Ambulance Waiting Times: Royal Cornwall Hospital

Edward Argar Excerpts

Wednesday 29th June 2022 Commons Chamber

[The Minister for Health (Edward Argar)]

I congratulate my hon. Friend the Member for Truro and Falmouth (Cherilyn Mackrory) on securing this important debate. Since her election, she has been a notable advocate both in this House and more privately with Ministers on behalf of her constituents and those who work in her local healthcare system—as, indeed, are all six Members of Parliament representing seats in Cornwall.

May I also take the opportunity—I know we do not always use this sort of language now, but I will—to congratulate the hon. and gallant Member for Tiverton and Honiton (Richard Foord) both on his election to this House and on his contribution to the debate this evening. I look forward to his maiden speech, but it is a privilege for me to have had the opportunity, I think, to be the first Minister to respond to him and congratulate him. It is always a pleasure to see the hon. Member for Plymouth, Sutton and Devonport (Luke Pollard), who may not be my hon. Friend but is my friend. I thank him for his contribution, highlighting the issues at Derriford Hospital.

As my hon. Friend the Member for Truro and Falmouth has made clear, there are complex causes behind the challenges faced by her constituents and those of other right hon. and hon. Members around the country with ambulance services and ambulance response times. As she will know, ambulance services faced significant pressures during the pandemic and continue to do so. I join her and Members on both sides of the House in putting on record, as she did, our gratitude to all the ambulance service staff and the NHS for their outstanding work, both at this time and particularly in recent years.

The service is still working under exceptional demand and pressures. In May 2022, the ambulance service answered more than 850,000 calls, an increase of 7% on May 2021 figures. Those are national figures; I will turn to my hon. Friend’s local situation in Cornwall in due course. She is right to highlight that the issue is not just with the ambulance service itself, although that is often the visual manifestation or symptom of broader challenges within the health ecosystem and the pressures it is under. It is about handovers and the ability do turnarounds and get the ambulances back on the road, having had a patient safely admitted to the A&E department in an acute setting. I will turn to that in a moment too. As she will be aware, other issues as well as demand impact on performance, including, still, although less so than there have been, elements of infection prevention and control measures. There are issues in particular areas with staff absence—for example, still, where there is an outbreak of covid. She also highlighted some very specific local factors that I will turn to.

Touching on that, I am aware of the local context that my hon. Friend set out, in that in Cornwall the demand for NHS services has combined with wider systemic issues, placing particular stress on the system. Some of those local factors include the demographic challenges of the age profile of the population and difficulties or challenges in securing the adult social care capacity to meet current and projected demand. I suspect that much of what I say about Cornwall will apply to Devon as well, as the context both demographically and in terms of patterns of demand are not completely dissimilar.

Other factors that play a key part include geography and, as my hon. Friend highlighted, the cost of living, affordable housing, and the ability to retain a skilled workforce. It is also worth remembering, in the context of Cornwall, that whereas many parts of the NHS system see very pressured demand over the winter period that tends to ease somewhat during the summer, allowing them time and space, Cornwall, and, I suspect, Devon as well, being such popular holiday destinations, see a different range of challenges and pressures on the system as holidaymakers come into to area and often need to use these services. I am very sensitive to that point.

I assure my hon. Friend, who touched on some of those issues, that significant work is under way across the entire local health and care system to improve patient flow through the hospital, which is the key element in making the system work smoothly to reduce the wait times for emergency care and reduce the numbers of delays in handing ambulance patients over to A&E. Importantly, the NHS Kernow clinical commissioning group, as it currently is—as she rightly highlighted, as of 1 July ICSs become statutory bodies—is continuing to work with all providers to create and commission additional capacity, including a plan to release 80 additional hospital beds now and 20 to 40 further beds in time for the winter. This will help to increase the flow of patients out of the emergency department, reducing overcrowding and the numbers of ambulance-patient handover delays. I pay tribute to my hon. Friend for the summit that she and local Cornwall Members convened with me earlier in the year not only to talk about the pressures faced by the system at the time but to begin looking forward to how we can mitigate future pressures.

The trust is expanding the use of virtual wards whereby patients are monitored remotely at home rather than being admitted to hospital. This further reduces pressure on local bed capacity and allows for patients to be safely treated at home, which can be beneficial for their recovery. Of course, that is done on the basis of clinical triage and assessment. There has also been an increase in the adult social care domiciliary care pay rate, helping to generate more social care capacity locally and ensure that patients are able to be discharged from hospital to home as soon as they are medically fit. That is supported by the Proud to Care recruitment campaign. I understand that the NHS and Cornwall Council are aiming to launch a targeted campaign in the autumn to encourage more under-25s to work in the care sector.

I now turn to discharge. I have highlighted some of the action that is being taken locally to improve patient flow through hospitals by discharging patients more quickly. The aim is partly to increase the number of discharges a day, but it is also to bring more discharges forward to earlier in the day, when it is clinically safe to do so, thus making those discharges much better managed. It is important that all partners work well together on that. At a national level, we have set up a national discharge taskforce. As Minister, I now get weekly statistics about where we are on delayed discharges. My hon. Friend alluded to the number of people who are clinically fit for discharge but have not been discharged, for a variety of reasons. Reducing that by even a small proportion would have a significant impact on the availability of beds and thus patient flow. It is a complex picture with a variety of reasons behind delayed discharges. However, it is important that we continue to work across the system locally and with national support to get the number of delayed discharges down.

The CCG locally is also establishing community assessment and treatment units for frail and elderly patients as an alternative to hospital admission, alongside an innovative reablement ward that is now moving to a community hospital location, as my hon. Friend mentioned, as a permanent model of care. Taken together, these interventions will help to ensure the effective flow of patients through hospital, reducing those waiting times and crucially reducing the number of ambulance handover delays, allowing ambulances to get back on the road more rapidly.

To address the wider issues around staff recruitment and retention, the NHS is working with local partners on schemes to address cost of living concerns, including work with the Supportmatch charity on the homeshare scheme, where a householder helps to offer affordable accommodation to someone working in the sector. There is the new guardianship programme developed by Supportmatch, NHS England and NHS Improvement in the south-west that enables householders to offer a spare room to fully vetted and checked health and care workers. Typical agreements can run from two months to two years. We should recognise those sorts of innovations that have grown up locally for the beneficial effects they can have.

It is also encouraging to see that these measures are delivering improvements. Performance against the four-hour A&E standard improved from 76.9% meeting that in April to just shy of 80% meeting it in May. There is more to do, clearly, but that is a positive direction of travel. The South Western Ambulance Service also saw notable improvements across all response time categories in May compared with April, including a 24-minute reduction in the average category 2 response time. Again, there is still more to do to get those down to target levels, but that is a positive step and a positive direction of travel.

There was a reduction of more than one minute in the average response time to the most serious category 1 calls. That does not sound like a huge amount, but in April, when we were seeing challenges, that was a bit over 11 minutes. Shaving a minute off that is still hugely important. There is more to do to get it down to the circa six or seven minutes that it was in May 2019, before the pandemic. We have further to go, but we are focused upon it.

Then there is investment in hospitals locally. In this context, I highlight the £1.3 million in 2020-21 of the elective recovery estates funding, the £2 million for technology to help elective recovery, the £2.8 million for A&E upgrades and the £1.7 million previously given to tackle the backlog maintenance in my hon. Friend’s trust. I pay tribute to her, but I pay particular tribute to my hon. Friends the Members for North Cornwall (Scott Mann) and for St Austell and Newquay (Steve Double), who in the nature of their roles in this place are not able to intervene directly in this debate. It is important that I put on record their work on behalf of their constituents in lobbying Ministers and securing that investment from Government in their local hospital trust.

There is a wide range of national support in place to improve ambulance performance more widely.

[Luke Pollard]

According to the South Western Ambulance Service, three of the five hospitals in the country with the longest ambulance waiting and hand-over times are south-west hospitals—Derriford, Bristol and Royal Cornwall. Is there something south-west specific that the Minister needs to look at as to why south-west hospitals are experiencing the longest hand-overs?

[Edward Argar]

I gently say to the hon. Gentleman that the hon. Member for North Shropshire (Helen Morgan) made the point about delays in respect of her county in March, so we are seeing significant challenges across the country. I have highlighted some of the specific points about Cornwall, such as the geography and the distances. It is also about demand, which, as I alluded to, does not abate even slightly in the summer. There is a range of factors—my hon. Friend the Member for Truro and Falmouth highlighted a number of them—and I have set out some of the measures that we are taking to address them.

Nationally, as my hon. Friend alluded to, a wide range of support is in place. Ambulance trusts receive continuous central monitoring and support from the National Ambulance Coordination Centre, and NHSEI has allocated £150 million of additional system funding for ambulance service pressures in 2022-23, which will support improvements to response times through additional call handler recruitment, retention and other funding pressures.

National 999 call handler numbers have been boosted to more than 2,300 at the start of May 2022, which is about 400 more than in September 2021, with further potential increases. We are also investing £20 million of capital funding in ambulance trusts in each of the three financial years to 2024-25, in addition to the £50 million national investment across NHS 111.

