Women’s Health Strategy for England

Emma Hardy Excerpts

Wednesday 20th July 2022 Commons Chamber

[Steve Barclay]

Through highlighting the tragic case of Nicola, the hon. Lady demonstrates very effectively why research in this area is so important and the fact that it has been insufficient in the past. The amount of funding is, to a large extent, shaped by the research proposals that come forward. A key part of the strategy is the clear signal that we are sending to the research community that we are encouraging those willing to do research in the areas that have not been focused on in the past so that funding can be prioritised to them.

[Emma Hardy (Kingston upon Hull West and Hessle) (Lab)]

As joint chair of the all-party parliamentary group on endometriosis, with the hon. Member for Livingston (Hannah Bardell), and as joint chair of the APPG on surgical mesh, with the right hon. Member for Elmet and Rothwell (Alec Shelbrooke), I welcome this strategy, but I want to raise two issues that we would be really keen for the Secretary of State to look at.

First, we would like to see all the recommendations of the Cumberlege review implemented, including redress for the people impacted by vaginal mesh. Secondly, it was good to hear him talk about recognising how women’s health affects women in the workplace, but the charity Endometriosis UK is promoting making workplaces endometriosis-friendly by recognising that women who have endometriosis may have shorter periods of time off more regularly, which, in terms of HR policy, is frowned on and looked on badly, resulting in some women losing their jobs through no fault of their own.

[Steve Barclay]

I know from my own involvement in the mesh campaign just how central the hon. Lady’s role was in it, and I pay tribute the work that she has done on that and a number of other campaigns over recent years. In respect of mesh, she will be aware that an annual review is published. On the workplace issue, a key thing that comes out of the report is the significance of the time off work that many women are experiencing, with the difficulty, quite often, in having these conversations with employers. It is very welcome that the civil service has taken a lead, as has the NHS, in certain aspects of that, but there will clearly be more to do, and the point she raises will be part of that wider conversation.

Gynaecological Services: Waiting Lists

Emma Hardy Excerpts

Wednesday 6th July 2022 Westminster Hall

[Emma Hardy (Kingston upon Hull West and Hessle) (Lab)]

I beg to move,

That this House has considered waiting lists for gynaecological services.

It is a pleasure to serve under your chairship, Mr Robertson. I start by thanking the many women who have contacted me about this issue, whether in my role as co-chair of the all-party parliamentary group on endometriosis or as chair of the all-party parliamentary group on surgical mesh. The APPG on women’s health has been in contact, and we have also received testimony through the House services from so many women raising their concerns about gynaecological treatment. I thank the Minister for still being in his place to respond to me at the end of today’s debate—it is appreciated.

The debate will focus on the length of waiting lists for gynaecological treatment, and the amount of time people spend on those lists. It has been prompted by the findings of the Royal College of Obstetricians and Gynaecologists report, “Left for too long: understanding the scale and impact of gynaecology waiting lists”. However, I remind Members that when we talk about statistics, it is easy to forget the real people who lie behind them—those individual lives—who do not exist in isolation. When people’s health is impacted, it impacts their families, their friends, their communities and their work. As we will hear, the length of waiting lists is prolonging the suffering of tens of thousands of women, and that suffering has physical, economic and emotional costs.

Gynaecological waiting lists across the UK have now reached a combined figure of more than 610,000—a 69% increase on pre-pandemic levels. An observer might say, “Well, of course. There’s been covid, there’s been a pandemic—what do you expect?” The total pausing of elective care at the start of the covid pandemic has, of course, had an impact. That observer might add, “Our NHS has been chronically underfunded for the past 12 years. There was a steady increase in waiting lists even before the pandemic, and the 18-week waiting time standard for planned elective care has not been met since 2016, so why are you just having a debate on gynaecological treatments? Why not have a debate on waiting lists in general?”

The answer is that RCOG’s analysis shows that gynaecology waiting lists in England have seen the largest percentage growth of all elective specialities, and the largest percentage increase in patients waiting over 18 weeks from referral to treatment. The number of women waiting over a year for care has increased from just 66 in February 2020 to nearly 29,000 two years later, at the end of April 2022—the highest number ever recorded. Concerted efforts across the NHS to focus on longer waiters—that is, patients who have been waiting over a year—have resulted in a drop across all specialities combined from the peak in 2021. However, for gynaecology procedures, the numbers are going in the opposite direction: while we are seeing a reduction in waiting over a year for other treatments, we are not seeing the same for gynaecological treatment.

In addition, we have the prospect of even more cases in the pipeline. Analysis by Lane Clark and Peacock’s health analytics team on behalf of RCOG shows that between March 2020 and November 2021, more than 400,000 women who were expected to join the waiting list based on referrals in previous years did not do so. Therefore, those people are missing from the data I have just mentioned. The number of missing referrals tended to be higher in areas where the waiting lists were already larger. Perhaps that means that women in areas with longer waiting lists are, coincidentally, not going to their GPs, or perhaps it is because they are not able to see their GPs, or their GPs are not responding to those longer waiting lists. We are not quite sure what is going on, but what we do know is that lots of women are not getting the treatment they need.

