Queen Elizabeth Hospital, King’s Lynn

Edward Argar Excerpts

Wednesday 23rd March 2022 Westminster Hall

[The Minister for Health (Edward Argar)]

It is a pleasure to serve under your chairmanship, Mr Hosie, and to respond to this debate, which was secured by my hon. Friend the Member for North West Norfolk (James Wild), about the quality of care and the estate at Queen Elizabeth Hospital, King’s Lynn.

As my hon. Friend has already alluded to, this is an important subject for him. It is rare that I pass him in the corridors of this place without him gently but firmly drawing me aside to raise this issue with me. I know that he does so because it matters hugely to his constituents. Indeed, as my hon. Friend the Member for Broadland (Jerome Mayhew) said, it also matters hugely to other people living in the region—the wider Norfolk area—and beyond.

My hon. Friend the Member for North West Norfolk rightly highlights the close interest that a large number of right hon. and hon. Members take in this subject. Indeed, I am conscious that even some Members in their lordships’ House take a close interest in this issue. I am grateful to my hon. Friend the Member for North Norfolk (Duncan Baker) for his words. He is absolutely right to highlight the dedication of our hon. Friend the Member for North West Norfolk to this cause. His constituents and, indeed, those represented by all hon. Members here today are lucky to have them, as they continue forcefully and firmly to argue the cause of the Queen Elizabeth Hospital, King’s Lynn.

As my hon. Friend the Member for North West Norfolk will be aware, the Government are backing our NHS with a significant capital settlement that will create a step change in the quality and efficiency of care up and down the country, including in Norfolk. We are pleased to confirm that an initial £3.7 billion has been provided over a four-year period—this spending review period—to begin making progress on delivering 48 new hospitals by 2030, with 30 of the hospitals already announced to be built outside London and the south-east. I am pleased that six of the 48 hospitals are already in construction and one has already been completed. Of course, this hospital building programme is in addition to the 70 upgrades, worth £1.7 billion, that are part of the wider programme of capital investment. Those commitments will result in outdated infrastructure being replaced by facilities for staff and patients that are at the cutting edge of modern technology, innovation and sustainability.

My hon. Friend the Member for North West Norfolk is, as always, passionate in putting the case for his local hospital to be among the next eight to be announced—I will turn to the process and timelines for that shortly. As he highlights, the Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust has been provided in recent times with significant national funding, including £5 million in 2021-22 from our targeted investment fund for the establishment of an eye care unit at the Queen Elizabeth and a modular endoscopy unit, and £2.65 million in 2020-21 for the emergency department expansion works and to address backlog maintenance across its locations. My hon. Friend advocated for both those investments.

Let me turn to a point that I know is a significant concern for my hon. Friend. We remain publicly committed to eradicating reinforced autoclaved aerated concrete from the NHS estate by 2035-36—I note my hon. Friend’s point highlighting that in his view and the view of others, that needs to happen more swiftly—and to protecting patient and staff safety in the interim period. As he said, we awarded the Queen Elizabeth £20.7 million this financial year as part of SR20 £110 million ring-fenced funding to address the most serious and immediate risks posed by reinforced autoclaved aerated concrete. In addition, further funding confirmed in the autumn Budget and spending review will allow for the continuation of this remediation work in the Queen Elizabeth Hospital and, indeed, on the wider NHS estate.

Let me turn to the next eight new hospitals. The proposal for trusts to submit an expression of interest to be one of the next eight was announced last year and, as my hon. Friend knows, his local hospital submitted its expression of interest. We have been reviewing all submissions against our robust assessment process, to identify a longlist of schemes to progress to the next phase. We will communicate with trusts in due course about the next stage of the process, and will announce the selected eight schemes later in the year.

I am conscious that my hon. Friend, his local trust and his constituents will be keen to see that progress as swiftly as possible. There is a challenge there. We want to ensure that the assessment is fair and rigorous. I am also sensitive to the upcoming purdah period for local election campaigns across the country, but I do take my hon. Friend’s point about the need for speed. I suspect that his local trust will wish to know swiftly whether it is successful or unsuccessful and, if it is successful, what it needs to do for the next stage. I hope that my hon. Friend will appreciate that I cannot comment, beyond those process points, on the specific bid that his local trust has submitted, save to say that it will receive very, very careful consideration in that process.

Let me turn to, more broadly, the quality of patient care and the points that my hon. Friend made in that respect. The CQC plays an important role, as he knows, in ensuring that NHS providers meet the standards of care expected by patients, families and carers. I recognise that the Queen Elizabeth had long struggled with financial and performance challenges, as previously identified by the CQC. The trust had previously been removed from special measures, now known as the recovery support programme, after being placed in the regime between 2013 and 2015, only for the CQC to subsequently recommend that it should fall back into those measures in 2018 when the regulator identified concerns across several core services.

Recent inspections in December 2021 and January 2022, which my hon. Friend highlighted, found significant improvements in the governance, leadership and culture of the trust. Although its overall rating was “requires improvement”, this represents a significant step forward from its previous rating of “inadequate”. I join my hon. Friend in paying tribute to the hard work and commitment of the chief executive, Caroline Shaw, the rest of the leadership of the trust and, crucially, all the staff at the Queen Elizabeth Hospital, King’s Lynn, who have clearly worked incredibly hard through even more challenging circumstances than they would usually encounter in the course of their work, and still made improvements in patient care and in the CQC rating. I pay tribute to all of them for the work they have done.

I welcome the commitment given to the CQC by the leadership to ensure that those improvements are sustainable and continue to be built on. As we would expect, the CQC will monitor the trust’s performance in order that the improvements are embedded and that further improvements in care and services are made for the benefit of patients and their families.

[James Wild]

I appreciate that my hon. Friend cannot get into the specifics, but can he assure me that the fact that this is the No.1 bid for the east of England will play heavily in the consideration of whether it will be on the shortlist and then chosen as one of the eight schemes?

[Edward Argar]

As my hon. Friend knows, each region will feed in its views about which of the schemes and bids in its area are the highest priority. Without prejudging that assessment process, I hope I can reassure him that one factor that I know he considers to be of significant importance—RAAC—will be considered. Patient safety and the safety of the buildings will be a factor in the analysis of which bids should go forward to the long list, but I do not want to go further than that at this point, however much he may charmingly seek to tempt me to do so.

Elective recovery is an area of real focus for the Department and for the whole Government, and I am aware that covid-19 has placed an unprecedented strain on routine and planned care, with waiting lists in England reaching a record high, at just over 6 million in January 2022. I understand that 19,366 of those patients are waiting for treatment at the Queen Elizabeth Hospital.

In February, the NHS published the “Delivery plan for tackling the COVID-19 backlog of elective care”, which set out a clear vision for how the NHS will recover and expand elective services over the next three years. That delivery plan commits to eradicate waits of longer than a year for elective care by March 2025. Within that, by July 2022, no one will wait longer than two years, and we will aim to eliminate waits of over 18 months by April 2023 and of over 65 weeks by March 2024.

To support elective recovery specifically, the Department plans to spend more than £8 billion from 2022-23 to 2024-25, in addition to the £2 billion elective recovery fund and £700 million targeted investment fund already made available this year to help drive up and protect elective activity. Taken together, this funding could deliver the equivalent of around 9 million more checks, scans and procedures, and will mean that the NHS in England can aim to deliver around 30% more elective activity by 2024-25 than it was delivering before the pandemic.

In highlighting the extra resources that we are putting into our NHS, it is vital to understand that this is not about the inputs; it is about the outcomes for patients and how those resources are used wisely to deliver improved patient outcomes and improved experiences for patients, with shorter waits. With regard to what is needed to achieve those outcomes, a significant part of that funding will be invested in staff, in terms of both capacity and skills.

I understand that an orthopaedic unit bid for about £18 million has been submitted by my hon. Friend’s local hospital trust. That is in the context of the £5.9 billion elective recovery funding, and the £1.5 billion from that for capacity and social hub improvements. Those bids will be carefully considered. They will need to meet the recommendations arising from the pilots that took place in London and the getting it right first time review, but I certainly look forward to considering the bid from my hon. Friend’s trust in due course.

[Duncan Baker]

Does the Minister know that the Queen Elizabeth Hospital was named after the Queen Mother? As it is Queen Elizabeth’s platinum jubilee this year, does he agree that it would be a fitting tribute to give the green light to rebuilding a hospital that is named after her mother?

[Edward Argar]

My hon. Friend is even more dextrous than our hon. Friend the Member for North West Norfolk in seeking to tempt me into an indiscretion or a prejudgment of the application process and consideration. I hear what he says and he makes his point eloquently, but I will not be drawn while that analysis and assessment of the bids is under way.

Ambulance services, like other emergency care services in the NHS, have come under significant pressure, as hon. Members will know. In February 2022, the service answered over 764,000 calls to 999—an increase of 13% on the number of calls in the same month before the pandemic. High levels of demand on the emergency care system, alongside the need for infection prevention and control measures, has resulted in higher instances of delays in the handover of ambulance patients to A&E in some areas.

