New Dementia Treatments

Helen Whately Excerpts

Thursday 11th January 2024 Westminster Hall

[The Minister for Social Care (Helen Whately)]

It is a pleasure to serve under your chairmanship, Mr Sharma. I congratulate my right hon. Friend the Member for Ashford (Damian Green) on securing this debate. I also commend the campaigning of several charities in this area, including Alzheimer’s Research UK, the Alzheimer’s Society, Dementia UK, Age UK and many others that do so much to raise awareness of dementia, fund research, and support people with dementia and their carers.

I commend my right hon. Friend on his speech. Like many, he has his own experience of dementia with his father, which has clearly informed the significant work that he has done in this area. He spoke about some of the statistics, which I will come on to, and about how a dementia diagnosis can be a bleak prospect. He also spoke about some glimmers of hope for people with dementia and for us as a society—for instance, the fact that dementia can be preventable for some people; our growing understanding of the importance of brain health and how we achieve it; and the progress being made towards treatments that can genuinely make a difference in the future for people with dementia. I heard his specific question about the evaluation by NICE of the treatments and whether the evaluation approach is fit for purpose; I will come on to that shortly.

My right hon. Friend also talked about the importance of better and earlier diagnosis. Indeed, he mentioned that, at the moment, more than a third of people who have dementia are estimated not to have a diagnosis, although, clearly, the other side of that is that about two thirds of people do have a diagnosis. Although we know that the pandemic hit our ability to diagnose people, we have seen some recovery in the diagnosis rate since the pandemic. It is now at the highest level for three years. He rightly said that, overall, for this area, as for many others, prevention is at least as important as a cure. He spoke about the opportunity, in that dementia diagnosis should no longer be a life sentence for this generation, which is an uplifting prospect for all of us involved.

We also heard from the hon. Member for Oldham East and Saddleworth (Debbie Abrahams), who spoke about her experience with dementia and how she cared for her mother Angela when she had Alzheimer’s, until she died. I have huge respect for her, knowing how difficult that must have been. She is also extremely knowledgeable about dementia and spoke about the many different sub-types of dementia, and I thank her for her work as the chair of the all-party group on dementia.

The hon. Lady spoke about hospital stays for people with dementia; a significant number of people are in hospital with dementia. As part of my brief, I have oversight of discharges from hospital and urgent emergency care, and I have spent a lot of time thinking about the flow through hospitals. I think a lot about people with dementia and how we can support them to be discharged to the best place for their care afterwards, or how we can avoid long stays in hospital for them. It can then be so difficult for them to be discharged, given the potential deconditioning that happens to people in hospital.

The hon. Lady rightly talked about how dementia is now the No. 1 cause of death in the UK, but it should not be seen as inevitable for us as we age, and in an ageing society. I heard her three asks, calling for dementia to be diagnosed more often at an early stage; for us to do better at diagnosing sub-types of dementia; and for us to improve access to PET scans and lumbar punctures for diagnosis. I will come to some of those points in a moment. I can definitely agree with the Opposition spokesperson, the hon. Member for Bristol South (Karin Smyth), that we have heard speeches from formidable colleagues in the debate, as well as from a number of others who joined us and contributed through interventions.

I will start with the impact of dementia. We know that close to 1 million people in the UK suffer from dementia. Around 900,000 people over the age of 65 and almost 50,000 people under the age of 65 are estimated to have dementia. We expect those numbers to increase to more than 1 million by next year and more than 1.5 million by 2050.

The stats are one thing, and they clearly point to the scale of dementia in our society, but they do not necessarily bring to life the human cost of dementia—what it means for people who have it, their families and friends, what it means practically for someone with dementia and those close to them, and what the challenges are of living with dementia or caring for somebody with it. There are significant financial burdens, both on people working who are then diagnosed and may be unable to work, so they have lost income, and on carers, who may have to cut back their work hours or leave work altogether. There are then the financial costs of professional care, whether that is state-funded social care for those who receive it, or self-funded care.

Most significantly, there is the emotional cost of dementia—what the diagnosis means for the individual who learns what is making life so difficult for them and knows the prospects ahead as the disease progresses, what it means for those they love, and what the experience is like for people who are close to them and care for them. It can be very difficult to care for somebody while at the same time feeling as if the person they know and love is being stolen from them. That emotional cost is unquantifiable, but we know that it hits very hard.

Like other hon. Members, I feel that I have painted a pretty bleak picture of what dementia means to our society, but I have no doubt that there are real reasons for optimism. First, we now understand that a significant proportion of dementia—it is estimated to be around 40%—is either preventable or at least delayable, and that we can actually make a difference. Secondly, real progress is now being made in the research into treatments, and there is the prospect of treatments becoming available that will genuinely make a difference to the progress of the disease. There are real reasons for optimism, although, as a Government Minister, I feel that optimism on its own is not enough.

The question that I am sure hon. Members would like me to answer is what we are actually doing to realise this potential and turn the optimism into improved outcomes. To prevent and delay the onset of dementia, we are and have already been acting and intervening to influence the risk factors. We know that we can influence them. For instance, the known risk factors for dementia, similar to other conditions such as cardiovascular disease, include high blood pressure, obesity, diabetes, smoking, poor diet and lack of physical activity. These are things that we can and are intervening in.

For instance, we offer a health check for all adults aged between 40 and 74 in England to identify the early signs of stroke, kidney disease, heart disease, type 2 diabetes and, indeed, dementia. Dementia was incorporated specifically into that health check, in part to raise awareness of the fact that people can make a difference and reduce their risk of dementia, and to motivate people to take steps to reduce that risk. There is a much greater awareness that people can make a difference and reduce their risk of suffering from heart disease or diabetes. Alzheimer’s Research UK has found that about 70% of people know that they can reduce those risks, but less than a third of people know that they can reduce their risk of and prevent themselves from getting dementia. We have offered that health check to over 9 million people, and about 3.7 million people have had it already. We will continue to encourage people to take that up.

Looking ahead, there is more that we can, should and, indeed, will do to prevent people from suffering ill health, prevent dementia and help people to maintain their health. That is at the core of our major conditions strategy, to which my right hon. Friend the Member for Ashford referred. Crucially, that includes dementia, alongside the five other major conditions that represent the major burden of ill health in the country, including cancer and cardiovascular disease.

The hon. Member for Bristol South questioned the point of having a standalone dementia strategy. Actually, it is very important to include dementia with other major conditions and major causes of ill health, partly because we are moving towards having a society in which many people suffer from multiple health conditions. In fact, many older people will have dementia alongside other health conditions, so it makes sense to look at people’s health in the round, not just pick one condition.

As I mentioned a moment ago, dementia is a common risk factor for many major conditions, so it makes sense for our health system not to look at any condition in isolation, but to look at how we can improve people’s health in the round and reduce their risks. The major conditions strategy is absolutely the place where I point right hon. and hon. Members to look at our evolving Government strategy to address some of the health and lifestyle factors, to move into prevention and to support people in the event that they receive a dementia diagnosis.

The other area where there is cause for optimism is the progress that is being made in the research and development of new treatments. Finding a treatment to slow or, indeed, cure dementia, rather than just manage it, would change the implications of receiving a diagnosis and make such a difference to thousands or even millions of people in the UK and globally. This is a challenge that we share with many other countries, particularly those in the developed world, and we are rightly collaborating internationally on research.

Since 2018, the Government have spent over £454 million on supporting dementia research. In 2019, we made a manifesto commitment to double our funding for dementia research to at least £160 million a year. We have since launched the Dame Barbara Windsor dementia mission, backed by £95 million of Government funding. The UK Dementia Research Institute, of which the Government are a founding member, recently announced a new partnership with the British Heart Foundation to establish a centre for vascular dementia, backed by £9 million-worth of funding. Vascular dementia is the second most common form of dementia, affecting around 150,000 people in the UK. We are determined to be a world leader in dementia research and to be recognised as such.

I turn to some of the new treatments. My right hon. Friend the Member for Ashford referred to lecanemab and donanemab as two of the treatments about which there is great excitement. Crucially, the Government want to make sure that treatments are made available to people as soon as possible through the national health service. It is important to sound a note of caution, because we know that such treatments do not come without side effects; in fact, the trials saw some significant side effects, such as the risk of brain bleeds. As ever, it is very important that we follow the proper processes that we have in place to assess the use of treatments by the national health service. That includes both licensing through the MHRA and evaluation by NICE. For the two drugs I mentioned, those processes will happen during the course of this year.