As I mentioned at the beginning of my speech, I am co-chair of the all-party parliamentary group on endometriosis and chair of the APPG on surgical mesh. Both come under the heading of gynaecological conditions, and both are being impacted by increased waiting times. Endometriosis is the second most common gynaecological condition. It impacts around 1.5 million women—one in 10—in the UK and can affect all women and girls of childbearing age. It is caused by cells that usually form part of the womb lining growing elsewhere in the body, but they still react to the monthly cycle of hormones that regulate a woman’s period. That can create extreme pain and fatigue, because the cells are growing in completely the wrong place.

Part of the APPG’s role is to raise awareness of the condition and get people to talk about it. One in 10 women have it, but I am not sure that one in 10 people in the country know anything about the condition or the fact that it even exists. Many of the sufferers are facing increased waiting time for the procedures I am highlighting today. Even pre-pandemic, people were waiting on average seven and a half years for a diagnosis.

I want to quickly mention surgical mesh, because tomorrow is the second anniversary of the report “First Do No Harm”, which was commissioned by the then Secretary of State for Health and Social Care, the right hon. Member for South West Surrey (Jeremy Hunt), and undertaken by Baroness Cumberlege, to look at the condition. Surgical mesh was used in the surgical repair of pelvic organ prolapse and to manage stress urinary incontinence. It was promised to be simple and quick, but for some it has resulted in severe complications, including chronic pain, infections, reduced mobility, sexual difficulties and autoimmune issues. Lives have been shattered and the issue of mesh injury, along with the scandal surrounding hormone pregnancy, resulted in the “First Do No Harm” report.

Women have been left disabled by the mesh treatments. One of the key recommendations of the report, which, to the shame of this Government, are still not fully implemented two years on, was the establishment of specialist mesh treatment centres. Some of these have opened, but they are beset with problems over access, waiting times and cancellations. Through my involvement with these centres, I have heard at first hand the testimony of so many women whose lives have been blighted by what are currently referred to in the NHS as “benign” conditions. Yet, as we have heard, these conditions can be so painful and debilitating that they impact on every aspect of family, social and work life.

One lady, Kelly, said:

“The impact the long waiting lists have on my life is horrendous. I have endometriosis and adenomyosis and the daily pain these conditions cause me is terrible. Some days simple tasks like walking are unbearable. I have been on the waiting list for surgery for my endometriosis since 2019, and the length of time I am currently having to wait and the symptoms I am having to deal with daily are massively affecting every aspect of my life and having a profound effect on my mental health. I have been told that despite going on the waiting list for surgery in 2019 I will likely be waiting 4 years to get my surgery. Every day is a struggle.”

These conditions are not benign and cannot wait.

“Benign” suggests that there is no harm in delaying treatment, but that is emphatically not the case. For both endometriosis and mesh injury, longer waiting times can have a significant impact on progression. As time passes, options narrow, opportunities are lost and surgery becomes more lengthy and complex. Mental health deteriorates and depression, anxiety and suicidal thoughts become more common.

This is borne out by the most recent data from RCOG. Nearly three quarters of the members surveyed felt that they were seeing women with more complex care and treatment needs as a result of waiting longer for care, resulting in worsening and often extremely debilitating symptoms. Four fifths of the women surveyed reported that their mental health had been negatively impacted while waiting for care. So why are the waiting lists for gynaecological treatments growing? Is it the lack of priority they have been given simply because they are considered benign and not a threat to life? Or is it because gynaecological treatment is the only elective treatment unique to women?

There is undeniably a problem with the health service’s attitudes, in some places, to women’s health, where it involves reported symptoms and the voice of the patients themselves. I stress that I continue to give my wholehearted to the medical profession and everything it does, but there seems to be a concern particularly around the treatment of women’s health conditions.

“First Do No Harm” contains a section headed, “‘No-one is listening’—The patient voice dismissed”. In this case, “patient” is synonymous with “woman”. Although the following passage from the report refers to “mesh complications”, it applies equally to any other gynaecological condition. The report, published two years ago tomorrow, says:

“Women, in reporting to us their extensive mesh complications, have spoken of excruciating chronic pain feeling like razors inside their body, damage to organs, the loss of mobility and sex life and depression and suicidal thoughts. Some clinicians’ reactions ranged from ‘it’s all in your head’ to ‘these are women’s issues’ or ‘it’s that time of life’ wherein anything and everything women suffer is perceived as a natural precursor to, part of, or a post-symptomatic phase of, the menopause. For the women concerned this was tantamount to a complete denial of their concerns and being written off by a system that was supposed to care.”

Amatullah said:

“My GP actually laughed at me when I initially expressed concern that my condition was worsening despite my family history. I had to be hospitalised with suspected appendicitis before I was taken seriously enough to have more testing to see if my fibroids had grown. They had doubled in one year.”

Joanna said:

“As a newly qualified junior doctor, who hopes to specialise in gynaecology, I can’t stress enough how important this debate is. For too long, women’s pain has been ignored or dismissed. The topic is considered taboo despite it being something that a significant percentage of women experience.”

Do such attitudes reflect the prioritisation of gynaecological procedures? The facts certainly point to its neglect in comparison with other procedures. In the RCOG report, both the women and the RCOG members surveyed describe the way in which gynaecological conditions were perceived and prioritised as one of the biggest barriers to reducing the length of the wait time.

