Chronic Obstructive Pulmonary Disease

Gillian Keegan Excerpts

Wednesday 17th November 2021 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Ms Nokes, for the first time. I add my thanks and congratulations to the hon. Member for Weaver Vale (Mike Amesbury) on securing this debate, particularly on World COPD Day. We very much appreciate his support for the taskforce for improving lung health. It was also a pleasure to hear hon. Members’ contributions to the debate, and I will try my best to answer their questions.

The Government are dedicated to supporting those with chronic obstructive pulmonary disease, or COPD, which is a lot easier to say. In the last 10 years, we have rolled out guidance and initiatives to support and improve this area.

In 2011, a Department of Health outcomes strategy for COPD and asthma set out a proactive approach to early identification, diagnosis, intervention, proactive care and management at all stages of the disease. A wrong diagnosis will result in patients not getting the care they need, as a number of Members mentioned. That is why in 2013 a guide to performing quality-assured diagnostic spirometry was produced by the NHS, with several charities and other stakeholders. The guide was published to support accurate diagnosis of respiratory conditions and tackle the effects of misdiagnosis.

The national asthma and COPD audit programme was launched in March 2018. Led by the Royal College of Physicians, it aims to improve quality of care, services and clinical outcomes for patients with asthma and COPD by collecting and providing data on a range of indicators. As part of the national COPD audit programme, NHS England and NHS Improvement have developed a best practice tariff for COPD. The tariff is applicable to hospital trusts, in order to promote best practice and ensure improvements in care. Best practice will be considered to have been achieved when 60% of patients admitted for an exacerbation of COPD receive specialist input to their care within 24 hours of admission, and where COPD patients receive a discharge bundle before actually being discharged.

The NHS long-term plan sets out the NHS ambition to improve access to treatments for COPD patients. A date was requested by the hon. Member for Strangford (Jim Shannon). As part of the long-term plan, access to pulmonary rehabilitation will be expanded by 2028. Pulmonary rehabilitation, an exercise and education programme, is one of the most effective treatments for COPD, with 90% of patients who complete the programme experiencing improved exercise capacity or increased quality of life. By expanding pulmonary rehabilitation services over 10 years, 500,000 exacerbations can be prevented and 80,000 admissions avoided.

[Ruth Jones]

I take the Minister’s point about pulmonary rehabilitation being so important—an integral part of the management of these long-term chronic conditions—but 10 years is a long time. People need help now, so what is she thinking in terms of immediately putting into place the extra staff and resources required for pulmonary rehab?

[Gillian Keegan]

I will come to that, and I will also come to the questions about recovery and catch-up, which a number of people mentioned.

To increase access to pulmonary rehabilitation, a population management approach will be used in primary care to find eligible patients from existing COPD registers who have not previously been referred to rehabilitation. New models of providing rehabilitation to those with mild COPD, including digital tools, will be offered to give support to a wider group of patients with rehabilitation and self-management support.

The use of COPD discharge bundles, where appropriate, will also help to increase referrals to pulmonary rehabilitation, and the NHS long-term plan will build on a range of existing national initiatives focused on respiratory disease. The quality and outcomes framework, or QOF, ensures that all GP practices establish and maintain a register of patients with a COPD diagnosis, and the QOF for 2021-22 includes the improved respiratory indicator, including the recording of the number of exacerbations and assessments of breathlessness, and an offer of referral to PR.

NICE quality standards have been published, with the aim of raising the standard of care that those with COPD receive. The NHS RightCare Pathway for COPD is being rolled out nationally. This pathway defines the core components of an optimal service for people with COPD, and it includes timely access to PR as part of the optimal treatment pathway. It provides resources to support local health economies, and the pathway also concentrates improvement efforts on addressing variation and population health.

At the beginning of the pandemic, NICE published rapid guidance on COPD, which outlines how to communicate with, treat and care for patients suffering from COPD. It also outlines how healthcare workers should modify their usual care and service delivery during the pandemic.

[Derek Twigg]

I am listening carefully to what the Minister is saying, but one of the problems that I referred to briefly in my speech is that of being able to see a GP—not necessarily just for diagnosis, but when someone becomes ill. I wonder how she can square that circle in terms of what has been put in place, if people cannot get to see a GP in person in the first place.

[Gillian Keegan]

Of course, access to GPs’ services is a concern that all Members will have heard a number of their constituents raise. That is why we put in place £250 million to increase access to face-to-face GP appointments as part of the recovery plans, which are quite extensive for the NHS.

The guidelines I was talking about aim to highlight ways to support people with COPD, such as signposting charities and support groups for better health and wellbeing. They recommend using technology to reduce some in-person appointments, while making sure not to provide a service that would increase health inequalities through a lack of digital access—it is additional, not instead of—as well as offering advice on how to modify care during the pandemic.

A number of questions were raised about the recovery plan, and how to restore services for patients and restore the diagnostics to pre-pandemic levels, or above them. The 2021-22 priorities and operational planning guidance set the priorities for NHS England and NHS Improvement, and includes tackling the backlog for non-urgent treatment such as services for lung disease patients. That plan aims to stabilise total waiting lists, and eliminate waiting times of two years or more and the increase in waiting times of more than one year. We have made £1.5 billion available to assist local teams to increase their capacity and invest in other measures to achieve those priorities, and the 2021 spending review announced £2.3 billion to increase the volume of diagnostic activity and open community diagnostic centres to provide more clinical tests, including for patients with lung disease.

Targeted lung health checks are running in the parts of the country with the highest rates of mortality from lung cancer. However, those projects will not just identify more cancers, but pick up a range of other health conditions, including COPD. People aged between 55 and 74 who have ever smoked are now offered a free lung health check closer to where they live. They may then have a lung cancer screen scan if that check shows that they need one. A review undertaken by Professor Sir Mike Richards highlighted that patients with respiratory symptoms would benefit from community diagnostic centres, due to the number of diagnostic tests that will be made available. As well as supporting patients with COPD, the Government are committed to strategies that will help to prevent that condition, as a number of Members have mentioned.

[Jim Shannon]

Just for clarification, following on from the question that the hon. Member for Halton (Derek Twigg) has asked, does the Department of Health proactively—perhaps even aggressively—contact smokers to follow through, rather than those smokers contacting the health service? I am not sure whether that would always happen. What is the Government’s policy on that?

[Gillian Keegan]

Obviously, there would be a relationship between the GP and the smoker, but that can go either way. Anybody who is in those age groups needs to be made aware that they are entitled to this free lung health check, and it is the responsibility of us all to make sure those checks are available. I am sure we will all ensure that that is understood.

In 2019, 85% of deaths due to COPD were attributable to smoking, and in 2019-20, 84% of hospital admissions with COPD were attributable to smoking. The proportion and the number have remained quite similar over the past five years, and as has been mentioned by a number of hon. Members, smoking is a key factor in many cases of COPD. This Government are committed to reducing the harms caused by tobacco, and have made good long-term progress in reducing smoking rates, which are currently 13.9%, the lowest on record. However, with 6.1 million smokers in England, tobacco is still the single largest cause of preventable mortality, and a radical new approach is needed to address the stark health disparities associated with tobacco use. As such, we have set out the bold ambition for England to be smoke free by 2030. To support that ambition, we have announced the publication of a new tobacco control plan, which will include an even sharper focus on tackling health disparities and will support the Government’s levelling-up agenda.

The NHS long-term plan commits to delivering NHS-funded tobacco treatment services to all inpatients, pregnant women and people accessing long-term mental health and learning disability services by 2024. COPD is responsible for around 33% of annual deaths from respiratory diseases and is the single largest cause of occupational lung disease. There are an estimated 17,000 annual new cases of self-reported, work-related breathing or lung problems, which is why our colleagues in the Department for Work and Pensions are also helping to tackle the causes of COPD in the workplace.

[Liz Twist]

I thank the Minister for recognising that a proportion of COPD cases are caused by work-related issues, which will of course affect the north and the north-east most of all because of their industrial heritage. I assume she will tell us what steps the Department will be taking to pursue that.

--- Later in debate ---

[Gillian Keegan]

Yes, indeed. In fact, one of my own family members—my uncle—has COPD and has never smoked. As we are from the north-west, it is likely to be due to his workplace conditions.

Tackling occupational respiratory disease remains one of the Health and Safety Executive’s health priorities, and the aim is to reduce the number of new cases of occupational-related lung disease. To help achieve that, HSE focuses its inspection and enforcement activity where it can have the most effect. It continues to work with a broad range of partners to extend its reach and raise awareness of the need to prevent exposure. HSE’s WorkRight campaign, which includes occupational lung disease, uses communication and social media channels to promote the benefits of good health and safety, and a range of initiatives are being undertaken to support reducing mortality rates among patients with lung disease—for example, HSE undertook interventions in 2019-20 to address the carcinogenic risks from welding fume exposure.

I hope that what I have set out answers the many questions that right hon. and hon. Members had, but clearly it is work in progress. We are working hard to ensure that COPD care improves for all, as outlined in the NHS long-term plan, and that people have access to the very best care available.

Randox Covid Contracts

Gillian Keegan Excerpts

Wednesday 17th November 2021 Commons Chamber

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

I am grateful to the Opposition for using today’s debate to raise such an important matter. I welcome the opportunity to debate it and to introduce a few facts.

We have risen to meet the greatest public health challenge in a generation, by working together. Whether it is the NHS, Government, academia, industry, the Army or, indeed, the British people, we have all had our part to play. That has meant that, today, we have given over 110 million life-saving vaccine doses and are now rolling out the booster programme. We have launched game-changing treatments such as dexamethasone and Ronapreve and, of course, built the largest testing infra- structure in Europe, with the new-found ability to test millions of people in a single day.

[Dawn Butler]

Why did we not use the infrastructure that existed when we were building the system?

[Gillian Keegan]

That is a very good question and one that I myself have asked. It is important to look at what we actually did. The equipment we had was in universities, and some of it was in NHS labs, but they did not have the scale that we needed, so we all worked together in what they call the triple-helix partnership: universities, the NHS and industry worked together to build and scale up to the level we needed. If you remember, there was discussion at the time about moonshot testing; you all laughed, as you always do because you do not have to deliver, but we delivered it. We delivered the moonshot.

[Chris Elmore]

On a point of order, Mr Speaker. I would be grateful for your guidance. The Minister keeps referring to the House as “you” which, I am pretty sure you will be aware, is used to addressed you, Mr Speaker. It is not you who has been dealing with contracts; it is the Government, and not Opposition MPs.

--- Later in debate ---

[Mr Speaker]

Thanks for that. What I will say is that I take no responsibility for the letting of these contracts, and nor do I wish to. I thank the hon. Gentleman, but I was letting things flow because, in fairness to the Minister, she is defending an impossible position. In fairness, when someone gets a bad hand, at times it is best to let them go on.

[Gillian Keegan]

I am feeling my luck, Mr Speaker.