My right hon. Friend asked what NICE takes into consideration in its evaluation. I can assure him and other Members that NICE takes into account all health-related costs and benefits, including the health benefits to carers of a treatment. It also considers the publicly funded cost of social care, so there is a social care element taken into consideration by NICE. I say that very specifically: I wanted to make sure, so I have double-checked in order to be accurate in saying it in this Chamber this afternoon.

I acknowledge and recognise the points that my right hon. Friend and others have made about the impact on unpaid carers and the economic cost. It is true that there is a limit to the costs that NICE considers. Clearly, looking at all the possible broader economic costs involved would have implications not only for dementia treatments but for the many other treatments that NICE considers. As that is a very big question, not just one that is pertinent to dementia, it is probably worthy of a separate conversation in its own right. Nevertheless, I assure him and other hon. Members here today that the publicly funded cost of social care is taken into account by NICE in its evaluation process.

There is also the question of the readiness of the national health service to make drugs available if they are successful through both the licensing process and the NICE evaluation. I assure hon. Members that NHS England is indeed working to ensure that the NHS is ready to support the adoption of new treatments, including the diagnosis processes that will be needed, while recognising—I believe the hon. Member for Oldham East and Saddleworth referred to this—that new treatments are likely to require greater access to forms of diagnosis such as PET scans and lumbar punctures, and also recognising that such treatments are likely to require earlier diagnosis in order to be effective.

One thing that I look forward to is that, particularly as treatments that require an earlier diagnosis become available, more people will come forward to seek a diagnosis, as they recognise that getting an earlier diagnosis will really make a difference, and then there will then be access to treatment. I feel optimistic that we will see a virtuous cycle where people learn that getting an early diagnosis can really make a difference in getting access to treatment.

[Debbie Abrahams]

I am reassured to some extent by what the Minister says, and I am grateful for her tone and her positive approach. Given the inequality—let us call it what it is—in current diagnosis, and these are non-specific dementia diagnosis rates, have she and her Department conducted any analysis of the gaps in more specific PET and CSF testing? Can she publish that data or write to us with it? That would reassure us, because rather than just hoping something will happen, we could identify it: “Yes, in Greater Manchester we are at 90% of the level we need for all these tests,” and similarly in Kent and so on. If she could do that, it would be very helpful.

[Helen Whately]

I fully appreciate the hon. Member’s question, and I can assure her that I do look at the variation in diagnosis rates between different areas, as she rightly pointed out in her speech. I would be happy to write to her with further detail on the specific question of more sophisticated diagnosis techniques and our readiness for new treatments and for carrying out earlier and more sophisticated diagnoses.

I assure hon. Members of the Government’s ambition for the UK to be a world leader in dementia research, diagnosis and treatment; I would also like us to lead the world in the prevention of dementia. That is why the Government are investing in research. We are getting ready to make new treatments available and building on what we are already doing in prevention with our major conditions strategy. Given the scale and impact of dementia on our society, successful prevention and treatment are not just a nice-to-have, but an imperative for individuals, for their families, friends and loved ones, and for our society.

Visiting in Care Homes, Hospitals and Hospices: Government Response to Consultation

Helen Whately Excerpts

Tuesday 5th December 2023 Written Statements

[The Minister for Social Care (Helen Whately)]

I make this statement on behalf of myself, the Minister for Health and Secondary Care, my right hon. Friend the Member for Pendle (Andrew Stephenson) and the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield) to announce the conclusion of the Government’s consultation on visiting in care homes, hospitals and hospices, and our response.

The covid-19 pandemic taught us valuable lessons about restrictions that had a serious effect on the health and wellbeing of care residents, patients and their families and friends.

Visiting was restricted at the height of the pandemic to prevent the spread of covid and keep people safe, but as restrictions eased the guidance for visiting in hospital and care settings changed accordingly.

The majority of settings adhered to the guidance but there have been reports of people being denied access to family members and loved ones, so the Government have acted to make sure expectations around visits are clear to providers.

On 21 June 2023, the Department of Health and Social Care launched a public consultation on our proposal to ensure that visiting in care homes, hospitals and hospices is protected in legislation.

Under the proposal, the importance of visiting for patients, care home residents and loved ones will become a fundamental standard of care, set out in regulations for the Care Quality Commission (CQC). This means that a visit from a loved one to patients and care home residents will be safeguarded, and Care Quality Commission inspections will monitor whether health and care providers are meeting those obligations.

We received over 1,400 responses to the consultation from a wide range of stakeholders, the majority of which supported the Government’s proposal. We therefore plan to bring forward secondary legislation to create a new fundamental standard in CQC regulations.

I would like to thank all those who participated in our consultation and in particular those from John’s Campaign and Care Rights UK, the hon. Member for Liverpool Walton (Dan Carden), my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) and the hon. Member for St Albans (Daisy Cooper) who have continued to campaign on this issue.

The Government recognise their efforts and those of the many health and care settings which understand the importance of visiting and continue to follow our existing guidance that visiting should be facilitated. We will work closely with the CQC to develop clear guidance so that all settings can be in no doubt as to the standard expected in the provision of care, including supporting visiting.

The Government’s response to the consultation has been published on gov.uk and I have deposited copies in the Libraries of both Houses.

[HCWS96]

Oral Answers to Questions

Helen Whately Excerpts

Tuesday 5th December 2023 Commons Chamber

[Wendy Chamberlain (North East Fife) (LD)]

3. What progress her Department has made on discharging patients from hospitals and moving them into social care.

[The Minister for Social Care (Helen Whately)]

When someone no longer needs to be in hospital, it is better for them and better for the NHS for them to go home. That is why we have been working hard to reduce delayed discharges, and we have been making good progress. In England, delayed discharges are down 13% since January, meaning thousands fewer people waiting in hospital and freeing up nearly 2,000 hospital beds every day.

[Wendy Chamberlain]

In my constituency of North East Fife, an average of 14% of social care and social work roles are filled when first advertised, but yesterday the Home Secretary announced plans to make it harder to recruit care workers from overseas. What assessment has the Minister made of the effect of that announcement on hospitals’ ability to discharge patients and free up hospital beds for those who need them?

[Helen Whately]

The hon. Member refers to yesterday’s announcement on migration. First, I am very grateful to all the international workers who come here to help in our health and social care system and to care for our loved ones. Clearly, we must get the balance right between migration and making sure that our health and care system has the workforce that it needs. That is what we are doing, both with the migration changes announced yesterday and with our reforms to the social care workforce to ensure that working in social care is appealing to home-grown talent.

[Madam Deputy Speaker (Dame Eleanor Laing)]

I call the shadow Minister.

[Abena Oppong-Asare (Erith and Thamesmead) (Lab)]

Thanks to their own internal chaos, the Conservatives have utterly failed in their promise at the last general election to fix the crisis in social care once and for all. We now have over 150,000 care vacancies and 390,000 care staff leaving their jobs each year, meaning that 60% of patients in England who are fit for discharge are being kept in hospital each day. Will the Minister therefore back Labour’s plan to deliver a fair pay agreement, with better terms, conditions, training and pay, to ensure that we have the staff required to care for all those who need it?

[Helen Whately]

Labour really have not got a leg to stand on when it comes to social care reform. They did not do anything the last time they were in government, and they still do not have a plan for social care. In government, we are reforming social care careers—[Interruption.] If the hon. Lady will take a look at what we are doing, we are introducing a new career structure for people working in social care, introducing new qualifications and investing in training for social care. We are doing what needs to be done to ensure that social care as a career works for UK workers. [Interruption.]

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. You won’t get your turn if you shout from there.

[Catherine West (Hornsey and Wood Green) (Lab)]

4. What steps her Department is taking to reduce pressure on NHS services in winter 2023-24.

[The Minister for Social Care (Helen Whately)]

We know that winter is hard for the NHS, as it is for other health systems. That is why we started planning for this winter earlier than ever before—back in January, when we published our urgent and emergency care recovery plan, which funds more beds and new ambulances for our NHS, funds more social care in our communities, joins up care, and makes the most of technology, so that more people can get the care they need when and where they most need it.

