Oral Answers to Questions

Feryal Clark Excerpts

Tuesday 5th December 2023 Commons Chamber

[Andrew Stephenson]

With respect, the hon. Gentleman is as wrong as usual. NHS England is taking forward work to improve the ways in which services for rare diseases are commissioned, putting patients’ voices at the centre of service delivery and ensuring co-ordinated access to specialist care, treatment, drugs, social care, mental health and special educational support. We will continue to work to improve services in this area.

[Feryal Clark (Enfield North) (Lab)]

10. What steps she is taking to improve maternity services.

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

Since 2021, we have invested an additional £165 million a year to improve maternity neonatal care; next year, that figure will rise to £186 million. That investment is leading to progress on outcomes: stillbirths have reduced by 23%, and neonatal mortality rates are down by 30%.

[Feryal Clark]

Women continue to be failed by maternity services across England, as has been highlighted by a string of scandals including East Kent, Nottingham and Morecambe Bay. The Care Quality Commission’s maternity inspections over the past year downgraded many maternity units, branding two thirds of them as dangerously substandard and highlighting shortages of staff, among other problems. What additional steps is the Minister taking to ensure that a woman can go into maternity services knowing that she and her baby will come out alive, and can she tell us whether the recommendations of the Kirkup and Ockenden reviews have been fully implemented?

[Maria Caulfield]

The hon. Lady has touched on three inquiries. The Ockenden inquiry covered the period from 2000 to 2019, the Kirkup review covered the period from 2009 to 2020 and the Morecambe Bay inquiry covered the period from 2004 to 2013, so the Labour Government were also responsible for parts of all those periods.

We are introducing radical changes. We are increasing the number of midwives, which is up 14% since 2010, and the number of midwifery training places has increased by 3,650. We have introduced the maternity disparities taskforce to improve outcomes for those women who face the poorest outcomes, and have also introduced a maternity support programme for those trusts that do badly in CQC inspections—32 trusts are going through that improvement programme right now. Those are some of the things we are doing to improve maternity services.

Cancer Care

Feryal Clark Excerpts

Tuesday 14th March 2023 Westminster Hall

[Feryal Clark (Enfield North) (Lab)]

It is a pleasure to serve under your chairmanship this afternoon, Mr Paisley. I will start by paying tribute to the hon. Member for West Bromwich East (Nicola Richards) for securing this important debate. I offer my sincere condolences on the passing of her mother and close relatives. I also want to praise the contributions of Members, including my hon. Friend the Member for Bootle (Peter Dowd) and the hon. Member for Westmorland and Lonsdale (Tim Farron).

Many important organisations do amazing work around this subject, including Cancer Research UK and Macmillan —the list goes on. We are grateful for all of the work that they do. Like me, those organisations are incredibly worried about the future of cancer care.

As hon. Members have set out, we all know that the best way to improve cancer care and survival rates is by diagnosing and treating cancer early. However, as we heard from my hon. Friend the Member for Bootle, the Public Accounts Committee report on NHS England’s backlogs and waiting times found that waiting times for cancer were

“at their worst recorded level”.

Responding to those findings, the chief executive of the NHS confederation said that “a decade of austerity” had left it to “grapple 133,000 staff vacancies” and

“a shortage of key equipment”.

We have a health service gripped by a funding and workforce crisis. It is a terrible indictment of the Government’s policy on cancer care, and I know that that will concern Members across the House. The current Chancellor himself recognises that. He said that Labour’s workforce plan was

“something I very much hope the government also adopts on the basis that smart governments always nick the best ideas of their opponents.”

I very much hope that, in tomorrow’s Budget, he takes his own advice and adopts Labour’s plans to double the number of medical school places and train an extra 10,000 nurses to alleviate some of the issues in the NHS.

The current waiting times are out of control. The Royal Free London NHS Foundation Trust—a trust that is very close to my own constituency and is used by my constituents—found that only 79% of people saw a specialist within 14 days of an urgent suspected cancer referral in January 2023, missing NHS England’s target of 93%. If the target was met, around 520 additional patients would have had cancer diagnosed or ruled out on time. That contrasts with when Labour left government, when over 95% of patients were seen within two weeks.

Ministers point to the impact of covid, but we entered the pandemic with record waiting lists, and cancer targets were repeatedly being missed. Indeed, cancer patients have been waiting longer for care every year since 2010. Will the Minister explain how the Government plan to get a grip on cancer care, and co-ordinate the strategy to cut waiting times? They are truly devastating for patients and families around the country.

