Pharmacy First

James Morris Excerpts

Wednesday 31st January 2024 Commons Chamber

[Dame Andrea Leadsom]

I am grateful to the right hon. Gentleman for his support for the programme. There are around 14,000 licensed medicines, the vast majority of which are in good supply. The Department works very closely with the sector on finding alternatives and sourcing supplies of medicines, and most of the time we are able to meet the demand. Occasionally there are challenges, but that does not change in any way the ability of community pharmacists to be the expert medicine suppliers that they are, and to meet the need that members of the general public have for treatment and advice.

[James Morris (Halesowen and Rowley Regis) (Con)]

I warmly welcome the statement. This initiative has the potential to transform primary care and access to treatment, but does the Minister agree that to realise its full potential, we need to invest in new technology—she mentioned digitalisation—to make sure that community pharmacies are set up to take advantage of these new opportunities? We also need to invest in the pharmacy workforce as part of the Government’s long-term workforce plan, so that those in alternative roles within pharmacies, such as pharmacy technicians, have the capacity to take the opportunities she has outlined.

[Dame Andrea Leadsom]

My hon. Friend is absolutely right. Investing in technology is vital, but so is investing in the workforce. We have seen a 61% increase in the number of registered community pharmacists since 2010, and we aim in our long-term NHS workforce plan to increase that by a further 50%. We have already increased the number of training places for both pharmacists and pharmacy technicians.

Oral Answers to Questions

James Morris Excerpts

Tuesday 23rd January 2024 Commons Chamber

[Andrew Stephenson]

The 62-day backlog has fallen by 27% since its peak in May 2020. We know there is more to be done, and that is why we are bringing forward more measures as early as possible. In April 2023, more than nine in 10 patients—90%—started their first cancer treatment within one month of a decision to treat.

[James Morris (Halesowen and Rowley Regis) (Con)]

Many of my constituents who use Regis Medical Centre have been left angry and frustrated by the botched implementation of an Anima booking system, leading to them being unable to get an appointment or the treatment they need. Will the Secretary of State meet me to discuss how we can learn the lessons from that botched implementation and make sure trust in that GP surgery is restored?

Oral Answers to Questions

James Morris Excerpts

Tuesday 5th December 2023 Commons Chamber

[Maria Caulfield]

The hon. Member is absolutely right: we know that in Sussex we have higher rates of mental health illness than in many other parts of the country, with a 15% increase in Sussex A&E attendances. He might not be aware of them, but multiple schemes are available in Sussex. Health in Mind is offering psychological support to those suffering stress and anxiety, which can be self-referred. We have the Sussex mental health crisis line, now open 24/7, which is accessed via the 111 service. We have mental health professionals rolling out the blue light triage service in Sussex, and we have the Brighton and Hove mental health rapid response service, open 24/7, to which anyone can refer themselves urgently. Perhaps if he looks at some of the services provided locally, he will be able to reassure his constituents.

[James Morris (Halesowen and Rowley Regis) (Con)]

The Minister mentioned the importance of parity of esteem, and she is quite right, but it is disappointing that the Government had a manifesto commitment in 2017 and 2019 to reform the Mental Health Act 1983, which they have not fulfilled, with no such Bill in the King’s Speech. Would the Minister agree with me that the issues that existed prior to 2017 in relation to the Mental Health Act still exist today with the disproportionate number of black and minority ethnic people being sectioned under that Act, and people with learning disabilities and autism kept in inappropriate settings? Can she give any encouragement to those of us who want to see that reformed, particularly in relation to the appointment of a mental health commissioner to oversee changes to the Act and to advocate for the parity of esteem that she is looking for?

[Maria Caulfield]

It remains our intention to bring forward a mental health Bill when parliamentary time allows. We have the draft Mental Health Bill, which we have put through pre-legislative scrutiny. We are looking at the report from the Joint Committee and will be responding to that shortly.

