Vaccination Strategy

Jeremy Hunt Excerpts

Wednesday 12th January 2022 Commons Chamber

[Maggie Throup]

I thank the hon. Gentleman for his measured approach. We have seen throughout the pandemic that everybody working together gets us where we need to be, which is making sure that people are safe.

The hon. Gentleman asked a few questions about the current vaccine programme and the uptake rate. I am delighted that about 80% of people over 18 have now been boosted, which is a fantastic achievement. Over 90% of the population aged 12 or over have had their first dose and 83% have taken up the offer of a second. I reiterate that the offer of a first and second dose is always there. If people have not yet come forward for their first dose, it is not too late: they can go to a walk-in centre or make an appointment through the national booking service or their GP to get that all-important vaccine.

With regard to 12 to 17-year-olds, the school-age immunisation service has started to roll out again this week. People can also take the out-of-school offer through the national booking service or the walk-in sites. The hon. Gentleman mentioned a case where somebody had to travel 50 miles. We did look into that situation, and it was not quite right. We have been in touch with that member of the public, and the situation has been resolved.

Housebound patients are the responsibility of the primary care network or the clinical commissioning group, depending on the local scenario. Every housebound patient has been offered their booster vaccine now, but if the time was not quite right, or any Member has taken up such a case with their CCG and not had a solution, I would be happy to take the case up on their behalf.

The hon. Gentleman talked about the ambition not just to vaccinate the UK but to make sure that people globally are protected. I am delighted to announce that, as of the end of last year, we donated 30 million doses, partly through COVAX and partly through bilateral agreements, which is a great achievement, and we have a commitment in place for 100 million doses by the end of June this year.

[Jeremy Hunt (South West Surrey) (Con)]

This country has one of the best vaccination programmes in the world and the very best in Europe. We should remember that the foundations were put in place when, at the height of the first wave, the then Health Secretary bought 400 million doses of vaccine that we did not even know would work. That has meant that we are now emerging sooner and more broadly than nearly anywhere else. But that success was also because a lot of GPs in the NHS were diverted away from their normal work into the vaccination programme, and that has come with costs in terms of the other treatments they are not able to deliver. When will we see a workforce plan that takes account of the new responsibilities for vaccination that the NHS will have? When will the budget for Health Education England be agreed, because two and a half months before the next financial year we still do not know what it is? Will the workforce plan have independent forecasts so that we can make sure we are training enough doctors and nurses for the future?

[Maggie Throup]

I thank my right hon. Friend for his question. He has made it his ambition, as has the Department, to ensure that we have the right workforce in place. He raises a really good point about the vaccines and how we continue to administer them—not just the covid vaccine but the flu and other vaccines that we have throughout our lifetimes. We have learned an awful lot from rolling out the covid vaccine programme, and like my right hon. Friend I commend the vaccine taskforce for having the foresight to look beyond what some other countries did, to make sure we had the vaccines in place when we needed them.

We do need to look again at how we maximise what has been such good will. In terms of the vaccinators who have come forward, some were not trained as vaccinators before. As I travel around some of the vaccine sites, I meet people from all backgrounds who have taken up the challenge to come forward and become vaccinators. The other day, I actually met a builder who is now a vaccinator, and he is loving every minute of it. I also thank the volunteers who have come forward and made sure that this programme has been so effective. It is about bringing together what we have learned in this programme over the last year to make sure that we can roll out other programmes in an effective manner.

Covid-19 Update

Jeremy Hunt Excerpts

Monday 13th December 2021 Commons Chamber

[Sajid Javid]

First, may I say that I heard your request, Mr Speaker? I am happy to take that up with you directly, if that is okay. I thank the hon. Gentleman for his support of the need to accelerate the booster programme. I join him, as I am sure the whole House does, in expressing condolences for the individual who was the first in this country to die with the new variant.

I turn to the hon. Gentleman’s questions. First, he asked about testing capacity. I would like to share more information with the House. There is no shortage of tests held by UKHSA—tens of millions of tests are in stock and millions are arriving each week. The limiting factor, because of the hugely increased demand—I am sure hon. Members understand why demand has suddenly surged—is the ability to deliver tests. The current arrangements with Royal Mail alone are not enough, but new arrangements have been reached with Amazon and other delivery methods. There will still be many hundreds of thousands—record numbers—delivered each day, but also the number of access points is being increased, including many more through pharmacies, and we are rapidly looking at other access points. The hon. Gentleman is right to raise this, but I hope he and others understand that there has been a huge surge and increase, and this is not just about the number of tests available but getting them through and delivered; both are equally important.

The hon. Gentleman raised the issue of the booster programme timing. He is right that just a couple of weeks ago the plan was to give everyone a booster before the end of January. That was after the change in advice from the Joint Committee on Vaccination and Immunisation that the dosing gap should be reduced to three months and that it should now include everyone over 18. For the reasons I have explained and that the Prime Minister shared in his national broadcast yesterday, we want to bring that forward. That involves working hard with the NHS, which has done phenomenal work already to reach four in 10 adults with boosters and in the vaccination programme in general.

This is asking a huge amount of our colleagues in the NHS, and it is our joint view that we can try to offer adults a chance to get boosted by the end of this month. That does not mean every single person can necessarily get that booster; it requires them to come forward and take up the offer as well as everything going right in this huge expansion plan. But again, I hope the hon. Gentleman can respect that the NHS is doing everything it can, with the full support of every Department of Government, and is throwing everything at this to offer as many opportunities as it can and the maximum possible capacity for delivering on that commitment.