It is not only diagnostics that are the issue. The NHS foundation that I just mentioned found in January that only 39% of patients started treatment within 62 days of an urgent suspected cancer referral, missing NHS England’s target of 85%. Only 39%; that is a damning indictment. It represents a two-month period of uncertainty for patients and families in this country over their future. Those stats are extremely concerning, for the reasons mentioned by Members throughout the debate. The longer patients wait for a diagnosis or treatment, the less their chance of survival.

It does not seem as though the human cost of inaction has fully registered with the Government. The key reason for the lack of staff is that, although NHS staff are working incredibly hard, there are simply not enough of them. Earlier, we identified 133,000 staff vacancies. If we look closer at those vacancies, according to the Health and Social Care Committee’s report on cancer services, on a full-time equivalent basis, we are due to be short of 189 clinical oncologists, 390 consultant pathologists, 1,939 radiologists and more than 3,300 specialist cancer nurses by 2030. The report is critical of the Government for lacking any serious plan to address that. We can all agree with that judgment.

In a statement in autumn 2022, the Government committed to publishing a comprehensive workforce plan in 2023, including an independently verified forecast for the number of doctors, nurses and other professionals who will be needed in five, 10 and 15 years’ time. What level of detail will be included in the published plan, and to what degree with there be transparency in projected staffing numbers in key specialist areas?

Promises of a dedicated 10-year cancer plan did not materialise last year, as we have heard. Ministers are instead consulting on a separate major conditions strategy. I know how disappointed the organisations I outlined earlier are about that. For example, Cancer Research UK stated:

“It is therefore extremely disappointing the promised plan will no longer be published and will instead be replaced by a 5-year Major Conditions Strategy, of which cancer will be only one part”.

What is that delay going to do to the future of cancer care, and how many patients will be affected? There seems to be a common theme of delayed reviews and empty promises with this Government. Patients need action now. The number of cancer cases is continuing to grow, and the future of cancer care is increasingly uncertain. It is vital that the Government ensure that they have a long-term strategic plan across cancer pathways. More work is needed everywhere with cancer care, including on prevention efforts, tackling the backlog, and chronic workforce shortages—the list goes on.

I will finish with some optimism for the future of cancer care. There have been huge advances in science, medicine and technology, and Britain has been leading the way. That gives us hope for the future, but cancer patients and their families need the Government to solve the huge problems in the NHS, starting with the workforce, in order to get the waiting lists down, get early diagnoses up and transform survival rates for cancer patients. We need a plan and we need to see some action; I look forward to hearing the Minister tell us how the Government intend to deliver that.

Patients with Rare Diseases

Feryal Clark Excerpts

Thursday 9th March 2023 Westminster Hall

[Feryal Clark (Enfield North) (Lab)]

It is a pleasure to serve under your chairmanship this afternoon, Mr Sharma. I start by paying tribute to the hon. Member for Strangford (Jim Shannon) for securing this debate today and for all the information he provided; I feel a lot more knowledgeable about the variety of rare conditions than I did before I came to the debate. He covered quite a lot of important statistics that we should all take notice of. I also pay tribute to my hon. Friend the Member for Blaydon (Liz Twist), chair of the all-party parliamentary group for rare, genetic and undiagnosed conditions, for her contribution.

As has been set out, a rare disease is generally considered as one that affects fewer than one in 2,000 people. While the occurrence of individual rare disease is low, it has been estimated that around 3.5 million people in the UK are living with one of the more than 7,000 rare diseases. The hon. Member for Strangford and my hon. Friend the Member for Blaydon both noted that 75% of these diseases affect children, and more than 30% of children with rare disease die before their fifth birthday. That is truly devastating.

With that in mind, I welcome the Government’s 2023 rare diseases action plan, but I have a few questions about the detail, starting with screening and early diagnosis. I was pleased to see the Government focus on that area in the action plan, which suggests that the NHS is exploring the implementation of whole genomic sequencing to screen for up to 200 rare genetic conditions in newborns. That is fantastic news.

Will the Minister clarify whether that scheme will be accepted and be implemented? As we have heard this afternoon, funding is a major issue in this area. If this plan is going to be implemented, will the Minister tell us how it will be funded? There is a lack of clarity in the action plan.

Early diagnosis can prevent and mitigate many of the complications associated with rare diseases. Therefore, it is imperative that such a scheme is made available as soon as possible. We heard from the hon. Member for Strangford on MFS, and from my hon. Friend the Member for Blaydon on SMA. If these conditions are diagnosed early on, while there may not be a cure, there can be treatment. That is why it is really important to get more information about this scheme as soon as possible.