NHS Long-term Workforce Plan

James Morris Excerpts

Monday 3rd July 2023 Commons Chamber

[James Morris (Halesowen and Rowley Regis) (Con)]

I welcome this long-term plan, particularly its recognition that the skillsets required in the NHS over the next 10 or 15 years, with the requirement for multidisciplinary working and generalised clinical skills, are going to change. Does my right hon. Friend agree that two things are needed for implementation? One is to improve the sense of culture in the NHS, which could lead to better retention. The second element is to ensure that digital innovation, particularly the use of artificial intelligence to improve clinical skills and other skills, is rolled out more generally in the NHS. We need to diffuse that innovation a lot more to support the critical new skillsets that are required for a modern health service.

[Steve Barclay]

My hon. Friend is exactly right. As a former Health Minister, he knows these issues extremely well. There is a requirement—this is something the chief medical officer, Professor Sir Chris Whitty, has spoken about—for more generalist skills in the NHS, not least given that one in four adults now has two or more health conditions. We need flexibility to respond to changes not just in technology, but in service design, which will evolve as well.

My hon. Friend is also right about the wider issues of culture. I think the whole House was concerned about recent reports of sexual assaults linked to the NHS. One of the key features of the agreement we have reached with the NHS Staff Council is to work more in partnership on violence against members of NHS staff. I know there will be consensus in the House that that is unacceptable, so we are working with trade union colleagues on how we tackle it. Again, with racism, we still have too many cases of concern. There are a number of areas of culture that we are working constructively with trade union colleagues and others to address.

Oral Answers to Questions

James Morris Excerpts

Tuesday 24th January 2023 Commons Chamber

[Maria Caulfield]

Local healthcare decisions are made by local commissioning groups, but I am happy to raise that on behalf of the hon. Lady. We are putting an additional £2.3 billion a year into expanding and transforming mental health services in the community and patient services.

[James Morris (Halesowen and Rowley Regis) (Con)]

Although I welcome the new investment in emergency mental health services that was announced this week, does the Secretary of State agree that we must not lose sight of the fact that we need a long-term plan for the transformation of mental health services so that we achieve parity of esteem between mental and physical health in the NHS?

[Steve Barclay]

I do agree. That is why the long-term plan signalled the importance of mental health and the parity of which my hon. Friend speaks. It is also why, as the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield), has said, additional funding is being targeted at mental health—the extra £2.3 billion a year from 2024—signalling this Government’s commitment to mental health, as he will have seen with the announcement on mental health ambulances this week.

NHS Winter Pressures

James Morris Excerpts

Monday 9th January 2023 Commons Chamber

[Steve Barclay]

The whole purpose of the £500 million is to put more support into local authorities’ funding for social care. About a quarter of that funding is going specifically on workforce interventions, but we are also using other measures. One of the other things we have been doing is boosting workforce recruitment through international recruitment, with care sector staff on the shortage occupation list.

[James Morris (Halesowen and Rowley Regis) (Con)]

I welcome the Secretary of State’s statement and in particular the additional money for discharge. Does he agree that, in regard to integrated care systems, we really need to accelerate the integration between health and social care? Notwithstanding what he said about maturity, that is the key to the future integration of health and social care, and that will solve many of the problems that we face at the moment.

Oral Answers to Questions

James Morris Excerpts

Tuesday 1st November 2022 Commons Chamber

[Maria Caulfield]

I have highlighted that there are additional pressures—more children and young people are coming forward with mental health conditions—but I assure the hon. Gentleman that we are putting early intervention directly into schools. Mental health support teams now cover 26% of pupils, with the aim of going up to 35% of pupils by April, and we intend to increase that further. So we are getting in as early as possible. Over 420,000 children and young people were treated through NHS-commissioned services in the last financial year. There is more to be done, but we have made a good start.

[James Morris (Halesowen and Rowley Regis) (Con)]

There is a real danger that prioritisation of mental health services is not what it was a few years ago. Does the Minister agree that we need to take urgent action on workforce development and other measures to increase capacity for mental health services, so we do not let down the hundreds of thousands of young people who are on the waiting lists? We need to take action now.

[Maria Caulfield]

I agree and we are taking action now. Our aim is to expand the mental health workforce by an additional 27,000 healthcare professionals by 2023-24. We have already seen an increase—almost 6,900 more full-time equivalent staff. The workforce are the key to that, which is why are investing in them so heavily.