The hon. Gentleman also talked about the challenges facing the NHS. I remind him and the House that this year the Government have put an extra £34 billion into the NHS and social care, £5.4 billion of that in the second half of this year, and over the next three years there is a commitment to at least £8 billion extra going into the largest catch-up fund the NHS has ever seen. In the last year almost 10,000 nurses and almost 3,000 doctors have joined the NHS; the NHS is increasing workforce and capacity, is looking at new ways to do electives, and is putting a huge amount of effort into its electives programme and its non-covid work as well.

Finally, I do understand what the hon. Gentleman said on adult social care and the limit on visitors, and it is important to get the balance right. We all know the problems and the sad deaths not long ago in care homes with this pandemic, and it is right to take balanced measures to protect people in care homes. We are working with, and listening to, those who run care homes and trying to take a balanced approach that allows visits to take place but also protects vulnerable people.

[Jeremy Hunt (South West Surrey) (Con)]

One year and five days ago the UK administered the first properly approved covid vaccine in the world, and the Government are absolutely right to focus on immunisation, but Israel approved booster jabs for all adults in September, France approved jabs for teenagers in June, both long before us, and the United States has already approved jabs for five-year-olds, again long before us. Is the Secretary of State worried that our regulators, having been the nimblest in the world, are now taking too long? They are brilliant scientists and they are rightly totally independent, but what can he do to speed up this crucial decision making in a pandemic?

[Sajid Javid]

My right hon. Friend makes an important point, from experience. We can be proud of so much of what our regulators have achieved and done. As he said, we were the first in the world to approve a covid-19 vaccine, but he is right to challenge on this and ask what more can be done, especially in light of the circumstances we face. The JCVI is not a regulator but it is an important part of the approvals process, and I hope he will also commend its swift response since the emergence of omicron in changing the rules around boosters.

Covid-19 Update

Jeremy Hunt Excerpts

Wednesday 8th December 2021 Commons Chamber

[Mr Speaker]

I call the Chair of the Select Committee, Jeremy Hunt.

[Jeremy Hunt (South West Surrey) (Con)]

Disappointing though the statement will be for many people, the Secretary of State has my full and unqualified support. This is not a choice between more and fewer restrictions; it is a choice between taking action early to protect a future lockdown and making such a lockdown inevitable. We all hope that the omicron variant is milder than delta, but if it is not, a failure to act now could cost many lives.

I want to ask the Secretary of State about the social care sector. I know that he will say more about it later this week, but he will have seen the estimate from NHS Providers that 10,000 beds—over 10% of all NHS hospital beds, and more beds than are currently occupied by covid patients—are occupied by people who are fit to be discharged but cannot obtain a care package. Will he provide funds to ensure that all those patients can be discharged, so that the NHS can be ready for any potential spike in new cases?

[Sajid Javid]

I thank my right hon. Friend for his support for the statement. He is right to emphasise that by taking swift, early and proportionate action now, we can potentially avoid further restrictive measures in the future. As I have said, there will be a statement on social care later this week, but I can also give him the assurance that he seeks: the statement will include further measures to help with the discharge of hospital patients who are clinically ready to be discharged.

Covid-19 Update

Jeremy Hunt Excerpts

Monday 6th December 2021 Commons Chamber

[Sajid Javid]

I thank the hon. Gentleman for his support for the measures that I talked of in my statement. I am pleased to hear that the Leader of the Opposition, the right hon. and learned Member for Holborn and St Pancras (Keir Starmer), had his booster jab today, as did, I think, the chief executive of the NHS, along with many thousands of other people.

I thank the hon. Gentleman for his general support for the booster programme and the importance of vaccines and for the call he has made for more people to come forward. The booster programme is steaming ahead at blistering pace: 2.6 million people across the UK were boosted last week and some 3.6 million are already booked in to get their booster—that is probably the highest number we have seen for boosters. I am confident that we are on track to meet our commitment to offer all adults across the UK a booster jab by the end of January. We are already far ahead of any other country in Europe and most certainly still will be when we achieve that by the end of January.

The hon. Gentleman was right to point to the importance of vaccination more generally, especially in respect of those people who have not yet even taken up the offer of a first vaccine jab. We estimate that around 5 million people across the UK have yet to take up the offer of a jab. Our general vaccination rate across the population—more than 88% of those over the age of 12 have had at least one jab—is one of the highest in Europe, but we need to do even more to get to that missing 12%. A huge amount of work has gone into that effort, especially in respect of communications and dealing with misleading information on vaccines, as well as improving access. In the past week, perhaps because of the concerns about the omicron variant, we have seen more and more people coming forward for vaccinations for the first time. That is of course to be welcomed, and we will continue to build on that.

The hon. Gentleman asked about responses to any potential future variants. It is reasonable to think that there will be future variants, but we will reserve judgment on them until we come across such issues. In any case, there will always be a balanced and proportional response based on what we know at the time. I do not think it would make sense to set out that response in advance.

The hon. Gentleman asked about the cost of testing, whether using PCR or lateral flow tests. We have rightly removed more than 100 providers from the Government website in recent weeks, and some 20 were removed this weekend for showing misleading prices. We will continue to take a tough and hard line on that, because of course no one should be misled and the pricing and availability should be absolutely clear.

The hon. Gentleman asked about ventilation in schools. My right hon. Friend the Secretary of State for Education gave further information last week on that and the improvements being made.

On sick pay, it is important that we have rightly kept in place access from day one rather than returning to the situation before the pandemic.

In terms of rules, of course they should apply to everyone, regardless of who they are.

[Jeremy Hunt (South West Surrey) (Con)]

I strongly support the balanced and sensible way in which the Secretary of State is buying time until we find out how dangerous this new variant really is. How is he preparing the NHS for the potential worst-case scenario that we might face, particularly in respect of the 10,000 NHS beds that NHS providers think are occupied by people waiting for a social care package? Given that in the first wave many people sadly died at home from stroke and heart attacks because they did not want to go into hospital, what are we doing for emergency care? Also, on cancer care, 45,000 fewer people started cancer treatment in the first wave, so how will the Secretary of State make sure that when we switch the NHS on for omicron we do not switch other services off?