[Dawn Butler]

May I clarify that, first, the Government did not actually deliver the moonshot, and secondly, that in the end the £100 billion for private companies was diverted to local councils and authorities, which were the ones that delivered the vaccination roll-out, with the help of the NHS, which is a socialist endeavour? I caution the Minister not to twist the truth.

[Mr Speaker]

Order. I am sure that no Member would twist the truth.

[Gillian Keegan]

The hon. Lady asked me about testing, which is what I answered on. Her question was about testing.

Let me move on—

[Mr Sheerman]

Before the Minister moves on too much, may I make a quick intervention? I know she has a tough job today.

[Gillian Keegan]

I do not mind; I am happy to take an intervention from the hon. Gentleman.

[Mr Sheerman]

Does the Minister accept that none of us on the Opposition Benches would fault anything done by the wonderful team and the effort that went into finding and developing the vaccine? We believe all that was wonderful; the problem is what came out about the equipment contracts and the testing contracts. It can be done above board and brilliantly, and it was in the production of a vaccine, but it was not in the other endeavours. That is what we are trying to say. I know the Minister is going to keep going on about the vaccine—

[Mr Speaker]

Order. The hon. Gentleman is not being fair. As he reminded us all earlier, he came to this place in 1979, so he knows the rules, and no rule is more apparent than that interventions have to be brief and not speeches. If he wants to speak, I am happy to put him on my list. He should not use up all his words just yet.

[Gillian Keegan]

I will use a few words to answer the hon. Gentleman’s question. We are in the position we are in today because of the countless powerful partnerships we have built. If we cast our minds back to less than two years ago, we faced a far more uncertain picture. SARS-CoV-2, which later became known as covid-19, had no known treatment and no vaccine, and we had little to no ability to test for it. It was spreading through the world at unprecedented speed, causing unprecedented death and widespread despair. I am sure that Members, when given a moment to pause and reflect, can recall just how they felt as they saw those harrowing pictures, first in Wuhan and later in the hospitals of Italy and Spain. With grim foreboding, we saw this very unfamiliar virus heading to our shores.

[Several hon. Members rose—]

--- Later in debate ---

[Gillian Keegan]

I will give way to hon. Members, but if they want to hear some of the facts, of which I have lots, I am happy to get on with my speech. I will give way to the hon. Member for Kingston upon Hull East (Karl Turner) on this occasion.

[Karl Turner (Kingston upon Hull East) (Lab)]

I am grateful to the Minister for giving way. She has been given a terribly tough gig, but she does not seem to be answering the point made a little earlier. Arco in Hull had existed for 135 years and had supplied the NHS with top-quality products since its very inception. It was blocked from the VIP lane—why?

[Gillian Keegan]

As I said, I would like to get on to answering some of these questions, so if Members will bear with me and let me get my speech out, I will have time to answer further interventions.

The context in which we were operating was the fear that we would run out of vital testing equipment, that we would not have the capacity to test people for covid and that, as a result, this deadly virus would continue to pass from person to person, overwhelm our national health service and cause untold devastation. It is the duty of any responsible Government to do all they can to prevent such a grim outcome, to save lives, to protect our key workers and to partner with as many people as are available with the experience and expertise to get things done. So we engaged with many thousands of businesses, large and small, from all over the country and all around the world, to set out what we needed and find out what they could do.

Randox has been globally recognised in the in vitro diagnostics industry for nearly 40 years. It is a British business with roots in Northern Ireland and a history of developing diagnostics solutions for hospitals, clinical settings and research labs. Even as early as March 2020, Randox had lab-based polymerase chain reaction testing capacity for covid-19. Against the fears that we would not have enough testing capacity, we worked with companies with existing diagnostic capability—that is just plain common sense.

[Several hon. Members rose—]

[Gillian Keegan]

As I have said, I would like to press on. I know that Members are very keen to get my words —[Interruption.] My words are correct.

As I was saying, this was against the fears that we would not have enough testing capacity. Members must remember those days. We all knew it. We saw it on the news every single night. So we worked with the companies that had existing diagnostic capabilities, and that is just plain common sense.

[Several hon. Members rose—]

[Gillian Keegan]

I will not give way until I get some facts out, so can hon. Members please bear with me?

Moreover, working with Randox made sense with respect to our cross-UK efforts against covid-19, giving us the ability to use the existing facilities in Northern Ireland for the benefit of the whole United Kingdom. Initial contracts with Randox were procured under regulations that allow us to marshal goods and services with extreme urgency in exceptional circumstances, and these were extremely exceptional circumstances, Mr Speaker. There is no question but that Randox played its part. The initial challenge that it faced was the challenge facing Governments the world over: a shortage of machinery and transport. None the less, it quickly overcame them to play a critical role in our pandemic response.

An independent assessment in June 2020, which the hon. Member for Brent Central (Dawn Butler) might like to read, found that Randox was ahead of all other labs in terms of its process, its plans and its reporting, so a six-month extension was agreed in September 2020. By March this year, Randox was actually exceeding its contract target—

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

Will the Minister give way?

[Gillian Keegan]

I will get the target out and then I shall let the right hon. Gentleman intervene.

The target that Randox exceeded, which was its contract target, was processing more than 120,000 tests in a single day.

[Jonathan Ashworth]

I am grateful to the Minister for running through the dates. She may recall that the Secretary of State for Health and Social Care came to this House in, I believe, July of last year to announce that 750,000 Randox tests that were being used in care homes had to be withdrawn because they were faulty. Subsequent to that announcement, the Government awarded a £350 million contract to Randox. Why?

[Gillian Keegan]

Why? It was because the Government were trying to get out as many tests as possible. As I said, Randox processed—[Interruption.] Just to put it into context, Randox has, to date, carried out more than 15 million tests for covid-19, and identified more than 700,000 positive cases. That is 700,000 people who might otherwise have gone on to spread the disease. As a result of this testing capacity, they received the right advice to isolate, thereby protecting their friends, their family and society at large.

[Mr Alistair Carmichael (Orkney and Shetland) (LD)]

I am grateful to the Minister for giving way. I am prepared to take at face value everything that she says about Randox, but it does then raise in my mind the question of what exact benefit the company had from engaging the services of Owen Paterson. That being the case, will the Minister commit now at the Dispatch Box to publish the minutes of the telephone conference call of which he was part?

[Gillian Keegan]

Obviously, I cannot answer that question. The right hon. Gentleman knows that the only people who can answer that question are those at Randox and the gentleman that he referred to—Owen Paterson.

[Mr Carmichael]

rose—

[Gillian Keegan]

I am happy to give way again.

[Mr Carmichael]

Just to be quite clear about this, is the Minister saying that her Department does not hold minutes of that conference call? That, from my experience of having been in government, would be a quite remarkable departure from accepted procedure.

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[Gillian Keegan]

With respect, I do not think that the right hon. Gentleman has ever been in government during a global pandemic. What I was answering was his question about the value to a company of employing someone on a contract. I cannot answer that. On the minutes, I think that we have said that we will publish things here in the Library. [Interruption.] I will get on to that.

[Mr Speaker]

Order. May I just say that this is a very interesting question? I know that the Minister has been put on the spot in being asked to provide an answer, but meetings should be logged and minutes of official meetings should be held. If the Minister cannot provide an answer to this very serious question today, I hope that it will be looked into, because it will bring a lot of other things into question if what has been said is indeed the case. I do not want to make a political point, but I am very concerned about this matter for all of us in this House. I am sorry to interrupt you, Minister.

[Mr Speaker]

In fact, to answer that point of order, I would have thought that it was even more important to hold meetings on the basis that we were in a pandemic, with minutes that we could refer back to. I am very, very concerned. I do not want to put anybody on the spot, but at some point this matter does need to be clarified.

[Gillian Keegan]

I will pull out that part of my speech now, so that people can hear it. We will give Members what information is held and in scope. We will come back to Parliament and deposit it in the Libraries of the House. We will commit to do that. I would like to press on now.

[Tony Lloyd]

rose—

[Gillian Keegan]

I will give way one more time—and I mean one more time.

[Tony Lloyd]

I am genuinely very grateful to the Minister. I have a lot of respect for her and she should know that. She may not be able to answer this question, but I hope that she will actually say that she cannot answer it. She appeared to say to the right hon. Member for Orkney and Shetland (Mr Carmichael) that he had not been a Minister during this time of national emergency. That is true, but can she be absolutely clear whether she knows if the conversation between Lord Bethell and a representative of Randox was minuted by civil servants, or does she know that it was not minuted, or will she simply not say? It would be helpful for the record today if we had that information. Does she know?

[Gillian Keegan]

Obviously, the hon. Gentleman knows that, personally, I was not there at the time. The meeting to which he refers was a courtesy call from the Minister to Randox to discuss RNA extraction kits. That was declared on the ministerial register of calls and meetings, but I have been unable to locate a formal note of that meeting. By the way, that meeting was after any contracts were let with Randox, which I will get onto.

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[Mr Speaker]

In all fairness, the Minister should be given time. There are Parliamentary Private Secretaries here, and I am sure that they will have heard and will try to get an answer to the question if we do not have that information. I would expect Government meetings with other people present always to be minuted. If they are not, it opens up another question. I do not want that question to be opened up, as I would prefer it to be answered. Therefore, I am sure that, at some point, we will get that answer. It is a fair point to be made, but in fairness to the Minister, I do not want to end up with a frenzy. Hopefully, some information will be fed back to her—I am looking to the Parliamentary Private Secretaries behind her to see whether it can be fed in at the moment.

[Gillian Keegan]

Thank you, Mr Speaker.

[Clive Efford (Eltham) (Lab)]

rose—

[Gillian Keegan]

Can I please just get some of these points out?

Of course, there are a phenomenal set of safeguards in place. The National Audit Office has reviewed the testing contract, and it has confirmed that all the proper contracting procedures were followed.

[Seema Malhotra (Feltham and Heston) (Lab/Co-op)]

The Minister has just said that there would be a review of what information is available that is “within scope”. Will she just make it clear to the House what she understands to be within scope?

[Gillian Keegan]

I do not have a definition of what is within scope, but we will provide that information.

The NAO report said that

“the ministers had properly declared their interests, and we found no evidence of their involvement in procurement decisions or contract management.”

The NAO has confirmed that all the proper contracting procedures were followed. As with all Government contracts, contracts with Randox are published online and can be found through Contracts Finder. I think that hon. Members will find that the date of the contract precedes any minutes or meetings that we have been talking about. In case any Opposition Members have forgotten, Ministers have no role in the evaluation of Government contracts, in the procurement process, in the value of contracts, in the scope of contracts or in the length of contracts. From start to finish, the procurement process is rightly carried out by commercial professionals, who are governed by a strict regulatory framework. I know this, because I was a procurement manager for much of my career before coming here.