I want to quickly mention the data that I was sent from the APPG on women’s health. This is from its “Informed Choice” report of 2017. The APPG’s survey of 2,600 women showed that 42% were not treated with dignity and respect; 62% were not satisfied with the information that they received about treatment options; and nearly 50% of women with fibroids and endometriosis were not told about the short or long-term complications from their treatment. That information is from 2017, so we cannot put all that down to the pandemic. I hate to say this, but there is a problem with people’s attitudes to women’s health when it involves reported symptoms and the voice of patients.

When the Government finally publish their women’s health strategy—something the Labour party has been calling for since 2019—they should include an investigation into possible gender bias in the prioritisation of gynaecological services, and an end to the use of the term “benign gynaecology” to describe gynaecological conditions such as endometriosis, fibroids and polycystic ovary syndrome. There needs to be a shift in the way gynaecology is prioritised as a speciality across the health service. I understand that the RCOG is keen to engage on that with the NHS in all four regions.

I have given a few examples, but there are so many more. I really was inundated with testimonies from women ahead of this debate. There were so many cases and examples of the terrible effects that a prolonged wait for treatment can have. The prioritisation of care as part of NHS recovery must look beyond clinical need and consider the wider impacts on patients waiting for care. There must be a significant re-think in the development of a prioritisation framework for recovery that considers the impact of ongoing symptoms on an individual’s physical and mental health, their quality of life, their fertility, and their ability to participate in work, family and social life.

The RCOG has offered to work with stakeholders across all surgical specialties and the NHS to look at what the framework could look like in practice. We have an unequal growth of gynaecological waiting lists compared with other specialities, and that must be addressed as a matter of urgency. We have seen that there is in all likelihood a huge reservoir of unreferred cases, which will only worsen an already unacceptable situation. The RCOG is seeking a national ringfenced budget for recovery and long-term sustainability of elective gynaecology, with national funding to support local solutions. We obviously need to focus that funding on areas with the longest waiting lists and where disparities are greatest.

The NHS in each nation should commit to tracking and publishing progress on reducing disparities in elective waiting lists. The Government must use the women’s health strategy to commit to mandating co-commissioning of sexual and reproductive healthcare, removing the barriers for services outside of hospitals to support women in their communities.

Finally, Conservative Governments have presided over more than a decade of underfunding in our NHS, and that must be addressed. RCOG members were very clear that staffing is the biggest barrier to reducing waiting lists in outpatient settings and in theatre, and to increasing the number of beds. In March, unfilled posts across health services in England rose to more than 110,000, including nearly 40,000 nurses and over 8,000 doctors. Yet nearly 800 medical undergraduates who applied to start training as junior doctors at the start of August this year have been told that there are no places for them—that is the highest number ever. And despite an increase in applications for nursing degrees this year, the number of applicants remains below that of 2016, which incidentally was the last time that a bursary was available to financially support student nurses before it was scrapped.

The answers to gynaecological waiting lists lie in front of us. However, without the necessary action from Government and the funding to increase staff numbers, there will be no sustainable solution to reducing them. Instead, the Government are content to let the NHS limp along, understaffed, overstretched and with record waiting lists and the personal suffering and wider damage to society that they bring.

--- Later in debate ---

[The Minister for Health (Edward Argar)]

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

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

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

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

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

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

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

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

[Emma Hardy]

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

[Edward Argar]

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

--- Later in debate ---

[Edward Argar]

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

[Emma Hardy]

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

--- Later in debate ---

[Emma Hardy]

I thank everyone who has taken part in the debate. In different circumstances this would have been a very full debate. I look forward to seeing the women’s health strategy as soon as possible. I feel I have been unable to give coverage to the number of women who have contacted me, but I say to them that I have read each and every one of their messages. The testimony that they give is incredibly moving, and clearly something needs to change.

Issues around women’s health appear to be disproport-ionately impacted, and that is not right. I am sure we will all raise this subject again and, in all sincerity, the Minister is always welcome to campaign with me on this issue from the Back Benches.

Question put and agreed to.

Resolved,

That this House has considered waiting lists for gynaecological services.

Access to GP Services and NHS Dentistry

Emma Hardy Excerpts

Tuesday 21st June 2022 Commons Chamber

[Sajid Javid]

I think that many people working across the NHS will be listening to the hon. Gentleman and realising that he has no idea about the pressures that covid has created for everyone working there, especially those on the frontline.

[Emma Hardy (Kingston upon Hull West and Hessle) (Lab)]

Excuse me for raising this issue, but I want to draw attention to the fact that there has been news released that the Secretary of State’s Government have declined to introduce mandatory reporting of complications resulting from mesh. In the context of problems with waiting lists, and wider issues, if we do not introduce a mandatory reporting scheme to identify problems with a medical product, more people will end up requiring medical intervention and medical treatment, so I urge the Government to look again at their declining to introduce mandatory reporting.

[Sajid Javid]

The hon. Lady raises an important issue. That is why the Government commissioned an independent report. We have responded to that report. We are still listening to what hon. Members such as herself and others are saying on this important issue, and then we will do a follow-up of the report within a year, so that will be later this year. I know that she will take an interest in that.

--- Later in debate ---

[David Johnston (Wantage) (Con)]

All the GP surgeries in my constituency have worked incredibly hard throughout this period. I saw some of that up close when I was volunteering with the vaccination effort in the weeks that I could. The entire period has been a complete whirlwind for them, and they went straight back into there being a huge demand for appointments. I commend them for what they did during covid and what they are doing now.