[Sajid Javid]

I thank my right hon. Friend for his support—he is right to talk about the importance of buying time—and for his comments about the NHS and the need to prepare. I reassure him that ever since we discovered omicron the NHS has been spending a substantial amount of time preparing.

My right hon. Friend mentioned the importance of discharges; they were important before but, where a patient is ready to be clinically discharged, they have become even more important now in the light of omicron. The recent funding that we provided for discharges—almost £500 million over this winter period—will help.

Adult Social Care

Jeremy Hunt Excerpts

Wednesday 1st December 2021 Commons Chamber

[Gillian Keegan]

It will take long. It is over 100 pages, so it will take a reasonable time if Members are interested in actually finding the solutions.

The hon. Member for Leicester West also asked about workforce strategy and the NHS compared with social care. Obviously, the people in the NHS are employed by the NHS, which is a public body. Social care is largely a private system. There are 18,000 or more businesses. That is why it is a different sector and why we deal with workforce strategy differently. However, we have £500 million to invest in the social care workforce and to make sure that we invest in the knowledge and skills framework, careers options and so on.

There are 1.54 million workers in the sector and they are hugely valued. The hon. Lady said they are leaving in droves. Actually, what we have in the sector is a continual demographic shift in terms of need, and it grows by 1% to 2% every year, so we are always trying to recruit new workers into the sector. Of course, it is very important that these fundamental reforms take place so that we get more people attracted to the sector, more people staying in the sector, more people progressing in the sector and more people providing excellent care all day, every day, providing a lifeline to people across the country.

[Jeremy Hunt (South West Surrey) (Con)]

I thank the Minister for her work putting the White Paper together in a very short period. I know that she has put a lot of effort into it, but it is hard to see it as more than three steps forward and two steps back. The step forward, which we should acknowledge, is the introduction of a cap. Whatever the arguments about what counts towards the cap, having a cap will make a big difference to many people, and that is welcome.

However, these measures do not really give confidence in two crucial areas. The first is the funding to local authorities for their core responsibilities. The White Paper barely gives them enough to deal with demographic change and national living wage increases, and it is a long way off the £7 billion-a-year increase the Health and Social Care Committee called for by the end of the Parliament. It is also hard to see the NHS and social care systems being fully integrated, as they should be, and an end to the workforce crisis, which sees 40% turnover in many companies.

This is a start. The Minister is a very capable new Minister and I personally have great confidence in her, but will she bring forward further measures to deal with those huge problems? Otherwise, we will see hospital wards continuing to be full of people who should be discharged, and older people not getting the care they need because the carers do not exist.

[Gillian Keegan]

My right hon. Friend is right that this is a start. It is a 10-year vision, and obviously we had a three-year spending review and the spending that we set out was a three-year spending settlement, so of course it is just a start.

On the steps to ensure that local authorities move to a fair rate and a fair cost of care, we are exploring a number of options, and we will set out further detail at the local government finance settlement later this year. Local authorities moving towards a fair rate of care is key to building a solid foundation for the future adult social care system, so we will be working closely with them to shape the best possible approach to implementation across different local markets. We will shortly be engaging with local authorities and providers, and we will publish further guidance in due course.

My right hon. Friend is absolutely right about the workforce. I have never worked in a business where the workforce was not key to anything that needed to be delivered, but in the care sector in particular, it is impossible to deliver anything without the workforce. It is also difficult to look at the workforce structure. As I say, it is the largest workforce in the country, with 1.54 million people working in it, but with 40% churn and very high amounts of zero-hours contracts and of retraining. I have never seen something that has that—[Interruption.] This has been the case for decades, and nobody has done anything to address it. [Interruption.] Nobody has done anything to address it. We do need to address it, and that is what we are here to do today, but—[Interruption.]

Covid-19 Update

Jeremy Hunt Excerpts

Monday 29th November 2021 Commons Chamber

[Sajid Javid]

I, too, extend my best wishes to the shadow Health Secretary and wish him a speedy recovery.

I have to say that I think the hon. Lady has misjudged the tone of the House. This is a very serious matter. The whole country will be looking for all Members of this House to work together and support the nation. Surely she is not blaming the UK Government for the emergence of the new variant. Perhaps she was just auditioning for the reshuffle that is going on in her party right now.

The hon. Lady asked about international donations. The UK is leading the world on international donations—quite rightly. It is absolutely right that that be treated as a priority. We would like to see other countries step up as well. A few months back, the Prime Minister pledged 100 million donations by June 2022, 80% of which will go through COVAX, of which we are a huge supporter; 20% will be made bilaterally. So far, we have donated over 20 million doses—more than many other countries. COVAX, which we helped found, and which we support, has donated, I believe, some 537 million doses to 144 countries.

The hon. Lady asked about the rules on travel and masks, and other rules that I set out. I think I have addressed that. I believe that the measures are proportionate, and that this is a balanced response. We have just set out a huge expansion of the vaccine roll-out programme, and it is a shame that the hon. Lady could not find it in herself to welcome that. As I said, I will set out more details in coming days on exactly how we intend to meet the requirement to vaccinate more.

On antivirals, we are one of few countries in the world to have procured the two leading antivirals. Our independent regulator, the Medicines and Healthcare products Regulatory Agency, was the first in the world to approve one of those antivirals. I am pleased with the over 700,000 courses that we have for citizens across the United Kingdom, but of course, given the emergence of the new variant, we will be reviewing that and seeing if more needs to be done.