The 2023 action plan also states that changes to the UK National Screening Committee have helped to improve how decisions are being made on newborn screening. Will the Minister clarify when those changes will come into effect and be actioned? I do not want to look back, but if we look back to 2021, the UK screened for just nine conditions—so hon. Members will understand why I was excited to see the 200 figure. We screened for only nine conditions in 2021, whereas Iceland and Italy screened for more than 40. Will the Minister update us on how many conditions are being screened for in the UK and whether the number has increased from nine since 2021?

Secondly, let me focus on workforce challenges in the rare disease action plan, which my hon. Friend the Member for Blaydon highlighted as one of the key areas for the rare diseases community. A recent survey by Rare Disease UK found that nearly half of all respondents did not feel that they were being given enough information or support about their condition and the care that they needed post diagnosis. It is clear that we need to scale up our wonderful healthcare professionals to equip them with skills and the awareness of rare diseases. For some people, as we have heard, it can take up to five years on average to get the correct diagnosis.

That brings me to the Lily Foundation story, which particularly touched me. I met Lily’s mother at one of the events organised by my hon. Friend the Member for Blaydon. Lily’s mother set up Lily’s Foundation, and it was a delight to speak to her. She is a part of the mitochondrial research campaign. Lily was diagnosed with mitochondrial disease when she was born in 2006; her mum said that the family felt shocked, isolated and devastated. They researched for information and support, but found none. There is no cure for mitochondrial disease—MD—and Lily sadly passed away when she was only eight months old. Although there is no cure, there is treatment, which focuses on relieving symptoms rather than treating them. According to NHS England, many aspects of MD can be prevented or helped by early diagnosis, before symptoms start to show.

The Government’s action plan states that it seeks to address the awareness of rare diseases by expanding digital educational resources on rare diseases for healthcare professionals. How will those programmes be delivered to healthcare professionals to ensure that we actually raise awareness? On the workforce, 7 million people are waiting for months—even years—for treatment, yet the Government cut the number of medical school places this summer. Given the need for an increased amount of care for rare disease patients, as well as more focused care, how do the Government plan to increase the number of available staff to support the aims of the 2023 action plan and wider strategy?

We heard a lot about the need for funding for research into rare diseases, and I want to focus on the Government’s £340 million innovative medicines fund. That was launched last year, and it is designed to provide for quicker access to the most advanced life-saving treatments. Why has it not yet been used? The Association of the British Pharmaceutical Industry has significant concerns that the design of the fund makes it difficult for companies to use. Will the Minister update us on whether the Government are addressing the industry’s concerns about the fund? If the fund is available, it should be used to find new treatments for rare diseases.

Finally, the indicators for measuring the success of the rare disease action plan have not yet been specified, so I would be grateful if the Minister set out when they will be specified. Without them, it will be impossible to assess whether care needs have been met or accurately measured by improvements in health outcomes.

This has been a great debate, and I thank both the hon. Member for Strangford and my hon. Friend the Member for Blaydon for continuing their campaign in this area. [Interruption.] Sorry, and the hon. Member for Edinburgh North and Leith (Deidre Brock)—I am slightly forgetful at the moment. I know that the Members present are determined to ensure that the voices of patients with rare diseases are heard, and that children and adults have access to the best knowledge, diagnosis and treatment available. I look forward to hearing from the Minister.

Draft Medical Devices and Blood Safety and Quality (Fees Amendment) Regulations 2023

Feryal Clark Excerpts

Monday 6th March 2023 General Committees

[Feryal Clark (Enfield North) (Lab)]

It is a pleasure to serve under your chairmanship, Sir George.

As has been said, the SI serves to allow the MHRA to increase the fees it charges for regulating medicines and related products. Of course, any steps the Government take to ensure that the MHRA can carry out its role more effectively are to be welcomed.

The SI will introduce a 10% increase in all the MHRA’s statutory fees, and an above 10% increase for 61 services that have seen costs grow significantly. Furthermore, it will introduce 22 new fees to ensure that the MHRA adequately recovers the costs of regulatory activity across all its services, in line with His Majesty’s Treasury principles on managing public money.

I understand and appreciate that the MHRA has not increased its fees to this extent since 2016-17, to provide the industry with certainty and stability through the EU exit period and the covid-19 challenges. I am pleased that the MHRA has gone through the consultation process to arrive at its judgment, thereby ensuring that the views of relevant stakeholders are reflected. The MHRA needs to be financially stable to be able to deliver regulatory services that protect and improve patient safety, with high-quality, safe, effective and innovative medical products, and any steps that the Government take to address that are of course to be welcomed.