[Catherine West]

Two accident and emergency departments serve patients in Hornsey and Wood Green. One is now serving double the number of visits by patients and is buckling under the pressure; and the other has seen 4,000 extra patients this year compared with last. What are the Government going to do about overcrowding in accident and emergency?

[Helen Whately]

The hon. Member is right that our hospitals are busier; we are seeing more patients in A&Es. That is why we are doing two things with our work on urgent and emergency care. One is providing more capacity—more hospital beds, more hours of ambulances on the road, and more capacity in social care to help with discharges. We are also doing things differently by seeing more people out of hospital, avoiding people coming to hospital unnecessarily, and providing more care at home; for instance, our 10,000 “hospital at home” beds are helping people recover at home, which is better for them and better for the system.

[Will Quince (Colchester) (Con)]

I know the considerable work the Department and NHS England have done preparing for winter. Given the importance of the NHS workforce, who do such an incredible job, and noting that there are still a few months to go, will the Minister update the House on the delivery of our manifesto commitment for an additional 50,000 nurses?

[Helen Whately]

I pay tribute to my hon. Friend for the excellent work he did as a Health Minister. It was a real pleasure to work alongside him and see what a difference he made for our constituents across the country. He asks a very good question about the work we are doing to increase the capacity of the NHS and ensure that it has the workforce it needs, including by delivering on our manifesto commitment to 50,000 more nurses for the NHS, which we have achieved.

[Gareth Thomas (Harrow West) (Lab/Co-op)]

One way the Minister could help Harrow’s health services be better prepared for this winter and future winters would be to invest in new intensive care beds at Northwick Park Hospital, which serves my constituents. Given that the Government have been told repeatedly that their promised 40 new hospitals are about as real as the Prime Minister’s meat tax, why do Ministers not invest in a hospital that actually exists and provide a new purpose-built intensive care facility at Northwick Park Hospital?

[Helen Whately]

I assure the hon. Member that we are investing in the national health service and, in particular, supporting it to prepare for this winter, ensuring there is more capacity in the system. There will be 5,000 more beds in hospitals around the country this winter, as well as 800 new ambulances on the road. But we are also doing things differently. The future of healthcare is not just about hospitals, but about caring for more people out of hospital. For instance, we are investing in proactive care, so that in every neighbourhood, the people who are more likely to go into hospital are known and reached out to, and the care is available for them. That is one of the things we are doing to ensure that people receive care when and where they need it.

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

Sleaford and North Hykeham is a beautiful rural constituency, but living in a rural area means people are further from specialist medical services, which is a particular challenge in the winter months when the roads can be difficult to travel on. As the winter approaches, what is the Minister doing to ensure that constituents in rural areas are well looked after?

[Helen Whately]

My hon. Friend makes a very important point about the additional challenges in rural areas. I want to ensure that this winter people get care when they need it and get it faster. We are already seeing progress on that. For instance, we are investing in making sure there are more ambulance hours on the road, and we are seeing ambulances get to people quicker—in fact, this October, they got to people 20 minutes faster than last October. Ambulance handover delays are reducing and we are already seeing progress in A&E, where people are being seen faster, too.

[Madam Deputy Speaker (Dame Eleanor Laing)]

I call the shadow Minister.

[Abena Oppong-Asare (Erith and Thamesmead) (Lab)]

Under the last Labour Government, there was no winter crisis. Under the Tories, we have gone from no winter crisis, to an annual crisis, to a crisis all year around. Rather than tackling the crisis at source, this Government have only sticking-plaster solutions for a few months at a time. How will patients know that a winter crisis has been avoided if problems persist into the spring?

[Helen Whately]

I am really sorry, but the hon. Member’s memory appears to be very short. I was working in healthcare when there was a Labour Government and I remember very well problems for the NHS during winter. She does not even need to look back into the past; she can look at the Labour-run NHS in Wales, where they are having so much difficulty with A&E performance that they even fudged the figures and hid a whole load of patients so people would not notice what was going on.

[Helen Hayes (Dulwich and West Norwood) (Lab)]

5. What steps she is taking to help reduce vaping by young people.

--- Later in debate ---

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. Can Members please cut their questions in half? Otherwise, I will have to stop this questions session and people will not get a chance at all.

[The Minister for Social Care (Helen Whately)]

I would be delighted to meet my hon. Friend’s constituent. What the employer does is really important for retention and recruitment of adult social care staff, along with our ambitious workforce reforms for the care workforce.

[Imran Hussain (Bradford East) (Lab)]

T5. The Health Secretary declared at the weekend that the Government will miss their target to cut NHS waiting times if doctors strike to defend their pay and conditions, but she seems to forget that since the Tories took power in 2010, waiting lists for hospital treatments are up, A&E waiting times are up, cancer referral times are up and ambulance response times are up. The only thing that has fallen is not waiting times; it is public confidence in the Government. Will the Minister finally admit that the threat to waiting time targets is not striking doctors, but her party being in government?

Hospice Services: South Devon

Helen Whately Excerpts

Wednesday 29th November 2023 Westminster Hall

[The Minister for Social Care (Helen Whately)]

It is a pleasure to serve under your chairmanship, Mr Sharma. I thank my hon. Friend the Member for Torbay (Kevin Foster) for securing this debate about hospice care in South Devon. Like many of us, he has personal experience of the wonderful work of hospices. He spoke of his mother Linda and his step-daughter. I remember my grandmother being cared for in a hospice that was also in the south-west, just outside Yeovil. It made such a huge difference to the end of her life, not only for her but for family members like me. I remember going to visit her there. Whether the care is given in the hospice or at home, hospices are so important to our constituents.

Even though the debate was short, we had contributions from other Members, including my hon. Friend the Member for Totnes (Anthony Mangnall). He asked that Ministers come to the south-west to see hospice care for ourselves. Perhaps slightly ironically, today I was meant to be visiting a hospital in Devon, but instead I am responding to this debate. I will reschedule the visit, and will see what more I can do in the area at the same time. We also heard from my hon. Friend the Member for Darlington (Peter Gibson), who is chair of the all-party parliamentary group on hospice and end-of-life care. He does important work lobbying on behalf of the sector in that role. He spoke of the importance of ICBs effectively commissioning end-of-life and palliative care services.

It was wonderful to hear from the hon. Member for Strangford (Jim Shannon); it would not be a Westminster Hall debate without a contribution from him. He spoke of the importance of the work of fundraisers and volunteers in hospices. That clearly applies in Northern Ireland, but it is also important in England. The hon. Member for Tiverton and Honiton (Richard Foord) referred to hospice care at home, and made the point that although the traditional hospice model involves people being cared for in a hospice building, a significant and increasing proportion of what hospices do involves caring for people in their home.

Taking a step back from the situation in south Devon, thousands of people across the country are receiving palliative and end-of-life care at the moment. We have an ageing population, and many people live with complex health conditions. Around 600,000 people die every year in the UK, so it is a demographic fact that the number of people who will need palliative and end-of-life care is likely to increase in the years ahead. That care is so important; care during the hardest times makes an unquantifiable difference. As my hon. Friend the Member for Torbay said, it is not necessarily about extra days of life, but adding life to the days. It can make what seems to be unbearable somehow bearable, and it makes a difference not only for the individual being cared for, but for all those around them.

The majority of palliative and end-of-life care is provided by NHS staff and services, but hospices are an important part of our end-of-life and palliative care system; they support over 300,000 people with life-limiting conditions each year, in addition to providing bereavement support. As hon. Members have said, hospices are independent, charitable organisations that generally receive funding not only from statutory sources but, substantially, from communities and charitable donations. That range of funding, and the important role that hospices play in communities, are real strengths. As a Minister with hospices in my portfolio, I strongly support that, and want hospices to continue to play that important role, which gives them such strong local support.

In south Devon, the services reflect the national picture: there are significant NHS palliative and end-of-life services, including a specialist NHS team, community nursing care and a Marie Curie night care service. There is also Rowcroft hospice, which my hon. Friend the Member for Torbay mentioned. Given that my portfolio includes the oversight of dementia care, I was interested to hear about the hospice’s ambitions to develop its services further into dementia care; that sounds like a truly exciting proposal. Department of Health and Social Care officials are due to visit Rowcroft in the coming weeks to find out more, so I look forward to hearing from them. My hon. Friend also invited me down to see it for myself.