East Kent Maternity Services: Independent Investigation

James Morris Excerpts

Thursday 20th October 2022 Commons Chamber

[Dr Johnson]

As a rural Member of Parliament, I understand the need for rural services to be just as good as those in more urban areas and to ensure that they are improved where they are not adequate. A medical education reform programme that is co-sponsored by NHS England and Health Education England is expected to direct investment for specialty training more towards area population need—to smaller and rural hospitals. The programme entered its implementation phase in August. Morecambe Bay, East Kent, James Paget and Shrewsbury and Telford are included in our current smaller hospitals list. I am not certain about the hospital in the hon. Member’s constituency, but I can find that information and write to him about it.

[James Morris (Halesowen and Rowley Regis) (Con)]

This is clearly a shocking and disturbing report. I found myself agreeing with the shadow Minister when she said that this represents a serious collective failure across our maternity services, because I know that it is not an isolated incident. Does the Minister agree that there is a role to be played by the Healthcare Safety Investigation Branch, which has set up a stream of work on maternity services? Could she redouble her efforts in conjunction with that body to ensure that we learn the lessons of the cultural failures in this case and that that learning is spread throughout the system? That is the only way we have an opportunity to ensure that these things do not happen again.

[Dr Johnson]

My hon. Friend will be aware that within HSIB the Government are establishing a new special health authority specifically for maternity investigations, with specialist expertise. This independent body will continue the work of HSIB from 2023. In the meantime, maternity investigations will continue without interruption until it is fully operational.

NHS Dentistry Services: Carshalton and Wallington

James Morris Excerpts

Wednesday 7th September 2022 Westminster Hall

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

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

I congratulate my hon. Friend the Member for Carshalton and Wallington (Elliot Colburn) on securing this important debate on dentistry. I recognise the scale of the challenge that he described and we are committed to addressing the challenges of NHS dentistry. Those challenges continue to be real across the country, but, as he remarked, we have taken steps to address these issues. We are committed to improving dental access and making NHS dentistry a more attractive place for dentists and their teams to work.

I appreciate that access to NHS dentistry varies across the country, as my hon. Friend described, and that access was a big issue before the covid-19 pandemic. However, the pandemic further exacerbated those challenges, as we had to reduce the amount of care delivered, in line with the infection prevention and control measures that were introduced at that time. The activity thresholds for NHS dentistry were carefully set at that time by NHS England, and balanced access for patients against necessary infection prevention and control measures. At that time, dental practices were asked to prioritise urgent care and care for vulnerable groups, supported by over 700 urgent dental care centres, of which I think there are a number in his constituency.

Services have gradually been returning to normal levels, and I am pleased to say that in July 2022 NHS England asked dental and orthodontic practices to return to full delivery—that is, 100% of their contracted activity. The sector has worked hard to deliver as much NHS activity as it can, with many contractors already delivering 100% or more of their contracted activity for some time. As my hon. Friend mentioned, at the start of this year an additional £50 million was secured and made available for NHS dental services, to support the dental access challenges further and to provide patients with more dental appointments. That additional funding supported NHS dental teams in increasing capacity and giving more people access to vital dental care across England.

Those most in need of urgent dental treatment, including vulnerable groups and children, were prioritised for the additional available appointments that were made possible through that funding, with a third of activities being provided at the weekend and outside core hours. That funding meant that those with higher level of need were seen, with over two thirds of treatments being for the provision of urgent care. More than 64,000 additional patients were seen. I would like to pay tribute, as did my hon. Friend, to all the staff at dental practices and community dental services who went above and beyond to provide this extra care for patients.

We are beginning to see some improvements in NHS dentistry as we recover from the pandemic. The most recent NHS dental statistics report, published a few weeks ago, showed delivery of more than double the number of courses of treatment, compared with the previous year, an additional 539 dentists returning to NHS dentistry and an increase in preventative care provided to children.

As my hon. Friend said, it is clear we need to go further. We are pressing ahead with the package of measures that he alluded to, which we announced on 19 July. To go ahead with the dental reform package was one of the first decisions that I took as a Minister. We worked closely with NHS England, which negotiated with the British Dental Association, and engaged with many other stakeholders on these improvements. The changes include improving the criticised 2006 NHS dental contract to ensure that practices are more fairly remunerated for the care they provide to patients, and enabling practices to make better use of the range of dental care professionals in a practice.