We appreciate the greater clarity that the SI provides on the increased costs of providing quality care in our health services. However, I am concerned about where the increased costs of the fees will be absorbed. They simply cannot be absorbed by the NHS, which is already facing the worst crisis we have ever seen. I would therefore appreciate it if the Minister could outline how the Government will ensure that the increase in costs is not absorbed by the NHS.

We are always looking to make further strides in patient safety, and we are confident that the SI takes that into account. I look forward to hearing the Minister’s response to some of the points I have made.

Hospice Sector: Fiscal Support and Cost of Living

Feryal Clark Excerpts

Thursday 2nd March 2023 Westminster Hall

[Feryal Clark (Enfield North) (Lab)]

It is a pleasure to serve under your chairmanship this afternoon, Mr Paisley. I pay tribute to and thank the hon. Member for North Ayrshire and Arran (Patricia Gibson), who secured this important debate. I also praise the important contributions from my hon. Friend the Member for Enfield, Southgate (Bambos Charalambous), who is no longer in his seat, the hon. Member for Twickenham (Munira Wilson), and the SNP spokesperson, the hon. Member for Glasgow North (Patrick Grady).

I pay tribute to the vital role that the hospice movement plays in the UK. I particularly want to mention Hospice UK and Marie Curie, who do so much in this area. The palliative care and services that hospices deliver is crucial to improving the quality of life for people with terminal illnesses. They are vital to a dignified, comfortable and compassionate end of life. Hospices serve a huge number of our communities. As we heard today, in the UK in 2020-21 more than 300,000 people received care from hospices; that is against a backdrop of more than 650,000 deaths in the UK in 2021. Hospices also work across the system to reduce the pressure on the NHS and to train and support health and care workers.

Hospices care for some of the most vulnerable people in our society. As we have heard today, the majority of hospices rely on charitable funding for a significant amount of the funding they use to deliver services. Prior to the pandemic, an average of 34% of adult hospice funding and 18% of children’s hospice funding came from the Government, but now many are struggling to pay the rising costs of energy, food and staff. Hospices face additional costs of around £100 million a year. Those who run them worry about the future of their services and the level of service that they will be able to provide, but reducing energy consumption in hospices, as we have heard, is not an option. They need to keep medical machines running and the in-patient units warm for those receiving care.

I am sure the Minister will point us towards the energy bills discount scheme, but, as we have heard today, under that scheme hospices will be eligible for the same reduced level of support as pubs and restaurants, and even less support than a zoo or a museum. I appreciate this is not in the Minister’s brief, but I would be grateful if he set out the rationale for that and whether the Government have a plan to reassess and address that in the coming Budget. Although NHS services may have their energy bills paid for by the Government, hospices will be expected to raise money to pay the astronomical bills that they will receive after April.

How do the Government expect already struggling communities to keep hospices running? I am sure the Minister agrees with me about how unfair that is, and I am sure he also agrees with the praise for the hospice sector we have heard this afternoon. In February, a written question in the House of Lords asked the Government what assessment they had made of the impact of the increased cost of living and energy costs on hospices in England. Sadly, the answer was:

“No assessment has been made.”

I would be grateful if the Minister gave a commitment to carry out such an assessment.

The NHS long-term plan includes a welcome ambition to improve end-of-life care. I struggle to see how that ambition will be met, in the light of hospices being under such fiscal pressure. It feels like Government support of the sector is lacking. So many of us will, at some point, rely on hospices to take care of us or our loved ones. Following the pandemic, we see even more referrals to hospices. I will be interested to hear from the Minister what assessments have been made of the ambition to improve end-of-life care in the light of the compelling arguments that Members have set out this afternoon.

Yesterday, the APPG for hospice and end of life care released its report, “The Lasting Impact of COVID-19 on Death, Dying and Bereavement”. One of its recommendations is that the Government should conduct a review of hospice funding in England. I would be grateful if the Minister could tell us whether the Government will be considering those recommendations and when we are likely to hear the response. Hospices do such fantastic work, in providing care in the most unimaginable of circumstances. We need to ensure that they continue to do so.

Health and Wellbeing Services: East of England

Feryal Clark Excerpts

Wednesday 1st March 2023 Westminster Hall

[Feryal Clark (Enfield North) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. I start by thanking and paying tribute to the right hon. Member for Witham (Priti Patel) for securing this important debate and her continued pursuit of the issue, but also for painting a comprehensive picture of the health and wellbeing disparities in her constituency and across the east of England. I welcome her comments about and the enthusiasm she showed for further including pharmacies in the way we deliver health. I support that wholeheartedly.