The job of an MP is to not just champion but challenge. As every other Member of the House has, I have heard complaints about the difficulty of getting GP appointments, which I need to raise with surgeries. Those complaints are about getting an appointment at all, getting a face-to-face appointment, getting through on the phone, or—more for dentists than GPs—being able to register.

We know that the covid pandemic is a huge part of that problem, because we asked the public to stay at home and protect the NHS, which they did almost to a fault. I remember Ministers at the Dispatch Box, as the pandemic went on, pleading with people to come forward if they thought they had something. Understandably, however, people did not want to burden their GP or hospital. They are now rightly coming forward, and they may have had hospital treatments delayed again because of the backlog, so they are going to their doctor instead.

Sometimes, my constituents are unhappy about not getting face-to-face appointments; they dislike eConsult and telephone appointments. I have used eConsult successfully, and I think it and telephone consultations have a place, but as a GP at one of my surgeries said, the risk with both of those is that GPs do not see the thing that the patient has not come in about. A patient may come in about their leg, and while they are there, the GP says, “Can I just have a look at the thing on your neck?”.

[Emma Hardy]

I completely agree with the hon. Gentleman’s point about GPs not being able to identify the issues that people have not come in for. Another thing that doctors can notice at face-to-face appointments is that someone is a victim of domestic abuse or violence.

[David Johnston]

I completely agree; the hon. Lady has made an important point. Sometimes, what people present with is not the biggest issue in their lives, and a skilled practitioner can uncover that.

As has been touched on, the issue is partly about telephone systems, bizarrely, as I will come on to, but it is also undoubtedly about a shortage of GPs. The Government have a grip on that: we have 1,500 more GPs now than in March 2019; 4,000 more trainees have taken up training places this year compared with 2014; and we have a health and social care levy which, as has been touched on, the Labour party opposes but which provides £12 billion a year to the health and care system, so there is more money to improve telephone systems and face-to-face appointments. Looking at the data this morning, we had 2 million more face-to-face appointments in April this year than in April last year, but we are still below pre-pandemic levels.

The complaints I get about dentistry are more about not being able to register anywhere. There is a particular issue with the promise that we make to pregnant women about being able to see a dentist, because even they cannot get registered. I met the Minister about that recently. The issue there is less about a shortage, as it is with GPs, and partly about the contract; there seems to be cross-party agreement that the 2006 Labour contract needs to be changed. I am also pleased that the Government will allow more internationally qualified dentists to support the dental system here.

There are two things that we need to get better at. One of them was touched on by my hon. Friend the Member for North East Bedfordshire (Richard Fuller). My constituency has also seen a huge growth in housing—we have two housing developments in Didcot alone, which will house 18,000 people—and the promised GP surgeries for these increased populations never arrive. As my hon. Friend said, we must get better at putting in the infrastructure first and at planning for the increased populations.

I shall finish on the second thing. Some Members may know that I worked in social mobility before I became an MP, running charities for disadvantaged young people. Unfortunately, the medical profession is the most socially exclusive profession in the country. Only 6% of doctors are from a working class background. A person is 24 times more likely to become a doctor if they have a parent who is a doctor. That is worse than politics, worse than the media, worse than the law, and worse than any other profession that we can think of. There are many reasons for that. It is about the allocation of work experience, how the recruitment process works, and the fact that 80% of applications to medical school come from 20% of schools. There is a whole range of things.

The young people with whom I worked were eligible for free school meals. A very high proportion were from ethnic minorities. Medicine was the profession that they most wanted to get into. It was the most popular profession. On the one hand, we have a shortage of GPs, and, on the other, we have this incredible talent pool that finds that it cannot get into the profession.

One thing the Government might consider, as well as how we get the infrastructure in first, is how we make what is a hugely popular profession more accessible for certain groups of young people with whom I used to work, because, at the moment, they simply do not get into it in the numbers that they should, and, if they did, they might help with this GP shortage.

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[Emma Hardy (Kingston upon Hull West and Hessle) (Lab)]

Before I turn to the main substance of my speech, I want to take advantage of the presence of the Under-Secretary of State for Health and Social Care, the hon. Member for Lewes (Maria Caulfield), who is sitting there waiting to sum up the debate, by raising a few points further to my earlier intervention on the Secretary of State. They concern the Medicines and Healthcare products Regulatory Agency and the mandatory logging of mesh complications, which was a recommendation in the Cumberlege review. It has been more than a year since the most recent review, so I think that the Secretary of State may have been a little confused when, in his response, he referred to what was happening a year later. We have just learnt that the MHRA will continue the yellow card system, and will not be introducing mandatory reporting. I am keen to hear the Minister’s response to that point.

As joint chair of the all-party parliamentary group on endometriosis, I am also keen to hear from the Minister when we will see the women’s health strategy. Although that is not specific to the debate, it does relate to GP services. I should also like to hear her response to the anecdotal news I have been hearing that more appointments for gynaecological procedures are being cancelled than appointments for any other operations, and that gynaecological elective procedures are the least likely to take place. Again, it seems that there is a real issue surrounding women’s health.