We want to see all members of the team, including therapists, nurses and hygienists working their full scope in a practice, which will make it easier for more people to access care. Practices will be supported to adhere more closely to the National Institute for Health and Care Excellence guidelines on recall intervals, which indicate that a healthy adult with good oral health need see a dentist only every two years, and a child every one year. That will free up capacity to deliver additional care required by higher need patients.

The changes that were also alluded to will also enable NHS commissioners to have greater flexibility in commissioning additional services to meet local need and will enable improved and more responsive management of those contracts. The highest performing practices will be able to deliver beyond their contract and treat more patients.

We will also improve information for patients who are looking for care, which is why we will make it a requirement for dentists to update their information on the NHS website. In addition to those changes, which will increase dental access and recruitment and retention of the dental workforce, Health Education England is working to implement recommendations from its recent 2021 “Advancing Dental Care Review” as part of its four-year dental education and reform programme.

The aim of that work is to develop a skilled, multi-professional oral health workforce, more able to support patient and population needs within the NHS, by reforming dental education and training. The programme will help address inequalities in dental care access across the country, better targeting areas that are currently less well served.

We know that international dentists are a vital part of the UK’s dentistry workforce. To improve the recruitment of overseas dentists and to ensure that international dentists remain a vital part of our workforce, we are currently working with the General Dental Council on legislative proposals that will allow the regulator greater flexibility to expand the registration options open to international dentists. The changes will support alternative routes to the overseas registration exam where appropriate, as well as expand access to the exams.

We aim to introduce the legislative changes this year, subject to the outcome of the recent consultation on the parliamentary approval process. In the meantime, current arrangements ensure that UK regulators continue automatically to recognise relevant qualifications of dentists from the European economic area, and we want to continue to facilitate their vital contribution to the dentistry workforce.

I want to emphasise that the reforms that we introduced on 19 July are one step. I and the Government recognise that they are a first step in a reform programme. In the longer term, we are looking at committing to improve access to urgent care and at the necessity of further workforce and payment reform. We will continue to work with NHS England and the dental sector to consider what further long-term changes may be necessary.

Question put and agreed to.

Access to NHS Dentistry

James Morris Excerpts

Tuesday 19th July 2022 Written Statements

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

Access to dentistry was severely impacted by the pandemic. The Government provided unprecedented financial support to the sector during the covid-19 pandemic to ensure that practices remained viable and able to offer treatment during the pandemic and to continue now, as we learn to live with covid-19.

Taking into account the evolving guidance on infection and prevention control NHS England has worked, throughout the pandemic, with the sector to increase levels of dental activity, while keeping dentists, patients and their teams safe. From the beginning of July this year, NHS England has set the expectation that practices will return to delivering treatment at pre-pandemic levels.

With NHS dentists operating at below 100% capacity for over two years, many people have not been able to regularly access a dental professional. We are taking action to address this, in a way which is fair for patients, dentists and the taxpayer.

In April 2021, the Government set out that any changes to NHS dentistry must meet six tests:

Be designed with and enjoy the support of the profession

Improve oral health outcomes (or, where sufficient data are not yet available, credibly be on track to do so)

Reduce perverse incentives for dental care that is not clinically necessary

Demonstrably prevent the loss of NHS commissioned dental activity to private pay

Improve patient access to NHS care, with a specific focus on addressing disparities, particularly those linked to deprivation and ethnicity

Be affordable within available NHS resources made available by Government, including taking account of dental charges

NHSE fully engaged the profession and patient representatives through an advisory board, technical groups and engagement events from May to September 2021 to fully understand the issues and potential solutions. The improvements set out here result from that engagement and have been refined through consultation with the British Dental Association and wider dental sector representatives.

These initial changes are aimed at improving information for patients; improving the incentives in the contract to deliver more complex care; and enabling the NHS to better work with the sector to ensure that dental care is delivered.

Improve care for high-needs patients

We have responded to the call from dentists to improve the remuneration system to incentivise complex preventive and restorative treatment. We will make changes to the way dentists are remunerated for the range of treatments that are currently covered in band 2 treatments. Dentists will be paid more when they need to do three or more fillings or extractions and provide endodontic care.