[Jeremy Hunt (South West Surrey) (Con)]

The late Donald Rumsfeld coined the phrase, “known unknowns”, and that is what we face with the new omicron virus. The Secretary of State is therefore absolutely right to take sensible and proportionate measures to buy time while we wait to understand how dangerous this new variant can be, but does he not agree that the fact that we face this danger is a symptom of the failure of western countries to make sure that vaccines are distributed adequately around the world? I recognise the enormous contribution that the UK has made through COVAX, the development of the AstraZeneca vaccine and so on, but is it not a moral and practical failure that while richer countries have managed to vaccinate 60% of their populations, for poorer countries the figure is just 3%?

Health and Care Bill

Jeremy Hunt Excerpts

Report stage
Tuesday 23rd November 2021 Commons Chamber

[Jeremy Hunt (South West Surrey) (Con)]

May I just comment that it feels a lot better this time?

[Justin Madders]

Let us just say that the more I hear of the right hon. Gentleman, the more I like what he has to say—I will leave it there.

We all accept the urgent need to address the workforce crisis, but I cannot find anyone who thinks that what the Government have put forward in clause 34 is the solution.

--- Later in debate ---

[Justin Madders]

I thank the hon. Member for his intervention. I think he is being very modest, but he is absolutely right that these things do not happen by accident. It is often the hard work, over many years, of campaigners and campaign groups who being these issues to the fore and do the diligence and the hard work behind the scenes that leads us to the sort of outcome that we will hopefully get today—an end to this abhorrent practice.

On the hon. Member’s other amendment, new clause 22, we also want to see hymenoplasty ended. It has no medical benefit whatsoever. As the Minister said, there is currently an expert panel looking at the issue, and he is waiting on its recommendations. I think the outcome is in little doubt, to be frank. However, I wonder whether the Minister can give us an assurance that, should those recommendations turn out to be as we would expect, he will be able to act on them quickly and get something down in statute as soon as possible so that we do not miss the boat.

Turning to the amendments on the health services safety investigations body, much of the proposed legislation is the same as that proposed in the other place, and there were extensive debates on this matter in Committee. There are, however, issues that remain, which are covered by amendments we will be debating today. I can imagine the other place having quite a lot to say about some of these issues. In general, we support the move to the new body, but over time attention must be applied to some aspects of the way it will function in practice. Our major reservation is, yet again, with the involvement of the Secretary of State. Our amendment 74 would have the effect of leaving out clause 115, which is another clause that gives the Secretary of State extra powers to interfere.

Our general observation would be that there is far too much extra power going to the Secretary of State in the Bill anyway, but we are particularly concerned at the powers set out in clause 115, which give him what we consider to be wholly unnecessary powers to direct. It is pretty much a blank cheque to enable him to step in and interfere any time he likes as long as he considers that there has been a significant failure. Under subsection (2), the Secretary of State can direct the HSSIB in whatever manner he determines, which I would have said is about as far away from independence as we can get—until we get to subsection (4), which means the Secretary of State can also effectively step into the HSSIB’s shoes and undertake the duties himself. I can do no better than refer to the evidence Keith Conradi gave to the Public Bill Committee, when he said:

“Ultimately, we end up making recommendations to the Department of Health and Social Care, and in the future I would like to ensure that we have that complete freedom to be able to make recommendations wherever we think that they most fit.”––[Official Report, Health and Care Public Bill Committee, 7 September 2021; c. 60.]

We also support the amendments put forward by the spokesperson for the Scottish National party, the hon. Member for Central Ayrshire (Dr Whitford), which are important in preserving the principle and status of protected spaces. We feel it is important that they cannot be nibbled away at, as the Bill currently allows.

The purpose of amendment 57, which we also tabled in Committee, is simply to delete clause 127, which deals with the role of the Secretary of State in professional regulation. So far, we have had no convincing explanation of why the Secretary of State needs these powers. If there are no professions that he wishes to remove, we do not need the clause. If there are, he should say so, so we can have a debate now on whether it is appropriate to hand over those powers to him.

Finally, on new clause 1, I pay tribute to the all-party parliamentary group on beauty, aesthetics and wellbeing, whose work in this area has been influential in producing it. Many of the group’s members have put their name to it. As we know, cosmetic treatments can include a wide range of procedures aimed at enhancing or altering appearance. Many of those procedures are becoming increasingly popular and new clause 1 speaks to the well-articulated concern that non-medically and medically trained practitioners are performing treatments without being able to provide evidence of appropriate training, and without required standards of oversight and supervision.

I hope the Members moving new clause 1 will have the opportunity to speak to it, as there are far too many stories of people suffering horrific, life-changing injuries. There would undoubtedly be a saving to the NHS in reduced visits to accident and emergency and GPs to correct mistakes made by poorly trained and unregulated practitioners. We therefore think the new clause has value. Some of the impacts on the NHS from the lack of regulation include outbreaks of infection at a skin piercing premises, resulting in individuals being hospitalised; disfiguration and partial removal of an ear; second and third-degree burns from lasers and sunbeds; allergic reactions due to failures to carry out patch tests or medical assessments, which led to hospitalisation; and blindness in one eye caused by the incorrect administration of dermal filler.

New clause 1 seeks to put the protection of the public at the forefront by giving the Secretary of State power to bring into force a national licensing scheme for cosmetic procedures. Clearly, given that this is a departure from the wild west we face at the moment, we recognise that significant research and engagement with stakeholders will be needed to develop a scheme, as well as the provision of a practical and efficient system for people to become regulators and practitioners. If that does not make it on to the face of the Bill today, we hope this is an issue the Government will return to shortly.