[Dawn Butler]

On a point of order, Mr Speaker. The Minister has been given a really hard gig today and I am actually beginning to feel sorry for her, because she has been given a script that is filled with inaccuracies, and the NAO report is filled with inaccuracies. It is really worrying that the Minister is continuing with an inaccurate script.

[Mr Speaker]

First of all, that is a point of debate, and the hon. Lady would not expect me to be brought into the debate. Ministers must answer points in their way, and it is for the Opposition to open up the statements that have been made. That is why we have Opposition days, in which I expect people to pose questions. I am sure that when the Minister sums up, she will fill in some of the voids. I am not responsible for what the Minister says; I certainly do not want to be and it would be wrong even to consider that I should be.

[Gillian Keegan]

Thank you, Mr Speaker. Of course, we all know that everything I say will go on the record and hon. Members can challenge it.

[Several hon. Members rose—]

[Gillian Keegan]

May I just make a little bit of progress, as I have been generous with my time? I am happy to be here and I am trying to answer hon. Members’ question as best I can.

I was a procurement professional for many years, and in preparing for today I have spoken to all the procurement professionals involved. We have to remember that they are highly trained, highly commercial, highly professional and highly regulated, and that they have an independent process that Ministers do not get involved with. I have only been a Minister for just under two years, but I can confirm that that is the procurement process.

[Dawn Butler]

Will the Minister give way on that point?

[Gillian Keegan]

I do not need any help on the procurement process.

I can confirm that no exception was made for Randox. Of course, Ministers have a role in understanding what is happening with contracts. We have calls and meetings with our commercial partners to find out what challenges they are facing, to drive them to go as fast as they can and to hold them to the commitments that they have made. Such meetings are only natural, but they are nothing to do with the actual contracts; they are to do with delivery and holding our partners to account on their commitments, as is only natural. We have behaved exactly as hon. Members would expect from a responsible Government operating in a national crisis.

The Government do not intend to vote against this Humble Address. We will review what information we hold in scope and—in answer to the question from the hon. Member for Feltham and Heston (Seema Malhotra) —we will define the scope. We will come back to Parliament and deposit the information in the Libraries, in line with the Government’s established stance on responses to Humble Addresses.

[Angela Rayner]

I welcome the Minister’s comments and hope that that transparency comes forward, but may I just remind her that part of the reason we tabled this motion was that the process was not followed, and there are questions about the process and how Ministers were able to fast-track through a VIP lane.

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[Gillian Keegan]

The VIP lane process was part of ensuring that we were aware of companies’ capabilities. At that point, they then went through a procurement process with highly trained, professional procurement people, whom I have spoken to and who would be quite insulted by the right hon. Lady’s thinking that they had not followed all the procedures.

This does not mean that we do not believe that there are lessons to learn; of course there are. No one can face such an unprecedented challenge and conclude that everything worked perfectly, and that is not what we are saying. We remain committed to procurement reform and are looking at coming forward with some. Last December, we published our transforming public procurement Green Paper, which provided commercial terms across Government. We have clarified the roles and responsibilities of everyone involved in decision making, and are determined to do all that we can to ensure that we have a simple and less bureaucratic system that is underpinned by the enduring principles of fair and open competition.

[Alexander Stafford (Rother Valley) (Con)]

Does the Minister agree that this is a situation that happened across the United Kingdom? I am under the impression that the SNP Government in Scotland gave £500 million-worth of contracts without competition, so what happened in England and the UK was no different to what happened in other parts of the country; this is how everyone operates in a global pandemic.

[Gillian Keegan]

The most important thing in a global pandemic is to secure supply of something that is not widely available across the world—to get security of supply—and that is what we did. We all know that there was a time when we were worried about running out of PPE, about not having enough testing capacity and about not having the large scale of supplies needed to meet the demand. Of course, any responsible Government would do that.

As I was saying, we are looking at procurement systems and are determined to do all that we can to ensure that we have a system that is simple and less bureaucratic, but which is still underpinned by the enduring principles of fair and open competition. We are also implementing the recommendations of the first and second Boardman reviews into improving procurement.

[Matt Western]

Will the Minister give way?

[Gillian Keegan]

Let me just finish this point and then I will give way, because I am sure that the hon. Gentleman is listening carefully and wants to hear these words.

Hon. Members will be aware that we have established an independent public inquiry that will begin work in the spring, with full powers under the Inquiries Act 2005, including the ability to compel the production of all relevant materials. We expect that the inquiry will be a valuable opportunity for us all.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

May I just correct a couple of things that the Minister has said? First, Exercise Cygnus and Exercise Alice both identified shortages of PPE should there be a global pandemic, although it was never a question of if; it was always a question of when. Secondly, on the procurement disaster, the Minister should not forget that the Government were found to have acted unlawfully in the publication of their contracts in the action that I took with the Good Law Project and other hon. Members.

[Gillian Keegan]

I said that I would also give way to the hon. Member for Warwick and Leamington (Matt Western).

[Matt Western]

That is very kind. I have a lot of time for the Minister, as do other Opposition Members. Like her, I was a procurement professional. I would not have been allowing this sort of behaviour—the actions of Lord Bethell, in particular—in the organisation for which I used to work, and I am sure that she would not have done so. This is a systemic problem in Government. A Department that I was dealing with, totally unrelated to the pandemic—I will not say who the Minister was—insisted on a meeting without any other representation and then insisted on texting me the information. The Minister should be aware that there is a problem at the heart of Government.

[Gillian Keegan]

Yes, we are both fellow procurement professionals—from the same industry, indeed. Procurement professionals like us feel very strongly that they would not have behaved to anything but the highest standards. They are highly commercial, highly regulated and highly professional, and they are the people responsible for the contracts.

In closing, I thank colleagues for their contributions—

[Chris Elmore]

rose—

[Gillian Keegan]

For their last contributions, I should say—I thank the hon. Gentleman.

[Chris Elmore]

The Minister is being very generous with her time. She has listed with great vigour all the things the Government have done to try to be transparent and all the things they will do to try to be transparent, so will she confirm to the House which way the Government will be voting on our motion?

[Gillian Keegan]

The hon. Gentleman may have missed it when I said that we were abstaining.

This is an important debate and I do take this issue very seriously. I am a professional of 30 years’ standing before coming here. My professional reputation is important to me, and I make sure that we uphold the highest standards of professionalism. Make no mistake: it is important to me to get this right. There are facts here, and I have set out the facts correctly. We do not want to play at political games and gimmicks: this is not the right time to do that. It may well play well with audiences on Members’ social media channels, but it is not the right approach.

[Mr Carmichael]

The Minister has made it clear that the Government are not going to oppose this motion, so we might reasonably expect it to pass. She said on a number of occasions that she will revert to the House with regard to the question of scope. The motion is very detailed on the question of scope, and we anticipate that it will become an instruction to the Government. Can she give an indication of what material her Department, or any Government Department, might hold that would not be disclosed under the terms of this motion?

--- Later in debate ---

[Gillian Keegan]

As I said very clearly, we will set out the scope and set out the documents.

In a spirit of openness and understanding, we need to see how we as a country can rise to meet the challenges of the future. We need to work with people who help to make the difference. This was a very important process. We have vaccinated and tested millions. We should be proud of that. We have built, from virtually nothing, the largest testing centre in Europe. We should be proud of that. Tens of thousands of people are alive today who otherwise may not have been. This Government have moved heaven and earth to get things done. While we continue to approach this serious subject with a willingness to learn, we must also do so with pride as to what has been delivered—pride that when we were needed, we stepped up for our nation when it needed it most.

--- Later in debate ---

[Brendan O'Hara]

That is a very good idea. Perhaps the hon. Member for Rother Valley (Alexander Stafford) would like to make a speech. The memo seen by The Times also states that the company feared that it did not “have enough extraction systems” and “was hoping yourselves” —the Government—

“could help us access extraction systems from universities, hospitals anywhere…Any we can get our hands on.”

Crucially, The Times further reported that this memo was written by an official in the Department of Health and Social Care after a phone call on 9 April between Lord Bethell, the Conservative Minister responsible for awarding testing contracts at the time, and Owen Paterson, the Conservative MP who was being handsomely paid by Randox to lobby on its behalf. It appears that the company employing a Conservative MP, which was fast- tracked and awarded a no-bid contract worth £133 million, was actually ill-equipped to provide the vital service it had promised to deliver. This absolutely stinks, and unless and until every record of what was communicated between Mr Paterson, Lord Bethell, Randox, Government officials and special advisers is made public, the stench of corruption will only increase.

[Gillian Keegan]

I want to be very clear that the contract is published. The contract date is 30 March. The meeting that the hon. Member referred to was on 9 April. The contract was let and published before that meeting.

[Brendan O'Hara]

Therefore the Minister should have no fears whatever about full disclosure, because that is what the motion asks the Government to do. It is not about selective disclosure; it has to be full disclosure and everything that was said and done among the parties that we have mentioned has to be put in front of this House and open for scrutiny.

The sending in of the Army to help Randox was not the only error or controversy that year. In August 2020, the UK’s medicines regulator had to ask Randox to recall three quarters of a million unused coronavirus testing kits after concerns were raised about safety. By any standards, Randox had not exactly covered itself in glory in the first few months of the contract, so it raises the question as to how six months later it managed to secure another Government contract, this time worth £347 million. That took its total contracts to half a billion pounds in six months. It really has been a bit of a Klondike gold rush for the Northern Ireland-based company that employed a former Secretary of State for Northern Ireland to lobby the Government on its behalf. As I said in response to the hon. Member for South Antrim (Paul Girvan), who is no longer in his place, everything could be above board and everyone could be beyond reproach, but we deserve to know.

Ironically, Mr Paterson was appointed Secretary of State for Northern Ireland in 2010 by the then Prime Minister David Cameron, who just months before becoming Prime Minister said:

“I believe that secret corporate lobbying…goes to the heart of why people are so fed up with politics. It arouses people’s worst fears and suspicions about how our political system works, with money buying power, power fishing for money and a cosy club at the top making decisions in their own interest. It’s an issue that…has tainted our politics for too long, an issue that exposes the far-too-cosy relationship between politics, government, business and money.”

In the same speech, he said:

“If we win the election, we will take a lead on this issue by making sure that ex-ministers are not allowed to use their contacts and knowledge—gained while being paid by the public to serve the public—for their own private gain.”

He said:

“We can’t go on like this…it’s time we shone the light…on lobbying in our country and forced our politics to come clean about who is buying power and influence.”

As we would say in Glasgow, aye, right, so ye will. Today, David Cameron, that self-styled great reformer, thanks to the Greensill scandal is up to his neck in the same cronyism, corruption and sleaze that he promised to call out and eradicate when in opposition. If it was not so sad, it would be funny.

