Gynaecological Services: Waiting Lists

Feryal Clark Excerpts

Wednesday 6th July 2022 Westminster Hall

[Feryal Clark (Enfield North) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Robertson. I thank my hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy) for securing this important debate and for her continued advocacy of this issue and many issues affecting health inequality, which predominantly affects women. I praise the contribution of my hon. Friend the Member for West Ham (Ms Brown), who set out some harrowing stories of women undergoing hysteroscopy, such as Emily and Francesca, who are ignored and brushed aside. We know that there are thousands more Emilys and Francescas.

That is why the debate is so vital—not just because of the need for meaningful progress on the long-promised women’s health strategy, but because fundamentally we are discussing issues that affect more than 50% of the population. Too often women’s health is pigeon-holed as niche and as a subsection of healthcare. The idea that gynaecological conditions are manageable for long periods of time, and can be deprioritised as a result, is just not acceptable.

Let me set out what that deprioritisation means. It means endometriosis surgery being delayed five times, resulting in irreversible fertility loss, and severe chronic pain. That perception must change, and women must be given the access to healthcare that they desperately need. Any other area of public policy that affected more than half of the population would not be treated in that way, and quite frankly, women have had enough.

We know that timely access to healthcare matters to women, and to young women in particular—the Government’s consultation on women’s health strategy tells us so. Gynaecological conditions were the No.1 topic chosen by women under 30, yet they are being consistently let down and made to wait day after day, year after year. Waiting lists are spiralling in all parts of the NHS, with records being broken consistently, but in gynaecology those spiralling lists are having a disproportionate impact. As we have heard, the Royal College of Obstetricians and Gynaecologists has found that gynaecological waiting lists across the UK have now reached 610,000—an increase of more than 106% since 2008. That backlog is made worse by significant geographic disparities in care.

Waiting lists are growing across the country: there has been an 89% rise in the north-west; a 97% increase in the midlands; and a 144% increase in the east of England. That means that the chance of getting what little care is available is down to a complete postcode lottery. That is disgraceful.

In my own clinical commissioning group area, north central London, the situation is absolutely dire. There are more than 10,000 women on the gynaecological waiting list, and 311 of them have been waiting for over a year. That not only puts pressure on gynaecological services, but has a knock-on effect on the rest of the NHS. Since 2010, emergency admissions for endometriosis have increased by 87%. Women are in A&E for ruptured cysts after their appointments and surgery are cancelled.

If women were listened to, and the services that they rely on were properly resourced, we would not be where we are. For women, the waiting times are having an impact that is far wider than just on their physical health, as we heard from my hon. Friends. The RCOG survey also showed that 80% of women surveyed felt that their mental health had been negatively impacted while waiting for care. If the problem is not tackled as a matter of urgency, the figures will only get worse and the impact will be more devastating.

Tinkering around the edges simply will not cut it. We need a fundamental rethink of how women’s healthcare is treated. We are in a situation in which, in some cases, we do not even have basic frameworks and clinical guidance in place. For example, there is no National Institute for Health and Care Excellence guidelines on how polycystic ovary syndrome should be treated. Just 8% of women feel that they have sufficient information when it comes to gynaecological conditions. What practical steps will the Minister take to ensure that women have the information that they need to make informed decisions?

I am sure that the Minister will tell us that the Government have listened and that the women’s health strategy will make a real change, but let us just look at how they have been listening. In the women’s health strategy consultation only 0.5% of respondents were from the north or the midlands, and only 7% were from non-white backgrounds. A women’s healthcare strategy that considers the experiences of only a small group of women will not be worth the paper it is written on. When it comes to gynaecology, the Government’s own vision for the women’s health strategy recognises that there is a problem. The unconscious bias that sees women’s health less well served than those in other parts of the system, and consistently losing out and being deprioritised compared with other surgical specialties, must be challenged.

Can the Minister confirm today whether the strategy will be published before recess and will follow through on the issues identified in the vision document? Furthermore, will he include an action plan to ensure that the strategy does not just remain a plan but makes practical changes to the way healthcare is delivered for women? Women who are suffering day after day, as they are being made to wait, deserve action. I hope the Minister has heard the asks from my hon. Friends the Members for Kingston upon Hull West and Hessle and for West Ham. I look forward to the Minister’s response.

NHS Dentistry in England

Feryal Clark Excerpts

Wednesday 22nd June 2022 Westminster Hall

[Feryal Clark (Enfield North) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Stringer. I thank the hon. Member for St Ives (Derek Thomas) for securing this important debate and praise hon. Members for their powerful contributions, which contained a lot of personal experiences setting out just how dire the situation is across the country.

Here we are again. The problem with NHS dentistry has come up time and again over recent months. No matter how much the Minister wants to bury her head in the sand, issues with access to NHS dentistry are just not going away. The situation is a national scandal, as recognised by Members from across the House, by the sector and by our constituents, whose heartbreaking cases continue to fill our postbags. One cannot help but feel emotional at the immense pain people are having to live with.

Shamefully, we know that children are particularly badly affected. Half of all children in England have no access to an NHS dentist, with 78 children under 11 going to A&E every single day for a tooth extraction. The hon. Member for St Ives described a family with three children, none of whom had ever seen a dentist, with one child only seen because they had to go to A&E. In Wakefield, a fifth of children suffer from tooth decay before the age of three. This is not just unacceptable; it is a downright disgrace.

In yesterday’s debate, the Minister held her hands up and recognised the problem in primary care. Frankly, I was delighted to finally hear something akin to humility from the Minister on access to NHS dentistry. However, just as it seemed we would make some meaningful progress, the same old script was rolled out and the blame was laid at the door of the Labour party. I put it to the Minister yesterday, and do so again today, that her party has been in government for 12 years. When Labour was in government and saw that the contract was not working, we committed to reforming it, as set out by my hon. Friend the Member for Sheffield Central (Paul Blomfield), and put that in our 2010 manifesto, just as this Government did in theirs.

[Anthony Mangnall]

How does the hon. Lady explain the Labour performance in Wales, where dental practices are going down and the system is not being addressed? It is clear that the Labour party has no suggestions.

[Feryal Clark]

I thank the hon. Gentleman for his intervention. If he wants to know about Labour’s performance on the NHS, he should look at the performance of the Labour Government between 1997 and 2010. Waiting times went from 18 months to 18 weeks.