To provide the capacity to deliver the additional care required by higher-needs patients, we will support practices to adhere more closely to the National Institute of Clinical Excellence guidance on recall intervals which indicate that a healthy adult with good oral health need only see a dentist every two years and a child every one year. We want to decrease the volume of any low-value clinical care provided through NHS dentistry, for the NHS and patients themselves.

These changes will support dentists and patients in getting the care they need as we start to tackle the pandemic backlogs in care.

Promote more effective use of skill mix

Dental care can be provided by a wide range of dental professionals including dental nurses, dental hygienists, and dental therapists. We will make clear that there is no legal barrier to the increased use of these professionals in the provision of NHS care and seek to increase their use in the provision of NHS care, as is already the case in private practice. NHS England will issue clear guidance on how to utilise these team members to provide NHS care that is within their scope of practice and which they have the skills, competence and experience to deliver safely and effectively in the best interests of patients. We will also work with the NHS Business Services Authority to make sure there are no administrative barriers to more effective use of this skill mix in practices providing NHS care.

This will help improve access to NHS care and make dental care professional roles including dentists more fulfilling and rewarding, and help to tackle workforce challenges in underserved areas.

Maximise patient access from available dental resources

NHS England will work with local commissioners to help ensure that dentists are able to deliver high-quality care to patients. Most dental practices consistently deliver their contracted amount of dental activity, but there are some that do not, and some that want to deliver more NHS dentistry.

We want to enable high-performing practices to expand to deliver more NHS care, particularly in those areas where NHS dentistry is less prevalent. To incentivise this, we will enable, subject to commissioner agreement, practices to deliver up to 110% contracted activity.

Where contractors are unable to deliver their contracted activity in-year or persistently across years, commissioners are currently limited in their ability to recommission that activity to contractors better able to do so. In 2019-20,13% of contractors had consistently failed to deliver. This lost activity represents around 4.6 million units of dental activity per annum.

As an initial step NHSE will encourage commissioners and contractors to work together so that where a practice has not delivered 30% of contracted activity by mid-year, 10% of annual activity will be rebased with agreement of the contractor. For contractors that consistently do not meet their targets over a number of years, we will enable NHSE to rebase contracts to achievable levels and release unused funding to commission care from other providers.

Improve communication with patients

Patients told us that they have difficulty finding an NHS dentist, in part because of the limited information on the NHS website. We will make the updating of the NHS website and directory of services a contractual requirement for dental practices. This will make it easier for patients to find a dentist who can deliver the care they need and for the system to refer patients to practices with capacity.

Recruitment of dentists

International professionals form a large proportion of joiners to the General Dental Council (GDC) register—indeed, in 2020, 35% of new GDC dentist registrants qualified outside the UK. They are a vital part of the UK’s dentistry workforce, ensuring that there is more capacity for dental treatment than UK graduates can provide alone

As part of the ongoing reforms to healthcare professional regulation, officials have identified prescriptive detail which restricts the GDC from modernising its international registration processes. This may in turn deter safe and competent professionals from seeking registration to practise in the UK. The Department is therefore taking forward a legislative change which will:

support flexibility for the GDC to ensure that international processes are proportionate and streamlined, while continuing to robustly protect patient safety;

enable the GDC to increase the number of overseas registration exam (ORE) seats it offers by charging a fee which covers the cost of the exam, explore alternative ORE providers, and make changes to the structure of exam and applicant information which will support an increased pass rate; and

allow the GDC to explore alternative pathways to international registration, such as recognition of programmes of education delivered outside the UK, or registration based on recognition of the qualification held by an applicant, as it considers appropriate.

Current arrangements ensure that UK regulators continue to automatically recognise relevant European economic area (EEA) qualifications of healthcare professionals, including dentists. This enables qualified dentists from other EEA countries to continue to practise in the UK and we want to continue to facilitate their vital contribution to the dentistry workforce. EU exit legislation places a duty on the Secretary of State to carry out a review of the operation of these provisions at the start of 2023. The system of automatic recognition will not terminate unless further legislation is made to bring the current system to an end.

Next steps

These changes are the first steps in our work to support NHS dentistry and patients in areas where they continue to struggle with access. We are committed to working with the sector to consider any further changes which meet the six tests set out above, in particular regarding improved access to urgent care and further workforce and payment reform.

[HCWS223]