While many of us very much welcome that Mr Paterson is no longer a Member of this House, the mess he has left behind needs clearing up. Until it is cleared up, the widespread belief that politics in this country is corrupt and this Government are corrupt will not go away. That perception is not helped by the Prime Minister himself deciding to go to Glasgow and stand in front of a hall full of world leaders and feel the need to declare that the United Kingdom is not a corrupt country. Here is the Prime Minister’s chance to do something about it. He can make a start by allowing full transparency over exactly what went on between Owen Paterson when he was a Member of this House, Randox Laboratories, Lord Bethell, Government Ministers past and present and their special advisers. Should he refuse to do that, his performance in Glasgow last week will be seen as one of a Prime Minister who protests too much.

--- Later in debate ---

[Mr Alistair Carmichael (Orkney and Shetland) (LD)]

I am grateful to you, Madam Deputy Speaker, for the opportunity to take part in what I think has been one of the most remarkable debates I have seen since I became a Member of Parliament in 2001. The hon. Member for Amber Valley (Nigel Mills), who has just removed himself from the Chamber, said that he suspects there is not much to see here. I suspect he is probably right about that. But when we hear the concession from the Minister at the Dispatch Box that no record was taken of the telephone conference call involving Lord Bethell and Owen Paterson, and when we hear the somewhat improbable history outlined by the right hon. Member for Ashton-under-Lyne (Angela Rayner) about the relationship between Lord Bethell and his various mobile phones, suspicious minds such as mine—and probably even worse—will ask why it would be that there is nothing much here to see.

[Gillian Keegan]

I just want to make clear what I said. We have been unable to locate a formal note of the meeting—that is what I have been told so far. That does not mean there isn’t one. We have been unable to locate one, but of course everything we have will be put in the Library.

[Mr Carmichael]

That is, indeed, an important distinction. I wonder whether the search for these minutes has extended as far as the shredding room. I say to the Minister and the Under-Secretary of State for Health and Social Care, the hon. Member for Erewash (Maggie Throup), who will wind up the debate, that it would be helpful if the House could be told how many other documents might be within the purview of the specification outlined in the motion. That is, how many are similarly difficult to locate?

I caution those on the Treasury Bench that saying that documents and text messages and WhatsApp messages on Ministers’ phones cannot be found only lasts so long as a defence. A full inquiry is coming and the longer that somewhat less than substantial defences are thrown up, and the more dust is kicked up, the worse it will be for Government Ministers at the end of the day. If the information is there, with the knowledge and control of any Government Department, it should be disclosed under the terms of the motion, which the House is going to agree to.

The Minister said a number of times, including when I challenged her, that the Government would define the scope. With respect to her, the Government will not define the scope; it is the House that will define the scope, which has been very clearly laid out in the motion. I do not see what justification or excuse there could be, given the fairly careful construction of the motion, for not disclosing information. More important than that, even if there is a tiny loophole it is a question of doing the right thing and being seen to honour not just the letter but the spirit of the motion, which the House will pass later. That is why, to quote David Cameron again, sunlight is the best disinfectant. We need to have the fullest possible disclosure.

--- Later in debate ---

[Anneliese Dodds]

My hon. Friend is absolutely right to point to the concrete impact of these failures and that procurement system. I will come to those matters, which he detailed very ably in the important speech he made a few minutes ago.

Again, the Minister maintained that all details of contracts are published. As my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams) set out, the Conservative Government were taken to court and found to have acted unlawfully because of their determination not to provide transparency over contracts. There is, again, a rewriting of history. What else did we see at that time? We saw the Conservative Government paying airlines to fly kits out to Randox’s laboratory in Northern Ireland for them to be analysed. We saw the Health Secretary warning people not to use Randox testing kits because they were “not up to standard”. In the end, Randox had to recall 750,000 tests because they were not good enough, as my right hon. Friend the Member for Leicester South (Jonathan Ashworth) rightly explained. It threw away more than 12,000 swabs in a single day because they had to be voided.

The Minister said that we should “pause and reflect” on what happened. Many of us have been pausing and reflecting, and we have been remembering what happened. Let us cast our minds back to the beginning of the pandemic. We remember when our country faced that nationwide testing shortage as the devastation of covid ripped through our communities. We remember when people were scared, when they were sick, when they were dying. We remember when, in Plymouth, people were told that their nearest testing centre was in Inverness. We remember when, in Bolton, at the epicentre of the pandemic, people could not access any testing at all. We remember, as my hon. Friend the Member for Blackburn (Kate Hollern) set out devastatingly, when care homes could not access the testing that they needed for elderly and vulnerable people. We remember the impact that that had.

The stakes could not have been higher. Lives depended on the Government securing the best possible testing contract. Almost 40,000 people died in care homes in the year after Owen Paterson’s phone call with Lord Bethell and Randox—care homes that took in people from hospital who had not been tested at all, and care homes whose own staff and residents could not access the tests that they needed until nearly two months after the national lockdown began, by which point it was too late. As my hon. Friend the Member for Rochdale (Tony Lloyd) said, we have to know whether this contracting played a role in those awful, awful outcomes.

How did the Government respond to their abject failures to deliver? Did they learn the lessons when new contracts came up, such as a contract for testing twice as lucrative as the previous one? Of course not. They doubled down—and Randox doubled up with a brand-new deal. Again, there was no competition; again, it was behind closed doors. Another £350 million of public money was dropped in the lap of a firm that just so happened to have a Conservative MP and former Secretary of State on its payroll.

The Minister has attempted to dispute that course of events. I say to her: prove it. Publish every dot and comma related to those deals: every email, every message, every letter between Ministers, special advisers and MPs. Explain why Lord Bethell’s WhatsApp messages have been lost as part of the sorry saga that my right hon. Friend the Member for Ashton-under-Lyne detailed, which is the 21st-century equivalent of “the dog ate my homework.” Come on! It is ridiculous.

Will the Minister please explain what on earth is going on with the minutes of the phone call with Lord Bethell and Paterson? We seem to have had mixed messages during the debate. At one point, it seemed that it was being suggested that there were no minutes—they never existed. That, in and of itself, raises extremely important questions. Were there no minutes of a meeting relating to two contracts worth £500 million of taxpayers’ money? It was then suggested, “Oh, it’s not that we necessarily know that there were no minutes, or that they were destroyed. No, we are unable to locate those minutes.” Well, when will they be located? They need to be located.

If the Department of Health and Social Care has been unable to locate the minutes, why has it been stating that it is not able to respond in a timely manner to freedom of information requests about the matter, without stating that that was because it believes that the minutes might not exist, that it has been unable to locate them, or whatever? Instead, it has just said that it is trying to respond to those FOIs. My goodness, what a mess.

Will the Minister explain how many other meetings might not have been minuted? How many other meetings might have minutes, but nobody knows where? When will we see them? Will she explain why the Government are so resistant to letting sunlight be the disinfectant that it needs to be in this process? As the hon. Member for Amber Valley (Nigel Mills) said: just publish them.

We are talking today about one specific contract, but we all know that the problem does not begin and end with Randox. This is a Government who rolled out the red carpet for many more companies with close links to senior Conservatives. Just yesterday we learned that, of the 47 firms that won contracts via the so-called VIP lane that so many Opposition Members have referred to, four were helped by a former Conservative chair, four by the former Health Secretary and one by Dominic Cummings. I regret the fact that the Minister has stated that

“Ministers have no role…in the procurement process”.

That was not the case with the VIP lane, was it? We know that now, in black and white. The Minister has the opportunity to intervene if Ministers played no role in that VIP lane. She cannot intervene, because she knows that Ministers, including her Health Secretary, were recommending those companies.

[Gillian Keegan]

I thank the hon. Lady for the opportunity to intervene. I think the difference is that the VIP lane is about the identification of potential sources of supply. The procurement process starts after that; that is when procurement professionals, who are highly regulated, take over.

[Anneliese Dodds]

The Minister is obviously doing her very best, but yet again, I am afraid that this is not an edifying spectacle. In the overwhelming majority of cases, the recommendation led to companies receiving enormously expensive contracts. It is risible to suggest anything less. It is also risible to suggest that in those cases the Government followed their own emergency procurement guidance:

“Contracting authorities should maintain documentation on how they have considered and managed potential conflicts of interest in the procurement process…Particular attention should be taken to ensure…decisions are being made on the basis of relevant considerations and”—

wait for it—

“not personal recommendations.”

There was nothing inevitable about this. I know how things ran in Labour-run Wales, and they did not run like this.

We have seen that companies with links to the Conservative party were 10 times more likely to secure a contract than others. Public money was doled out based not on a company’s abilities but on its contacts book. When it comes to spending taxpayers’ money on testing and PPE equipment that can save lives, one would hope that the Government would take things more seriously, but as my hon. Friend the Member for Wallasey (Dame Angela Eagle) said, the switch into an emergency process provides no justification for the ransacking of public money we have seen. As the hon. Member for Amber Valley said, an emergency situation was not a reason for having no process at all. In practice, there should have been more sensitivity around the process, not less.

Because of the Government’s approach, British businesses that did not have Tory MPs on speed dial missed out.

[Anneliese Dodds]

My hon. Friend is absolutely right. Earlier in the debate, he detailed that sorry tale in devastating manner, as did my hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy). Arco had existed for 135 years, providing essential material. It was completely ignored, yet Ayanda Capital, for example—an investment firm with no PPE experience —ended up being used by the Government to purchase 50 million masks that were not even usable.

There were other companies that missed out. Multibrands International, based in Bradford, had been providing PPE to the Chinese Government since the end of 2019. It spent months trying to offer those services to the UK Government, but got absolutely nowhere. What did the Government do instead? They bought 400,000 protective gowns from Turkey that were unusable.

That is the way it always seems to be with the Conservative party: one rule for the Conservatives and their friends, another rule for everyone else—and it is the British people who pay the price. This Conservative Government are doing their best to suggest that every politician was engaged in graft. They are trying to drag everyone else down to their level and feed a growing disillusionment with our politics that damages us all. But Labour Members know that that is not true; I suspect that a fair few Conservative Members know it, too.

The people of Britain know when they are being taken for fools. When a party found guilty of breaking the rules tries to remake them to protect one of its own, there is a word for that: corruption. That is what this Prime Minister has brought into the heart of our politics, and the British people will not tolerate it. That is why the Prime Minister panicked last week and U-turned: because he knew that he had been rumbled.

We all have to play by the same rules, whatever the Prime Minister thinks. Labour has been clear that if we were in power, things would change. We would ban dodgy second jobs like those of the former Member for North Shropshire—and I mean a proper ban, not the watered-down cop-out that the Prime Minister is trying to lay down this afternoon. We would close the revolving door and ban Ministers from lobbying for at least five years after they leave office. We would stop Conservative plans to allow foreign money to flow into our politics, and ban the use of shell companies to hide the source of donations. We would create a new office for value for money and reform procurement rules to put an end to the industrial-scale wasting of public money, and we would create a new, genuinely independent integrity and ethics commission to restore the standards in public life that have been trashed by this Government.