May I praise the important contributions made by all Members, especially my hon. Friend the Member for Bedford (Mohammad Yasin)? It is clear that patients are being failed in all aspects of health and wellbeing services in the east of England. We have heard about many aspects of those services, but let me start by talking about the front door of the NHS, the GPs. Primary care and GP services are struggling, and patients are struggling to gain access to primary care. The latest patient survey tells us that those who are able to get an appointment are less and less likely to see a GP because of staff shortages.

The right hon. Member for Witham mentioned that patient numbers and needs are growing in the area, but we know that the number of fully qualified GPs in the east of England fell from 3,263 full-time equivalents to 3,020 in December 2022. Across NHS England, there is a shortage of 4,200 GPs, so I welcome the call from the right hon. Member for Chelmsford (Vicky Ford) for the number of medical school places at Anglia Ruskin to be doubled, although I would go further and say that we should do that across the country, maybe every year.

There is also a quality issue. Essex has five inadequate GP services, according to the Care Quality Commission, which is second only to London. Maternity services are also failing communities in the east of England day in, day out. At Mid and South Essex NHS Foundation Trust, such services have been found by the CQC not to have staff with the right qualifications, skills, training and experience to keep women safe from avoidable harm. Since last year, the use of gas and air pain relief at a hospital’s maternity suite has been suspended on and off following a botched repair, which exposed some staff to high levels of nitrous oxide, and routine testing of the maternity suite revealed that midwives had been exposed to excess nitrous oxide levels during their shifts.

It is heartbreaking that services for mothers are so poor, and maternity services are unable even to provide the basics. Access to gas and air pain relief should be a basic when someone goes into maternity, and it is really disappointing that it is not available to mothers in the area.

[Giles Watling]

A moment back, the hon. Lady mentioned inadequate GP services and how some GP services fail, but is it not the job of us MPs to get involved? There were failing GP services in poor practices in Clacton. I got personally involved, we got new management in, and we turned things around. We, the MPs, can get involved. We got involved with what was then the local health authority, and we changed things. We can do that by getting together and being united with our health leaders.

[Feryal Clark]

I welcome those points, and I absolutely agree.

On mental health, the stories that the right hon. Member for Witham set out are devastating. I offer my sincere condolences to all those affected by the loss of loved ones between 2000 and 2020 at Essex mental health services. I also pay tribute to the families and the local MPs—especially the right hon. Member for Chelmsford, who is no longer in her place—for fighting for justice for the loved ones. A mental health unit should be a place of safety for patients, and it is heartbreaking that that was clearly not the case in Essex. It is imperative that the truth of what occurred in Essex is finally heard. As the right hon. Member for Witham said, it is vital that the families and loved ones get answers about what happened, and above all lessons must be learned. That is why the work of the Essex mental health independent inquiry is so important.

Concerns were raised in January, and the Under-Secretary of State for Health and Social Care, the hon. Member for Harborough (Neil O’Brien), said that he expected changes to be made. I will be grateful if the Minister can set out the steps the Government are taking to ensure that the inquiry can effectively investigate what went wrong and can make recommendations so that it never happens again. The inquiry is currently non-statutory. The Government said in January that they would not hesitate to change their approach if we do not see the change we need rapidly. Will the Minister tell us whether there have been any changes? Is there an update on that?

Although there are tragic extremes to health and wellbeing services in the east of England, they reflect issues that we see across the country, including patients not being seen on time and not receiving the care they need and deserve. That ultimately leaves them at risk at of adverse harm. Patients in the east of England—indeed, patients across the country—deserve more.

I would be grateful if the Minister set out the actions the Government are taking to improve care in the east of England and ensure access to primary care, safe maternity care and dentistry. Will she also give us a further update on the mental health inquiry?

--- Later in debate ---

[Helen Whately]

It is very good to hear that update. I refer my hon. Friend to the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield), who has oversight of mental health in the ministerial team and who can go further into the progress of the inquiry. It is good to hear that he is taking such an active interest in the work of the inquiry, because it is clearly important, and I thank him for that.