We continue to work closely, in terms of additional resources and system pressures, with the ambulance trusts in the south-west and across the country. I am grateful to my hon. Friend for highlighting this hugely important issue. Her constituents are lucky to have her representing them in this place. I will continue to work with her and other right hon. and hon. Members, and the system, to deliver the improvements that we all wish to continue seeing.

[Mr Deputy Speaker (Mr Nigel Evans)]

I, too, welcome Mr Foord to the House on his maiden intervention—if such terminology exists; it does now.

Question put and agreed to.

Correction to PQ118520, PQ118521 and PQ118522

Edward Argar Excerpts

Wednesday 22nd June 2022 Written Statements

[The Minister for Health (Edward Argar)]

On 28 February 2022, the Department answered three parliamentary questions asked by Nick Smith MP. The single answer given to all three questions included an incorrect reference to a supplier of PPE.

The questions were:

“118520: To ask the Secretary of State for Health and Social Care, whether his Department paid £600 million to Unispace Global Ltd for the purchase of personal protective equipment in 2020.”

“118521: To ask the Secretary of State for Health and Social Care, whether Unispace Global Ltd met its contractual obligations for providing adequate personal protective equipment under the contractual terms set by his Department in 2020. ”

“118522: To ask the Secretary of State for Health and Social Care, whether any Government Department has taken steps to investigate why payments made to Unispace Global Ltd were not reported by that company in its financial accounts; and, if he will make a statement.”

The departmental answer was:

“…Unispace Global partially met its contractual obligations, supplying the National Health Service with £484 million items of PPE from April 2020 till December 2021. We are working with the company on a commercial resolution for the remainder of the contract... ”

However, all contracts between Unispace Global Ltd and the Department for Health and Social Care were novated to Unispace Health Products LLP in December 2020, which has since changed its name to Sante Global LLP. Accordingly, the departmental answer should have referred to Sante Global LLP rather than Unispace Ltd.

Through this written ministerial statement I am correcting this error, which arose as one of our internal record management systems had not been updated to reflect the change in name. This system has also been updated.

[HCWS128]

Draft National Health Service (Integrated Care Boards: Exceptions to Core Responsibility) Regulations 2022

Edward Argar Excerpts

Wednesday 15th June 2022 General Committees

[The Minister for Health (Edward Argar)]

I beg to move,

That the Committee has considered the draft National Health Service (Integrated Care Boards: Exceptions to Core Responsibility) Regulations 2022.

As always, Ms Nokes, it is a pleasure to serve under your chairmanship. I will endeavour to be brisk in my remarks this morning. The purpose of the regulations is to ensure operational continuity as the changes from the Health and Care Act 2022 are implemented following Royal Assent in May. That Act strips out needless bureaucracy, improves accountability and enhances integration. It forms the bedrock for the NHS to build on in years to come, which is why I am delighted to be here to debate the regulations that will facilitate its implementation.

The regulations relate specifically to the transfer of functions from clinical commissioning groups, which were abolished by the 2022 Act, to newly established statutory integrated care boards. Under the National Health Service Act 2006, which was amended by the 2022 Act, NHS England may set rules so that integrated care boards have “core responsibility” for every person who is provided with NHS primary medical services through registration with a GP practice in their area of England, and for every person resident in the ICB’s area who is not registered with a GP practice. That means that when a person sees a GP in an area, the relevant ICB is responsible for arranging the provision of secondary health services that that person may need.

This instrument provides an exception to that obligation for individuals who are usually resident in Scotland, Wales or Northern Ireland but are registered with a provider of NHS primary medical services in England. The regulations do not prevent those who are resident in Scotland, Wales and Northern Ireland from accessing health services in England; instead, they simply make clear where the commissioning responsibility sits for those patients. They promote autonomy for devolved Governments to commission secondary care services for their residents, while still allowing patients to access secondary healthcare services in England. In essence, it is about which authority commissions and pays for a patient’s care, not the patient’s right to access care. The regulations are vital to give clarity and ensure consistency among authorities in England and those in Scotland, Wales or Northern Ireland in respect of who commissions and pays for a patient’s secondary care.

To conclude, it is important to be clear that this instrument does not change existing cross-border commissioning arrangements. Health is a devolved matter, and the instrument simply transfers an existing commissioning exception from clinical commissioning groups to integrated care boards, to reflect the changes in the nomenclature in the new legislation. The arrangements are a continuation of the approach to devolved health policy that was introduced in the National Health Service (Clinical Commissioning Groups—Disapplication of Responsibility) Regulations 2013, which are to be revoked as a consequence of the 2022 Act.

The regulations before us will ensure operational continuity of services for patients as the English health system implements integrated care boards, they are supported by the devolved Governments and they provide clarity on the role of integrated care boards within the existing cross-border arrangements. I commend the regulations to the Committee.

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[Edward Argar]

I am grateful to the shadow Minister for her remarks and for her support for this instrument. It was a pleasure to serve opposite her for, as she alluded to, many months in the the Health and Care Bill Committee, before she was shadow Minister. She is right to talk about the length of time that that legislation spent going through Parliament before it received Royal Assent; of course, we could not introduce these regulations until Royal Assent was granted in the middle of May, although we did secure the early commencement of the 2022 Act’s provisions in order to be able to bring forward the relevant consequential regulations as swiftly as possible.

The shadow Minister asked how many more consequential regulations we anticipate—I think she was referring specially to those that relate to the implementation of ICBs and integrated care systems by 1 July on a statutory footing. To date, I think I have seen, commented on and approved a further five instruments. They are overwhelmingly technical in nature, and replicate existing arrangements but change the language and nomenclature used. Of course, one of those sets of regulations will formally, legally commence these provisions from 1 July—that has to be done through regulations.

We would of course have liked to have seen Royal Assent earlier than we did, but a considerable number of amendments were tabled, both in our House and in the other place, so it took a considerable amount of time to navigate through the parliamentary process. However, we got there and received Royal Assent for a piece of legislation that will go a long way towards building on the success we have seen so far in improving health outcomes in this country, and that will enable the NHS to go forward with a strong base on which to build and from which to evolve. I again commend the regulations to the Committee.

Question put and agreed to.

Oral Answers to Questions

Edward Argar Excerpts

Tuesday 14th June 2022 Commons Chamber

[Ian Levy (Blyth Valley) (Con)]

3. What progress he has made on recruiting 50,000 nurses.

[The Minister for Health (Edward Argar)]

This Government committed to growing the NHS workforce, including our pledge of 50,000 more nurses by 2024, and we are delivering on that, as we are delivering across Government, with almost 31,000 more nurses so far as of March 2022—the latest data point we have.

[Ian Levy]

I commend the Government on their target to train 50,000 new nurses. I know first-hand how hard the nursing staff work in the NHS as I worked as a mental health support worker for almost 30 years. With that in mind, I welcome the new school of nursing to be built at the Cramlington A&E Hospital. Will my hon. Friend do me the honour of visiting Cramlington to see for himself the construction of this amazing new facility?

[Edward Argar]

I pay tribute to my hon. Friend for his work supporting the NHS and healthcare in this country both prior to and subsequent to his election to this House. I would be delighted to visit Cramlington with him—indeed, on the same visit perhaps I could visit his local health facilities to see modular construction in action. I should also say that his ever-efficient office has already invited me.

[Gareth Thomas (Harrow West) (Lab/Co-op)]

More nurses across the country, and particularly in Harrow, would make a real difference in helping those who suffer from diabetes. Given that this is Diabetes Week and that diabetes has a disproportionate impact on those from a south Asian background—particularly, for example, among my Gujarati constituents—when will the Minister put extra resources into tackling this terrible health condition?

[Edward Argar]

I am grateful to the hon. Gentleman for his important question. As he highlights, we are investing more in more nurses, but there is also a large piece of work to do on health education and improving access to those services for people with diabetes. I urge him to look forward with eager anticipation to the health disparities White Paper.

[Jonathan Gullis (Stoke-on-Trent North) (Con)]

Mr Speaker, you will be aware that I am proud to support the “no time to wait” cross-party campaign to ensure that we have a mental health nurse in every GP surgery across the country. I am delighted to see the hon. Member for York Central (Rachael Maskell), who supports the campaign, in her place.

I was delighted to read that the Secretary of State has said that we will recruit 2,000 mental health nurses into GP practices. Can I have more detail on how that will work? Can we look at Norfolk, which is using primary care networks, and third sector organisations such as Mind to help with that recruitment?

[Edward Argar]

I am grateful to my hon. Friend for drawing attention to this important issue as well as for highlighting what is going on in Norfolk and the opportunities to learn from that. The Government have put record funding into mental health, and I understand that my right hon. Friend the Secretary of State is due to meet him and supporters of the campaign soon.

[Mr Speaker]

I call the shadow Minister.