[Several hon. Members rose—]

[Feryal Clark]

I will make progress because I have a lot to say in only five minutes.

Here we are again. After more than a decade in power, the Conservative party has absolutely nothing to show for it, other than a record of complete and utter failure. The Tory Government made a commitment to reforming the contracts in their 2010 and 2017 manifestos, so I would be fascinated—as, I am sure, would other hon. Members—to hear from the Minister what on earth has been happening for the past 12 years. If she is happy to associate herself with that record, that is her decision, but I would be embarrassed and ashamed, to be frank.

The Minister is presiding over a national scandal. It is simply not good enough to keep shirking responsibility. Whenever the Government have had something that looks like a plan, it has been woefully inadequate. I am sure that the Minister will—as other Members have—tell us about the £50 million of extra funding that we have heard so much about, but if she thinks that it has made a blind bit of difference, she is very much mistaken. I have been made aware that Yorkshire and the Humber, for which £8.3 million was allocated, drew down just £2.3 million. Barely any of that money was used by general dentists; it was used predominantly by hospitals.

I would be grateful if the Minister could confirm or deny whether yesterday, after being asked about this matter by my hon. Friend the Member for Sheffield Central, her answer was simply that we should wait for the data. At best, we have had a mixed response on when we will receive the full breakdown of how much of that £50 million was taken up. Can she confirm whether we will receive that data before the summer recess?

If that funding was designed to regain the confidence of dentists and encourage them to increase their NHS activity, it has completely and utterly failed. Across England, the number of patients being seen by an NHS dentist actually dropped by 22% overall between March and April. As the Minister will be aware—I mentioned this yesterday—there was a 34% drop in her own constituency. I ask her again: how can she expect dentists across England to have confidence in her when it is clear that she does not even have the confidence of dentists in her own patch?

One way of building trust would be to communicate with the profession. Yet just eight days before the start of the next quarter, dentists have no idea of the targets that they will be working to. Can the Minister confirm whether that announcement will be left until the eleventh hour once again? Furthermore, can she confirm that, as the Secretary of State said yesterday, the target will be 100% of pre-pandemic activity?

Let me remind colleagues of a story that my hon. Friend the Member for Lancaster and Fleetwood (Cat Smith) told in yesterday’s debate. A constituent of hers came to her surgery and placed on her desk the teeth that he had pulled out of his own mouth with pliers. Does the Minister think that such stories, which are now disturbingly common, are acceptable in 21st century Britain?

I am sure that the Minister will say once again that the Labour party is just shouting from the sidelines and does not have any plans, but when it comes to NHS dentistry, her Government have nothing to show for their 12 years of shouting from the centre circle. “Shouting” is a generous description, in the light of the Minister’s refusal even to speak to dentists at the Association of Dental Groups conference just a few weeks ago.

This Government might have a track record of failure, but it does not need to be that way. It is time for meaningful action that will make a difference to patients. I look forward to hearing the Minister’s answers.

[Graham Stringer (in the Chair)]

We are not short of time, but will the Minster leave a minute or two at the end of her speech for the mover of the motion to wind up?

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

It is a pleasure to serve under your chairmanship, Mr Stringer. I thank my hon. Friend the Member for St Ives (Derek Thomas) for securing this important debate—even if it is two days in a row that we have highlighted some of these issues. I thank hon. Members on both sides for speaking on the matter.

I am slightly disappointed in the response of the shadow Minister, the hon. Member for Enfield North (Feryal Clark). In yesterday’s debate, it was acknowledged that in all four nations, no matter who is in charge—whether it is the Labour Government in Wales, the SNP in Scotland, or in Northern Ireland, where the Assembly is still being formed after the election—there are exactly the same problems. In my speech yesterday I made reference to the fact that in Labour-run Wales there has been a 71% reduction in dental activity in the last year. The shadow Minister spectacularly failed to answer the intervention from my hon. Friend the Member for Totnes (Anthony Mangnall) on that very point.

It is important to recognise that, yes, there have been problems since before covid, but covid has dramatically impacted—

[Feryal Clark]

Here we go.

[Maria Caulfield]

The hon. Lady says, “Here we go,” but it is important to recognise that for two years there were no routine appointments available due to infection control measures. We are now back up to 95% of activity, but the backlog that existed before is significantly larger than it was.

It is also important to recognise that the nub of the problem around covid has been the dental contract. The shadow Minister may not have heard what I said yesterday, but we have been negotiating a new contract with the BDA; we started those negotiations on 24 March, a final offer went to the BDA on 20 May, and we are awaiting its response. We have been in negotiations; we have not just been waiting for the work to be done. We expect to make an announcement before the summer recess—I said that both at oral questions last week and in the debate yesterday. We will be making an announcement in the coming weeks on those contract reforms.

Access to GP Services and NHS Dentistry

Feryal Clark Excerpts

Tuesday 21st June 2022 Commons Chamber

[Feryal Clark (Enfield North) (Lab)]

I thank Members from across the House for their contributions this afternoon. I want to praise some of the powerful contributions we have heard during the debate.

My hon. Friend the Member for Sheffield Central (Paul Blomfield) raised the absolutely ridiculously long waiting lists for NHS dentists in his constituency. It is worrying to hear that pregnant constituents cannot even register with a GP, let alone see one. Shockingly, he mentioned the children in his constituency, one of whom has had to wait 35 months to see an orthodontist. He rightly pointed out the issues with the dentist contract, which is disincentivising dentists to take on NHS patients, and reminded us of the last Labour Government’s commitment to reforming it.

We heard from the hon. Member for Waveney (Peter Aldous), who set out the NHS dentistry crisis in his constituency. He rightly set out that many dentists are simply not drawing down on the £50 million Government funding that the Minister says is being used. He set out, in comments I really welcome, the issue of our crumbling primary care assets. I thank him for raising the issue of the NHS app and I could not agree with him more. When are the Government going to move the app into the 21st century? Finally, he mentioned that patient choice is really important. I welcome those comments.

We then heard from my hon. Friend the Member for Lancaster and Fleetwood (Cat Smith), who mentioned the huge number of constituents who are frustrated with their current lack of access to primary care. She mentioned her constituent Dr Mark Spencer, who set up Healthier Fleetwood to tackle health inequalities. I, too, send my thanks to him. She also mentioned that demand is not being met in primary care, and she rightly mentioned the Government’s financial illiteracy, with patients being forced to go to A&E instead of having their demand met in primary care.

