Cumberlege Review: Pelvic Mesh

Graham Stringer Excerpts

Thursday 5th December 2024 Westminster Hall

[Several hon. Members rose—]

[Graham Stringer (in the Chair)]

It looks as though hon. Members do not need reminding that if they wish to catch my eye they should bob, even if they have put in to speak. I call Sir Alec Shelbrooke.

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[Anna Dixon]

I think the right hon. Gentleman makes a very valid point. Obviously, from my professional background, I see myself as fairly well-informed, but the scale of the damage done by this particular implant—the pelvic mesh—is also a shock to me. It is really timely that new Members are made aware of this issue. Hopefully, we can support any efforts to continue to raise it, and I commend Members who have been in this place for longer on their work to date.

I hope that the Minister will reflect on the specific point about research. As someone with a research background, I absolutely agree with you—I am sorry, Mr Stringer; I meant the right hon. Gentleman—that more effort needs to be put into research, not only on how we might treat such cases in future, but on the remedial effect.

[Graham Stringer (in the Chair)]

I thank the hon. Lady for correcting herself and acknowledging that “you” refers to the Chair. I also remind all hon. Members that interventions should be brief and to the point.

[Sir Julian Lewis]

That being said, Mr Stringer, I am absolutely delighted that the hon. Lady made that intervention. When someone of her expertise and experience says that even she had not realised the scale of this issue, it shows the magnitude of the task that faces us. This is every bit as bad as we heard in the excellent introduction from the hon. Member for Harlow (Chris Vince)—I apologise for not paying tribute to him earlier. He has done us all a great service by bringing this debate to Westminster Hall. This is on a level with the infected blood disaster, and it deserves the same level of treatment and remediation in so far as that is possible.

Reverting to the written question I asked, the Minister of the State at the time answered:

“There are no current studies specifically relating to new and improved techniques for the removal of eroded surgical mesh. However, there are five studies ongoing on surgical mesh implants and the National Institute for Health Research welcomes funding applications for research into any aspect of human health, including on the removal or implantation of vaginal mesh. There are currently no plans to establish a unit in order to train mesh removal specialists.”

I want to quote a third and final written question of those 15. Question 124936, from February 2022, stated:

“To ask the Secretary of State for Health and Social Care, what recent progress has been made in establishing the South East Regional specialist centre for the treatment of women damaged by mesh implants; and whether checks will be carried out to ensure that such women, when seeking remedial treatment from that specialist centre, are not placed in the hands of surgeons who were responsible for (a) implanting the mesh originally, (b) denying that anything had gone wrong with the implants and (c) claiming that women reporting extreme physical pain from the implants were imagining it.”

After a fairly long paragraph in reply, the answer concluded:

“Patients can discuss their choice of surgeon with the multi-disciplinary team if they have concerns regarding a specific clinician and can also discuss a referral to a surgeon in another specialist mesh centre.”

Think of the conversation that would require. A patient would have to explain to the person who had—to quote my right hon. Friend the Member for Wetherby and Easingwold—“butchered” them that, because they did not want to have his or her ministrations any further, they wanted to be referred to somebody else a long way away. Good luck with all that.

I will briefly touch on some points raised by people in the community of damaged women. I have been told about difficulties regarding personal independence payment applications. It has been suggested that staff managing PIP applications and renewals need better training and understanding of mesh injury. There has been some progress, apparently, in the gradual acceptance that many women had not given informed consent at the beginning, and this is perhaps beginning to make itself felt in relation to the legal actions that some people are undertaking. Just imagine being in constant pain and having the burden of undertaking those legal actions.

There is concern that mesh removal centres do not seem to have the same approach across the board for treatment or surgery. There are also very lengthy waiting lists if someone opts for a second opinion, for the reason I have already explained or any other reason. Mental health support and counselling is not readily available, which is another gap. We have already heard an excellent contribution by the hon. Member for Shipley (Anna Dixon) noting that the 10-year limitation for legal action on medical devices needs to be reviewed, because by the time some women have confirmation that the mesh is the problem, the 10 years could well have passed.

I have already mentioned that the Government ought to be looking to assist the legal cases against the pharmaceutical company or companies. It would be interesting to know whether the Government are making any progress on the subject of interim payments, which I believe the Cumberlege report recommended prior to any more bespoke payments based on individual circumstances. Will the Government encourage the yellow card Medicines and Healthcare products Regulatory Agency reporting to be made mandatory? If people are not reporting in when these things go wrong, how can we be sure of the scale of the problem? Finally, it is noted that there is a clear need for transparency for the public to be aware of exactly what payments medical professionals in the health sector receive from the pharmaceutical industry when they recommend these “routine procedures” that so often go wrong.

I conclude with a case that I have deliberately anonymised. Nothing should be drawn from where I happen to represent as to which surgeon in which mesh centre I might be referring to. This is what one victim has said about someone I will call surgeon X. He

“operated on me in 2009 to insert the mesh, which was described as a simple procedure that would solve my problems. Mesh was eroding through the vaginal wall immediately, and I had seven further ‘repair’ surgeries, which did not solve the erosion problem. In 2016, he advised me he could remove the mesh, so I paid privately for the surgery. During the surgery, nerves were damaged, causing severe pain and limitations, and the mesh was not all removed. I am left with the pain and limitations permanently, and have been told by another surgeon that full removal is now not possible. This surgeon is the clinical lead of the mesh centre”

local to her. She concludes:

“No surgeon should ever be allowed to cause damage to multiple patients, yet not only continue to perform the same surgeries, but to be head of the very centre which should be helping women. I feel sick at the thought of passing him in the street, let alone needing to see him as a health professional. I am sure we all feel the same.”

[Mrs Sharon Hodgson (Washington and Gateshead South) (Lab)]

Do you want to give some guidance on how long is left, Mr Stringer, so I can cut my speech accordingly?

[Graham Stringer (in the Chair)]

I intend to call the spokesperson for the Liberal Democrats at 2.30 pm.

[Mrs Hodgson]

In the short time I have available, I will try to make some important points. It is a pleasure to serve under your chairmanship, Mr Stringer. As co-chair of the all-party parliamentary group for first do no harm—along with Baroness Cumberlege, who it is a pleasure to see in the Public Gallery—it is a pleasure to speak in this important debate. I also point out how many officers of the all-party group are here in the Chamber, on a Thursday and on a one-line Whip. That speaks for itself as to how important the issue is to the House and to all of us. I thank my hon. Friend the Member for Harlow (Chris Vince) for securing this important debate to shed further light on this still under-discussed scandal.

Members present, campaigners watching at home, and especially patients, will all be aware of the extent of the injustice. I have had the privilege of working with wonderful campaigners over many years, and I take this opportunity to pay tribute to Kath Sansom from Sling the Mesh, who is a key campaigner for mesh victims and has been a great support to me and to colleagues over the years. I am glad that she is in the Public Gallery to watch the debate, alongside Debbie, who is the constituent of my hon. Friend the Member for Harlow, and who brought this scandal to his attention.

My first contribution in this House on surgical mesh was in 2017, during my time as shadow Minister for Public Health, and I am glad to see the actual Minister for Public Health and Prevention in his place to hear this debate. I have continued to campaign tirelessly on the issue through debates and my work with the all-party group ever since.

The issue is not only of political importance to me; it matters to me on a profoundly personal level. As I am sure some in the Chamber will know, among the thousands of women affected by mesh complications is my mam, who was one of the 617 mesh-damaged women who met, or made submissions to, Baroness Cumberlege for her review. I took my mam along to an evidence session in Gateshead, and she was able to meet Baroness Cumberlege and tell her story personally. She still talks about that to this day—she is very grateful.

After suffering mild stress incontinence, as we have heard from a number of people who went through the procedure, my mam had SUI surgery to have some tension-free vaginal tape inserted, which was a quick and common treatment offered to women for incontinence. However, had she known the life-limiting complications she was about to suffer as a result, dealing with slight stress incontinence would not have seemed very bad at all.

Two to three years post-surgery, my mam had one health complication after another. She suffered all sorts of autoimmune reactions, recurrent urinary tract infections, and was in constant pain in her groin, arms and legs. She became a shadow of her former self, and it took us quite a few years to work out what was causing the symptoms and pain. It was only through my research for that debate back in 2017 as the shadow Minister that I was able to join the dots together, and from that moment on we both wished constantly that she had never had the operation.

My mam will be 80 in January, and she would say that she is one of the lucky ones. Since I first spoke on the topic, she has been able to get the mesh surgically removed. It was a long delicate operation, thankfully carried out by the amazing Suzy Elneil, which she had to undertake in London in order to avoid the surgeon who put it in her in the first place—something that the right hon. Member for New Forest East (Sir Julian Lewis) and others have spoken about. That is something that many mesh-damaged women will understand. With the removal of the mesh, many of her health complications vanished immediately. The road to recovery is far from smooth for many mesh-damage victims, however, and my mam is no exception. She is still recovering to this day and, in her words,

“will never be the same again.”