My hon. Friend mentioned the role of integrated care boards, which are responsible for commissioning end-of-life and palliative care services to meet the reasonable needs of their local population. In the Health and Care Act 2022, palliative care services were added to the list of services that an ICB must commission to ensure a more consistent national approach, and to support commissioners in prioritising palliative and end-of-life care. Back in July 2022, NHS England published statutory guidance on palliative and end-of-life care to support commissioners with that duty. The guidance refers to the need to ensure sufficient provision of specialist palliative care services and hospice beds, and to ensure future financial sustainability.

On financial sustainability, I acknowledge that, as my hon. Friend mentioned, hospices contend with significant financial pressures, including rising energy costs. Charities, including hospices, have already benefited from the energy bills discount scheme. Furthermore, hospices may be entitled to a reduction in VAT from 20% to 5%, and to exclusion from the main rate of the climate change levy on the energy that they use for non-business purposes, should they meet the scheme criteria.

On the question about the funding for pay uplifts for staff on “Agenda for Change” contracts, as my hon. Friend will know, his hospices are independent, charitable organisations that employ their staff themselves. They have the freedom to set salary rates and other terms and conditions at a level that reflects the skills and experience of their staff. Given the difficult economic context, the Government are providing additional funding on this occasion to support one-off payments to eligible staff employed by non-NHS organisations, where those organisations employ their staff on dynamically linked “Agenda for Change” contracts. Details for hospices that believe themselves to be eligible for that scheme are outlined in guidance published this week by NHS England. I encourage hospices in the south-west—and in fact around the country—to consider whether they are eligible, and to apply for the scheme if they are.

[Kevin Foster]

Will the Minister give may?

[Helen Whately]

I am happy to, although I am also watching the clock.

[Kevin Foster]

I will keep it fairly brief. I welcome some of the comments made. It is worth remembering that while the hospices are independent, paying a nurse or qualified medical personnel less than the NHS would is clearly not going to work. Rowcroft is one of the best sponsors of skilled worker visas, but of course, as the Minister will know, it is obliged to pay the equivalent of the NHS rate if it recruits internationally via that route.

[Helen Whately]

I cannot say, as I stand here, whether Rowcroft would be eligible for the support that I mentioned, but I would encourage it and others to look at whether that route would help it to address the point raised by my hon. Friend.

My hon. Friend spoke about hospice care for children and young people. NHS England recognises the importance of quality palliative and end-of-life care for children and young people; it has already confirmed that the £25 million children’s hospice grant is being renewed for 2024-25. I can assure him that NHS England will communicate details of that funding allocation in the coming weeks; that is far as I can go on that point. I cannot comment on the future of the children’s hospice grant beyond that financial year, but I can pick up briefly on my hon. Friend’s broader question about the future of palliative care. We recognise that demand for it is expected to grow. I reiterate the point about ICBs’ responsibility to plan to meet the needs for the local population’s palliative and end-of-life care.

At the national level, our NHS long-term workforce plan sets out how we will ensure that we have the necessary healthcare workforce for the future. For the first time ever, it looks 15 years ahead. It also recognises that we will need an increasing number of staff in community settings, providing people with care out of hospital and helping people with long-term conditions to live more healthily and independently. The plan recognises that people want to live in their own homes for as long as possible, and we know that many people would much rather die in their home as well.

To sum up, as I watch the clock, I fully agree with my hon. Friend on the important role of hospices in our community in palliative and end-of-life care. I can assure him and other hon. Members that I will continue to work closely with NHS England to ensure that ICBs deliver on their responsibility to commission palliative and end-of-life care in every area of the country. I thank my hon. Friend for his invitation to see the hospice care in his constituency for myself. As I will be rescheduling my Devon visit, I will do my very best to see if I can come his way.

Question put and agreed to

Seaton Community Hospital

Helen Whately Excerpts

Monday 13th November 2023 Commons Chamber

[The Minister for Social Care (Helen Whately)]

I congratulate the hon. Member for Tiverton and Honiton (Richard Foord) on securing this debate. I appreciate his interest and concern about the future of Seaton community hospital. As he said, it was built only as a result of a huge fundraising campaign in the local community, which was matched pound for pound by the NHS. It therefore holds a lot of importance for the hon. Member’s constituents. I fully understand his interest in making best use of the facilities. I know that my hon. Friend the Member for East Devon (Simon Jupp) also wants to see this situation resolved, and I met him earlier to talk about it. I remind the hon. Member for Tiverton and Honiton that decisions about the use of NHS property such as this community hospital are taken at a local level—as they should be—and not by a Minister in Whitehall.

It may be helpful to recap some of the history, as the hon. Member covered in his speech. Between 2015 and 2017, the then NHS clinical commissioning group—CCG—undertook a recommissioning of community services in Devon. That was about introducing a new model of care—more integrated and more community based, with more people receiving care at home. I heard him raise concerns about that model and the shift to getting care closer to the community. My ministerial brief includes supporting the discharge of people from acute hospitals to try to care for more people in their own homes. Some patients spend longer in hospital than is good for their recovery, so for many people it is much better that, when they are declared fit for discharge, they recover and receive care at home.

Returning to the situation of this particular community hospital, as part of the commissioning change there was a change of lead NHS trust as the provider of services in local community hospitals. That meant that ownership of 12 community hospitals, including Seaton, was transferred from the former NHS provider trust to NHS Property Services, as the hon. Member spoke about. NHS Property Services’ model of charging a market rent for properties is to build an incentive to make good long-term decisions about the use of buildings. NHS Property Services then invests that income into those properties and the services that they provide.

At the point of transfer, many community hospitals in Devon had a large amount of empty space. The transfer happened on the basis that the NHS commissioning body—now the ICB—would be responsible for the full cost of that space. The costs include the recovery of the market rent and service charges, such as energy, rates, cleaning and maintenance. Over the past seven years, progress has been made to identify sustainable, alternative healthcare uses for vacant spaces in other community hospitals in Devon, such as in Axminster and Ottery St Mary’s. However, I understand that Seaton and some others still have significant amounts of vacant space. In addition, the ICB and NHS Property Services have worked closely with the voluntary sector, and have supported local initiatives in some properties, such as the Waffle café at Seaton Hospital. However, it is for the local commissioners—not NHS Property Services—to determine the best use of the healthcare spaces that they are responsible for.

Despite sincere efforts from the ICB, I understand that no sustainable healthcare use has been identified for the former ward space at Seaton, which adds up to about half the hospital space. I know the hon. Member’s constituents are frustrated by this situation. Local community groups have expressed an interest in taking on some of the empty ward space, but they see the level of charges as an insurmountable barrier. The ICB has explored a range of potential healthcare uses with NHS providers, but the proposals have not yet come to fruition, so I know the situation is not satisfactory for them either.

The costs to the system of the vacant space are a pressure on the health budget. Clearly, having unused space is not a good use of resources and, ultimately, taxpayers’ money.

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Motion made, and Question proposed, That this House do now adjourn.—(Gagan Mohindra.)

[Helen Whately]

It is important to note that NHSPS operates on a cost recovery basis. That means any reduction in its charges counts as a loss to the health budget if it is not directly offset by actual cost reductions in the facilities. As the hon. Member mentioned, the annual charges for the vacant space in this facility are approximately £300,000, of which £140,000 is the rental charge. The rest is spent on a share of the utilities, business rates, maintenance and cleaning costs for the property.

[Richard Foord]

I am grateful to the Minister for explaining the charge-back system. Could she explain why the NHS is charging the NHS and hence the NHS cannot have this space, and why it cannot be used for health purposes? Could she explain the charging mechanism a little bit more please?

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[Helen Whately]

The hon. Gentleman says it cannot be used for health purposes. What I understand is that what is being looked at is what healthcare it can be used for, albeit recognising the shift of more care into the community and the changing model of care. On the way the system works, in essence the philosophy behind NHSPS is to ensure that best possible use is made of property. If there are no charges associated with the use of buildings, we could get lots of buildings sitting empty and there is not the same incentive to ensure the best possible use of facilities and resources. That is the philosophy behind having this kind of system. I think he mentioned in his speech bringing specific expertise together as part of the organisation that is NHSPS. I hope that addresses his query.

