues that they have raised extremely seriously, and I too look forward to the publication of the strategy.

Financial Directions to the NHS: Variation 2022-23

Edward Argar Excerpts

Thursday 30th June 2022 Written Statements

[The Minister for Health (Edward Argar)]

I am varying the 2022-23 financial directions to NHS England made on 31 March 2022.

These are primarily technical changes required as a result of the Health and Care Act 2022. The main purpose of the Act is to establish a legislative framework that supports collaboration and partnership-working to integrate services for patients. Among a wide range of other measures, the Act also includes targeted changes to public health, social care and the oversight of quality and safety.

NHS England and NHS Improvement have now been formally brought together into a single legal organisation. Therefore, NHS Improvement’s resource and administration limits, as well as its capital budget, have now been incorporated into NHS England’s budget.

HM Treasury’s consolidated budgeting guidance will now apply to the whole of NHS spend including providers, requiring the addition of funding for annually managed expenditure and ringfenced funding for impairments for NHS trusts and NHS foundation trusts.

Finally, funding is being provided from NHS England to Health Education England (HEE) for investment in workforce initiatives.

The Act now decouples the financial directions from the NHS mandate and requires the directions to be laid in Parliament. They will be published on gov.uk. The existing NHS mandate remains unchanged.

[HCWS163]