On dentistry, my hon. Friend set out how children in her constituency cannot access NHS dentists and the shocking experience of constituents who are resorting to DIY dentistry, as was raised by many hon. Members. She rightly set out that the Government are getting it very wrong. She also set out the Government’s shocking record on GP recruitment and the exodus of NHS dentists. Most shockingly, she mentioned the number of children aged zero to 10 years old who are admitted to hospital for tooth extractions in her constituency in just one year: 30 in Lancaster and 40 in Wyre, of whom 30 were aged five or younger. If that is not a wake-up call for the Minister, I do not know what is.

So many shocking incidents and examples—too many to mention—were raised today, and I thank all hon. Members for sharing their constituents’ experiences. Primary care is in crisis—I know it, Members across the House know it, and the public know it—but the Government continue to bury their head in the sand.

As we have heard from right hon. and hon. Members, our postbags are packed with letters from constituents who are desperate for someone to listen to them. There is the person who cannot get an appointment to be prescribed the medicine they need to manage their chronic pain. There is the person with MS who cannot get an appointment to be referred to a specialist whom they desperately need to see. There are the patients in Wakefield, where every day a child under 11 is taken to A&E for tooth extraction because they cannot see an NHS dentist.

We have heard Ministers come to the Dispatch Box time and time again to lay the blame of primary care’s problems at the door of the pandemic. No doubt, it has had an impact, and we should pay tribute to our amazing NHS staff who have done admirably in the face of an immense challenge, but blaming everything on the pandemic will no longer cut it.

Going into the pandemic, the Government’s preparations were “wanting and inadequate”—not my words, but those of the Culture Secretary. When the argument is not even washing with the Cabinet, how does the Minister expect the public to believe it? After a decade of Tory mismanagement, we went into the pandemic with record waiting lists and staff shortages of 100,000. It is not just that the Tories did not fix the roof when the sun was shining; they dismantled the roof and removed the floorboards. The impact of that became plain for all to see.

The Government promised to recruit an additional 6,000 GPs by 2025, yet we now have more than 1,500 fewer full-time equivalent GPs than when records began in 2015—that was in the Minister’s response to one of her colleagues in April. Given that we have heard from the Royal College of General Practitioners that the average cost of GP appointments is £40 and that an A&E visit is £359, that is not just an access problem but financially untenable. Even the Secretary of State admitted that the target is beyond reach. With a fifth of GP practices having closed or merged since NHS England was formed in 2013, the pattern is becoming clear. The Government have been completely incapable of delivering for more than a decade, creating not a covid backlog but a Conservative backlog.

On dentistry, the situation is a national scandal. Over a third of adults and half of children do not have access to an NHS dentist and, with paying to go private simply not an option for most, we have children being admitted to A&E for tooth extraction on a daily basis and others choosing to take matters into their own hands with DIY dentistry, as we have heard from hon. Members on both sides of the House. In Wakefield, as of 2020, almost a quarter of children have tooth decay before the age of three—double the national average of 11%. How on earth can that be tolerated in 21st-century Britain? Thanks to this Government’s complete inability to come up with a solution, we are not just facing a return to Dickensian Britain; we are already there.

I am sure that the Minister, when she responds, will roll out her usual line about the crux of the issue being the 2006 dental contract, and how this is all Labour’s fault. I am sorry, but after 12 years of Tory Government that simply will not wash. The issue of access is only getting worse, with figures obtained by the British Dental Association showing an overall drop of 22% in the number of patients seen by NHS dentists in England from March to April. In the Minister’s own constituency the figures was 34%. How can she expect dentists across England to have confidence in her when she clearly does not even have the confidence of those in her own patch? If that is not evidence that dentists are leaving the NHS or cutting their commitment, having no confidence that her promised reforms will ever be delivered, then what is? If her idea of tackling the problem is to run scared from even talking to dentists at a conference, then there really is no hope.

This must change. We need a Government who listen. We need a Government who act. Quite frankly, we need a Government who care. This Government have run out of road, have no ideas left and are holding our country back. A Labour Government will give our NHS the staff, equipment and modern technology it needs to deliver for patients. It is time for the Conservative party to move out of the way and let us get on with the job.

Oral Answers to Questions

Feryal Clark Excerpts

Tuesday 14th June 2022 Commons Chamber

[Mr Speaker]

I cannot jump questions; this question is about dentistry so I now call the shadow Minister, Feryal Clark.

[Feryal Clark (Enfield North) (Lab)]

Members across the House have been calling on the Minister to fix the crisis in NHS dentistry, but she seems intent on burying her head in the sand. The Government have no plan, with the Minister running scared from even talking to dentists at a conference last week. Patients are suffering as a result, with a third of adults and half of all children not having access to an NHS dentist. In Wakefield alone, a child under 11 is admitted to hospital every day for tooth decay. Does the Minister agree that the people of Wakefield should bear this in mind next Thursday?

[Maria Caulfield]

I am sure the people of Wakefield are as frustrated as I am that the Labour dental contract, put in place in 2006, is the nub of the problem. If the hon. Lady were to meet with dentists, she would hear loud and clear that the dental contract is causing the problem. [Interruption.] She might not have listened to my previous answers because she is not listening now, but we will be announcing changes before the summer recess.

Menopause

Feryal Clark Excerpts

Thursday 9th June 2022 Westminster Hall

[Feryal Clark (Enfield North) (Lab)]

It is a pleasure to serve under your chairmanship this afternoon, Mr Robertson. I pay tribute to my hon. Friend the Member for Swansea East (Carolyn Harris) for securing the debate. She has gone above and beyond in pursuit of this cause, empowering women across the country to stand up against a system that is simply not working for them. She inspires me and so many others in this place, and I am proud to call her a colleague and a friend.

I thank all Members for their passionate and important contributions, especially those who have shared their experience and the experiences of their constituents. I praise the work of campaign groups such as Menopause Support and Menopause Mandate, which do great advocacy work and provide women with the information and support they need in what are often incredibly difficult situations.

As we have heard from hon. and right hon. Members throughout this debate, too many menopausal women are suffering unnecessarily in silence. This remains a national health scandal. Too many women are still being dismissed and told that menopause is a natural part of life—that they just need to put up with it. That is simply not good enough. Women should not be made to put up with it. I am pleased to say that, seeing the recent campaigns and hearing Members speak today, I am confident that it will not continue for too long.