I sat next to my mam at her local hospital and watched her be gaslit and undermined by her original surgeon when she first sought help with her pain and symptoms. Our doctors, surgeons and healthcare providers are meant to protect us, not harm us. Hence, “first do no harm”—an unwritten contract between patients and healthcare providers that rightly makes us feel that when we seek medical help, we trust that we will be made better, not worse. Surely the least we can expect in cases where harm does happen is accountability and for wrongs to be righted. Instead, we see a culture of defensiveness and a lack of accountability. It is therefore shocking that the surgeons responsible for the implantation of this life-shattering mesh are the very same people tasked with removing it.

I was going to talk about Baroness Cumberlege’s recommendations—which we have had success with and which we have not—but sadly the right hon. Member for New Forest East used up all the time, so I cannot.

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[Sarah Green]

I could not agree more. This is where I must pick up Carol’s story again. She tried to pursue her claim against her original surgeons through the courts, and she hit on an unexpected problem. She approached multiple legal firms who would not take her case because one or both of the surgeons were advising them on other cases and, as such, it would have been a conflict of interest. Indeed, the same surgeon who caused Carol life-changing injuries acted as an expert witness in an unrelated surgical mesh negligence case. The judge in that case said:

“he had cherry-picked those parts of the evidence which were supportive of the Defendant’s case and did not comment on those parts which were consistent to the Claimant’s. That is not the correct approach to be taken by an independent expert, whose duty is to the court. His evidence lacked balance and was unpersuasive.”

On this occasion, the judge called it out, but that is not the only instance of the medical profession closing ranks—it is not a unique occurrence. Such clear bias and conflicts of interest are a huge barrier to justice for mesh victims around the country.

The point of recommendation 3 in the Cumberlege review was to establish a non-adversarial avenue for redress after someone has been harmed in a healthcare setting. Both the Hughes report and, more recently, the Darzi report found that the current clinical negligence system is difficult for patients to navigate and prevents the healthcare system from learning from its mistakes. It is also eye-wateringly expensive for the taxpayer. If it is the dead hand of the Treasury blocking a redress scheme, Ministers would do well to reflect on that. As the Patient Safety Commissioner points out, the clinical negligence system is behind only nuclear disarmament and pensions on the list of liabilities on the Government’s balance sheet. I must ask the Minister when the Department will respond to the options outlined in the Hughes report, and when families can expect to see redress schemes up and running.

Recommendation 5 relates to the establishment of mesh centres around the country, and while such centres have been established, they get mixed reports from patients. My question on the mesh centres is about their outcomes. How is the Department ensuring a consistent service across them all, and how are outcomes being measured? With so many people reporting dissatisfaction with the centres, it is not enough that they exist; they need to be working well for the patients they are there to serve. Recommendation 6 relates to the MHRA, and it is clear that we still need the yellow card reporting system to improve. I would also welcome the Minister’s thoughts on progress against recommendation 7, which is about creating a central patient-identifiable database. To my understanding, it is still a work in progress.

The previous Government’s decision not to take forward the eighth recommendation, which is for a mandatory register, is disappointing. The recommendation called for

“Transparency of payments made to clinicians”

and

“mandatory reporting for pharmaceutical and medical device industries of payments made to teaching hospitals, research institutions and individual clinicians.”

I fail to understand why more progress has not been made on that. I know that campaigners have written to the Department asking it to consider a sunset Act that speaks to that recommendation, and I urge the Minister to chase a response to them.

[Graham Stringer (in the Chair)]

Order. The 10-minute time allocation is up. I now move to the official Opposition.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

It is a pleasure to serve under your chairmanship, Mr Stringer. I congratulate the hon. Member for Harlow (Chris Vince) on securing this important debate. I draw Members’ attention to my entry in the register of interests, as I am a practising NHS consultant, although in paediatrics rather than in any form of gynaecological surgery.

I begin by expressing my heartfelt sympathies to the women affected by injuries from pelvic mesh and, indeed, mesh in other sites, as we have heard about. Mesh is a surgical material and technically, therefore, a medical device, which was implanted in thousands of women to treat organ prolapse and urinary incontinence. However, in many cases, as we have heard today, it has caused serious long-term effects, including chronic pain, infections, organ perforation and, in some cases, permanent disability, which continues even after the mesh has been removed.

The exact number of affected women is still not known. Some have estimated the number to be 10,000, and today we have heard an estimate of 40,000. However, it is clear that it is a very large number of women. I echo the hon. Member for Chesham and Amersham (Sarah Green) in thanking Baroness Cumberlege, the Conservative peer who published the independent medicines and medical devices safety review in 2020. The review panel spoke to more than 700 women and their families from across the country. The document is exceptionally comprehensive, and it puts patients’ and families’ views at the heart of the review. Their experiences make for harrowing reading. The women speak of lives damaged, families put under immense strain, relationships destroyed, careers broken, financial ruin and chronic pain.

Last week, I spoke to a woman who is suffering after having had such mesh put in. Following the surgery, the skin never healed because of a low-level infection. That lady faces awful difficulties. The mesh is visible through the skin, from the surface. It is incredibly difficult to remove. Indeed, she has not been able to find a surgeon who is willing to even try to remove it, so she suffers in the house, unable to go out and experiencing infection after infection, an increasing number of which are resistant to some antibiotics. She knows that without the mesh removal, her prognosis is poor. It is an awful situation to be in, as I am sure the Minister will agree. I know he will be doing his best to try to help. Our healthcare system has to learn from those it has failed, such as that lady, and ensure that patients are put at the front and centre of healthcare so that this cannot happen again.

The Minister needs to focus on two things: how we help those affected by the mesh scandal, and how we prevent similar incidents with medical devices that we do not yet know the harms of, or that may not yet have been invented. People should not have to pay privately for treatment to rectify things that the NHS has done wrong. When someone has had a mesh put in and the mesh needs removing, the NHS should pay for that care. If the NHS cannot provide it, the NHS and the Minister must find a way of funding that care, provided by whoever can provide it, so that women are not financially out of pocket to the tune of tens of thousands of pounds for something that is not their fault.

The nine centres have been set up, and that is a good thing; they have been set up with a full multidisciplinary approach, which is also good. However, as we have heard, the outcomes are not 100% good in all cases. Surely it is intuitive that women should not have to see the same surgeon again. They should not be forced to make that explicit. It should be automatic, unless they want to see the same surgeon; it should be an opt-in system.

I urge the Minister to look at what the centres do. They provide help for women who have had pelvic mesh repair, but there are people suffering with mesh problems who have had mesh put into other places, for example near the rectum or in the abdominal wall. That may be women, but it may also be men, and they may suffer quite significant problems as a result. They need a centre, or several centres, of people who can support them and ensure that their mesh is removed, or their treatment needs are met, to stop the suffering they are experiencing.

We need a balance between ensuring that a similar scandal does not happen again and that long-term effects are picked up, and not restricting people’s access to new and innovative good treatments. In this place, we often have debates on treatments that are widely available, but not necessarily available here yet. We want to make good treatments available here quickly, but we need a robust system to identify problems as quickly as possible.

Part of that system includes the Medical Devices (Post-market Surveillance Requirements) (Amendment) (Great Britain) Regulations 2024, on which the hon. Member for Harlow, the Minister and others were recently involved in debate. When that statutory instrument was discussed in the Lords, the noble Lord Cryer said that the Government intended to introduce implant cards, and that the SI was part of a wider review of the regulation of medical devices that would be carried out in due course. Will the Minister give us some information on what that will entail? What are his thoughts on the process, and when will it happen? People need these things quickly.

I recognise the work that my right hon. Friend the Member for Wetherby and Easingwold (Sir Alec Shelbrooke) has done over a long time on many topics affecting women’s health, including the menopause and other concerns, and I congratulate him on that work. He represents female constituents very effectively. He talked about the fact that when surgeons inserted pelvic mesh, they often thought that it was the right thing to do. Only over time did it turn out not to be the panacea that it had been thought to be.

I remember in my medical training being told that a good surgeon is not just a surgeon who can operate well; the best surgeons are those who know when they should not be operating. It is very sad to hear that for many of the women, treatments that did not involve surgery could have been done instead, and that would have meant that those women did not suffer in the way they have done.

I highlight the point made by the hon. Member for Shipley (Anna Dixon) and my right hon. Friend the Member for New Forest East (Sir Julian Lewis) on the importance of research. When we are trying to resolve the problems caused by the mesh, we need to know that we are doing that in the most effective way. We need someone to look at the clinical outcomes and ask what we are doing, whether we are doing it in the best way and what other options might be available. This problem is not limited to the United Kingdom. What is being done elsewhere? Are there international comparators that do this better, and can we emulate what they are doing?