I hope that the Minister will be able to address those issues of the women’s health strategy, endometriosis and mandatory reporting, but I will now turn to the main substance of my speech on access to GP services. Hull has only 40 GPs per 100,000 patients, which is one of the lowest proportions in the area. I want to draw attention to what two of my constituents have said. One, a gentleman called Rob Grimmer, told me about the birth of his granddaughter Nova. That was wonderful news, but unfortunately the family were unable to contact a GP surgery or get through to 111 when they needed to, and eventually they had to take the baby to A&E for treatment. The good news is that the baby is fine, but I am sure that Members can imagine the trauma involved. I have been a new mum myself, and I know that going to A&E with a new baby must be terrifying and very upsetting. I should like to hear from the Minister why we are seeing so many mums and babies having to go to A&E to obtain support.

Another constituent, a gentleman called Steven Draper, said that he waited three weeks for his grandson to see a GP. His grandson is only eight years old. What I really want the Government to take on board in this debate is the impact on children, and particularly on children’s education. If a child is repeatedly not feeling well and is unable to gain access to the services that they need, they will miss more school. The Department for Education says that attendance is very important and that it wants children to be back at school—Ofsted and a member of the Social Mobility Commission have also stressed the importance of attendance—but that does not seem to be joined up with children’s problems in accessing dental treatment and GP appointments, which lead to their having time off school.

I remember that when I was a primary school teacher there was a “brush bus”—I am not sure whether anyone else encountered one of these—which visited the school so that children could learn about the importance of brushing their teeth. There were even giant teeth in the classroom, which the children loved, so that they could see which bits get missed out during brushing. The problem is not just cuts in dental services, but cuts in public health provision, prevention measures and education. Long before the pandemic, we saw public health information services go.

Having teeth removed when a child is very small has an impact on that child’s education, not just in terms of time off but in terms of speech and language, and it will therefore affect phonics. It has a knock-on effect. I must emphasise to the Minister that we need to get this right. We are failing children when it comes to dental treatment. Indeed, we are failing people from cradle to grave, because we are also failing those at the other end of the spectrum.

This is another issue of which the Government should have been fully aware. They should have understood that people were ageing before the pandemic and that older people’s requirements are different. A few decades ago, most people in care homes had false teeth, which actually made them easier to look after, especially if they were dementia patients. I raised in Parliament, three or four years ago, the specific issue of dental care for people in care homes, particularly those suffering from dementia, who can find the whole procedure very traumatic while not understanding what is happening to them. This problem has existed for a long time, since way before the pandemic. There should have been plans that recognised that people were ageing, and ageing with their teeth, and would therefore continue to require dental treatment.

We are reaping what the Government have sown in the net spending cut of 25% between 2010 and 2025. We are reaping what they sowed in the five years before the pandemic, when the number of practices providing NHS dentistry fell by more than 1,200. I have huge sympathy for dentists and GPs in my constituency, and I want to add my thanks for everything that they do.

I was contacted by a local dentist about how she had been feeling. It was quite an upsetting letter. She had been pregnant and on maternity leave for part of the pandemic, but while she was pregnant she was trying to do her job in the middle of it. She was obviously worrying about her own baby, and she told me that she was having to give up being an NHS dentist because it was just not working out.

In her letter to me, she says:

“The Government have only offered £50 million in time limited funding which amounts to £40 a week per dentist. After a decade of savage cuts, it is no more than a sticking plaster of no consequence to the wider issues. I am likely going to go private this year despite enjoying helping high-need patients due to the Government’s poor contract and lack of funding.”

With respect, it is a bit odd for the Minister to blame the Labour party for not changing the dental contract when the Conservatives have had 12 years to look into it. I hope the Minister will urgently address the issue before more dentists step away from practice. That dentist had 3,200 patients in her practice, which means 3,200 more people now looking for support and help.

Unlike my hon. Friend the Member for Lancaster and Fleetwood (Cat Smith), I have not had a gentleman present me with his teeth, but I have had some really upsetting cases. A lady, who was pregnant and unable to access any other free NHS dental entitlement, said to me:

“Being entitled to free NHS dental care when you’re pregnant clearly isn’t an option any more. I think the situation needs to be addressed as I am sure it is not just in my area in Hull.”

She is absolutely right. Why is it that pregnant women are given free dental treatment? It is because pregnancy is likely to have an impact on teeth, so the lack of access to free treatment is storing up problems in the long run. I have had countless emails from people telling me they have been struck off their dentist’s list due to not attending during a period of illness. Someone else told me that despite the swelling in her mouth causing immense pain, she had been dismissed as a patient and told that there was a six-to-12-month waiting list even if she was accepted again. Another who needs dental treatment and whose dentist had passed away told me:

“I complained to the ombudsman service. The ombudsman has today telephoned with the news that they are so overwhelmed with complaints that they are only allocating caseworkers to cases where death or serious injury has occurred. Even the ombudsman service cannot cope with the incompetence and failure that we have in the NHS dental service.”

Another gentleman wrote to me about how he broke his tooth in July 2021 and was still waiting in pain to have it removed in February 2022. The list of people who have contacted me to say they cannot find a dentist goes on and on. We are storing up more problems for the future. Someone else contacted me to say that their one-year old son—aged one, children are meant to have a dental check whether they have teeth or not—is unable to get a dental appointment. If we do not treat people when they are younger, we will create more problems in the future. Mismanagement of our NHS and our public finances, because of a lack of preparation and things not being thought through, means that everything costs more in the long run,

Our dental services are in crisis. We are facing a collapse that will take years to put right. Waiting lists, delays, cancellations and shortages are the real growth areas in Conservative backlog Britain. My constituents, along with those in the rest of the country, have had enough.