Change needs to start with ensuring that healthcare professionals are properly informed and have the confidence to give women the advice and treatment that work for them. We know that, at present, that is simply not the case. As we have heard today, women are still being fobbed off and given the wrong treatment. In 2021, Menopause Support revealed that 41% of UK medical schools did not have mandatory menopause education on their curriculum. Healthcare professionals are not adequately trained to give women the right solution and treatment or even to identify menopause in the first place.

When it comes to treatment, hormone replacement therapy is recommended by the National Institute for Health and Care Excellence as a first-line and proven treatment for menopause symptoms, but that is only if patients can get it. We have heard today about the recent shortage of HRT. It is reported that the Health Secretary knew of the shortage as early as October 2021, and yet he did nothing. It took until May—seven months on—for the Government to allow pharmacists to make swaps to women’s HRT prescriptions to deliver the care they need. It took a mass public outcry for the Government to listen to the needs and voices of women. A failure to plan left women unable to access the treatment they so desperately need.

The situation is even worse for black and ethnic minority women, as set out so eloquently by my hon. Friend the Member for Edmonton (Kate Osamor), and I thank her for sharing her personal experience. It is even harder for black, Asian and minority ethnic women to get diagnoses or to be heard. A report by the Fawcett Society showed that 45% of BAME women required multiple appointments for their GPs to realise they were experiencing menopause or perimenopause. I hope the Minister heard my hon. Friend’s helpful suggestions, and that she will do more to ensure that black and Asian women’s voices and experiences of the menopause are heard and that the campaigns my hon. Friend mentioned are recognised.

Menopause is yet another example of women’s health being ignored. In the Government’s own survey on women’s healthcare, 84% of respondents said there had been instances where they had not been listened to by healthcare professionals. In recent years, we have seen a string of healthcare scandals primarily affecting women. The Minister needs to wake up to the fact that women are still not listened to when it comes to health. Let me just some of those scandals: nearly 2,000 reported cases of avoidable harm ands death in maternity services at Shrewsbury and Telford; more than 1,000 women operated on unnecessarily by a rogue breast surgeon, Ian Paterson; and thousands in the UK given faulty PIP breast implants. There is a really long list of health scandals, which indicate that women are still not heard in the health system.

On access to HRT, the Government have delayed changes to prescription charges, leaving some women paying £200 more this year for HRT, making it inaccessible to many women in the middle of a cost of living crisis that is particularly felt by women in BAME and deprived communities, as set out by my hon. Friend the Member for Swansea East. In some communities, HRT is considered a luxury. That is a scandal in the fifth richest country in the world. How can we be in this place? It is disgraceful that women are being priced out of getting treatments that they need while trying to make ends meet.

The recent shortage of HRT, unfortunately, merely adds to the ever growing list. The Government have failed to take meaningful action to improve women’s health. They are a Government of tsars, taskforces and reviews but no action. There is a huge list of reviews that have been commissioned by the Government, the recommendations of which they have refused to fully implement. The menopause taskforce, which my hon. Friend the Member for Swansea mentioned, will run for 18 months and there will only be nine meetings. How will that create meaningful change for women?

I have a lot of respect for the Minister, and I believe she is one of the hardest working Ministers in the Health Department, but she works very hard to act as a gatekeeper for the Treasury. How do we make sure that this taskforce is not yet another example of the Government covering their own back, with no action? The Government had promised their comprehensive women’s health strategy by the end of last year, but it has still not appeared. Waiting lists across the NHS are at a record high, and when it comes to health issues affecting women, the waiting lists for essential appointments are even longer. The Government must start taking women’s health seriously.

We have heard great suggestions about raising awareness of the menopause, including from the hon. Member for Cities of London and Westminster (Nickie Aiken). Making it easier for women to access HRT and improving the education and training of health professionals is essential. That is the only way we will get women across the country the right diagnosis and right treatment at the right time. However, it is clear, sadly, that health continues to be an afterthought for this Government, and the voices of women have been, at best, ignored and, at worst, silenced.

Will the Minister commit to finally publishing the women’s health strategy and listening to women by delivering the healthcare they need, when and where they need it? Furthermore, when will she finally deliver the Government’s commitment to enable women to pay a single annual prescription for HRT? As my hon. Friend the Member for Swansea said: no more warm words—women need the Minister to act. If history tells us anything, it is that women will not sit back in the face of injustice. From what I have heard today, we can be sure that those voices will not go away—they will get louder and louder. I hope the Government wake up and start to act.

Draft Pharmacy (Preparation and Dispensing Errors - Hospital and Other Pharmacy Services) Order 2022 Draft Pharmacy (Responsible Pharmacists, Superintendent Pharmacists etc.) Order 2022

Feryal Clark Excerpts

Monday 6th June 2022 General Committees

[Feryal Clark (Enfield North) (Lab)]

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

It is the first duty of any Government to keep people safe, especially through the safe and secure running of our health service. Pharmacies play a crucial role in our healthcare system across the country, so it is vital that we put measures in place to ensure they are run with the safety of patients front and centre. Any steps that the Government take to do that are to be welcomed and, for that reason, we will be supporting the statutory instrument.

Managing and securing the pharmacy dispensing process is a significant challenge. More than one billion prescriptions were dispensed last year; with numbers like that, it is impossible to completely eradicate all errors. Given the vast numbers of prescriptions being dispensed, the error rate is remarkably low and pharmacists should be applauded for that. However, that does not mean we can sit back and relax, as more can and must be done to ensure patients are protected.

As well as patients, it is right that the statutory instrument looks at the effect on pharmacy staff. Most healthcare professional groups do not face criminal conviction and potential imprisonment for an inadvertent dispensing error, and it would be wrong for pharmacists to be the only group to do so. Therefore, it is welcome that the SI extends legal protections to pharmacists working in a range of locations, such as prisons, hospitals and care homes. Pharmacists working in those settings are often under increased stress, which has been exacerbated by the challenges of the pandemic. The Pharmaceutical Journal recently found there had been an approximate doubling in pharmacists reporting feeling “stressed” compared with previous years.