What we need from the Minister is rapid action to address the problems faced by women who have had this mesh put in. We need him to assure us that he is doing what he can to introduce proportionate regulations that will ensure that any other devices in use and in circulation across the United Kingdom do what they are supposed to do, and do not do any harm.

[Graham Stringer (in the Chair)]

I remind the Minister to leave two minutes at the end for the Member who secured the debate to reply.

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[Chris Vince]

I thank everyone who has spoken about this vital issue. At its heart, it is about women who have been let down and made to feel guilty because they are the victims. That is just not right.

I thank everyone who has taken part in this debate. My right hon. Friend the Member for New Forest East (Sir Julian Lewis)—today, we are all hon. Friends—rightly said that we have had this debate time and again. My ask is for the next debate to be after a ministerial statement—

[Graham Stringer (in the Chair)]

Order.

Motion lapsed (Standing Order No. 10(6)).

New Hospitals

Graham Stringer Excerpts

Thursday 25th May 2023 Commons Chamber

[Graham Stringer (Blackley and Broughton) (Lab)]

Will the Secretary of State clarify the position on North Manchester General Hospital? It is not mentioned in the written copy of his statement and I did not hear him mention it. When the right hon. Member for Uxbridge and South Ruislip (Boris Johnson) announced the original building scheme, North Manchester General Hospital was a top six—if not the top—hospital. Its problems are not mid-20th century concrete; they are mid-19th century buildings that need replacing with modern buildings. I thank the Secretary of State for emailing me in the middle of his speech—it was very clever; I got the email when he was on his feet—to say that initial works and progress can start. That has happened—grounds are being cleared, a car park is under construction and a new mental health unit is being built on that site—but the final clearance for what was a half-billion pound scheme has not been given. The trust has told me in correspondence that it cannot get clearance. Will he give the final go-ahead now, and will he return to north Manchester and visit the hospital? I know that he has been before.

[Steve Barclay]

I have been before, as the hon. Gentleman knows, not least because I was an unsuccessful candidate in 1997, when he was elected to the House. I am very happy to ensure that a note comes with any further clarification—I will take that away and pick it up with the Department. I know that enabling works commenced in 2022. There have been extensive demolition works, which have continued into 2023. There is, as he is well aware, the key dependency for the Park House mental health project, which also needs to be factored in. The multi-storey car park is under construction, so that work is already under way. I hope that he can see the clarity that the statement will bring to the conversations that we can now have with trusts on enabling works and the next steps, but I am happy to get a more detailed note to him following the statement.

Medicinal Cannabis: Economic Contribution

Graham Stringer Excerpts

Thursday 20th April 2023 Westminster Hall

[Ronnie Cowan]

I am curious. What we have done is—

[Graham Stringer (in the Chair)]

Order. Can the hon. Gentleman return to parliamentary language in this intervention? I am not participating in this debate at all. The hon. Gentleman referred to “you” in his last intervention, so I would be grateful if he could return to normal language.

[Ronnie Cowan]

The Minister is saying that he is allowing a licence for a product to be manufactured in the United Kingdom, in East Kilbride, so that is okay. We are allowing it to be manufactured here in the United Kingdom—that is all right. We are saying that people cannot get it on the NHS, but it is okay for other people to have it. Surely it has passed all the tests that we need it to.

[Sir Jeremy Wright]

The Minister is probably right, but I am sure that when he looks at this again he will also want to look at the NICE guidelines that apply, which are extremely restrictive. The risk to an individual doctor from making a decision to prescribe will be perceived to be much higher if the NICE guidelines appear to deter such a prescription. The Minister is right that there are many elements to this, but one of them is how much we encourage doctors to believe that this is the right thing to do. I go back to the point that I was making: there is some logical dissonance here. We have said already that it is right to reschedule these products as far as the Home Office is concerned. We are starting to see prescriptions in the NHS, but not in the numbers that will benefit the maximum number of patients.

[Graham Stringer (in the Chair)]

Order. We have not been short of time this afternoon, and every hon. Member has had the opportunity to speak. Interventions should be brief and to the point.

[Will Quince]

Thank you, Mr Stringer. My right hon. and learned Friend makes a good point. When we meet the members of the APPG, it is very hard not to be moved and to want to do all in our power to bring about the change that people want to see. I have considered the calls to change NICE guidelines, which have recently reviewed the basis of these products, but I am afraid the guidelines are unlikely to change until the evidence base develops, and that will happen through clinical trials and evidence. That is why I say all roads lead back to building an evidence base and a clinical trials base. That is the crux of this debate.

In January, the National Institute for Health and Care Research issued guidance recommending that the NHS prescribe cannabidiol to patients with a rare, seizure-causing genetic disorder, which is, I think, the fifth condition for which a cannabis-based treatment has been approved by regulators and offered to NHS patients in England. I understand that the treatment is also available and approved in Scotland and Northern Ireland. The NHS now funds thousands of these medicines each year.

I mentioned Jazz Pharmaceuticals earlier. I am not sponsored by it; it just happens to be the manufacturer and provider that I visited. It is a good example of the trailblazers in this space that not only create, but undertake the research, manufacturing and—the key part—licensing of cannabis-based medicines. It has shown what can be done. The key is very much in the research.

My right hon. Friend the Member for Dumfriesshire, Clydesdale and Tweeddale mentioned consistency and coherence in policy, which is why it is key that we treat cannabis-based products as we would any other medicinal product that we wanted to prescribe on our NHS. There is an economic case as well, although that is not what drives the Government. My whole focus in this is what is right for our NHS and patients. I am aware that there is huge hope and patient demand for access to medicinal cannabis, and that it is claimed that it can help with an array of medical conditions from chronic pain to anxiety; I believe there is also research under way at the moment on how cannabis-based products might be able to help with psychosis. I very much hope that those trials are successful. That is the right approach.

To date, much of the evidence suggesting cannabis could be an effective medical treatment is anecdotal or observational. As I mentioned earlier, only for a handful of conditions have enough clinical trials been done to prove scientifically that the drug is safe and effective. However, I am acutely aware that there are thousands of patients who now pay to access those unlicensed products on private prescriptions. Having spoken with campaigners and members of the APPG, I also know that some patients believe that funding cannabis on the NHS will reduce overall healthcare costs by alleviating symptoms and reducing the extent of hospital visits and other treatments. I understand and hear that case, but—I apologise for labouring the point; I have to keep coming back to it—before any new medicine can be proven to be cost effective, it must be proven to be safe and clinically effective. That is why research is so essential.

The Labour Front-Bench spokesperson, the hon. Member for Bristol South, asked what steps we are taking. That is a challenging question, because it is a pioneering area of research. Following collaborative work with clinicians and patient representatives, the NIHR and NHS England have confirmed support for two clinical trials into early onset and genetic generalised epilepsy. If you will permit me, Mr Stringer, I would love to use this debate to highlight a tender opportunity that will be launched by University College London in the next few weeks. UCL is seeking a supplier to assist in a world-first randomised control trial comparing cannabis-based medicines containing CBD and THC in the treatment of drug-resistant epilepsies in adults and children. I hope that that tender process is successful and that UCL finds a commercial partner to supply products for the trials so that they can commence as soon as possible.

Ambulance and Emergency Department Waiting Times

Graham Stringer Excerpts

Wednesday 6th July 2022 Westminster Hall

[Richard Foord (Tiverton and Honiton) (LD)]

I found on the doorsteps in my part of Devon over the last month that pretty much every door I knocked on had somebody behind it with an anecdote about how ambulance waiting times had affected them personally. In south-west England we have the longest waiting times in the country. One paramedic told me that despite his very best efforts to treat patients, there were times when he came across very undignified scenes. He talked about one example of how he came across a lady who had fallen down and had to wait 14 hours for an ambulance to arrive.

[Graham Stringer (in the Chair)]

Order. I realise that the hon. Gentleman is new, but interventions should be short and to the point. I did not want to interrupt him, but I ask him to remember that interventions should be as brief and to the point as possible.

[Wera Hobhouse]

Thank you, Mr Stringer. I think every one of us has such stories from the doorstep. Almost everybody knows of a loved one or a friend who has waited an unacceptably long time. That is why it is so important that we get the urgent review that Liberal Democrats have been calling for.

We are calling for a formal inquiry. The Government need to fund thousands of extra beds to stop handover delays in A&E so that ambulances can get back on the road as soon as possible. Will the Minister comment on a formal inquiry into the crisis?

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[Several hon. Members rose—]

[Graham Stringer (in the Chair)]

I think there are 10 hon. Members wishing to speak. I intend to start calling the Front-Bench spokespeople at 10.40 am. Therefore, Members have approximately five minutes each. I will not impose a time limit unless people abuse this privilege.