Oral Answers to Questions

Emma Hardy Excerpts

Tuesday 19th April 2022 Commons Chamber

[Maria Caulfield]

My hon. Friend is quite right in his question and is campaigning hard to increase dental activity in his constituency. One of the key pieces of work is being done through Health Education England, which set out a range of recommendations in its “Advancing Dental Care” review. That will do a number of things, such as increase the skill mix and scope of practitioners across dental teams, and we may well require legislation to bring some of that work forward. Health Education England is also introducing more flexible routes into dental training and doing some workforce modelling to identify the parts of the country with the biggest gaps in provision, so that we can establish centres of dental development in those areas. I will look at Ipswich in particular.

[Emma Hardy (Kingston upon Hull West and Hessle) (Lab)]

My constituent contacted me to tell me that when she broke her canine and went to contact her NHS dentist, she found she had been kicked off the list and was facing a bill of £4,000, which she simply does not have, to have the work done privately. Will the Minister speak to some of the dental practices about the possibility of relaxing their rules on kicking people off their dental lists, especially as covid has meant that patients might have had legitimate reasons for missing appointments?

[Maria Caulfield]

I am sorry to hear about the hon. Lady’s constituent’s experience. There is not actually a list system for dentists as there is for GPs, so patients can see any dentist when they have a dental issue. With that said, we have asked dental practices to update their availability for NHS patients on the website. This morning, I looked at the website to see what availability there was throughout the country and saw that many dentists still have not updated their availability, so I will ask officials—particularly in her constituency—to update the lists so that patients can access NHS dentistry more easily.

Oral Answers to Questions

Emma Hardy Excerpts

Tuesday 18th January 2022 Commons Chamber

[Sajid Javid]

I am very sorry to hear about what happened to my hon. Friend’s constituent. It cannot be right that people are unable to visit their loved ones while they are in hospital. It should not require the intervention of a Member of Parliament to do so. Allowing such visits should be an absolute priority in every trust, and I have recently raised this issue with the chief executive of the NHS. She has assured me that this message will be sent loud and clear to all NHS trusts.

[Emma Hardy (Kingston upon Hull West and Hessle) (Lab)]

Too many women with endometriosis are being forced to go to A&E or seek hospital admissions for their treatment. This is partly because they wait on average seven and a half years for a diagnosis. What can the Secretary of State do to improve the knowledge and awareness of endometriosis right across all aspects of the NHS?

[Sajid Javid]

The hon. Lady is absolutely right to raise the importance of endometriosis. She will know, I hope, that in the women’s health strategy there will be an important focus on it. Within that strategy, we have set out how we can work together to do much more.

Health and Care Bill

Emma Hardy Excerpts

Report stage
Tuesday 23rd November 2021 Commons Chamber

[Emma Hardy (Kingston upon Hull West and Hessle) (Lab)]

As part of the Minister’s workforce review, will he look at the Carr-Hill formula, which local GPs tell me incentivises GPs to go to areas with longer life expectancy—therefore, wealthier areas—at the expense of areas such as Hull? It feels like the funding mechanism for GPs is not fair.

[Edward Argar]

The Carr-Hill formula has been through many “almost reviews” over the years and has been looked at by different Governments. Various GP practices in my constituency—as I am sure is the case in the hon. Lady’s—understandably raise opinions about how the formula might be improved. The point does not necessarily goes to the entire heart of what we are discussing, but she has managed deftly to make it within scope, in the context of GPs and so forth.

Finally, the report in clause 34 will increase transparency and accountability of the workforce planning process. It is for those reasons that I encourage—perhaps unsuccessfully—my right hon. Friend the Member for South West Surrey and the shadow Minister, the hon. Member for Ellesmere Port and Neston, to consider not pressing their amendments to a Division.

--- Later in debate ---

[Justin Madders]

Like just about every profession and sector in the NHS, midwives are under tremendous pressure and are understaffed. We need a clear plan, and a plan that is delivered. Of course, having a plan is not the whole answer, which is why it is important that we hear regular reports back from the Secretary of State on progress. That is why we hope amendment 10 will be supported.

[Emma Hardy]

One reason I want to emphasise the importance of new clause 28 is that we are anticipating a greater demand for mental health services, and therefore a greater demand for mental health professionals working in the NHS. Only by having regular reviews will we be able to anticipate what that demand will be and prepare accordingly.

[Justin Madders]

My hon. Friend is correct; we could not have anticipated what has happened in the past 12 to 18 months, but we can see what it means moving forward. Regular reviews of demand are critical, and we know that training these highly qualified and skilled staff takes time, which is why a longer-term view and approach are required.

--- Later in debate ---

[Robin Millar]

I thank the hon. Gentleman for his question, which is a good and relevant one, and it speaks directly to the heart of what the Minister said in his opening comments. There is good collaboration and an emerging consensus on this, so I am optimistic that that will be the case. In fact, my concluding remark is to say that I will not press new clause 61 to a Division, but I will listen carefully to the Minister’s response.