[Jeremy Hunt]

I rise to speak in support of amendment 10 but, before I do, I also want to express strong support for amendments 40 to 43, tabled by the hon. Member for Central Ayrshire (Dr Whitford), which will make a big difference in making the new health services safety investigation body a success. I strongly encourage the Minister to listen to what she says later not just with the deference due to an experienced surgeon, but with the enthusiasm to follow a doctor’s advice, because what she says is extremely important.

I also thank the hon. Member for Ellesmere Port and Neston (Justin Madders) for his generous comments about me. Having sat opposite him at the Dispatch Box on many an occasion, I realise how difficult they must have been for him to say. He must have wrestled with those thoughts for a long time, and I am delighted that he has been able to unburden himself today.

The hon. Gentleman was absolutely right to focus on burnout in the NHS workforce. All of us would agree that NHS and care staff have done a magnificent job looking after us and our families in the pandemic, but right now they are exhausted and daunted. They can see that A&E departments and GP surgeries are seeing record attendances. They can see nearly 6 million on waiting lists, which is more than one in 10 of the population. They also have the vaccine programme and covid patients.

[Jim Shannon (Strangford) (DUP)]

I commend the right hon. Gentleman for amendment 10. With 2,700 vacant nursing posts in Northern Ireland, and 40,000 in the NHS as a whole, will the amendment offer more nursing bursaries, train nurses up to relieve the pressure, and provide a decent working environment?

[Jeremy Hunt]

I believe it will. I am grateful to the hon. Gentleman for raising that issue, because medical training is relevant to the whole United Kingdom, not just one part of it. I hope the amendment will be beneficial to Northern Ireland as well.

If we put ourselves in the shoes of any frontline doctor, nurse or care worker, we would see that they are all completely realistic that this is not a problem that can be solved by next Monday. It takes a long time to train a doctor or nurse. All they have is one simple request: that they can be confident that we are training enough of them for the future, so that even if no immediate solution is in place, there is a long-term solution. That is the purpose of amendment 10. It simply requires the Government to publish every two years independently verified estimates of the number of people we should be training across health and care.

The Government have recognised the pressures on the NHS by giving generous amounts of extra funding. I commend the Government for doing that, but extra money without extra workforce will not solve the problems that we want to solve. At the moment, the NHS just cannot find the staff.

[Munira Wilson]

I congratulate the right hon. Gentleman on amendment 10 and on how he has built such a coalition of support. Many of the challenges facing those with mental health concerns are because, as he says, there simply is not the workforce—it has hardly grown over the past decade. There are over 16,600 full-time equivalent vacancies and a waiting list of 1.5 million. His amendment, which would require a report every two years, is so important for ministerial accountability because the targets in the five year forward view have not been met, so we have no chance with the 15-year projection.

[Jeremy Hunt]

The hon. Lady gives a good example, because mental health is an area that we have all recently come to realise can be immensely beneficial to ourselves, our families and our constituents. However, while there has been explosive growth in demand, we have not had growth in the supply of people able to look after those with mental health issues. We can only do that with the kind of long-term planning that amendment 10 will make possible.

The royal colleges say that, as of today, there are shortages of 500 obstetricians, 1,400 anaesthetists, 1,900 radiologists, 2,00 A&E consultants, 2,000 GPs, 39,000 nurses and thousands of other allied health professionals. That is why this problem has become so acute.

The Minister has engaged thoughtfully with me on the issue on a number of occasions. He and I both know that there is some concern in the Government about the cost of training additional doctors and nurses. I want to take that concern head on. Yes, the amendment would lead to more doctors, nurses and professionals being trained. Yes, that would cost extra money. Yes, it would save the NHS even more money, because every additional doctor we train is an additional locum we do not need to employ. Locums are not only more expensive for the NHS, but less good for patients. Patients prefer to see the same doctor on every visit if they possibly can, which is much harder with a high number of temporary workers.

[Dr Whitford]

It is not just that patients prefer to see a doctor long term. There are safety issues when locums in acute specialties move from hospital to hospital, particularly if they are dealing with an acute case. They do not know where things are or who to phone; passwords and phone numbers change. There is a real safety issue with having too many locum staff in the very exposed acute services.

[Jeremy Hunt]

I absolutely agree with the hon. Lady, who knows about acute services. I also point to recent evidence from Norway that shows the same for general practice: patients who see the same GP over and over again go to A&E departments less than patients who see different GPs.

[Dr Murrison]

The hon. Member for Central Ayrshire (Dr Whitford) is absolutely right about acute safety; I speak from personal experience. My right hon. Friend is right about general practice, but the issues are different. In general practice, the issue is chronic long-term care: patients need to know that practitioners have a view of their condition that spans a long period—sometimes generations. The issues are very different in acute and primary care, but they come to the same thing.

Does my right hon. Friend agree that part of the problem with the workforce is not recruitment, but retention, particularly the retention of senior doctors in their mid-50s? It pains me to say it in this consensual debate, but the root cause is the GP contract and the consultant contract brought in by the last Labour Government. Those contracts incentivise people—in my demographic, as it happens—to leave, potentially leaving the service short of 10% of their entire career.

[Jeremy Hunt]

My right hon. Friend is right that there are problems with the GP contract. I do not want to get into too many discussions about doctors’ contracts in this very consensual debate, but Conservative Members have to take responsibility for not having remedied the pensions anomaly, which gives people an incentive to retire much earlier than we would want. We have to address that issue.

Lots of people might reasonably ask whether I did enough to address the issues in the nearly six years that I was Health Secretary. The answer is that I set up five new medical schools and increased by 25% the number of doctors, nurses and midwives we train. However, that decision was taken five years ago and it takes seven years to train a doctor, so not a single extra doctor has yet joined the workforce as a result.

That is the nub of the problem: the number of doctors, nurses and other professionals we train depends on the priorities of the current Secretary of State and Chancellor. As a result, we have ended up with a very haphazard system that means that although we spend about the average in western Europe on health, as a proportion of GDP, we have one of the lowest numbers of doctors per head—lower than any European country except Sweden.