[Helen Morgan (North Shropshire) (LD)]

Will the Minister give way?

[Helen Whately]

I will make a bit of progress, if that is all right.

As I outlined, the ICB is required to pay for the costs and it is not sustainable for the ward space to remain empty for a further lengthy period of time. When an ICB decides there is no long-term healthcare use for an asset, it will usually be sold to allow the funds to be reinvested elsewhere. I have been told that that is not the plan in the case of Seaton community hospital, not least because half the building is an operational health facility and the ICB is fully committed to keeping those services open. I also appreciate that a huge fundraising effort was put in by the local community to build the wing at the hospital in the first place, a point that my hon. Friend the Member for East Devon (Simon Jupp) made when he intervened earlier, and so selling the facility would not be what the community wants.

We know that providing high-quality care and support in the community benefits patients, and their carers and families, helping people to stay well and independent for longer. Across the country, we have achieved a lot as part of our commitment to move more care out into the community. For example, urgent community response services are doing a great job of helping to keep people out of hospital when they are at risk of a crisis. Virtual wards or hospital-at-home services are providing hospital-level care in people’s own homes, helping to avoid admissions to hospital and allowing earlier discharge, and ensuring extra support is there if somebody is concerned about being discharged home, or, as I heard the hon. Member mention, is concerned about a family member being discharged home.

[Richard Foord]

I am grateful to the Minister for raising the concept of the virtual ward in this context. It reminds me a little of conversations that I have had with constituents in recent months about the virtual shopping experience, the virtual rail ticket purchasing experience, and the difficulty that they are having in dealing with humans. I think that the last thing people want when it comes to health and social care is “virtual”. They want the human touch.

[Helen Whately]

I can only encourage the hon. Gentleman to visit a team that supports a virtual ward, and speak to some patients who have been cared for through hospital at home or virtual wards. I have done both, and the feedback from patients is phenomenally positive. If someone is concerned about being discharged and supported in this way, it does not happen, but many people would much rather recover in their own homes with that support than be in a hospital where it is hard to get a good night’s sleep because there so much going on around them. Moreover, while people recover in their own homes, beds are freed up for people who really need acute hospital care on site.

A third model that is doing very well in helping people to receive care close to home is the proactive care model delivered by multidisciplinary neighbourhood teams. These are real game-changers, helping people to live independently and stay out of hospital. The teams consist of—among others—doctors, nurses, care workers, allied healthcare professionals, all coming together to ensure that people have the care that they need in order not to be going in and out of hospital, as sometimes happens when people become unwell.

While I fully understand the hon. Gentleman’s frustration, I have been assured that the integrated care board, local providers and NHS Property Services are working together to resolve the situation at Seaton Hospital to ensure that facilities—and, indeed, funds—are put to good use for patients.

Question put and agreed to.

Building an NHS Fit for the Future

Helen Whately Excerpts

Monday 13th November 2023 Commons Chamber

[The Minister for Social Care (Helen Whately)]

It is a pleasure to open this debate on behalf of His Majesty’s Government, and to have the opportunity to speak about the long-term decisions that the Government have been taking for a healthier future for our country, for our national health service, and for our social care system.

We are building our health and care system for today and for tomorrow. We are increasing the capacity of the NHS and social care systems, boosting primary care and community care, investing in diagnostics and in treatments, building our NHS workforce with the long-term workforce plan and building our social care workforce with our 10-year vision, putting people at the heart of care. We are giving people choice and control over their health and care, and investing in the facilities and technology that need to be at the forefront of care and sustainable for the long term. We are driving reforms to prevent ill health, joining up health and care in integrated care systems and delivering a shift towards prevention and proactive care, keeping people out of hospital and enabling them to live independently in their communities.

Every day since last winter, we have been planning and preparing for the challenges that lie ahead this winter. The first ever NHS long-term workforce plan underpins our plans for the future of the NHS. It will double the number of medical training places, almost double the number of adult nursing places, and expand GP and allied health professional training numbers, giving the NHS the staff it needs for the future, creating new roles, building new training pathways and delivering a huge boost in diagnostic capacity.

By the end of this year, we will have opened 160 new community diagnostic centres. That is the biggest investment in MRI and CT scanning capacity in NHS history. Community diagnostic centres will bring care closer to home, on high streets, in supermarket car parks and at football stadiums. They have already done more than 5 million tests and scans, getting patients faster diagnosis for cancer, heart disease and other life-threatening conditions. That is not all we are doing to diagnose conditions faster. The number of people receiving blood pressure checks at local pharmacies has more than doubled, reducing thousands of people’s risk of suffering a heart attack or stroke.

We are expanding primary care, too. There are now over 30,000 more primary care professionals working in GP practices than in March 2019. We will deliver 50 million more GP appointments by the end of next year and we are investing more than £200 million in tech to end the 8 am rush for GP appointments. Pharmacy First will give people another choice, giving pharmacists the power to prescribe treatments for seven common conditions, freeing up as many as 10 million GP appointments, and as we put test results on to the NHS app, that will free up GP time again.

That is also one of the ways that this Government are giving patients more choice and control. Just as we are going to give people more choice in where they are treated when they are referred by their GP for specialist care, we have committed to giving patients a choice between by five providers so that they are treated based on what matters to them—be that shorter waiting times, seeing a particular doctor or getting care closer to home. We have given patients who are waiting more than 40 weeks the right to request treatment elsewhere, making better use of available capacity across the NHS and bringing in more capacity from the independent sector.

On patient choice, there is a clear dividing line between the Government and the Opposition. The Leader of the Opposition calls the Welsh Government the blueprint for what Labour would do in power, yet in Wales, under a Labour Government, there is no legal right to patient choice, and patients there wait on average five weeks longer for treatment than in England. We know where Labour’s plans would lead. We just need to look at its Welsh blueprint: less choice for patients, longer waiting lists and more bureaucracy for doctors and nurses who just want to get on with the job.

Before the most disruptive industrial action in NHS history stalled progress, we were reducing the longest waits. Last summer we hit our target to eliminate two-year waits for planned operations. This June we had virtually eliminated waits longer than 18 months. We are spending more than £8 billion between 2022 and 2025 to increase elective activity, including opening over 140 new surgical hubs to deliver 2 million more operations. We are investing almost £6 billion in beds, equipment and technology, and this year we started preparing the NHS for winter sooner than ever before.

Back in January, we published our recovery plan for urgent and emergency care, setting clear targets to improve A&E waiting and ambulance response times and using £1 billion of dedicated funding to provide 5,000 more permanent staff beds and 800 new ambulances. We are seeing results. In October, average category 2 ambulance response times were more than 90 minutes faster than in the same month last year. Delayed discharges have been coming down and we have brought forward flu and covid vaccinations, protecting the most vulnerable from illness this winter and reducing the likelihood that they will need hospital treatment.

A strong social care sector is also vital this winter and into the future. That is why we have made up to £8 billion available over this year and next to boost adult social care across the country. This is enabling local authorities to buy more care packages and help more patients to leave hospital on time, together with 10,000 “hospital at home” beds which mean that patients can receive their care where they are most comfortable, recovering in their own homes with support from secondary care when they need it. Through social prescribing, thousands of people up and down the country are benefiting from activities such as reading circles, choir groups, walking and football. We are driving reforms to the intermediate and proactive care framework, which sets out how local systems should support adults who need support after discharge, freeing up hospital capacity for those who need it most and giving people more care as they need it—in their community, away from A&E and out of hospital.

We are rolling out technology that will give patients life-saving treatments now and in the future. By the end of the year, every stroke network in England will have AI technology that can examine brain scans an hour faster, cutting stroke patients’ risk of suffering long-term consequences by as much as two thirds. What is more, almost half of NHS acute trusts have won a share of £21 million to invest in AI, accelerating the analysis of X-rays and CT scans for suspected lung cancer patients. That will save radiologists’ time, boost efficiency and cut waiting times. For the long-term, we are investing a further £100 million to use AI to unlock treatments for diseases that are incurable today, be they novel treatments for dementia or vaccines for cancer.