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[Karin Smyth (Bristol South) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Stringer, and to listen to this very well-informed debate. I commend the hon. Member for Bath (Wera Hobhouse) on securing it and on highlighting this important issue. We share boundaries across the south-west. I also thank the Minister for staying in the Chamber for the entire debate. He is now free to use his time. We will all be with him.

We know that under this Government record numbers of people are waiting for care, and they are waiting longer than ever before. Waiting times for ambulance and emergency department care are a symptom, as we have heard this morning, of the problems across the entire health and social care system. A record six million people are waiting for NHS treatment. There is a shortage of 100,000 staff and 17,000 fewer beds. That is not due to the pandemic, but deliberate underfunding of the NHS by a government who themselves admit—as the Culture Secretary recently did—that a decade of Conservative mismanagement had left our NHS “wanting and inadequate” even before covid hit.

I welcome the hon. Member for Tiverton and Honiton (Richard Foord) to his place and commend him on the points that he made. As we all know, on the doorstep, waiting times matter to constituents—a point that he made eloquently.

Waiting times for emergency care are nothing short of shocking. Like many Members of Parliament, I hear that every day from constituents. It is very distressing—and dangerous. There are cases of people waiting in agony outside the emergency department in an ambulance for over four hours, and waiting in the road for an ambulance for more than five hours. The average response time for an ambulance call-out for a stroke or suspected heart attack is 51 minutes and 22 seconds. The target, introduced by the last Labour Government, is 18 minutes. In May 2022, more than 19,000 patients were reported by NHS England as having spent more than 12 hours from the decision to admit to their admission to hospital. That really is a damning indictment. This winter, 89.8% more ambulances than the previous year were subject to delays of more than 30 minutes or more. My hon. Friend the Member for Jarrow (Kate Osborne) told us of the shocking incidents in the North East Ambulance Service and the investigation.

I could go on. What I am really interested in is the solution to this appalling state of affairs, as many hon. Members have said this morning. In fact, many hon. Members, particularly those on the Government side, have written my speech for me. Our highly skilled emergency department staff and paramedics show incredible courage and quick thinking on a daily basis. They need our support and they need a proper workforce plan that addresses shortages not only in emergency care but across the whole NHS.

Alarmingly, the Government’s manifesto commitment to improve waiting times for emergency departments was downgraded in the mandate from the Department of Health and Social Care to the NHS. The aim is now to improve performance “as conditions allow”. Under this Government, that will be never.

The hon. Member for North Shropshire (Helen Morgan) raised the case of the West Midlands Ambulance Service predicting a date on which it felt it would not be able to cope. This is not just about funding; it is also about the incoherent policies that leave patients and the public perplexed—a point that was touched on by the hon. Member for North Norfolk (Duncan Baker). Most urgent care takes place outside hospitals, but the complex mix of 111, GP out-of-hours, minor injuries units, walk-in centres, urgent care centres, as well as the plethora of online advice, is part of the chaos of fragmentation caused mostly by the now-discredited fetish for outsourcing and competition.

Currently, as we heard from the hon. Member for Waveney (Peter Aldous), schemes such as HALOs—hospital ambulance liaison officers—are just a sticking plaster. If we look at this as an A&E problem or just an acute hospital problem and do not incentivise all the ambulance services and primary care bits of the system to work together, we will not address the demand, which is a point made by the hon. Member for Broadland (Jerome Mayhew). The incentives, particularly after the Health and Social Care Act 2012, really do not help.

We need to make it simple for patients and their families to access the right care in the right place. That means supporting primary and community care, as well as ambulance services. As my hon. Friend the Member for York Central (Rachael Maskell) said, it is about bringing medical care to where people are and not expecting them to keep moving into the system.

Our highly skilled emergency teams must be free to manage all but the really serious acute cases referred to them, and then some of the problems would lessen, but the crux of the matter is that unless we improve discharges from hospital—as all hon. Members have said this morning—and ensure that our social care system is fit for purpose, we will not resolve the issue at the front of the hospital and we will not be helping patients. The pressures in leaving hospital has a direct impact on waiting times in emergency departments, and they put staff under pressure and patients in danger.

As my hon. Friend the Member for Weaver Vale (Mike Amesbury) said, the Government’s so-called fix for social care is not a fix at all. It is due to start in 2023. We need action now. We need to increase capacity in social care, improve pay and conditions for staff and ensure that we have a sustainable, working care system that will alleviate the pressures on the NHS, as well as support our constituents. There is no quick fix, but if the Government are serious about improving waiting times, they must look at the whole system.

We know the serious harm that waits and crowding in emergency departments have on patients and staff. Crowding is undignified and inhumane for patients who are left waiting for treatment in precarious circumstances. As well as impairing the efficiency of hospitals, it contributes to staff burnout, morale injury and the loss of emergency care professionals. It is associated with increased mortality and increased length of hospital stay.

Last year, the Royal College of Emergency Medicine estimated that crowding was potentially associated with more than 4,500 excess deaths. My hon. Friend the Member for Wirral West (Margaret Greenwood) noted the Royal College’s point that we are in the summer. This is not the critical time. We will go into another winter—winter follows summer every year, but it seems to be a shock to the Government. This is a very serious problem.

To prevent delays, I would welcome the Minister’s commitment to primary and community care and to supporting the timely discharge of patients when their hospital care is complete. Does he agree that there is an urgent need to support the social care workforce to ensure that it can offer the provision that meets the needs of our growing and ageing population? Will the Minister commit to the safe staffing of our emergency departments?

[Graham Stringer (in the Chair)]

Before I call the Minister, I ask that he leaves two minutes at the end for the proposer of the debate to wind up. I call Edward Argar.

NHS Dentistry in England

Graham Stringer Excerpts

Wednesday 22nd June 2022 Westminster Hall

[Derek Thomas]

I thank the hon. Gentleman for his intervention.

It is probably fair to say that although the responsibility lies with the Minister here today, it is not her responsibility, or even in her power, to ensure that every member of the British public can access NHS dentistry, simply because NHS England, or indeed any part of the NHS, does not commission enough dentistry to cover the whole population. Perhaps the Minister will clarify today the Government’s expectation regarding access to NHS dental care, and say whether there is a right for everybody, whoever they might be, to access that care. However, it is a very important point that has been raised. It surprises people that we do not commission enough dentistry to meet the needs of every one of our constituents.

It is not enough to blame the pandemic, although it has certainly not helped. I was raising the state of NHS dentistry in Cornwall before we had a single case of covid in this country. Over two years ago, I spoke about the difficulty of recruiting and retaining dental staff. At Prime Minister’s questions two years ago, I raised the shocking results of the lack of access to NHS dentistry for children in Cornwall. I also told hon. Members that these inequalities needed to be addressed quickly and creatively.

Outside this House, I have been working to improve access to dentistry in the constituency, most recently by getting the council to overturn a decision not to allow electrical works to proceed in St Ives that would have delayed the opening of a new dental surgery until the autumn. I have been meeting the regional health commissioners and Cornwall’s public health officers to discuss dentistry on a regular basis, and I cannot fault their speed and creativity. Their south-west dental reform programme has been working hard to improve access by helping to reopen a surgery in Hayle and in St Ives, piloting child-focused dental practices, and developing its own evidence-based workforce plan, but the Government must lead the way. Resolving these oral health inequalities is not just this Minister’s responsibility; it will require a cross-Government approach.

NHS England has launched a drive to recruit dental professionals to the south-west, but a key challenge in Cornwall, and maybe other parts of the country, is finding housing for those who want to take up a job in dentistry. I am working on that issue with the Department for Levelling Up, Housing and Communities. The national food strategy was a wasted opportunity. We could have extended the sugar tax, which has successfully incentivised the reformulation of sugary drinks. That would have helped oral health as much as health in general. I shall continue to argue for a national food strategy that is truly strategic, even if the Government have made a tactical withdrawal from tax rises to support public health.

The Minister has responsibility for the dental contract. In oral questions in January, she agreed that the contract was

“the nub of the problem”.—[Official Report, 18 January 2022; Vol. 707, c. 195.]

She said in February,

“there is no doubt that the UDA method of contract payments is a perverse disincentive for dentists. The more they do, the less they seem to be paid. I for one certainly do not underestimate the problems that that causes dentists, and I can see why many hand back their NHS contracts.”—[Official Report, 7 February 2022; Vol. 708, c. 780.]

I could not have put it better myself. I have asked dentists in my constituency if they would prefer to see increased budgets or reform of the UDA contract, and they asked for reform.

There are two main issues with the dental contract, both of which are not just obstacles to dental health but actively create problems for the future. First, the current system does not focus on prevention. When units of dental activity are the sole measure of contract performance, there is no incentive for preventative work; nor is there an incentive to make the best use of the whole dental team’s skills when the practice cannot make a claim for payment for a course of treatment purely because it was initiated by someone other than a dentist.