I reassure hon. Members that significant support is in place for acute trusts, to help address handover delays. NHS England and Improvement and its regional teams are working with local systems—in this case, with the Queen Elizabeth Hospital in the constituency of my hon. Friend the Member for North West Norfolk—to improve their patient handover processes, helping ambulances get swiftly back on the road. Ministers are in regular contact with NHSEI on the performance of the emergency care system, including the ambulance service and accident and emergency departments.

In conclusion, I once again pay tribute to my hon. Friend the Member for North West Norfolk and all my hon. Friends who have spoken in this brief but very important debate for the work that they are doing to champion the Queen Elizabeth Hospital, King’s Lynn. As I say, his constituents are incredibly lucky to have such a champion of their cause, of healthcare in his constituency, and of investment in his local hospital, and I look forward to continuing working with him to ensure that the quality of healthcare his constituents receive is the best the NHS can provide. I note his very kind offer, which has been reiterated to me, to visit him in sunny Norfolk—as I suspect it will be in the coming months—to see his local hospital. If I am able to do so, I will be delighted to visit.

Question put and agreed to.

NHS Capital Spend and Health Inequalities

Edward Argar Excerpts

Tuesday 22nd March 2022 Commons Chamber

[The Minister for Health (Edward Argar)]

As ever, it is a pleasure to be here at the end of the day for the Adjournment with you in the Chair, Madam Deputy Speaker—I may jest slightly, but these Adjournment debates are hugely important, as you know, because they give an opportunity to raise matters of genuine local importance to Members of this House, as my hon. Friend the Member for Telford (Lucy Allan) has done.

With that in mind, I congratulate my hon. Friend on securing this debate, and on her passion and commitment to her constituents. She has raised these issues consistently in this House, both in the Chamber and in Westminster Hall debates, and I pay tribute to her for that. She is a strong and passionate campaigner on behalf of her Telford constituents, and they are extremely lucky to have her as their Member of Parliament.

Occasionally, as a Minister, one may catch one’s breath slightly when one sees an Adjournment debate in my hon. Friend’s name on this subject in the Chamber, because one knows she will press her constituents’ points hard, which is exactly what she is here to do. That is why they have wisely elected her three times now to this place. I know her determination on behalf of her local hospital and her constituents, and I gently say to her local trust that it ignores or dismisses that at its peril—something I have learned doing this job for two and a half years. I hope she will feel that I have never ignored or dismissed the points she has raised.

I will turn to the national picture on capital spend before turning to my hon. Friend’s specific points. This Government are prioritising capital spend in the NHS to transform and improve healthcare outcomes for people and to put health financing on a sustainable footing. We are building new hospitals, upgrading those that have reached or are reaching the end of their life and tackling backlog maintenance and RAAC—reinforced autoclaved aerated concrete—challenges in hospitals. We are also improving the mental health estate, investing in technology, the digitisation of the NHS, elective recovery and research and development.

It is our firm belief that health services will need to do things more efficiently and differently from before, and for that reason the DHSC’s capital budget is set to reach its highest real-terms level since 2010: £32.2 billion for the period 2022-23 to 2024-25. My hon. Friend mentioned the importance of improving our diagnostics facilities. This Government are proud to have invested £2.3 billion in the community diagnostic centres programme. Some £5.9 billion of capital investment will be provided for the NHS to tackle the backlog of non-emergency procedures and to modernise digital technology to tackle waiting lists, including £2.1 billion for the innovative use of digital technology, and £1.5 billion for new surgical hubs, increased bed capacity and equipment to help elective services to recover, including surgeries and other medical procedures, as well as the community diagnostic centres that I have referred to previously. Based on increasing demand and patient convenience, the CDCs aim to carry out the range of diagnostic tests required for a patient in as few visits and in as few locations as possible, and they genuinely have the potential to improve health outcomes.

My hon. Friend talked about health disparities particularly in the context of her own constituency, sitting within our country but also within the county of Shropshire. She is right to say that health disparities across the country are stark and have been further highlighted and exacerbated by the pandemic. We are determined to address the long-standing health disparities that exist in many areas, be they in access to services, health outcomes or people’s experience of their local health service. To that end, later this year we will publish a health disparities White Paper setting out actions to reduce the gap in health outcomes between different places and communities across the country so that people’s backgrounds do not dictate their prospects for a healthy life ahead of them. This will mean looking at the figures for preventable killers such as tobacco and obesity as well as wider causes of ill health and access to the services needed to diagnose and treat ill health in a timely, accessible way. This will be a cross-system endeavour relying on close working with the NHS, wider health and care services, and across local and central Government. I welcome any thoughts my hon. Friend has in her local context as we develop that White Paper.

Let me turn to my hon. Friend’s two specific points relating to her health and care system. She highlighted her campaign to retain a 24/7 A&E local in Telford. As she said, in 2019 my right hon. Friend the Member for West Suffolk (Matt Hancock) made his decision, which still stands, for the Future Fit programme to proceed, but also, crucially, for an A&E local to be in place in Telford. It is very important that I put this on the record. The success of my hon. Friend’s call—the fact that that was agreed to—is down to her campaigning work on behalf of her constituents. I suspect that without her, it may not have happened. The fact that it has, as I believe was confirmed by my right hon. Friend the current Secretary of State in a letter to her recently, is testament to the success of her campaign, regardless of some of the more misleading views that have been spread around in the course of this process. She has succeeded. She has campaigned for her constituents and she has won on this point, and I pay tribute to her.

On my hon. Friend’s second key point about the Future Fit programme more broadly, and the budget available to it, she will be aware that as of this month £1.1 million has been made available to the trust to continue the development of that programme as part of the £6 million-worth of early funding agreed in late 2020. NHS England and NHS Improvement continue to work with her local trust to develop the business case for that programme, and we still wish them to go ahead with it. We want them to work to come up with the right solution for the local community, and we remain committed to that. My hon. Friend asked a very specific point about that. It will have to follow the usual business case approvals process.

We are clear that the £312 million that my hon. Friend alluded to remains, as it was at the outset, the maximum amount currently allocated to that programme. It reflects the original allocation and continues to be the allocation, so I encourage her trust to continue working with NHS England and NHS Improvement to develop a scheme and a programme that matches that budget for the benefit of everyone’s constituents in Shropshire and in Wales, who this hospital also serves.

I look forward to continuing to work with my hon. Friend and other hon. and right hon. Members from Shropshire and Wales on the future of services at Shrewsbury and Telford. I conclude by once again paying tribute to my hon. Friend for her passion, her determination and her perseverance on behalf of her constituents.

Question put and agreed to.

NHS Charging Exemption: Ukrainian Residents

Edward Argar Excerpts

Thursday 17th March 2022 Written Statements

[The Minister for Health (Edward Argar)]

I want to update the House about further measures this Government are taking to step up their response to Russia’s invasion of Ukraine, which continues to see hundreds of thousands of people who ordinarily live in Ukraine forced to flee their homes and seek safety and support in other countries.

Today I want to announce new legislative measures in England to exempt Ukrainian residents from NHS charging so that they can access the NHS on broadly the same basis as someone who is ordinarily resident in the UK. We will apply these exemptions retrospectively from 24 February 2022 to further protect people.

Current overseas visitor NHS charging legislation requires us to recover NHS secondary care treatment costs from anyone who does not ordinarily live in the UK, unless an exemption applies to them. Primary care and A&E services and certain types of treatment—including for most infectious diseases—remain free to all, regardless of a person’s home

We have therefore now amended the charging regulations to allow everyone who is ordinarily resident in Ukraine, and their immediate family members, who are lawfully in the UK to access NHS care in England for free, including those who transfer here under official medevac routes.

This will cover all potential treatment needs, except for assisted conception services, to align with the existing exemption for those whose immigration health surcharge fees have been waived. Those who will benefit from this additional exemption include:

Anyone who uses an alternative temporary (less than six months) visa route outside of the family or sponsorship routes

Anyone who chooses to extend their visit or seasonal worker visa temporarily, without going through the IHS system

Anyone who is in the process of switching visas (which could take some time to process).

We have applied a six-month review clause to this policy and it is our hope that this will help not only to provide security and peace of mind for the NHS and those in need, but to remain open to further developments.

Ukrainian residents who are in the UK unlawfully are not covered by these measures but will remain within the scope of existing provisions within the charging regulations. This means that not only treatment needed immediately, but any treatment that cannot safely wait until the overseas visitor can be reasonably expected to leave the UK, must never be withheld or delayed, even when that overseas visitor has indicated that they cannot pay. Some NHS services will remain exempt from charge for all overseas visitors, such as primary care, A&E services and treatment of infectious diseases.

This Government continue to stand shoulder to shoulder with our Ukrainian friends and we are proud to continue to offer support for Ukrainian residents in our country.

[HCWS695]

Draft Food and Feed Safety (Miscellaneous Amendments and Transitional Provisions) Regulations 2022

Edward Argar Excerpts

Thursday 17th March 2022 General Committees

[The Minister for Health (Edward Argar)]

I beg to move,

That the Committee has considered the Draft Food and Feed Safety (Miscellaneous Amendments and Transitional Provisions) Regulations 2022.