[Ian Paisley (North Antrim) (DUP)]

Can the Minister say something about the availability of new and specialist drugs that the National Institute for Health and Care Excellence is not recommending? Will an effort be made to make these specialist drugs, which in many instances are effectively regarded as miracle cures, available for cystic fibrosis and cancer treatments, for example?

[Helen Whately]

I understand what the hon. Gentleman is saying, and I know how strongly families and patients feel about this. It is not for me, as a Minister, to step on the independence of NICE, which has a remit to take those decisions. I am sure that the new Secretary of State for Health and Social Care, my hon. Friend the Member for Louth and Horncastle (Victoria Atkins), and other Ministers in the Department will continue to listen to the concerns of families about access to those treatments.

If we want to fully embrace preventive care, we must tackle the single biggest preventable cause of ill health, disability and death, which is smoking. Unlike drinking alcohol or eating fatty, salty or sugary foods, there is no safe level of smoking. It causes almost one hospital admission every minute, one in four cancer deaths and 64,000 deaths a year.

Four in five smokers start by the time they are 20, so the best thing we can do is to stop young people smoking in the first place. That is why this Government will automatically raise the smoking age by one year every year, so anyone who is 14 or younger today will never be able to buy tobacco legally. Increasing the smoking age works. When it rose to 18, smoking rates dropped by almost a third in that age group. Restricting choice is never easy, but this time it is the right thing to do. Existing smokers will not be affected, but the next generation will be smoke-free, saving thousands of lives, reducing pressure on the NHS and building a brighter future for our children.

[Mr Kevan Jones (North Durham) (Lab)]

I hear what the Minister says about the Government’s commitment to this policy, but can she explain why the Government are allowing a free vote rather than whipping Back Benchers to vote for Government policy?

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[Helen Whately]

I am not going to stand here and explain whipping policy, which is not my job as a Health Minister, but I am delighted to see the potential of this legislation. As with so many other worthwhile Government policies, such as increasing funding for the national health service, I would be delighted to see the right hon. Gentleman and other Opposition Members support this policy.

We are also cracking down on the alarming rise in vaping among children. There is no doubt that vaping is safer than smoking and is a terrific tool to help adult smokers quit, but, like Members across the House, I am concerned that one in five children has tried vaping, which can be hugely damaging to their health. The whole House knows that no child should be using nicotine.

The rise in youth vaping is no coincidence. Disposable vapes are consistently marketed at children and are available at pocket-money prices, with many retailers ignoring their duty not to sell them to young people. With more than 5 million being thrown away every week, disposable vapes are also damaging our planet. We are acting now to protect our children and our planet. We are looking at banning child-friendly flavours, restricting colourful packaging and mandating that vapes are displayed only behind the counter. We are also exploring a ban or a restriction on disposable vape sales and empowering local authorities to dish out on-the-spot fines for selling vapes to children. All these proposals are being developed with parents and teachers across the UK, and they will strike a balance between giving adult smokers a choice to switch to vaping and preventing our children from taking it up.

I recognise the disappointment that the mental health Bill was not included in the King’s Speech, but I can assure hon. Members that this Government are committed to achieving genuine parity between mental health and physical health, improving the care of those detained under the Mental Health Act 1983 and bringing forward the Bill when parliamentary time allows.

We are not going to wait for legislation to make change. We will continue to pilot models of culturally appropriate advocacy, providing tailored support to hundreds of people from ethnic minorities to better understand their rights if they are detained under the Mental Health Act. This comes on top of the record investment and staff numbers we are putting into mental health. Since 2010, the mental health workforce has grown by more than 20%, and by March we will have invested over £2 billion more in mental health than four years ago, meaning that 2 million more people, including more than 300,000 children and young people, will benefit from mental health support.

[Fleur Anderson (Putney) (Lab)]

One of the biggest issues raised by every school I visit in my constituency is mental health support, and I am disappointed not to see the mental health Bill in the King’s Speech. Will it be addressed in any other way? Where is it?

[Helen Whately]

As I said a moment ago—let me remind the hon. Lady of this—we are not waiting for legislation in order to bring forward mental health reforms. That is why, for instance, we have already been rolling out mental health support teams in schools. We are already ahead of schedule on that; we are giving a quarter of England’s school and college children access to mental health support teams a year ahead of schedule. In addition, thanks to this Government, dormitory accommodation for mental health patients will soon become a thing of the past.

It has been a pleasure to work with the new Secretary of State for Environment, Food and Rural Affairs, my right hon. Friend the Member for North East Cambridgeshire (Steve Barclay), and a huge honour to work with my hon. Friends the Members for Colchester (Will Quince) and for Harborough (Neil O'Brien) as part of a Government taking the long-term decisions to build a health and care system for the future, one with more doctors, nurses, pharmacists, physios and care workers, better mental healthcare for adults and children, more proactive care in the community, greater capacity, the newest technology and more choice, where conditions are diagnosed quicker or prevented altogether, thus helping people to live longer and healthier lives.

[Mr Speaker]

I call the shadow Secretary of State.

Shared Outcomes Toolkit for Integrated Care Systems

Helen Whately Excerpts

Monday 23rd October 2023 Written Statements

[The Minister for Social Care (Helen Whately)]

Shared outcomes in health and care are a powerful tool for driving integration in integrated care systems. As shared priorities, they bring organisations together to deliver on a common purpose for the people they serve. This is why shared outcomes were an important part of our integration White Paper (IWP), “Joining up care for people, places and populations”, which outlined opportunities to progress further on the integration of health and social care.

Since the IWP was published, we have seen good progress in places developing local shared outcomes focused on addressing the needs of their populations and with a focus on health improvement. We have heard a consistent message from stakeholders that place leaders should have autonomy to select local outcomes that are appropriate to the needs of their populations, while also complementing national priorities. Our approach to supporting the development of shared outcomes reflects this feedback.

I am therefore pleased to update the House that we have published the shared outcomes toolkit.

Just as the Government have provided the NHS with a more focused set of priorities in the mandate published in 2023, we are supporting places through this toolkit to develop local outcomes and priorities that are as impactful as possible for local people. The publication of the shared outcomes toolkit also meets recommendations made in the Hewitt review and the Health and Social Care Select Committee hearing report into integrated care systems, both of which recommended that Government publish the shared outcomes framework as soon as possible.

This toolkit shares the learning from places that are further on in their development of shared outcomes, and includes case studies, examples of good practice, and suggestions for overcoming challenges. It is designed to be a resource to support places in developing shared outcomes, and recognising that places will be at different levels of maturity.

With the support this toolkit offers, we expect all places in each ICS will be able to evidence the work they are doing towards developing shared outcomes by March 2024. Going forward, shared outcomes are referenced as evidence in the Care Quality Commission (CQC) single assessment framework and this evidence may be considered as part of the CQC ICS reviews and assessments.

As places progress with their outcomes frameworks we will consider how the balance between nationally mandated and locally driven priorities is working in practice and review the commonalities that may inform the development of national shared outcomes.

The shared outcomes toolkit is available on the www.gov.uk website, and copies have been deposited in the Libraries of both Houses.

[HCWS1083]

Oral Answers to Questions

Helen Whately Excerpts

Tuesday 17th October 2023 Commons Chamber

[Gavin Newlands (Paisley and Renfrewshire North) (SNP)]

6. What recent assessment he has made of the impact of the UK’s departure from the EU on trends in the level of recruitment in the health and social care sector.

[The Minister for Social Care (Helen Whately)]

rose—

[Mr Speaker]

You can respond sitting down if you wish.

[Helen Whately]

It is fine; thank you, Mr Speaker.

Since Brexit, we have more than 13,000 more doctors and 48,000 more nurses working in the NHS in England, and 40,000 more full-time equivalent staff in adult social care. Our points-based immigration system means that we can recruit the talent we need from all over the world for our health and social care system, including from the European Union.

[Patrick Grady]

If everything is as rosy as the Minister says, why did a spokesperson for the Nuffield Trust say last year that

“greater costs, more paperwork and uncertainty over visas because of Brexit have been among the biggest barriers to recruiting and keeping EU and EFTA doctors”?

Cannot she admit that Brexit is exacerbating difficulties with recruiting appropriate staff for the NHS across the whole of the UK? Scotland did not vote for Brexit. Why are we having to pay the price?