[Dr Whitford]

All Governments in the UK are expanding medical school places and trying to train more students, but that has led to a shortage of foundation places. In the first two years after a doctor graduates, they are not allowed to practise outwith a foundation job, and they can never practise if they do not go through a foundation job. In the summer, about 400 young graduates were still struggling to find a place. It took 19 years from my entering medical school to my becoming a consultant surgeon. We need to think not just about medical school, but about the whole pathway.

[Jeremy Hunt]

The hon. Lady is absolutely right. Medical school, the foundation years and, as my right hon. Friend the Member for South West Wiltshire (Dr Murrison) said, the retention of staff—all those things need to be built into long-term planning and baked into the system.

That long-term planning strikes a contrast, if I may say so, with some of the short-termism that we have seen recently. Even in the recent Budget and spending review, the budget for Health Education England, which funds the training of doctors in this country, was not settled. Although I think that the proposed merger with NHS England is probably the right thing to do, I fear it will mean that the budget is not settled for many more months, at precisely the moment when the workforce crisis is the biggest concern for the majority of people in the NHS.

[Greg Clark (Tunbridge Wells) (Con)]

My right hon. Friend is making an excellent speech, and I strongly support his amendment. Will he add to the list of factors that need to be considered in the future the requirement for many research scientists in medical sciences to be trained in medical schools first? If we want to expand and build on the excellence that we have there, it is not just a question of meeting the needs of the NHS workforce; we need to have extra people who can become the brilliant researchers and discoverers of new medicines in the future.

[Jeremy Hunt]

My right hon. Friend speaks about these issues with a great deal of knowledge, given his former ministerial and Select Committee roles, and he is absolutely right. I think that the big lesson from the pandemic, and indeed an issue that emerged in the report that our Committees jointly produced, is the way in which science can add value to clinical practice and clinical practice can add value to science.

[Rachael Maskell]

One of the key workforces is, of course, in public health, where the aim is to shift the balance by increasing prevention so that we do not need all the doctors and nurses and other health professionals further down the road. The health visitor delivery programme led to a heavy stream of new health visitors, but it had other consequences. That is another reason why the right hon. Gentleman’s amendment is so important: we see rapid changes in the workforce which could have other consequences.

[Jeremy Hunt]

I thank the hon. Lady, who before entering this place spent her time campaigning to support NHS and care staff. She speaks with great experience, and I think that the fundamental point she makes is very important. Unless there is long-term strategic planning, when we have a priority such as the one we have at the moment of tackling the backlog, we will often make progress on that priority by sucking in staff from other areas, which then suffer. That is an unintended consequence which happened when I was Health Secretary, and I fear that it will happen again without a long-term strategic framework.

Amendment 10 has wide support. It is supported by 50 NHS organisations, including every royal college and the British Medical Association—an organisation which, to be honest, is not famous for supporting initiatives from me—and by six Select Committee Chairs and all the main political parties in this place. I am sure that the Government will ultimately accept it, because it is the right thing to do, but if they are intending to vote it down today, I would say to them that every month in which we delay putting this structure in place is a month when we are failing to give hope to NHS staff on the front line.

Let me end by quoting the Israeli politician Abba Eban, who said that

“men and nations behave wisely when they have exhausted all other alternatives.”

Let us prove him wrong today by supporting amendment 10.

[Dr Whitford]

I am delighted to follow the Chair of the Health and Social Care Committee, and, in this rather unnerving outbreak of consensus and good humour, to mirror his speech and add my support to his amendment on workforce planning.

It is important to remember that healthcare is not delivered by hospital buildings or fancy machines; it is delivered by people to people, which is why the most important asset in any health service is its workforce. As I pointed out in an earlier exchange with the right hon. Gentleman, we need a long-term view, because it takes a long time to train senor specialists. As I said to him, it took 19 years from my entering medical school to my becoming a consultant breast cancer surgeon. We will struggle to work out what specialties we might need in 20 years’ time, because medicine is evolving, but many aspects and many sectors of staff do not change. If we do not get even those right, we are constantly in a position of drought and thirst, and it is not possible for staff to evolve—to pick up new rules, to use new techniques and to develop new services.

Although this workforce strategy would apply only in England, I would encourage consultation with the Health Secretaries and the workforce bodies in the devolved nations, because junior doctors in particular tend to move around during their training. During the junior doctors’ strike, which the right hon. Member for South West Surrey (Jeremy Hunt) might remember rather painfully, I talked to students on the picket lines whom I had trained. People move around, and it is important that such a strategy does not end up just sucking staff out of the three devolved health services. Also, many aspects of medical training are controlled on a UK basis. Foundation places for new graduates are decided on a UK basis, for example, so it is important to take that wider view.

The workforce shortage is the biggest single challenge facing all four national health services across the UK. It has been exacerbated by the loss of EU staff after Brexit, with an almost 90% drop in EU nurses registering to come and work in the UK. Early retirements are being taken due to the Government’s pension tax changes, which, as has been highlighted, have not been sorted out and are resulting in senior doctors paying to go to work. There is only so long that they will continue to do that. Finally, there is the exhaustion of dealing with a pandemic for the past 18 months. This is why it is really important, when we talk about NHS recovery, to have a greater focus on staff wellbeing and on their recovery. There can be no recovery of the NHS without them. I am really disappointed to see how the clapping of last spring has turned to severe criticism and attacks directly from members of the public, from sectors of the media, and even from some Members in this place and members of the Government.