[Dr Rosena Allin-Khan (Tooting) (Lab)]

Working a shift in A&E just two days ago, I could not have felt prouder of the teams of nurses who form the foundation of our NHS. As the Minister is so gushing about the Government’s track record, will he explain why specialist food banks are being opened up in hospitals? Will he explain why, in a report by the Royal College of Nursing, 83% said that staffing levels on their last shift were not sufficient to meet patients’ needs safely and effectively? These lifesavers need a Government who are on their side. Only Labour will deliver for the NHS workforce and ensure that nurses and patients get what they rightly deserve.

[Edward Argar]

I think that I detected the hint of a question in there. On a serious point, I pay tribute to the hon. Lady, as I often do on such occasions, notwithstanding the challenges that she throws at us, for the work that she does in the NHS and the work that she did before she was elected to the House. Through her, I also pay tribute to NHS workers up and down the country for their work.

The Government have put in place record support for our NHS, including nurses, which is about supporting those already on the frontline in the profession—that is absolutely right—and about growing that workforce to ensure that the work that needs to be done is spread among more people. That is exactly what we have done. We have record numbers in our NHS workforce, and we are well on target to meet our manifesto commitment on more nurses.

[Suzanne Webb (Stourbridge) (Con)]

4. What progress he has made on recruiting 26,000 primary care staff.

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[Rosie Cooper (West Lancashire) (Lab)]

6. What assessment he has made of the effect of integrated care systems on cross-boundary NHS trusts.

[The Minister for Health (Edward Argar)]

NHS trusts have an integral role in the local health and care system. We expect appropriate engagement between integrated care boards, integrated care providers and the respective NHS providers in an area. An NHS trust is a formal partner of an ICB if it provides any services in the ICB area and has the function of participating in the nomination of members to the board. Regulations give details as to how to determine which trusts that provide services in an ICB area should participate in the nomination process.

[Rosie Cooper]

Notwithstanding the Minister’s comments, Cheshire and Merseyside integrated care system has recently made the decision to stop my West Lancashire constituents accessing routine dermatology at St Helens Hospital, which is the only nearby provider. Due to geography, my constituents are in the Lancashire ICS, and are therefore not represented in Cheshire-Mersey—in place or local authorities.

My question, which I have asked several times, is: what is the Department doing to ensure that there is a mechanism for my constituents in Lancashire ICS to be represented in Cheshire-Merseyside’s decision-making process, which directly affects the care they are given? I have raised this point about cross-border difficulties so many times that I must question whether we any longer have a national health service, or whether we have a series of protected ICS kingdoms.

[Edward Argar]

The hon. Lady and I speak regularly about different aspects of her local health system, and I am happy to do so again on this matter. I do not know the exact details behind the specific example, but I do not think it relates directly to how ICSs are configured in statute and guidance. I would be happy to meet her to understand the local factors that may have contributed to the situation.

[Jacob Young (Redcar) (Con)]

7. What steps he is taking to increase the quality of nursing in care homes.

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[Luke Hall (Thornbury and Yate) (Con)]

A new hospital at Thornbury would provide greater primary care and outpatient services, more GP appointments and a proactive frailty hub to support the elderly to stay in their own home longer. Our bid was submitted against the sustainability and transformation plan wave 4 capital pot, and I thank the Minister for all his work and effort in speaking to me, South Gloucestershire Council and our clinical commissioning group about this bid. Will he update the House on the timescales for its outcome?

[The Minister for Health (Edward Argar)]

I am grateful to my hon. Friend; he rightly alludes to the fact that he is a strong champion of his constituents and has met me on a number of occasions to argue the merits of the Thornberry health centre. As he will be aware, we now have a multi-year capital settlement for our NHS, which will allow us the opportunity, through local systems, to consider the most appropriate projects for investment.

[Mr Speaker]

Like Chorley.

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[Edward Argar]

It was a great pleasure to visit my hon. Friend before the jubilee weekend and to meet the staff who do such an amazing job at his local hospital. As ever, his puts his case clearly and firmly for a new hospital to replace the QE in King’s Lynn, and we hope to be able to announce the longlist of those expressions of interest in due course.

[Mr Speaker]

Including Chorley, I hope.

Hospital of St Cross: Accident and Emergency

Edward Argar Excerpts

Thursday 9th June 2022 Commons Chamber

[The Minister for Health (Edward Argar)]

I congratulate my hon. Friend the Member for Rugby (Mark Pawsey) on securing this important debate. He is right to highlight that it is the responsibility of Members of Parliament to highlight and champion their constituents’ concerns, and he is doing exactly that today, just as his illustrious predecessor and father did over a combined total of about 18 years in this House, representing that area with distinction just as he does. My hon. Friend has been a regular campaigner for the NHS in his constituency. Indeed, as I recall from oral questions some time ago, I think I am right in saying that he volunteered at the Locke House vaccination centre during the pandemic to assist his local NHS. Not only does he talk the talk; he walks the walk in supporting his local NHS, and his constituents in Rugby are incredibly lucky to have such a passionate local champion for their cause in this House.

My hon. Friend’s engagement with his constituents, and his being in tune with their concerns, is reflected by the survey he mentioned. He said he had received around 3,000 responses, which is a phenomenal response rate for such a survey. I think I read that it was reported on the excellent CoventryLive site, which highlighted exactly what he had done. He asked me to acknowledge, and of course I do, the virtual uniformity of the concerns raised in his constituents’ responses. That is a powerful message that his constituents are sending to us.

I understand that the Hospital of St Cross has operated an urgent care centre since the closure of the full A&E in 2011, transitioning to become an urgent treatment centre in line with national changes in 2019. That service is available 24 hours a day, seven days a week, allowing patients to access the urgent care services that it is able to provide at any time. Trained nursing staff are on hand and patients can have X-rays and blood tests and access a pharmacy. As my hon. Friend said, patients with more complex medical conditions requiring advanced tests or investigations will be referred or taken by ambulance to be cared for by specialists at the University Hospital in Coventry. This, to a degree, reflects the staffing availability and specialist staff required for different services, and which services are available in a particular setting.

My hon. Friend highlighted an important point, which applies not only to his local hospital but more broadly across the country. There is more we can do to help our constituents, and those who may need services, to understand what services each different NHS destination —be it an A&E or a UTC—can provide, and hopefully reduce the number of people who see the H sign on the motorway and think, “I’ll go there because I need assistance,” only to end up being transferred to another hospital to receive the services they need for their condition. There is more we can do to make that clear.

I appreciate my hon. Friend’s call for a restored full A&E service in Rugby, on the basis of demographic change since the decision was taken in 2010 and implemented in 2011. He is right to highlight the pace of change, including in population. I know his patch a little; it is a relatively short hop down the M69 and back across the M6 from my patch to his. He is right to highlight all that Rugby and the area is doing to help support the objectives of providing affordable housing for people who need it; but that of course comes with additional pressures on local public services and local infrastructure, as he rightly emphasised.

As my hon. Friend knows, the original decision to alter local service provision was made following a full public consultation to address concerns raised at the time that the unit was not able to sustain full A&E services, with serious cases, even then, being sent to Coventry for treatment. I can assure my hon. Friend that this decision will rightly be taken by the local clinical commissioning group, as it was in 2010—although it was possibly a primary care trust at the time. Shortly, it will be a decision for the local integrated care boards, which are due to come into force very soon, following the passage of the Health and Social Care Act 2022. It would not be right for the inception of such decisions to come from Ministers in Whitehall. I would note, however, that for any future changes we will see slightly altered powers for Ministers, with the power of direction and intervention introduced in that legislation.

I can assure my hon. Friend that the funding available to his local health system has risen in line with demographic change since 2010—as determined by the formula set by the Advisory Committee on Resource Allocation—and that ensuring that resources are allocated to deliver the best care for patients is a key duty of both the CCG and, subsequently, the ICB. The local health system is best placed to consider sustainability, location, and demand for services across its area. Any such assessment of whether to reduce services, move services or open new services should include consideration of the mix of accident and emergency services, UTCs and other treatment services, such as GP access.

Without wishing to pre-empt any particular course of action that my hon. Friend’s local system might be persuaded by his forceful advocacy to consider, I would also comment that it is for the ICBs and trusts to plan for reconfigurations of NHS services. Judging by what my hon. Friend said, he is already lobbying them pretty firmly. Where services are reconfigured, we are clear that these are subject to four stringent Government tests, which are strong public and patient engagement, consistency with current and prospective need for patient choice; a clear clinical evidence base, and support for proposals from clinical commissioners.

Decisions on any reconfiguration are rarely easy or straightforward; they are effectively about balancing different needs and benefits, including patient transport and inequalities, and it is important to hear from as many local people as possible about the practical impacts and concerns. As I alluded to, I encourage my hon. Friend to continue his conversations with his local NHS system.

Before turning to pressures on A&Es more broadly and the ambulance service locally, I should say that there is already significant investment to improve services in Rugby. The University Hospitals Coventry and Warwickshire Trust remains committed to expanding services at the Hospital of St Cross, and in recent times that has included the opening of a £1 million purpose-built haematology and oncology unit, and new modular theatres to help treat more patients on elective waiting lists. It is probably fair to say that a degree of credit goes to my hon. Friend for fighting the corner for his local hospital, as he always does.