I made sure that the title of the debate referred to NHS dentistry not NHS dentists. We need to recognise the contribution of the whole team of dental professionals —dental nurses, hygienists, therapists and technicians—and use them. Again, this is about not just saving money, but using professionals in the best way we can. Yesterday I spoke to a dental nurse who works with people in care homes. If she wants a resident to switch to a high-fluoride toothpaste, she has to get a dentist to prescribe it. Our regional dental commissioning team has been running a pilot to take supervised toothbrushing conducted by dental nurses out to the community. Given that more five to nine-year-olds are admitted to hospital for tooth decay than for any other reason, this work should be at the heart of NHS dentistry, not something that is topped up by flexible commissioning.

Second, the UDA method does not properly reward dental practices for their work. A dental practice is faced, in effect, with a UDA cap for an entire course of treatment, which means when a patient has complex needs, the money involved does not even cover the overheads of the practice. The predictable result is that dental practices are moving away from NHS work. Around 3,000 dentists in England have stopped providing NHS services since the start of the pandemic. Every time a dentist leaves the NHS and is not replaced, approximately 2,000 people lose access to dental care. If you cannot do the arithmetic in your head, Mr Stringer, 3,000 times by 2,000 is 6 million, so 6 million patients have lost access to a dentist just over the course of the pandemic. For every dentist leaving the NHS, another 10 are reducing their NHS commitment by a quarter on average; that is another 500 patients losing access to an NHS dentist. According to the British Dental Association, 75% of dentists plan to reduce the amount of NHS work they do next year.

The fewer dental practices there are doing NHS work, the more pressure the remaining practices are under. A recent BDA members survey found that nine in 10 owners of dental practices committed to NHS work found recruitment difficult, with 29% of vacancies going unfilled for more than a year. That is nationwide, but one provider in Cornwall told me that their surgeries were unused 52% of the time due to shortages of dentists and nurses. The vast majority said that it was the UDA contract that was the biggest factor in their recruitment difficulties. The Minister said last week that the Government are serious about reforming the dental contract, but I want to press that point. It is not enough to be seriously planning a reform; we must be planning serious reform. Tweaks to the existing system are not enough when the contract is fundamentally flawed.

I have focused on the contract because we need the Minister to focus on the contract. Other Members will no doubt raise the issue of recognising overseas qualifications, passing the section 60 order that would give the General Dental Council discretion over qualifications, maintaining the mutual recognition of professional qualifications with Europe and extending that to the Commonwealth, and expediating the process for experienced candidates to register with the NHS. Dental care professionals need to be allowed to initiate treatments. The issue of funding will come up—for a catch-up programme of overseas registration exams in the short term, and university places in the long term—but it is striking how many of those proposals are cost neutral. We could even save money by catching mouth cancer in the early stages when it is more easily treated.

To quote the Minister, the contract is the nub of the problem. I urge her to commit to a firm date when we will see the end of units of dental activity, and a better contract focused on prevention and increasing access.

[Graham Stringer (in the Chair)]

I have indications from six Members who wish to speak. I intend to call the Opposition spokesperson at 3.40 pm. You can do the arithmetic—it is fairly straightforward—I do not intend to impose a time limit unless Members indulge themselves.

--- Later in debate ---

[Feryal Clark]

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

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

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

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

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

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

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

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

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

[Graham Stringer (in the Chair)]

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

North East Ambulance Service

Graham Stringer Excerpts

Monday 23rd May 2022 Commons Chamber

[Maria Caulfield]

I can reassure the hon. Gentleman that NHS England is doing work on workforce planning, which is crucial to ensuring that we have not just the right number of staff, but the right skills mix. I can also reassure him that performance in the ambulance service nationally has improved from March to April.

The ambulance service has been working under severe stress during the pandemic and in dealing with the ensuing backlog. We need to be mindful that although these are tragic events, the vast majority of ambulance staff are working extremely hard and caring for patients.

[Graham Stringer (Blackley and Broughton) (Lab)]

This is an appalling scandal and tragedy. Unfortunately, it follows a whole series of events that everybody in this Chamber could name, from Morecambe Bay to Mid Staffs to Bristol. The Minister claims that the NHS is open and that it has a learning culture when genuine mistakes are made. That is good rhetoric, but I am afraid that it is not the reality. What will she do to make it a reality? Last week, The Economist estimated that 1% of all deaths in this country are down to mistakes in the NHS.

[Maria Caulfield]

As I have said to other hon. Members, mistakes are always going to happen; that is human nature. The difference is that we are trying to introduce a culture of openness and learning in the NHS so that staff feel confident in coming forward, and so that when a mistake does happen, lessons are learned to prevent it from happening again.

Let us look at the record of this Government. It is this Government who are introducing a commissioner to oversee patient safety across the NHS. It is this Government who have introduced a statutory duty of candour so that when mistakes happen, patients and their families are notified and the process of learning starts. It is this Government who have introduced an early notification system specific to maternity—

Men’s Health Strategy

Graham Stringer Excerpts

Tuesday 22nd March 2022 Westminster Hall

[Graham Stringer (in the Chair)]

Nick Fletcher will move the motion and I will then call the Minister to respond. There will not be an opportunity for the Member in charge to wind up, as is the convention in these 30-minute debates.

[Nick Fletcher (Don Valley) (Con)]

I beg to move,

That this House has considered the potential merits of a men’s health strategy.

It is a pleasure, as ever, to serve under your chairmanship, Mr Stringer. Although this is only a 30-minute debate, I would still like to extend my thanks to the Backbench Business Committee for granting the time to discuss this extremely important issue. I am pleased that the Minister for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield), will respond, given her very positive contribution to the Westminster Hall debate on prostate cancer earlier this month. I am confident that she will give a positive response today.

Over the past year, the all-party parliamentary group on issues affecting men and boys, which I chair, has continually heard from a range of national and international experts that there is a need for an improved focus on and a far more co-ordinated and strategic approach to men’s health in England. This approach has been adopted elsewhere, in countries, such as Australia and Ireland, which have their own men’s health strategies, as does the World Health Organisation in Europe. We all agreed that there are serious challenges in men’s health.

It is important to place on the official record that nearly one in five men do not live until they are 65, with an increasing gender age gap; that 13 men take their own lives every day; that men in some parts of Kensington and Chelsea live 27 years longer on average than those in some parts of the north; that one man dies of prostate cancer every 45 minutes; that nearly 6,000 men die an alcohol-related death every year; and that two thirds of men are overweight or obese.

The troubling matter for me is that the situation is not improving but seems to be getting worse. The time has come for the Government to take a fresh and strategic approach that is in keeping with their positive levelling-up agenda and their What Works approach to policy making. The Government approach to men’s health is based on individual conditions and is disease-based. However, as well as not having the impact that we would hope for, such an approach looks only at the outcomes of poor men’s health, not at the causes. To me, that is key.

We need to address and prevent the underlying causes and barriers that have a negative effect on men’s health, while also making the health system more responsive. For instance, if we continue to address suicide, alcoholism and obesity as separate issues, we will fail to see that they are often a result of similar circumstances. Why are men who live in economically disadvantaged areas dying from a whole range of illnesses far earlier than men who live in wealthy areas? There is no innate biological reason for that. We need to strategically join the dots on the causes, not place the outcomes in separate buckets labelled condition A, B or C, as is currently the case.

A men’s health strategy would ask more questions of the health sector. What of the gender age gap? It is a well-known fact that women live longer than men. Why is that? It was not always so. This is not something that we should just shrug our shoulders at and accept as normal. I want all men to have a long life and for those lives to be lived in a state of wellbeing. I am sure that nobody in the country would disagree with that ambition.

Another issue is that despite making up 75% of all suicides, men make up only 34% of those referred for specialist therapy. Why is that? Is it because they are not being referred or because suicidal men are not accessing the health system in the first place? It could be a combination of the two, of course, but why are men not getting the support they need, and what is being done to address that? We need to look at this at a systemic level. Of course, men need to adapt and help themselves, but the final responsibility has to be on society and the health system to change to help men.

During the APPG’s evidence sessions, the experts raised a number of points that struck home. When I visit my GP, which is thankfully rarely, I always notice how few other men of working age are there. We have to work out why and address that. Is it hard to get time off work? Are GP opening hours flexible enough? Do men fear that their bosses or workmates will raise questions about whether they are healthy and fit enough to do their job? Do they just get on with it? It could be all or none of those reasons.