It is a pleasure once again to serve under your chairmanship, Ms Rees. It is also a pleasure to serve opposite the shadow Minister, the hon. Member for Cambridge. Over a number of months, the hon. Member for Nottingham North (Alex Norris) and I regularly debated European Union-related statutory instruments in Committee, to the extent that we could almost finish off each other’s speeches by the end of it. I suspect the same was true for the hon. Member for Cambridge and the Minister for Farming, Fisheries and Food, my hon. Friend the Member for Banbury (Victoria Prentis), in a similar context. It is a pleasure to serve opposite him today.

This draft instrument, which concerns food and feed law, is made under powers in the Food Safety Act 1990 and the European Union (Withdrawal) Act 2018. It follows on from the 18 EU exit instruments on food and feed safety made during 2019 and 2020—probably many of them etched on the hon. Gentleman’s mind. The Government’s priority is, as always, to ensure that the high standard of food safety and consumer protection we enjoy in this country continues to be maintained now that the UK has left the European Union.

The draft instrument is technical in nature. None the less, I am sure that hon. Members will welcome a brief summary of the regulations and the changes that we are making. The measure serves three key functions. First, it will ensure that emergency powers can be applied equally to all food and feed entering Great Britain. Retained EU regulation 178/2002 on the general principles of food law provides Ministers with emergency powers to suspend or restrict the placing of food or feed on the market. That can be used where food or feed presents a threat to human health. Legal analysis of article 53 of that regulation identified that, as worded at present, it is not possible for a Minister to exercise those emergency powers over third-country food and feed entering Great Britain via Northern Ireland.

I emphasise that that operability issue is confined only to third-country goods entering Great Britain via Northern Ireland. Emergency powers to restrict third-country products that present a risk to health having access to the Northern Ireland market are already in place. To correct that identified issue, the draft regulations include a technical amendment that will enable all Ministers to apply, equally, the same emergency controls to all food and feed destined for our market, regardless of their place of origin or route of consignment. The amendment does not extend the remit or gravity of the controls that may be introduced, but will ensure that emergency controls are exercisable equally across all parts of the United Kingdom.

Secondly, the draft instrument ensures that authorising provisions for feed additives and for genetically modified food and feed authorisations will be made by legislation. Again, legal analysis of fixed and retained EU law identified that retained EU regulation 1831/2003 on feed additives and retained EU regulation 1829/2003 on GM food and feed contained a number of omissions. The regulations did not sufficiently make it clear that the authorisation decisions for those products must be prescribed in legislation. While that does not prevent Ministers from taking decisions to authorise those products, provision for those decisions to be implemented through legislation makes certain their enforceability in law and, of course, the role of this House. The proposed amendment therefore clarifies the fact that decisions on authorisations for feed additives and for genetically modified food and feed will be prescribed through legislation, thus ensuring consistency with other retained EU law in this area.

Thirdly and finally, the draft instrument provides a period of adjustment for changes to labelling requirements made necessary by EU exit legislation. In preparation for EU exit, changes were made to the legislation on extraction solvents and quick-frozen foods to reflect the fact that the UK would no longer be part of the EU. As a result, relevant food placed on the market on or after 1 January 2021 is required to be labelled with the name and UK address of the legal person responsible for it, rather than an EU contact and address.

The draft instrument provides for a period of adjustment in those sectors, allowing for the continued use of labels with an EU contact and address until 30 September this year. The adjustment applies to England only. The Food Standards Agency has worked with its counterparts in Wales and Scotland to ensure a co-ordinated approach, and similar measures are already in place in those Administrations. Through the hon. Member for Coatbridge, Chryston and Bellshill, I put on the record my gratitude to all the devolved Administrations for the constructive engagement that we have had with them on these matters. The regulations will support food businesses in England that source products from the EU, or from outside the EU, through an EU distributor. They are also in line with the approach being taken by Department for Environment, Food and Rural Affairs to labelling changes within its remit.

Let me make it clear that the SI does not introduce any changes that will impact on the day-to-day operation of food businesses; nor does it introduce any new regulatory burden. The essence of the legislation is unchanged, but it provides benefit for certain businesses by enabling a period of grace in the introduction of the labelling changes.

To the point that I just made to the hon. Member for Coatbridge, Chryston and Bellshill, it is important to note that Scotland and Wales have provided their consent for the SI. The Northern Ireland Department of Health has been briefed on the amendments, and we have engaged positively with the DAs. I welcome their engagement on that and the constructive relationships that officials of the Scottish Government and others have with my officials and officials in DEFRA.

I want to take the opportunity to reassure hon. Members that the overarching aim of the regulations is to provide continuity for business and to ensure that high standards of safety and quality for food and feed regulation continue across the UK. As I said, the changes do not affect the essence of existing legislation. They are simply technical in nature and ensure that emergency provisions that allow for controls on food or feed identified as presenting a serious risk to health may be applied equally to any goods destined for the market. They will ensure that appropriate legislative provision is in place to enable decisions taken to authorise feed additives and GM food or feed to be enacted through legislation. Finally, they will provide for a smooth transition through the transition period, to allow businesses to adjust to the new labelling requirements.

Having effective and functional law in this area is key to ensuring that the high standards of food safety and consumer protection that we enjoy in this country are maintained in the immediate and longer term. I therefore ask hon. Members to support the SI before us.

--- Later in debate ---

[Edward Argar]

I will be brief, but will endeavour to respond to the shadow Minister and to the SNP spokesman, the hon. Member for Coatbridge, Chryston and Bellshill.

If I may, I will turn first to the SNP spokesman’s comments and then come to the shadow Minister’s comments. At the risk of creating a challenge for us in respect of GM—I know that that issue attracts considerable attention across the House—I say, with slight hesitancy, that of course it is open to the hon. Member for Coatbridge, Chryston and Bellshill to choose it for an Opposition day debate. I am sure that the relevant Minister would be delighted to respond. That is obviously a matter for the hon. Gentleman and his party, but there are and will continue to be opportunities in the House for an issue of that public interest to be debated.

More broadly, the hon. Gentleman made the point about the relationship between the devolved Administrations and the UK Government. I have worked throughout the pandemic and through the Brexit period, leading on a number of issues in the relationship with the Scottish Government and others, and I am certainly grateful for the constructive approach. There will be times when we have political differences of opinion. That is in the nature of a democracy and of the stances that we are all elected to espouse. But I certainly have found the relationship to be constructive and open, particularly in the context of the current legislation on health that we are putting through, and I look forward to continuing that open and constructive relationship, at both official and ministerial level, on issues such as this and more broadly.

Turning to the shadow Minister’s comments, I am, as ever, grateful both for his support and for his tone and his reasonable questions. I am always happy to give credit where it is due, and quite rightly he highlighted the creation of the FSA under a Labour Government. That is a matter of fact, and I am certainly happy to give him, on behalf of his party, the credit for that achievement and for what he did there.

The hon. Gentleman highlighted the paragraphs in the explanatory memorandum that set out the Northern Ireland protocol, and the impacts on how the current system or the previous, EU-led system works and how that will transition. I, perhaps like him, always ensure that I read through explanatory memorandums before taking part in a delegated legislation debate. Indeed, I make a point, when it is in my policy area, of actually reading them, given that it is my signature as a Minister on the bottom of them. In this case, it is the signature of the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Erewash (Maggie Throup), who sadly is not able to be here today, but I know that she takes the same approach. I will take this opportunity, if I may, to thank all the exceptionally talented and hard-working officials who have worked on this statutory instrument, got it to this stage and done the due diligence to ensure that we can have this debate and that we have the right materials to make it an informed debate. I am always grateful for the work of incredibly talented officials, who serve not just me as the Minister but this country, whoever is in government.

We continue to maintain the high standards of food and feed safety that the hon. Member for Cambridge highlighted, as set out in the explanatory memorandum. He touched on paragraphs 7.7 and 7.9. I am not aware of any practical events that have been a cause; I think that this is about tidying up and making the legislation fit for purpose. I am not aware of any specific ones. However, should I be informed that I am incorrect, I will of course write to the hon. Gentleman to correct what I have said. But I am not aware of any. The hon. Gentleman asked what procedure would be used. It would be the negative procedure for delegated legislation, in respect of that.

On labelling and the timescale, I hear what the hon. Gentleman says, both about the challenges faced by the sector overall—in recent months, we have seen that manifesting itself in a variety of ways—and about the challenges, potentially challenges we do not yet fully know, coming out of the international situation. But I believe that the labelling deadline, the grace period till September 2022, provides a proportionate and reasonable amount of time to enable industry to adapt. I am very conscious, through my work on the Northern Ireland protocol in the context of medicines and medical devices, of the different lead times that industry needs, depending on the nature of what it has to do to its logistics networks, supply chains or compliance regimes, but in this context I believe that the six-month period is reasonable.

The hon. Gentleman mentioned that of course in 2018 we were in a very different place—I think that is something on which he and I would agree. We may disagree about what has happened since and whether it is for the best or not, but I cannot disagree with his statement of fact that 2018 was a very different place and certainly felt like it.