I shall now mention pressures on emergency departments. The emergency department at the University Hospital in Coventry has also been granted £15 million by the Government to increase its capacity and further enhance patient care. This investment will expand the department, including with a new minor illness and injuries unit. The funding will also be used to install additional treatment cubicles, to expand the waiting room in the children’s ED, to increase the level of same-day emergency care and to support diagnostic capacity with an additional CT scanner.

It is right that we take a whole-system approach to these challenges, and all this work is designed to complement existing services provided at both the Rugby and Coventry urgent treatment centres. My hon. Friend is right to highlight the pressures we are seeing in EDs across the country, which is often manifested in ambulance delays and ambulance queues. That is a symptom of the patient flow challenge in hospitals. Space is needed to offload patients safely into EDs, for which EDs have to be able to discharge patients safely or admit them into the hospital. To do that, hospitals have to be able to discharge patients to free up the bed space to enable that patient flow. In recent months we have seen sustained pressure in hospitals across the country in that respect, and he rightly highlights his local hospital.

My hon. Friend talked about the ambulance service and highlighted the tragic case of Jamie Rees, which has been reported on extensively by CoventryLive. Jamie sadly passed away on new year’s day following a cardiac arrest. Through my hon. Friend, I extend my sympathies and condolences to Jamie’s family and friends.

I understand the West Midlands ambulance service believes that, sadly, an ambulance station, had there been one in Rugby, would not have altered the outcome in Jamie’s case. In the 90 minutes before it received the first 999 call, I understand there had been five other emergency calls in the Rugby area. That means any ambulances based in the town would have already been dispatched to deal with those emergency cases, so the ambulances would not have been available wherever the station were based. I fear that reflects the pressures at the time. None of that will be any consolation to Jamie’s family, but I wanted to highlight the context.

My hon. Friend also rightly highlighted the “Our Jay” campaign and the number of externally mounted defibrillators, which is a hugely important topic. It is sad that there is sometimes an unwillingness to fund externally mounted defibrillators due to the despicable behaviour of utterly heartless individuals who, for some reason, think they have the right to vandalise or steal this life-saving kit. It is a sad reflection on them, and I sincerely hope they never find themselves in a situation where they need such kit to be available. I pay tribute to the “Our Jay” campaign.

More broadly, we have put a number of measures in place to try to ease the pressure on A&E and ambulance services. The discharge taskforce is helping to free up patient beds by ensuring that patients who are fit to be discharged are discharged more rapidly. In recent years, £450 million has been spent on expanding A&E departments, and there has been a £55 million investment in strengthening ambulance trusts and keeping an extra 156 ambulances in service and on the road to bolster capacity and resilience during the winter period.

I hear the passionate case my hon. Friend makes. There is significant support in place, both locally and nationally, to help ensure constituents in Rugby can access the care they need when they need it, but I also wish to make a number of points. First, I am happy to meet him to discuss this matter. I was going to offer to make the short hop down the M69 and the M6, but from what he has says I have been pipped to the post by my boss arranging to do that visit; he has perhaps upgraded the offer, with the Secretary of State rather than a mere Minister of State. I hope my hon. Friend will feel free to share the detail of his survey and the responses with me. I am also conscious that I have some outstanding correspondence from him—I checked that this morning—and I will ensure that I respond to it in the next few days. I will pull it out of the system and ensure that he gets answers to the specific points he raised.

I thank my hon. Friend, once again, for rightly raising this important issue, securing an important debate on the Floor of the House today and doing what he does so well: championing his constituents’ best interests, and making sure that Ministers have no opportunity to forget them and to forget the people of Rugby. Indeed, he ensures that they are impressed upon our minds. I look forward to meeting him to discuss this further, and I hope that will happen shortly.

Question put and agreed.

Correction to PQ62745

Edward Argar Excerpts

Wednesday 27th April 2022 Written Statements

[The Minister for Health (Edward Argar)]

I would like to inform the House that I wish to correct the formal record in relation to written answer 62745 to the hon. Member for Aberavon (Stephen Kinnock) on 28 October 2021.

The reply stated that neither the Department nor the former Public Health England has any collaborative, commercial or contractual links to the Beijing Genomics Institute or its subsidiaries.

The correct answer is that BGI Genomics UK Limited was awarded a call-off contract from a framework contract held by Public Health England in August 2021 following a mini competition. This call-off contract lapsed on 14 November 2021 and no further contract with BGI has been let.

[HCWS793]

National Strategy for Self-Care

Edward Argar Excerpts

Tuesday 26th April 2022 Westminster Hall

[Sir Charles Walker (in the Chair)]

I will call the shadow Minister shortly. There is usually a five-minute limit for the Opposition spokesperson, but as we have quite a long time left, if the hon. Lady would like to speak for longer, she can do so, although she is under no obligation to do that. I am sure the Minister would not mind either.

[The Minister for Health (Edward Argar)]

It is like being back in Committee.

--- Later in debate ---

[The Minister for Health (Edward Argar)]

It is always a pleasure to serve under your chairmanship, Sir Charles, and a particular pleasure to serve opposite the hon. Member for Bristol South (Karin Smyth), the shadow Minister. We spent many happy days in Committee on the Health and Care Bill, even if we were not in full agreement. The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield), within whose portfolio this would normally sit, has just been answering a debate in the Chamber, which is why I am responding to this debate.

I will endeavour to do justice to the very important points that the right hon. Member for Knowsley (Sir George Howarth) raised in his speech. I will do something, which, even within my own portfolio, would cause my officials to wince—and I suspect that the same may happen given that this falls within somebody else’s portfolio—which is that, notwithstanding the wonderfully well written notes that my officials have provided me with, I may well say what I think on this subject and respond to the specific points that have been raised in the course of this debate. This could be career limiting, but we will see.

The right hon. Member made a powerful speech. Essentially, the way in which he illustrated through the prism of a particular condition of diabetes a number of the points that could be applied more broadly across the spectrum of self-care was particularly helpful to hon. Members. Although we may not have a huge quantity of hon. Members in this Chamber today, what we do have is quality, judging by the contributions that we have heard.

The right hon. Member is absolutely right, as is the shadow Minister, that, in talking about self-care, we must be very clear that we do not see it as an alternative—an either/or—to medically qualified support or other forms of support. The two parts of the system should work hand in hand. Indeed, I see it as a continuum. I have seen the work done by PAGB, the Self-Care Forum and others on that self-care continuum. We start at one end with education, which I will turn to in a moment. The pure end of self-care is around diet, daily calorie intake, and the simple lifestyle changes that can make a big difference to our own health and the risk of our contracting illnesses or diseases. Those lifestyle and dietary factors may not be for everyone given the nature of particular conditions, but, by and large, are within the control of the vast majority of us.

At the other end of that continuum, we have things such as major trauma, or treatment for illnesses such as cancer or cardiac conditions where medical care, and often hospital-based care is essential. Then there is that space in the middle around self-treatable conditions. There are the minor ailments where people might be able to self-care, but where, as the hon. Member for Bristol South put it very well, some might need some confidence or advice to be able to do so.

There is also the management of acute conditions and long-term conditions, which, I suspect, will entail a degree of professionally qualified medical care, but, equally, a degree of self-care based on that advice as well. We have that spectrum—that continuum—and it is important that we view it in that way. The ability to turn to the right type of support at the right time is crucial to maximising the benefits and opportunities for individuals in self-care.

Through the pandemic, we have seen the opportunities to innovate. They were opportunities forced on us by the circumstances in a dreadful situation, but, none the less, there have been ideas and innovations that have come out of that pandemic. We have seen also the consequences of demand within our healthcare system, particularly at GP practices, at accident and emergency, and at urgent treatment centres. Notwithstanding the record investment by this Government in our NHS, and notwithstanding the record numbers of staff in the NHS, we do see pressures. An effective and proportionate self-care approach that people feel confident in can play a key part in helping to manage the pressures, where people go to the most appropriate point to be treated.

Empowerment is key—people understanding and being educated in their choices and the implications of their choices, through public health messaging. There is a telling statistic, although it may be a little out of date—I was discussing this with some officials earlier this week: 43% of the population do not feel fully confident in understanding health information conveyed in words. The figure leaps to 61% of people who do not feel fully confident in understanding information about their own health and their choices when the information contains words and numbers. That signifies that there is a lot more work for us to do.

[Sir George Howarth]

I am encouraged by the first part of the Minister’s speech that he gets this, as I was by the response of my hon. Friend the Member for Bristol South (Karin Smyth) on the Front Bench. The Minister is right that people who have long-term conditions—or, for that matter, the general population—need to understand better what they can do for themselves. It is not always obvious to people what they can do. It is also important—I referred to the recommendations—that medical practitioners understand these issues in their initial training and that they are kept up to date on the potential. Otherwise, people are operating in a fog, without understanding the potential. I am sure the Minister will agree that those things are important.