As they often work in pressured circumstances, it is right that we protect pharmacists, who are often people’s first point of contact with the healthcare system and are too often victims of abuse, from unintended mistakes. Ensuring the right to legal defence against prosecution in cases relating to inadvertent error will undoubtedly remove some of the fears these clinicians feel in admitting errors, helping to prevent and reduce patient harm through taking the wrong medication or dosage.

We welcome the greater clarity that the SI provides about how those legal defences are applied, but we have some concerns. There remain a number of offences that do not have a corresponding statutory defence laid out in the SI. Will the Minister put on record the offences for which no statutory defences are provided and the reasoning behind the decisions about them?

A key facet of the SI is the greater culture of transparency that providing security to pharmacists should hopefully foster, as set out by the Minister. Rather than creating a point-and-blame culture, we need a system that recognises errors in dispensing and preparation of medicines and puts active steps in place to ensure that they are not repeated. It is, however, absolutely right that the SI focuses on inadvertent errors. Where errors are made deliberately through staff acting in a negligent way, they will and must continue to face criminal prosecution—something we fully support.

There are a number of outstanding points that I would appreciate the Minister covering in her reply. There is particular concern about the reporting process for dispensing errors, which at present is at risk of letting too many fall through the gap. Only 5% of dispensing errors made each year are reported, making it very difficult for us to get a proper picture of the potential harm they are causing. Is the Minister therefore concerned that the 2017 legislation designed to increase protections has been largely unsuccessful in encouraging honesty among pharmacy staff? I would be grateful to hear what plans she has to ensure the number of errors being reported increases.

Furthermore, what steps will the Minister take to ensure pharmacists feel safe to come forward if they have made a dispensing error? The people affected by the legislation are often more isolated in their workplaces, without the benefit of a robust and easily accessible professional support network, so I would appreciate it if the Minister outlined how she will ensure that those affected by these changes are properly informed about them.

We are always looking to make further strides in the area of patient safety, and the orders are by no means the end of the road on this issue, but they are a welcome step. I look forward to the Minister announcing further improvements in the area in due course.

Dialysis Care Outcomes

Feryal Clark Excerpts

Thursday 19th May 2022 Westminster Hall

[Feryal Clark (Enfield North) (Lab)]

It is a pleasure to serve under your chairmanship, Sir George. I congratulate the hon. Member for Strangford (Jim Shannon) on securing this important debate and on his continued advocacy on the issue. He is a voice for issues that often do not get enough time in this place.

I thank the hon. Gentleman for sharing the experience of his nephew, Peter, because experiences help to paint a picture of how these conditions impact on real people’s lives. Yesterday, I was delighted to meet two kidney patients, Dale and Tejal, through Kidney Research UK, who told me about their experience of suffering with kidney disease and of dialysis, and about the impact that is having on their life.

I praise the important contributions made by the hon. Members for Rutherglen and Hamilton West (Margaret Ferrier) and for East Lothian (Kenny MacAskill). It is a pleasure to have the Minister in her place. It is the first time we have had an exchange in a debate in Westminster Hall, so I welcome her today.

I pay a huge tribute to the fantastic advocacy undertaken by charities such as Kidney Care UK and Kidney Research UK. They are great champions for patients and will no doubt have been a support to colleagues in their preparation for the debate.

As we have heard, today’s debate is particularly timely, given that tomorrow marks the second anniversary of the law that changed organ donation to an opt-out system. That change has made, and will continue to make, a massive difference for patients with kidney disease and other conditions, and it is right that we recognise that.

In the UK, some 3.5 million people, and rising, are living with kidney disease, so we cannot afford to ignore the issue. We know the debilitating effect that living with kidney disease and undergoing dialysis can have on patients. As the hon. Member for Rutherglen and Hamilton West said, it is not just the disruption that it causes to their everyday lives that we must consider, but the physical and mental consequences of living with a long-term condition.

Unlike treatments for conditions such as cancer and heart disease, treatments for kidney disease, such as dialysis, have barely changed in the last few decades. For patients living day in, day out with the effects of dialysis, that lack of progress is simply not good enough. Research led by Kidney Research UK has shown that new developments in treatment, such as high doses of intravenous iron, can make a real difference to patients.

Sadly, such new developments are not being delivered uniformly across the UK, leading to the kind of postcode lottery that affects so many long-term conditions. It is no surprise that those who are already the most vulnerable are the worst-off when it comes to being able to access treatment at home. The hon. Member for Strangford highlighted that point, and we place further emphasis on it because of the stark health injustice facing people in this country. The rate of patients receiving at-home treatment was almost 23% in the most affluent areas of England, compared with 15% in the most deprived areas.

We know that people from lower socioeconomic groups are more likely to develop and die earlier from chronic kidney disease. We also know that when people from those groups experience kidney failure, they have poorer survival rates on dialysis and fewer are treated with peritoneal dialysis. That inequality extends to lower rates of kidney transplants and increased rates of transplants being affected by episodes of rejection.

Those inequalities are stark and cannot and should not be tolerated. We can and must do more to ensure that everyone, regardless of their background, can access the treatment that works best for them, including being able to dialyse at home. For too many people, at-home dialysis is just not an option.

People with chronic kidney disease, for which there is no cure, already experience financial difficulties because of barriers to employment and additional costs of disability. With utility bills soaring, people have to shut off their heating or skip meals just to be able to afford to continue their vital treatment, as colleagues have mentioned. Figures from Kidney Care UK show us that the additional cost for a dialysis patient doing five overnight sessions a week is £1,454. That was before the energy price cap increased in April. As hon. Members have already set out, that is a stark increase in bills. Energy prices are already soaring and are set to rise even further when the cap rises again in October. What assurances can the Minister give to dialysis patients who face those added pressures that they will be protected from the cost of living crisis, here and now? Some 30,000 people in the UK rely on dialysis to stay alive. They cannot afford to wait.

Just yesterday at Prime Minister’s questions, we heard the Prime Minister reassure patients that the NHS is responsible for covering the costs for at-home dialysis patients. Sadly, that simply does not chime with the experiences of dialysis patients up and down the country. Although the NHS service specification advises that NHS trusts reimburse the additional costs of home dialysis, reimbursement is inconsistent across the country. Many patients receive no or very little financial support to pay for the additional costs of carrying out treatment at home. Some do not even have the luxury of having the option of a reimbursement scheme discussed with them; they are simply left to fend for themselves.