This scandal has presented a clear choice about the kind of politics we want for our country. Do we want Boris Johnson’s politics of the gutter, or Keir Starmer’s politics of decency and integrity? Conservative Members have a choice today as well. They can abstain, under orders from the Prime Minister, their Chief Whip and the Leader of the House; or they can decide to make a stand. They can decide that they want to have a vote on this because they want to take a better path. Let us be very clear about the message that abstention is going to send. We have heard weasel words during this debate, and it seems clear that the scope of what the Government are proposing today, in terms of what they are willing to release, is far less than what Labour’s motion requires.

I see the Minister shaking her head. I sincerely hope that she has got that correct, because, having listened to what she said and compared it with what is written in the Labour motion, I think that there is far less that this Government are prepared to reveal.

[Gillian Keegan]

I said that we would advise on the scope, and, as the right hon. Member for Orkney and Shetland (Mr Carmichael) pointed out, it could be discussed. I have not yet commented on the scope because I do not yet have the details.

[Anneliese Dodds]

I hoped that the Minister might say at this stage, “Yes, absolutely—we will follow what Labour has called for. We will make sure that those documents are published; we will make sure that the minutes of meetings are set out.” Instead, she seems to have muddied the waters. I do not mean to be unfair to her, but that is what her response has done for me.

[Gillian Keegan]

rose—

[Anneliese Dodds]

I shall be happy if the Minister can clarify that.

[Gillian Keegan]

I do not want to appear to muddy the waters by not saying what the scope is. What we have said is that we will publish the documents and place them in the House Library. I am sure that the scope will be as broad as would be expected, to satisfy the hon. Lady.

Autism and Neurodiversity Research Funding

Gillian Keegan Excerpts

Tuesday 16th November 2021 Commons Chamber

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

I thank my right hon. and learned Friend the Member for South Swindon (Robert Buckland) for securing this important debate on funding for autism and neurodiversity research and for such a wonderful, heartfelt speech. It is truly my honour to respond. I commend him on the incredible work that he has done throughout his career to improve the lives of the nearly 560,000 autistic people and about 5 million neurodivergent people across the country. In his previous roles as Lord Chancellor and chair of the all-party parliamentary group on autism, he has been instrumental in driving improved awareness and understanding of autism across Government.

We know that too many autistic people and neurodivergent people more generally are ending up in the criminal justice system and that much more needs to be done to improve people’s experiences. The review that my right hon. and learned Friend commissioned as Lord Chancellor in 2020 looked at this important issue and, as a direct result of his contribution, I expect our newly published national autism strategy will make a big difference to the lives of autistic and neurodivergent people who come into contact with the criminal and youth justice systems. We know that the strategy needs to improve autistic people’s lives. It was informed by a national call for evidence and incorporated the views of more than 2,700 autistic people, their families and carers. It is underpinned by an implementation plan for year one—that is 2021-22—and backed by over £74 million for the first year alone. It sets out our vision for what we want autistic people’s lives to be like by 2026. Over the next five years, we will improve understanding in society, reduce diagnosis waiting times and improve access to high quality health and social care for autistic people.

My right hon. and learned Friend mentioned social care, and that will be a key part of the White Paper along with the social care needs of working-age adults. We will also publish further implementation plans for year two and beyond that will build on our actions this year. They will set out how we will drive improvements across health and care, employment, education and the criminal justice system.

We have made important strides across England in the last decade since the introduction of the landmark Autism Act 2009. I pay tribute to our friend Dame Cheryl Gillan for all her work in this area. The Act includes improvements in public awareness of autism and the availability of diagnostic services. To date, we remain one of the only countries in the world to have such legislation—I know that we are proud of that—but we know that we still need to do more to ensure that autistic people have equal access to services across their lives.

One of the biggest challenges that we face is, as my right hon. and learned Friend outlined, gaps in our evidence about what services and support work best for autistic people. I saw the real-life impact of that recently when I was interviewed by an impressive young woman called Immie. She told me about her struggle and how long it took her to get diagnosed with autism as well as the struggles faced by women and girls in getting the right support due to under-diagnosis. While we know that that is an issue and are taking action to address it, we need better evidence about the effects of masking and under-diagnosis of autism for women and girls.

When I was the Apprenticeships and Skills Minister, I met many young autistic people who told me they struggled to find and get into work. Recently, at the start of UK Parliament Week, I visited Littlegreen Academy in my constituency, which specialises in providing education to boys aged seven to 16 with autism. Pretty much every single one of them asked whether I would help them to get some work experience, to help them get on the ladder towards employment. Like my right hon. Friend the Member for Tunbridge Wells (Greg Clark), I took that as my action from the meeting.

Through our new autism strategy we are strengthening and promoting pathways to employment, such as supported internships, traineeships and apprenticeships, but to make further headway on closing the unacceptable autism employment gap we need to better understand the barriers to employment and the other barriers faced by people with autism.

We know that we have not reduced fast enough the number of people with an autism diagnosis in in-patient care, which is important, as my right hon. and learned Friend the Member for South Swindon said. There are many reasons for that number, but a main reason is that people are being diagnosed as autistic after they are admitted. We need to make sure the number of autistic people in such settings is reduced, as in many cases they are not the right settings. We set up a delivery board across Government and across system partners to make sure we monitor progress, identify blockers and propose actions so that people are better supported in their community, not in inappropriate in-patient care.

Many hon. Members mentioned the lack of understanding, and it is so important that we have more general understanding. I am sure many hon. Members remember the autism training that MPs and their offices received, again at the behest of Dame Cheryl Gillan, who pushed and encouraged us all to do that. I certainly learned a lot.

As set out in the “Right to be heard” publication in 2019, we are also trialling the Oliver McGowan mandatory training in learning disability and autism for all health and social care staff, backed by £1.4 million of funding. The trials are under way, and three providers are currently delivering the training. Hundreds of staff have already been trained. There will be a final evaluation report, which is due in the spring, and the outcomes will inform the wider roll-out of the Oliver McGowan mandatory training. We are working with his parents, Paula and Tom, to introduce the training.

As part of our new autism strategy, we will publish a cross-Government research action plan that lays out the steps we will take to improve and embed a culture of autism research by 2026. We know that we need a strategic approach to ensure that areas currently receiving less research investment, such as care and support—my right hon. and learned Friend mentioned the postcode lottery—are prioritised in future. We also need to make sure we are prioritising the right areas for research and that the research delivers the right change.

We will work with autistic people and their families, the research and voluntary sectors and NHS England to carry out this research action plan, which will ensure that we are building on the important work already happening in autism research. For example, we have already provided £81 million for autism and neurodiversity research in the past five years, which includes funding for a study on the impact of covid-19 on autistic people, a project to improve the accuracy of adult autism assessments and a systematic review to understand what mental health support works for autistic people.

In addition, we were delighted to announce this year a three-year partnership between the National Institute for Health Research and the UK’s leading autism research charity Autistica—which my right hon. and learned Friend mentioned—to fund research into the social care that works for autistic people. The partnership will encourage and support more research applications in this important subject area and we encourage many people to make such applications. I am glad we have had the opportunity today to hear about Autistica’s fantastic work and to welcome its new support plan. I am due to meet Autistica next week—that gives me some time to read the report—and I look forward to working with it on the development of our research action plan to transform the autism research funding landscape over the next few years.

I again thank my right hon. and learned Friend for securing this important debate and all Members for their contributions. I recognise that we must ensure that the actions we take to support and improve the lives of autistic people and their families are grounded in evidence. Through our new autism strategy and research action plan, we will level up support for autistic people throughout the country. I look forward to working with my right hon. and learned Friend and other Members to make that happen.

Question put and agreed to.

Adult Social Care: Winter Plan

Gillian Keegan Excerpts

Wednesday 3rd November 2021 Written Statements

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

On 3 November 2021, the Department of Health and Social Care will be publishing the “Adult Social Care: Winter Plan 2021 to 2022.” This plan has been developed in conjunction with the NHS and social care sector stakeholders, drawing on the recommendations of Sir David Pearson’s review of last year’s adult social care winter plan; advice from SAGE and UKHSA; and extensively on lessons learned so far in the pandemic.

The adult social care winter plan 2021-22 will set out the actions that national Government will be taking to support the sector, along with the steps that local authorities, the NHS, and care providers should take to prevent and control covid-19 outbreaks. The plan focuses not just on covid-19, but also on other viruses such as flu and norovirus, to ensure that those who receive social care are protected this winter.

Thanks to the huge success of the UK’s vaccine rollout, we are in a favourable position as we approach this winter, and I am determined to ensure that those in all social care settings remain protected while maintaining their quality of life. The UK Government have already set out a comprehensive package of measures to support the adult social care sector throughout the winter. These are:

£388 million in further funding to support infection prevention control, testing and vaccination uptake in adult social care settings. This is in addition to a further £478 million to continue enhanced hospital discharge support until March 2022.

A new £162.5 million workforce recruitment and retention fund to bolster the dedicated care workforce. This funding will support local authorities, working with providers, to recruit staff and retain the existing workforce—through a range of measures which could include local recruitment activity, the creation of staff banks, additional overtime hours and payments to incentivise joiners and recognise loyalty—to ensure the right number of staff with the skills to deliver high quality care to meet increasing demands.

Free flu vaccination for eligible frontline social care workers and carers and ensuring pharmacists can vaccinate staff and recipients of care in care homes.

Covid-19 booster vaccinations to those in JCVI cohorts 1-9 that received their second dose more than six months ago. Older adult care home residents and staff will receive covid-19 boosters within their home.

Continuing the designated settings scheme, in order to provide appropriate care for in a covid-secure environment for those likely to be infectious with covid-19 who are discharged from hospital. The designated settings indemnity support has also been extended to cover the winter period until 31 March 2022, in order to maintain the current level of support for these vital settings.

Continuing to provide free PPE for covid-19 needs to the adult social care sector until the end of March 2022, with sufficient stock to cope throughout winter. Regular asymptomatic covid-19 testing will be maintained, with the availability of more intense testing regimes for higher risk settings.

We are also publishing the evaluation from the workforce capacity fund. The fund which saw £120 million support provided to the sector in January 2021, helped the sector to deal with the challenges of covid-19 last winter, delivered 7.3 million additional hours with over 39,000 new recruits. It was deemed, by the overwhelming majority of LAs, as either “somewhat” or “very” effective in supporting them to strengthen workforce capacity last winter.

The Department of Health and Social Care has worked closely with the NHS to ensure the adult social care winter plan is co-ordinated and integrated with their planning. NHS England and NHS Improvement’s winter planning guidance is already available at: NHS England » 2021/22 priorities and operational planning guidance: October 2021 – March 2022. The adult social care plan and NHSEI’s planning guidance enable the providers of care across both sectors to prepare for winter.