Hon. Members have touched on community diagnostic centres. We in Government see them as incredibly important, because we know that many patients across the east of England, and more widely across England, are waiting for a diagnosis for their condition. Waiting for a diagnosis can be one of the most worrying times, particularly if someone is concerned that they may have cancer, which is why the Government have been opening more community diagnostic centres across the country—an innovation to provide easier access to vital community diagnostic services and to speed up diagnosis. By separating some of these services from acute hospitals—the hot site, I suppose—we can ensure efficient processes to diagnose as many people as possible at pace. The good news is that we have recently announced the approval of two new community diagnostic centres via the mid and south Essex integrated care board, and there are more in the pipeline with other Essex integrated care boards. I encourage my right hon. Friend the Member for Witham and others to keep an eye on our progress with community diagnostic centres, as I am sure she is doing.

Finally, I want to talk about integration and the broader question of health and wellbeing in our communities. My right hon. Friend the Member for Witham spoke about the health challenges and disparities in her constituency and across the east of England. We see real differences and inequalities, not only in life expectancy but, crucially, in healthy life expectancy. That means people’s ability to work and have fulfilling, independent lives, to have relationships and the quality of life we would like for everybody.

The Government are determined to improve that—for instance, under the auspices of levelling up in healthcare. Crucial to achieving that is the work of our integrated care system, the integrated care boards and integrated care partnerships. They bring together all the organisations across the national health service, local authorities, social care and third sector organisations, which play an important part in our health and social care systems. Indeed, joining up NHS organisations is an important part of that in its own right. All of us who spend time with the NHS in our constituencies know that it is not one thing; it is multiple organisations. Bringing them together, along with the wider health and social care system, is important.

It is crucial for our integrated care boards and integrated care partnerships to look at the needs of populations, looking at the population as a whole, and to set out strategies for reducing health disparities and, as my right hon. Friend the Member for Witham talked about, for closing the gap—levelling up for those with a lower healthy life expectancy. That is absolutely crucial to the work of integrated care systems. It is relatively early days for these entities. The extent to which they are established varies around the country, but we are seeing an excitement and a willingness in those organisations to come together.

I have spoken to many chief executives and chairs of integrated care boards, as well as local authorities around the country. We have talked about integration many times before; it has been a buzzword for decades in health and social care. What I am hearing from the frontline is that this time it really feels like it is working and making a difference. As part of those conversations, I have spoken to many about the work they are doing on looking upstream at prevention, crucially, and the steps we can take jointly between the health system and local authorities to prevent ill health.

[Feryal Clark]

The Minister mentioned prevention and the role of local authorities. She will know that the public health funding formula for local authorities was set in 2013 and has not been reviewed. There are real disparities across the country in how they are funded. Do the Government have a plan to review that, to ensure that areas such as the east of England get the fair funding they deserve?

[Helen Whately]

The hon. Lady will know very well that we are under substantial fiscal constraints as a Government, recognising the extra spending we put in through the pandemic to keep our economy going and come out as strongly as we have. We also face challenges with inflation and the cost of energy. She will also know that in the autumn, against those constraints, the Chancellor showed the Government’s commitment to health and social care by putting an extra £14.1 billion into health and social care, including a record funding increase for social care of £7.5 billion over the next two years.

The Government’s commitment to health and social care should be clear to the h L. We are driving efforts behind the establishment of the effective working of integrated care boards and integrated care partnerships, because of the importance of joining up the system. It is not just about the public health budget; what we need to do to prevent future ill health and reduce disparities is much broader than that.

In conclusion, I thank my right hon. Friend the Member for Witham and other hon. Members for this important conversation, which has shown the complexity and the interconnections in our health and social care system. It is important to have joined-up systems, not only to treat people in the here and now, but crucially to intervene earlier and prevent ill health. We want to achieve not only longer lives for our constituents, but healthier and happier lives.

Oral Answers to Questions

Feryal Clark Excerpts

Tuesday 24th January 2023 Commons Chamber

[Mr Speaker]

I call the shadow Minister.

[Feryal Clark (Enfield North) (Lab)]

The women’s health strategy was an opportunity to fundamentally change the inequalities women face. Women were promised a clinical women’s health lead in the NHS, yet a former Health Minister, the hon. Member for Sleaford and North Hykeham (Dr Johnson), admitted that there has not even been a discussion about establishing the role. Women in east Kent were promised change after the damning review of local maternity services, yet the Care Quality Commission is now threatening the trust there with enforcement action. Time after time, women’s voices are at best being ignored and at worst being silenced. So I ask the Minister: when will this Government stop letting women down with empty promises? Is the women’s health strategy worth the paper it was written on?