There are some wonderful charities supporting patients living with kidney disease and on dialysis. The work they do to support patients is incredible and invaluable. Kidney Care UK handed out more than half a million pounds-worth of grants to patients and their families in 2021. In that time, they saw a rise in demand of 47% for their immediate hardship grants of £300. Patients are having to rely on charities to be able to fund their bills to pay for treatment, because the Government are not implementing their own policy properly. This is simply not acceptable and it must be changed.

Millions of our disabled, elderly and vulnerable neighbours are at the sharp end of this crisis. They simply cannot afford to live with dignity. Many are living through this nightmare, feeling like they have been totally abandoned by the Government. Labour’s plan for a windfall tax on oil and gas companies would take up to £600 off household energy bills and put it back in people’s pockets. I am sure the Minister will have heard yesterday, and many times before, that that will make a real difference to people on dialysis. It will make a difference now.

Many Ministers have been asked this, but I am asking the Minister today: will she back Labour’s plan for a windfall tax? Patients on dialysis deserve better security and the respect of the support they are entitled to. It is time for the Government to deliver. I look forward to hearing the Minister’s response.

[The Minister for Care and Mental Health (Gillian Keegan)]

It is a great pleasure to serve under your chairmanship, Sir George. I would like to begin by thanking the hon. Member for Strangford (Jim Shannon) for securing a debate on this important issue and for his kind words.

I heard his impassioned case for improving outcomes for patients receiving kidney dialysis treatment. I also appreciate how kidney health is an issue of personal importance to the hon. Gentleman. It was very moving to hear the story of his nephew, Peter, who required a kidney transplant and happily got one when he was 16, after being born with posterior urethral valves. The hon. Member for East Lothian (Kenny MacAskill) mentioned how important it is in this place to share those stories. It really brings the debate to life. It shows why we are here, and why this matters.

We heard other moving stories from across the House. We heard about the stresses and strains that chronic kidney disease and dialysis treatment put on lives. We heard about Billy McIlroy and David Johnson from the hon. Member for Strangford, and about Dale and Tejal from the hon. Member for Enfield North (Feryal Clark). They spoke about the impact the treatment has on the lives of those around the patients. I would like to thank all Members for giving those patients a voice and making their stories real to us all.

I also recognise the fantastic work being done by charities, including Kidney Care UK, Kidney Research, the National Kidney Federation and the Polycystic Kidney Disease Charity, on behalf of people living with chronic kidney disease and their families. They are ensuring that issues such as those covered today are kept at the forefront of our thinking. That is why such debates are so important. I would particularly like to commend those charities for their recent work supporting World Kidney Day, which raised awareness of the issues faced by those with chronic kidney disease. I also commend Kidney Care UK’s campaign on the impact of the rise in energy costs on those who undergo dialysis at home. It is a very important matter.

I would like to reassure the hon. Member for Strangford that the Government remain absolutely committed to improving both access to and the quality of dialysis treatment that many kidney patients across the UK depend on, in particular to ensure that treatment at home is available to those for whom it is suitable, which we heard about today. The Government are working closely with NHS England to implement the renal services transformation programme, which was commissioned in September 2021, following specific recommendations published in Getting It Right First Time’s national report on renal medicine mentioned by the hon. Member for Strangford.

The aims are to reduce unwarranted variation in both the quality and accessibility of renal care, which the hon. Gentleman mentioned. One of the key priorities of the transformation programme is to increase the provision of home dialysis, with the aim of increasing the percentage of patients per renal centre receiving home therapies to 20% in each renal centre. That target of 20%, which was mentioned, is still in place, but several centres have actually exceeded that target and gone beyond 30%.

However, the Government acknowledge that there is a concentrated drive within the renal community for increasing access to at-home dialysis treatment, and for good reason. We heard some of those reasons. Home dialysis has the potential to deliver significant benefits for patient experience and outcomes, giving patients both flexibility and autonomy in their treatment. By investing in home dialysis so that patients do not need to make long and disruptive trips to hospital for regular treatment, local systems will be able to deliver better experiences and outcomes for patients and reduce spending on the transportation of patients to hospital dialysis centres. That makes sense, and we will of course ensure that those services are available to all people from all backgrounds. It is very important that they are equally available across the country.

A range of guidance, produced by the National Institute for Health and Care Excellence, is available for commissioners and clinicians to support patients’ access to home dialysis treatments when appropriate for the individual. Patients and their family members or carers should be involved in the decision-making process, alongside healthcare teams, when considering treatment options, and should be offered regular opportunities to review their treatment and discuss any concerns or changes in preferences. That includes a choice of at-home or in-centre dialysis modalities to ensure that the decision is informed by both clinical considerations and patient preferences.

In support of that, NHS England has set up 11 renal clinical networks, which are working closely with integrated care systems to determine local priorities. Providers of renal services, ICSs and regional commissioners will continue to monitor uptake of home dialysis via the UK renal registry and NHS England renal datasets. The transformation programme has also appointed a national clinical adviser specifically for dialysis, to develop and share best practice. The programme will provide recommendations to all renal services to support achieving the 20% prevalence rate.

The Government know that the impact of rising energy costs is a concern for many. I share the concern, raised in today’s debate and by patient charities, that those undergoing dialysis treatment at home may be particularly vulnerable to the impact of rising costs due to the high energy consumption of the dialysis machines that they rely on for their treatment.

I am pleased to be able to provide reassurance, as the Prime Minister did in PMQs yesterday, that provisions are already in place for patients receiving haemodialysis treatment at home to be reimbursed for additional direct energy costs as a result of their treatment. The arrangements are outlined in the “Haemodialysis to treat established renal failure performed in a patient’s home” service specification, and the NHS meets those additional direct utility costs through the payment of the national tariff to the patient’s usual dialysis provider.

There is no national policy on determining the amount to be reimbursed to patients, with costs to be agreed between the provider and the individual based on the amount of energy used and charged. However, the amount reimbursed is expected to match increases in the patient’s utility tariff. We fully expect providers of at-home dialysis services to inform patients about that financial support available to them, and I have asked my officials to keep me informed about rates of reimbursement over the coming months, to ensure that the policy is working well. I would also be delighted to meet with the APPG, where we can discuss this further and ensure that that progress is being made.