[Emma Hardy]

I will be brief, speaking to new clause 32 in my name. It is an amendment based on the proposed Charlie’s law. I thank my dear friend and colleague, my hon. Friend the Member for Enfield, Southgate (Bambos Charalambous), who has been working on the issue with the Charlie Gard Foundation and the tireless campaigning of Charlie’s parents.

I will be as brief as I can be. In short, my new clause seeks to do five things: first, to require the Secretary of State to put in place measures to improve early access to mediation services in hospitals where conflict is in prospect; secondly, to provide for access to appropriate clinical ethics committees, so that both doctors and parents are supported in making difficult decisions by impartial ethical experts; thirdly, to provide the means necessary to obtain second medical opinions swiftly and to ensure that, when requested, parents receive access to their child’s full medical data, so that the second opinions are fully informed; fourthly, to provide access to legal aid to ensure that families are not forced to employ costly legal representation or to rely on outside interest groups to fund representation in court; and, finally, to create a new legal test of whether an alternative credible medical treatment would cause a child a disproportionate risk or significant harm in deciding whether a parent is able to seek that treatment for their child.

In essence, the provisions set out in the new clause would mitigate conflicts at the earliest stage, ensure that the voices and opinions of parents are listened to, save hundreds and thousands of pounds for parents, doctors and the NHS in protracted legal battles, and ensure that a critically ill child is given the best care and support available at a crucial time in that child’s life. No parent wants to spend time in court or in battle against the NHS when their child is critically ill. There must be a better way to resolve conflict. I hope that the Minister looks seriously at my new clause 32 and at ways to incorporate it into future legislation.

[Mrs Maria Miller (Basingstoke) (Con)]

I speak to new clause 50, tabled in my name and that of the right hon. Member for Kingston upon Hull North (Dame Diana Johnson).

We badly need a wake-up call, because at the moment we are allowing the criminal law as currently drafted to drive a fundamental wedge between Northern Ireland and Great Britain, treating women in Northern Ireland in a completely different way from women in England and Wales when it comes to abortion. Two years ago, the Government changed the law governing abortion in Northern Ireland after a vote in this place, removing criminal sanctions on abortions in Northern Ireland, while leaving women in England and indeed Wales facing the possibility of the harshest criminal sanctions for abortion in the world, under laws passed more than 50 years before any women was even able to vote for the people representing them in this place.

New clause 50 would change that. It would decriminalise abortion and ensure that women in England and Wales are treated in the same way as women in Northern Ireland when it comes to abortion. Our values and our rights are what unite our four nations. To treat women differently in those nations weakens those ties. That needs to be rectified. The new clause does just that, and it would change nothing about abortion services, access to abortion or the time limits on abortion.

The women most likely to be affected and governed by the criminal law are some of the most vulnerable in our society: victims of domestic abuse, of honour-based violence and of rape, and those who are too poor or marginalised to travel to a clinic to seek help. If a desperate woman attempts to end her pregnancy, do we really want her to not seek medical help for fear of arrest and prosecution? New clause 50 simply removes women from being subject to the criminal law for seeking an abortion, and it is fully supported by the medical experts, the Royal College of Obstetricians and Gynaecologists and the Royal College of General Practitioners.

Oral Answers to Questions

Emma Hardy Excerpts

Tuesday 23rd November 2021 Commons Chamber

[Sajid Javid]

My hon. Friend will understand that there is often good reason to change the criteria. They might be changed, for example, on the latest advice from the Joint Committee on Vaccination and Immunisation; the Government must of course consider that advice and take it seriously. As was mentioned earlier, we are extending the booster jab to 40 to 49-year-olds. NHS England has issued guidance to CCGs on the covid-19 vaccination programme, which includes guidance on eligibility for booster vaccines and how to manage those appointments. We encourage everyone to visit the NHS website on gov.uk for the very latest information on the programme.

[Emma Hardy (Kingston upon Hull West and Hessle) (Lab)]

A disabled member of my community needs the booster and is very keen to have it. However, he is housebound and unable to go the 1.2 miles to where the booster is being offered. What can the Secretary of State do to ensure that people who are housebound and unable to leave their homes can get the booster that they desperately need?

[Sajid Javid]

The hon. Lady makes a very important point. Hundreds of thousands of people have received their booster jabs directly from primary care—from their GPs—in most of the type of cases that she describes. If anyone is housebound or, for example, in a care home, they will receive a visit from their GP. That has happened up and down the country. If the hon. Lady is aware of any individual that has not received such contact, I ask her please to contact me, and I will do everything I can to assist.

Randox Covid Contracts

Emma Hardy Excerpts

Wednesday 17th November 2021 Commons Chamber

[Angela Rayner]

My hon. Friend is absolutely right. This goes to the nub of the problem. The Prime Minister—even when asked to apologise by the Leader of the Opposition; even when his Ministers have already apologised; and even when Conservative Members will not attend this debate because they are embarrassed by their Government’s actions—refuses to accept his responsibility. That is why we are calling for transparency today.

[Emma Hardy (Kingston upon Hull West and Hessle) (Lab)]

I would like the Minister to think for a moment about the companies that were not awarded contracts. Arco, in my constituency, is known for being the UK’s leader in safety equipment. It had a warehouse full of personal protective equipment that it would have been willing to give to the NHS but, for some reason, it could not find its way through the maze of bureaucracy involved in awarding Government contracts. We hear about companies being awarded contracts that had no record of expertise or knowledge, yet companies such as Arco were denied. How can that be right?