[Maria Caulfield]

Perhaps the shadow Minister will reflect on her comments when she receives the “Dear colleague” letter later today outlining the eight priorities areas for our first year of the strategy, with work such as the prepayment certificate for hormone replace treatment being done already; it is launching in April and saving women hundreds of pounds on the cost of HRT. May I say that I am gobsmacked by the Labour party’s position on this? Not only does it struggle most days to define what a woman actually is—for reference, it is a female adult human—but it cannot stand up for women either. There was no greater example of that than what we saw in this Chamber last week, when Labour Members were heckling the hon. Member for Canterbury (Rosie Duffield) and intimidating my hon. Friend the Member for Penistone and Stocksbridge (Miriam Cates). Come back to us when the Labour party is reflecting on the behaviour of its own MPs before dictating to us.

Draft National Health Service (NHS Payment Scheme - Consultation) (No. 2) Regulations 2022

Feryal Clark Excerpts

Monday 9th January 2023 General Committees

[Feryal Clark (Enfield North) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Graham. Ensuring that patients get the best quality care is in the interests of everyone, and the Labour party will always support measures that seek to achieve that. Although we have some reservations, we will not oppose the regulations today.

The proposed consultation is important because the NHS payment scheme will govern how billions of pounds of taxpayer money is spent. Quality of care and value for money should always be at the core of our health service’s decision making. They are not alternative options or binary choices. They are both critical to the future of our NHS, so we need financial management in the health service to be able to deliver both in parallel. Given the urgency of the crisis affecting the NHS, action to deliver that must come at pace. We have seen during the pandemic what happens when the NHS strays from those principles, and we cannot allow such events to happen again.

The former tariff system, which the regulations form part of replacing, sought to deliver a more competitive environment to drive up quality and improve outcomes for patients, yet too often it was a rigid system that did not allow for the flexibility that individual commissioners needed. Giving local decision makers the tools that they need to improve services in their areas is vital to ensuring that the NHS meets the needs of patients where they are, not where the system thinks they should be.

It is because of that that a rigorous and effective consultation on changes is so important. Done properly, payment schemes can deliver a meaningful impact on patient outcomes. The payment-by-results incentives used by the last Labour Government made a significant impact on elective waiting lists. However, they are not appropriate in every case, and options must be carefully considered. Hon. Members will know that elective waiting lists are now at record levels. Given the reports of Ministers wanting to bring back the payment-by-results incentives in some form, I would be keen to hear from this Minister what plans they have to do that.

Getting these changes right through effective consultation is in the interests of everyone and, crucially, will ensure better outcomes for patients. I look forward to hearing from the Minister how the Government intend to deliver that.

Aortic Dissection: Patient Pathways and Research Funding

Feryal Clark Excerpts

Tuesday 13th December 2022 Westminster Hall

[Feryal Clark (Enfield North) (Lab)]

It is a pleasure to serve under your chairmanship this afternoon, Mr Pritchard.

I want to take a moment to sincerely thank the hon. Member for Mid Derbyshire (Mrs Latham) for securing this debate and for sharing her very personal story. I offer my profound condolences to her for the loss of her son, Ben, and I recognise her extraordinarily brave work in campaigning to improve the patient pathway for aortic dissection, and to increase research and screening.

As we have heard, aortic dissection occurs because of a partial tear in the wall of the aorta. The tear then spreads, and can rupture or interrupt the blood supply to vital organs. There are two distinct types of aortic dissection: type A, which occurs in the front of the chest, and type B, which occurs in the back of the chest. Type A is far more dangerous; if untreated, it is sadly almost always fatal. We have also heard today that over 2,000 people per year lose their lives from aortic dissection. Some 11% of maternal deaths from cardiovascular causes are due to aortic dissections. Worryingly, the Oxford Vascular Study projects that those figures will almost double by 2050. It is crucial, then, that we engage with experts and give this life-threatening condition the attention that it deserves.

As the hon. Member for Mid Derbyshire said, there have been some positive advances in aortic dissection care over the last year—notably, the launch of the acute aortic dissection toolkit—but we cannot afford to take our foot off the pedal. Deaths from aortic dissection are avoidable, and with timely treatment the survival rate is good, as we have heard. It is therefore crucial that we do everything we can to drive up diagnosis rates. The Aortic Dissection Charitable Trust estimates that one in three of those who have aortic dissection are misdiagnosed. I would be grateful, then, if the Minister will update colleagues on the steps her Department is taking to improve diagnosis rates for aortic dissection.