A common thread running through all the work that we are doing in this space is that we seek to make the relevant regulations and put in place the relevant compliance regime, to protect safety, to protect the consumer and to protect high standards, but, at the same time, to ensure that that is proportionate and does not place an undue burden on business. I believe that with these technical amendments and what they pertain to more broadly, we have struck an appropriate balance.

The hon. Gentleman mentioned the NFU. I suspect I share his view. I have a good relationship with my local branch of the NFU and I pay tribute to the work that it does and that nationally the NFU does to highlight issues relevant to our agriculture and food production industry in this country. We always carefully consider any representations that they or others in this space make.

Finally, the hon. Gentleman talked about the relationship with EFSA. We have no plans to deviate from the current relationship, and that relationship is broadly characterised by close collegiate working. We recognise the importance of data sharing and working in a co-ordinated and, as I said, collegiate way in this space.

As I said, these are technical amendments, but I hope that we have also had the opportunity to explore a little more widely some of what sits behind them. With that, I commend the regulations to the Committee.

Question put and agreed to.

Healthcare Professional Regulators' Emergency Registers

Edward Argar Excerpts

Wednesday 16th March 2022 Written Statements

[The Minister for Health (Edward Argar)]

In response to the covid-19 pandemic, to support the National Health Service and social care providers, the Government enabled some healthcare professional regulators to establish temporary emergency registers. The Nursing and Midwifery Council (NMC) and the Health and Care Professions Council (HCPC) maintain emergency registers using powers conferred to them under the Coronavirus Act (CVA) 2020; the General Medical Council (GMC) and the General Pharmaceutical Council (GPhC) maintain emergency registers using existing powers. The circumstances for justifying the continuation of these emergency registers are reducing as the impact of the pandemic reduces. I am today announcing our intention that the emergency registers will close on 30 September 2022. This will provide those healthcare professionals who are practising on the basis of emergency registration six months in which to take up full registration if they so wish. Prior to the closure of the emergency registers the Secretary of State for Health and Social Care (Sajid Javid) will notify the regulators that the emergency conditions no longer apply, and the registers will close.



Context



The NMC and the HCPC currently maintain emergency registers using powers conferred to them under the Coronavirus Act (CVA) 2020. Under section 89 of the CVA, the Act will automatically expire two years after coming into force. This means that, following expiry, the NMC and HCPC will no longer be able to add new registrants to their emergency registers, but those already registered will remain so until the register is subsequently closed. The GMC and the GPhC currently maintain emergency registers using powers they held prior to the pandemic.



The powers to set up emergency registers, both under the CVA s.2 and in the GMC and GPhC legislation, can only be exercised where the Secretary of State declares a state of emergency to exist.



To manage the closure of the emergency registers and mitigate any impact on the NHS workforce we are providing regulators, registrants and employers with six months’ notice of the closure of the registers, in order to facilitate transfers between emergency and permanent registers. At the end of this notice period the Secretary of State for Health and Social Care will notify the regulators that the circumstance required for emergency registration no longer apply. Once this notification is made the emergency registers will close and those professionals on the emergency register will be unable to continue to practice.

[HCWS686]

Multi-hospital NHS Trusts: Transportation

Edward Argar Excerpts

Wednesday 9th March 2022 Westminster Hall

[The Minister for Health (Edward Argar)]

It is a pleasure to serve under your chairmanship, Ms Nokes. I congratulate my hon. Friend the Member for Eastbourne (Caroline Ansell) on securing this important debate. As she alluded to, she has been a regular and persistent—albeit always courteous—campaigner for the NHS in her constituency, for her local hospital and, most importantly, for her constituents and their ability to access the services they need. I am aware of her long-standing interest in the issue. It is fair to say that her constituents are incredibly lucky to be represented by someone with such a passion for Eastbourne.

I join her in paying tribute to her hospital trust and everyone who works there, across the three sites, for what they have done, not just over the past two years in extraordinary circumstances, but what they do every day, year in, year out. I also join her in paying tribute to the Eastbourne Herald, of which I am maybe not as assiduous a reader as I should be. The latest story I read was about disco public lavatories. I have followed the important work undertaken by India Wentworth, since she joined the Herald in 2020, in campaigning on the issue and drawing to public attention the challenges faced by my hon. Friend’s constituents and others in Sussex.

It is rightly the responsibility of clinical commissioning groups—CCGs—or what will soon become integrated care boards and trusts, to plan for reconfigurations of NHS services. It is important that any such plan commands local legitimacy and confidence. I will respond to my hon. Friend’s questions. One was about consultation around reconfigurations, and how public transport and accessibility featured in that. All reconfigurations are subject to four Government tests. The first is strong public and patient engagement. To her point about the 2019 survey, I encourage her trust to continue engaging with that patient voice, including specifically around access. I will come on to access in a moment in the reconfiguration criteria.

Other tests are consistency with current and prospective need for patient choice: a clear clinical evidence base; and support for proposals from clinical commissioners. It is important to hear from as many local people as possible about the practical impacts and concerns. None of the decisions on reconfigurations is easy or straightforward. They are about balancing different needs and benefits. Rightly, in the different reconfigurations my hon. Friend alluded to—ophthalmology and cardiology —as we would expect in any reconfiguration, clinical needs and safety in achieving the best clinical outcome for patients are obviously paramount.

Achieving that sometimes comes with challenging changes to where people may access services, compared with where they previously did so. We would expect, among that consideration of benefits and challenges, patient transport, inequalities and equality of access to feature heavily. I expect my hon. Friend’s trust, in reaching decisions, will have given due weight to such considerations.

I am well aware of the geography of her constituency and that of her near neighbour, my hon. Friend the Member for Hastings and Rye (Sally-Ann Hart), having grown up on Romney Marsh and having late grandparents who lived in the Icklesham/Winchelsea area of my hon. Friend’s constituency. I know the area well, going across to Hastings and further to Bexhill and Eastbourne. I also know the horror which is the A259, on most days. I was going to say at rush hour, but it is not just at rush hour these days. My hon. Friend’s comments about congestion going up from 36% to 60%, certainly on that road, chime with me; and that is going back 20 to 25 years to when I was last regularly in that part of the world.

The challenges of getting between the three sites are considerable. My hon. Friend alluded to the bus routes. There are bus routes but she is right that, certainly in one case, a change must be made to make the connecting journey. A patient going into hospital wants to minimise the stresses and challenges faced in getting there and back.

My hon. Friend alluded to two specific reconfigurations. With regard to the ophthalmology reconfiguration, the travel analysis summary, included as part of the consultation documents, set out that proposals would affect outpatients and people who come to the Conquest Hospital, in the constituency of my hon. Friend the Member for Hastings and Rye, for procedures but do not stay overnight. That is around 27% of all ophthalmology patients who attend East Sussex Healthcare NHS Trust hospitals for treatment and care. The analysis indicates there will be an increase in travel time for around 21% of patients who would use public transport and for 8% of patients who might travel by car—their own car, taxi or similar.

Were the proposals to go ahead, some people would have a shorter journey and others a longer journey to their appointment. The longer journeys would cost more, but, as the trust pointed out to me, people would, hopefully, have fewer appointments overall, would therefore not have to go to the hospital as often, and would not incur cumulatively the cost for the extra appointments that were no longer required, so they should not pay too much more.

My hon. Friend set out the impact on people on low incomes—the 25% who have no car and for whom a taxi or private hire vehicle might be prohibitively expensive—and she gave a moving example in her remarks about the choices that some people might have to face. I expect the trust to consider that extremely carefully.

My hon. Friend touched on the shuttle bus service and gave an example of where it has worked well in providing a service that works for patients, and it has environmental benefits as well. I encourage her trust to continue looking at such options. If it is helpful to my hon. Friend, I will speak to NHS England’s south-east region to see whether it can convene a meeting to discuss that further with her and her trust to see what options might help fill the gap, even if what was initially put forward might be deemed impractical by the trust.

My hon. Friend focused on patients and the impact on them, but she talked about staff as well, and it is important that in considering services and transport services for people to get to, from and between hospital buildings in the same trust, we do not forget the impact on staff. Although I know that sunny Eastbourne, Hastings and Bexhill are wonderful places to live, work in and visit, I will not tempt my hon. Friend to talk about the challenges of the rail links between her constituency and London. Because of the location of the hospitals and trusts, there is still a degree of temptation or ability for highly qualified professionals to perhaps say, “I will have a longer commute and work in London”, or, “I will go and work in a big London teaching hospital”, so we need to do everything we can to make it attractive and easy for people to make the conscious choice to work in the local hospitals to make sure we have the workforce that we need.

My hon. Friend raised other issues. As well as thanking the team and her local paper, she has talked in the past about getting me down to Eastbourne to visit her local hospital—something I have agreed to—and I will see whether that might be possible during the Easter recess. I hope sunny Eastbourne will be sunny by the time we get to April.

[Sally-Ann Hart (Hastings and Rye) (Con)]

I am sure the Minister will join me in congratulating my hon. Friend the Member for Eastbourne (Caroline Ansell) on her well-presented and organised argument. Will the Minister also consider the community volunteering work that went on during the pandemic at HEART, for example, in Hastings? Perhaps a helping hand could be given there. It took patients to hospital and helped in that way, but sometimes these organisations need a bit more resourcing. Will he look at how we could maximise the potential of the community volunteer groups that have really grown throughout the pandemic to see how best we can utilise them in taking people to hospital for appointments?