[Angela Rayner]

My hon. Friend makes an important point. We have heard about this distinction from other companies and organisations that have experience in the field; they feel as though they were blocked and there was not a transparent process for them to go through. We have seen concerns about how procurement decisions were being made for companies such as Randox, with the lack of any paper trail showing that they were made properly. How is that fair? The question is very simple: what are Ministers hiding?

Endometriosis and Polycystic Ovary Syndrome

Emma Hardy Excerpts

Monday 1st November 2021 Westminster Hall

[Emma Hardy (Kingston upon Hull West and Hessle) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Mundell. I would like to add my thoughts and recollections of working with Sir David. As he was chair of the all-party parliamentary group on endometriosis and I was vice-chair, we worked very closely together, and I really enjoyed working with him. I found him to be a funny, engaging and generous man. He will be very missed.

As much as I am pleased to be sharing the new role of chair with the hon. Member for Livingston (Hannah Bardell), I do not think that any member of the group will quite get over the loss of Sir David. The last conversation that we had was when we caught each other near the lifts in 1 Parliament Street, if Members know it. He said, “Oh, Emma, Emma! Let’s find out who the new Minister is. We must get them to come to our APPG.”—this was during the reshuffle—“We must tell them about our report. Let’s do this together.” I said, “Brilliant!” He said, “I’ll find out. I’ll get hold of them,” and I said, “That’s great news.” I am very pleased to say that before the debate began, the Minister agreed to meet the APPG, so I thank her for that.

I would like to mention our APPG and the work we did—I can see members of the group here now—and some of the points that we came up with. It was a really detailed piece of work. We listened to thousands of women. Sir David chaired some of the events, as did I and other Members. We were both passionate about following up on the report’s recommendations. The point he made to me was, “It must not be left to gather dust, Emma,” and I said, “No, it must not be left to gather dust,” so we will push on with the recommendations.

One of the things we talked about was highlighting the unacceptable delays in diagnosis and the need for research into diagnostic methods. One of the recommendations was that Government should commission research to discover the cause of the disease. No one really understands why some women have it and some do not, and there is no research on that. Research needs to be done on better treatment and management options, and—the dream for everyone—one day finding a cure.

We need increased awareness. It feels as though we are becoming more aware of the condition, but I still find myself having conversations with people who ask, “How do you say that? What is endometriosis? I have not heard of that before.” We should do anything we can to raise awareness and increase understanding among health professionals of the severity of the condition.

We need to recognise endometriosis in statutory support as a source of chronic disability, and we have talked before about having a debate about that. Sir David and I, along with other members of the group, wrote to the Minister in the Department for Work and Pensions about personal independence payments, disability benefits and women’s difficulty in accessing them for conditions such as endometriosis. The definition and criteria for statutory sick pay do not recognise long-term conditions such as endometriosis. Everybody who needs it should have access to the appropriate care.

I would like to mention the women that I met during my recent Big Conversation event. I pay tribute to Mr Phillips, who is an incredible consultant and an expert in endometriosis, for all the work he does in my local area. The women at the event reported the same things as we have heard from the women here: this is a condition that takes seven and a half years to diagnose, it is not taken seriously and they are left in extreme pain for long periods of time. However, I want to offer some hope to everybody. I am really pleased that Dr Barbara Guinn and Leah Cooksey, a PhD student at the University of Hull, have just been given £10,000—a pitifully small amount, one could argue—to look into researching biomarkers for endometriosis. That would be revolutionary if it came through. The idea is that someone could give a urine sample to identify the biomarkers that mean they are likely to have the disease, without the need for the current invasive medical procedures.

My final, specific ask for the Government concerns the Health and Care Bill. The Royal College of Obstetricians and Gynaecologists is asking that it be made mandatory for integrated care systems to ensure that NHS organisations for which they are responsible conduct and resource clinical research. Can measures about mandatory research into this condition be included in the new Health and Care Bill? I am very sorry that Sir David is not here with us, but we will continue to push for all the recommendations and points that he stood for so proudly in our all-party group.

Oral Answers to Questions

Emma Hardy Excerpts

Tuesday 19th October 2021 Commons Chamber

[Edward Argar]

In the context of elective surgery recovery, my right hon. Friend makes an important point about the role that community hospitals play in helping to drive down waiting lists. I am grateful to him for drawing that to my attention and I will look into the specific situation he raised. It is important that, alongside providing a service, it is a safe service. I am happy to work with him to see what can be done in that situation.

[Emma Hardy (Kingston upon Hull West and Hessle) (Lab)]

Delays in procedures are causing increased pressure on our adult social care system. In September, East Riding of Yorkshire Council told my constituent that there was not a single carer to be had for her mum in the whole of the East Riding, and that the family’s options were to put their mum into residential care or to deal with it themselves. I spoke to those on the Conservative-led council to check whether that was true, and they said yes. They are facing a huge shortage of carers and they asked for my support in lobbying their Government for increased funding for social care. Will the Government give East Riding of Yorkshire Council the extra funding it needs to raise the wages of carers and try to attract some of them back to the profession?