[Edward Argar]

I entirely agree that for health professionals, having up-to-date and refreshed knowledge is hugely important. In my current role and my previous role at the Ministry of Justice, I have looked at this point when considering domestic abuse and domestic violence. GP practice staff are often the first people to get an indication that something is wrong—not necessarily because a patient presents saying so, but because of the nature of their injuries or what they present with. Up-to-date knowledge across a range of areas is hugely important.

The hon. Member for Bristol South is right that education cannot start too early for forming good habits, and that, through school and beyond, it is important to educate people about the choices they make and the impact of those choices. That is not the so-called nanny state; it is about people being given the information to make an informed and educated choice for themselves and the benefit of their health. Another key element is confidence. People need information, but they also need to be confident to take a decision on that basis and to know where to go if they are not sure. I will turn to community pharmacies in a moment.

There are two other broad points to highlight—mental and emotional health—which the hon. Member for Bootle (Peter Dowd) quite rightly highlighted. I hope that all of us in this place agree, and that it is understood more broadly in society, that we cannot look at physical health in isolation. All elements interact with and impact on each other. We need to be fully cognisant of that and of the broader determinants of health and health inequalities, be they social, economic or health factors. There are a whole range of impacts on individuals and their overall health.

We need to ensure that people have access not only to information, but to the technology and kit to be able to manage their condition. During the pandemic, virtual wards have become more prevalent. For example, there are pieces of kit that monitor oxygen levels in blood and report back to the GP to give an early indication. That is just one example of how technology can assist, and it expanded rapidly of necessity.

I will turn to the recommendations in the report, speak a little about community pharmacies, which have quite rightly been highlighted, and then turn to the request of the right hon. Member for Knowsley for a meeting—always an easy point to respond to when one is not the Minister responsible. It is always nice to be able to commit other colleagues to meetings, but I will also address the issues in my own right.

I hear what the right hon. Member for Knowsley says about the need for a specific strategy, but I would sound a slight note of caution. It is often the case that the first call in a particular area of policy is, “We need a strategy around this”, and I am slightly cautious about having a multiplicity of strategies without bringing together a whole range of actions. That may be a point that the right hon. Gentleman wishes to raise with my hon. Friend the Member for Lewes, who I will commit to meeting him in a moment.

On that specific recommendation, self-care is an integral part of the NHS long-term plan, which we are looking at at the moment in the light of the experiences and impacts of covid, and the community pharmacy contractual framework—the five-year deal running to 2024. For that reason, I merely sound a note of caution about an additional national strategy, because over the past two and a half—almost three—years, what I have often seen in the Department of Health is a strategy for a particular issue or area of care that does not always interact with other elements of the system or take into account just how complex that landscape is. The right hon. Member for Knowsley is aware of that point from his many years in this House, but I merely sound a slight note of caution.

[Peter Dowd]

The Minister is making an important point. However, I am sure he also recognises that there are already lots of things out there in the care continuum he spoke about: the health literacy toolkit, the e-learning programme on health literacy from Health Education England, the health literacy support hub, guidance on physical health and mental wellbeing in schools, the community pharmacy contractual framework to which he referred, modules on self-care for minor ailments and successful self-care, and so on. Part of a strategy, if that is what we want to call it, is trying to bring all those things together. On top of that, does the Minister agree that in the plan, so to speak—the “Realising the Potential” document—there is a reference to how

“There should be a cultural shift among healthcare professionals, towards wellbeing and away from the biomedical model of care”?

It is about trying to fit those things together in a coherent strategy, if that is what we want to call it.

[Edward Argar]

The hon. Gentleman is seeking to find a way through some of these points in his typically dexterous way. Suggesting “a strategy, if that is what we want to call it”, leaves open the option for my hon. Friend the Member for Lewes to consider other ways in which the same thing might be achieved. I do not want to prejudge the conclusion that she will come to, but I will ensure that she receives a transcript of this debate.

[Sir George Howarth]

I hear what the Minister says. To be honest, I am not overly fussed about what we call it. My concern is that the Government—and, for that matter, the rest of us—are able to draw on the experience of patients, clinicians, and all those in the healthcare system to examine how we can do things better. If the Minister wants to call it something else, I am not here to have a row with him about that; I am here to try to make some progress.

[Edward Argar]

I am grateful to the right hon. Gentleman for that typically courteous intervention. A lot of what we are seeking to do in this area comes back to the refresh of the NHS long-term plan, which will have to happen in the context of what we have seen during the pandemic. The hon. Member for Bristol South highlighted the health inequalities White Paper, which will come forward in due course. There is a genuine opportunity to use that White Paper to draw a number of these elements together.

I am conscious that the right hon. Member for Knowsley had six other key recommendations, which I will address briefly. I will say a little bit about community pharmacy before I turn to meetings. He raised the issue of building on the successful community pharmacist consultation service, and exploring additional pathways to access that service through the implementation of self-care recommendation prescriptions to support GPs and other professionals to appropriately refer patients to self-care. Rather than taking the issue of community pharmacy separately, I will address it in response to this point, because that is probably the neatest way to do so.

I fully recognise the value of community pharmacy, and the hon. Member for Bristol South also rightly highlighted its importance. My first official engagement when I took on this job in 2019 was to attend, in lieu of the Pharmacy Minister at the time, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), the Pharmacy Business Awards ceremony, which recognised community pharmacies that had done amazing work in their communities, such as the one the hon. Member for Bristol South highlighted.

As constituency Members of Parliament, we all know the depth of expertise and local knowledge that our community pharmacies bring to the communities they serve, and we know just how well regarded they are by our constituents as friendly, accessible sources of advice. Constituents do not have to be there first thing in the morning, and they do not have to make an appointment. They can stroll in and talk to a pharmacist who can give them genuinely helpful advice, without having to wait. I put on record my gratitude, and I suspect that of all hon. Members, to community pharmacies.

We are increasing our potential to expand the Community Pharmacist Consultation Service to urgent treatment centres and A&E departments. It has already taken just shy of 184,000 referrals from GPs, which, as hon. Members have suggested, is of benefit to our general practitioners, who can better manage their workload, given that some people do not need to see a GP. We are promoting the uptake of that service and incentivising its use through the GP contractual arrangements. Negotiations with the PSNC on what community pharmacy will deliver in 2022-23 as part of the five-year deal are ongoing, and hon. Members would not expect me to prejudge those negotiations. As soon as they conclude, we will announce the arrangements so that Members can consider and scrutinise them as they see fit.

The right hon. Member for Knowsley talked about primary care networks. I know the value of primary care networks. My own GP in Leicestershire is actively involved in the PCN. We saw their potential to do amazing things during the pandemic when they supported our communities with the vaccination programme and in a whole range of ways. He is right to highlight their potential to consider ways to improve self-care in their local populations as part of their network development. I hope that the soon-to-be-statutorily-constituted ICSs and ICBs will also take that very seriously, obviously subject to the other place and their deliberations later this evening.

I know from my own GP, who I regularly speak to, that many local health systems are proactively exploring upstream prevention initiatives across the health and care system and looking for further partnership opportunities to support people to improve their overall health and care outcomes. Clinical commissioning groups—soon to be ICSs—and NHSEI regionally also have the option to commission a local minor ailments service in addition to CPCSs. I hope they will explore those options as they go forward—particularly ICSs.

The fourth recommendation was that NHSEI should enable community pharmacists to refer people directly to other healthcare professionals where self-care is not appropriate, enhancing the role of pharmacists as a first port of call for healthcare advice. I entirely agree with that. There is an educational point as well in making people aware that they can go to their pharmacists. Equally, all community pharmacists are required under the terms of service to signpost people to other health and social care providers and support organisations as appropriate. There is, I suspect, more we can do in that space, but I think we have an extraordinary resource there at our disposal. NHSEI is accelerating efforts to enable community pharmacists to populate medical records and give them full integration into operability of IT systems as part of LHCR partnerships and national support for data sharing.

Data and the sharing of data in this space is, as all hon. Members know, a vexed and complicated subject, but when got right, it holds incredible potential for improving health outcomes and care. NHSX is leading the Government’s plans that will see the development of interoperable NHS IT systems that integrate health and care records, while of course considering issues that the hon. Member for Bristol South brought up in Committee when we were discussing similar matters—issues such as patient consent and data security.

We are very clear in our view that community pharmacy must play an enhanced role in the healthcare of our country, and it is our responsibility and NHS England’s responsibility to help support that. The right hon. Member for Knowsley made two final recommendations about meetings. The Government should promote a system-wide approach to improving health literacy, including working with royal colleges to include self-care modules in healthcare professionals’ training curricula and continuous professional development. I touched on that point in my response to his intervention. I have had many helpful and positive meetings with the royal colleges. I seek to meet them regularly—perhaps not as regularly as I would like, given the pressure of business in this place at times—because they have a depth of knowledge that is incomparable and incredibly useful.

Public Health England, when it was around, undertook a programme of work to improve health literacy across the country, and the Office for Health Improvement and Disparities will continue to work on that issue. The pharmacy integration programme will deliver a further almost £16 million-worth of post-registration training. That investment will equip pharmacy teams across primary care so that they are better prepared to support wider integrated healthcare delivery and expand their role in providing clinical care to patients. A pharmacist independent prescriber can provide autonomously for any condition within their clinical competence, with the exception of certain controlled drugs, particularly for the treatment of addiction. To become an independent prescriber, pharmacists must complete additional qualifications, which last typically six months, before they can prescribe.