[Edward Argar]

Before my hon. Friend’s intervention and although my private secretaries will wince at the logistics, I was about to offer to try to come down to Eastbourne, via Bexhill, and then go to see my hon. Friend in Hastings and visit the Conquest. I may then re-live the experiences of travelling along the A259 and possibly regret doing so. None the less, I will be happy to visit her at the same time. She mentioned, rightly, the hugely important role played throughout the pandemic—and in more normal times—by organisations of volunteers, charities and third-sector organisations to help with patient transport.

My hon. Friend mentioned HEART—I entirely endorse what she says about the value of such organisations. I encourage local authorities and NHS trusts to recognise that value and seek to work collaboratively with such organisations to enable them to continue doing that vital work. In same spirit, I am also an occasional reader of the Hastings and St Leonards Observer. I enjoy my local papers. I tend to find the news I get in local newspapers rather more interesting and accurate than some of what I read in national newspapers. Perhaps when we go down to visit her, we might talk to both local papers if that would be helpful.

My hon. Friend the Member for Eastbourne raised a number of points about the bus improvement strategy and the broader approach to improving public transport links in this country. My right hon. Friend the Member for North East Somerset (Mr Rees-Mogg) set out recently in the House that the Government are investing more than £5 billion in buses and cycling during the course of this Parliament. Local authorities have published bus improvement plans, which provide an assessment of existing services in the area, including details of current provision for rural and coastal communities. It is right that those plans are driven by local authorities, who know their areas best and have that local engagement. I encourage them to think broadly, about not just links between a town centre and other areas but the broader transport links that might exist in an area and how public transport can help enhance them, reflecting the patterns of travel that individuals have for particular purposes, be it work, going to a hospital appointment or otherwise.

We recognise that for those unable to travel independently, NHS-funded patient transport services are essential. Those services are commissioned locally for eligible patients with a specific need for transport assistance to and from their care provider for planned appointments and treatment. Although most people can travel to treatment independently or with support from family and friends, as my hon. Friend set out, those services play a hugely important role for those whose medical condition, severe mobility constraint or financial circumstances make that challenging. They deliver around 11 million to 12 million patient journeys each year, covering around half a million miles each weekday.

In August 2021, NHS England and NHS Improvement published the outcome of a review into patient transport services. The review’s final report sets out a new national framework for the services, with the aim of ensuring that they are consistently responsive, fair and sustainable. The first component of the new national framework is a commitment to update the national guidance on eligibility. That commitment responds to the concerns raised by patient groups and others during the review process that access to patient transport services is inconsistent between areas.

[Caroline Ansell]

One of the issues we have seen is reimbursement. It is a hugely bureaucratic process that also involves up-front costs for those who need to access that support. My concern remains that eligibility is still very narrow, yet there is significant movement across the piece, not least from maternity and paediatrics, where transport often involves taking little people. I hope that features in the review.

[Edward Argar]

My hon. Friend is right to highlight the breadth of people and groups who need to be included and reflected in that. We have consulted on the new national eligibility criteria. They have been developed through engagement with a wide range of stakeholders, including patient groups and charities, transport providers, healthcare providers and commissioners. On her question of when, we look forward to publishing them very shortly. If she wishes to make any last-minute representations to the team, she is welcome to write to me.

In the final few seconds I have left, I pay tribute once again to my hon. Friend the Member for Eastbourne for securing this debate and to my hon. Friend the Member for Hastings and Rye for speaking in it, and for their work in this place as such vocal champions of their local communities.

Question put and agreed to.

Draft Human Medicines (Coronavirus and Influenza) (Amendment) Regulations 2022 Draft Human Medicines (Amendments Relating to the Early Access to Medicines Scheme) Regulations 2022

Edward Argar Excerpts

Tuesday 8th March 2022 General Committees

[The Minister for Health (Edward Argar)]

I beg to move,

That the Committee has considered the draft Human Medicines (Coronavirus and Influenza) (Amendment) Regulations 2022.

[The Chair]

With this it will be convenient to consider the draft Human Medicines (Amendments Relating to the Early Access to Medicines Scheme) Regulations 2022.

[Edward Argar]

It is a pleasure to serve under your chairmanship, Ms Rees. It is also a pleasure to be here today. It is right that we debate these important provisions.

I would like to take the opportunity, as we often do at the start of such sittings, to pay tribute to every individual who has been involved, in the UK and beyond, in the development and the roll-out of an unprecedented vaccination campaign, not just in this country, but around the world, from the people who have received their jabs, to the professionals and volunteers who have made this happen and those who have continued to keep our NHS running.

The purpose of the provisions in the draft Human Medicines (Coronavirus and Influenza) (Amendment) Regulations 2022, which, for convenience, I will refer to as the human medicines regulations, is to amend the temporary provisions that cease to have effect on 1 April 2022. The provisions support the continued deployment of safe and effective covid-19 and flu vaccinations at the pace and scale required both now and potentially in the future, while safeguarding patients and limiting disruption to other NHS services.

The SI amends provisions in the Human Medicines Regulations 2012—SI 2012/1916, originally amended by the Human Medicines (Coronavirus and Influenza) (Amendment) Regulations 2020—SI 2020/1125—and the Human Medicines (Coronavirus and Influenza) (Further Amendments) Regulations 2020—SI 2020/1594 —either to make permanent or to extend by a further two years those key regulatory flexibilities.

In summary, the regulations before us make three key provisions permanent. First, they enable injectable, prescription-only medicines, which include vaccines, to be given under a patient group direction commissioned by the NHS or a local authority. That effectively expands the workforce of available vaccinators. Secondly, they enable pharmacy-led covid and flu vaccination services to operate outside their normal registered premises, thereby enabling, for example, pop-up vaccination clinics to be run by pharmacists at convenient locations for patients. Thirdly, they add several additional groups of healthcare professionals to those who can administer vaccines under occupational health schemes, thereby expanding the workforce to vaccinate health and care staff. The final two provisions relate to a further temporary exemption of easements to licensing requirements for the end-stage preparations of vaccines prior to use and the sharing of vaccines between sites.

The mass vaccination roll-out on the scale and pace that has been possible to date would not continue to happen if the regulations are not approved, and the covid-19 and flu vaccination programmes would not be able to continue running as they currently do. Nor would they be able to be re-established at the pace and scale that has been so vital to our recent success. It is therefore crucial that I provide the rationale in support of these important provisions, which I hope will enable members of the Committee to support them.

It is true that we are debating the provisions from a completely different place than at the onset of the pandemic and since the key regulatory flexibilities were first made in late 2020. Where we are now is a place that we can all be proud of—the culmination of a national mission that has helped us to withstand the pandemic and restore more freedoms to people in this country. It is a reminder of what we can accomplish when we all work together and testament to the success of the biggest ever vaccination programme in the history of the NHS. The vaccines remain our best line of defence against the virus and to help us live with covid. That is the reason why it is vital to make some of these provisions permanent or to extend them for a further period.

As the Committee would expect, patient safety is at the heart of any public health vaccination programme, and is therefore at the forefront of the provisions in this statutory instrument. I firmly believe that the provisions to maintain an expanded workforce, able to lawfully administer covid-19 and flu vaccines under occupational health schemes, will ensure that we can continue to provide critical protections to health and care workers, while ensuring that vaccines continue to be administered by highly trained, qualified staff operating under rigorous professional standards.

Similarly, the provisions enabling injectable prescription-only medicines, which include vaccines, to be given under a patient group direction commissioned by the NHS or local authority have been critical to supporting widespread protection from covid-19 and flu among the general public. By making the provisions permanent, I strongly believe that we can ensure that public health benefits are maintained through the roll-out of covid-19 and flu vaccination, while striking the right balance of maintaining the rigorous standards of oversight for vaccines to be given safely and effectively.

The provisions to enable a pharmacist to offer vaccinations at sites other than their registered premises have already supported improved patient access for underserved communities. For example, faith leaders at a mosque in Blackburn in Lancashire worked in partnership with NHS Blackburn with Darwen clinical commissioning group and the local council to turn the mosque into a pop-up vaccination clinic. It was successfully able to target and support at-risk groups from all local communities who had potentially been hesitant to come forward for their vaccine. I pay tribute to the work that was done in that setting. Making those provisions permanent will enable that type of crucial activity to continue when and where it is needed.

The provisions relating to the temporary extension of wholesale dealer licences and end-stage vaccine preparation have already supported the swift and safe distribution of covid-19 and flu vaccines, and will continue to be critical to efficiently delivering any necessary future covid-19 and flu vaccination programmes, as well as reducing the wastage of vaccines. We have seen the success that those provisions have allowed. We are therefore prioritising the implementation of them to give health services the certainty that they need to be able to continue to plan and operate any necessary mass covid-19 and flu vaccination programmes on the same basis as now.