[Helen Whately]

I suggest it is really time that the hon. Gentleman stops blaming Brexit. He should in fact look to his SNP colleagues in Holyrood and ensure that they make Scotland’s NHS a better place to work. If he had listened to my answer, he would have heard me say that since Brexit we have recruited more than 13,000 more doctors to the NHS in England. In fact, we are doing so well that we recently recruited a doctor from the SNP Benches. [Laughter.]

[Gavin Newlands]

Very droll. I congratulate the Minister on that one.

If not the Nuffield Trust, perhaps BMA Scotland’s Chair Dr Iain Kennedy will be good enough. He recently said that the recruitment and retention of senior medical staff across the NHS in Scotland remains a huge challenge, with the health immigration surcharge cost increases announced by this Government potentially further deterring foreign workers from joining the NHS. Given the recently announced NHS long-term workforce plan, what steps is the Minister taking to ensure that Scotland has the immigration we need for future recruitment and retention for our health service?

[Helen Whately]

We have the health and social care visa, which supports our health and social care services to recruit doctors, nurses and other professionals, as well as social care staff, helping to boost those numbers. The hon. Gentleman referred to the important NHS workforce long-term plan, which will increase the home-grown staff in our health service. That will give us 60,000 more doctors, 170,000 more nurses and 70,000 more allied health professionals in our NHS over the next 15 years.

[Mr Speaker]

I call the SNP spokesperson.

[Amy Callaghan (East Dunbartonshire) (SNP)]

It has been reported that the Home Secretary plans to tighten the rules for those arriving on a health and care worker visa, to block most from bringing dependents with them—yet another in a long list of her vendettas against children coming to these isles. What recent assessments has the Secretary of State made of how that will impact international recruitment and capacity in our already struggling health and care services?

[Helen Whately]

I work closely with colleagues in the Home Office to ensure that the health and care visa achieves the objectives set out. We are seeing real success in social care—the recent Skills for Care workforce report showed that we have 20,000 more care workers in England. We are doing well on recruitment to social care.

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[Justin Madders (Ellesmere Port and Neston) (Lab)]

12. What recent assessment he has made of the effectiveness of integrated care systems.

[The Minister for Social Care (Helen Whately)]

Integrated care systems and the organisations within them are making real progress in understanding the health needs of their populations, setting out their plans, developing the infrastructure needed for collaboration, and bringing health and social care organisations together to serve the needs of their communities.

[Justin Madders]

NHS Cheshire and Merseyside integrated care board has instructed all NHS providers to make cuts of 5% in their services. Its instruction is not being discussed with members of the public, Members of Parliament or indeed anyone, and it is clear there is no mandate for this action. Given that the Government have made great play of the NHS having more funds than ever before, I am at a loss to understand why the cuts are necessary, so will the Minister intervene to ensure that they do not happen on her watch?

[Helen Whately]

NHS England determines the funding received by integrated care systems. That follows a formula which takes into account the needs of local populations, demographic deprivation and so on, and ICSs are then able to direct resources as they are best needed across those populations. Part of their value, and part of the intention in setting them up along with the organisations within them, lies in that ability to understand the health needs of local populations and direct resources accordingly.

[Virginia Crosbie (Ynys Môn) (Con)]

Integrated care systems bring partner organisations together to improve health, tackle inequalities, and enhance value for money. Detailed data such as that produced by NHS Digital is critical to their work, but we learnt this week that A&E waiting times in Wales had been under-reported for the last 10 years. Does the Minister agree that without accurate data, the Labour Government in Cardiff are scuppering the attempts of NHS Wales to deliver better health outcomes throughout Wales?

[Helen Whately]

My hon. Friend has made a good point about the importance of transparency and accurate data. As she said, just this week we learnt that Labour-run NHS Wales had been under-reporting its A&E waiting times. According to the Royal College of Emergency Medicine, about 45,000 patients are missing from the data. While we are working hard to improve services in the NHS in England, the Labour-run NHS in Wales is merely fudging the figures.

[Mr Speaker]

I call the shadow Minister.

[Andrew Gwynne (Denton and Reddish) (Lab)]

The whole purpose of integrated care systems is to join up social care and NHS services in a better way. We know, for example, that fracture liaison services keep 100,000 people out of hospital, but only 50% of English NHS trusts have them, and despite the commitment given by the Under-Secretary of State for Health and Social Care—the hon. Member for Lewes (Maria Caulfield—to providing more, nothing has happened, and Lord Evans has walked back from her commitment. I realise that I am pushing at an open door in directing this question to a Minister whose leg is strapped up, but when will the Government finally deliver for the “back better bones” campaign to help older people to survive and thrive?

[Helen Whately]

As the hon. Member has mentioned, I have a broken ankle, and I am taking my responsibility as Minister with oversight of urgent and emergency care very seriously in making use of several of those services. As for my oversight of integrated care systems, what I am seeing is that they are making a very good job of enabling the integration of services. For instance, we are seeing real success in the growth of virtual wards—or “hospital at home”—which bring together acute and community services to look after people in their homes and help them to be discharged earlier. The NHS has achieved its target of having 10,000 “hospital at home” places ready for this winter.

[Mr Tanmanjeet Singh Dhesi (Slough) (Lab)]

13. What steps he is taking to improve access to primary care services.

Oral Answers to Questions

Helen Whately Excerpts

Tuesday 11th July 2023 Commons Chamber

[Mr John Baron (Basildon and Billericay) (Con)]

3. What steps he is taking to implement section 5 of the Health and Care Act 2022.

[The Minister for Social Care (Helen Whately)]

In accordance with section 5 of the Health and Care Act 2022, the Secretary of State’s mandate to NHS England for this year set out ambitious objectives to improve outcomes for cancer patients, including the specific aims of improving one-year and five-year survival of all cancers.

[Mr Baron]

Many on the Conservative Benches are pleased that section 5 is finally being implemented, but we would urge the Government to ensure, when consulting on the NHS mandate, that the focus is on outcomes such as the one-year survival rate to encourage earlier diagnosis, and is not watered down in favour of softer objectives such as patient experience surveys, because patients may not be aware of how badly the NHS compares on international survival rates, as recent research from the King’s Fund has shown.

[Helen Whately]

I congratulate my hon. Friend on his commitment to ensuring that we are focused on cancer outcomes and on his successful campaign for that to be included in the NHS mandate, which it has been, as I just mentioned. The best way to improve outcomes for cancers is by catching cancer early. That is one reason why we have a range of metrics, including process metrics, which measure early diagnosis and therefore help us to achieve our ambitions on outcomes. Other metrics such as patient experience are important as well.

[Derek Twigg (Halton) (Lab)]

I agree with the hon. Member for Basildon and Billericay (Mr Baron). One of the problems is the time it takes from the GP’s referral to the consultant at the hospital and the treatment then starting; there are still concerns about delays in that. What is the Minister doing to speed up the process from not just the GP’s referral to the consultant but from the consultant to treatment starting?

[Helen Whately]

The hon. Member is right that the duration is very important. One reason why we are focused so much on increasing early diagnosis is because we know that the sooner we diagnose people, the more likely they are to have a successful outcome from cancer treatment. We are seeing improvements in cancer survival. For instance, in 2010, two thirds of people would survive for one year after a cancer diagnosis; now the figure is three quarters. The NHS is working very hard on further improving cancer diagnosis, and we have reduced the number of people waiting more than 62 days since the pandemic by over a third.

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

4. What steps he is taking to increase awareness of (a) cervical screening and (b) ovarian cancer.

[The Minister for Social Care (Helen Whately)]

We are catching more cancers early than ever before, and work to raise awareness of cancer signs and symptoms, screening programmes and investment in early diagnosis are all playing their part. We fund community events to raise awareness of ovarian cancer, and NHS England is working to increase cervical screening take-up by providing more convenient appointments, including at weekends and evenings.

[Mrs Hodgson]

I thank the Minister for that answer, but Target Ovarian Cancer has found that 40% of women in the UK wrongly believe that their smear test will detect ovarian cancer. There is currently no viable screening process for ovarian cancer. However, messaging remains unclear when women are going for their smear test. What steps are being taken to ensure that information provided at such screening is clear?