The ADCT has made the case for a review of A&E triage processes, imaging, diagnosis and transfer for surgery. Notably, it also advocates diagnosis being made pre-hospital, which bypasses emergency departments and saves vital time. That work already happens with acute coronary syndrome and acute heart attacks. The ADCT states:

“The current pathways are ineffective… There are problems transferring images… Medical management, blood pressure control, imaging protocols, investigation of genetics…and long-term follow-ups are all sporadic and often not addressed well.”

The AAD toolkit has made a positive difference to some of those problems, but there is still much work to do. Has the Minister met with ADCT recently to review pathway processes? In addition, what work is taking place to eliminate regional variations in aortic dissection care, and to streamline aortic care so that patients can be seen before it is too late?

I also wish to highlight preventive interventions and why it is important that the Government support diagnostics to enable clinicians to save lives. Genetic screening, functional imaging and biomarker analysis are now possible, and if used efficiently, they enable clinicians to provide treatment before an aortic dissection occurs. As the hon. Member for Mid Derbyshire highlighted, once a patient is identified as having a family history of the disease, there is scope for potentially life-saving genetic screening. The ADCT estimates that 20% to 30% of families with dissections have an identified gene. Work is ongoing to identify the remaining 70% to 80% of genetic causes, but if we can screen that 20% to 30%, potentially thousands of lives could be saved over the next few years. I am sure that both sides of the House will agree that that is a worthy endeavour. Will the Minister therefore clarify what steps she is taking to support those exciting and potentially life-saving diagnostic tools?

Finally, let me touch on the workforce. We know that the NHS has the facilities to treat those suffering from aortic dissection. The problem lies in diagnostics. The reality, however, is that system-wide pressure on the NHS exacerbates misdiagnosis and compounds issues in patient pathways. It is therefore essential that targeted aortic dissection strategies come alongside whole-system workforce overhaul.

The next Labour Government will oversee the biggest expansion of the NHS workforce in history, doubling the number of medical school places, training 15,000 new doctors, creating 10,000 new nursing placements, and recruiting 5,000 new health visitors. That will be paid for by abolishing the immoral non-dom tax status. I encourage the Minister to nick Labour’s idea and commit to implementing that workforce strategy as soon as possible. Unless we solve the systemic workforce shortages, we will not be able to robustly tackle conditions such as aortic dissection.

In conclusion, I want to see a future where aortic dissection is diagnosed quickly, treated rapidly, and receives appropriate long-term care and management.

Draft Dentists, Dental Care Professionals, Nurses, Nursing Associates and Midwives (International Registrations) Order 2022

Feryal Clark Excerpts

Tuesday 6th December 2022 General Committees

[Feryal Clark (Enfield North) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Bone.

I welcome the measures regarding the registration of international dentists, dental care professionals, nurses, nursing associates and midwives. When we have 132,000 vacancies in the NHS, I am not here to stand in the way of cutting unnecessary red tape. However, let us not pretend that this is a long-term solution, or even a sticking plaster, when it comes to the problems that the NHS is facing.

The number of NHS dental practices had fallen by more than l,200 in the five years before the pandemic. Dental staff are leaving the profession: 2,000 dentists quit the NHS in 2021 alone. In nursing, there are 46,828 empty nursing posts across hospitals, mental health, community care and other services. That means one in 10 nursing roles are unfilled across the service overall. In midwifery, there are 800 fewer midwives than following the 2019 general election.

I will give the Government some credit: they have heeded the calls of their own Chancellor to assess, finally, the NHS workforce needs. Words will not be enough, however. Encouraging the recruitment of international healthcare professionals has serious ethical implications. It risks worsening the lack of healthcare workers in other countries that are dealing with shortages of their own, and it is no substitute for training home-grown talent.

That is why Labour has pledged the biggest expansion of medical school places in history, which will give the NHS the doctors it needs, and will be paid for by abolishing non-dom tax status. It includes creating 10,000 new nursing and midwifery placements every year, training 5,000 new health visitors, doubling the number of district nurses qualifying every year and doubling the number of medical school places, so that we have the doctors we need in our NHS. Labour will also produce a long-term workforce plan for the NHS for the next five, 10 and 15 years, which will ensure that we do not find ourselves in this position again.

Although I welcome the measures outlined by the Minister, the Government must acknowledge the scale of the crisis and rise to the challenge.

[The Chair]

I am quite generous about allowing the debate to go wider, but although I will allow some latitude, we will not have a debate on the NHS as a whole. On the other hand, Ministers are not supposed to get helpful pieces of paper from officials directly. Yes, that was a slap on the wrist, Minister, so it is one-all at the moment. John McDonnell will sort it out, though.