Campaigns to encourage men to access the health system are necessary and welcome, but deeper issues need to be addressed. We also need to ensure that we do not look at men’s health from a negative perspective. Our approach should be based on the needs of men and boys, rather than on men and boys having to accept what they are given. That is the positive What Works approach taken by a number of men’s health strategies around the world. I hope that the Government can draw comfort from the fact that they do not need to start from scratch in devising a strategy, because strategic work is already being done in Ireland, Australia and elsewhere.

In addition, a host of leading men’s health experts and charities in the UK are ready and able and want to help the Government. The Government should look at the great work that is being done on men’s health in Leeds—everything good in life starts in Yorkshire. The Government could also harness the knowledge, expertise and help provided by a number of great, growing and pioneering organisations that support men’s health, including, to name a few, Andy’s Man Club, UK Men’s Sheds, Prostate Cancer UK, Lions Barber Collective, Men Walking and Talking, MANvFAT, Mates in Mind, Football Fans in Training, and Black Men’s Health UK.

In addition to their great work, all of those organisations know that men do talk and take action on their health when the right environment is created. Many of those initiatives also prove the importance of taking support to where men are, not to where it is thought that they should go—many experts have made that point. I am sure that those organisations are all on stand-by to help the Government, as are a number of health bodies, such as the Men’s Health Forum and the Patients Association, which support the proposal to create a strategy, with the former leading a national campaign.

Since becoming a Member of Parliament in 2019, I have been struck by how the Government are taking a fresh, constructive and positive look at all policy areas. Old ways of thinking are no longer taken as read. We can see that in the field of women’s health, where the Government are introducing a strategy for the first time, which I am sure all of us in the House support. To be clear, that is not a reason in itself for a men’s health strategy, but it does signal the need to have a consistent, cross-Government approach that takes into account specific, gender-based aspects affecting the health of women and men. Without a change in policy, it would be incumbent on the Government in the coming months to explain, with hard evidence, why and how their current approach is improving men’s health.

My concluding point is that a men’s health strategy would benefit not just men and boys but the women and girls with whom they share their lives and society. They all have fathers, uncles, brothers, cousins. This is a strategy for the nation as a whole. It would also be cost-effective, saving the health service millions of pounds in treating illnesses, and helping employers in reducing sickness levels. It is a win-win situation and would lead to a healthier, happier and more productive society for all. The Government have an ideal opportunity, with the coming White Paper on disparities, to start the ball rolling, and I am confident that they will take it. I look forward to hearing the Minister’s comments on this incredibly important issue.

Future of the NHS

Graham Stringer Excerpts

Monday 31st January 2022 Westminster Hall

[Matt Vickers]

This is a debate that we have in every election campaign, and other than the issues around dentistry, which I am sure we will come to, the NHS remains free at the point of use. I will fight the corner to keep it that way, and I am sure that the hon. Gentleman will do so as well.

[Graham Stringer (Blackley and Broughton) (Lab)]

I think everybody in this room would agree with the principle that the NHS was founded on—care that is free at the point of use—but the NHS has had many structural forms since its inception immediately after the second world war. My concern is that its current form and the proposals that the Government are bringing forward further centralise the NHS, and waste further money on bureaucracy, mimicking the private sector and creating an artificial market. Does the hon. Gentleman agree that that is a waste of money, and that the NHS should be decentralised in order to provide better services to local communities?

[Matt Vickers]

I am sure we are going to hear about the ways in which these structural reforms will take place with that very aim in mind. I am going to try to get through my speech, because I am sure that Members would prefer for everybody to get in and to hear from the Minister, who is wiser on this issue than I am.

In my view, the Health and Care Bill does not represent an attempt to create a “pay for play” system—quite the opposite. While I am sure the Minister will go into detail about this point in his response, my understanding is that the Bill is largely the work of the NHS itself, inspired by NHS England’s own desire to restructure its organisational system to be more efficient and effective. It builds on the NHS’s own long-term plan, as set out in 2019, and the NHS people plan, which was published in 2020. Many of my conversations with leaders from my local NHS trust suggest that the answers to improving health outcomes require multi-agency working and empowerment of local health agencies, and my understanding is that the reforms and structural changes in the Bill set out to do exactly that.

One point on which I strongly agree with the petitioners is the need to drive value for money within our NHS, reducing management costs and excessive use of consultants, so that the huge increases in funding for the NHS can actually reach the frontline, not just fund more fruitless layers of bureaucracy. I am hopeful that the Minister will update us on what is being done to drive efficiency in that regard. Another point that I fundamentally agree with is the petitioners’ view that private finance initiative contracts have no place in our NHS. I know all too well the debilitating effect they have on the ability of the NHS to administer care across our country. Nationally, PFI contracts cost our NHS £1 billion a year and restrict numerous hospitals across the breadth of Great Britain.

I have seen at first hand how PFIs have damaged our local services in the Tees Valley. South Tees Hospitals NHS Foundation Trust, in particular, has been plagued by a dodgy new Labour PFI contract. The James Cook University Hospital was completed in 2003, but its PFI contract does not run out until 2034, and will cost over £1.5 billion. The trust currently has to meet annual payments of £57 million a year—more than £1 million every week. Of course, hospital upgrades and rebuilds are expensive, but that trust is paying £17.5 million over and above what an equivalent Treasury-funded hospital would cost annually. Shockingly, that is enough to pay for more than 530 nurses. It is ludicrous.

Even if there were not an extra 530 nurses at South Tees, there is so much the hospital could do with this money, such as investing in its building, equipment and staff to help improve health outcomes and inequalities. Excessive costs from historic PFI contracts are listed as the largest single contributory factor to the hospital’s troublesome financial position. At time when retention is a huge issue for our NHS, this money would be crucial to making a substantial difference to the working lives of our NHS heroes. I am glad that in 2018 a Conservative Government decided that PFI contracts would be phased out. However, hospitals up and down the country are now stuck dealing with a Labour legacy that has damaged our NHS, our people and our ability to tackle health inequalities across this country.

Public Health

Graham Stringer Excerpts

Tuesday 14th December 2021 Commons Chamber

[Wes Streeting]

My hon. Friend makes such an important point. Going back to the staff surveys, particularly given that the overwhelming majority of staff are vaccinated, it is not that they do not want their colleagues to be vaccinated, but that they have concerns about the way in which the Government are going about this. We accepted from the Government and from NHS England a very clear view that omicron has raised the stakes in this regard, which has had a big bearing on our position. It is very difficult for me and my colleagues on the Labour Benches to put ourselves in a position that is on the other side of the argument from the NHS and from the public, but the point about engagement is really important. The Government must work with and take the workforce with them. It is not good enough for us to just clap for the NHS, or clap for carers; we must work in partnership with them and respect that these are people who have given their lives to public service and caring for others. They do care. They will instinctively be on the right side, but they just need some persuasion, some patience and genuine engagement and that is where the Government have gone slightly wrong.

[Graham Stringer (Blackley and Broughton) (Lab)]

My hon. Friend started off his speech in an excellent way and has got better as he has gone through it. I say that, but I will almost certainly not be in the same Lobby as him on some of the votes this evening. There is a general point to the specific point that he is making on vaccines, which is that the Government should be clear, explicit and transparent on every issue that they raise if they want to take with them people who are not just worried about vaccines but worried about this whole affair. Repeatedly, the Government have refused to do a cost-benefit analysis on the impact of their policies. We have before us now a number of statutory instruments without impact assessments. Does he agree that that information should be available?

[Wes Streeting]

Let me say to my hon. Friend that, in his intervention, he started off well, dipped in the middle and then got better at the end. He made some absolutely fair points about impact assessments and transparency. In fact, I can see the Vaccines Minister waving impact assessments at me, so I am sure that she will make them available to my hon. Friend.

It comes back, as we have discussed at various points today and previously in relation to these sorts of restrictions and measures—it is how I began, and will begin to close, my contribution—to how we really cannot be complacent when it comes to public support, public compliance and public consent for the measures that we are considering. We know that we have asked so much of the British people and they have played their part. We also know that recent events have dented their trust and confidence and their willingness to comply, because they have seen No.10 saying one thing and doing another. That makes it even more important that, when we discuss measures that impact on people’s lives, livelihoods and liberties, we have these sorts of exchanges, look over the evidence rigorously, test each other’s assumptions and come to a conclusion.

With some of the exchanges that we have heard today, people across the country on both sides of these arguments can at least take some reassurance from the fact that, when these matters are under consideration, we do take them seriously. The Government could do a little better sometimes on bringing measures forward in advance of their implementation and on setting out the rationale and argument, and not just assuming that, because measures have been supported by the public previously, they will be supported today. I think we have public support for the measures under consideration this afternoon, but we should not be complacent about it. That is why it is right that we spend so much time exploring these issues.

--- Later in debate ---

[Graham Stringer (Blackley and Broughton) (Lab)]

As you know, Madam Deputy Speaker, I was trying to help you with the intervention by withdrawing from the list, but I am grateful to be on top of the list for the Labour Benches.