The emergence of the omicron variant and our critical ongoing booster campaign have further highlighted why those key regulatory flexibilities cannot be allowed to fall away on 1 April. Last month, the National Audit Office, in its report on the roll-out of the covid-19 vaccination programme in England, highlighted the balance between central command and control structures and wider empowerment locally, and that that was a success factor in achieving more than 139 million vaccinations in the 15 months since the programme began, 71% of which were administered by GPs and community pharmacies. That was against a planning assumption of 56% of vaccines delivered that way.

There can be no doubt that the provisions in the draft Human Medicines (Coronavirus and Influenza) (Amendment) Regulations are vital, as they have supported the safe delivery of the biggest programme of vaccination in our history and have proved their worth. That said, I know that there may be some concern among the public, and indeed in today’s Committee, that extending or making the provisions permanent might constitute mass vaccination forever by the back door. I appreciate those concerns, but I categorically put on the record for those who might seek to make mischief with such a suggestion that that is not the case. These are enabling provisions only. There is no requirement to use them, and they will not be used unless they are required; rather, they will be a vital addition to the toolkit for the NHS if mass vaccination campaigns against new variants of covid-19 or flu are necessary in the future.

Turning relatively briefly to the second instrument before the Committee, the Government want patients in the UK to be able to access the most effective and innovative medicines as quickly as possible. We have made real strides in recent years to achieve that, including the launch of the Medicines and Healthcare products Regulatory Agency’s innovative licensing and access pathway and reductions in the National Institute for Health and Care Excellence assessment timelines. The early access to medicines scheme is another key aspect of how we deliver on that agenda. The scheme helps to give people with life-threatening or seriously debilitating conditions early access to new medicines that do not yet have a marketing authorisation or licence but where there is a clear unmet medical need.

Since 2014, the scheme has transformed the lives of patients up and down the country. For example, through EAMS UK patients were among some of the first in the world to access the breakthrough treatment pembrolizumab, which I have hopefully pronounced correctly—I challenge my shadow, the hon. Member for Denton and Reddish, to attempt to do it rather more fluently and smoothly than me—with approximately 500 patients with advanced melanoma receiving that medicine when no other treatment was available to them.

Just one new product made available through the EAMS can benefit hundreds of patients. Putting the scheme on a statutory footing allows us to maximise the benefits it offers to patients, as well as to support the early development of medicines by innovative manufacturers in the UK.

The provisions deliver three key benefits. First, they reduce the regulatory burden on manufacturers supplying EAMS medicines, making it easier to supply and assemble EAMS medicines in the UK. Secondly, they will facilitate the collection of real-world data from EAMS to support patient access to novel treatments in the future. Thirdly, they will reaffirm in legislation the importance of patient safety within the scheme. As a package of changes, this will help more patients to benefit safely from EAMS products and ensure the UK remains internationally competitive in the pre-market medicines access landscape.

I am pleased to bring forward the first instruments using the powers under the Medicines and Medical Devices Act 2021, allowing us to use effective regulation to provide patients and the public with timely access to critical medicines and vaccines. The provisions in the instruments are important; they will be in force if mass vaccination campaigns against covid-19 and flu are necessary to protect the public and our freedoms and will also ensure that patients with serious conditions can be offered new, life-changing treatment options.

--- Later in debate ---

[Edward Argar]

I am grateful to both the shadow Minister and the SNP spokesperson for the tone and manner in which they have approached this. Often when our activities in this House are looked at from outside, what is seen is the disagreement across the Dispatch Box in the Chamber, but actually there are many things such as today’s instruments that are of importance to all our constituents, wherever they are in the UK, and there is a great degree of consensus. I am grateful for that, and it is a pleasure, as always, to serve opposite the hon. Member for Denton and Reddish.

Both hon. Members who spoke were right to highlight the collective effort that has been involved in the vaccination programme. We rightly pay tribute regularly to our health and care workers, but it is equally important that we pay tribute to those in central Government, the civil service, local authorities and local councils up and down the country, to volunteers and others who have given of their time and commitment to make this work, and of course to the great British public, who bore the restrictions under which they lived for two years, on and off, to a greater or lesser degree, with fortitude. They have done the right thing and got vaccinated in their millions, and it is right that we say thank you to them for that.

The shadow Minister rightly touched on a number of points. He talked about health inequalities in the context of vaccination. He is absolutely right, and we continue to focus very much on that issue in terms of driving further uptake of the vaccine. A range of different inequalities manifest themselves in this context. The example that I used of a mosque becoming a vaccination centre is, I think, a powerful one. That took place in similar settings up and down this country, in our towns, cities and rural communities. Using such venues to make it easier for people to engage with the vaccination programme is central. That is why the statutory instrument is so important.

Alongside that, we rightly continue to work with community leaders and others to inform and educate people about the reality of the vaccine and its potential to save lives and prevent serious illness, to try to counter some of the dangerous misinformation that can often be found on the internet or elsewhere, and to encourage people to take up the vaccine if they have not already done so. I reassure the SNP spokesperson—though I do not know that he needs reassurance—that we have engaged fully with the devolved Administrations, including the Scottish Government, who have been extremely helpful and supportive in what we are seeking to do here. Through him, I pass on my gratitude to the Government in Scotland.

The shadow Minister rightly highlighted the success of the EAMS programme and what it has achieved, and the example of a medicine being available four months earlier than it otherwise would be, and just what a difference that can make. It is literally the difference between life and death in many circumstances, so it is hugely important. I share his view of the 2016 review. We have made progress today, and will do subsequently, but there is still more to do on the review, and we continue to look at how we can build on it. He talked specifically about the gap that could occur between the EAMS programme and an MA being granted. It is an important point, because if someone is undertaking a course of the medicine or needs to start it, returning to our earlier discussion about timeliness being important, any delay—be it one month or two—can be a real challenge. I commit that we will look at that, in the context of the other 2016 review recommendations that we need to reflect on to see whether we can go further.

I agree with the shadow Minister entirely that it is vital that we do not let up in our vaccination efforts, because the vaccine has been our route out of this highly dangerous pandemic. Nor must we take our foot off the gas in respect of promoting and enabling access to cutting-edge research and treatments for patients in this country—all of our constituents, should they need it. I believe that the two sets of draft regulations before us help to enable us to achieve that goal, and I commend them to the Committee.

Question put and agreed to.

draft Human Medicines (Amendment Relating to the Early Access to Medicines Scheme) Regulations 2022

Resolved,

That the Committee has considered the draft Human Medicines (Amendment Relating to the Early Access to Medicines Scheme) Regulations 2022.—(Edward Argar.)

Oral Answers to Questions

Edward Argar Excerpts

Tuesday 1st March 2022 Commons Chamber

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

6. What steps he is taking to help ensure high standards of performance and efficiency for managers in the NHS.

[The Minister for Health (Edward Argar)]

The NHS is recognised as one of the most efficient health services in the world. Between 2010 and 2018, productivity in the NHS grew faster than in the wider economy. However, there is always room to do more. My right hon. Friend the Secretary of State has commissioned a review led by Dame Linda Pollard and General Sir Gordon Messenger to explore health and social care leadership and management, including the drivers of performance and efficiency, and they will report back later this year.

[Mr Sheerman]

We have learned today that innocent children are being killed in Ukraine. I could not get the Ukrainian colours, but I am wearing my UNICEF tie.

We have brilliant nurses, doctors and support staff, but too often the management of hospitals is not as good as it should be to support them. The Topol review should be kept alive, but we should also make sure that the training of managers is of the utmost importance. A recent survey of the world’s best hospitals had only one British hospital in the top 100: Guy’s and St Thomas’s. Does the Minister agree that this is not good enough?

[Edward Argar]

Possibly at some risk to my political prospects, I find myself in agreement with the hon. Gentleman on the importance of good and effective leadership. Of course I join him in his remarks about Ukraine.

I highlight that 84% of our NHS workforce are either clinically trained or are directly providing clinical support to clinicians, but it is also important that we recognise the importance and value of the administrators and managers who support the team. That is why we need the best people in those roles, and it is why my right hon. Friend the Secretary of State has commissioned the review led by two extremely eminent people. We are determined to continue driving up the quality and standards of management in the NHS.

[Esther McVey (Tatton) (Con)]

7. If he will make an estimate of the percentage of (a) doctors and (b) nurses being paid locum rates in the latest week for which figures are available.

[The Minister for Health (Edward Argar)]

In NHS hospital trusts to date in 2021-22, there have been on average 14,826 full-time-equivalent agency nurses and 4,621 medical and dental FTE agency staff. It is hard to draw direct percentage comparisons given different methodologies for measuring such percentages, but my understanding is that overall about 3% of nursing shifts and about 1.5% of doctors’ shifts in hospitals are filled by locums or agency staff.

[Esther McVey]

Can we get greater clarity on that information and have it held centrally, given that wages are such a large proportion of the NHS budget? It is essential to know how many hours are paid at the higher locum rate to ensure value for money for the extra billions of pounds that the Government are putting into the NHS to get waiting lists down and for social care.