[Helen Whately]

On the one hand, cervical screening is incredibly important and very effective at saving lives from cervical cancer—we estimate that it saves around 5,000 lives per year. There is no evidence to support a screening programme for ovarian cancer, and I will take away the hon. Lady’s question about whether there should be communications about that when people go for a cervical smear.

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[Sir Desmond Swayne (New Forest West) (Con)]

16. What steps he is taking to increase the social care workforce.

[The Minister for Social Care (Helen Whately)]

Social care depends on the skills and compassion of our care workforce. That is why we are investing £250 million in reforming care as a career, with a new care qualification, specialist training courses for experienced care workers and a new career structure to support progression, alongside increased funding for social care, our national recruitment campaign and the care worker visa.

[Sir Desmond Swayne]

We need many, many more domiciliary care workers. How will we get them?

[Helen Whately]

My right hon. Friend is right. We have some good news: Skills for Care data shows that home care job vacancies are falling—something I hear when I speak to home care providers. Looking ahead to next winter, I want every local authority to have enough home care on hand. That is why I emphasised the importance of home care when we distributed £600 million of discharge funding to local councils and NHS organisations in April. We are asking all local authorities to plan ahead and book enough home care in advance for this coming winter.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

Is this not the very day to thank our care workers up and down the country? So many families depend on those people who toil away, day by day, visiting houses, often not being paid in between their visits. Could we look closely at recruitment and the agencies involved? Let us get real pay for care workers up, now.

[Helen Whately]

I think that every day is a good day to thank our care workers for their skills, compassion and hard work. We gave social care a record funding settlement of up to £7.5 billion in the autumn statement, which is being used to help local authorities increase the fees that they pay to care providers, in turn enabling care providers to pay their workforce better. That is going hand in hand with extra funding to support discharge into social care this winter and our reforms for the care workforce.

[Dan Carden (Liverpool, Walton) (Lab)]

17. What steps he is taking to ensure that people in care settings are permitted family visits.

[The Minister for Social Care (Helen Whately)]

I know how important it is for people in care homes, hospitals and hospices to see their family and friends. The majority of health and care providers follow national guidance. I do not want anyone to worry about not being able to visit a loved one, which is why in June we launched a consultation to change the law on visiting.

[Dan Carden]

As the Minister knows, last month I introduced my ten-minute rule Bill, the Care Supporters Bill, to make sure that we recognise in law the value of the care of a loved one. Will her consultation differentiate between a care supporter and a visitor? Currently, the Care Quality Commission does not investigate individual cases. Will it have the power to do that in future?

[Helen Whately]

First, I commend the hon. Member for his campaign on this issue. He has been a powerful advocate and draws on his own experience, as do I. He is probably asking me to pre-empt the outcome of the consultation. I encourage him and others concerned about this matter to put their views into that consultation, and we will respond once it is closed.

[Esther McVey (Tatton) (Con)]

18. What recent progress he has made in negotiations with the World Health Organisation on proposed amendments to the International Health Regulations 2005.

--- Later in debate ---

[Andrew Lewer (Northampton South) (Con)]

T7. What steps is the Department taking to prevent chronic kidney disease, given that the recent report published by Kidney Research UK predicts a significant rise in cases of kidney failure in 10 years’ time?

[The Minister for Social Care (Helen Whately)]

In the last three years, the National Institute for Health and Care Research has invested more than £30 million in kidney disease research. NHS England is following a national approach to reduce healthcare inequalities, with a specific focus on some of the risk factors for kidney disease, such as chronic respiratory disease. As diabetes is the most common cause of kidney disease, it will be a focus of our major conditions strategy.

[Marsha De Cordova (Battersea) (Lab)]

Four in 10 people who visit low vision clinics have been diagnosed with clinical depression. It is vital that blind and partially sighted people have access to psychological therapies throughout their sight loss journey to address the impacts. However, National Institute for Health and Care Excellence guidance does not include psychological support in the eye care pathway. Will the Secretary of State commit to reviewing the NICE guidance to ensure that psychological therapies are integrated into the eye care pathway?

Visiting in Care Homes, Hospitals and Hospices Consultation

Helen Whately Excerpts

Wednesday 21st June 2023 Written Statements

[The Minister for Social Care (Helen Whately)]

In collaboration with my hon. Friend the Minister of State for Health and Secondary Care (Will Quince), and my hon. Friend the Minister for Mental Health and Women’s Health Strategy (Maria Caulfield), I am making this statement for the benefit of all members of Parliament to bring their attention to the Government consultation on visiting in care homes, hospitals and hospices.

Ensuring that care home residents and hospital and hospice patients maintain contact with loved ones is vital to the health and wellbeing of people receiving care or treatment. Friends and family also provide invaluable practical support and advocacy for those receiving treatment. However, the Government have heard from Members across both Houses, members of the public and campaigners of continued instances of loved ones being denied contact following the lifting of restrictions introduced during the covid-19 pandemic.

Restrictions were implemented during the pandemic to help prevent the spread of covid-19 in health and care settings. While those restrictions were in place at the time to keep people safe and control the risk of transmission from a virus that was not yet well understood, we recognise how detrimental it was for loved ones to have been kept apart and to not have had friends and family advocating on behalf of patients and care home residents. We constantly sought to enable safe visiting wherever possible and made it clear that end-of-life visiting should always be possible. Our guidance is now clear that visiting should be encouraged and facilitated in line with efforts to return to normal.

The Government recognise the efforts that so many health and care settings have made to implement guidance and facilitate visits. NHS England has guidance in place which sets a minimum expectation for visiting in inpatient, outpatient, diagnostic service settings and the emergency department, that hospitals should facilitate a minimum of two visitors to visit patients for at least one hour per day, ideally for longer. Compliance with this guidance is now a requirement in their standard contract for all providers of NHS services.

However, we know that some restrictions continued beyond the lockdown periods and continue to hear of instances where loved ones are unable to see each other for prolonged periods or provide support when someone is attending hospital. We understand the harm this can cause to the health and well-being of those receiving care as well as how distressing this is for their friends and families visiting and, in many cases, providing vital care to loved ones.

The Government are therefore announcing a consultation today that sets out our proposals for going further to tackle this issue. The consultation document outlines the current position, including current Government guidance and data on visiting in health and care settings, as well as further details on current regulations, the Government proposals, the questions for respondents, how to respond and next steps.

Current regulations

The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (CQC Regulations) set out fundamental standards which must be upheld by all Care Quality Commission (CQC) registered providers. CQC assesses health and care providers against the fundamental standards and other requirements set out in CQC Regulations. Providers are required to comply with certain fundamental standards of care which implicitly cover visiting.

Although visiting is not explicitly mentioned in the current CQC regulations, it is considered best practice that visiting is not normally restricted, and that any restrictions should be reasonable, proportionate and time limited. CQC has enforcement powers to protect people who use regulated services from harm, the risk of harm, and to protect people’s rights and welfare.

In addition to the fundamental standards, other legislation may allow individuals to take legal action against their providers, set out in further detail in the consultation document.

Policy intention and proposal

DHSC wants to ensure that visiting is protected and that it remains a priority. We are therefore considering putting visiting on a statutory footing. It is important that any visiting requirement is workable, reasonable and proportionate. We therefore propose to do this by introducing secondary legislation to amend CQC Regulations to include a specific visiting requirement. This could be done either by introducing a new regulation specifically for visiting, or by amending an existing regulation to include visiting, such as “person centred care” or “dignity and respect”.

We want the legislation to have as far reach as possible and our proposal is therefore for the new visiting requirement to cover CQC-registered health and care settings. This would include NHS and independent providers—both acute and mental health—care homes and hospices.

This consultation relates to visits from family, friends and volunteers such as befrienders and includes accompanying patients attending outpatient or diagnostic appointments and emergency departments at hospitals. It is not about access to visiting professionals, and any change made regarding visiting would not override pre-existing statutory arrangements regarding visiting professionals, such as the entitlement for people detained under the Mental Health Act 1983 to meet independent mental health advocates (IMHAs) in private if they wish to.

Through this consultation we will hear directly from those most likely to be affected by this policy proposal and will gather the evidence required to determine what action should be taken on visiting in health and care settings.

[HCWS874]