I agree with my right hon. and learned Friend the Member for Holborn and St Pancras (Keir Starmer) the Leader of the Opposition when he says that the Prime Minister is a threat to public health. I think that that is absolutely right. I draw a different conclusion from my hon. Friends on the Labour Front Bench on how we should respond: not by being irresponsible but by taking a look at the way the Government have dealt with the whole of the covid crisis from the very beginning to what they continue to do.

I am a member of the Science and Technology Committee. Together with the Health and Social Care Committee we produced a 150-page report. I hope that right hon. and hon. Members have had the time to read it. They may not agree with its conclusions, but it contains very valuable information. The key point, which a lot of the press missed, was not that the Government followed the science on the issue but that they got into a groupthink with the scientific advisers and did not challenge them. They assumed that science was something handed down on tablets of stone, whereas it is not. It is a process and it needs challenging by those of us who have responsibility in this House for making laws and policies, and by other scientists. We seem to be repeating that process.

My Committee had as a witness this morning Susan Hopkins. Let me say that at best—if I can use a word somebody else used—the advice we were getting from her as an adviser was opaque. The information we were getting was opaque when it should be transparent. This time last week, the Deputy Prime Minister stood up and said there was no plan to go to plan B. Some 36 hours later, we were starting plan B. Why was that? What was the scientific advice given?

We were told fairly definitively that no such advice was given to change the view. What changed the view was that the Prime Minister was in a state of crisis and under pressure from his own Back Benchers and everybody else. That is not a sensible way to make decisions. It is not a sensible way to make decisions to put forward statutory instruments that say—the Under-Secretary of State for Health and Social Care, the hon. Member for Erewash (Maggie Throup) was waving a sheet about, which may or may not have been the impact assessment—that no impact assessment has been done.

[Mr Steve Baker]

I have in my hand the impact assessment for vaccination as a condition of deployment in health and care providers—I was not able to get in earlier. I feel confident that the Front Benchers will know that the estimate is that 88,000 people will leave the health sector, 73,000 will leave the NHS, 15,000 will leave the independent health sector, and 35,000 workers will leave domiciliary care. Does the hon. Gentleman agree that that is reason enough to vote against imposing this on the nation?

[Graham Stringer]

That is very interesting. It is also interesting that papers circulated by the Vote Office said there was no impact assessment. That does not impress me.

The point I was just about to make—I do not know if other hon. and right hon. Members have noticed this—is that the 355-page Act passed at the start of the epidemic, the Coronavirus Act 2020, is barely being used. The Government could have used the Civil Contingencies Act 2004 to bring in some of the restrictions that they have placed—maybe necessarily, maybe unnecessarily—on people’s freedoms. The difference between the 2004 Act and the Public Health (Control of Disease) Act 1984 is quite simply that much less scrutiny is available under the latter. Once regulations are passed, if there is not a sunset clause, they last. The Government should not be rewarded for unnecessarily using tough authoritarian legislation when other legislation was available that would have allowed more scrutiny.

The Government have refused to give information. My hon. Friend the Member for Ilford North (Wes Streeting) began his speech by saying that different people have different views and weigh the factors of civil liberties and health in different ways. That is absolutely right, but the Government will not tell us the costs and benefits of their policies. We now know that three quarters of a million people have failed to be tested for cancer. This is not a win-win situation. Cancer patients who are yet to be tested will eventually die because of the decisions being taken, because services are not available; some people will die of covid.

To come to the right decisions, this House needs all the information available, but it is not coming from the NHS and it is not coming from Government Ministers. That is why I will not give the Prime Minister the benefit of my support for the way he has arranged to respond to this covid crisis.

Covid-19 Vaccinations

Graham Stringer Excerpts

Monday 20th September 2021 Westminster Hall

[Jack Dromey (Birmingham, Erdington) (Lab)]

It is a pleasure to serve under your chairmanship, Ms Ghani, and I welcome the Minister to her position in Government and here today. One of the welcome innovations of parliamentary democracy in recent years has been the notion that the public can trigger debates by way of e-petitions, and we are here to debate two e-petitions that commanded significant public support.

The hon. Member for Carshalton and Wallington (Elliot Colburn) was absolutely right to talk about the development of the vaccines as a remarkable triumph of British science, and all those who have been involved deserve huge credit—not least because the consequence has been to save the lives of tens of thousands of people who would have otherwise have died. We in the Labour party are committed to following the science and, as has been said eloquently, we can see that vaccination is having a dramatic impact, reducing hospitalisation and preventing people from becoming very ill with covid. As the hon. Member for Airdrie and Shotts (Anum Qaisar-Javed) rightly said, it is absolutely vital that everyone who can get the vaccines should do so. We therefore need to send an unmistakable and united message from Parliament: by keeping uptake rates high, we can beat the virus. Anyone who is worried about the vaccine—there are many—should speak to health professionals about their concerns and receive proper advice. They should not be influenced by anti-vaxxer fantasists, whose advice is not just wrong, but dangerous to health and wellbeing.

[Graham Stringer (Blackley and Broughton) (Lab)]

I agree with the point that my hon. Friend is making. I was talking to a 14-year-old over the weekend, and she said that she had seen on the internet a magnet that was attracted to somebody’s arm because they had been vaccinated. Does my hon. Friend agree that the internet companies and the Government should get such nonsense taken down as soon as they can?

[Jack Dromey]

My hon. Friend is absolutely right. Some of the propaganda that we have seen, including on the internet, is positively pernicious. If anyone is seduced into believing it and, as a consequence, catches covid and dies because they are not vaccinated, those responsible bear should bear a heavy burden for what they are doing. Everyone with power, including the internet companies, needs to be more proactive and dynamic in ensuring that shameful propaganda is not propagated on social media.

Over the past year, we have seen the tragic impact of coronavirus on our communities. I stress once again that it is absolutely vital that the importance of taking the vaccine is constantly emphasised. I think of Jane Roche in my constituency, who lost her father and, five days later, her sister to covid. Jane remains distraught to this day, one year on. People such as Jane know all too well just how important it is that vaccine uptake remains high, so that no one should suffer the grief that she has suffered. Like other hon. Members who have spoken in the debate, I therefore strongly encourage everyone to get vaccinated for their own protection, but also for that of the wider community.

The Labour party calls on the Government to make a more direct effort to vaccinate those from communities in which vaccination rates are low, particularly young people. I hope that in her response, the Minister will be able to update us on the Government’s efforts to tackle the problems of low uptake.

On vaccine passports, in relation to the petitions before us, we understand why the public might be confused or anxious about perceived discrimination against those that are not vaccinated. I have to say that the Government’s approach to covid passports has been chaotic at times. There has not been consistent clarity from Ministers about what vaccine passports are supposed to achieve, how they would work and what would be expected from the public, businesses and workers, and that meant we had a degree of chaos over the summer and no real preparation before the winter. Two weeks ago, the then vaccines Minister, the right hon. Member for Stratford-on-Avon (Nadhim Zahawi), stood before Parliament to confirm the introduction of covid passports and stress their importance; days later, the Secretary of State for Health and Social Care said that they had been scrapped. No matter the measures being introduced, businesses, workers and consumers need clarity from the Government, not conflicting messages and rapid U-turns. We have therefore repeated many times that we would not accept any certification or passport scheme that was vaccine-only.

The Welsh Labour Government have made some interesting progress on this very issue. They followed the data and applied a mandatory risk assessment that takes into consideration the full risk posed, and then recommends a range of mitigations on that basis. For large venues, crowded events and close-contact businesses, such as nightclubs, the NHS covid pass application is mandated for use; that means using familiar mitigations such as masks, social distancing and ventilation in most business settings, based on the risk level. Use of the NHS covid pass gives people the option to present a negative test result as an alternative to full vaccination.

We do not support the introduction of any scheme that provides access to a service for only fully vaccinated people. Free testing should therefore remain widely available so that we can identify and isolate the virus. The approach in Wales has been welcome in other respects, as it makes a clear distinction between venues such as local cafés on one hand and Wembley stadium on the other, where different mitigations for covid are needed.

We also do not support any potential covid pass scheme for access to essential services that does not get the balance right. That includes, but is not limited to, access to doctors and dentists, supermarkets and other essential retailers. We do not agree that vaccine passports should be used for day-to-day, routine access to the office, health services, dentistry or food.

On health and social care workers, we want everyone working in care homes to take up the vaccine—that is absolutely essential. The vaccine is safe and effective. I stress again: do not believe the sometimes poisonous propaganda of the anti-vaxxers. However, we do not support the case for compulsory vaccination. There are serious warnings from the care sector that the Government’s plan could lead to staff shortages in already understaffed care homes, which would have disastrous consequences for the quality of care.