NHS England is working closely with renal networks to support consistency of approach regarding the reimbursement arrangements. That work has already commenced, with NHS England providing clinical networks with examples of formulas to calculate electrical outputs from dialysis machines to support that reimbursement for patients. Examples of good practice in supporting utility costs from dialysis centres have also been shared across renal networks during April 2022, so very recently.

NHS England has also agreed to communicate directly to all commissioned providers of home dialysis, and renal clinical networks, to remind them of the reimbursement arrangements within the adult service specification and that they should proactively alert eligible patients to the arrangements.

The hon. Member for Strangford also mentioned support for children on home haemodialysis.

[Feryal Clark]

I thank the Minister for giving way. The issue with a lot of the reimbursements is that renal patients are having to wait months—three or four months, in some cases—for that reimbursement. They are being treated as if they are a company that has put in a claim to the trust. Will the Minister ask NHS England to look into that and see if it can reduce that wait, or have a set time, so that people are not having to wait three or four months to be reimbursed? In this cost of living crisis, they need the cash back in their pockets quickly.

[Gillian Keegan]

The hon. Lady makes an important point. Hopefully the best shared practice includes that reimbursement should be paid very quickly. Clearly, the billing systems that are in place across the various providers will differ. It is important to state that best practice when it comes to reimbursement is to do it as quickly as possible.

We were talking about home hemodialysis support for children. That applies to about 20 children, as of February 2022, and it is currently at the discretion of individual providers. However, the renal service clinical reference group has begun an urgent review of the reimbursement process for children. Hopefully that will give some comfort to the hon. Member for Strangford.

If people with chronic kidney disease and their families need further information, there are a range of resources available on the excellent Kidney Care UK and National Kidney Federation websites, including information on treatment options, financial support and other support services to help people live well. NHS England will continue its work with those charities and others to engage their support in promoting awareness of reimbursement options available for those on home hemodialysis. In terms of wider ambitions, the renal services transformation programme is developing optimal pathways, tools and resources that will transform the delivery of renal services across England. That will support better healthcare outcomes for patients undergoing dialysis treatment, and provide integrated care systems with a whole-patient pathway approach to commissioning renal services.

The hon. Members for Rutherglen and Hamilton West and for Enfield North both mentioned the importance of providing suitable mental health support for dialysis patients. The Government acknowledge that this is very important. There can be a detrimental impact on an individual’s mental health when undergoing complex dialysis treatment. To address that, the national adult renal services transformation programme has identified psychosocial support in renal services as a key theme for improvement. Work is being taken forward with clinicians, patient representatives and other subject matter experts to identify best practices that can support patients’ psychosocial needs, as well as the steps that are needed to spread those best practices. Those suffering with renal issues can also access mental health support via self-referral to Improving Access to Psychological Therapies, which the Government have invested £110 million in to expand access.

As the hon. Member for Strangford is aware, health policy is a devolved matter, and I understand that there are different arrangements for Northern Ireland, although commissioners and trusts remain equally committed to excellent care and better outcomes. The transformation programme has established a multi-agency programme board with representation from key stakeholders, including regional commissioners, patient charities and relevant national bodies, to ensure that a full range of views are considered. It has also established five expert-led multi-disciplinary clinical workstreams, including work- streams on improving access, identifying best practice and developing solutions in chronic kidney disease. All transformation programme workstreams intend to make key deliverables available by April 2023. That will include documentation outlining best practice, a data dashboard outlining key metrics to support better decision making, and support for the review of the renal service specification led by NHS England’s renal clinical reference group.

I was asked earlier what the Government are doing to fund research into kidney conditions and their treatment. We are committed to supporting research and funding it through the National Institute for Health and Care Research. For the financial years 2016-17 to 2020-21, the NIHR spent £113.2 million on kidney research. That research includes kidney disease, but also explored why people with kidney disease are at an increased risk of death and disability following a heart attack, the relationship between covid-19 and kidney disease and whether aspirin reduces the risk of major vascular events in patients. There is a full research programme ongoing.

Once again, I extend my continued gratitude to all charities working to support improved outcomes for people with chronic kidney disease. We are very happy to continue to work with them; we all have the same objective.

Finally, I thank the hon. Member for Strangford for securing the debate and giving me the opportunity to promote the vital schemes that are available to support patients with chronic kidney disease, to make sure people know what is coming next and are aware of the financial support available to them, and to outline the strong programme of work we are undertaking across the country to transform these services. I urge all patients receiving dialysis at home to speak to their provider so that they receive the full NHS support they are entitled to through their care.

Oral Answers to Questions

Feryal Clark Excerpts

Tuesday 19th April 2022 Commons Chamber

[Maria Caulfield]

My right hon. Friend is right. Health Education England is addressing the overall system of where dentists are training and where the gaps in provision are filled in its “Advancing Dental Care” review. It is also working with commissioners at a local level to develop more opportunities in those places that we term dental deserts, where there is currently a lack of provision.

[Feryal Clark (Enfield North) (Lab)]

NHS dentistry is in crisis. Patients are stuck with either a never-ending wait for an NHS appointment or footing the bill for going private, which is simply not an option for most families suffering rising bills and taxes. With a third of the population experiencing untreated tooth decay, when will this Government, who have had 12 years to do so, finally come up with some practical solutions that put patients’ needs first, rather than the half-baked, unworkable ideas we have heard to date?

[Maria Caulfield]

I am sorry to the hear that tone from the hon. Lady. We are working under Labour’s 2006 dental contract, and she may have missed that dentists were unable to offer any routine care during the pandemic over the last two years, which we have slowly worked up to 95% of usual activity. She may want to play politics with this issue, but perhaps she should speak to her Labour colleagues who run the NHS in Wales, where 6% of dental posts were lost last year. She should get her own side in order before lecturing this side of the House.

Ockenden Report

Feryal Clark Excerpts

Wednesday 30th March 2022 Commons Chamber

[Feryal Clark (Enfield North) (Lab)]

Thank you, Mr Speaker, and I thank the Secretary of State for advance sight of his statement. I am pleased to respond today, not just as the shadow Minister for patient safety, but as a woman and a new mother. I thank Donna Ockenden and her team for the report. I also thank the families who have come forward; we would not be here today without the persistence and resilience that they have shown for more than 20 years in their fight for justice.

Today marks an important milestone for hundreds of families who have been seeking justice. The Ockenden report lays bare the harrowing truth of what those families had to face and why their fight for justice has been such a fierce one: cries for help going unheard; parents having to try to resuscitate their children because there was no one there to help; and women and babies dying needlessly because they simply were not listened to.