I shall now speak to my own amendments 40 to 43, which seek to tightly define the materials covered by the safe space protections as part of Health Service Safety Investigations Body investigations. The idea behind HSSIB was to learn from air accident investigations and to provide a confidential and secure safe space in which healthcare staff could be open and candid in discussing any patient safety incidents. I was on the pre-legislative scrutiny Committee, which was chaired by the hon. Member for Harwich and North Essex (Sir Bernard Jenkin), and the recommendations of that cross-party—and indeed cross-House—Committee were very clear: evidence gathered under the safe space protocols should be protected and disclosed to third parties only in the most pressing situations, such as an ongoing risk to patient safety or criminality. Despite that, there are aspects of this Bill that could undermine the principle of the safe space, and that is what I am seeking to amend.

Amendment 40 would define he safe space materials much more tightly, because it seemed as though anything that HSSIB was using would be covered by the safe space protocol and that exemptions would then be made, whereas it makes much more sense to be very clear about the materials that are defined as protected materials. Therefore, all the original clinical information—medical notes, etc—would still be available to all the other bodies to enable them to carry out their investigations as they do now.

Amendment 43 would remove the ability of the Secretary of State to use regulation at a later date to authorise the wider disclosure of protected materials beyond the provision that is finally passed in this Bill. Amendment 42 would remove the provision allowing coroners to require disclosure of protected materials, as this has already led to calls for access by other health bodies and even freedom of information requests, as I highlighted in my earlier intervention. If a coroner uses safe space materials in their report, that report is public. The question is: how are they going to handle that so that the safe space materials are not further disclosed? It is critical to defend this. It is important to stress that HSSIB does not limit anyone else’s access to original materials, but nor should HSSIB be seen as an easy way for other bodies to avoid doing the legwork and carrying out their own investigations.

HSSIB will not apply in Scotland, where the Scottish patient safety programme is focused more on preventing patient safety issues in the first place. My interest is purely personal, as a surgeon. I experienced the impact of the Scottish patient safety programme when it was introduced to operating theatres in 2007. It cut post-operative deaths by 37% within two years. It has subsequently been rolled out to maternity, psychiatry, primary care and all the main sectors. It has not just reduced hospital mortality, but prevented morbidity—such as pressure sores, leg thrombosis or sepsis, which all in their own way cost the NHS a huge fortune.

Oral Answers to Questions

Jeremy Hunt Excerpts

Tuesday 23rd November 2021 Commons Chamber

[Mr Speaker]

I call the Chairman of the Health and Social Care Committee, Jeremy Hunt.

[Jeremy Hunt (South West Surrey) (Con)]

Thank you, Mr Speaker.

The Secretary of State knows that some in Government are worried about the extra cost of training additional doctors, but does he agree that every additional doctor we train means one fewer locums that the NHS has to hire, which is cheaper for the NHS and better for patients?

[Sajid Javid]

I agree that we want more and more full-time doctors, which will mean that there is less demand for locums and is, of course, very good for the NHS. I also agree that there should be more focus on the workforce, and I hope that my right hon. Friend welcomes the measure that I took yesterday of merging Health Education England with the NHS, so that we can have a much more joined-up workforce plan.

Health and Care Bill

Jeremy Hunt Excerpts

Report stage
Monday 22nd November 2021 Commons Chamber

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. It will be obvious to Members that a large number of colleagues want to contribute to the debate. I urge brevity, so that others can participate. I call the Chair of the Health and Social Care Committee, Jeremy Hunt.

[Jeremy Hunt (South West Surrey) (Con)]

Madam Deputy Speaker, I think on this occasion I can oblige you, because I will be very brief. I wish to speak to amendment 114, which may seem a rather technical amendment—as is evidenced by the fact that, out of 650 colleagues, only one has actually signed it, and that is me—but it makes up in quality for what it does not have in quantity. It is about making sure that the new integrated care boards focus their energy on the safety and quality of care of patients. That is very important, because the new integrated care boards will have enormous power. In effect, they will be the local governing bodies of our NHS.

Although the statutory structures matter, what the people running those care boards focus their attention on is incredibly important to all our constituents. The amendment will make sure that when care boards consider their priorities, the things that matter to patients—the safety and quality of care—are put at the very top of their list. We know the way the NHS works. It is the fifth-largest bureaucracy in the world, and there is a plethora of internal NHS—

[Edward Argar]

rose—

[Jeremy Hunt]

I see the Minister wants me to give way. May I make my argument for one moment, and then give way?

There is a plethora of internal NHS targets, there are operational targets and there are financial targets. They often have an excellent purpose, but, as in the case of Mid Staffs and other cases where things went badly wrong, being under a lot of pressure to meet those targets means corners can be cut, and the quality of care experienced by patients can be really damaged. The amendment would make sure that there was discipline in the system, so that whatever pressure NHS managers were under, they were always focused on safety and quality of care.

[John Redwood]

I pay tribute to my right hon. Friend for what he did as Secretary of State to stress the importance of this crucial work, and he is not on his own: I support him.

--- Later in debate ---

[Jeremy Hunt]

Before I come to the Minister, I want to say—and I am very grateful to my right hon. Friend the Member for Wokingham (John Redwood), who gave me consistent support on this agenda when I was Health Secretary—that, in the public sector, the one system that has seemed to make sure we focus public bodies on our constituents’ priorities is the Ofsted system in schools. We have rolled that out, I think reasonably successfully, to hospitals, GP surgeries and care homes, and this amendment makes that possible for the new integrated care boards. I want to give the Minister a chance to intervene to tell us his reflections on whether this system could work.

[Edward Argar]

I am grateful to my right hon. Friend. It is not just my right hon. Friend the Member for Wokingham (John Redwood) who supports him on this; I and the Government do, and we are delighted to accept his amendment.

[Jeremy Hunt]

I am most grateful to my hon. Friend, and I am also grateful to the Opposition, who have indicated that they will not oppose the amendment.