Again, the UK Government should learn from the work done in Wales, which is running the fastest vaccination programme in the world, and has vaccinated a far greater proportion of its care staff than England. The Welsh Government have rejected compulsory vaccinations and have instead chosen to work closely with the care sector to drive up uptake, as well as valuing the workforce, including a proper pay rise. The Government should focus on driving up standards and retention of staff by treating care workers as the professionals they are, with improved pay, terms and conditions and training. We need all care homes and care workers to have proper personal protective equipment, regular testing and good training.

We are now approaching what is likely to be one of the most challenging winters that the national health service has ever faced, and the top priority must be to protect it. We urgently need a plan from Government that sets out the direction of travel in the next stages. Any plan for the winter period must, first, get vaccination rates up in areas where uptake is low; secondly, outline how and by when vaccinations for children will be rolled out; thirdly, finally fix the issues of self-isolation and sick pay; fourthly, provide proper ventilation in schools and public buildings; and, fifthly, provide a clear plan for businesses, workers and consumers. Those are significant steps the Government could take to greatly improve the country’s response to coronavirus. I hope that when the Minister responds, she will be able to outline in more detail the Government’s plan to fix those problems.

Once again, as other hon. Members have done cross party, I emphasise the importance of vaccine take-up. Covid-19 vaccines have saved thousands of lives and been crucial in protecting the national health service. It is critical that we maintain the protection the vaccine affords and send a clear and unambiguous message to all that vaccines work, and that anyone who can, should receive the vaccine.

--- Later in debate ---

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

Thank you, Ms Ghani.

I am grateful to my hon. Friend the Member for Carshalton and Wallington (Elliot Colburn) for introducing this debate on these important topics, and I commend him for setting out the importance of vaccines in combating so many diseases. When we look at the history of vaccination programmes in previous eras, we realise just what impact they have had on people’s lives.

We know that the covid vaccination programme is the nation’s best line of defence against covid-19. Vaccinated people are far less likely to face severe disease from covid-19, to be admitted to hospital or to die from it. They are also less likely to pass the virus to others. More than 93 million covid-19 vaccinations have already been administered, and the latest estimates from Public Health England indicate that the programme has saved more than 112,300 lives and prevented more than 24 million cases.

As other hon. Members have done, I pay tribute to everyone who has played a crucial role in the success of the vaccine roll-out—our brilliant scientists, clinical trial participants, the armed forces, NHS England, frontline healthcare workers, vaccine volunteers and local and central Government. Their life-saving efforts have helped to maintain the rapid pace of the roll-out across the entire country. I also recognise the brilliant work of the former Minister for vaccines, my right hon. Friend the Member for Stratford-on-Avon (Nadhim Zahawi). I know that I have very big shoes to fill.

The public’s continued willingness to get vaccinated, to test, to self-isolate if they have symptoms and to follow behaviours and actions that mitigate all methods of transmission has played a key role in the lifting of restrictions. Over autumn and winter, the Government will aim to sustain the progress made and prepare the country for future challenges, while ensuring that the national health service does not come under unsustainable pressure.

In my first debate as Minister with responsibility for vaccines, I join the plea of my hon. Friend the Member for Carshalton and Wallington and other hon. Members for those not yet vaccinated to take up their vaccine offer and join the around 89% of the UK who have had at least their first dose. I am sure the whole House will join me in thanking them for playing their part in helping us all to live safely.

We will continue to make vaccines easily available to everybody, to maximise uptake among those who are eligible but to date have not taken up the offer. In England, 11.3% of people ages 16 and older—more than 5.5 million people—remain unvaccinated, which heightens the risk of rising hospitalisations, particularly when prevalence is high. Take-up so far varies by ethnicity, age and deprivation, with some groups recording lower rates of vaccine uptake than others.

Building on lessons learned through phases 1 and 2 of the vaccine roll-out, the Government continue to work closely with the NHS to make it as easy as possible to get a vaccine, including through “Grab a Jab” in England, pop-up vaccine sites across the country and easy-to-use walk-in sites found on the NHS website. Pop-up sites include those at football stadiums and shopping centres, reaching out to the whole community. The Government have partnered with transport providers, such as Uber and FREE NOW to ensure access to vaccine sites is easier than ever before.

The hon. Member for Birmingham, Erdington (Jack Dromey) asked how the Government have reached out to people who are hesitant to take part in the vaccination programme. Despite having been in post for only a matter of days, I reassure him that the Government and the NHS are working closely together to ensure that we reach out and get the extra 5.5 million jabs into the arms that need them, and fill the gap that is in the community. I reassure him that that is one of my key priorities in my role as vaccine Minister.

The last 18 months have shown that the pandemic can change course rapidly and unexpectedly. It remains hard to predict with certainty what will happen. There are a number of variables, including the levels of vaccination, the extent to which immunity wanes over time, how quickly and how widely social contact returns to pre-pandemic levels, which is partly to do with the return to schools and as offices reopen, and whether a new variant emerges that fundamentally changes the Government’s assessment of the risk. That is why the autumn and winter plan sets out our plan B.

Vaccine status certification is part of the Government’s plan B if the data suggests action is required to prevent unsustainable pressure on the NHS. For venues, certification could allow settings that have experienced long periods of closure to remain open, compared to more stringent measures that may severely reduce capacity or cause them to close entirely. The autumn-winter plan committed to publishing further details shortly on the proposed certification regime that would be introduced as part of plan B.

In this scenario, certification would be introduced in a limited number of venues. Communal worship, wedding ceremonies, funerals and other commemorative events and protests would also not fall under the certification regime. Exemptions would continue to apply for those who cannot be vaccinated for medical reasons, those on covid vaccine clinical trials and for under-18s.

The NHS covid pass would continue to certify individuals based on vaccination, testing or natural immunity status, with more than 200 events and venues already introducing voluntary certification and the NHS covid pass as a condition of entry.

Care home staff provide a critical role in supporting the health and wellbeing of some of the most clinically vulnerable to the effects of covid-19 in society, and have maintained their dedication and professionalism through highly challenging conditions. Since the start of the pandemic, the Government have committed over £6 billion to local authorities through non-ringfenced grants to tackle the impact of covid-19 on their services, including adult social care. We continue to be committed to supporting the social care sector.

To prevent individual susceptibility to covid-19, from 11 November it will be a condition of deployment for anyone working or volunteering in Care Quality Commission regulated care homes that provide accommodation for persons who require nursing and personal care to be fully vaccinated. Thanks to the incredible efforts of people across the sector, over 1.2 million social care workers in England have now been vaccinated. This is a fantastic achievement and an important step for staff to protect themselves, their loved ones and the people they care for from becoming seriously ill or dying from covid-19.

[Graham Stringer]

Can the Minister answer the question that her predecessor failed to answer on the Floor of the House on Second Reading of the Bill? Everybody agrees that it would be a good idea if all care workers were vaccinated, but why will it be effective to force reluctant care workers to either have it or lose their employment, when other people entering care homes—hairdressers, musicians and entertainers and such—would not be forced to? How is that an effective policy?

[Maggie Throup]

I thank the hon. Gentleman for the question. If he will excuse me, I have obviously been in post a short time. As I am led to believe, it is people who regularly go into care homes that will need this. It is not just restricted to the actual carers. If anybody needs to go into a care home in an emergency situation, that is a different scenario. If I may, however, I will clarify that after the debate.

Vaccine uptake nationally in the care home workforce is high, at 85.6% for first doses. This is in line with vaccine uptake in the general population. There is, however, significant variation at a regional, local and individual care home level. Vaccine requirements are designed to level up uptake in the care home workforce. While the majority of care home workers have been vaccinated, the latest published data as of 12 September highlighted that only 81.3% of older adult care homes in England were meeting the SAGE advice that 80% uptake of first doses among staff is the minimum needed to reduce the risk of outbreaks in these high-risk care settings.

While residents in care homes are some of the most at risk from covid-19, the responses to this initial consultation on care homes made a clear case for extending this policy to other settings where vulnerable people receive care and treatments. The Government are therefore seeking views on whether to extend vaccination requirements to other frontline health and care workers—those with face-to-face contact with patients and clients through the delivery of services, as part of a CQC regulated activity. Recent research has shown that people infected with both flu and covid-19 are more than twice as likely to die as someone with covid-19 alone and nearly six times more likely than those with neither flu nor covid-19, so vaccination requirements for both flu and covid-19 are being considered.

I trust that the debate will have helped to dispel some of the myths that hon. Members have raised about vaccinations, and will really reach out to the public to ask them, as colleagues have done, to go and get vaccinated to protect themselves and others. To conclude, I reassure the House that we are doing everything we can to widen and deepen our wall of defence that the vaccine provides. The ask of our NHS colleagues is challenging and complex, yet they have risen to this challenge and do it every day. Once again, I thank them for their dedication.