The fact that women were silenced and ignored at their most vulnerable, when they were relying on the NHS to keep them safe, is shameful. No woman should have to face not knowing, when she goes into hospital to give birth, whether she and her baby will come out alive. These were not one-off or isolated incidents of negligence. This was the institutional failure of a system that failed to take up many opportunities to realise that it had a serious problem. We are where we are today because of the persistence and resilience of those families and their refusal to give up the fight to expose those failings. The only comfort we can offer them is that their voices have been heard, and that we are committing today, across this House, to ensuring that those failings are never repeated.

For far too long, patient safety issues and the voices of women have been an afterthought in health; that has led to the kind of crises that we saw in Shrewsbury. This needs to change. Patient safety must be a priority for health professionals and Ministers, so I welcome the fact that the Secretary of State has today committed in full to ensuring that the local actions for learning are taken by Shrewsbury and Telford Hospital NHS Trust, and to all the immediate and essential actions in the wider system that are recommended. Will the Secretary of State come to the House later this year to update us on the progress of those actions? The report makes it clear that a safe service cannot be run without a culture of transparency and accountability, so will he set out how he intends to ensure an open culture in the health service with a willingness to learn within maternity services and identify future failings far more quickly?

Underpinning issues in maternity care, as is the case across so much of our NHS, is workforce. Only 10 months ago, as a first-time mother, I experienced just how stretched to the limit maternity services are. The NHS is now losing midwives faster than it can recruit them. A recent CQC survey shows that almost a quarter of women were unable to get help when they needed it during labour. Hundreds of pregnant women were turned away from maternity wards last year because staff were not available to care for them. What is the Secretary of State doing to ensure that the NHS recruits the midwives it needs? What is he doing to keep the midwives we have in post?

It is only with the necessary workforce that the NHS will be able to ensure that women receive care that meets their needs and prioritises their safety. That security and respect is all that the families who suffered so much at Shrewsbury want, and it is all that the women who put their own and their babies’ lives in the hands of the NHS want.

Draft Commissioner for Patient Safety (Appointment and Operation) (England) Regulations 2022

Feryal Clark Excerpts

Monday 14th March 2022 General Committees

[Feryal Clark (Enfield North) (Lab)]

It is a pleasure to serve under your chairmanship, Dr Huq. Although the Labour party welcomes the provision that the statutory instrument makes for a patient safety commissioner, and we will support it, we have a number of concerns. Keeping people safe should always be the first priority of any Government, and healthcare is no different. When people, often at their most vulnerable, put their trust in the hands of healthcare professionals, they rightly do so with the expectation that their safety will be of paramount concern. Sadly, on far too many occasions that has not been the case. Not only has patient safety been an afterthought, too often, where incidents have occurred patients have been made to jump through hoop after hoop in their fight for justice. Too many people are still having to take up that fight for justice, and it is for them we must speak out.

I know that there are many champions of this issue here and in the other place. I pay particular tribute to the passionate and determined work of Baroness Cumberlege. Her report has been a landmark in the fight to improve patient safety, and thanks to her vital work we have made the progress that brings us here today. I also praise the work of a number of campaign groups in this area that I have had the pleasure of meeting in recent months. Whether it be on sodium valproate, Primodos or surgical mesh, they have stood up on behalf of thousands who have suffered because patient safety has not been taken seriously enough. Their unwavering determination is truly admirable, and I look forward to working with them as they continue their fight to ensure that patient safety is not treated as an afterthought.

Despite the fight of so many to improve patient safety, the Government continue to lag far behind where we can and must be. The Cumberlege review has given hope to thousands who have gone through decades of pain and suffering; however, it cannot remain as another review that sits gathering dust on the desks of Ministers. While we support the steps taken today, where is the progress on the remaining recommendations of the Cumberlege review? The Government cannot take a pick-and-mix approach to patient safety. Unless reform is viewed as a whole package, patients will not see the speed and breadth of progress that is urgently needed.

An independent patient safety commissioner will take steps to ensure that patient safety is a top priority and will act as a voice for all those who have suffered for far too long. It will be a crucial step in ensuring that the entire health care sector is responsive to the steps that need to be taken and listens properly to the voice of patients; however, there remain a number of questions for the Government to answer on the function of the role, and how it will deliver the change that we need. The role cannot simply be a token gesture to those campaigners who have given so much; it must be a fierce champion of patients, willing to speak truth to power.

A particular concern raised by Baroness Cumberlege is the tenure of the commissioner being three years, as the Minister and the right hon. Member for East Yorkshire mentioned, rather than five years as for similar roles such as the Children’s Commissioner. As it is a new role, and we have to get an organisation up and running, I share the concerns that such a short period is setting the commissioner up to fail. I would be grateful if the Minister outlined how the decision on length of tenure was reached and what further provisions will be made to avoid a revolving door of commissioners. She mentioned an additional three years, but I would like to hear more about that.

We welcome the obligation on the commissioner to lay an annual report before each House of Parliament; however, the additional obligation for the commissioner to publish a business plan at the start of each year is not mentioned within the obligation to publish an annual report. What would be the purpose of the commissioner providing a business plan if they were not held accountable for its contents? Can the Minister therefore outline what accountability functions will exist to ensure that the commissioner delivers on the plans that they will set out? I would also like to hear what opportunities will be available for Parliament to scrutinise the contents of the report when published.

Lastly, I will focus on the provision for the advisory panel, which will

“provide the Commissioner with advice and assistance...and encourage good practice in involvement with patients.”

The SI goes on to state:

“The advisory panel must consist of persons who…represent a broad range of interests which are relevant to the Commissioner’s functions.”

In this instance, the clue is in the name: the patient safety commissioner. For statutory patient representation not to be embedded within the advisory board is simply not good enough. It is the lack of patients’ voices that has led to many of the scandals that we have seen, and the breakdown of trust for many.

For patients’ voices to have been an afterthought once again for the Government does not bode well for the future, so what reassurances can the Minister give to patients that the role will do what it says on the tin, and be a commissioner for patients? Although the SI has our support, the Government must not see this as the end of the road. Patients will continue to make their voices heard, and I will not stand for anything less than a commissioner who will put them and their safety at the forefront of the Government’s approach to healthcare.