[Kevin Hollinrake]

Now that that one is sorted, would my right hon. Friend offer the House his views on new clause 49?

[Jeremy Hunt]

I am happy to do that, because I know my hon. Friend has a great interest in social care issues. I feel conflicted by new clause 49. I think that what we will end up with after this measure will be a whole lot better for people on low incomes than what we had, because the means-test threshold will be raised from £23,000 to £100,000, and that is a very significant improvement. However, I have to be honest and say that it is nothing like as progressive as we had hoped, but it is a step forward. My concern when it comes to social care is that our entire debate is focusing on what does and does not contribute to the cap, when the fundamental problem in social care is the core funding to local authorities; that, though not a matter for this Bill, has a direct impact on the care received by our constituents.

I conclude by thanking the Government for their support for amendment 114. I will move it formally later, but I am not expecting to divide the House on it.

[Dr Whitford]

I initially want to touch on new clause 49. Like other members of the Bill Committee, I sat through hours and hours from September to November, and the Government have suddenly pounced on us with this at the last minute. It is such a complicated new clause, but it has not been interrogated.

It is quite clear that the Government’s original spin that no one would pay more than £86,000 for social care and no one would have to sell their house is completely misleading. All the accommodation costs are on top of this. As has been highlighted in the media and by Members in the Chamber, those with assets of about £100,000 will not see any real gain from this policy, while those sitting on assets of £500,000 or more will keep a lot of their wealth. That means it exacerbates the differences, and penalises those in the north of England and areas where house values are not so high. Basically, it is feeding the frenzy down here of people sitting on over-inflated house prices. As has been said, this is not levelling up, just doubling down.

The cap applies only to personal care, which means things like washing and dressing. That has been provided free in Scotland both within the care home and in home care since 2002. It was expanded in 2011 to provide more hours so that people with greater need could stay at home longer, and it was extended to those under 65 with care needs in April 2019. Scotland is the only UK nation that provides free personal care, and we see it as an investment. It is an investment that we spend 43% more per head on social care in Scotland, but it is an investment in people’s independence and their inclusion in society. The problem is that we spend far too much time talking about social care just as a burden, instead of actually seeing it from the point of view of the user.

The Scottish Government have already added an extra penny on taxation for medium and high earners to cover things such as our wellbeing policies, health or social care, but this Government’s plan to increase national insurance contributions will disproportionately hit low-paid workers and young workers. I would say that the biggest weakness of all, as we know from the original debate on the national insurance change, is that the funding is not going to go to social care initially; it is going to go to the NHS, yet it is social care that is in crisis. This is what is causing the pressure in accident and emergency, because people who are ready to be discharged simply cannot be, as the care support is not there. I do not think that this fixes the problem. There will actually be very little money, because a lot of it is going to go on capping the overall payment. I do not see social care benefiting from this at all, yet it is social care that needs investment more than anything else.

Turning to the main substance of the Bill, which is meant to some extent to unpick the damage and fragmentation of the Health and Social Care Act less than a decade on, I wish to express support for amendments 9 and 72. Many in the NHS, including me, will be glad to see the back of section 75 enforced tendering. Others in the Chamber know that it was the Health and Social Care Act that brought me into politics, as I just could not believe anybody thought what they were doing was a good idea. It is still clear from the pandemic that this Government are absolutely wedded to outsourcing services to private companies, and to the flawed notion that financial competition somehow drives up clinical quality. I am sorry, but that simply is not the case. As the Chair of the Health and Social Care Committee has highlighted, we have to focus on safety, on clinical audit, and on peer review if we want to drive up care quality for patients, not just on the money in the system.

The Government appear to have conceded that integrated care boards should be statutory bodies, as health boards have always been in Scotland, but partnership boards can include private providers, such as with Virgin Care in Bath. As the partnership boards will be involved in devising the local strategy for health services, that is likely to lead to a blatant conflict of interest, and I do not see a resolution to that. The NHS simply should be the presumed provider of health services. That is not just, as the shadow Health Minister said, because the NHS is in it for the long term, or for a quick contract, but because the NHS provides the training to nurses and doctors who are the vital workforce of the future. Private providers do not do that; private providers largely live off the NHS. As well as not training staff, where there are major problems or complications, patients inevitably end up in the intensive care unit of an NHS hospital.

In conclusion, for all the size of the Bill, and the scale that the reorganisation will involve for staff in the NHS, who we all know are frankly exhausted, the Government have failed to take the opportunity to repair fully the damage of the Health and Social Care Act 2012, and to recreate in England a unified public health system, such as the one we are lucky enough still to have in Scotland.

Covid-19 Update

Jeremy Hunt Excerpts

Monday 15th November 2021 Commons Chamber

[Mr Speaker]

I call the Chair of the Health and Social Care Committee.

[Jeremy Hunt (South West Surrey) (Con)]

I welcome the statement; I absolutely agree with what the Health Secretary has announced.

No one can fault the Government’s political commitment to the vaccine programme, which has had a pretty much unlimited budget and has been a huge priority, but my right hon. Friend will be aware that despite that commitment, we have now fallen behind Spain, Portugal, South Korea, Singapore and other countries in the proportion of adults who have been jabbed twice. I am just worried that our regulators have lost some of their fleetness of foot in decision making. It is great that we are giving boosters to the over-40s, but we must now have the data on the under-40s. It is great that we are giving a second jab to 16 to 17-year-olds, but what about 13 to 15-year-olds?

America has already authorised the Pfizer jab as safe for the over-fives. If we are to have a vaccine-led rather than restrictions-led strategy, we need to be absolutely at the front of the pack with approvals. I fear that we are in the middle of the pack, so what will my right hon. Friend do to turbocharge our regulators and the decisions that they are giving him?