[HCWS371]

NHS Efficiency

Gillian Keegan Excerpts

Tuesday 2nd November 2021 Westminster Hall

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

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

I welcome the idea and the timeliness of this debate. My hon. Friend the Member for Peterborough (Paul Bristow) has raised an important issue, and I know many hon. Members present have great experience of various parts of the NHS, including my hon. Friends the Members for Watford (Dean Russell), for Bosworth (Dr Evans) and for Central Suffolk and North Ipswich (Dr Poulter). I thank them for their contributions to the debate.

We all have a responsibility to taxpayers to make sure that the NHS uses its resources as effectively as possible. To do that, we need to ensure that productivity grows every year, which is why the NHS long-term plan includes financial test 2:

“The NHS will achieve cash-releasing productivity growth of at least 1.1% per year.”

I make it clear that increasing productivity does not mean making staff work harder or making cuts. It means getting the most out of every £1 the NHS spends, and making sure that as much as possible is spent on frontline care. It means doctors and nurses doing the tasks they are trained to do and that nobody else can do. It means buying the right drugs at the right price. It means more patients getting the right treatment in the right place at the right time. That is good for patients, good for clinicians and good for the taxpayer.

Thanks to the hard work and innovative mindset of many NHS staff, the NHS is regularly recognised as one of the world’s most efficient health systems, although I take the point made by my hon. Friend the Member for Watford that there are different ways of measuring efficiency globally. In fact, in the decade before the pandemic, productivity growth in the NHS was faster than in the wider economy, as was independently verified by the Office for National Statistics.

Furthermore, the UK spends only around 2% of healthcare expenditure on administration—we spend a lot on the NHS, but only 2% of it on administration—and managers make up only 2.6% of the NHS workforce of 1.35 million. They might be an easy target for criticism, but good managers are of course essential to making services work, and many of us will have had experience of that throughout our various careers. If there were no managers, clinicians would have to manage their own workforce, logistics, finances and websites, and spend less time with patients. None the less, we want to improve the quality of management further, which is why we have asked General Sir Gordon Messenger to lead a review of leadership in health and social care.

[Dr Poulter]

I refer to my earlier declaration about my entry in the Register of Members’ Financial Interests, as a practising NHS doctor. On the point that the Minister just made, of course we want to promote clinical leadership in the NHS in senior management positions, because we know that that benefits patients and leads to efficiencies, but we also need to consider the fact that although there are many good NHS managers, a lot of them have never had experience of life outside the NHS. I wonder whether my hon. Friend the Minister could briefly say how we can draw in better business experience and other experience, so that NHS managers have broader experience, and can bring that benefit to the NHS and drive efficiencies.

--- Later in debate ---

[Gillian Keegan]

I have heard exactly the same point being applied to many different industries, even politics—how many people come from business into politics, or go from politics to business? That crossover between the public sector and the private sector, including bringing particular skills and learning from one to the other, is not done nearly enough, which is why I spend a lot of my time trying to get more business people involved in politics. However, I am sure that it is a challenge for people to do that, because I guess that people tend to get stuck in the way that they know and go up the career ladder in the world that they know, so there is too little crossover. I guess that the recruitment companies have something to answer for here. They look for square pegs for square holes—namely, people to do what they have already done, so that there is a natural progression.

Nevertheless, we need to encourage that crossover. If we put out a call to say, “Actually, we really do want businesspeople to join us and help us,” I am sure that many businesspeople would be interested in having a second career in public service, as we ourselves are all doing here in Parliament.

As I was saying, General Sir Gordon Messenger will review leadership; the terms of reference for that review are being developed right now.

There is no doubt that covid has had a severe impact on NHS productivity. Covid significantly increased costs for the NHS, while we also had to stop some regular activity, so productivity was obviously much lower than it would have been otherwise; indeed, many patients did not even wish to attend in-hospital services. Of course, covid made more stringent infection prevention and control measures necessary. Those measures, such has having to put on and take off personal protective equipment, slow staff down and limit the number of patients they can see, and will probably continue to hold down productivity in the immediate future. We know that that has happened, with the existence of green zones and red zones, and other new processes to try and control infection during this period.

We do not yet know what impact covid has had on NHS productivity, but we expect that it will turn out to be large and negative. The ONS estimated that public service productivity as a whole fell by 22.4% between July 2020 and September 2020, compared with the same quarter a year earlier. Even as productivity recovered, it was still 9.8% lower in the first quarter of 2021 compared with Q1 in 2019. Covid has definitely had a massive impact on productivity, and it is reasonable to expect that the impact on NHS productivity will be similar.

At the same time, however, the pandemic has been a spur for innovation. Across the NHS, clinicians said that the pandemic offered an opportunity to cut through bureaucracy and try new ways of working and new ways of partnering with local services. In London, the hospitals worked together and, as my hon. Friend the Member for Peterborough mentioned, their Getting It Right First Time programme will pilot a new approach to high-volume, low-complexity surgery. That is now being rolled out across the NHS. My hon. Friend also mentioned budget numbers, but it is not easy to compare like with like, because that programme has been integrated into the NHS Improvement budget and is now embedded within the plan for elective recovery, so that is where the finances are coming from.

Trusts will be benchmarked against the programme standards for surgical productivity through the model hospital system, and NHS England and NHS Improvement have set up a beneficial changes network to collect evidence of innovation during the pandemic. The network has distilled 3,000 submissions and 700 examples of recognised beneficial changes into 12 high-impact change areas, which will now be rolled out to the NHS. That is something good that has come out of the pandemic through the need to work together to face challenges.

As the NHS begins to recover, increasing productivity is more important than ever. Many patients could not receive the care they needed during the pandemic, and the NHS faces unprecedented waiting lists. We owe an immense debt of gratitude to NHS staff, who have worked so hard to care for patients throughout the pandemic, but the NHS now needs to use the investment that we have provided to deliver more care more effectively and to remove the burden from staff. This year, we are providing £2 billion through the elective recovery fund to increase activity levels, and £700 million through the targeted investment fund to fund improvements in surgical productivity and digital productivity tools. Digital will be a big feature—we have all learned a lot during the pandemic.

We have announced a further £1.5 billion to build surgical hubs across the country in order to develop new models of care and increase productivity, which is being piloted by GIRFT and the London region. Some £2.3 billion has been allocated to transform diagnostics by rolling out at least 100 community diagnostic hubs and investing in digital diagnostics that will deliver 10% higher productivity. Another £2.1 billion has been allocated to digitise frontline services and free staff from admin tasks, so that they can spend more time with patients—something that was mentioned by my hon. Friend the Member for Bosworth.

Our aim is to return productivity to an ambitious trajectory, so that we can deliver on our ambitious plan to build back better and to clear the waiting list, but also to build an NHS that is fit and able to cope with the demands of the future. Of course, we have more work to do on integrating social care and developing best practice so that the systems work well together. It is not over and we have a lot of work to do, but I am sure that with all the measures that we have put in place, my hon. Friend the Member for Peterborough will feel satisfied that the NHS is continuously looking at continuous improvement.

NHS Allergy Services

Gillian Keegan Excerpts

Friday 29th October 2021 Commons Chamber

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

I thank the hon. Member for Dagenham and Rainham (Jon Cruddas) not only for securing this debate on this important issue but for arranging for me to meet, on Wednesday, the wonderful APPG to receive a copy of its report in person.

The Government recognise the challenges faced by people with allergies and are taking a number of actions to further support them. Allergies affect around 20 million people in the UK. For most, they are mild, but for some they are severe and can be fatal. That was the case for 15-year-old Natasha Ednan-Laperouse, who sadly passed away in 2016. Thanks to the tireless work by Natasha’s parents, Tanya and Nadim, and their charity, the Natasha Allergy Research Foundation, Natasha’s law came into force in October this year. That milestone legislation sets out the legal requirement for all food retailers and operators to display full ingredient and allergen labelling information on every food item they sell pre-packed for direct sale. This will give the millions throughout the UK who are living with food allergies and intolerances better protection and more confidence in the food they buy.

We know how important it is that healthcare professionals, people with allergies and those close to them have the information that they need about the safe and effective use of adrenaline auto-injectors—AAIs—when they are administered in an emergency situation. That is why the Medicines and Healthcare Products Regulatory Agency is developing a communications campaign to convey key messages to improve the safe and effective use of AAIs, including the need to carry two AAIs at all times.

People with allergies continue to be supported through locally commissioned services but, to support patients with more complex conditions, NHS England and NHS Improvement also directly commission some specialised services such as specialist allergy clinics.

As with all conditions, we acknowledge that we need to have the right professional support in place for people living with allergies, including national clinical leadership. We have already established a clinical reference group for specialised allergy and immunology services, chaired by Dr Tomaz Garcez, a consultant immunologist. Membership includes clinicians, commissioners, public health experts, patients and carers. They use their combined knowledge and expertise to advise NHS England on the best ways to provide those specialist services. To support clinicians in the implementation of clear care pathways, the NICE website has guidance to support diagnosis and treatment of a range of allergy conditions, including how to identify allergies, when to refer to specialist care, and how to ensure allergies are recorded in people’s medical records.

The importance of getting that right was emphasised to me when I had the privilege of meeting people on Wednesday, when the all-party group shared its report. In particular, I was personally touched by the story of the two young boys I met, Arlo and Monty, who suffer from serious allergies. The report rightly emphasises the need and the importance of having a highly skilled workforce educated in allergy diagnosis and treatment to ensure that they can appropriately support people in managing their conditions. I have agreed to meet the hon. Gentleman and other representatives from the group to discuss that important issue further. I also plan to arrange a roundtable meeting in due course, so we can understand what additional help is required.

On ensuring we have the right workforce in place, there has been some encouraging progress. However, we know that more can be done. We are working with HEE to increase the uptake in available training places. The latest figures to June 2021 show that the number of doctors, and doctors in training, in specialist allergy and immunology has increased. I know there are already many dedicated medical professionals working in allergy and immunology specialisms.

Relevant training is the responsibility of the Royal College of Physicians, with a certificate of completion of training in allergy and immunology available to support specialist allergy care. The RCP also runs an accreditation scheme, improving quality in allergy services. Currently, there are seven accredited NHS trusts in England: North Bristol NHS Trust; Nottingham University Hospitals NHS Trust; Royal Brompton and Harefield Hospital NHS Foundation Trust; University Hospitals of North Midlands NHS Trust; University Hospitals Birmingham NHS Foundation Trust; University Hospitals of Leicester NHS Trust; and University Hospitals Plymouth NHS Trust. A further 22 trusts across the UK are working towards accreditation. In addition, the British Society for Allergy and Clinical Immunology provides training for primary care staff across the country through workshops and education. The Royal College of General Practitioners has developed an allergy e-learning online resource to support CPD and revalidation, which aims to educate GPs about the various presentations of allergic disease, how to access an atopic patient, and when to investigate in primary care or refer to secondary care.