In 2021, the General Pharmaceutical Council introduced new professional standards for initial education and training to ensure that the next generation of pharmacists is equipped with essential clinical skills. A key theme running through all the contributions today is that, when a resource is used, there can still be an untapped element of it that can be better utilised to provide support, alongside education, self-care and all the things we can do as individuals, to provide confidence and professional expertise.

NHSX should evaluate the use of technologies that have been developed during the covid-19 pandemic, and develop them to cover a wider range of minor ailments to promote self-care and manage demand on the NHS. I alluded to one example that we are working on. The Department is working with NHS Digital and NHS England and Improvement to encourage innovation and enable new approaches and organisations to support services and collaborate effectively.

I hope that, as someone whose policy area this is not, I have addressed at least in outline some of the right hon. Gentleman’s key recommendations. He made specific requests about meetings. I am always wary about that, because I have discovered that when I have meetings with my right hon. Friend the Member for Maidenhead (Mrs May) and you, Sir Charles, I come out having agreed to something or changed the direction of a policy, after being persuaded by both of you. I know that the right hon. Member for Knowsley is equally persuasive. With that in mind, I am happy to ask the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes, to arrange to meet the right hon. Gentleman, my right hon. Friend the Member for Maidenhead and you, Sir Charles, to discuss this issue more broadly.

The right hon. Member for Knowsley also asked for a meeting with Diabetes UK and the relevant Minister. I will certainly pass that on to the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes. In the context of the elective recovery work and my work with the NHS more broadly, I have met a number of charities in the course of developing the elective recovery plan and since we published it. I am always happy to meet charities and other organisations that do so much not only to educate people and campaign on issues, but sometimes to press us in particular directions. They always do so with good intentions and to support people. In that context, I have also met trade unions and other bodies, because I believe that a collaborative approach in this space is useful. I will pass the request on to the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes, but if the right hon. Member for Knowsley feels that this could also fall within the ambit of elective recovery or of my role as Minister sponsoring the NHS long-term plan, I will of course, framed in that way, also be happy to meet Diabetes UK—I have met many charities in recent months.

If that does not provide the right hon. Gentleman with immediate agreement on what he called on the Government to do, I hope it provides him with some reassurance of just how seriously we take this issue and the recognition of just how important self-care is for each of us as individuals, for our constituents, for our healthcare system and indeed for this country. And I am very grateful to him for bringing the matter before the House today.

[Sir Charles Walker (in the Chair)]

I call Sir George to sum up, for no more than two minutes.

Health and Care Bill

Edward Argar Excerpts

Consideration of Lords amendments
Monday 25th April 2022 Commons Chamber

[The Minister for Health (Edward Argar)]

I beg to move, That this House disagrees with Lords amendment 29B in lieu.

[Madam Deputy Speaker]

With this it will be convenient to consider the following:

Lords amendments 30B and 108B to words restored to the Bill, Government motion to disagree, and Government amendments (a) to (i) in lieu.

Lords amendment 48B in lieu, Government motion to disagree and Government amendment (a) in lieu.

Government motion to insist on disagreement with Lords amendment 80, insist on Commons amendments 80A to 80N in lieu, and disagree with Lords amendments 80P and 80Q.

[Edward Argar]

The Lords amendments before the House today relate to the NHS workforce, reconfigurations, modern slavery and the adult social care cap. In respect of amendments 30B and 108B on reconfigurations, I am grateful for the constructive debate on these issue across both Houses. This House has twice voted strongly in favour of the ability for the Secretary of State to call in reconfiguration proposals when needed, and it remains a key principle that decisions on how services are delivered should be subject to ministerial oversight. However, my right hon. Friend the Secretary of State and I have listened carefully to the debates throughout the Bill’s passage, and as a result we have proposed a series of amendments to minimise bureaucracy and ensure transparency.

The first set of changes would mean that the NHS had to notify the Secretary of State only about those reconfiguration proposals that were deemed notifiable, which we will define through regulations. We intend to align that definition with the existing duty on NHS commissioners to consult local authorities where there is a substantial development of variation in the health service. We also propose to remove the requirement for commissioners and providers to inform Ministers of

“circumstances that are likely to result in the need for the reconfiguration of NHS services”.

Taken together, these changes will mean that the NHS will need to notify the Secretary of State only about proposals that are substantive and of great importance to people.

Secondly, we will give local authorities, NHS commissioners and anyone else the Secretary of State considers appropriate a right to make representations to the Secretary of State when he has called in a proposal for reconsideration. We expect this to include any relevant provider. The Secretary of State will be required to publish a summary of the representations he receives, and we will set out in statutory guidance further detail on how local bodies, including providers, will be engaged.

Thirdly, transparency is vital to ensure that these powers are always used by Ministers in the clear interest of the people we all serve. We will therefore require the Secretary of State to provide the reasons for his decisions and directions when he makes them. Finally, we have heard throughout these debates that it is vital that decisions are made expeditiously and expediently in order to give certainty to local bodies so that reconfigurations can be made quickly to improve the quality of services received by patients. We are therefore introducing a requirement that, once a reconfiguration proposal has been called in, the Secretary of State must make any decisions within six months. We believe that this set of changes addresses the key concerns raised in this House and the other place, and I commend it to the House.

I turn to Lords amendment 48B, and the Government’s amendment in lieu, on modern slavery. We share the strength of feeling expressed in both Houses on ensuring that the NHS is in no way inadvertently linked with modern slavery and human trafficking through its supply chain. That is why the Government brought forward an amendment in the first round of ping-pong to create a duty on the Secretary of State to undertake a thorough review of NHS supply chains. I am pleased to announce today that we are going further. The Government’s amendment in lieu of Lords amendment 48B will require the Secretary of State to make regulations with a view to eradicating the use by the NHS in England of goods or services tainted by slavery or human trafficking. The regulations can set out steps the NHS should be taking to assess the level of risk associated with individual suppliers, and the basis on which the NHS should exclude them from a tendering process.

I particularly commend my right hon. Friend the Member for Chingford and Woodford Green (Sir Iain Duncan Smith) for his consistent and vocal campaigning on this issue. I am delighted that he has confirmed his support for the amendment in lieu. I look forward to working further with him and his supporters to bring these measures forward.

[Ms Nusrat Ghani (Wealden) (Con)]

I congratulate the Minister and the Department on taking this extraordinary step. The public may believe that we already do not use slave-made goods, but unfortunately we do. It is remarkable that the Department has taken this step, and it is incredibly important that we look at Xinjiang in particular, where Sir Geoffrey Nice QC determined there has been a genocide, as there was in Bosnia. The sanctioned MPs and all our colleagues in the inter-parliamentary alliance on China will work with the Department to ensure we have no Uyghur slave-made products in our NHS.

[Edward Argar]

I paid tribute to my right hon. Friend the Member for Chingford and Woodford Green, but my hon. Friend the Member for Wealden (Ms Ghani) has also taken a keen interest in this issue. The Secretary of State and I will continue to work closely with others across Government to ensure that our measures to eradicate modern slavery in NHS supply chains are effective and targeted, and reflect best practice.

On Lords amendment 29B, the Government are committed to improving workforce planning and are already taking the steps needed to ensure that we have record numbers of staff working in the NHS. In July 2021, the Department commissioned Health Education England to work with partners on reviewing the long-term strategic trends for the health and regulated social care workforce over the next 15 years. We anticipate the publication of that work in the coming weeks.

[Jim Shannon (Strangford) (DUP)]

Will the Minister give way?

[Edward Argar]

Very briefly, as I am conscious that we have limited time.

[Jim Shannon]

If the right hon. Member for South West Surrey (Jeremy Hunt) were to pursue the matter, my party and I would be minded to support him. Although I understand from the figures in the press today that there are significant numbers of new nurses coming into the NHS, there is still a large shortfall. Will the Minister confirm for Hansard in the Chamber today that every step is being taken to recruit the nurses needed to address the issue of workforce safety?

[Edward Argar]

The hon. Gentleman is right to highlight the work we are already doing, which I will address in a moment, and the number of nurses we have recruited. I believe we have now recruited 29,000 or so en route to our target of 50,000 more nurses by the end of this Parliament.

[Sir Robert Neill (Bromley and Chislehurst) (Con)]

Will my hon. Friend give way?

[Edward Argar]

I will make a little progress, if I may—a few more paragraphs—as I am very conscious of allowing time for Back-Bench colleagues to speak.

Building on this work, we recently commissioned NHS England to develop a workforce strategy. We will set out the key conclusions of that work in due course. In addition, we have committed ourselves to merging Health Education England with NHS England to bring together responsibility for service, financial and workforce planning in one organisation. We will continue to grow and invest in the workforce. There are record numbers of staff, including nurses, working in the NHS.