[Edward Argar]

I am grateful to my right hon. Friend, who is tireless in her determination to ensure value for money for her and all of our taxpayers’ pounds, particularly in this space. We continue to work hard to drive down agency and locum spend, focusing instead on both bank staff and our full-time recruitment, on which the Secretary of State has set out the success that we have been having. Since 2015, we have controlled agency spend through price caps and procurement frameworks. However, she is absolutely right, and we want to see more full-time NHS employed staff working at NHS rates in our trusts.

[Peter Dowd (Bootle) (Lab)]

9. Whether his Department is taking steps to help improve health outcomes through the implementation of public-private partnerships.

[The Minister for Health (Edward Argar)]

Throughout the pandemic, partnerships between the public and private sectors have been vital in securing the resources to protect public health. As one element of that partnership, independent sector providers, for example, delivered almost 7 million episodes of care for NHS patients between April 2020 and December 2021 according to hospital episode statistics data. We continue to support the partnership approach more broadly as part of our plans both to tackle the backlog of elective care and to improve broader health outcomes.

[Peter Dowd]

I thank the Minister for that response. As he is aware, the national diet and nutrition survey has shown that average intakes of dietary fibre in the United Kingdom are well below recommended levels and less than a quarter of those of countries such as Denmark, where the Government work across industry on a public-private partnership basis to boost wholegrain intakes. What consideration has the Minister given to implementing such an initiative in the United Kingdom to provide a much-needed boost in fibre intakes among the public?

[Edward Argar]

The hon. Gentleman makes a typically sensible and reasonable point. Government advice on a healthy balanced diet is encapsulated in the UK’s national food model, the “Eatwell Guide”. It includes advice on incorporating fibre into the diet through fruit and vegetables, bread, rice and pasta. We set nutritional standards for catering in all Government Departments and related organisations to improve the nutritional content of food served, including increasing fibre. I agree that it would be helpful to increase intakes of fibre in our diet, guided appropriately by clinical and medical advice, and a key element of achieving that is working with industry.

--- Later in debate ---

[Mr Philip Hollobone (Kettering) (Con)]

19. If he will ensure that the NHS new hospital programme team complete approval processes by summer 2022 to allow the preparation of the full business case for the redevelopment of Kettering General Hospital by the local NHS trust.

[The Minister for Health (Edward Argar)]

The joint DHSC and NHSE/I—NHS England and NHS Improvement —programme team is working closely with all schemes in the programme, including Kettering, on how and when new hospitals will be built across the decade. That is to maximise the potential benefits that the programme’s approach can bring for all the new hospitals. We will continue to support all trusts in the programme, including Kettering, to ensure that there is the swift approval of all business cases—including, in this case, for early enabling works—but that will always be in line with due process to ensure that there is value for money, as my hon. Friend would expect.

[Mr Hollobone]

I thank the hospitals Minister very much for his visit to Kettering General Hospital on 17 February. Specifically, can we have feedback from the new hospital team on the strategic outline case for the hospital by the end of April, so that the hospital can submit its outline business case for the next stage in July?

[Edward Argar]

It was a pleasure to visit my hon. Friend’s constituency. He is a forceful advocate for that constituency and for his hospital, as indeed—if I may slightly crave your indulgence, Mr Speaker—was the late Sir David Amess. Today is the day that Southend-on-Sea officially becomes a city, so I just wanted to shoehorn that into the record. On my hon. Friend’s point, we will do everything we can to expedite the approval of business cases while ensuring that due process is followed to make sure that there is value for money.

--- Later in debate ---

[Selaine Saxby (North Devon) (Con)]

T6. Devon’s community hospitals and minor injury units, such as the Tyrrell in Ilfracombe, have been unable to open fully for some time. Would my hon. Friend consider extra help where it is needed to enable them to reopen, because although adding extra capacity is welcome, using what we have effectively is surely essential?

[The Minister for Health (Edward Argar)]

I am grateful to my hon. Friend for her question. The minor injuries units at Ilfracombe and Bideford have been temporarily closed since March 2020 due to the pandemic, to allow skilled staff to be redeployed to the emergency department at North Devon District Hospital to meet clinical needs. The Northern Devon Healthcare NHS Trust continues to work with the local CCG to ensure planning for safe staffing levels for the temporary reconfiguration and for permanent solutions. Were anything to be made permanent, it would of course have to go through the local authority health overview and scrutiny committee. No such referral has been made, and this remains temporary.

[Jessica Morden (Newport East) (Lab)]

T2. Happy St David’s day, Mr Speaker. Physician associates in my constituency, who play a vital role in the NHS, want to hear from the Government when long-awaited regulations that will allow them to take on more responsibility and play an even greater role in our NHS will come forward. Can the Secretary of State update the House and will he meet me and constituents to discuss this?

--- Later in debate ---

[Greg Smith (Buckingham) (Con)]

I am grateful to the Minister for Health for giving his time over recent months to hear the case for an exciting and innovative new health centre for the village of Long Crendon in my constituency, as proposed by the parish council and action group. Will he update the House on where we are with finding funding to help the construction of the project?

[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?

Healthcare Payments to the EEA and Switzerland

Edward Argar Excerpts

Tuesday 22nd February 2022 Written Statements

[The Minister for Health (Edward Argar)]

First Annual Report on International Healthcare Payments under the Healthcare (European Economic Area and Switzerland Arrangements) Act 2019

I have today laid before Parliament the first annual report on international healthcare payments pursuant to section 6 of the Healthcare (European Economic Area and Switzerland Arrangements) Act 2019.

The 2019 Act was enacted as a result of the UK’s decision to leave the EU. It provided the legislative means to respond to a wide range of possible outcomes of the UK’s exit from the EU in relation to reciprocal healthcare, including the implementation of new reciprocal healthcare agreements with a European economic area (EEA) state, Switzerland or an international organisation.

The 2019 Act implements the social security co-ordination protocol to the UK-EU trade and co-operation agreement. That agreement ensures UK residents continue to benefit from reciprocal healthcare arrangements, including covering necessary healthcare when travelling to Europe (previously known as the EHIC scheme, now the GHIC scheme). Planned healthcare arrangements have also continued after EU exit (known as the S2 scheme); and eligible pensioners, frontier workers and certain other groups can have their healthcare costs covered when they move to the EU (known as S1 scheme). Under the 2019 Act, the UK has also implemented the various separation agreements with the European economic area and Switzerland.

Building on the successful continuation of EU reciprocal healthcare agreements, the Government now wish to negotiate further agreements with other states to bring greater benefits for UK nationals. The Health and Care Bill includes amendments to the 2019 Act which will enable us to implement comprehensive healthcare agreements with countries outside the EEA and Switzerland.

This report covers payments made under the powers conferred by the 2019 Act between the end of the transition period on 31 December 2020 and 31 March 2021. During this period only one payment was made under the 2019 Act payment powers for discretionary planned treatment. Other payments made to the EEA and Switzerland during this period were for healthcare incurred prior to the end of the transition period. These payments are reimbursable as a matter of EU law and not therefore paid pursuant to the 2019 Act. Member states are now in the process of submitting claims which have been paid under the 2019 Act, details of which will be provided in the second report which will be published after the end of March 2022.

[HCWS619]

Ambulance Services in England

Edward Argar Excerpts

Thursday 10th February 2022 Commons Chamber

[The Minister for Health (Edward Argar)]

Reflecting the rest of the week, Mr Deputy Speaker.

I am grateful to the hon. Member for Ellesmere Port and Neston (Justin Madders) for securing this important debate. In the same spirit, this is rather nice; it is like déjà vu: he used to shadow me at that Dispatch Box and in Committee. It is a pleasure to respond to his debate on this occasion.

However, I must say that responding to the hon. Gentleman is a pleasure slightly tempered by caution on my part, because I know the depths of his expertise on this subject after his many years shadowing the Minister for Health—I think he shadowed my predecessors as well. He has great depth of knowledge in this space. He is and has been a notable advocate for our ambulance service and what it needs, and he looks forensically into those issues. I also know that he is a diligent reader of The BMJ, the Health Service Journal and various other excellent trade and specialist publications. It is a genuine pleasure to respond to him on this extremely important issue. It is a shame that the way in which the House allocates debates means that this is the last debate of the day, so there are few Members in the Chamber for it, because it is important. However, those we have in the Chamber are quality, and I look both at the shadow Minister—sorry, the former shadow Minister—and the hon. Member for City of Chester (Christian Matheson).

As the hon. Member for Ellesmere Port and Neston highlighted, ambulance services have faced extraordinary pressures during the pandemic. I am sure that the House will join me and the shadow Minister—the former shadow Minister; by force of habit, I keep calling him the shadow Minister. The hon. Gentleman and I have not always agreed, but we have been as one in paying tribute to all those who work in our ambulance services up and down the country. They have done an amazing job over the past two years, during the pandemic, to the very best of their ability. Of course, they do that amazing job day in, day out; irrespective of pandemics, they always do everything they can to support those who need them.

The hon. Gentleman rightly highlights that the pandemic has placed significant demands on the service. In January 2022, it answered more than 800,000 calls. That is an increase of 11% on January 2020 and is one of the factors placing significant pressures on ambulance services, the wider NHS and the A&E departments to which they will take people when they feel that there is a clinical need. Although 999 calls tend to highlight the demand related to more serious medical conditions, many ambulance services are also responsible for 111 calls, which, in December last year, saw an increase of 15.5% compared with December 2019.