Looking to the future, we continue to invest in research to improve the health outcomes of those living with allergies. Over the past five years, the Department of Health and Social Care has awarded the National Institute for Health Research over £2 million for research into food allergies. It is currently funding two trials investigating food allergy using oral immunotherapy, including one that compares two treatments for an allergy to cows’ milk in babies and another which seeks to overcome severe allergic reactions to peanuts in adults.

This is a very important debate, and I genuinely thank the hon. Gentleman for bringing it forward. I look forward to working with him to improve services. The NHS works really hard to care for all its patients, including those suffering from allergies, mild or severe. I want to ensure that all adults and children, like Monty and Arlo, living with allergies continue to receive the best care possible and feel safe and confident in the care that they receive. We will continue to work with our delivery partners and stakeholders to ensure that we have the workforce, clinical leadership and expert guidance in place to best support those living with allergies.

Finally, I want to say a special thank you to Arlo and Monty. On Wednesday, during half-term, they gave up their time and, when most other children were out and about enjoying activities, they got here early with their parents to present the report to me. They looked fantastic and spoke very wisely. That really brought home to me the maturity of young children who have to live with allergies, with all the things they need to know and all the personal responsibility they need to take. I will do all that I can to make life better for them and others like them.

Question put and agreed to.

Oral Answers to Questions

Gillian Keegan Excerpts

Tuesday 19th October 2021 Commons Chamber

[Caroline Dinenage (Gosport) (Con)]

3. What steps the Government is taking to improve health outcomes for people with learning disabilities and autism.

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

I thank my hon. Friend for her work as the Minister for Care and particularly for starting the work on the Oliver McGowan mandatory training. We are currently trialling the training to improve awareness and understanding of learning disability and autism for all health and care staff. The improvement of health outcomes for people with learning disability was also championed by our dear friend Sir David Amess; I shall think of him every day in this role and try my very best to live up to his expectations.

[Caroline Dinenage]

I warmly welcome the Minister to her role, which I know she will do with great care. Will she expand a little on the roll-out of the mandatory training for all health and care professionals working in learning disability and autism, which is, as she knows, named in honour of Oliver McGowan? Will she say when it is likely to be rolled out nationwide and what sort of funding will be attached to it? Will she also say when the annual GP health checks for people with learning disability or autism are likely to be rolled out throughout the country on a face-to-face basis post covid?

[Gillian Keegan]

We have started the trials and they are well under way. We are using three trial providers. Our final evaluation report is due in spring 2022 and I would be very happy to share that with my hon. Friend. The outcomes of this trial and the evaluation will inform the plans for the roll-out across the country. I am working closely with Paula and Tom, Oliver McGowan’s parents, who, incidentally, grew up in the same place that I did—in fact, two streets away. They are key stakeholders and, obviously, we will make sure that we set out the detailed plans for roll-out as soon as possible. I thank my hon. Friend and Paula and Tom for all the work that they have done in this area; it really is remarkable and will make a massive difference. On the annual health checks for people with learning disabilities, the NHS has already met its target two years ahead of time for 75% of people on the GP learning disability register to receive an annual health check. I would urge anybody to come forward to make sure that they take advantage of that very important step.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

The Government have not responded to the report of the Health and Social Care Committee on the treatment of autistic people and people with learning disabilities and that response is now well overdue. Sadly, there is continued evidence of ongoing abuse of people with learning disabilities and autistic people. I point the Minister to the deaths reported at Cawston Park. There was a terrible report on that recently. This needs immediate and assertive action. Autistic people and people with learning disabilities are often trapped in inappropriate units for six years on average. By delaying their response, the Government are demonstrating apathy with regard to the terrible treatment in places such as Cawston Park and other units. When will the Government respond and act?

[Gillian Keegan]

I share the hon. Lady’s concerns; it simply is not good enough. The events at Cawston Park—my first response as a Minister to an Adjournment debate was on that subject—were unbelievable and deeply traumatic. My deepest condolences are with the families of Ben, Joanna and Jon. I have committed to meeting with the families at the earliest opportunity so that I can understand their experiences directly. This is currently being arranged by officials and the Norfolk Safeguarding Adults Board. The Department continues to work at pace through the delivery board of cross-Government and cross-system partners to drive progress on implementing the Building the Right Support national plan, which is ultimately the answer to have much better support in the community. We will publish an action plan, outlining all of the plans that we have, how we will improve outcomes and how we will enable people to live well in our communities.

[Mr Mark Harper (Forest of Dean) (Con)]

First, let me welcome my hon. Friend to her position. As chair of the all-party group on learning disability, I look forward to working with her.

On the point that the hon. Member for Worsley and Eccles South (Barbara Keeley) raised, the Government have a plan to reduce the number of people in in-patient units—the assessment and treatment units—like the one at Winterbourne View, which delivered completely inappropriate treatment. When will that delivery plan be published? Her predecessor committed to doing it four months ago; she said that there was work to be done. Can my hon. Friend set out when it will be published so that we can press the Government on delivering those ambitious goals?

[Gillian Keegan]

I look forward to working with my right hon. Friend. I have been along to the first board, although I have not yet chaired it. But we will be developing that action plan. I cannot commit to the date but I will let him know as soon as I can when we will publish the plan. We will be publishing a winter plan for the NHS, which will include lots of different support, in the next couple of weeks.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for her response. Given recent statistics that show that one in 20 schoolchildren in Northern Ireland has an autism diagnosis, may I ask her what steps have been taken here on the mainland to ensure that children with learning disabilities or autism have guidance in their health journey and are never left overwhelmed without specialised support at those very necessary appointments?

[Gillian Keegan]

I thank the hon. Gentleman for his question. He is right to identify this concern. Compared with the general population, people with learning disabilities are three times more likely to die from an avoidable medical cause of death. That is why these annual health checks to ensure that we get early diagnoses for these people are so important. That is why I am delighted that many people are coming forward and that the NHS is two years ahead of its plan here in England. Hopefully, others will follow that lead.

[Nick Fletcher (Don Valley) (Con)]

4. What plans his Department has to build a new hospital in Doncaster.

--- Later in debate ---

[Damian Green (Ashford) (Con)]

7. What steps he is taking to provide a long-term solution to social care.

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

Last month the Prime Minister announced an unprecedented investment in social care to support our own futures and those of our loved ones and our growing ageing population. This investment of £5.4 billion will support the wellbeing of the 1.5 million-strong workforce, offer professionalisation and provide hundreds of thousands of training places. It will also fund supported housing, better advice and capped care costs at £86,000, removing the fear of spiralling care bills.

[Damian Green]

I am grateful for my hon. Friend’s answer, but she will acknowledge that even the promised better integration of health and social care, although very welcome, will not be enough. We need a long-term plan covering workforce issues, the use of technology, and provision whereby people can live in their own home for longer if we are to achieve ultimate success. If we do not solve all those issues, then I am afraid we will not have fixed social care.

[Gillian Keegan]

I agree with my right hon. Friend. The forthcoming White Paper on adult social care reform, which we will publish before the end of the year, will set out our vision for the sector. It will cover issues that affect care users, including housing and innovation within our housing models, access to information and advice, and funding for the workforce. I am very happy to be meeting him on 4 November in his role as chair of the all-party parliamentary group on adult social care to ensure that his insight and all the work that he and the APPG have done in this area are carefully considered.

[Liz Kendall (Leicester West) (Lab)]

I welcome the hon. Lady to her post. I listened carefully to what she said about the Government’s recent announcement. However, is not the reality, as the Association of Directors of Adult Social Services says, that all the additional money announced is going to the NHS in the first three years and little, if any, will ever make it to social care; there is nothing to deal with the overwhelming workforce pressures and increased levels of need we are experiencing right here, right now; and we will not see a single extra minute of care and support or an improved quality of life for older and disabled people or family carers? On top of this, at £86,000 the cap on care costs will not even stop people having to sell their homes to pay for care, and the vast majority of people will be dead before they ever reach the cap because it does not cover the costs of accommodation or food. How is this a long-term solution to social care, and is the Chancellor finally going to fill these gaping omissions in his Budget and spending review next week?

[Gillian Keegan]

I am sure the hon. Lady is in fact delighted that finally a Government have come forward with a plan for social care. In addition to that, this Government have spent an extra £34 billion this year in the NHS and we have raised the levy, which, as she says, will fund both the electives and the catch-up from the pandemic—we all know that many of our constituents need this—but there is also the £5.4 billion that is the biggest investment we have had in social care in this country. As things stand, one in seven adults over 65 face care costs of over £100,000 in their lifetime. Nobody will be forced to sell their home, as people will now have a very clear cap of £86,000 that will give families peace of mind that their assets will not be wiped out, and people can already take a deferred payment agreement so that their payments can be deducted from their estate after they die. Most people I have spoken to truly welcome this announcement and are absolutely convinced that this Government will introduce it.

[Siobhan Baillie (Stroud) (Con)]

We all know that when the care sector is struggling, the NHS feels the pressure, and that is certainly the case in Gloucestershire at the moment. The demand for adult social care is increasing for us locally by 4% year on year, which is higher than the average, and the huge number of requests for new care packages means that there are now delays for domiciliary care, as the market cannot respond to demand. Will the Minister, who I welcome to her new post, tell the House and the Gloucestershire care sector that the Government are working to support us? Will she meet the six Gloucestershire MPs and the leader of the council to discuss this matter?

[Gillian Keegan]

This is absolutely vital. The recent announcement of £500 million over three years to fund social care professionalisation is very warmly welcomed by the sector. It is a sector that employs 1.54 million people. It is larger than the NHS, construction, transport or food and drink. I am of course happy to meet my hon. Friend and other Gloucestershire MPs. I know this issue is a challenge. We have some short-term actions, and it is a key pillar of our long-term reform.

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

With the Government introducing a health and social care levy, will the Minister ensure that social care is not at the back of the queue for spending? Can she provide clarity about every penny of Barnett consequentials that will be given to the devolved nations?

[Gillian Keegan]

I am sure that the Chancellor will be setting out what will happen with the Barnett consequentials. Yes, this issue is important. The most important thing to say is that this is the start—we have £5.4 billion over the next three years for us to embed some of the changes we need in the system, but this levy will continue, and social care will be a big part of and a big beneficiary from that levy in the future.

[Mr Peter Bone (Wellingborough) (Con)]

Will the Minister recommend what North Northamptonshire Council has just done, which is to pay its social care workers as a minimum the real living wage and to backdate that to April this year? That would be a small step in helping with this situation.

[Gillian Keegan]

Yes, I completely agree. Some 95% of the jobs are with private providers, so it is important that they take care of their workforce. There is a lot of competition for labour and a lot of skills shortages in our country. Most workers are on just above the national living wage, but it worries me that a third are on zero-hours contracts, so there is a lot we can do to improve the terms and conditions of the social care workforce. My hon. Friend raises a good leadership example.