[Sir Robert Neill]

I am grateful to the Minister for giving way. He will know of my interest as chair of the all-party parliamentary group on stroke, and he will be aware of the particular concern of the Stroke Association and others about the number of qualified therapists to provide the therapy people need after a stroke. Will he commit himself to that being part of the workforce strategy and to moving swiftly? This is already a pressing problem for stroke survivors who are not getting the care they need.

[Edward Argar]

I reassure my hon. Friend that my right hon. Friend the Secretary of State has made it clear that he wishes the whole health and care workforce landscape to be considered by Health Education England.

The growth in our workforce comes on the back of our record investment in the NHS, which is helping to deliver our manifesto commitments, as I said to the hon. Member for Strangford (Jim Shannon), including our commitment to 50,000 more nurses by the end of the Parliament. The spending review settlement will also underpin funding for the biggest ever intake of undergraduate medical students and nurses.

Although I might not be able to say anything sufficient to fully convince my right hon. Friend the Member for South West Surrey (Jeremy Hunt), I put on record my gratitude to him not only for the insight, expertise and knowledge he has brought to our debates on this issue but for the typical courtesy he has displayed throughout our interactions and conversations. I do not know what he will say in a moment, but I have tried to pre-empt him. I hope that he may be tempted to stick with it.

I hope that the House will recognise that the Government are already doing substantial work to improve workforce planning, and that placing a requirement such as Lords amendment 29B on the statute book is therefore unnecessary.

[Kim Leadbeater (Batley and Spen) (Lab)]

Will the Minister give way?

[Edward Argar]

Very briefly, but I am sensitive to Madam Deputy Speaker’s instruction to be brief.

[Kim Leadbeater]

I thank the Minister for giving way. More than 100 organisations, including the Royal College of General Practitioners and the British Medical Association, have expressed their support for Lords amendment 29B. Does he agree that the only way to ensure that we recruit and retain the talented staff that our NHS and social care sector desperately need is through a long-term workforce plan in consultation with the experts in the field, such as health and care employers, unions and integrated care boards?

[Edward Argar]

That is exactly what we are doing through the work commissioned by my right hon. Friend the Secretary of State, which is why Lords amendment 29B is unnecessary.

[Steve Brine (Winchester) (Con)]

Will the Minister give way?

[Edward Argar]

I fear that I cannot, but my hon. Friend may catch me during my winding-up speech. I want to make progress, as about 10 Back-Bench colleagues wish to speak.

Finally, on the adult social care cap, the Government have announced our plan for a sustainable social care system. It is fair, affordable and designed to end the pain of unpredictable care costs by capping the amount anyone needs to pay at £86,000. Without clause 140 there would be a fundamental unfairness: two people living in different parts of the country, contributing the same amount, would progress towards the cap at different rates based on differences in the amount their local authority is paying. We are committed to levelling up and must ensure that people in different parts of the country are benefiting to the same extent, and our provisions support this. Amendments 80A to 80N also make crucial changes to support the operation of charging reform, as these changes were lost by the removal of clause 140 in the other place.

Lords amendments 80P and 80Q insert a regulation-making power to amend how

“costs accrued in meeting eligible needs”

is determined in section 15 of the Care Act 2014. However, if regulations were made using this power, they would result in anyone entering the care system under the age of 40 receiving free personal care up to that age. As local authority contributions would count towards the cap under these changes, a 35-year-old with average care costs would reach the cap and not have to pay anything towards the cost of their care, yet a person who enters care the day after their 40th birthday would need to contribute towards the £86,000 cap over their lifetime. We believe this is unfair. Our plan already includes a more generous means test that means more people will be eligible for state support towards the cost of care earlier, enabling them to keep more of their income.

The changes introduced in the other place also threaten the affordability of our reforms. Lords amendments 80, 80P and 80Q would clearly affect financial arrangements to be made by this House and, as such, have financial privilege. These new Lords amendments would cost the taxpayer more than £1 billion a year by 2027-28. Ultimately, this would mean we need to make the same level of savings elsewhere, making the system less generous for other users. I hope I have been able to provide some reassurance that we believe our approach is still the right one, and I ask the House to disagree with the other place’s amendments.

Finally, I put on record my gratitude to my hon. Friend the Member for Aberconwy (Robin Millar) and the noble Baroness Morgan of Cotes for their constructive and positive engagement during the Bill’s passage on ways to strengthen co-operation between the UK Government, the UK Statistics Authority, the Office for National Statistics and the devolved Administrations, and for their passion for strengthening the Union. I am pleased we are taking forward that work, albeit outside this Bill. I am stimulated by their important work.

We have sought throughout the passage of the Bill to be pragmatic and to listen to this House and the other place in either accepting their amendments or addressing them in lieu. I hope the House recognises that this approach continues to characterise our work, save where we sadly cannot agree with the other place in respect of its amendments on both the workforce and social care caps.

[Several hon. Members rose—]

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[Matt Warman]

I agree that the Government need to continue to address that issue in the way I have described, through more extensive engagement to try to demonstrate some of what is happening.

That brings me to my second point—I will try to stick to the original time limit—which is that these issues are about trust. We need trust with the NHS workforce. As my right hon. Friend the Member for West Suffolk (Matt Hancock) said, with reconfiguration it is very often the case, as it is in my constituency, that even though the data says we will save lives by moving a service from Boston to Lincoln or vice versa, we need to engage with local communities, because right now they simply do not believe that a service that is further away may yet save lives. That does not ring true, and often the data is not yet there.

I simply appeal to my hon. Friend the Minister to deliver on what he said at the Dispatch Box about engaging with the profession, because that is essential to try to improve the morale that the pandemic has damaged so much. I also appeal to him to ensure that local NHS organisations engage with local people, because only that will win public support for the reconfiguration that is so essential for our NHS both locally and nationally.

[Edward Argar]

With the leave of the House, I would like to thank right hon. and hon. Members who have spoken in this debate. I am grateful to the shadow Minister, the hon. Member for Bristol South (Karin Smyth), and indeed to the hon. Member for Ellesmere Port and Neston (Justin Madders), with whom we spent many happy hours over many weeks in Bill Committee.

I also put on record my gratitude to the amazing Bill team in the Department, with whom it has been a pleasure and a privilege to work on this piece of legislation. They have done an amazing job.

I thank my right hon. Friend the Member for West Suffolk (Matt Hancock), under whose leadership we saw the genesis of this Bill, and whom it was a pleasure to work with and work for over a long period of time.

On reconfigurations, and on tackling modern slavery and supply chains, I hope and believe that these measures attract support across the House, and therefore will not reprise the case for them here.

In respect of workforce planning, I join my hon. Friend the Member for Boston and Skegness (Matt Warman) and many others who have spoken in highlighting our gratitude to the NHS workforce and our recognition of the pressures they have faced, particularly over the past two to two and a half years, but also more broadly. That is why we have not only put in place the measures I outlined to deliver an assessment through Health Education England of the needs of the workforce and the framework for growing it, but rather than waiting for that, already put in place measures to continue to significantly increase the workforce.

[Steve Brine]

Will the Minister give way?

[Edward Argar]

Yes—it is the only intervention I will take, but I promised my hon. Friend.

[Steve Brine]

When I visit the elective orthopaedics team at Royal Hampshire County Hospital in Winchester later this week, I suspect that they will not tell me that the workforce is not one of the things on their worry list, so it is regrettable that the Government cannot accept amendment 29B. They are obviously going to get their way and win the vote, but will the Minister and his team reflect on the argument that has been had between the two Houses over the past year and, in that spirit, take this issue forward? It is not going away, I need to have an answer for the team on Friday, and what I am hearing right now is not going to satisfy them.

[Edward Argar]

I hope I can reassure my hon. Friend that I always reflect carefully not just on what he says and what my right hon. Friend the Member for South West Surrey (Jeremy Hunt) says, but on what the other place, and other hon. and right hon. Members on either side of this House, say.

I hope I have provided the majority of colleagues with sufficient reassurance about the steps the Government are already taking and our commitment to ensuring that we have the right number of people working in the NHS, coupled with the increases in staffing that we have already delivered and continue to deliver. I hope that the House will again agree that the substantial work already being undertaken by the Government to improve workforce planning is leading to the improvements we all seek, and I therefore urge hon. Members to reject their lordships’ amendment.

We also ask that amendments 80, 80P and 80Q are rejected and amendments 80A to 80N are accepted in lieu. The cap on care costs clause is key to this Government ending unpredictable care costs for everyone by introducing a universal £86,000 cap. That must stand part of the Bill, alongside the necessary further amendments 80A to 80N, and we encourage hon. Members to back us on this.

This Bill is an important step forward in evolving our health and care system to meet future needs, and it comes from a Government who are clear in both their record and their future plans in their support for our NHS. I hope that the other place will heed the large majorities with which this House has already sent these measures back to it, and I hope that we will do so again this evening. We always listen to the other place, but we believe that this House has, on multiple occasions and hopefully again this evening, expressed a clear view of our position on these matters.

Question put, That this House disagrees with Lords amendment 29B in lieu.