I use those statistics to illustrate the demand pressures, but I understand that behind those numbers, in every case, lies a human story—someone in need of care, someone worried and anxious, with friends and family anxious for them—so before I seek to go into the reasons, statistics and our plans and support, I want to say that I am sorry for patients who have suffered the impact of those service pressures. I want to be very clear that patients should expect and receive the highest standards of service and care.

The hon. Gentleman highlighted some specific examples, including the case of Bina Patel. He is right that the right hon. Member for Ashton-under-Lyne (Angela Rayner) has raised that with me. I have asked for full information because I want to get back to her with as full an answer as I can, and I hope that he can convey that to her, if he speaks to her before I do. I am fully aware of her correspondence raising this on behalf of the family.

Let me turn to ambulance response times and the reasons sitting behind some of the pressures. The ambulance service is facing a range of challenges that are impacting on its performance. The hon. Gentleman will be familiar with many of them, including the impact, still, of infection prevention and control measures not only in the ambulance service but particularly in A&E departments and wider acute clinical settings. Higher instances of delays in the handover of ambulance patients into A&E as a result of some of those factors, which I will turn to, are therefore leading to ambulances waiting for longer in queues and not being as swiftly out and about on the road and able to respond to calls. So there are knock-on effects there.

One of the key challenges, which the hon. Gentleman will be very familiar with, remains the question of flow through an A&E and through a hospital. I am referring to the flow of patients out of ambulances into the A&E, who are then able to be treated in the A&E and discharged, hopefully, or who are then, in some cases, able to be admitted to a bed in a hospital ward. To do that, we have to see discharges continue of patients who no longer meet the criteria to reside because they have recovered sufficiently, and the national discharge taskforce has done a huge amount of work on addressing that challenge.

In recent months, we have seen the combined pressures of winter—the hon. Gentleman and I are familiar with those on an annual basis—and the impact of the omicron variant on the number of hospitalisations, which have not been as high as many feared and predicted, thankfully, but which have still had a significant impact on hospital beds. The combination of those factors, coupled with a high level of workforce sickness absence rates, including through positive covid tests—particularly over recent months with omicron—has created pressures that we would not expect to be systemic or built into the system. That partly reflects longer term pressures, and I will move on to what we are doing to address those, but a large element of it is down to the specific circumstances of the past winter.

The hon. Gentleman touched on the support in place to improve services, and asked what we are going to do about it, and what is being done to address these issues. He is true to form from when he shadowed me, as he will always set out the challenge and ask me what I am going to do or am doing about it, rightly holding the Government to account. Because of the pressures I mentioned we have put in place strong support to improve ambulance response times, including a £55 million investment in staffing capacity to manage winter pressures to the end of March. All trusts are receiving part of that funding, which will increase call handling and operational response capacity, boosting staff numbers by around 700.

NHS England has strengthened its health and wellbeing support for ambulance trusts, recognising the pressure of the job on those working in the ambulance services, with £1.75 million being invested to support the wellbeing of frontline ambulance staff during the current pressures. NHS England and Improvement is undertaking targeted support for the most challenged hospitals, to improve their patient handover processes, helping ambulances to get swiftly back out on the road. That is focused on the most challenged hospital sites where delays are predominantly concentrated, with the 29 acute trusts operating those sites being responsible for more than 60% of the 60 million-plus handover delays nationally. That is targeted support for trusts that have particular challenges, either from the current situation or where there are underlying issues that we need to resolve.

There is capital investment of £4.4 million to keep an additional 154 ambulances on the road this winter, and a £75 million investment in NHS 111 to boost staff numbers by just over 1,000, boosting call taking and clinical advice capacity that will better help patients at home, and better help triage those who genuinely need an ambulance and those who can be treated safely in a different context. There is continuous central monitoring and support for ambulance trusts from NHS England’s national ambulance co-ordination centre, and we have also made significant long-term investments in the ambulance workforce. The number of NHS ambulance staff and support staff has increased by 38% since July 2010.

More broadly, alongside the ambitious plan set out by the Government earlier this week, showing how we will invest the significant additional resources in outcomes for patients, just over a year ago we invested £450 million in A and E departments, to help mitigate the impact through increased capacity of infection prevention and control measures. I have regular direct meetings about discharge rates, and what we can do further to improve the flow of patients through hospital trusts within NHS England, with members of the taskforce on that.

I am pleased to reassure the hon. Gentleman that those measures have had an impact, and we are seeing improvements in response times from the peak of the pressures in December. Performance data for January, published today, shows significant improvement against all response time categories. Performance for category 1 calls—the most serious calls, classified as life-threatening—has largely been maintained at around nine minutes on average over the past several months, and improved to eight minutes and 31 seconds in the latest figures. That is despite a 19% increase in the number of incidents in that category compared with December 2019. Average responses to category 2 calls improved by more than 15 minutes compared with December, and the 90th centile responses to category 3 calls by more than two hours.

We recognise that that is welcome progress, as I am sure the hon. Gentleman would agree, but there is much further to go to recover fully from the pandemic’s impact on response times and to sustain that improvement. We welcome the service’s hard work and dedication and pay tribute to it for making those changes and delivering the significant improvements on which I am updating the hon. Gentleman.

[Justin Madders]

As always, the Minister is being courteous and comprehensive in his response. Will he comment on the concern expressed earlier about patients being told, when visited by the service, that they needed to go to hospital but should find their own way there? That is extremely worrying, and we should be clear that it is not what we expect to happen.

[Edward Argar]

I am grateful to the hon. Gentleman—I keep feeling tempted to say shadow Minister; he is a shadow Minister but he is no longer my shadow—for that point. He is right that when people ring 999 they should be given the appropriate clinical advice on whether they need to go to hospital, and if they do, an ambulance should be sent. I suspect that in individual cases a call handler may have made a tough clinical decision about the fastest way to get someone to hospital given the availability of ambulances, but the hon. Gentleman is right that if someone rings 999 and their condition is clinically deemed to require an ambulance and swift transfer to hospital, they should be able to expect an ambulance to come, assist them and take them to hospital.

At a time when the NHS is facing unprecedented demand, ambulance services are absorbing some of the increase in pressure. They are treating more people over the phone and finding other ways to reduce pressure in a clinically safe way. With clinical support in control rooms, the ambulance service is closing around 11% of 999 calls with clinical advice over the phone. That is far more than the 6.5% achieved in January 2020 and saves valuable ambulance resources for response to genuinely more urgent clinical needs.

Let me say a little about North West Ambulance Service, if that is helpful to the hon. Gentleman—I know that he and the hon. Member for City of Chester take a close interest in their local ambulance service. Our support and investment has benefited the North West Ambulance Service. The hon. Member for Ellesmere Port and Neston’s local trust received £6.2 million of funding, which it has used to increase its workforce for operational and contact centre teams. The trust is also engaged with regional NHS England and Improvement and commissioning teams to develop a six-point winter plan that seeks to address six key areas throughout the winter period. As it starts to get a little warmer and the daffodils start to come out, it is tempting for people to think that winter has passed, but winter pressures in the NHS can continue into late February and occasionally a bit beyond. I wanted to add that caveat.

Three systems-led initiatives focus on the reduction of hospital handover times, the improvement of pathways for patients with mental health presentations and ensuring that alternatives to emergency departments—including access to primary care and other non-emergency-department pathways—are available to North West Ambulance Service in a timely and responsive manner.

Hospital handover delays continue to challenge the North West Ambulance Service footprint. Through its Every Minute Matters collaboration, which began three years ago, the trust has been working with other hospital trusts on improvements by working with senior leadership teams in hospital trusts to ensure there is a shared understanding of the risks of handover delays and a lack of ambulance resources to respond to patients in the community, to revisit action cards for operational commanders and, crucially, to recognise and thank staff for their continued reporting of delays and willingness to highlight problems to their managers or to the trust.

The trust’s strategic winter plan has been activated and includes details of the measures in place to handle winter pressures and mitigate the effects of increased demand and a loss of capacity. The plan is comprehensive and covers a wide range of topics and details on the preparation for various scenarios. It includes several continuous improvement initiatives for support during the winter period.

In summary, North West Ambulance Service is increasing its double-crewed ambulance capacity in line with winter funding arrangements, reducing conveyance to emergency departments and reducing the number of lost operational hours caused by day-to-day operational challenges. The trust has already seen significant improvements in the number of patients managed effectively through telephone advice, which helps free up ambulances to be deployed to where they are most needed. The trust has recruited additional paramedics and emergency medical technicians and upskilled its ambulance care assistants to blue light driving standard, thereby enabling the trust to deploy 269 additional frontline staff by the end of December.

I close by reiterating the Government’s commitment to support the ambulance service. We retain regular contact with ambulance services, trusts and those delivering on the frontline to help to ensure that patients and the ambulance service receive the care and support that they need. I am grateful to the hon. Member for Ellesmere Port and Neston for bringing this matter to the House.

Question put and agreed to.