[Sarah Olney (Richmond Park) (LD)]

8. If he will make it his policy to keep prescriptions free for people aged over 60.

Cawston Park Hospital: Norfolk Safeguarding Adults Board Review

Gillian Keegan Excerpts

Tuesday 21st September 2021 Commons Chamber

[The Minister for Care (Gillian Keegan)]

I thank my hon. Friend the Member for Broadland (Jerome Mayhew) for securing this debate on this deeply disturbing, upsetting and important topic, and for his continued work on exposing the failings at Cawston Park.

I would like to begin by expressing my sympathy for the families, friends and loved ones of Joanna, “Jon”, as he is referred to in reporting, and Ben. These are three people whose lives were cut short tragically and needlessly. The accounts of their experiences at Cawston Park Hospital, a place that should have been there to care for and support them, are heartbreaking. I can only imagine how distressing it would have been for their families and loved ones to read about the events leading up to their deaths. I send the families of Ben, Jon and Joanna my deep condolences, and I would like to invite them to meet me so that I can understand their experiences directly—I would be happy for my hon. Friend to join me in those meetings.

I would also like to thank those who have shared their experiences of the services and support at Cawston Park, and the Norfolk Safeguarding Adults Board for under-taking the review and preparing the final report. That is essential for shining a light on what has happened. I know that my officials are in dialogue with the board to identify how recommendations can be progressed as impactfully and as quickly as possible. I believe they met today.

The appalling care and practice uncovered at Cawston Park is completely unacceptable. Every person with a learning disability, and every autistic person who needs it, must receive safe and high-quality care, and they must be treated with dignity and respect. Both my hon. Friend and I have dearly loved family members who have Down’s syndrome and know many people with autism, and we are horrified to think that vulnerable people who put such trust in others for support would be treated in such an appalling way.

I recognise and acknowledge the frustration and strength of feeling about the issues raised today. The Department is working with the NHS, local government and the Care Quality Commission to ensure that we identify unacceptable care with urgency and take robust action immediately. I can confirm that Cawston Park closed in May, following action taken by the CQC, and all of the people who were in-patients at Cawston Park have moved either to a supported community setting or to an alternative hospital setting, where immediate discharge was not possible.

I appreciate that everyone listening will want assurance that anyone with a learning disability and any autistic person in one of those hospitals—any one of the 2,000 people he mentioned—is safe. NHS England’s reviews of each individual person’s care arrangements will ensure that there is a clear care plan in place with a clear path to discharge. Such treatment where there were no clear paths to discharge must not happen again.

More broadly, I welcome this opportunity to set out the work that is under way to eliminate poor-quality in-patient settings and properly invest in the community alternatives that people with a learning disability and people with autism deserve.

As the regulator for mental health hospitals, the CQC has a central role in identifying any cases of poor in- patient care and taking immediate action. The Department fully endorses the increased scrutiny by the CQC and its improved inspection approach, which includes spending more time with patients and their families to identify settings that are at risk of developing a closed culture. In particular, the CQC takes more account of what families have to say. The enhanced processes have revealed cases in which quality falls below the standards we expect. Where that is the case, robust regulatory action is being taken. We must not tolerate poor care and treatment, and any provider that cannot meet standards should be tackled immediately, including through closures.

In the report, families describe the excessive use of restraint and seclusion by unqualified staff. Any kind of restrictive practice or restraint should only ever be used as a last resort. The Department is taking action to increase the transparency and reporting of the use of restrictive practices, in response to the recommendations made by the CQC in its review of the use of restraint, seclusion and segregation. Increased transparency is a central aim of the Mental Health Units (Use of Force) Act 2018 statutory guidance, on which we have recently consulted. Work is now under way to commence the Act from November 2021.

As part our longer-term plans to limit the unnecessary detention of people with a learning disability and autistic people, we are seeking to implement once-in-a-generation reforms to the Mental Health Act. Under our proposed reforms, we will limit the scope to detain people with a learning disability or autism for treatment if there is no diagnosed mental health cause for distressed behaviour. To support that, the proposed reforms will create new duties for commissioners to ensure an adequate supply of community services and that every local area understands and monitors the risk of crisis at an individual level. For those who continue to require in-patient care, we are clear that this should be for the shortest time possible, as close to home as possible and the least restrictive possible.

Alongside the longer-term plans to improve in-patient care and support, the situations outlined in the review of Cawston Park highlight the need for urgent action in quicker time. That will require cross-system, cross-Government action in a number of priority areas that have historically presented blockages to progress. The Government are taking action specifically to target such blockages, ranging from identifying best practice models in the community to ensuring that the right workforce with the right training is in place.

In closing, I thank Members for their contributions on this important topic and their commitment to ensuring that people with a learning disability and autistic people receive the high-quality care and support that they deserve. The CQC’s robust inspections are helping us to identify and prevent cases of unacceptable care, such as that of Cawston Park. It is our priority—and my personal priority—to reduce reliance on in-patient care. I have set out today the range of work that is under way not only to reduce in-patient numbers but to drive real change in the care that is available to people with learning disabilities and autistic people, to enable them to live fulfilling lives in the community, as we all want. All our actions will be shaped by the Norfolk Safeguarding Adults Board review report, to ensure that the experiences of Ben, Jon and Joanna are not repeated.

Question put and agreed to.

Oral Answers to Questions

Gillian Keegan Excerpts

Tuesday 5th May 2020 Commons Chamber

[Steve Double (St Austell and Newquay) (Con)]

What assessment he has made of the potential effect of the introduction of T-levels on the (a) quality and (b) recognition of technical education.

[The Parliamentary Under-Secretary of State for Education (Gillian Keegan)]

T-levels are based on the best international examples of technical education and, crucially, they are employer designed. They will help to raise the quality and prestige of technical education across the UK, with longer teaching hours and a meaningful industry placement. I am confident that they will provide a high-quality alternative to A-levels, giving technical education the status and recognition that it deserves.

[Steve Double [V]]

I thank the Minister for that answer. It is clear that T-levels will have a valuable part to play in ensuring that we have the workforce of the future across the economy, but the sector of the economy that is being most adversely affected by the current crisis is hospitality, and it is vital that that sector is able to access the workforce that it will need to recover, particularly in a post-Brexit world, so will the Minister please consider bringing forward a T-level in hospitality as soon as possible?

[Gillian Keegan]

I agree with my hon. Friend: equipping people with the skills that they need is crucial to our economic recovery, particularly in St Austell and Newquay. To support tourism and hospitality, which are important to his constituency, we will offer T-levels in cultural heritage and visitor attractions, catering, and management and administration. I hope that, with my hon. Friend’s support, T-levels will be available soon so that young people in St Austell and Newquay can benefit from a high-quality technical education.[Official Report, 1 July 2020, Vol. 678, c. 2MC.]

[Joanna Cherry (Edinburgh South West) (SNP)]

What discussions he has had with Cabinet colleagues on support for the further and higher education sectors during the covid-19 outbreak.

Non-invasive Precision Cancer Therapies

Gillian Keegan Excerpts

Thursday 18th July 2019 Commons Chamber

[Gillian Keegan (Chichester) (Con)]

It is a pleasure to follow the hon. Member for Easington (Grahame Morris). Half of everyone in the UK will develop cancer at some stage in their lives and a quarter of us will receive radiotherapy treatment. Radiotherapy is highly effective, especially when compared with other therapies, given that survival rates improve by 16% compared with just 2% with other therapies such as chemotherapy. That is important because the UK has the second worst survival rates for lung cancer in Europe and we lag behind the European average in nine out of 10 cancers. We know that our population is ageing and that, more and more, our lifestyle choices are detrimental to our health. This means that over the next six years, cancer rates are expected to increase by a quarter, so ensuring that we get cancer treatment right is of fundamental importance.

The Government are making progress in this area. Since 2010, rates of cancer survival have increased year on year. It is thought that 7,000 people are alive today who would otherwise not have been. The NHS long-term plan has set out a way to ensure that future radiotherapy treatment will be faster, smarter and more effective. Although it is a welcome strategy, we in the all-party group on radiotherapy have been looking into the detail and have highlighted some pressing issues, which we look forward to publishing in due course.

As has been mentioned, there are serious workforce shortages; for example, radiotherapy clinical scientists have a current vacancy rate of 8%. We need to take swift action to address that, and specifically, to support the education and training programmes that feed the pipeline of talent. There are only 10 therapeutic radiography degree programmes in England and that will soon reduce to nine, as one very close to me in Portsmouth is due to close soon.

Since 2016, entry-level training for this industry has fallen by 23% since the loss of the bursary; last year, only 240 students undertook this training. I therefore hope that the Department for Health and Social Care and the Department for Education will review the impact of terminating the bursary programme and consider how to attract students to this profession. The Society of Radiographers recently developed an apprenticeship standard at degree level to provide another entry point to the profession. I believe that that is exactly the right approach, whereby the next generation of industry professionals can learn and earn on the job. Sadly, however, the Institute for Apprenticeships and Technical Education offered a funding band of around £19,000 for the programme’s delivery, but given the high-tech and expensive infrastructure needed to support it, the level of funding was insufficient. I urge the institute to carry out a review of the scheme and ensure that we have the right funding requirements.

During evidence sessions for the all-party group on radiotherapy, the current tariff system came up again and again, including the fact that the tariff is paid per fraction. Clearly, if we have new technology that will reduce the number of fractions, there may be a perverse incentive that would discourage the use of it. Earlier this year, the all-party group visited Elekta in West Sussex, which is pioneering the future of advanced radiotherapy technology, including the MRI LINAC—linear accelerator—machines. Ironically, West Sussex does not have a single LINAC machine—neither the MRI version nor even the standard version—so many of my constituents are travelling as far as London and Brighton for their treatment. Time and again, I have heard from them, and from charities including CancerWise, which is based in Chichester, just how gruelling these daily journeys are. Many adjacent counties have this capability, and I started this journey to make the case for having that capability for my constituents.

It is worth highlighting that £130 million was invested in 2016-17, and that upgraded and replaced machines right across England’s cancer centres. It was the largest investment for 15 years, so we thank the Department of Health and Social Care for it; it was very welcome. However, we are concerned that in the long term, the equipment may not be maintained unless there is a rolling fund. The way we budget for this seems stochastic. We know that the equipment has a life span. As it is all new, perhaps we can now plan for when it is old, and ensure that there is a rolling budget in place. We have mentioned IT. It is vital that we have the latest network, to ensure that all the constituent parts are interconnected.

Radiotherapy is the most incredible resource, and is involved in 40% of cancer cures. It is a cost-effective treatment, taking up just 5% of the cancer budget while treating 50% of cancer patients, but it needs a bigger voice, and I am grateful to my colleagues on the APPG for securing this debate and allowing us to give it that voice.

I would like to take this opportunity to thank the NHS staff across our country who deliver this phenomenal service. The changes that we are discussing could save many more lives. Britain has always embraced innovative technology, so I have no doubt that advanced radiotherapy and integrated IT networks will be the standard in the future; the question for all those suffering from cancer is merely when.