Oral Answers to Questions

Edward Argar Excerpts

Tuesday 19th April 2022 Commons Chamber

[Dr Alan Whitehead (Southampton, Test) (Lab)]

6. What steps he is taking to reduce NHS waiting lists in Southampton.

[The Minister for Health (Edward Argar)]

Reducing waiting lists and waiting times, exacerbated of course by the impact of the pandemic, is a key priority for this Government. Southampton, like the rest of the country, will benefit from the detailed actions set out in the elective recovery plan published by my right hon. Friend the Secretary of State a few months ago. In addition, as part of Solent Acute Alliance hospital upgrade programme, University Hospital Southampton NHS Foundation Trust has received £12.1 million to increase capacity at Southampton General Hospital.

[Dr Whitehead]

The hospital trust in Southampton, which is an excellent provider, is desperate to get back to elective surgery and non-life-threatening procedures, but finds that it cannot because it cannot integrate covid treatment into general ward activities, and has a continuing high level of staff sickness, which means that procedures are often undertaken very inefficiently in terms of resources. What assistance can the Minister provide for the trust to enable it to get on the front foot as regards elective procedures and non-life-threatening treatments in the near future?

[Edward Argar]

The hon. Gentleman rightly pays tribute to the staff at his hospital trust, and I join him in doing so. The number of those in his area waiting for an elective procedure or routine operation has reduced slightly. There is more to do, but the trust is making inroads, as he says, and I know that it wants to do more. As we set out in the elective recovery plan, some innovations, such as surgical hubs, allow a greater separation between covid areas, or areas where covid may be present, and elective activity is a key part of that. If it is helpful, I am always happy to meet him to discuss the specifics of his local hospital.

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[Kirsty Blackman (Aberdeen North) (SNP)]

11. What recent progress his Department has made on NHS (a) short-term and (b) long-term workforce planning.

[The Minister for Health (Edward Argar)]

The workforce are the heart of our NHS, and I join the Minister for Care and Mental Health, my hon. Friend the Member for Chichester (Gillian Keegan), and Opposition Members in paying tribute and putting on record our thanks to those who work in the NHS. In the short term, the NHS has well-established processes to ensure that the health service has the right number of staff with the right skills, and that is alongside our investment in workforce expansion, including delivering 50,000 more nurses over the course of this Parliament. For the longer term, we have commissioned Health Education England to set out the key drivers of workforce supply and demand. It is due to report this spring. Building on that, my right hon. Friend the Secretary of State has commissioned NHS England to develop a long-term workforce framework. We will share the conclusions in due course.

[Kirsty Blackman]

The anti-immigration, “hostile environment” rhetoric and actions of this Government are having a significant impact on our NHS workforce, both by not encouraging people to come here to work in our NHS and by discouraging current staff from staying here. The Health and Social Care Committee recommended the introduction of a national policy framework on migration to support national and local workforce planning. When will the Government implement that recommendation?

[Edward Argar]

I am very grateful to the hon. Lady for her question. We are clear, and always have been clear, about how much we value the huge contribution that overseas workers in our NHS make towards keeping our health service up and running, and delivering first-class care every day. There are three strands to our approach to building and increasing our workforce. The first is increasing the numbers of people training in this country and the second is increasing retention. The third focuses on the workforce who come from overseas and who are incredibly welcome here. Indeed, the number of people coming from countries outside the EU into our NHS workforce has increased.

[Anne Marie Morris (Newton Abbot) (Ind)]

The Minister will be aware that I have highlighted the challenge for rural areas in developing a workforce plan on a number of occasions. Indeed, the last report from the all-party parliamentary group on rural health and social care made 10 recommendations, including for how we might address workforce planning in rural areas. Will the Minister advise me of what steps he has taken to put in place any of those recommendations to improve the plight of those living in rural areas?

[Edward Argar]

I am grateful to my hon. Friend, who takes a close interest in this issue, which she and I have discussed on a number of occasions. She is right to highlight the challenges that some more remote or rural communities can face in securing the workforce they need to meet their communities’ needs. The HEE work and the subsequent workforce framework will be looking at that across the whole range of different geographies and the challenges they face.

[Mr Speaker]

I call the SNP spokesperson.

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

The Scottish Government have recently bought Carrick Glen, a private healthcare hospital, in order for it to become part of the national network of treatment centres, which once fully operational will have capacity for over 40,000 additional surgeries and procedures each year. In contrast, the UK Government have taken the path of further privatisation of the NHS, so what recent assessment has the Minister made of the impact on the workforce of further privatisation of NHS England?

[Edward Argar]

I am grateful to the hon. Gentleman, and had we been going further down the route of privatisation, his question might have had a little more resonance. What we are doing in the NHS in England is investing in our workforce and investing in our national health service, while of course working closely with the independent sector to maximise the use of its capacity in parallel to make sure we bring down waiting lists and waiting times.

[Mr Laurence Robertson (Tewkesbury) (Con)]

T1. If he will make a statement on his departmental responsibilities.

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[Mr Peter Bone (Wellingborough) (Con)]

T6. In 2019 Kettering General Hospital, which serves my constituency, was promised £46 million for a major upgrade. Three years later the hospital still has not got the money. Secretary of State, will you go out and buy a very big pair of scissors, cut through the red tape and get it sorted?

[The Minister for Health (Edward Argar)]

No one, with the possible exception of my hon. Friend the Member for Kettering (Mr Hollobone), is more passionate than my hon. Friend the Member for Wellingborough (Mr Bone) about seeing improvements delivered in their local hospital, and I had the pleasure of visiting. As my hon. Friend will know, the £46 million was allocated originally for an urgent treatment centre; the hospital asked that that be changed and it folded in with the overall programme. It has yet to submit a business case for the enabling works; when it does, I will make sure that it is expedited.

[Tony Lloyd (Rochdale) (Lab)]

T4. The gap in life expectancy between people living in the richest and poorest areas is once again growing. That affects my constituents directly. I have heard nothing to date that tells me what the Secretary of State is going to do to narrow the gap; Secretary of State, what will you do to protect my constituents?

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[Dehenna Davison (Bishop Auckland) (Con)]

Thank you, Mr Speaker. I will try not to make this one a waste. I was grateful to the Minister for meeting me to discuss my ongoing campaign to restore the A&E to Bishop Auckland Hospital. Many of my constituents face a long drive to get to Darlington or Durham, and given that swift treatment can be a significant factor in outcomes for conditions such as strokes and heart attacks, does he agree that having A&E services spread geographically rather than just in strong population centres is an essential part of keeping our community safe?

[Edward Argar]

I did indeed have a positive and constructive meeting with my hon. Friend. It is right that we have access geographically spread to A&E services, but the decisions are rightly taken by clinical commissioners on the basis of clinical evidence. I know that she will continue fighting the corner for the reopening of her local A&E with tenacity and passion.

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

T8. The 10-year cancer plan that the Secretary of State has announced is a key opportunity to ensure that future services are designed with the patient at their core, especially for those living with cancer. What steps is his Department taking to engage with under-represented groups in the development of the 10-year cancer plan, and will he agree to meet with Macmillan Cancer Support to discuss how it can provide support in this key area?

Health and Social Care: 2022-23 Mandate for NHS England

Edward Argar Excerpts

Thursday 31st March 2022 Written Statements

[The Minister for Health (Edward Argar)]

As we are learning to live with covid, we must now return our focus to delivering the Government’s important strategic goals for health and care, including—subject to the agreement of Parliament—by taking forward the further reforms set out in the Health and Care Bill, which is nearing its final stages.

We can define our goals in terms of four key priorities. First, we must prioritise prevention, supporting people to live healthier lives with reduced risk of future health problems. This is crucial if we are to ensure that health and care services can focus resources on those who most need them. It is a central theme of the Government’s command paper “Build Back Better: Our Plan for Health and Social Care” and also supports our action plan on levelling up the United Kingdom.

Secondly, we must create more personalisation—empowering people by putting them in control of their own care. Thirdly we must prioritise performance—driving up the quality of care by working smarter. And in achieving our goals, we must support our people, without whom health and care services could not provide high quality and safe care to all who need it.

I am today laying before Parliament the Government’s 2022-23 mandate for NHS England. This sets out the action that the Government expect the NHS to take in the year ahead in support of these four priorities. There is a firm focus on recovering important NHS-led services that have been impacted by the pandemic. Beyond that, there will be further progress on the NHS long term plan, which will be updated in summer 2022 to ensure it remains aligned to the Government’s post-pandemic priorities. It then paves the way for more resilient and integrated health and care services in future, with excellent leadership, a culture of transparency and openness, and a strong commitment to support and develop the NHS workforce. Key work remains on covid-19. High rates of infection will still need to be managed as we shift from pandemic to endemic.

The revenue and capital resource limits for NHS England in 2022-23 set out in the mandate reflect the updated NHS financial settlement and also take account of the additional support provided through the 2021 spending review to fund the biggest catch-up programme in NHS history.

Also as required by the Act, I am today laying a revised 2021-22 mandate. This revision is to update NHS England’s capital and revenue resource limits for 2021-22 in light of in-year funding decisions.

[HCWS764]